Two Girls

I haven’t dusted off the blog in awhile.  I’ve been talking with a lot of people lately about the obvious differences between my two daughter’s personalities already apparent at ages 7 months (Amy Elizabeth) and 2.5 years (Ruth Hazel).  I’m finding this aspect of parenthood to being one of the most satisfying and interesting- having the opportunity to look back and see aspects of their personalities present even at very early ages.  Ruth’s personality traits were almost present from the moment she was born.  Amy it’s harder to tell only because she is younger and her “real personality” isn’t as clear yet. I’ll start this brief discussion with pictures of both girls at age 6 months.  It’s important to realize that looking at the pictures side by side you can see some difference in their faces, but if you show us (me or Dorothy) a picture of one of the girls at any certain age we can probably only tell who it is by the outfit.  Although as I thumbed through picture after picture of both girls as I was preparing for this blog post, I now think I have cracked the code.  Here’s two pictures right around 6 months of life.

IMG_0188 IMG_1491

Both girls were exactly the same weight 13#7oz at their 6 months visit.  Amy was 1.5 inches longer and was born heavier (that’s a different post on her poor rate of weight increase and the efforts we have gone through to improve that).   They are both bald, same color and complexion, very similar eye color, very similar cheeks, similar eye brows, mouths the same (though not the shape they put them in- which we’ll talk about) and the main difference is a slight difference in nose structure.

But I chose these pictures because I think they effectively display what is now very obvious from the pictures- Ruthie has that same look in almost all pictures she has taken and Amy has that same smile in almost all pictures taken.  To date those looks pretty well sum up the differences in personality.

We don’t know as much about Amy- she naps well, is generally happy when fed (which has been a slight problem in the afternoons when the milk supply just wasn’t keeping up), and smiles all the time.  If fact it’s hard to find a picture of Amy not smiling because if you are looking at her that much to take a picture she’s probably going to smile at you. She’s very likeable.  Which is a different word than you’d use to describe Ruthie, who’s also likeable, but there’s several other traits that describe Ruth better.

So what is that look in Ruth’s picture?  Intensity!  That would be the word that Dorothy and I would use to describe Ruthie.  In fact that very same intensity could already be seen in the very first picture have of Ruthie seen here in the pictures at the bottom of this post.  Both pictures have that look, even at 5 minutes of life she was looking around.  In fact every picture we have with her is like that.  She is smiling in almost none of her pictures before 1 year of life.   We used to think of her as “social” because she loved being in a crowd and around other people. Now we know that Amy is actually social, she wants to be around people, make eye contact, smile, etc. Ruthie wanted to grab the name tag off your shirt, pull your glasses and investigate the pen in your pocket. Eye contact only with that intense look that you see in the picture above.  People commented from day one about how alert she was.

Ruthie is now a lovely girl, social, engaging, and loves talking with people. But she is still incredibly intense. She is very emotional. Several people have commented about having “adult conversations” with her.  When she is playing it’s like “get back Jack I got a job to do”. She will frequently just begin running laps around things.  If Mommy and Daddy are not done having dinner at the table, she’ll begin to run laps around the table.  If I’m lying on the floor she’ll begin to run laps around me.  She’s 2.5 years old and can spell her name, she knows her birthday, and can do 50 piece puzzles.  She’s intense.  She didn’t nap during the day until she was 9 months old, she would cry for an hour in her bed.  She has slept three times in public that we can remember- once on my beloved Aunt Liz’s (RIP) bosom, once recently when she inexplicably fell asleep while playing stickers on the airplane.

I look forward to getting to know Amy.  I have a feeling that she will be much easier to get along with.   It’s hard not to enjoy someone that smiles continually.  She has some of the intense, focused features that Ruthie has and is actually louder in many ways.  Ruthie is to focused on things to be really loud (unless she was bawling about being in the car seat, which she did every time as a baby), but Amy is often very loud because she has realized that it gets her more attention (and smiles).

We only have one mold to create kids in our house, but they have very different flavors.

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Published in: on February 16, 2013 at 5:22 am  Leave a Comment  

Always a wrestler….

I was out running with my dog today and I couldn’t help but think “The human body is amazing.”  I ran roughly 7.2 miles today with my dog which was twice as far as her previous long run with me (we’ve had the dog for less than two weeks).  While she was significantly stronger this go round then our 3.5 mile run (it was a lot cooler today) she was still definitely dragging a little by the end.  I look at my stocky, wrestler-pretending-to-be-an-endurance-athlete body and then my dog and think, how’s it even possible that I can out run her?  Our physiology is amazing and I got to remembering about how humans can outrun horses in distance races.  Say What!?!?  No really, take a minute (after my blog) to go read this:

