February 27, 2007

Continuity of Care

The first time, they took his legs. This time, they took his heart.

There isn't supposed to be continuity of care in the emergency department. People go to their primary doctor for most of their problems, and they come see me for life or limb threatening emergencies. That's how it's supposed to work. But our healthcare machine doesn't always work the way it's designed...

I work more than any of the other physicians in our department. It's a choice, not a necessity, and I like what I do. No, I love what I do. Can't imagine doing anything else. My residents think it's funny that they can look through the computerized records of every patient in our department at any given time and I have taken care of at least half of them previously. Continuity of care, in a way.

The people that come to the ER regularly are usually the people with severe and unrelenting diseases, or with personality disorders (who have been banned from "regular" doctors), or who have been labelled "drug-seeking."

Of the many I see fairly regularly, there are a few that I have become attached to. I look forward to them, grow giddy when I see their name appear on my computer, and greet them fondly with an appropriate embrace.

I lost one of them this morning.

I was a new attending in our ER when I first met M. He came by ambulance after suffering a missile wound to the abdomen, his spine shattered by the .45 in the name of street justice. He would never walk again. He was 18 then.

Over the last several years I saw him at least every couple of months, sometimes every few days. His crippled legs developed blood clots, his non-emptying bladder developed UTI's, his post-op abdomen developed obstructions. He lost weight, became malnourished, and developed a painful condition called SMA syndrome that causes the bloodflow to the upper intestines to be restricted with every meal.

And despite all of this misery, M was always pleasant. He never complained, although he had every reason to do so. He was a master of the XBox 360 and competed in the local Madden tournaments (once he blistered a thumb so badly from XBox that I had to debride and bandage it with burn-wound dressings...).

I never once saw a family member or friend with him, although he insisted to me that he had many of both.

Today, after he arrived DOA from another gun shot, this time a lethal strike through his heart, I met his family. Dozens arrived... They cried, and I did too.

What could a 23 year old paralyzed chronically ill guy possibly do that is so atrocious that the penalty is execution?

I don't know, maybe he was still a thug, maybe he incited something today, maybe he had wronged someone who was hell-bent on retaliation. I probably will never know, and I don't think it much matters.

The first time, they took his legs. This time, they took his heart...

Sometimes continuity of care can be painful.

Disclaimer: Any patient information has been alterred by name, age, gender, location, and in other ways to protect individual privacy.

February 26, 2007

Want a Free SwiMP3?

Today marks the first day of fundraising for me for the Race for a Reason/Challenged Athletes Foundation.

This organization is a non-profit that helps challenged athletes compete. It helps with equipment such as special chairs and prosthetics, and it helps with therapists and trainers who help them get to the starting line.

If you have ever gotten a little motivation from watching Sarah Reinertsen cross the finish line at Kona, or from seeing Major David Rozelle finish in 2006 at IM CDA and Kona, then you owe the Challenged Athletes Foundation your support.

What does this have to do with a free Swim mp3? Well, some of you may know that I bought a new Finis Swim mp3 a few weeks ago.

I've used it twice, and I decided that it is too bulky on the back of my head for my taste. Now, don't get me wrong, there are tons of people who love this product, and nearly every review I've read raves about it. I think that it isn't good for me because I still am way too conscious of my head position so that I constantly "feel" it.

Anyway, it works great. Sound quality is excellent. It holds about a 4 hour battery charge (although I've only actually used it twice for about 45 minutes each time), and holds about 30 songs.

Free. Free (including domestic shipping) to the first person that emails me and tells me they want the player and will donate $50 towards my CAF goal. You don't have to donate the money until you are confirmed by me as the first, unless you want to donate anyway. And it's a helluva good reason (and a tax deductible one) to donate anyway...

So that's the deal. Want a free Finis Swim mp3? Zap me a message (my email is at the top of my sidebar).

Thanks for joining me on My Daily Spin.

February 23, 2007


She's all I think about. Whether I'm driving my kids to school or intubating a patient in cardiac arrest, she's right there with me.

She's the last thing I'm aware of before I sleep, and the first thing in my mind when I wake.

