Tuesday, December 30, 2014

Just Hold On

I see the world through doctor-colored glasses. Tragedy rules the day, and then I go home and run with my dog. As a medical student I once watched several surgical removals of acoustic neuromas. For a long while after that, this was my number one concern for anyone who presented with ringing in the ears. It was also around this time that I palpated my children's abdomens for Wilms' tumors while they took their baths. But this post is not about cancerous growths. And it has been a very long time since I have been allowed to palpate my children's tummies, or saw the world through acoustic neuroma glasses. That is one freaking long surgery, by the way.

I see the world through doctor-colored glasses. You may see the drunk on the corner and just make a wide berth, but I see his shrunken liver, gasping for its very last breath. And those kids on the plaza, smoking weed and in dire need of a bath are not just incredibly annoying, they are likely getting more than they bargained for in their weed. Plus the other drugs that they do on purpose. Like ecstasy, which is mostly methamphetamine these days. All those rotted teeth and pock-marked faces on Broadway, they are the site of civil war. People against their own best interest. People who are seduced by escape only to find themselves in the worst kind of jail they could ever imagine. It starts with getting high, it ends with just trying to not withdraw.

I see the world through doctor-colored glasses. I know the track marks that hide under those hoodies and the deep abscesses that have made my medical students turn green with their nausea of their not-yet-jaded humanity. My nausea center has been dulled. Ah, yes, another limb lost, another putrid smelling muscle with infection to the bone. Heroin must be pretty sweet to suffer the nightmarish pus balls that cling onto your heart valves, where your very life-blood pumps by and flows into your arteries and veins and sends satellites of death to every inch of your body, brain to toes. Can you blame those bacteria? They too need to live, and drug addicts are just so nice to provide a cozy and welcoming home.

I see the world through doctor-colored glasses. When I run, I know the power of my heart and my muscles and the clarity of my mind and the way the endorphins make me feel. Maybe without running, I would look elsewhere for those endorphins. Maybe in a bottle or a needle or a joint or some powdery shit I would sniff right up my tender nose without shame. Or maybe I would have shame, but not enough to keep me from stealing things from people I love just to get more of that feeling. If I had shame I would hide it in my complaints about how the world is so hard and it has caused me so much pain that my only choice is to hurt myself. Anyone I hurt around me? Well, in times of war, there has to be collateral damage.

I see the world through doctor-colored glasses. I have seen people saw off parts of their bodies while under the veil of drug psychosis. Good parts, like legs and penises. I have watched people smoke cigarettes through their tracheostomy. I have treated people for burns induced by smoking next to their oxygen tank. I have had people swear at me for denying them more cigarettes, more drugs, more alcohol, as if I took an oath to pull a pin out of a grenade and hand it to my patient just because they think it would be a good idea to cradle a grenade in their precious hands and watch themselves explode.

I see the world through doctor-colored glasses. Which means sometimes that I lose hope. It means, also, that sometimes I see miracles and sit back amazed once again at the machine called human being. It means that I studied hard to put people right even when they insist on fucking themselves right back up.

My doctor-colored glasses hold no super powers, as it turns out. I mean, I can diagnose your acoustic neuroma for sure. And I am as about as nerdy as they come. But it has not saved me from the deepest sadness I have ever known. One of these days, I may need to call one of my dear colleagues to treat my very own child, almost a man actually now, who has decided to walk down the favorite path of destruction of this ironically gorgeous, generous, life-affirming town of ours.

Doctors like to say: prepare for the worst, hope for the best.
Some days, all I can do is breathe, and that barely, for the paralysis of grief that possesses me.
Some days, I just reach for what is good in my life, and hold on.
I just hold on.

Sunday, December 21, 2014

Solstice. Or: The End of the World as We Know It.

I feel fine.

Even though the earth is sooooooo far away from the sun. It does this every year and it means tomorrow my sunlight quota will be just a tad larger.

I am a little tired of rain. I am thankful for it too, and feel guilty to be tired of it. It is just that my running shoes are so very wet. And my dog gets so muddy. And it is hard sometimes to even get out the door. For a run, or for anything. I could easily lay abed all day long, sipping coffee, reading, listening to the rain on my roof. It turns out work is kind of important though. To me, and my family.

If my husband's book sells enough, maybe I can follow my dream of doing medicine for those with the greatest need, without depending on pay. Also, I could probably lay in bed more, play more piano, run more and cook a decent meal every single night.

Today, I ran with oldest daughter and it was eerie. She thought it was kind of like running on clouds. I felt like I was looking at the edge of the earth. Like the earth had an end that you could dive off of and just fall into an infinite abyss.

Marsh, Dec 21, 2014

What would it feel like to face the end of the world?
Would it be like one of your children in danger, on a path of self-destruction?
Would it be like a mountain lion staring you down on a path, when you least expect it?
Would it be like falling asleep?

Marsh, Dec 21, 2014

It is a good thing we have markets. In the old days, I imagine the whole winter solstice thing was pretty grim. Will we starve? Probably. Let's have some kind of celebration and try to ward off that whole depressing prospect. 

Mother Nature is the bomb. Isn't she?

Marsh, Dec 21, 2014

The smell of pine tree in one's home reminds you that things live, even in the winter. Of course, in California this is sort of a given. There is not the deep freeze to make you feel like you were never actually warm for one day in your entire life. In California, the winter months actually might be the most alive of all. Rain brings green and it quenches a thirsty state of denial. I like to avoid puddles when I first start my runs, but once I realize the futility, I just plough through those guys, mud splatters be damned. A hot bath after such exercise is one of my favorite things.