All Men Can’t Jump

But I was also thinking this week (thanks to a question by Tim Sinnett) about my habitus.  I was a pretty scrawny, short kid with a reasonable amount of innate talent in running, but where I grew up outside Chicago during the peak of the Jordan years there was only one sport- basketball. That wasn’t the best for me given that only one girl was shorter than me in my 8th grade class.  When I moved to Washington I joined cross country.  I ran too much too fast, suffered through shin splints, didn’t know how to suffer athletically and really didn’t like the coach. I never went back which was probably a mistake in the grand scheme of things, by the end of high school I posted a few *almost* collegiate level running times in local races and ran a marathon a few days before my 18th birthday.  BUT I never did really run again for a team other than my wrestling team. Wrestling was fundamental to my development as me.  I’ve discuss this before, but it also probably changed the way I looked.  I wrestled 101 pounds my freshman year, really weighed 99 and didn’t need to worry about making weight ever.  By my senior year I was about 150-155 pounds (wrestled at 135) and could bench over double my body weight 315lb one rep max on bench, I did 405lb x 3 in back squats AND ran a marathon a few months after my senior wrestling season.  I was a machine.  I was a terrible wrestler but great at training for wrestling.     My sophomore year at 115 varsity I was 5-15 and my senior year I was something like 13-13 for the season.  I was probably at to low of a weight class but I would have been JV behind our very good 141 wrestler but that’s a different story.

The summer after high school (before heading off to college) I basically worked out all day.  I rode my bike to Godfather’s Pizza (my only fast food job ever) and on break had all-you-can-eat pizza buffet every day.  After work I rode my bike to Gold’s gym and worked out hard (including long runs).  I did this until around the start of August when I got sick.  In retrospect I realize it was mono, but all I knew then was I was to sick, tired to workout.  In-fact I think I couldn’t even ride my bike to work for that next month.  I remember being all but couch bound from exercise.  Then I went off to college, lifted weights, ate to much, partied to much and shortly after college I was 205 pounds (at 5’6″).  I certainly didn’t look super fat or anything, I have some unflattering pictures of me with a bit of a gut but I still basically looked like a muscly wrestler.  I got into medical school (accepted spring 2001) and knew that I needed to return to cardiovascular fitness. That led me to a several year path of pursuing greater and greater levels of fitness and eventually hitting ~155 pounds again during winter of 2006 while training for bike racing. That next year I had my early season crash, hurt my AC joint and never really had a great season (though I did race all year) and the next year we moved to Jerome and I basically stayed around 168-170 average until early this year.

During all of that though I’ve always looked more like a wrestler faking it in endurance sports.  During medical school my VO2 max was tested somewhere around the mid to high 50’s ml/kg/min, which is pretty good by today’s standards though certainly not elite athlete levels.  Average males today are under 40.  They have detailed information from ancient Rome on soldier’s gear, height, weight and march times, etc and have calculated that the average Roman legionaire was over 40  (here’s the article I remember though they don’t mention what the average must have been in that) and I recall reading in one place that the average was probably closer to 55 for the legionarres. So I wouldn’t have made the height cut off, but I maybe could have hung in a forced march with them.  Even at my skinniest post-college fitness my back and legs in particular looked like a scrapper not a bike racer.  It’s pretty clear in my post crash photos (here) what I mean (especially my back).  I was right at my current weight (~160) in that picture though from several years of bike racing my habitus was a little different in that today I have bigger arms by a long shot, so it’s a little unclear where all that extra weight was in that crash picture, legs maybe?

So to sort-of go somewhere with all this discussion about my body habitus: do I look like a wrestler because I was a wrestler or if I had run all along would I have eventually looked like this?  I have no idea.  I certainly have a significant tendency toward muscle development, I’ve never been worried about my testosterone levels, but I really prefer endurance sports.  Right now I really don’t care very much because I really do enjoy lifting weights also.  I’m not really willing to only run and shrink down that muscle mass that I continue to carry.    I’ve also become convinced that muscle is super important for long term health.  There’s several controversial population studies that suggest being in the overweight range of BMI (25-29.9) is associated with lower mortality then normal (even when corrected for smoking).  This could be from it being bad for your health to be “frail” as an elderly person?   Mortality rate after a hip fracture is 25% that first year.

Either way what I can say is that “you can take the wrestler off the mat, but you can’t take the wrestler out of the man.”

Published in: on August 18, 2012 at 10:17 pm  Leave a Comment  

Round #2

5 days of life.

I’m a pretty outspoken non-lover of the early months of a babies life.  Seriously is there any reasonable answer to the question “How’s your baby doing?”  Um….she cries, interrupts my sleep, and needs a diaper change a lot of the time.  She doesn’t roughhouse or draw or talk or ….do much of anything fun.  Someone taught me the response “Pretty helpless still” I think I might adopt that.