If I go a day without her, I feel awful. Miserable. Forgotten my mother's birthday miserable. So I try not to let a day pass when I don't give to her at least a little bit of me.

And she repays me like nothing I've experienced before. She gives me confidence like Ali and speed like Sugar Shane (ok, I wish she gave me speed like Sugar Shane, but a boy can dream can't he?). She tempers and humbles me, humiliates and rebuilds me.

She makes me hurt. Oh my God, she makes me hurt. But I beg for more, insatiable like Mardi Gras gluttony.

I buy things for her. Little gifts here and there, sacrifices to the greater cause of our relationship. She uses my gifts to hurt me more, and it only makes me want to repeat the cycle, again and again and again.

She controls me, even without making demands. She puts me to bed early, forces me to abide to a one beer a week rule, and laughs at me when I remember ever smoking a cigarette. Yet I've learned to accept her rules, knowing that we will be stronger by avoiding the habits of my former I.

And her wishes and desires and needs have become my wishes and desires and needs, so that we are symbiotic in this creation.

And as one, for better or for worse, richer or poorer, in sickness or in health, we will face all obstacles thrown at us on June 24, and on September 9, and on any future days when we might happen to find 17 hours to swim, bike, and run our way over 140.6 miles.

My girl... My girl...

February 21, 2007


is the
that saves
from the
spin of drift.

February 19, 2007


Last week I was in a funk of uncertain etiology. Maybe it was the training hours starting to add up, or maybe it was the kids needing a little more attention and chaperoning than normal. Maybe it was just one of those weeks...

There are times in life when you have to stop thinking of all the reasons that you should or could or would do something, and you just need to shut up and do it.

I used to be a thinker. Or maybe I am still a thinker, I am just learning to suppress it.

Every decision, every fork in the road I would analyze with the detail of an archaeologist whispering away the flecks of sand from a 20,000 year old skeleton. I wouldn't order from a menu without reading EVERY single option, including a perusal of the dessert menu just in case I needed to plan on extra room for an irresistible treat (oh and believe me, I need to!). I wouldn't go to the gym without asking myself a million times why don't you just sit down and drink a beer and watch the football game like every single one of your friends?

But things are changing. Circumstances are changing. Goals are changing. Me, I'm not changing; but I am adapting to the changes around me.

I look forward to the gym like never before. I'm talking about 3 trips to the gym yesterday - yep, count 'em, a morning stretching-core routing, then home to fuel, then back for a swim session, then off to meet some friends for lunch, then one last time for a dreadmill run prior to work.... Unheard of for me... 3 workouts in one day! I must be effing insane!

[Which reminds me of one of the better lines from the movie Breach, in theatres now... Hannsen says of himself, "I must be either insanely brave, or just plain insane, or maybe both..." Check out the movie if you get a chance...]

But back to the thinking. One of our fellow tri-bloggers taught me a while back to just stop thinking about that which you have to do, and do it. I can sit here all day and think of a million reasons why I should skip my swim today, or I can get off my ass and go swim. Know what? I don't think about it anymore, I just swim.

And that, my friends, is progress. When you are able to do what needs to be done without trying to talk yourself out of it, without sitting at that fork for 20 minutes trying to reinvent daily why you are on this journey, you are becoming inseparable from your goals.

And that is what I want... I want to be so ingrained in what is important to me right now; teaching and loving my kids, helping those who are suffering, and training for the upcoming Ironman season, that I am inseparable from it.

Man this is going to be one helluva spring and summer! I can. not. wait. for my first 70.3, the Florida Half Ironman in May! Train on, my brothers and sisters, and thanks for joining me for My Daily Spin.

Singing Cowboy

The best anti-smoking PSA I've seen.

February 15, 2007

Life Press

Sometimes I feel like the demands of life are an Olympic bar and each responsibility is a separate plate. The job is a 45# one, the kids are 2 45#'s, the house a 35#, training maybe a 25#.

And me, I'm trying to press that bar successfully.

Now any of you that have spent any time pressing know the importance of technique. A successful press requires perfect form, with feet shoulders width apart, knees nearly fully extended, wrists extended and elbows pointing forward. The motion should be all upper body - no lower body cheating allowed. Straight up, then slightly back as the bar extends over your head.

