Sleep, Self Tanner, and the Sweat Life I Lead

Are you looking for the keys to happiness?

I have found them.

They are sleep and self tanner. Both make you instantly look and feel better.

I highly suggest trying this.

Sunday: The Day of Rest.

Since becoming a resident, I have become worse at resting. This is paradoxical and counter intuitive since my work is exhausting. If I were to be my own psychologist, I would suggest that the reason I do this is two-fold. First, I know my time off is slim to none so when I do have some spare hours I try to squeeze in every.last.thing. Spin! Go to the park! Spend like 2 hours in CVS looking at things I don’t need! Nails! Spending more money I don’t have! Write this blog that likely only a few people read!

Second, I have a life-long habit of not sitting still. This started when I was two and asked to do gymnastics. It continued when I was six and was in probably six different after school activities (thanks, Mom and Dad!), which I thought was the best life a six year old could lead (dance, gymnastics, soccer, tennis, piano — scratch that, I hated the last one). Being a life long athlete, I had a ample opportunity to not sit still. And, now, I run around at work, run around after work, and then crash into bed. Overall, I think this is my coping mechanisms for life’s anxieties, of which I have many, chief among them “matching into fellowship.” Writing those words makes me feel ill and start to sweat. So, yes, I likely seek the sweat life in order to not feel any other feelings other than endorphin fueled happiness.

See, who needs a therapist when you have writing and the internet?!

Sunday is also the day of the ritual I started in residency: the pre-work week pep talk.

Although I’m terrible at resting, my time after 5 pm on a Sunday is fairly relaxed, usually, unless I’m at work. This is because about now is when the “omg, can I make it through another week” starts to kick in.

Residency, like any job, is taxing. It takes a lot out of you – emotionally, physically, mentally. You have to give 100% of yourself all the time – both to learning new information, in taking care of patients, in teach the juniors, in being super detail oriented and conscientious, in trying to impress your attendings, and, overall, just trying to do a damn good job. But, being exhausted sometimes means you just can’t bring 100% to something. As type A as most doctors are, this is frustrating and then, I think, we spend extra emotional energy beating ourselves up over not being 100% perfect all the time. It’s this self induced torture that many of us put ourselves through.

Or maybe that’s just me.

Lack of sleep has made me slightly more relaxed though. I mean, sometimes I only use a one color pen instead of a four color pen.

Jokes aside, the Sunday night pre-work week pep talk is crucial. So, is the walk to work music.

Currently, Lupe Fiasco “The Show Goes On” or “Battle Scars” really hits home. I’m sure you didn’t expect this of me.

Final thoughts: Amongst the overabundance of specialty stores in Manhattan, there has yet to be a specialized seltzer store. This is, truly, a shame and, I believe, a missing hole in the landscape of niche food boutiques.

All I wanted today after I left Jess’ killer TRX/Pilates class was a seltzer over crushed hospital ice.

There’ s a specialty seltzer store drought in Manhattan. And, if this medicine thing doesn’t work out, I’m going to fill it.

Smith’s Seltzers. It has a nice ring to it ,right?

Until next time…

Daily coffee tally: 2.5

Kidneys: Your Body’s All-Natural Daily Juice Cleanse

And other ways your body is actually amazing.

First, let me qualify this post with a few caveats:

Caveat #1:

I am not a registered dietician, health coach, nutrition mad-scientist, guru, Jedi master, or the Dalai Lama. I have not received any specific training in nutrition. I am also not Dr. Oz.

Addendum to Caveat #1:

What I can say about myself is the following: I have a B.A in Chemistry and a MD, both from NYU, which hopefully did something productive with all of that tuition money I paid them. Given these two degrees, I would consider myself to have at least a basic fund of knowledge and critical thinking skills to evaluate and interpret scientific literature on health “fads” and trends.

Caveat #2:

I am allopathically (“Western”) physician. However, what I will say about myself is that I’m very open-minded when it comes to complementary and alternative medicine as well as nutrition and fitness, the latter of which greatly impacts my everyday working life (diabetes, anyone? Can SoulCycle be a prescription?).

I’ve tried acupuncture (LOVE, I’d still go if I had time), cupping (interesting), Graston (ow), and Active Release Therapy (super ow). I swear my chiropractor and acupuncturist kept me from getting injured while doing two marathons in one year. That being said, if I have cramps, I’m going straight for ibuprofen and not an herb.

Caveat #3:

Despite degrees mentioned in #1, I can just as easily be fooled by great marketing, which is what inspired me to write this post. I’ve bought alkaline water (I mean, I drink a lot of coffee so I should balance that, right?), thought I was intolerant to gluten (turns out, no one can actually digest gluten), and used to drink more green juices than my bank account could handle. Turns out, doctors, too, can be suckers for good marketing.

Caveat #4:

This post is not an extensive review on every single piece of literature of what I’m going to talk about. It is, however, a review of facts and some literature. I don’t have the time to do an entire thesis on alkaline water or activated charcoal, but, hopefully, a few paragraphs with be sufficient.

So, let’s get to it…

THE TOPIC: ALKALINE WATER 

THE CLAIM: BALANCING THE BODY’S PH, “DETOXIFICATION,” COMBATING ACIDOSIS, ENHANCED IMMUNITY

THE REAL SCOOP: YOUR BODY ALREADY DOES THIS FOR YOU! 

THE SHORT STORY: That is to say that every day your kidneys, liver, digestive system, and lungs are exquisitely controlling your blood’s pH (to a very narrow range) and ridding your body of the toxins you put into it. You are, in fact, “cleansing” every day. 

 

The claims make sense, right? We terrible Americans are drinking all this acidic coffee so why not just wash it down with a little alkaline water for, not only, neutralizing your body’s pH, but also ridding your body of toxins leading to better skin, fewer headaches, easier respiration (what?), a better functioning heart, and more stable and regular bowel movements (which, if you’ve worked in health care, you know everyone loves this).

