January 28, 2008

As Good as Can Be Expected

His last words spoken were "How's it lookin' doc?"

I responded, after a few seconds hesitation trying to summon the most appropriate thing to say to a man who likely would be dead within a few hours, "Well, I guess as good as can be expected..." And then I took his hand, gave it another squeeze, and he drifted off into that unconscious abyss between life and death.

He was 72. It seems appropriate to say only 72, because I think he should have lived much longer. He never smoked, or drank too much, he fought in wars and represented his people in the political arena. He had a colonoscopy every 5 years and a PSA annually. He took his pneumovax and routine flu shots. He did everything he was supposed to do.

Then again, he was 72. To me, that still seems old. It's more than 20 years longer than my dad lived, and almost 20 years longer than my dad's dad. But this guy had none of my family's bad genes, or bad habits for that matter.

This was the first time I had met him. He was lying on an ER gurney, gasping for breath but not particularly anxious or panicky. He was alone.

Three months prior he had gotten up to pee in the middle of the night and passed out. A doctor's visit followed the next day, and an xray led to a biopsy which showed metastatic lung cancer. He was given a prognosis of 6 months to live. Chemo and radiation wouldn't help him, and the cancer was too extensive to remove surgically. But he told me he never believed them; he thought he would beat it somehow.

For 3 months he toiled along, occasionally having some trouble breathing and coughing a little more, but doing reasonably well. No more doctor visits. No hospitalizations. He didn't tell his family - "didn't want to get them in a worry about nothing" he said.

But the night he came to my ER he started having a harder time breathing. He stayed home struggling for most of the night but when he collapsed to the floor in the bathroom and slammed his right chest into the commode he couldn't stand the pain and was having even more trouble breathing. When he arrived by ambulance about 4 am he was on a 100% oxygen mask with oxygen levels only about 90%, his heart rate was in the 140s, and he was breathing about 40 times a minute. One thing that I try to teach my residents early on is to try to differentiate the patient who is sick sick versus not so sick. This guy was sick sick - no doubt.

He was still coherent, and still competent, despite being critically ill. I sat down beside him, held his hand, got within inches of his face and talked to him while the rest of the ER staff started IVs and got EKGs and blood drawn.

He told me his story, as best he could with the little breath he had. He asked me to call his daughter and explain what was happening, and I did.

His labs and xrays and ekgs revealed to us that he had a heart attack within the last couple of days, that he had multiple broken ribs from the fall, and that his cancer was eating way at both lungs as well as his entire spine, his femurs, and his pelvis.

And so I had to talk to him, about what his options were and about what we could and couldn't do for him. I told him that this wasn't something that he could fix, and that he was going to die within the next day or 2. His daughter arrived.

We all agreed that we would do whatever we could to make him comfortable and let him die as peacefully as painlessly as possible. I ordered repeated shots of morphine and ativan, and we let him drift away.

Ya know, each person has their way that they need to deal with things. Some people won't understand that he wouldn't tell his family he was dying. They might think it was selfish or get angry. But everyone handles their problems uniquely, and there will never be, cannot be, a right or wrong way to handle many of life's scenarios. There can only be your way, his way.

In the end, he got what he wanted. His family never had to worry about him. And as I talked to them in the ER that night, I knew that they understood his decisions. He was intelligent, independent, and strong - and that's how he needed to be remembered.

I guess it went about as good as could be expected...

Thanks for joining me for My Daily Spin. [This story has been altered slightly to protect confidentiality]

January 19, 2008

Mars and Max

Meet Mars (left) and Max (Right), the newest additions to my family. M & M are 5 month old brothers that I adopted from the humane society. New training partners!!!

January 17, 2008

RNR Arizona Half Marathon Race Report

Yesterday the story finally ended.

Normally after a weekend race I'm ready to post a race report Monday morning. But this one was a little different, so the race report is a few days delayed. Let me explain.

The PF Chang's Rock n Roll Marathon was on my sights since late summer. It was to be my Boston qualifying race, my breakout event. I was gunning for a 45 minute PR performance that I was confident would be cake.

But things didn't go exactly like I thought they would.

First, in mid fall I had a mild IT band flare that cut short my long runs for a month. Then in December I had posterior hip pains that necessitated another 2 weeks without running. When I ran again, on January 2, there was a new and unexpected pain with every left foot strike.

Now last August I suffered a right foot 3rd metatarsal stress fracture, but that completely healed and is pain free. So I was NOT expecting this new left foot/ankle pain. The pain cut short my run on the 1st to 4 miles, then the following day the pain continued and cut my run to 3 miles.

I decided not to run any more before the RNR race and drop from the full to the half. On Friday, 2 days before the race, I ran 3 miles to see if it was better. It wasn't. I decided I would run anyway.

Race morning Sunday I lined up at the starting line nervous about the ankle/foot but intoxicated with the excitement that comes with these huge races. I LOVE mega-races. I positioned myself in the 3rd of about 30 corrals, opting not to go to the 1st corral like my race number suggested I should.

We started and the ankle/foot hurt immediately but was tolerable. Before the race I had rubbed 2 different pain relieving creams on it and taken (yes this is a raceday no no but I was desperate) ibuprofen. I think without the pain relievers I wouldn't have made it as far as I did.

5 k came in under 22 minutes and I was feeling good with only a little pain. But by 5 miles the ankle was hurting more, and by 10 k the pain was sharp and starting to limit my pace. 10 k passed in just under 44 minutes (which interestingly is still the fastest 10k I've ever run - ever...).