Well that’s not totally true she’s a month now and has really started smiling, that’s pretty cute.  Despite all my ranting…I definitely love this little girl sooner than my first.  It’s not just that she cries less than our first did, it’s not that she sleeps a little better than the first did, it’s not that she actually likes the car seat.  Because those things are all true and really, really nice.  It’s more that I know what to look forward to.  I love my oldest so much it’s actually crazy sometimes.  We were wrestling on the carpet yesterday and her giggles filled our house with joy beyond description.  Dorothy was feeding the youngest in the rocking chair and Ruthie was playing her double knee drop on daddies genitals game.  High comedy.  Don’t worry- hands for protection and it’s actually pretty hilarious.  I’m sometimes amazed at the fact that I haven’t really ever injured or hurt her because she really plays very aggressively and I’m 8x her mass.

Knowing that down the road I’ll have a similar experience with this new Baby Amy makes me more relaxed about the whole thing.  Some if it may simply it being “round 2” and being a more experienced father, but I don’t think so.  Ruthie smiled at me when she was 1 month old but it still took until this post when Ruthie was almost 4 months old to really “fall in love with her”.  I really know what’s in store and I have stronger feelings about this second baby at a younger age than with the first.

I might even consider doing this again, even though I suspect I’m destined to have 3 girls….

About to start crying actually.

Published in: on August 15, 2012 at 4:02 am  Leave a Comment  

Sissies

I saw some of my dear friends Kate and Josh this weekend. I forget how much I miss some of my old friends until I see them. Josh, Kate and I have a way of talking about things and thinking about things that I don’t have with other friends. It’s probably a combination of having been through medical school together but also all having been athletes (Josh having competed at the highest level of the three of us). The course of our 3 hours of socializing brought a few related ideas to the surface of my mind. For clarity I’ll break them apart into two seperate sub-sections:

De-Sissification
The approximate quote from Josh: “Rowing was good for de-*&%^ification.” The word there being another word used for a cat. I’ll use the word *sissy* from now on for what Josh was refering to when he was quoting another of his friends related to the benefits of having been a rower. I am however thinking of that other word every time I use it. Josh competed as a rower at a very high collegiate level, having been teammates with Olypiads and having competed in national level competitions. He is not a *sissy* for many reasons but rowing certainly didn’t hurt. It made me again think of what *sissies* most Americans are. I can’t tell you how often people’s excuses for various things I’m advising them on could be tranlsated as “I”m a *sissy*” (if they could only realize what it was they were actually saying).

A few brief examples: 1) “Health food is to expensive” in response to my advice to eat less food. I’ll go on to argue with them that making a whole wheat sandwhich at home is the same or less money then a fast food meal and they’ll look at me like I have 4 arms. What they really meant was “I’m a *sissy* and fast food is easy, tastes good, and I’d rather watch tv after eating in the car on the way home then have to “make a sandwhich” when I get home.” 2) “I get to hungry (insert other adjective like “weak”, “dizzy”, “low blood sugar”, etc) when I try to diet.” when I advise people to try to lose weight. Again could be translated as “I’m a *sissy* and I’m incapable of tolerating any mild discomfort other then being stuffed from over eating or being constipated from my terrible diet. “Oh…and I’ll probably come see you for medicaiton about my reflux or constipation which is brought on directly from eating to much”.

This American diffuse and pervasive *sissiness* could be cured by giving PE teachers the green light to actually push kids in gym class again. Now most schools don’t even have PE and you certainly couldn’t push a kid to their limit, in fact the 1 mile “run” is school is actually a “let the obese teens walk”. Or make all teens work for a summer on a farm. Let a farmer be their parent for a summer, *sissiness* reduced by 50% in 3 months guaranteed. Manditory 2 years of service in the National Guard after high school? Most kids need boot camp, the problem is that they need to be de-*sissyfied* before their 18. Many kids are obese before they are teens now. The wide availability of food, the sendatary life styles of their parents, and kids are often way behind before puberty hits.

Pain Tolerance
The second related idea is this: people who tell you (as a physician) that they have a high pain tolerance: probably do not. I’d say that 9/10 times that someone tells me “I have a high pain tolerance” it probably means a) I have a low pain tolerance and a moderate injury that most people wouldn’t need pain medication for or b) I’m a pain medicaion seeker/abuser/addict/salesman and I don’t really even have an injury. With that said I had been smuggly thinking in my own mind “I have a pretty high pain tolerance” though I would never say it outloud because of the above required translation.

I took only 6 of my opioid pain medications after my surgery on Monday. I was getting around petty well and felt I had recovered quickly enough that I was thinking I was pretty tough. Then I saw Kate yesterday and realized I’m closer to being a *sissy* then actually having a high pain tolerance.

She had a similar procedure surgery to my laprascopic appendectomy and took NO pain medication. She also was back to work 5 days after her surgery (which was yesterday for me and I was still moving pretty stiff). I do feel loads better today, bordering on normal at times, but I’m sure glad that I don’t have to go to work for another two days still. There’s always somone tougher then you. Being smug usually ends with you looking a fool.
Proverbs 14:22-24
22 Do not those who plot evil go astray?
But those who plan what is good find love and faithfulness.
23 All hard work brings a profit,
but mere talk leads only to poverty.
24 The wealth of the wise is their crown,
but the folly of fools yields folly.