Sometimes I feel like that bar is so loaded with responsibilities that I'm maxed out. And any additional plates will force me to break form and use my legs, or, even worse, send me crashing to the floor in defeat.

I guess that's why flexibility, and compromise, is important, so that I won't be so bull-headed about perfect press form and will let myself use my legs for a little extra oomph when needed. That extra oomph might just keep me from crashing.

And that's also why repetition is important. If I practice enough, get fluid and strong enough, I will master the form and be able to handle a heavier load. My responsibilities sure don't seem to diminish as I get older, so the capability to gradually handle more seems a necessity.

But lately, it seems like there's been an extra 10# plate added to just one side, knocking off the entire balance of the bar. And that one, that one I haven't figured out how to handle yet...

February 12, 2007

Great Training Day, and a Wallflower

Friday: Swim 1000y TT 20:45
Run 2m WU (7:31 pace), then
1m repeats
Saturday: Run Easy 2m with kids
Sunday: Sick (gave up after 3 unplanned stops in 1st mile of run)
Monday: Run 7m (59:59)
Stretch/core (30m)
Bike 21.8m (64 min)
Swim 1500y (500 wu, then
then 10x50 (all :41-46s)
Today was fun! I finally got to take my bike for her maiden voyage (why are things like bikes, and cars, always considered she's?) I learned how a bike is supposed to feel, finally. You see, my first tri bike came from ebay and naive me bought a 51cm bike because it was a good deal and it was a Cervelo and that was the only brand tri bike I ever had seen.
And funny thing is, I didn't even realize it was too small for me until probably 3 or 4 months after I bought it when I was complaining to my friend JM about how I couldn't stay aero for more than a minute or 2. That's when she informed me that for tri bikes size does matter... Light bulb moment! I see...
So today I took my properly fit bike for its maiden voyage and stayed aero the entire hour! I did realize that I need to lower the cockpit somehow; I didn't feel aero enough. Heh, maybe that's why I felt good for the whole hour. Hmmm. So I flipped the stem, and that lowered it by a couple of inches. I dropped the clip on aerobars (I am totally lusting after the HED aerobars with the third brake lever - I gotta get me one of those!) so that they are at a slightly negative slope. I've taken out all of the spacers. Any other suggestions???
I just finished reading The Perks of Being a Wallflower by Stephen Chbosky. I didn't realize it until I downloaded the photo that it is classified as "adolescent fiction." This is fitting, but I swear it was in the plain ole literature section not the teenager section at the local bookstore. Anyway, I guess in many ways I'm just an old adolescent anyhow...
The entire text is a series of letters (this kind of book has some special name which I'm probably supposed to remember from Ms Frucci's 10th grade English class, but - sorry Ms F - I have no clue what it is...) from a 10th grader named Charlie to a never-named recipient described only as someone who wouldn't sleep with a girl just because he could. Hmm.
Charlie is one messed up little dude. He's depressed and occasionally psychotic (in a seriously mental health need-a-psychiatrist kind of way). The story is about Charlie's first year of high school, a series of highs (some literally) and lows as he finds love in a group of friends, makes peace with his football hero brother and older sister, experiments with pot and LSD, and laments the loss of his Aunt Helen. There is an overwhelming sense that there is something more to Charlie that forces his social awkwardness, and that something finally is revealed in the last 10 pages (but ya have to read it to find it out!).
It's a fun read that forces you to reminisce about high school; and, if you're like me, when you read those last 10 pages you suddenly can identify wholeheartedly with the troubled Charlie. Grab a copy and see for yourself!
Thanks for joining me for My Daily Spin.

February 10, 2007

Mercedes Race Report (Troupe)

Today was the 2nd race of the season for 2 members of the TriJack Troupe, Tess and Emma. They raced the last mile of the Mercedes Kids Marathon in Birmingham.

So I was new to the kids marathon format until we started this adventure a few months ago. Each registered kid, and there were around 4000, ran 25.2 miles individually between October and today, then completed the last mile of the marathon together this morning.

Emma has been counting the days until racetime, even telling me yesterday how she was going to sprint at the finish to take 1st place. Tess wasn't quite as excited, although her interest level did increase dramatically when I promised ice cream after the race (how anyone can want ice cream when it is 25 degrees is beyond my comprehension...).