QUICK LET’S ALL BUY AN IONIZER!!!

Not so fast…

First, let’s answer “what is alkaline water?”

Alkaline water is water whose pH is more basic than that of “regular” water and human blood. The pH of the delicious water I’m drinking right now is 7.0. The pH of my blood is controlled by my body to be between 7.35 and 7.45.

How does my body do this? It appears that when God made Adam and Eve, he put in our own natural Brita filters and pH regulating systems so we would all survive until we were able to create, market, and sell alkaline water (which I admit, I have bought).

Your body tightly regulates your blood’s pH through both the digestive system, your kidneys, and your lungs.

First, let’s give a big shout out to the pancreas.

You see, when you eat, your food travels to your stomach, where the pH is a brutal 2 due to hydrochloric acid secreted from these little guys called parietal cells in your stomach. The function of this is two fold: the acidic pH both starts digestion and is anti-microbial. This is why the “5 second rule” when you drop food on the floor totally works (just kidding).

Once your food has been adequately churned, its released to the good ol’ duodenum where the pancreas then squirts a bunch of juice into. This magic pancreatic secret sauce has a bunch of bicarbonate in it to neutralize the aforementioned acid. Your gall bladder also helps out in the cause, too, so the sum effect is that you are neutralizing what you’re about to absorb to a more physiologic pH.

But, what if some acid does get into your blood. WHAT NOW?

Take your hands and put them behind your back right under neath the edge of your ribs. Now, give that little spot a love tap. That’s your kidneys. Thank them.

If you have functioning kidneys, which I hope you do, then your kidneys take care of any imbalances in pH for you. I’ll leave it at that because otherwise we’d have to go into a long discussion about the nephron and loop of Henle. Unless you’re a medical student, spare yourself and just know that it works.

Your lungs help out, too. For instance, if your blood is too acidic, you’ll breathe off more carbon dioxide to, in essence, breathe out excess acid. Again, I’m leaving it at that as a discussion of this entire process is too lengthy (and, likely for you, boring).

On a brief review of medical literature, there does not appear to be any purported health benefit of drinking alkaline water. I did read one study where alkaline water may be an adjunct to treatment of reflux as alkaline water may inactive tissue bound pepsin (an enzyme) that plays a key role in the pathogenesis of reflux disease.

However, if you want better skin, a better heart, clearer thinking, easier respiration (what?), or any of the other aforementioned benefits, then you should be drinking water – alkaline or not. For your body to do all of the amazing things it can do, it needs water. Your body is approximately 70% water, after all, unless you just ate a entire bag of tortilla chips (then maybe slightly more).

THE TOPIC: “V-STEAMING”

THE CLAIM: HORMONE BALANCE, “PROTECTING” THE UTERUS, FERTILITY, DIGESTION, INFECTION, AND EVERYTHING IN BETWEEN 

THE SCOOP: I’M NOT SURE WHERE TO START WITH THIS ONE

Let me just say that I think if you are putting anything in your vagina it should be a) because you are on your period, b) because you’re at the gynecologist, or c) you’re with your significant other.

There has been nothing that has gotten be more fired up lately than “V-steaming.” (Pun intended).

It came to my attention that on Goop there was a post recently about, what else, but detoxing, but this time including a “V-steam.”

Apparently, you can sit on some tiny throne that then steam cleanses your V as well as your uterus using a concoction of herbs, including Mugwort, which legitimately sounds like it is from Harry Potter.

I looked into Mugwort, out of curiosity. Mugwort is used in some Traditional Chinese Medicine therapies, like moxibustion with mugwort to turn breech babies to head down position or to bring about uterine contractions. It brings “heat,” and I know a lot of TCM focuses on heat/cold and blood flow or stagnation. Mugwort was also used to ward off ghosts by Native Americans so I’m definitely giving it out at Halloween next year (get some education with your candy!)

A few things on the V-steam…

First, let’s suffice it to say that the vagina has a lot of bacteria, more than you’d want to know. However, thanks be to God, when He made Eve from Adam’s rib (right?), he made this “system” to be a self cleaning oven, if you will. You do not need Stanley Steamer a few times a year for down there. It does the job itself and, if not, you’ll know and, hopefully, be going to see a gynecologist.

Second, your female “system” is built to protect things from ascending into the uterus (see cervix, mucus, etc). Otherwise, we gynecologists call this an ascending infection and, in fact, this is how people infected with certain bacteria get pelvic inflammatory disease (see Chlamydia). Therefore, I would hope the Mugwort isn’t making it into your uterus, as cool (or hot?) as it may sound.

Third, this sounds like a set up for burning your V and disrupting the normal vaginal flora. That sounds horrifying, painful, and like the world’s most interesting ER consult I’m sure I’ll get one day.

Fourth, maybe the steam helps stimulate circulation, or something, but this seems like an awfully expensive and potentially weird way to do so.

Fifth, if your hormones are “off balance,” please see an endocrinologist and not the V-steam.

Sixth, I don’t know what a uterine ulcer even is….(see ad above)…and I’m an OB/GYN resident…so take the ad with that in mind.

So, instead of the V-steam, go get a pap smear. 

——-

If you have any data that refutes the above, please do let me know. Science is always a debate and I know I don’t have all the answers, knowledge, or time in the world to scour all of the information that is available to us today.

And, I also get that sometimes people just like certain things, even if they don’t work according to the medical literature. I’m currently drinking Aloe Water from Juice Press because I think it calms my stomach. It probably doesn’t, but the placebo effect on me is mighty strong with this one, so I’ll keep throwing down $2.50 for it…

Anything else the 5 of your who read this want to hear about?