Marsh, Dec 21, 2014

I will miss Stephen Colbert's Report. I will miss the current AHS XC Team. I will miss being a year younger. Goodbye to the potential of 2014. Impermanence. Blah blah blah.

Still, it rains. The children grow and the old people forget. The country takes two steps forward, five back and then scratches its proverbial head and laces up its sneakers for another go-round. Every year that passes, a sub-3 marathon becomes less probable. Still, it rains, and I run and tomorrow will be a longer day and a shorter night. 

It is not bad. And I feel fine.

Thursday, November 27, 2014


For the

sound the ocean makes, and the way the sky and the dog is reflected in the wet sand after the waves break, making a downward dog doppelgänger who also enjoys chasing large flocks of shore birds.

imperfectly good health that grants me a daily run, if I make the time.

fact that even when life is too much, the chickens still require release from their shelter not long after sun-up.

three teenagers who are flying from my nest, one by one.

piano that once was the Leithold's. They owned the music store in my home town. It was middle aged when I was a teenager, and now I am middle aged and my piano is old and wise enough to play Brahms.

22 years plus with my best friend, who knows the words to every important song, and knows word-crafting like Ollivander knows wands.

memory of my parents.

one certain redwood on trail 10 that is my touchstone.

friends, silver and gold. Which totally makes sense if you ever spent a summer at Camp Ehawee.

fact that I do not have to spend every day worrying about Ebola, malaria, my next glass of clean water and what the heck that huge insect is crawling up the wall by my bed.

work I do, which is interesting, pretty useful, and gives back to me more spiritual mojo than you can shake a stick at.

endorphins. If everyone on earth just ran a lot, we would not have any drug addicts. We might, however, run out of deodorant and spandex.

smell of my dog's feet. Seriously, it is like cinnamon and nutmeg and pine needles. I know this because he often shoves them directly into my face when I am trying to sleep.

ability to live on the coast. Despite my midwestern beginnings, I seem to need the ocean really close by.

fact that it is now seasonally correct to listen to The Messiah. Over and over. Till your family starts making jokes about how much we like sheep (see below).

smell of the top of my children's heads.

quotes of William Osler.

books, music, movies, art, food, drink, travel I will experience, with no end in sight. Unless my plane crashes. In which case, I told you so! You know who you are, all those who quote me facts about the safety of air travel every second of the day.

metro card.

terrifying and beautiful and awful and inane nature of being human.

exhilarating feeling of knowing you are going to totally kick ass in this race (Go Tigers!).

heck of it.

Monday, November 10, 2014

If Music

"If music be the food of love, play on."-Twelfth Night, Shakespeare

I am a musician. More a musician than a runner. More a musician than a doctor. More a musician than a person soon to get a root canal.

I left music professionally to be a doctor and I wish I could be a professional runner, but the sub 5 minute mile eludes me, so, here I am. But music, it never stops feeding my soul. I play it, I listen to it. And I listen to it while I run.

I am thinking about bringing my headphones and music to listen to during my root canal. There is some vague science to support this. What is an optimal root canal play list? Please, let me know your thoughts on this.

Running playlists, they are very personal, I think. I recall the days of carrying a walkman while running. Now why they did not name this the "runman" I do not know. And why it has to be a man, not a person or a woman or an ambulator not otherwise specified, well, this is mysterious to me. What I can say is they were cumbersome and often skipped if you ran over a bump. The fact that I can turn on my playlist on my iPhone and just run for miles and miles without a glitch is a gosh darn miracle!

My running playlists vary. Some days I truly do not want any music at all. Or books, because the other thing I enjoy is audible.com which is the iPhone version of books on tape. This is nice for a 3 hour long run. Advertisements show Ryan Hall listening to the Odyssey on his long runs, but let's face it: Ryan Hall is so fast that the Odyssey would still be in the introduction and he would already be showering and eating his pancakes.

I do not listen to music when running with my dog, Miles. I like to be in tune to what he is needing and to talk to him along the way. Like, "Hey buddy! Almost home!" or "Boy, you sure showed those seagulls", or "C'Mon Miles, this hill is nothing. We OWN this hill. You are king of the hill, my friend."

Usually, he just looks at me quizzically. He is not disturbed by hills. And he does enjoy torturing the beach birds. Sometimes he does fall behind, usually at the end of a long run. But if a cute labrador retriever comes running by, he suddenly is Mr. Speed and Strength. I know when he is F.O.S. but I never call him on it. I love him so.

Before track meets as a high school kid, I liked this song. When I hear this song, I still automatically recall the smell of Icy-Hot. And that feeling of anticipation before a 1600 meter run on a track, where there was nowhere to hide.

I have running playlists dating back a few years now, to when such a thing was first possible for me, device-wise. I have been strongly influenced by my friend Martha and my daughter Vera. And her friends, on the road during the Portland to Coast high school challenge. Each of them would request a song to hear blasting as we drove by them, maybe at 2am, maybe in the middle of a hot, sunny day. I have been influenced by a musical education, alas a degree in music as it turns out. I have been influenced by my brother and my husband and my checking out what the great runners of today listen to. I turns out I am often shocked by the language in the songs the great runners of today listen to, but they are usually in their 20's and I am…..not.

Sometimes the music takes away the pain. It is an interesting thing, as a scientist of the physiological being, to consider that there is power in something so benign as music. Maybe the greatest marathoners could've broken 2 hours by now if they could've run with music.

Run. Play music. Listen to music. This is my ideal job description. Is anyone hiring? Hellllooooo out there?????

Here's a great one. A helluva great one.