Published in: on April 3, 2011 at 6:59 pm  Leave a Comment  

On The Other Side

I’m about 30 hours out from joining the legions of appendectomied people. For me the actual appendicitis wasn’t that terrible of an experience. Sunday afternoon had a vague feeling of abdominal discomfort. Largely right sided, though somewhat more around the belly button. (For anyone not medical reading this: my description of symptoms is basically directly out of a textbook for presentation of appendicitis.) We went walking around 3:30 PM and my babies bottom bouncing against my lower abdomen was sort of uncomfortable. I tend toward constipation so I was thinking constipation or gas pain.

As the evening wore on I developed increasing (right lower quadrant) RLQ pain. Around 9 PM I emptied my bladder which evoked a somewhat more significant but brief RLQ pain. I came out to the living room and was lying on the floor examining myself and telling Dorothy “I wonder if I have appendicitis” to which she responded “shut up”. I went back to playing at the computer and about 11 PM I took a shower and was starting to feel vaguely ill- like mild body aches. Dorothy has had a cold so I started hoping “please start getting a sore throat”. I was asleep for about 30 minutes when I was awakened to terrible nausea, significant chills, and somewhat increase RLQ pain. I still only rated the pain at 3/10 at the worst. The nausea is what sent me to the ED. That was terrible. I knew at that point what I had. I called up to St. Ben’s to make sure that we didn’t have a surgeon available (we didn’t) so I drove myself to St. Luke’s for evaluation.

What a strange, bordering on fun (if having appendicitis and eventually getting a few thousand $ bill can be called fun) experience being a patient. I had been to the ED once before for something minor, never for anything major. I have a vague memory of getting stitches in the ED at age 3. Early Monday morning about 1:45 AM: They got met settled in, IV placed, the Physicians Assistant came and evaluated me (listened to my heart and lungs through my gown). Labs drawn. Then I carried my IV bag to X-ray and had my first ever chest x-ray and abdominal flat plate. Lying on the X-ray table was very uncomfortable with appendicitis. It’s a very flat and hard table that they must chill to about 10 degrees. I gave a urine sample after that, which was tricky with a gown on and my IV bag slung over my shoulder. Then I saw the ED doc (also examined me through my gown). He was basically like “you’ve got appendicitis and the surgeon is on his way in”. Yup, I sorta thought the same thing. WBC was 10.5 (barely elevated), CRP was 2.9 (very elevated- a general marker of inflammation).

I also saw Garth, whom is my favorite Murse of all time (one of my favorite nurses over-all too, but that’s largely because he acts and sings and I saw him in a local show of Jekyll and Hyde and he killed it as the main role of Jekyll/Hyde- unfair advantage), in the ED. He gave me a shot of promethazine after the 2 shots of Zofran had not touched my nausea at all. I did not enjoy the promethazine. It made me very altered (keep in mind it’s now about 2-2:30 AM and I haven’t really slept). Drowsy but not exactly falling totally asleep. I was slurring my words and couldn’t think straight. I think next time I’ll just stick with the nausea. It was bugging me that I wasn’t clear headed enough to pray. I later wondered if they had given me some morphine or something too, though I don’t think so, I told them I wasn’t having much pain and didn’t need anything.

It dawned on me later that I was never afraid. I wasn’t just being tough or stoic. I knew what was wrong with me and I just simply wasn’t afraid. My personality is somewhat like that (see my post about bike racing- I had to quit doing that because I had become afraid) I don’t get nervous about much anymore, which definitely comes from surviving the experience of medical school and residency- it changes you. It also just never really felt life or death to me, I pretty much felt like it was going to turn out fine. I really never was that “sick”.

Sometime after the promethazine I saw Dr. Blair, who’s quite a young guy. He’s a very calm person, I liked him immediately. I could barely follow him because I was altered. They took me to the pre-op area, which I can’t remember well because of the promethazine kicking my butt. I had to stip down (I left my socks on) and pee in a urinal so I didn’t have to get a foley catheter. I peed all over the edges of my gown. I think I was having more pain at that point and being all altered from the promethazine, not being able to stand up straight from pain, and trying to pee in a urinal in front of people was pretty awkward. I could feel my pee from the bottom of my gown on my leg.