Until next time…

 

 

 

 

 

 

What It’s Like Being A Resident

A lot of people ask me “how is residency” or “what do you do as a resident? Are you a doctor? Are you in school?”

Yes, I am a doctor or so says this diploma. Not an “attending” which is what you might think of when you think of doctors in practice. 

Let me tell you what it’s like to be a resident. At least, from my perspective. And we know no two of those are the same. But, anyways….

Being a resident is both special and suffocating.

Special in the fact that, I think, it’s a very seminal point in your life where you learn your potential craft, what you’re truly passionate about, and start to get to do what you worked 8+ years to do.

Special in the fact that, if you’re lucky, you’re thrust into a family of people that, if you like them, become people you look forward to seeing, miss on vacation, and don’t mind spending 80+ hours a week with. People that even when the shit hits the fan at 3 am and everyone is hemorrhaging, delivering, needing their ER consult, or just all decided to roll into triage at once, you can still laugh about it the next morning over egg wraps and hot sauce (the hot sauce is truly crucial in this scenario).

My NYU family, who I see more than my real family.

Residency is also suffocating. When you work 60-80 hours a week, it can start to feel like you live from one extended nap to the next and really never venture all the far from work or your work brain.

[Side note: I think that’s why I like exercise classes so much – it helps me to get out of my work world and into, well, the other world? real world? boy meets world?]

But, it’s very special to get to do what you wanted to do in life even if it is slightly suffocating for a four year period.

Residency is also terrifying.

As an intern (your first year), everything is terrifying – from being terrified that you’re going to hurt a patient, to attendings and senior residents you’re afraid to screw up in front of (which you always do), to figuring how to do a C-section, to figuring out just how to stay afloat and do anything, something RIGHT. I think I spent the first 6 months of my intern year with a heart rate above 100 bpm and a cortisol level higher than someone on “Naked and Afraid.”

Residency then becomes even more terrifying as you realize that you really had little responsibility as an intern and, as you progress, you get more responsibility. And, then you’re worried you don’t study or read enough, know enough, do enough….that you sleep too much or exercise too much….and that this all this responsibility is going to one day fall on you and you’re going to be one of “those doctors” that doesn’t know what they are doing. And, that thought is truly terrifying.

However, there are some days – brief, shining moments in time – where you do realize that maybe, just maybe you do know something….even with that 7 hours of sleep you got and that 6 mile run you went on instead of reading. You can explain an induction of labor to your friend. You know a thing or two about pre-eclampsia and birth control. You can practically do an (uncomplicated, primary) C-section in your sleep.

And, then you think that you may make it out of the 4 year vortex of residency ok.

On to the next extended nap and then back into the vortex…

Until next time…

 

 

About That Marathon…

So, yeah, I’m not running it.

I’ve become an exercise class junkie (can I get some sort of sponsorship to pay for these?) and running long distances has gone on the back burner.

Working 80 hrs a week will do that to do.

At first, I felt guilty about NOT wanting to run a marathon and thought “something must be wrong with me” since I’ve been head over heels in love with long distance running for the past few years.

When I finally “gave it up,” as they say, it was a huge relief. Someone actually congratulated me on NOT doing something (there’s a first for everything I guess).  And then I realized that running marathons all the time is not entirely normal. It’s a huge strain on your body and a lot to ask of yourself week after week, long run after long run. I just happen to be socialize in a community where weekend marathons are a normal thing.

And, to be honest, it’s nice to say “no” to something. To realize that saying “no” takes a lot more courage than saying “yes” sometimes.

So, for now, I’m trying to figure out how to print money in the basement I don’t have to fund my quotidian, average daily exercise need – 45 min to 1 hr usually about 5 times a week, 3-4 minimum (sanity minimum that is), and 6 if I’m lucky.

BUT, for those of you who ARE running the NYC Marathon or another marathon in the next few weeks, here are my ever so humble amateur runner tips. These are now tempered by my residency glasses, meaning I don’t get too worked up about too much outside of the hospital (I mean, besides get wait listed at SoulCycle or FlexStudios).

1. STRATEGY: Having a marathon pacing plan is fine. But, here’s the meat and potatoes of it all. It’s about putting one foot in front of the other, speeding up if you feel good, slowing down if you don’t. If you want the simplest race plan, it is as follows:

A. Smile as much as you can the first 10 miles. Don’t be an idiot. Don’t run too fast. Don’t waste emotional energy on anything. Have fun ONLY.

B. Once you get to 13-14, if you feel good, you can run faster.

C. Once you get to 21, it’s going to hurt no matter how well trained you are. At this point, employ the “if you feel good, speed up and, if not, then            slow down” plan. And, if you’re in pain, that’s normal.

2. TAPER: Don’t hate it. Use this time to do things you didn’t have time to do while training and running 3 hours each weekend. I highly recommend starting a new TV series. Netflix can be really useful. Or a book.

3. IF YOU’RE STRUGGLING WITH YOUR MENTAL GAME: Purchase “Golf Is Not A Game Of Perfect” by Bob Rotella or “Run: The Mind Body Method of Running By Feel” by Matt Fitzgerald. You will not regret it. I’d read these anyway, even if you’re brimming full of confidence.

4. THE MORNING OF: The morning of a marathon, I like to repeat something really cheesy and positive to myself. Something like, “You’re doing something amazing today! You’re going to run 26 miles! That is awesome. Not everyone can do that. You are amazing.” It will help make you excited about the race rather than fearful, dreadful, or thinking about mile 21.

When in doubt, repeat “You’re doing something amazing today!” Cheesy works, guys.

5. YOU BURN 2600 CALORIES NO MATTER WHAT: You can have that DQ Blizzard no matter what. That’s really what we all do marathons for, right?