Sunday, November 2, 2014

Day of the Dead, Day of the Alive

"The reports of my death have been greatly exaggerated".
-Mark Twain

The whale on the beach where I ran last night was most certainly dead. In fact, its skull stared me in the face, but parts of its flesh still clinged to its body. A flipper and some vertebrae were present. Down a bit further, some more of said whale. Certainly more existed elsewhere, perhaps washed up on some other beach for some other runner to stumble upon. Miles, a poodle through and through, was skeptical and a little disgusted. I, a nerd and a philosopher through and through, was intrigued.

Whale, Nov 1, 2014

I have observed death several times. Mostly in patients: I have been present for many deaths and pronounced many others. I am a good doctor, really. But people die, and I want to be there for them in that moment too, so, there it is. I have seen the gruesome, the serene, and the personal. Watched my Dad die, and he seriously cracked a joke as his final words. My Mom? I sat vigil for days, but she waited till everyone went down to the stupid hospital cafeteria. She, apparently, was not interested in spectators. Death is mystical, physical, inevitable, sad and not all that pretty. It is almost impossible, in my experience, to make peoples eyes close after they die. Death on television is much cleaner.

I used to read this book to my kids about Day of the Dead. We have often celebrated it, in the blunted American sense. Our departed are not found in local graves, and my sense of mysticism has not been adopted by my children. But somewhere in their brains is planted this idea about death as a part of the journey, and the departed as part of us all.

The Mission District, San Francisco, November

Until we die though, I think we should live. I have 3 teenagers, and they are very set in their ways. If they would believe a thing I said, I would want them to believe this:

Life is full of beauty. Notice it. 

I ran in the woods this evening, with my dog. We set the clocks back last night, and the sunset came hard and fast at 5:30pm. So Miles and I, we ran in the dusk. I breathed the crisp air of fall, and reveled in the soft redwood carpet below me. Miles hung close to me, and we were solidly planted in the moment. Once my phone rang: the hospital, about a patient. I breathed, and responded. Miles cocked his head at me, wondering when we would resume running. But even he was not bothered. 

How can one be bothered, under the canopy of a redwood forest, on a fall evening, with the crisp air caressing skin and the clean air of the north coast filling the lungs? 

Please, please, when I die: visit my grave with marigolds and sweet pan de muertos. 

Until then, notice the beating of your heart and how it bids you to be alive. Yeats says it best:

      WHEN you are old and gray and full of sleep,
    And nodding by the fire, take down this book,
    And slowly read, and dream of the soft look
    Your eyes had once, and of their shadows deep;
    How many loved your moments of glad grace,
    And loved your beauty with love false or true,
    But one man loved the pilgrim soul in you,
    And loved the sorrows of your changing face;
    And bending down beside the glowing bars,
    Murmur, a little sadly, how Love fled
    And paced upon the mountains overhead
    And hid his face among a crowd of stars.


Wednesday, October 22, 2014

Horowitz, 26.2 and Palliative Care

One evening when I was 5 years old, I was thumbing through my parent's records. After passing by Peter, Paul and Mary and the soundtrack to West Side Story (which I loved, I used to do reenactments of the entire musical for my probably bored-to-death mother in our living room), I came across this album with a a candelabra and a piano and Beethoven. It was Vladimir Horowitz, who, truth be told, is not the world's best Beethoven player by a long shot, but it stopped me from further seeking and I took that LP out of the cardboard cover and placed it on my parent's record player.

Now let me explain for a minute. A record is this thing that we used to use to listen to music. It is round, and has grooves in it and the needle of the record player contacts the grooves and magically produces music. Records look like this.

So anyway, it was a winter evening when I found this Horowitz album. It was dark outside. We had a very small house but the rest of my family was doing their own thing. My Dad was probably at a meeting. My Mom was watching TV after a very long day at work. My sister was probably at work or in our shared room listening to ELO or the Beach Boys. My brother was probably in his room plotting his next terrorist attack on me. I put this album on and laid on the couch which my parents had for approximately one thousand years, and I closed my eyes, and I listened to Vladimir Horowitz play the Moonlight Sonata by Ludwig Van Beethoven and I decided, then and there, that I was going to do that too.

This is a true story.

My husband wrote this song once with the lines: "when I was born I was gifted, now I'm just about average. So somewhere I drifted…"

Fast forward seven hundred years to the present time. Parents: dead. Sister and brother still tolerate me. Brother no longer with terrorist tendencies toward me. I am a music major gone astray, now a medical doctor and a mother of teenagers who don't know Horowitz from their very cute behinds.

I spend my days now largely caring for people either at the end of their lives or at the frail end of the aging spectrum. I ran this marathon last weekend, and at the awards, there were not one, but TWO guys in the 85-89 age group. They ran the half marathon. They are not frail, though they are aged.

What is frailty? Scientists really cannot come to an exact consensus on this. You can measure grip strength. You can do the "get up and go" test (how easy is it for you to get out of a chair and start walking). Usually it is more vague. Frequent falls. A lot of trips to the ER or hospital. Choking on food.  Episodes of forgetfulness. Your kids or loved ones start to wonder if you can manage anymore, and if you need to be "placed" somewhere to keep you safe.

Vladimir Horowitz did his last concert at age 86. This was in Moscow, and was the first time he went back to Russia since his exile 61 years prior. He reported continued stage fright even at 86, puking prior to performances. I find this oddly reassuring. He also owned over 600 bow ties.