They wheeled me back to the OR and I vaguely was aware of the anesthesia person giving me something in my IV. I scooted over to the OR table and my next memory is about 3 hours later with a nurse asking me all these questions and me falling asleep. The nurses were turning over at 7 AM and the outgoing nurse was trying to get her work done before the next nurse came on. It was sort of comical. I’m pretty sure I asked “Is my appendix out” which is so classic- ahhh anesthesia. Then about 8:30 I really woke up. Another very strange feeling. I was really awake. I was feeling pretty comfortably tucked into a bed and knew where I was and was clear minded. No pain to speak of, no nausea. I hit the button and called the new nurse in because I felt I needed to pee. Jessica was my nurse for the rest of the day and she was very nice. Getting out of bed was awful. I’d rate it as the worst pain I’ve ever felt. What’s weird was the pain was now in the LLQ (left lower quadrant) where the biggest of the laparoscopy ports was. I imagine that pain is what it feels like to be stabbed. If the appendicitis pain was 3/10 this pain standing up was about 8. Peeing in a bed-side urinaral while a female nurse is 6 inches away was pretty weird. Trying to get the flow of urine started with 8/10 pain and a female nurse standing 6 inches away was not easy. I got about 600 cc and struggled my way back into bed. She gave me 2 mg morphine IV and two hydrocodone right after. I slept away much of the morning. I called various family members and eventually my wife and baby came to visit which was nice. Later I micturated an amazing 750 cc of urine!

I improved quickly through the morning. Getting out of the hospital bed was still a 6/10 pain struggle, but even walking or sitting up wasn’t that bad. I had solids for lunch and walked 150 feet in the hall without much trouble. I even danced a little jig for Jessica near the nurses station. Eventually I saw Dr. Blair and he discharged me home. I was home 13 hours after getting my appendix out.

I’m home now. I’m doing ok, still pretty painful moving around, but it’s a different kind of pain now, more like “man I worked out to hard” type of pain. I let myself go a little long without pain meds last night and had a weird response to the pain- shivering. Happened again in the middle of the night after I had slept soundly for 5-6 hours. Shivering for about 10-15 minutes until the pain medication kicked in. Very weird. At first I was getting a little spooked that I was having a sepsis response or something, but it definitely faded with my pain and it didn’t start until I tried getting out of bed in the middle of the night. It’s amazing how much you use your abdominal muscles. Even weird little things like passing gas or flushing the toilet uses a surprising amount of abdominal muscle.

I can’t say that I really learned much about how to be a better doctor or about how we can provide better health care at our hospital as a result of my experience. I’ll probably just have a bit more empathy going forward. I really feel for C-section patients more then before. The amount of pain I have from these little port sites, I can’t imagine the C-section incision- even more so because you want to get up and take care of your little baby. Less c-sections! Actually the one thing I think I’d like to see is a change to how we handle the call light at St. Bens. Every time I hit the call light someone (upwards of three different CNA’s and three different nurses) came in within 1 minute to see what I needed. At St. Ben’s the ward clerk hits the button to try to found out what the person needs- often the TV is blaring or there’s background noise, the person not talking loud enough, etc. I think a personal drop in by a CNA would be better patient care and patient’s would feel more responded to.

The worst part for me (besides the eventual bill) is not being able to play with Ruthie. I really can’t get down on the floor yet and I definitely don’t feel up to picking her up yet (she’s very squirmy). Just picking a shirt up off the floor is tough! I’m also sad about having to take several weeks off from Kung-fu. I was really starting to get into shape again. I imagine I’ll be able to practice some of the forms again in a few weeks, but I definitely won’t want to do anything aggressive for 6 weeks. That sucks.

Our first major medical situation as a family! I can’t thank my wife enough, I can’t imagine trying to get through stuff like this without her. Even just knowing that if I needed her to she would get me something without griping about it- that’s love.

Published in: on March 29, 2011 at 3:39 pm  Comments (1)  

Delayed Gratification

Being a doctor is almost certainly equal to being an expert on delayed gratification. You can’t do a minimum of 11 years of college, medical school and residency training for essentially no reward without a healthy sense of delayed gratification. So I guess I should rephrase that. During training to get where I am, one must have a healthy sense of delayed gratification.

I’m not sure how long that lasts once doctors actually get to the point where they are making the much awaited for salary. You often see them quickly get new cars, new houses, etc. I’ve always been a bit of a tight wad and not really into cars, so that sort of possession accumulation hasn’t been that much of an issue for me. Most specialist make 2-5 x what I make so maybe that’s who I’m thinking of. But I definitely feel my delayed gratification skills fading. For the first time in my life I usually have the money for what I want or need, which is a first. It makes you soft from a delayed gratification stand-point. Why this is relevant now is being a father (and really probably any parent for that matter) requires a healthy bit of delayed gratification. I mean, let’s face it, being the parent of a 2 month old is not exactly that “fun”.

There are moments of fun, my daughter is very social and alert about 1-1.5 hours per day. During that window she smiles at you, goos and coos, and it’s wonderful. Then that window closes and she will cry for an hour because she’s dying of tiredness but refuses to go to sleep. I would not trade my work for Dorothy’s work at this point. She spends much of her day calming, soothing and cooing to the baby when little Ruth not in the mood to do anything. So 23 hours a day the baby sleeps, feeds, cries and poops. Not exactly the “good life”. Dorothy actually does get some “fun” with some of the feedings and just watching her precious baby sleeping, but I’m not sure fathers are programmed that way.