They divided the 4000 kids by grade, so Emma started at 11:00 with the 1st graders. She had told me for weeks that she wanted to run by herself, and I had talked myself into being ok with that, but at the last minute she decided she wanted me to run with her. Cool!

That girl ran the entire way, passed tons of peeps, and then finished with a kick that Carl Lewis would be proud of. Final time - 9:09.

I hurried back to the starting line for Tess's 11:15 start. She was a little more nervous, but was fighting the cold and a little nausea like a champ. She ran for the first half mile, then did a 100 yard power-walk, and then finished running! She was so proud to hear her name at the finish line. Final time - 12:27.

The kids collected their medals, and both have already decided that next year they want to "run another marathon!"

February 9, 2007

TriJack Gets Pimped

While the Kahuna is getting stripped, TriJack is getting pimped in a techno kind of way.

You see, I tend to do things kinda old-fashioned. I like tuxedos and old Cadillacs, I open your car door even if we're not on a date, and I'd rather have a person look real and flawed than plastic and perfect.

And that's how I've been doing my training - bare bones old school grinding it out based on how I feel on any given day. But things are changing.

My motivation and goals in triathlon have transitioned from stepping up to a friendly challenge from my friend Mark to do a sprint tri with him last summer to racing, not just finishing, 2 ironmans this year. Big step up, without a lot of the baby steps along the way.

In taking that step, I'm starting to realize that I need the resources to support me. For that first sprint tri last summer, I bought a tri-bike off ebay (which turned out to be about 5 cm in frame size too small - I'm so naive!), a timex watch and a pair of swim goggles. That's all I needed. Problem is, the only thing I've added to my equipment since then is a pair of fins.

My friends, TriJack is about to get pimped... My new bike, the Cervelo p2sl, has arrived. And I've ordered a Computrainer which hopefully will be arriving within the next few days. I think I'm more excited about this than I am about the bike.

The concept of riding countless different course simulations stimulates the little-kid video game geek in me, and I think this will work well for my training. I've noticed that it is hard for me to commit more than an hour on the bike at a time due to kid responsibilities, but I think the Computrainer will help me fix that issue. I hope...

And, of course, with the Computrainer I can "train with power..." Because it seems everyone is preaching that if you aren't training with power, you aren't really getting the most from your training. Well, I'm stepping up to the big leagues my friends.

The second techno pimp item I've ordered is the Garmin Forerunner 301 heart rate monitor. Now I'll know whether I'm supposed to run faster or slower or just quit for the day (heheh)...

It will be interesting to compare my old fashioned how-I-feel training to power and heart-rate training. I'm certain that the new toys will add a bit more fun to the sessions, at least for a few weeks until the novelty fades.

The final pimp-my-TriJack item is the Finis SwimMP3. Most all of the reviews I've read for this are good to outstanding, and I'll try anything to keep me in the water longer!

Well, old-fashioned TriJack is being replaced by techno-training TriJack. But know what? I'm still going to open the door for you, and I still like you more real than plastic.... Some things never will change.

Thanks for joining me for My Daily Spin.

February 8, 2007

Crashed, Like a Barge

Wednesday: Swim 250y WU, 5 x 100 on 2:15, 250y kicks, 10 x 50 holding
Run: 5m easy (38:30)
Thursday: Swim 20 x50 drills, 250 kick

My swim yardage has increased quite a bit this week, and I felt it this morning. My shoulders and legs were sore and tight, and I felt like a barge. Didn't help that I was training on 2 hours sleep over the last 36 hours. Tomorrow will be better though, especially since I get to sleep tonight!

I think my web-host has crashed. I haven't had access to my pages for the last 24 hours. Frustrating...

My eyelids are heavy, the kids are asleep. It's time for me to follow their lead and re-energize!

Tomorrow I'll post some news about TriJack entering the tech age - stay tuned!
Thanks for joining me for My Daily Spin.