My friend and colleague Dr. Michael Fratkin is doing some interesting work. People, it turns out, are more than their disease, more than their age, more than their cancer stage, more than their frailty index, more than their fall risk, more than their ability to run half marathons or do internationally televised performances at age 86. I think Michael's work is worth supporting. He is touching on something vital and true, and though I am a boot-straps-pulling midwesterner at heart, I can see that palliative medicine is what we all need: even if at the prime of our health. It is about health in the context of being a real, live human being, whether you are about to fall and break your hip, or on your way to radiation therapy for recurrent cancer. Cure may be sexy, but palliation is the very core of healing.  What does it mean to be mortal? And what is it you plan to do with your one precious life?

I ran my 6th marathon in 6 years this past Sunday. I am a Master (aka "older American"). I am not as fast as I used to be. I am not as sore as I was for the prior 6 marathons. In fact, after one day post 26.2 miles of dreading stairs, I am not sore at all. This makes no sense whatsoever. I can only think the following:
This run was palliation for what ails me.
I am meant to run, until I can no longer run, at which point I will call Dr Fratkin.

My next goal is to tap into my 5 year old self. The one that snuggled into the well worn couch of my Mom and Dad, and listened to a miraculous bow-tied gentleman play Beethoven, and knew this was my calling.

I do love Beethoven.

Sunday, October 12, 2014


"…so lift me up, increase my buoyancy. I'm still not floating, please, attach more nothing to me."
-Atthys Gage, "Surface"

I was reading through the medical records of a patient and came across this diagnosis in their chart:
Weightlessness. It turns out there is an ICD-9 code for this, specifically E928.0. This is not to be confused with E485, which is "an accident involving a spacecraft".  Neither of these is billable, incidentally. And in the case of this patient, I suspect it was the transcriptionist's mishearing of weight loss. Because if someone is weightless in a forest, do they really need a doctor?

For the last 19+ years, I have been either in training or in practice as a doctor. It starts, for most of us, as a naive wish to help, with no serious strings attached, nothing weighing us down. Most in this profession will give up something, or many things: time with family for sure, other passions and pursuits, often one's own health. Still, a good job: you get to be useful, and you will eventually usually get paid reasonably well.

As with most things in life, what was once carefree becomes slowly laden with the stuff that sticks to you, irritatingly increasing your friction and slowing down your cheerful ride. Like Katamari.
If a doctor was a Katamari ball, they would be covered in: MCATs, mean Attendings, grumpy senior residents, expensive licensing exams, soul-sucking debt, grief over all the sad stuff they see, PTSD from that noise that pagers make, one step away from madness from one-too-many middle of the night awakenings, and bewilderment at why, when they are generally just trying to help people, they are so often the target of people's anger and desire for more. Doctors are now on Craig's list alongside the guy who unplugs your toilet.

I have great respect for plumbers, let's get that straight.

Doctors can do some cool stuff that everyone admires, like my surgeon friend who fixed up the surfer who got munched on by a shark, or the times we pick up a diagnosis that was elusive, or when someone gets saved from the almost certain death of ebola. But a lot of times, what doctors do is create a space where someone can get hurt as little as possible while their own body does the work of healing. And truly, a lot of the real work is done by nurses. One of whom is now dealing with her own case of ebola after caring for the man in Texas.

Lately there have been some serious discussions though about what we cannot do. For instance, we cannot keep people from getting frail as they age. We cannot change the fact that the death rate for all humans remains at 100%.

As the parent of teenagers, one thinks a lot about what the point of life is. This is for two reasons:
1) You want to be some kind of advisor for these people who are about to step out of your nest.
2) You find yourself with less life ahead of you than behind you.

As the parent of teenagers, a hospice doctor and the medical director of a clinic for the frail elder, I think way too much about what the point of life is. I sometimes feel like I am trapped inside that Rodin sculpture, with my eyes darting back and forth while people admire me: wow, she's a thinker!

Advice to the offspring, to myself and for those that feel like they are a Katamari ball or trapped within a ripped, iron thinker guy:

Be kind and useful.

Ride your bike to work, take a run, do Zumba, do yoga, take a senior aerobics class, do chair exercises, wiggle your little toe: MOVE YOUR BODY. There is no better drug. Not even lipitor. I know: radical.

Let the angry people vent at you, smile and be kind, and useful.

Never let your work hurt you. Never let your passions wither.

Do not look only to doctors, pills or operations for salvation. They can help, sometimes. But ask yourself: what is it you seek? And did you eat well, exercise, and tend to your own spirit on this fine day?

Move your body, be kind, be useful. Let go, and float to the surface.

Tuesday, September 16, 2014

It Hurts

Around age 6 or 7, I was solemnly walked into the CCU to say goodbye to my father, after his massive heart attack at age 40-something. He went on to live into his 60's (albeit gaining a literal new heart along the way), against the odds. When I was 10, I came home one day from school and could not get into the locked and dark house. I was furious, and when my folks came home, finally, I let them know in no uncertain terms. Turns out Mom had been diagnosed with breast cancer that day, and I still feel guilty for being such a brat.

Both my folks made it into their 60's, against the odds. I feel sorry that they died so young, but happy I had them as long as I did. Sorry they had to be sick, but happy our family grew closer in the process. Sorry I have such anticipatory grief, like Jiminy Cricket on my shoulder every second of the day, telling me to beware of the inevitable loss of all I love. But happy that I know just how important it is to notice life. In fact, my largest irritation with people over the years is how they take the beauty and impermanence for granted, and find so much negative to focus upon. Teenagers are fairly expert at this,  which is highly annoying, but I too was a teenager once. It hurts.

Anyone who knows me knows I do two things when I hurt. I write, and I run. Ironically, when I run, I sometimes hurt more than I did before I was running, but it is a different kind of hurt. When I had my angst-ridden moments as a child and preteen, I often burst out the front door and went running down the street. It was dramatically therapeutic, histrionically healing.