My special “daddy bonding time” as designated by mommy is bath time. Bath time usually sounds somewhere between a siren going off and a hysterical hyena as my daughter bawls through the entire thing. Not exactly “fun”. I think my baby stinks a little bit because I find excuses to not give her a bath because 15 minutes of solid bawling is so un-fun for me. Being a parent requires a significant amount of patience. That’s not something I’ve usually been accused of having in abundance. When I try to get the baby asleep I frequently pass the baby off to Dorothy 5 minutes before she goes to sleep but at times I just don’t have that last 5 minutes in me. I also really think that the baby falls asleep for Dorothy better than me, though Doro doesn’t agree with that.

I’m looking forward to tea parties and taking my daughter out on errands when she can talk and tell me stories and play games. I’m looking forward to cuddling, playing basketball, looking at grasshoppers in the yard, playing catch, reading books, all that “fun” stuff. This part….is about patience and delayed gratification. I’ve been dusting off my delayed gratification but it’s tough, I thought I had put that behind me. Dorothy wants to do this how many more times?!?

Published in: on August 7, 2010 at 10:57 pm  Leave a Comment  

Adulthood

Being on the precipice of being a father has made me somewhat introspective. Dorothy was backing up some photos this week and ran across pictures from my bike accident. Looking at those pictures got me to thinking about the 3 years since my crash, the 1.5 years since I rode my bike and the 15 pounds I have gained since then.

March 2007: the start of what would be my last bike racing season. I was in an early season race in Seattle. Driving rain, cold, suffering, that was the order of the day. This was the season that I was going to graduate into Category 3 to a higher level of racing, but also a safer level of racing. I trained hard over the winter leading up to this, spending 4 hours on my bike every weekend day often watching movies in my basement in Boise because it was just too cold on the ground. I had spent a lot of time working the hills and I was my lightest weight since high school. I was ready. Forty miles into the race I’m, in fact, optimally positioned and going into the last .5 mile I was in the top 6-10 and as the final sprint is where I excel I was probably looking at a top 5+ easily.
We are now in the full sprint 100 yards from the finish, out of the saddle, 35+ MPH. Then… the guy in front of me lays his bike down.

Needless to say, in those wet conditions, in full sprint I hit the deck. I had been in very mild “skid-out” type crashes or “into the bushes” type crashes before, but nothing like this. I broke my helmet, tore up my bike, destroyed a racing jersey, separated my left AC joint, contused my ribs, and had a terrible amount of road rash. The pictures (for the strong of stomach) are below which show that since changing into my jeans (1-2 hours before) I bled through them from the one wound you can’t see in the pictures (on my left hip).

Dorothy was standing about 10 feet away when the crash occurred. She heard me cursing the pain and the other rider. There were about 5 others that hit the dirt. One of the other guys ended up with surgery to repair a tendon in his hand which was lacerated by the gears of another rider’s bike. A few other guys I knew came over and wanted me to sit down because I must have looked a mess and they were worried I was more hurt then I thought I was. Which later it turned out I was. On the way home I called the sports medicine fellow in my residency and she offered to call in some pain medication. I initially refused but about 15 minutes later when the pain started I called her back and requested some.

That was the worst pain I’ve had in my life. Showering when I got home was awful, trying to clean road rash like that on such a wide spread area of my body was excruciating. The worst pain though was my shoulder and ribs that first night when I awoke in the night and needed to use the restroom. I almost couldn’t get out of bed from the pain. It faded quickly over several days and I ended up only using about 10 of the pain pills. The damage was done though, I was racing bikes within 2 weeks but I was never the same. I was scared. You can’t be scared when you race bikes because to do well in the sprint you have to be willing to take risks. I finished out that season and had a few good results, but never had the fearlessness I had previously had. I remember one race in particular that we hit the last half mile, I was in the front, I was feeling strong and when the sprint started I just sat up because I got too afraid.

So I quit bike racing after that, but not because of the fear. Because I was about to graduate from residency, thinking about having a baby with my new wife, and knew that if I had been the guy with the lacerated tendon I wouldn’t be able to work to the full extent of my profession and I would lose money.

I think that had I trained biking over the next winter I would have been fine, from a fear stand-point, that next year. But this was the first time that I was forced to really face my mortality and I had to make the adult decision that a broken arm and loss of income probably wasn’t going to be worth the pleasure I got out of riding bikes. This is, however, part of what being an adult is. Besides maybe marrying Dorothy or going to medical school this was probably one of the first really adult decisions I ever made. I sacrificed what I wanted for what I needed to do to take care of my family. I foresee, of course, similar decisions to be made in the near term as we begin to raise our daughter.

