Thursday, May 22, 2008

A Most Extraordinary Day

I have a project today. My project is to show you all how running takes what may seem like an ordinary day and transforms it into an extraordinary one. And since I know how you all enjoy my race report narrative, I’m going to take you through this journey as if we’re running in a race, which for all intents and purposes, wouldn’t be that far away from the truth. So grab your numbers, race chip, gel packs and running shades, ‘cause we’re going for a run…

[Mile 1 – 10:30AM] “Any questions from the audience?” I asked, wrapping up my talk for the crowd of intensivists. Judging from the clock in the back of the small auditorium, I knew I had done well to finish ahead of time to allow ample opportunity for fielding questions. As I sipped the last remaining gulp of water from the cup situated next to the podium, I looked around the room to see a bunch of uncertain eyes and quizzical faces staring back at me. Have I completely baffled them with my intricate description of the vitamin D pathway or were they just waiting for the mandatory 10 seconds before sinking me with their criticisms? Finally a hand shoots up from the back and the head of the department speaks, “Fine talk doctor. I’m interested to hear your perspective…”

[Mile 2 – 11:15 AM] “Listen doc, your patient is here without an appointment. Mom says they’re here for a special test, but they don’t know what.” “Tell him not to move, I’ll be right there. Thanks.” I tell the nurse and hang up the phone. On the one hand, I’m extremely upset because he had a missed appointment with me yesterday where I had planned to examine the child and explain everything to mom. Instead, now he shows up unannounced when I was not ready to see him. Still, I was glad he was here because he had a relatively serious medical condition, called CAH or congenital adrenal hyperplasia, which causes his body to make excess testosterone resulting in his going into puberty prematurely. Any delay in the treatment of the disease would not only push him further into puberty, but also compromise his final adult height. My job was to explain all this to mom, and have her consent for a hormone stimulation test which would establish the diagnosis. It was a monumental task not having met the patient or mom before, but one that I must do in order to help this child. I push aside my annoyance with her timing and press on to the task at hand.

[Mile 3 -12:30 PM] I’m having lunch with my longtime friend and previous running mentor. He chides me about my recent running successes. “So how fast do you think you can run a mile?” He asked. “I don’t know, I’ve never tried. Maybe a 5:50 or so…” I answer, somewhat sheepishly. “I think you’d do a 5:30; maybe even a 5:15…” “I think you’re crazy.” “Have you ever thought about a triathlon?” “I’ve thought about it, but I can’t swim. I mean I can swim, but I can’t float…which means that I could possibly die in the middle of the ocean. So I can’t swim.” “Of course you can, you don’t need to float in order to swim.” Really?

[Mile 4 – 1:30 PM] I’m back on the hospital ward, rounding on the inpatients who are under my care. In one bed I have a 15 day old baby girl who has DiGeorge syndrome and is struggling to keep her calcium in the normal range despite the supplementations we’ve given her. In the bed next to her, there is a 10 year old type 1 diabetic who got admitted for DKA for the 4th time in the past 6 months. I’ve seen them both earlier in the morning so was quite familiar with their current medical condition. A medical student looks at her notes, looks at me, and starts to present. “On bed 1 is a 15 day old with DiGeorge…” “Wait, wait, wait.” I interrupted. “What is the baby’s name?” She ruffles her notes. “Uuhhh…I…uh…don’t…know…” “She’s been here for 3 days and you don’t even know her name?” I close her notebook for her. “Please get her name, read the chart, and come back to me when you can tell me her whole story without these papers. Remember, these are people we’re treating, not textbook cases, and each of them has a story to tell. It’d be worth your while to learn them.”

[Mile 5 – 3 PM] “I think we should report this mother to the Agency for Child Services and file a grievance for medical neglect,” the social worker says before she’s even halfway into my office. “I think this child is going down the tubes and mom’s not taking care of her.” “Hold on. I think we need to give the mom the benefit of the doubt here. She’s been here for less than 24 hours. We don’t even have some of the labs back yet. Let’s see what we’ve got before we jump the gun.” We’re discussing the fate of the 10 year old diabetic girl who’s treating the hospital like it’s a revolving door. “Besides, you really think this girl will be better off in foster care than with her own mother?” “That’s really not for us to decide. Our job is to report neglect when we suspect it for the safety of the child. What happens after isn’t really up to us.” “I understand, but is mom really neglecting? Let’s wait at least a couple more days before we decide to break up the family.” She leaves, not satisfied. I’m staring at my patient’s chart laid out in front of me while trying to decide if my moral compass is pointing me in the right direction.