Today, when the call came that Matt had died, I felt trapped. I had 14 minutes to get my shit together to lead a family conference at work. I was trying to field questions about medications and I was just about to renew my ACP membership. I mean, I was pulling out my credit card to renew my ACP membership when I got this call that my friend and colleague and partner and sometimes irritator of 12 years was dead! I shoved my glasses on my head and cried like a stupid baby, then could not find my glasses. I called my husband. I called my friend who knows about death. My medical assistant asked what she could do. I wiped my snotty nose and went to run a family conference.

Several weeks ago, I spoke to Matt and explicitly told him I was concerned about his health, given the stress of his job. He was too, but this guy had elected to take on a monstrous task: the well being of a medical staff in a very broken world, the well being of patients with unfathomable needs, the well being of a budget that is geared toward some alternate universe.

I was thinking today: is it written on our DNA somewhere when we die? I mean, does it matter what we do or is it all just fate? As a physician, I must believe it matters, at least somewhat. But I watched my grandmother eat red meat and butter and live a life on the plump side, and she fell into her final sleep on the couch at nearly 100 years of age. I watched my mother live a life of healthy food and exercise, and she gets her ass kicked at age 42 with the big C.

What matters?
Kindness. Compassion. Love.

Jiminy Cricket would say: do not take it for granted.

Sunday, September 7, 2014

Garmins, Coaches, Young People, Poodles, and Half Marathons.

My Garmin died. You may think this is not a true tragedy. I would have to agree. Yet consider this:
1) Garmins are made of plastic and probably will NEVER leave the landfills.
2) I have only had it for about 3 years.
3) If I continue running with Garmins till I die, which could be tomorrow but let's just say it is 40 years, that is approximately 13 more Garmins I will go through.
4) The Earth is doomed.

I ran yesterday with Map My Run. OK, this is actually a pretty cool app. It lets you choose your music from your list (I chose shuffle from all of my music, which led to a pretty crazy mix of Bach, Beyonce and John Coltrane). Then you hit start workout, and you just run and every mile this flight-attendant voice comes on, politely pausing the bebop or English Suite or whatever and tells you your mileage, overall pace and split for the last mile. Bitchin'.

It does not (yet) talk to Strava though. I really like Strava! All my friends use Strava! It is not real if I do not post it to Strava!

Yesterday, I went out to run, to see where my body was at. I am signed up for the local fall marathon. I have not, however, put in enough miles to give it its due respect. Yesterday was a test run, and my body said "Yeah, so, not going to happen." I mean I can run 26 miles. But not with gusto, and I want to run with gusto. So, as the song goes, If you haven't got a marathon, a half marathon will do. If you haven't got a half marathon, God bless you.

There is an amazing athlete who gives me some coaching. She is like a God(dess). She was kind enough, when I informed her of my decision to go half instead of full, to say I was wise to listen to my body or something like that. Also, I think she said something about kicking some ass at the half. Gulp.

Coaches are key, if they are the right ones. Mean words, discouragement and abuse do not a good coach make. But someone who can see a flicker of fire within you, and blow on it and add just the right amount of kindling to turn it into a full on roar? That is priceless.

Several weeks ago, on a run with my eldest child, I spoke out loud my uncertainty. I said I am not actually sure I am a runner anymore. My body just does not seem to respond like it used to. In a couple of short weeks I turn 45, and maybe I am just done as a competitive runner. My child, who really is no longer a child, turned to me with these words. "Don't stop." And something along the lines of wanting to be as fit as I am when she is my age. I think the word inspiration might have come up in this particular conversation. I held back my tears.

And then there is my dog. He is not super fast (except when the pit bull was chasing him a couple of weeks ago: man, was he fast then). But he LOVES running. When we go for a walk, he looks at me quizzically, as if to say "What is this? Why do you move so slowly? Are you somehow damaged or lame?" The best is the beach. Off leash, he stretches his limbs and we run. For the first 2 miles, he is ahead or by my side. After that, he falls behind, but his tracks are neatly aligned with mine, evidenced in the sand which tells you where you were and what your gait is and what size shoe you wear. Do not commit a crime, then walk through sand.

He falls behind, but he is so content, running at his own pace for 6 or 8 miles, on the beach, with the spy-hopping seals and the flocks of chase-worthy birds and the smell of sea salt and fish and rotting seaweed.

As much as I love the Earth, I will get another Garmin.
As much as I doubt the fire within, I will listen to my Coach.
As much as I mourn my lost youth, I do appreciate the word of a kind young woman.
As much as I hate the way my dog smells after a beach run, I will continue to take him along and revel in his joy.

Thirteen point one: kiss my (almost) 45 year patooty.

Sunday, August 24, 2014

Pixie Dust

On a lighter note, I would like to note that everything is always changing and yet the same. For instance, I recently dropped my eldest at college. She is a freshman. What got me was not only the devastation (I put up a good front but cried for the first 2 hours of the drive home, then pulled myself together, worried that crying while driving was about like texting while driving in terms of danger to self and others), but also the generally overweight and old appearing parents. I kept looking at myself and thinking, dang am I like that? And I think maybe I am, but it is a hard pill to swallow. And for as long as they have made colleges, the parents of students have looked out of place. It is written in some book somewhere, I know.