Published in: on May 29, 2010 at 6:50 pm  Leave a Comment  

Fruit

I remembered this post idea I had awhile back after going to Rudy’s twice in a week. Rudy’s is the local cooking/wine shop and first we went the wine tasting “First Friday” even last friday and then cooking class this week. The class was taught by a fairly well known chef name John Ash. He knew Julia Childs (if you haven’t seen Julie and Julia yet go to netflix and move it to the top, best movie I’ve seen in awhile), had a show on the early Food Network, has award winning cook books, and a top restaurant in California and somehow teaching a class in Twin Falls to 30 Idahoins. We had a wonderful time and Rudy’s is a great place, good wine selection especially given our local, see more here: http://cooksparadise.com/

So anyway, being immersed in foodie/wine culture twice in a week made me remember the hazards of being a discriminating palate. Anyone that knows my mother knows that I was raised in a food/wine culture. A comment I made at the age of six or so was “My mother doesn’t cook she makes recipes”. Which at the time was basically an insult to my mother’s complicated cooking, but now as an adult the fact that the list of foods I don’t like is limited to like 2 things (which I can’t think of right now) speaks to the diversity of exposure in my youth. My mother can tell you about the time I ordered the $30 Pheasant (again probably age eight) meal at a restaurant because it said “half off any entree under age 12”. The margin on fresh caught pheasant is presumably fairly tight and the restaurant could not honor the previously stated arrangement for the pheasant. And no they had not every run into that problem before.

I also have a very good sense of smell. This delicate nose of mine can be quite a problem in my profession as we are frequently dealing with the smell of rotten butt abscesses or various other discharges of the nether regions which are unpleasant to the olfactory system of any person. With wine however it makes me quite astute as picking up subtleties that others perhaps don’t appreciate. I admit that my wife is somewhat better at brainstorming what she smells and we make a very good pair to taste wine. It’s the thing I miss the most about pre-pregnancy is drinking wine with my wife. The result of this wine enjoyment has been that I have built up a fairly impressive collection of expensive wine and I’ve tasted or drank some amazing wine as a result of this passion.

So I have a refined palate, broad food enjoyment potential and oenophelia. This however comes with it’s draw backs. The main drawback and the one that I’ll finish this small discussion is a degree of snootiness that borders on the wasteful or absurd. I originally thought of posting something about this when I found myself getting ready to throw away a piece of fruit at work. I don’t now remember the type of fruit, but the details were essentially this: the fruit was not spoiled, it did not taste bad, it was not bruised, it had no mold, is just simply was not very good. So I was going to throw it away.

I’m a little horrified at myself even now. I caught myself and finished eating the fruit as I should have in the first place. But the simple fact was that for a brief second I knew I had had better fruit before and I was not interested in finishing that piece of fruit despite being hungry and globally needing more fruit in the diet. This is my concern. It’s easy to do this with wine also. Have a few sips of less than delicious wine at a party and think “I’m not drinking freaking Merlot” (Sideways reference…if you haven’t seen that go and put that at #2 on Netflix), despite the fact that you are having fun at the party and the wine does not have poison in it.

It’s the rich stockbroker forgetting that they came from poverty and not associating with “common folk” anymore. Similar idea. In fact it was after that fruit incident that I decided I would use my wife’s pregnancy as an opportunity to revisit cheap wine (I went through a stretch where the average price of wine I was drinking was around $30!) and do what I did when I first really got into wine.

My wine turning point for me was an expensive bottle of wine ($60) I bought at the Co-op in Boise, which my mother still talks about to this day. I decided to splurge for my own birthday and on 5/26/2006 we drank a bottle of 2001 Elderton Shiraz, which had received like 96-98 points from one of the wine magazines. This wine was amazing, the quote of the night was “this is the best shiraz I have every had” –Susan Kern. I liked wine before that, but not like this. It totally changed my view on what was possible with taste. We had an amazing meal and it was after that that I really, really started getting into wine. I started buying about one good bottle per month to save away (which I’m still basically doing) and drinking a lot of cheaper wines to learn about the various tastes, sites, smells, etc. Overtime as I had more money available I stopped drinking as much of the cheap stuff. After the fruit incident and after my wife became pregnant however I have been going back to the $7.50-10 price range to re-hone my palate and prepare myself for enjoying wine again.

So it’s important to remember what not so good wine and not so good fruit tastes like so when the really amazing stuff comes along we appreciate it even more. I think this has broader applications in life, but I’ll leave it to you to decide on that since this post has already gotten pretty long…

Published in: on May 14, 2010 at 1:22 am  Leave a Comment  

A Tale of Two Disabilities

If it wasn’t clear to me that disability is a state of mind, it has become so over the last month. I have two patients with bad disease, but the wide difference between them has been weighing on me. Both are about the same age and both have what some might argue are self-inflicted disease.