SOME NYC MARATHON SPECIFIC TIPS:

1. WAITING ON STATEN ISLAND: It can be cold on Staten Island. TAKE LOTS OF EXTRA LAYERS TO WEAR while you wait around for a few hours to start running. I highly recommend going to Kmart and buying extremely large and warm clothing to wear. I have been known to wear a snowsuit (go look in the boy’s section). I did not regret this.

NYRR donates all of then clothing “shed” to charity.  Warm win-win.

Also, bring the following: a snack and water, toilet paper, an old heat sheet if you have it.

The latter two you will need when you inevitably pee on the bridge when you wait there for like 30 minutes. Like the good runner you are, you will be trying to stay well hydrated before the start. Don’t hate the bridge pee, embrace it. Everyone does it. Even [professional runner] Lauren Fleshman.

2. THERE ARE MORE HILLS THAN YOU THINK: So just be aware of that. Specifically, there are hills at miles 8-10, mile 13-14 (Pulaski bridge), The Queensboro Bridge, and the uphill grind from apprx 110th street to 89th street….and, of course the finish. 🙂

3. TAKE IT IN. There’s absolutely nothing like the crowds of the NYC Marathon. It MAKES the marathon. It would’ve been the whole reason I was running it this year (if I did). The crowds will get you through the race. Trust me, from last year’s experience. Even if you’re having a “bad” race, things are going as planned, so on and so forth, please enjoy the crowds and people. It’s really special if you let it be.

In the end, here’s my parting advice on marathons that should be taken with a grain of salt seeing as I’m not a professional runner nor psychologist nor Ghandi.

Of the 6 marathons I’ve run, my best and most enjoyable marathons have come when I was running for a reason bigger than a result.

When I ran the NYC-turned-Richmond marathon, I wanted to (as I wrote at the time) “express my appreciation for my health and ability to run” and to actually enjoy a marathon. And, it was. 

When I ran the Eugene Marathon (where I qualified for Boston and probably the fastest marathon I will ever run), I was so in love with running and the training process that I almost thought of my running that marathon as a performance, a ballet of sorts – something so memorable and moving that anyone who saw me run could tell that I loved what I was doing.

And, when I ran the NYC Marathon last year I wanted to prove to myself that as long as you loved what you were doing, you could do anything, no matter how many hours you were working or how many people told you it was a “bad idea.”

So, that’s my biggest tip – figure out WHY you’re running that isn’t a goal time. And, run for that.

Race happy – enjoy!

TELL ME: RACING A MARATHON? YOUR GOAL? LIKE ME AND SKIPPING OUT THIS YEAR?

Until next time…

 

 

Musings

If you want to know what my life has been like since age 18, I refer you to this – “The 7-Stage Life Cycle of a Doctor.” http://www.edocc.com/the-life-cycle-of-a-doctor/

If you ask anyone who knew me in college or med school, they’d probably say all of this is true. Living in the depths of the library? Yep, I was there. The amount of time I spent on LL2 of Bobst Library might approach that of “Bobst Boy.”

And, this got me thinking. [I know, this is shocking.]

Thinking about all that has changed in the 10 years I’ve spent studying to become a doctor and being a doctor (albeit as an intern and now resident). And, moreover, how much I’ve learned about myself through the process and, most specifically, residency.

Residency is an arduous, 4 year semi-indentured servitude. To put it in numbers, its an approximately 80 hr per week gig for four years.  The rigors of residency force you to adapt your lifestyle to levels of sleep deprivation you never thought possible. They also make you become fairly introspective on a regular basis because, in my opinion, before you can improve you have to know yourself and what you’re good at (or, sometimes, have some one tell you — you know, constructive criticism.)

So, here’s what I’ve learned in what is apparently stage 5 in my 7 stage life cycle. Categorized, like any good, type -A, four color pen using, check box obsessed person would do.

1. FRIENDS:

I spent most of my 20s saying “no” to friends all the time, usually being “No, I have to study because I have X test soon.” There was always another test.

Now, I spend any waking hour I have off from the usual 70 hour work week figuring out how I can spend time with friends. I’ll even skip sleep to see people (see #2).

Life’s weird like that.

2. SLEEP

Prior to residency I was fiercely protective of my sleep. I had to get 7-8 hours. OR ELSE.

Now, sleep is sort of this figment of my imagination. A beautiful thing, in theory,  but you never get quite enough of it no matter how hard you try.

As a resident, I’ve pushed the boundaries of abnormal sleep patterns more than I ever thought I could. When push come to shove, sometimes sleep is more important (exhibit a: the time I slept 18 hours in a row) and sometimes going to that pilates class you are stoked about or seeing a friend (or doing both at the same time) is more important.

And thankfully, there is always coffee.

3. POSITION / ROLE

After 24 hours of work, you can become fairly introspective. For instance, I realized that I don’t like being the center of attention but do like being “the favorite.” I always wanted to be the teacher’s pet. I don’t want the approval of all, just the approval of the “expert.”

And, now I’ve admitted this on the internet. I was totally the somewhat passive aggressive first grader that REALLY wanted to be line leader. If it wasn’t about line leader, I was totally relaxed and nice. Line leader? STEP ASIDE, kids, I’m in it to win this.

4. THOSE BELOW YOU

Let’s get real here, there aren’t too many people below me. I’m a 2nd year resident.

But, I always find it funny when the med students say “oh, you guys [the residents] are nice.” And, then I forget that as a student, your residents are intimidating to you. It is inconceivable to me how I could be intimidating to anyone. But, hearing that is always a nice reminder that you should remember what it was like to be the person below you and how you liked to be treated when you were that person.

But, really, you should just be nice to everyone. Unless, its about being line leader. Then, STEP ASIDE.

5. STRUCTURE, HABITS, COMPULSIONS

I’ve been an athlete my entire life. And, prior to residency, skipping practice or a workout was like Christmas came early. A day off? I’ll take it!