Tomorrow, school starts for one of my still-at-homes. Back to school he goes, after a hiatus of independent study. Here is what has changed in my view of education since I started parenting. If you are a new parent or not yet a parent but plan to be in the future, feel free to take notes.
1) Rich people who can send their kids to private schools with a lot of resources, small classes, and a high standard for academics will get a better education. I used to think public schools were where it is at, and I continue to use them, but the harsh truth is they, by necessity, cater to those who are already going to be successful, not those who need that extra something. And I am as about as liberal as they come.
2) Boys are not welcome in public schools, unless they act like girls. I used to think boys and girls were more a societal pressure difference than an actual difference. But boys make guns with hands and sticks before they ever watch a TV show and they make things drive like cars before anyone teaches them to, and they are, in general, bewildered by the rules of school, which largely include keeping your hands politely on your lap and yes-ma'aming a lot. God help you if you are a boy with an engine that needs to stay revved during all waking hours.
3) I love public school teachers. Just to be clear.
4) I had better change the subject as this is no longer qualifying as "on a lighter note".
5) I dropped out of high school at age 16 and went to college. Little known fact.
6) No, I will not be making up those lost PE credits. I burned that uniform long ago.

My other still-at-home has 2 more weeks of summer,  as there is a late start for some of our schools in town. She is off at camp and is generally the busiest human being I know. Anyway, I have 2 more weeks to try to talk her into cross country as the sport of choice. Wish me luck.

And what does any of this, aside from pushing my child into the best sport ever, have to do with running? I have noticed that about 3 months ago I made a goal for myself, regarding marathon times and pixie dust. Actually really it was just about marathon times, but I am now in search of pixie dust because without it I am not sure if I can believe. I am almost never injured. In high school, a stress fracture put my tibia out of commission. A few years ago, my achilles tendon screamed at me for awhile. And for awhile my iliotibial band rubbed me the wrong way. But since I declared a goal for the 26.2, my body has been in full rebellion. Head to toe, actually: depression. Back pain (thank God for Molly, masseuse extraordinaire). Hamstring tightness. Plantar fasciitis. And most recently what was surely, in my mind, a stress fracture, though now I think most likely just garden variety shin splints. It is like the Field of Screams. If you declare the goal, they will make you succumb.

As long as they have made runners, they have made injuries. But they have also made dreams. And spandex. What did we run in prior to spandex?

I want to briefly discuss the iliotibial band, known also as the ITB. I have seen it up close and personal in my anatomy class. It is like a really big, long piece of beef jerky. How can it possibly be stretched? Have you ever tried to stretch a piece of beef jerky? What, exactly, is beef jerky anyway?

Tinker Bell was supposedly created from the laugh of the first baby (Adam? Caveman? Was it a girl? Who came first, the baby or the Mom?), which broke into a thousand pieces and went skipping about, starting the whole fairy thing. The first Tinker Bell model was Margaret Kerry. She had to wear a swim suit for 6 months so the animator of Tinkerbell could draw her and her "slender cute figure". OMG.

All I am saying is that Peter Pan could not fly without the Pixie Dust. And I want some of that.

Modern Day Pixie Dust for Marathoners and other Miscreants:
1) A Coach,
2) Adequate Sleep.
3) Zen and the Art of Musculoskeletal Maintenance.
4) A Sense of Humor.
5) A Dog Who Will Not Tolerate a Day Without a Run.
6) Daily Stretches of the Beef Jerky and Such Tendons.
7) Realization that Being a Master Means You Might Be Old,  But Damn Are You Ever Wise!
8) Knowledge that the Kids will be What They Will Be. Now Go For a Run, For Heaven's Sake.
9) Shoes. Stop Going Barefoot. Unless You Weigh 12 Pounds.
10) Belief.

Wednesday, August 13, 2014


I wrote about depression recently. Of course it is on everybody's radar now, at least for a few minutes.

Robin Williams was so funny. Nay, the funniest. He used to scare me a little back in the 70's and 80's when he would just get going on some stage and the host of whatever show he was on was clearly no longer in the driver's seat, but sat back in awe, probably thinking something like "I used to be funny too." Over the decades, RW mellowed a bit. Probably more sober, maybe less manic.

He rode bike to feel well. He talked about this a little last year on The Daily Show. Also, in "Night at the Museum 2" (yes I watched this and I enjoyed it, so there) he, as Teddy Roosevelt, said the key to happiness is "daily physical exercise". The key to so much in our health is daily physical exercise: I do not care if you are 5 or 95, wobbly or an elite athlete. When I tell people this as a doctor, their eyes generally glaze over. It is not B.S. though, it is science.

So maybe if Robin Williams had just gone for more bike rides? Ah, if only. And yes, maybe. But it can be hard to get in the saddle when you are pinned under despair, and particularly if that despair is accompanied by a whiskey chaser. Or whatever the drug of choice (video games? meth? our local personal favorite, weed?).

There is a general malaise that has always accompanied being human, and we have become fairly adept at using technology and busy-ness to avoid it. I am reading This House of Sky by Ivan Doig right now. In that time and place (ranching in the unrelenting wilds of Montana, mid last century and earlier), hard work really does not leave any space for malaise. It is a lovely memoir, a tenderly painted picture and a love story of sorts, love of land and family. It also is about the pain of loss. Their life sort of sucks: I keep imagining my own children being put to the chores, the constant moving, the boarding with townsfolk they hardly know during school months. I cannot imagine it.

The ranchers, with their outhouses and their biting off of the testicles of baby lambs, are not movie stars, nay icons of a generation or three, living in one of the most beautiful parts of Marin County. Not like Robin Williams.

Everyone has their struggle, it is said. I am here to tell you that is a fact, though some people glide through much easier than others, and I am just not sure why that is. We are just made up of all these cells and chemicals and infinitely smaller particles that flavor us just so, and somehow hold us together in the days we are allotted here on Earth.