By 8 miles my pace had slowed and I was limp-running. It is such a terrible feeling when you start to drift back into the pack, knowing that all the work you put into the early mile is going for naught. And I drifted. Way back...

Miles 10-13 were at 10 minute pace, and I was miserable. I didn't pass a single person after mile 9. I considered walking, or dropping, but I knew that when I stopped running I would barely be able to walk and that seemed even more unbearable than running with the pain.

Those last few miles I kept thinking about Momo's post about her friend with cancer who still runs religiously and about taking running for granted. I was going to finish this, because I could. No matter the pain, I still could.

I was able to get a little bit of a kick at the finish to cross the line at 1:46.

When I finally walked post-race, I could barely put any weight on the ankle and I was suffering. I hobbled over to collect my gear and went straight to my rental car. I considered waiting for my peeps, but my misery didn't need to be shared...

I got on the interstate and drove solo for 250 miles to the Grand Canyon. I hadn't planned the side-trip, but I needed some time to reflect, and I needed some instant inspiration to pick me up.

Let me tell ya the GC is a damn good place for inspiration! When I left the race in Tempe it was mid 60s. When I got out of the car at GC it was snowing with 4 inches on the ground and 30 degrees, blue skies (mostly) and crisp crisp crisp. I hobbled around the South Rim for a couple of hours and felt the morale return.

This race meant nothing, and that's how I needed to treat it. There will be more races, there will be a time when I'm not always injured.

I got back in the car and drove the 250 miles back to Phoenix, then hooked up with friends old and new for a fantastic dinner and poker.

And life was good...

I returned to Alabama Monday and met with the orthopedic surgeon Wednesday. The xrays show a fractured calcaneous - the heel bone.

6-8 weeks of no running for me, but the bigger question is how do I keep from getting injured so frequently in the future? Already I never run more than 30-35 miles a week. I do a ton of cross training. I've decided to start taking calcium supplements. And I'm going to have a stride analysis when I can run again. But beyond that, I don't know....

So there it is... Anticipation, Loss, Excitement, Defeat, Inspiration, and Hope...

Life is good.

Thanks for joining me for My Daily Spin. Next time I'll tell you about the latest (surprise) additions to my family!!

January 8, 2008

First Swim

I swam Sunday for the first time since 24 HOT.

I was nervous about it, afraid that anything and everything I have learned over the last couple of years about swimming would be gone - ya know, use it or lose it right... But with the nervousness came a little excitement that by jumping in the water and starting to work on my weakest event, I was in a way committing myself to and beginning training for Ironman.

It's a good thing the water was in the mid 80's because if it at all felt cool I might have just climbed right out and headed for the steam room. But it felt good, and I felt good.

Oh it wasn't pretty.

Take an ugly inefficient stroke and give it a 3 month break and what happens? It gets uglier and more inefficient.

But it was easy at least. I swam 5 x 150 then a 250 and stopped for time constraints rather than fatigue restraints. This was definitely a satisfactory result for me - after all it was less than a year ago when I still couldn't swim a 1000 yards straight.

And with this swim I commence Ironman training.

It feels good to be back!

January 2, 2008


As much as I love vacation, the best part is coming home.

We returned home to Birmingham at 10 last night after a marathon day of travelling after spending the week in Steamboat Springs, Colorado. When we stepped out of the airport, I was expecting, maybe hoping for, temps in the 60's - not unusual in the deep south in January. Instead I found 20's and felt like I was still in the mountains, sans snow.

Oh, the snow. Wow the snow. We arrived in Steamboat on the 26th and it snowed every day. More than 2 feet during our 6 days there snow. Snow snow everywhere!! It was truly a winter wonderland. Hmm... Ok, it would have been a winter wonderland except it was TOO DAMN COLD!!

Oh... The cold. Curse the cold... I'm talking it only climbed higher than 15 degrees (yea, unfortunately I AM talking Fahrenheit here folks) once. When Emma and Tess did ski school for a day, the high was 6. They started the lessons at 0900 - it was below zero. They toughed it out for a 6 hour day but didn't want to ski anymore. Too cold!

So we spent all of the other days tubing and sledding and snowballing and sliding on the snowslide we made near our condo.

Oh,, and we went swimming... In an outdoor pool... Yep, it was somewhere around 10 degrees and we swam outside. The pool was obviously heated but to get to it we had to walk barefoot in our swimsuits across the snow and ice. It was so cold that we had to completely submerge ourselves at least every 30 seconds or so because our heads would be freezing... Luckily, the hot tub was only 30 feet from the pool, and it was inside!

I didn't ski, or board, any this trip. I had planned on it, and I could have. My friend J came with us to be the ski nanny, so she could have watched the kids while I skiied. But once the opportunity was there, I didn't want to stop playing with the kids to go play by myself. Maybe it's the reason I do better with kid relationships than adult relationships - I would just rather play kid games 99% of the time. My kids are so cool, so much fun, so loving and so happy. And I have tons of fun with them, even in the moments when they are driving me absolutely crazy.

But I don't think I'm too kid crazy... I'm already scouting days for another trip to the slopes sans kids so I can actually do some ski play of my own. After all, I may be kid crazy, but I'm also an unabashed adrenaline junkie... Soon...

Click on the video above for a little sledding action.
Well, Happy New Year to all of my blogger friends. And thanks for joining me for My Daily Spin.