Now, I hold on to my “exercise schedule” with a kung foo grip not unlike that of Ben Stiller and his suitcase in “Meet the Parents.”

I think it’s because my work life can be somewhat unpredictable (who knows when the ER will page with a consult or a new triage will roll in) and, in turn, I like the rest of my life to be structured. I like to know I’m going to get in a weekly pilates class. Or a run. Or my favorite spin class. And it upsets me that I get upset when these things don’t happen. Because, really, its silly to get upset over something that isn’t really all that important.

Its keeping hold of a constant, which is all we sometimes want in life, right? Something that doesn’t change. Like vanilla wafers and saltines.

6. SANITY/HAPPINESS

Stage #5 of the physician life cycle really makes you distill your life down to only the essentials. With so few hours to myself, whenever I do have spare time, I usually just think “what is going to make me super happy at this moment in time.” And, I do just that. And then I go to sleep or go back to work.

Its kind of  a nice way to live, actually.

7. NEWS

What is the news? Who even anchors the news these days?

I’ve accepted that I won’t know most of what goes on the world from the years 2013-2017. Except for what comes up on The Skimm daily email (and, thank God for that).

I mean, did Kim and Kanye actually get married or was that a publicity stunt? I’ll never know. Is Khloe actually divorced?

Oh wait, that’s not the actual news.

8. THE CHILD IS THE FATHER OF THE MAN 

This is just a fancy way of saying that some things about your never really change.

My mom has always said that I remind her a lot of her mom. Mostly, in that I can’t put things together, am clumsy, and like structure or schedules.

And, this is still true.

I still cannot put the blade on the scalpel without looking like a fool (thank God for scrub techs and those handy ready made scalpels). But, I can talk to people for 45 minutes about their inductions and every fear in the world they have about cytotec, pitocin, and their birth plans.

I’m a good talker/listener (I think). Just don’t ask me how to use your can opener or put together that Ikea furniture.

That’s enough rambling for now.

I’ll leave you with that.

Because what is about to make me the happiest person in the world is a 10 pm bedtime.

Night!

TELL ME: SOMETHING ABOUT YOURSELF YOU LEARNED IN THE PAST YEAR. 

Until next time…

 

 

 

 

Stubborn

Alternate title for this post could be: “Lessons Learned From Revisiting the Long Run.”

It’s apparently 16 weeks out from the NYC Marathon. I have yet to formalize a training plan. I did download something, thanks to my friend, Nicole, entitled “Run Less, Run Faster” marathon training plan. I’m sure it’ll work miracles.

The problem with “training” is that I enjoy my other activities far too much to commit to just one. Why just run when you can do other fun things, too? (Albeit expensive little things, but well worth it, in my broke resident salary opinion). Let’s spin! Let’s go to pilates! Let’s try yoga! Let’s try stand up paddle boarding! Let’s try napping! Let’s have our cake and eat it too!

Regardless of what I want to do, I did sign up for the NYC Marathon and I’ve “committed” to it in so much that I paid >$200 to run it. And, I’m sure come September or October I’ll get bit by the fall marathon bug and would be mad at myself if I weren’t doing the NYC Marathon. (If history proves anything, I’ve signed up for the marathon last minute the past two years…because I had fall marathon FOMO).

I guess this is where that whole discipline thing comes in – doing what you’re supposed to be doing, when you’re supposed to be doing it, even if you don’t want to be doing it. And discipline for marathon training means running, especially those weekend long runs.

Luckily, I had a fast friend in town on Saturday (and some other running buddies) and I actually wanted to do a long run…so I did.

Truth be told, I went out a little too fast or at least too fast given my fitness level and the heat/humidity. It was one of those times where you want to quit at mile 4-6. Its too hard. Its too hot. I don’t “have” to do this. I could just stop, right?

Luckily, I had some good ol’ stubbornness kick in. I really think part of being good at anything, whether it be tennis, gymnastics, running, or chess, is that you have to be an asshole to yourself sometimes and be a little bit stubborn.

I had told myself I would run 10 miles that day. I was going to finish 10 miles even if I had to walk half of it. And I was going to keep up with these people until I actually collapsed or threw up because, until that happens, you’re probably fine and just making up excuses in your head. You never know how far you can push yourself until you try, right?

Part of what made this a little bit hard is that a lot of my intern year, I would go easy on myself with respect to running. I gave myself a lot of slack (and I think fairly well deserved) for working 60-80 hour weeks. I didn’t have to run fast. I didn’t have to turn up the resistance at SoulCycle. I didn’t have to not put my knees down on the carriage during a plank at Flex. I work a lot, I should get a little freebie here or there, right?

Well, yes and no. I think.

There are a lot of times I find myself giving myself an out even though I may not need it. Or at least that’s what I discovered on Saturday.

[In case you like numbers, splits were as follows for 11 miles – 8:47, 8:33, 8:15, 8:24, 8:19, 8:23, 8:57, 8:24, 8:39, 8:08, 7:56 — proof that you can definitely do more than you think.]

So, here’s to something new. Running a little faster, a little farther. Turning up the resistance in spin. Napping a bit harder. You know, giving everything you do 100%.

All in.

See you November 3. (I think).

[But the thought is still a little scary.]

 

 

Intern Year: Cliff Notes and Survival Guide

I’m not sure I’m entirely qualified to write this post, seeing as I just graduated from intern to PGY-2 at that magical hour of 12:00 am on July 1st last week. However, I like to think I somewhat maintained my sanity and a slightly sunny disposition, albeit probably more jaded, and made it from July 1, 2013 to June 30th, 2014  sane, happy, and healthy, for the most part.

The short of it is this: intern year is hard work. This is what you signed up for. Get used to it. All you have  in your back pocket is a positive attitude and enthusiasm. Hold on to that as best you can.