One is applying for disability essentially because he is so obese that he cannot work. It is hard for him to get out of the house. We- the state tax payers- already pay for his medical bills because of his poverty. We sent him for evaluation for gastric bypass, but he was too heavy, needing to lose ~15 pounds to show that he was mentally ready for such a drastic change in his life. He has since gained weight and I have since filled out some paperwork related to his new disability claim. A lawyer out of Utah that specializes in “Bariatric Law” is helping him.

The second patient is a lifetime smoker. Until recently he has smoked upwards of 3 packs per day. He now has terrible lung disease at a premature age as a result. He has been in my office with an O2 saturation of 75%….having just come from work. This is a guy that continues to work despite the fact that he cannot wear his oxygen while at work. His lung disease is so bad that it is giving him heart failure. His 5 year survival rate is around 30%. All this guy wants to do is work. It would not take him a lawyer to get on disability; it would take quitting his job. That’s all, he already qualifies for disability, but he does not want to quit his job. We- the state tax payers- now pay his medical bills, but he previously was paying for office visits out of his own pockets and continuing to work. Last time I had him in the hospital he wanted to leave before I thought he was ready because he didn’t want to take any more time off work. This is not a bikini model sun tan lotion applier kind of a job. This is a factory job, on a line.

Self inflicted disease? Perhaps. Totally different world views? Clearly. The problem for me is the emotional reaction each of these patient’s evokes in me. I probably don’t really even need to spell it out, because I suspect most people would feel the same way. Many would be quick to point out that it is very hard to weigh over 400 pounds, the strain on his body and joints is immense and he probably really can’t work. Which is probably true, but the other patient is literally killing himself to work (wearing his oxygen all the time would basically help halt the heart damage and help him live longer and healthier).

Regardless of what anyone might feel about these patients, the obviously underlying message is that disability is a state of mind. Two patients with disease which results directly from a combination of addiction and bad genetics (not everyone that smokes gets lung disease and not everyone that over-eats gets to be 400 pounds), but one has whatever feature of personality that lets him continue to work and the other is perfectly content to let us pay for his 3500 calories per day just to maintain that weight lying in bed all day. Oops that sounded like judgementalism. I need a cigarette

Published in: on April 13, 2010 at 7:02 pm  Comments (5)  

The Drawbacks

I went out for beers last night with a buddy of mine who’s a physician in Twin Falls, the neighboring larger town with the referral hospital.  Doing that and the conversation that we had led me to think this morning about the two worst things about my job (for me in particular).  Number 1 is I often feel like I can’t drink alcohol.  Number 2 is managing chronic pain.  I’ll elaborate briefly though, these don’t require much more than that.

Not drinking alcohol. This isn’t that huge of a problem I guess.  I gave up my brief stint of drinking regularly to excess quite some time ago.  In the meantime however I do very much enjoy a hoppy beer or a glass of wine. I often feel like I’m limited in my ability to do that however because of the nature of my job.  Even last night I met my friend for a beer about 6 hours after finishing a C-section.  The patient’s doing fine, she didn’t need my attention, but the possibility of something going wrong still exists and after two beers I would then have to dump this problem on the doctor on-call.  More commonly I feel the weight of my next OB patient’s looming due day on my consciousness.  I think “She could go into labor anytime, I’d hate to miss her delivery just for a glass of beer.”  Which is both for the financial impact of missing a delivery, but that’s also my favorite part of the job.  So what I’ve been doing is if I have a patient coming due, I generally will only have a glass of wine on Friday nights which is the night that I turn my work phone off and sign out.  But “women coming due” can be a fairly long time period and if you have 2 within a month’s time, it at times doesn’t leave me much window.  At the end of the day, it’s not really about actually having the drink because I might not drink much more then I do anyway, but it’s about the lack of control over my time and my lifestyle.   If I weren’t a physician I’d probably have a small glass of wine every night for the health benefits.  I still collect wine and will continue to do so, I just have to pick my times to actually imbibe them. 

Number 2 is a huge problem in this country.  Upwards of 20% of people in this country have used prescription pain medications for “non-medical” reasons.  Upwards of 9.5% of 12th graders in this country reported using Vicodin without a prescription in the last year.  It has gotten to the point that it’s often hard to tell the real chronic pain patient that is responsible from those selling/abusing them.  The street value of narcotics (last I did research into this)  is around $1 per milligram of drug and it’s not uncommon for a pain patient to get in the neighborhood of 1800 mg per month!  That’s not even on the high end, that’s pretty typical.  So if your doctor ever seems reluctant to give you prescription pain medications, that’s why.  I have a policy of not writing narcotic pain prescriptions for new patients.  That cuts down on the drugs seekers quickly because word gets out.  Some doctors pass them out like candy, why come to me if there is someone else that the “pill popper” community knows will probably give you some, but I do still get a patient that comes in and first visit needs a refill of their $2000 street value of prescription pain pills.  That conversation often goes poorly.  It’s sucky.

Published in: on March 23, 2010 at 1:38 pm  Comments (1)