My father sang every morning, while knotting his tie in front of the mirror of his room in his very modest home. He was a dramatic guy, and funny and unpredictable in his humor, unapologetic to the world for being himself, all full of opinions about justice and peace. You just never knew when he would break into an imitation of Richard Nixon, or break into song in a public place. He had a heart attack in his early 40's, and several after. He lost his wife, he had a heart transplant, he watched his children struggle, he watched the world continue to war with itself. And yet he sang. He walked religiously, and I think he knew religious, being a pastor and all. And he just made this one request to me: leave the world better than how you found it. He rarely swore (at least not in English), and almost never involving God in that transaction. But I did hear him once say "That goddamn depression." He knew that it was real, and not everyone can greet the day with song, no matter how hard they will themselves to do so.

There is an opportunity, in losing such a widely loved man as Robin Williams, for a better understanding and a bit more compassion for the struggles of others. Because that is really why we are here on Earth: to be kind to others.

And to exercise. Seriously, exercise is the strongest drug, the purest medicine, the absolute best high, the ticket to a front row seat in the happy life extravaganza.

Music is good too. As is nature.

My oldest child leaves for college in 2 days. That alone could be cause for complete devastation. And yes, I am sad. But inside of me there is this little burst joy for her. The world, it is out there. Its pleasures and hurts must be deeply mined and there is no time to waste. Read! Write! Learn Latin, go to parties, run cross country, stay up late and study. Fall in love. Learn about your inner strength. Visit often. Call even more often. And never forget, in times of despair, that you are deeply loved. Leave the world better than how you found it. Be kind to others. Notice everything. Exercise daily.

We must not let Robin Williams dash our hopes. He was gifted. He gave us his gift. And he also was human and deeply mired in goddamn depression. The world might have been kinder to him.

Rest in peace.

Saturday, August 2, 2014


Every day at exactly 11:30 am, I am treated to a chorus of "Oh, When the Saints". I am seated above an adult day health center, with a window to overlook the daily activities. And that is just one of the daily activities. DAILY. I have thought about taping a poster with requests for new songs on my office window, but it occurred to me that my need for variety in musical tunes may not meet the needs of an elder with significant memory loss. Routine, dependable, unwavering, predictable routine might be the best thing. And delving into the oldies is no mistake. A person with dementia may not remember what they had for breakfast or that they met you 5 minutes ago, but they have the most solid of memories of their young years. It is like the brain shuts one door and opens another. During our relatively youthful years the door to the past is maybe just a bit ajar, but we cannot really access the full experience. This may be good, because if I could spend my day playing in my backyard with my Mom bringing me cookies and Kool-Aid, I would probably never get anything else done.

I am not all that old yet, but I am finding myself craving routine. My work offers that now (insofar as any doctor job can: there are usually a few surprises each day. Not at 11:30 am though). My saint of a husband keeps us all fed and watered. My dog knows when it is bedtime and my chickens know when it is time to get up in the morning. My runner self is completely discombobulated though. I have spent so many years in complete time chaos (college, jobs with changeable shifts, med school, residency, and the last 12 years of work ruling me with no intention of offering me a routine) that I developed a plan for running: do it whenever. Which no longer works for this body and mind.

As I find myself relatively out of shape, and signed up for a marathon in 11 weeks, I wonder if it is wise to waddle to the starting line. I am very competitive with myself, and dislike failure. I also respect the marathon. You gotta invest in the aerobic account, or you will find yourself broke and shattered at mile 20.

All that said, it is time to get serious. I am tired of my brain chemistry putting me in a stranglehold. So what if I go and run slow or (gasp) DNF. I could DNS, but I think that might be the end of me. I will just become one of those characters in Wall-E.

Therefore, come humiliation, lactic acidosis or pain beyond belief, I will try.
But I need to focus on what inspires me:

1) Young Warriors.

2) Old (as in friends for a long time, just to be clear), Speedy friends.

3) Dog.

4) Roxana.

5) Beauty.

6) The Strong Person I know resides within.

Oh, When the starting gun sounds its call, Lord I want to be in that number.
And if I am last, well, at least I showed up.

Come on everybody, sing along!

Wednesday, July 16, 2014

Brain Chemistry

Running is about talent.

Running is about physique (skinnier the better, with muscles in all the right places).

Running is about mental toughness.

The End.

Just Kidding, or "JK" as they say nowadays.

I started running at age 12. I mean, I ran before age 12--all kids run, but usually they get yelled at for it ("no running in school!" "no running in church!" "no running in the house!" "no running in the grocery store!").

But at age 12, I ran intentionally. I ran to start getting faster, to consider the possibility of winning races. I started taping pictures of Alberto Salazar on my wall.

Talent? Not really.

Physique? Nope.

Mental toughness. Well, yes, I guess so. Aye, there's the rub.

I have decided: Running is about Brain Chemistry. Has anyone out there ever experienced depression? I am not talking about: "Geez, I am so depressed that the Giants lost again." Or, "I find that movie "The Fault in Our Stars" rather depressing". Or, "Are you as depressed as I am that the Supreme Court is in bed with a store as stupidly named as The Hobby Lobby?"

I am talking about the crush of despair, for no good reason. There are plenty of reasons to be down and discouraged in life, but depression is pure darkness.

It is challenging to run in the dark. There are head lamps, of course. Last time I used a head lamp, a 15 year old had to lead me out of the woods. My vision is fair by day and abysmal by night. Close your eyes and imagine an abyss. You are not sure if your next step will lead to oblivion or if your last step did and here is where you landed. Oblivion is nothing to crow about. And crows are the darkest birds I know.