[Mile 6 – 4:30 PM] The commute home took less time than I expected, which is a rarity. What’s even better is that sometime during my journey home, the rain had stopped and given way to a sliver of sunlight. I’m sitting in front of my computer staring at the plan for my interval workout. I can hardly believe my eyes. Apparently, my string of recent PRs means my old training paces are no longer adequate for me. What was once 3XM@6:14 pace, has now been replaced by 3XM@6:04 pace. Similar, a casual tempo run of 4M at 6:40 pace has suddenly turned into a hard 8M at 6:39 pace. Sonnafa… This is one consequence of running fast that I am not a big fan..

[Mile 7 – 6 PM] I did it, I did it…it wasn’t pretty but I did it. The road was wet, the pacing was poor, but I completed my three 1-mile intervals. Splits of 5:43, 5:52, and 6:01 clip are so much harder and faster than of my previous workouts that I really wanted to keel over in the middle of every mile and pass out. Still, I was excited that I was able to step up my game and run faster than I’d ever had before. At the end, after limping to the finish on my last lap, I wonder if these extra fast efforts would translate to any real effect in my next race.

[Mile 8 – 7 PM] I head over to the park for another Flyer group run. Maybe because of the bad weather, or maybe because people haven’t yet recovered from the grueling race over the weekend, there were only 6 of us who came out for the race. I aligned myself next to our group leader who I found out suffers from a disease that I have some expertise in. Through the next 6 miles, he shares his story with me as I try to offer my best medical advice to him. Although our pace was the slowest of the group and a couple of people had already left by the time we finished our run, I had a fascinating time talking and learning about medicine from his perspective. It was such an enlightening experience that the running almost became secondary. Afterwards, I was just so happy that I was able to bring together my two biggest passions for the benefit of another that I went completely home before I realized that I hadn’t yet had dinner.

All in all, it was the perfect ending to a most extraordinary day!


Xenia said...

Wow. Even though you do one of the most difficult jobs in the world, I envy you the sense of satisfaction and completion you can get from a day's work. Quite humbling, really. Thanks.

sRod said...

Thanks for sharing your day. After seeing what you deal with ona daily basis my job doesn't look so bad.

jb24 said...

Thanks for listening yesterday during our group run. It was a great help talking to you. Even though we were at the back of the pack, we still ran an 8:25 pace (wow!) See you soon and glad to hear that you joined our Need for Speed team.

Non-Runner Nancy said...

All right already. I'm grumpy and crabby and my day is sucking. I will go for a run. Thanks, Lam.

Jamie said...

Wow! What a day. I really don't have much room to complain anymore about my job :)

Reid said...

This was really a great post. Thanks for sharing.

So, do you want to race to the 5-minute mile mark?? That's my current project. Really tough, but progress is incredibly rewarding.

Run For Life said...

Sounds like a fantastic day!

Betsy said...

As a parent, I have to say how much I appreciate your attitude towards your patients. It's a kid, not a diagnosis.

Brian Hawkinson said...

I really liked this post and will certainly read more in the future.

When I first looked at your blog I started readng your races in 2008 and all I kept seeing was PR PR PR... Must be nice.

Anyway, happy running!

bill carter said...

Hi Lam

This was absolutely bar none one of the most fascinating posts I have ever read. You have a gift my friend... actually a few gifts. I, like you, try and empathize with patients, parents, caregivers etc. and realize that things aren't always as cut and dry as they might seem. I worked my first 8 years at Henry Ford Hospital in downtown Detroit and saw things I never could have imagined coming right out of school. But it gave me a perspective to treat EVERY patient the best I can and not waver from that standard. We are all just people in this world trying to do the best we can and whether or not we achieve that... well who am I to judge... or anyone else for that matter.

Thanks for your humanity Lam and I don't mind saying it... DAMN YOUR GETTING FAST!!!

aham23 said...

great "life report."

some of the life splits beg for a follow up.


Anonymous said...

I am glad there are doctors who take the time to teach the residents and fellows about patient care. I am sure all your patients and their families appreciate the quality of care you provide.

Will said...

Sir, you have a great job, and an even better hobby as a runner. Don't let your job overwhelm your hobby, it will be damaging to your profession over the long term. Keep on blogging!

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