February 6, 2007

I Told You So, the Prologue

Monday 4.5 m run, 2 m WU then 10 x 200m on 9% with 200 m rest
2000y swim, 4 x 500 with 1-2 min rest
Tuesday Crossfit/Strength/Stretch

I was talking to a group of tri guys at the gym yesterday, guys who have been tri'ing for several years and a couple of whom have completed a few different Ironmans. I told them about Zurich, and Wisconsin, and about my swim struggles. They expressed a sincere doubt that I would be able to swim IM Zurich by the time cutoff, AND that I would be able to survive IM Moo just 2 1/2 months after Zurich...

I smiled, a bursting at the seams new car for my birthday kind of smile...

You see, there is very little that motivates me more than someone who knows what it takes to accomplish something doubting that I too can accomplish it. If a couch potato with a beer belly the size of Montana doubts I can swim 2.4 miles, who cares... But if a 3 time IM doubts me, game on.

My high school guidance counsellor pleaded for me not to drop out... What will happen if this doesn't work? Yea, you're smart, but you can't do anything without a diploma... Well, Ms C., how ya like me now??? Doubters...

You can't take 4 kids 5 and under for a week-long road trip covering 2500 miles... Ha!! Ask my 2 oldest kids what the most fun thing they ever have done and you know what they say?? "Driving around the world with Daddy," that's what! Doubters...

It probably is pathological and child-like, but I get immense pleasure from saying "I told you so..." Not that I usually actually say that, but you better believe I think it.

So, as if I needed any extra motivation, from this point on IM Zurich is about I told you so... Because I can, because I will, and because they think I can't...

Game on!

February 5, 2007

Slap Training My Latest Read

I think it's time to start posting my training stats to make myself accountable, so:
Sunday - 1750 y swim:500wu, 5x200,10x25, 6m run (50min)

I'm feeling stronger each day with the swim, and I'm ready to start pushing the volume up. It was pointed out to me recently that my IM is only 4 months away, and that I need to be swimming 5000 yards or so straight (holy sh*t!) prior to the race. So it's time to get grooving!

Moving on...

I'm foolhardy. I admit it. Guilty as charged. Find me a judge and a jury, let me cop a plea, and give me the punishment I deserve. Or maybe I'm just a fool.

You see, sometimes I don't think before I act. OK, I'm supposed to be honest here, so let me restate the last sentence. You see, usually I don't think before I act. I'd rather leap then look, follow my passion then clean up my messes. It frequently is not the most logical thing to do, but it usually is my modus operandi.

And yea, sometimes it gets me in a lot of trouble and gets some people hurt.

Now I'm not talking about physical harm to anyone except occasionally me (the leap occasionally is followed by a resounding thud), and I'm not talking about my professional me in this post. My professional me and my non-professional me are 2 way different persons that I tend to keep separated for the safety of everyone involved. My professional me is definitely a thinker by necessity.

Complicating the problem is that I'm not savvy enough to always realize the meanings of what someone says, nor even the meanings and ramifications of what I say. You know how some people can think with such clarity that it seems like everything they say is perfect? Well, that's not me.

So sometimes I write and say things, things which sometimes might appear in this forum in the context of posts or comments, which are poorly conceived or have meanings or interpretations that I don't recognize. It's a problem for me, and it's a recurring problem for me no matter the context in which I am writing or speaking.

I speak before I think thoroughly about what I am saying.

I was reminded of this problem by a particularly stunning slap in the face via phone from a friend who was hurt by something I said. It was an ill-conceived comment and it didn't represent my thoughts in a way consistent with my actions and feelings. The details of the comment are absolutely unimportant to anyone but me and said friend, but the slap definitely reminded me of this problem.

So, add this to my list of ways that I ef things up. Heh, funny how that list seems to get longer the older I get. Isn't it supposed to be the opposite? Maybe I just know myself deeper and recognize my faults easier (especially when recognition is forced by things like a slap in the face, even if it is a phone slap)... Yea, I like that answer...

I just finished reading Life and Times of Michael K by J.M. Coetzee. It's a shortish novel set in 197o's civil war South Africa. The story chronicles Michael K, a slightly disfigured fatherless guy institutionalized as a child with other physically or mentally challenged kids. When he reaches manhood, he wanders the countryside, through warzones and abandoned farms, while he tries to avoid contact with essentially all of society. He is malnourished but only wants to eat what he grows for himself. He repeatedly is captured and interred in labor camps, but always escapes to wander back into the nowhere.