Here are some truths about intern year:

1. IT IS NORMAL TO FEEL OVERWHELMED. I think I have PTSD from last July. Not that anyone was mean or awful to me or anything particularly bad happened. The transition to intern year was just a really hard adjustment for me and I learned that I don’t deal with change very well (I mean, I would get really sentimental when my parents would get rid of cars for a new one…I’m not sure why I didn’t know this about myself). I think the hardest part for me was feeling inept and helpless. Even with 8 years of higher education, I still couldn’t tell you on July 1 of last year how much motrin to give someone. You aren’t supposed to know what you are doing, but you are supposed to be trying your hardest to learn. That’s what counts. I  went home every day last July thinking I was going to be fired for incompetence. The learning curve is steep. Hold on!

2. IT IS NORMAL FOR THIS FEELING TO LAST THROUGH A LOT OF THE YEAR. Just when you think you have something down, the labor floor or something will rip you a new one.

3. IT IS NORMAL TO FEEL LIKE YOU’RE GETTING MIXED MESSAGES: One attending will tell you to do this and the other will ask you why on earth you’re doing it like that. Some days, you’ll feel as if no matter what you do, you aren’t doing anything right, even if you delivered a baby upside down and blindfolded. “But, why did you put the blindfold on that way? Who taught you that? I mean, I guess you can do it that way, but don’t.”

Its normal to feel like you’re owned by this little box.

4. YOU MIGHT HAVE MOMENTS WHERE YOU FEEL LIKE “YOU’LL NEVER BE ABLE TO DO IT.” I think there was a moment last August when I thought I was never going to be able to do a C-section well.  And then you realize you’re being dramatic and its a four year residency for a reason. [Side note: this still sometimes happens, I’m fairly impatient with myself, at best.] And then you do approximately 150 C-sections by the end of your intern year.

5. YOU MIGHT HAVE DAYS WHERE YOU FEEL LIKE YOU DID NOTHING RIGHT: There are days where you’ll be pretty sure you’ve done everything wrong down to the placement of your pinkie finger when grasping an instrument. And see #3 and #4.

6. YOU MIGHT FEEL LIKE YOU’RE A BURDEN OR DEAD WEIGHT: Maybe this was just me, but I often felt like I was dragging everyone down because they had to teach me and guide me so much. I realized (and was reassured) that this was sort of the norm for the beginning of intern year but its still hard to feel like you’re slowing down efficiency.

Here are some tips for intern year:

1. IT IS IMPORTANT TO EAT AND DRINK WATER. You cannot subsist on air alone. You need food to think. Bring snacks. Take advantage of saltines in the hospital in emergencies. And diet the water machines on all the floors.

Resident hydration at its finest.

2. BE NICE TO EVERYONE. It will only help you. And, I feel like people should do this anyways. You know, that golden rule thing…

3. IN YOUR TIME OFF, DO WHATEVER MAKES YOU HAPPY. For me, this was exercise. I’ve spent more money on exercise this year than food (well, maybe) but it was worth every penny spent. It was something I looked forward to and my reward at the end of the day (or night). [Disregard this is if I’m evicted soon. Thanks to deep sea predator spin instructor and power tool pilates instructor.]

GROUP exercise – kill two birds with one stone.

4. DON’T UNDERESTIMATE SLEEP BUT ALSO DON’T MISS OUT ON YOUR LIFE. This one surprised me. I am big on my 7-8 hours of sleep. But, sometimes you’ll get six (or less). Sometimes you’ll forgo a little sleep to do something with your friends that you’ve been looking forward to. Always do what is going to keep you happy – sleep, exercise, friends, eating, trashy TV. Do whatever that thing is.

 

Here are some things that might help you:

1. LIKING THE PEOPLE YOUR WORK WITH. To me, this is the most important thing. If you like the people you’re working with and can laugh about the shit hitting the fan at 3 am the next morning, you’ll be ok.

My NYU family, who I see more than my real family.

2. THE FOUR COLOR PEN AND CHECKBOXES. Ok, actually these two are the most important things.

3. REMEMBERING THAT UNLESS YOU ARE NEGLIGENT OR DISHONEST, IT IS NEVER THE INTERN’S FAULT.  This is the secret of intern year you won’t realize until about half way through the year. Unless you don’t report information or are dishonest, nothing will ever be your fault.

Here are some things that might happen to you:

1. INTERN CHIC APPEARANCE:I No make up? Hair a little squirrel dog? Breakouts from stress? Wearing scrubs with winter boots and a sweatshirt? Intern chic. Make it your thing. And you can always blame you appearance on “the 80 hour work week.”

2. A “WHATEVER” ATTITUDE OUTSIDE THE HOSPITAL: You will suddenly care far less about things you used to care about. How many weeks is it until that marathon? Maybe 10. What do you want to drink? I don’t know, surprise me.

In the end, this is what I hung on to (one of my favorite quotes of all time) and still do:

Ability is what you are capable of doing.

Motivation determines what you do.

Attitude determines how well you do it.

– Lou Holtz

I sure hope that’s true.

TELL ME: SURVIVAL TIPS FOR STARTING A NEW JOB/ROLE? 

Until next time…

Observations on Unconventional Half Marathon Training

Hi there! I’m still here! And, by here, I mean the hospital, my apartment, SoulCycle or Flex Studios.

Way back when (alright January), I wrote about not training for a half marathon coming up. Then, I didn’t run that half because I wanted to sleep (#internproblems).

In the depths of the polar vortex, I had imagined the Miami Half would provide the kick in the butt to start training for May’s Brooklyn Half. And then after I didn’t run the Miami Half, I figured that the winter would turn around and I’d be doing long runs again in no time. Half marathon in May? No problem.

The weather sort of turned around, but my “training” didn’t. Of course, I will still exercising a fairly good bit, but long runs, tempos, even running in general? Well, it just didn’t quite pick up as the months went by.