The book is interesting on several levels. It is yet another example of how you only are truly free when you have and want nothing. Michael is offered shelter, and food, but he shuns almost all assistance ("Why are you so interested in helping me?" he asks) so that he can live as he chooses. Michael is not dumb, but he is by no means sophisticated. In the end, he wanders back to the town where his mother first tried to raise him to drink his water from the earth one teaspoon at a time.

Not a life-changing read, but an entertaining one definitely.

Thanks for joining me on My Daily Spin.

February 1, 2007

The Maserati

I read her, jaw open eyes wide
like a voyeur,
who spies
the pinnacle prize

It sounds absurd, but
without saying a word,
"Tell me your dreams
and I will tell you my fears..."
with mine eyes I heard.

Your dreams, my dreams, all one and the same
Your fears, my fears, all part of our game.
Your hand in my hand, at least in our mind
Patience, Patience, 'til each other we find...

I tried, I tri'ed
I reached out and I cried
with her when
she confessed
her surprise to me...

And I, I shared mine
The rape, the wine
that erased
ten whole years
from my mind...

Your dreams, my dreams, all one and the same
Your fears, my fears, all part of our game.
Your hand in my hand, at least in our mind
Patience, Patience, 'til each other we find...

And who once was whole
Now 2 broken souls
Spoke their desire,
Unfair to all,
But out of control...

But she, being wiser than I,
Said stop! We must try
Not to paint yet
the last layer is wet -
a masterpiece begins dry...

Your dreams, my dreams, all one and the same.
Your fears, my fears, all part of our game.
Your hand in my hand, at least in our mind
Patience, Patience, 'til each other we find...

Then she walked away
Said save the flame for another day
And thanks a lot
You mean so much
To me, by the way.

And now she won't call
Or text or be there at all.
Found the cave and
buried this habit
Until we meet in the fall

Your dreams, my dreams, all one and the same
Your fears, my fears, all part of our game.
Your hand in my hand, at least in our mind
Patience, Patience, 'til each other we find...

And me, I can't think straight
Think she's effing with fate
Gotta let the dice roll
Even out of control.
But know what? Madison awaits...

Your dreams, my dreams, all one and the same
Your fears, my fears, all part of our game.
Your hand in my hand, at least in our mind.

Patience, Patience, 'til each other we find...
Patience, Patience, 'til each other we find...

Training Progress and My New Bike

This is an easy week for me, and the the final week of base training before I move to the first month of build. I'm sluggish, probably the product of a little more work volume the last couple of weeks and too much coffee/too little water.

My first race of the season, the Powerman Alabama, is just over 2 months away. I'm already a bit nervous about fulfilling my expectations as this will be the first race ever for which I've actually reasonably trained. Huge... But this race really isn't that important to me, and likely I will try to use it as a training brick with lots of friends.

I'm incorporating a local 5k, the Miles for Smiles, into my run this Saturday. I'm sure I'll push the tempo a little beyond the 8-9 minute miles I've been walking, er running, during this base phase.

Triathlon is flu-like contagious! My friend Carmel has just resolved to do a tri before she turns dirty thirty in 5 months. She just bought herself a sweet Scott Contessa. One of the other ED docs at work has been asking me about joining the Vulcan Tri Club, and my friend Anne has committed to do the swim portion of a relay team with me and Mark in an as yet unnamed (Chattanooga Tri?) tri this summer. We should smoke that course - Anne was an NCAA national champ swimmer for several years back in the day...

In other exciting news, I've placed the order for my new bike today. After much deliberation, I've opted for the Cervelo P2SL. Hopefully I can pick it up this weekend!!!

Want to know a secret that I recently learned? I can actually swim decently fast - but only for short bursts. Lack of swim endurance is holding me back, but that too is getting better. It's hilarious to look at the precipitous drop of my 100 splits over the course of a 10 x 100 session. But, on the positive side, I can do 10 x 100 sessions now!! Woohooooo!!

Thanks for joining me on My Daily Spin.