Since November’s NYC Marathon, I’ve been on a huge spin kick. I love running and still do, but I just usually wasn’t feeling it. And spin? I was feeling it.

The last time I ran over 8 miles prior to Saturday….

No good blog post would come without some analysis of largely unimportant details of a 20-something’s first world problems. Thus, I thought about why I was so spin crazy all winter/spring and not run drunk as usual. I think I spent what equates to a small wedding fund at SoulCycle this winter for three reasons: 1) indoor heating; 2) music; 3) community/people. In the throes of intern year, when you all you really want to do is drink some water and sleep, the thought of running in the cold alone is fairly bleak. Inside exercise? Check. Getting lost in music and forgetting about the labor floor? Check. Having some sort of unspoken peer pressure by those around to work hard? Check. Add more classes to that cart.

As May drew closer and closer, I did start to get slightly concerned that I might crash and burn in this half marathon, especially since I had told my co-resident, Meagan, that I would “pace” her through her first half, which would require me to be in some kind of shape.

Sure, I was exercising a lot. But, would it be enough? Since analysis is my middle name, I thought this through a little bit.

I estimated that my exercise/workouts were broken up as follows:

– 10% pilates (new obsession thanks to this power tool)

– 50% spin (including a lot of “doubles” and a few “triples”)

– 40% running (including a lot of run/spin or run/pilates combos)

I equate a 45 min spin class to be the cardiovascular equivalent of a 5 mile run. I also consider it like a “mini” track workout or tempo since its often high cadence against moderate resistance and potentially this evokes some sort of fast twitch neuromuscular stimulus or another equally fancy term.

If the above was true, then doing a double or triple spin was like a long run (double spins feel like a 12 miler to me and triples feel like a 16 miler in terms of my cardiovascular stimulus). Or doing a spin + 4-5 mile run was like getting in a 9 or 10 miler. Or so I hoped.

Pilates was a plus in the strength corner.

This left only one real variable, which was the one I was most worried about — time on your feet.

I learned from Steph that I lot of your long runs were just getting used to being on your feet and running for that long. It helps your muscles, tendons, and ligaments adapt to that stress and get stronger. And, that was the one very crucial thing that I was missing.

Slight oversight.

A little more of this may have been useful…

To sum up the analysis: 

General cardiovascular endurance + moderate strength from pilates – time on feet aspect + the square root of 20 =  Half Marathon?

Turns out, everything went well, as it usually does in these complicated first world problems for 20-somethings.

In fact, I had a lot of fun. Pacing someone in their first half was even better than running your own PR in a way.

To be fair, my legs did NOT feel used to running 13.1 miles and I started to feel a bit heavy legged by about 10 miles (pilates the night before also may have had something to do with this). But, I didn’t feel terrible either. Meagan and I finished in 1:53:43 (amazing first half marathon, right?!) which I thought was really great. Judging on how my legs felt at the end, I think that 1:53 was about the limit of my leg strength/power. They just weren’t quite used the pounding of 13 miles and the leg power needed for that, which I’m glad I now realize when I approach future races (NYC Marathon 2014!) with likely unconventional training plans.

Unconventional includes 18 x1 jumping selfie attempts. #nailedit

After I wasted all that brain space analyzing whether I could physically run 13.1 miles (when my longest run since November’s NYC Marathon was 8 miles), I realize that what was really missing from the above equation and, perhaps, is the most important variable is this: your mind and attitude.

Over the 5 years I’ve been running and racing, I’ve gone from seeing running as a thing I “needed to do” or “have to do” to now something that I get to do. Running, going to spin, taking pilates – it really is a privilege. Not everyone gets to do it. And I do. And, I’m really thankful that my body is able to do it and that I have the time and resources to do so.

Can’t talk about my running roots without mentioning my running buddy OG, Erika. Thanks for inviting me to run that time. It worked out ok.

What I learned from the Brooklyn Half was this: When you run from a place of joy and appreciation,the result is so much sweeter, no matter the time on the clock. 

This only took me about 5 years and half a billion races to learn.

On a final note, don’t underestimate your power. Even a lowly intern can convince her senior residents to run a half marathon.

NYU OB/GYN – excellent surgeons in excellent shape

TELL ME: WHAT YOUR SPORT HAS TAUGHT YOUR ABOUT ATTITUDE, MENTAL TOUGHNESS, OR SOMETHING RELATED TO THE BIG ORGAN BETWEEN YOUR EARS. 

Until next time…

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A “Typical” Day In the Life

While there is no one “typical” day for me, here’s a little glimpse into life as the intern on labor and delivery.

*day to day routine varies based on what rotation/service you are on…variety is the spice of life, right?*

Here goes:

4:45-5 am: ALARM!

[Thankfully, “getting” ready takes all of 10-15 min given I wear scrubs every day. I eat breakfast on the way – a Picky Bar and a green juice, usually. And coffee #1 of day.]

5:15-6 am: Get to the hospital somewhere in this time frame depending upon the number of postpartum patients to round on that morning. Get sign out on post partums from night resident.

[Sign Out = Running through the list of patients and active issues with them. Ie Ms X had a fever last night and x,y,z was done. Or Ms A has severe pre-eclampsia, is on magnesium until 5 pm today, tox labs q 6 hours, blood pressures have ranged X to X…or something like that]

Until 7 am: Round on the post partum patients. Write notes.  Usually ranges between 10-20 patients.

How best to describe post partum rounds?

7 am: Get sign out on the “board” (triage and laboring patients) and antepartum patients from the night resident. Give sign out on post partums to nurse practitioner (aka the intern’s God send).

7:30 am: Didactics (educational activity)

8 am: Sign out “the board” to all of the staff on labor and delivery

8:45 am to 5:59 pm: “Run the floor”

There are four basic things you do as an intern in a day on labor and delivery.

***Intern = first year resident***

1. C-SECTIONS: There are always scheduled C-sections each morning, usually at least two and sometimes three. Interns do all primary C-sections, meaning the first C-section anyone has ever had. Repeat C-sections or those on people with prior abdominal surgery usually get bumped up to the second year resident, unless they are in clinic. Really complicated patients may get bumped up to a chief. In general, the labor and delivery intern ends up with at least a few sections every day.

All residents bow down to the holy check box so I’ll include that in this post as to neglect the check box in a post about “the day in the life” would basically be leaving out the meat of my day.

In “check box” terms, C-sections get five check boxes: history/physical exam, consent form, pre op orders, cross for blood products, post op orders, baby orders.

2. TRIAGE: Triage is like our OB emergency room. Anyone over a certain number of weeks pregnancy gets sent to our triage. Usually, it is people who are coming in to determine if they are in labor, if they broke their water, etc etc.

Triage patients get four check boxes: history/physical exam, consent form, triage orders, call attending to discuss plan for patient.

3. LABORING PATIENTS: This entails watching the “tracings”, checking in on them, monitoring or managing their labor course/starting an induction, and, hopefully, delivering them!

*Tracings = external fetal heart rate monitor and contraction monitor*

Laboring patients get the following check boxes: history/physical, consent form, admission orders, cross for blood, baby orders, post partum orders.

4. PAGES: It beeps (a lot). You answer it. Pages can be for anything – from a colace order to someone with severe range blood pressures who needs to be evaluated for pre-eclampsia to a post partum hemorrhage.

I wear my pager on my ID necklace/lanyard along with looping my four color pen. Suffice it to say I look super cool when I’m at work.

During the day, our nurse practitioner covers the post partum pager and patients. This probably saves the intern at least a billion pages per day.

The antepartum service (i.e. those admitted prior to labor)  is covered by the second year resident. However, they are sometimes in clinic and you hold the pager at all times and, therefore, are also responsible for the antepartums in some capacity each day.

6 pm: Sing out the entire service to the night resident. Hand off the pager to said resident.

6:30-7 pm: Leave hospital!

***There is, of course, always the possibility of the 5-5:30 pm high acuity situation in which you get a bit delayed on the 6 pm sign out or you may need to catch up on note writing or some aspect of patient care from the day and stay a bit later than what is listed above.***

At some point, you eat lunch and, hopefully, drink water. I drink at least two coffees a day, minimum and sometimes shove down a Picky Bar in the afternoon, especially if I’m going to run or spin that evening.

I was on a huge diet ginger ale kick during my last month on labor and delivery. There’s something so satisfying about the little mini cans of diet Shasta (ginger ale) apparently only available at hospitals. Combined with hospital ice (the soft ice like they have at football games), its heaven in a small styrofoam cup.

I usually crash by 10 pm. Sometimes earlier. And hopefully not any later than that.

And then you get up again and do it the next day!

So, that’s it.

Until next time…

[And if you have any questions, ask! Not sure if what I wrote is common knowledge or jargon…]

Race Rebellion

You know what’s awesome?

Doing what you want to do.

Most of my time is spent doing what I’m supposed to be doing when I am supposed to be doing it – you know, discipline. Getting to work at 5:30 am to round on post partum patients is my job. Like many of you, I spend most of my time crossing my t’s and dotting my i’s, on a relentless little journey to figure out how to be good, better, and, ultimately, best at what I do. I’d say for most of us, they aren’t many occasions where you get to say “You know what? I don’t want to to this today so I’m not going to.”

So, it’s pretty liberating when you can do that – decide exactly what you want to do that will make you happy and do just that.

I went to Miami this weekend with Gia, KScott, and Theodora for a girl’s trip, including a half marathon. At 6 am. In 70+/humid weather (not that I’m complaining). Undertrained. Sleep deprived (as usual). And not really all that amped up to run 13 miles.

What did I really want to do? Sleep in til a luxurious 7 o’clock (my how times have changed from med school!), run when I want to and how far I felt like, do a few Canyon Ranch classes (yoga! zumba! ballet!), get more steps on my fitbit, drink a green juice, soak up some vitamin D….

So, that’s what I did. And, it was fantastic!

My approach to exercise has drastically changed since starting residency and very much mirrors this weekend.

Last year, I used this race as a training run for Eugene [marathon]. I wanted to get up at 3 am for a 6 am race. I wanted to run 13.1 miles. It was all a part of “the training plan.”

Now, there is no plan. And, its perfect for this part of my life. I only get a few precious hours a day that are totally and completely mine so I typically pick whatever exercise (or non-exercise) will make me happiest. Sometimes its SoulCycle. Sometimes its running. Sometimes its catching up on my DVR.

This time last year I was logging all of these miles, splits for crazy workouts, honing my marathon mental game. Now, I’m logging work hours, cases, and figuring out how best to stay sane and how to afford my SoulCycle classes, new Oiselle gear, and green juices.

Before residency, I was really scared I was going to miss training and racing like I did in med school. I had fear of fear of missing out big time. I’m happy to stay I don’t at all. I push myself hard enough at work that I don’t really miss track workouts and race day early mornings. My biggest goal is to figure out how to relax my shoulders in SoulCycle (I tend to carry my shoulders up near my ears — comes with the uptight, stressed out territory) and that’s just fine by me.

I don’t really know what the point of this post is. Do blogs have to have points or lessons like Full House episodes do? I guess its be open to change, do what makes you happy if you have the opportunity to, and skipping a race can be very liberating (even if you’re out the race fee which is the equivalent of a few SoulCycle classes). And that sleep is very important.

Lose a race entry fee. Gain some freedom.

Tomorrow…its back to the early wake ups and the post partum rounds (and, the best part, delivering babies!)

Bring it on!