Alberto Salazar talked about depression in his book 14 Minutes. He took Prozac and ran faster for it. He got a lot of flak for that. We say depression is accepted, but it is not. Yet here I am writing about it for all the world to see.

Mental toughness? In running, it means you accept pain as a fact. You cope with it. You are capable of telling yourself it is a limited condition. You get in a zone, probably not unlike an accomplished meditator (is that an oxymoron?).  But depression completely messes that up. You start to run and from step 1 you question: who am I to think I can do this? Clearly I am too fat and old to do it well. So, therefore, what is the point?

Depression ="what is the point?"

Ponder it: what is the point?
OK, there can be many good answers to this question, normally. But with depression, there is not a single answer worth uttering.

Practice your music, and still not be as good as you want to be. What's the point?
Study your profession and still deal with a broken system. What's the point?
Love your children, and still find your heart broken. The point?

I come from a tradition of pulling yourself up by your bootstraps. I believe in hard work, sacrifice, and compassion.

But I am no longer clear that I am a runner.

Monday, July 7, 2014

How to Like It. Maybe Even A Lot.

I sat in a couple of fairly decent hotels, drinking coffee in the morning hours while the teens were abed, reading. Currently, my book of choice is called Behind the Beautiful Forevers. This book is about the kind of poverty that makes you feel like a total shit for your irritation regarding your hotel's lack of air conditioning, and the fact that its "pool" is about the size of a bath tub, begging you to do 1000 laps before bed.

Travels with my teenaged daughters made me feel sort of like a kidnapper. I declared "we are going on a trip", and mind you, they were happy enough with the prospect. They never complained (well not very loudly) and they made tremendous adventure mates. I can, and did, rip them from the far more interesting world which they inhabit, and I do not, to spend a few days with a middle-aged Mom. And with the other 17 million people who chose the Central Coast of California as a dandy place to spend 4th of July weekend.

Seriously, who goes to the Santa Cruz Boardwalk on the 4th of July? OK, everyone, and us. But it seemed to me we were the only legitimate visitors, and everyone else was just foolish and were they REALLY going to eat that deep fried Twinkie? I dropped the girls with some cash and promises to be back as soon as I found parking, which it turned out was all the way back at the hotel, and the 2 mile walk after the 1 hour it took to get from Boardwalk back to hotel was rather a relief. For me, anyway. The Girls were dubious. At least they got to ride the Giant Dipper. It made the day both fun and educational.

Travels to tourist-ridden places brings out the snob in me. Truth be told, that snob is probably not so deep under the surface. But more than snobbery, it brings out the questioning mind, the one who recalls a quote a friend shared recently, "think of the poorest person you've ever seen and ask if your next act is of any use."

Monterey Aquarium is a favorite of mine. I have been there perhaps 10 times in my life. Pre-children, when I was still a teenager myself. Then with my little kids in tow. Then with older kids, and this weekend with two teens. WHO CHOOSES JULY 4th WEEKEND TO GO TO THE AQUARIUM? OK, everyone, and us. Thankfully I had my tickets beforehand and could avoid the 60 minute line, after the over 60 minute 2 mile drive through town in a traffic jam of people dying to walk down Cannery Row. When we got into the aquarium, I felt suffocated by the throngs of unhappy, whining children and obese adults (snob, I know), and the people pointing at these amazing sea creatures and saying "ewww that's so gross". I almost turned around and left, but J just gave me this look like, Mom, you have to be kidding me here, and I pulled myself together and made the best of it. Rewards: sea otters, penguins, sharks, tunafish, ocean sunfish, jelly fish, sardines. All somewhere in the range from awe-inspiring to unbearably cute. But the treasure of my day was this magnificent octopus. It spread itself into its full sail, tentacles reaching and it is just so hard to describe how lovely it was.

After the crush of Monterey (Steinbeck was puking, I am sure of it. Though in reality I bet Cannery Row was pretty disgusting and horrible back in the day), we were driving back to Santa Cruz and I turned off and up this single land road, in the higher hills where the redwoods grow, and into a quiet space that re-inflated my soul. No, seriously, it was like someone gave my soul CPR, though technically the new guidelines no longer involve mouth to mouth/chest inflation. At the end of this road was The Land of the Medicine Buddha. We prayed with the prayer wheel. We hiked (a bit; mind you, two skeptical teens in flip flops are at my side). Prayer flags everywhere, the sky intensely blue and SO quiet. Granted, 2 monks drove by in a SUV and that sort of blew the effect a little, but I guess it also cracked me up. Purity does not exist.

The only proper ending to the 2 days of tourist stew being shoved down my throat was a good cry. Have you seen The Fault in Our Stars? I almost choked to death on my own sob snot.

The next day, we headed up the coast. I say this as if I take it for granted. I do not. The central (and northern) coast of California is my absolute favorite place to be in the whole entire world. I think the teens like to too, though maybe not with the intensity of someone who considers each day precious, and who is deep in her questioning mind. We did hike out to see the elephant seals. They travel approximately 25,000 miles per year, so said the naturalist at our well earned vantage point (deep sand, headwinds, and what J described as "the longest walk I have ever taken in my entire life). And they always come back to this place, where they were born. It was all males that day, head-butting each other and making this guttural growl which V said sounds like a backed up toilet (which is true). After viewing them, the guttural noise and wind was at our back. I was happy, and my kidnappees were real survivors.

A long walk, and oh yeah, there was some running later on, along the coast trail (my coast! I could eat you on toast, I love you so!), and we were so hungry. We had to wait for V to finish writing a paragraph or a chapter or something. Being the wife and mother of authors can be very trying at times. But we made it to dine with The Blue Lady. She haunts the Distillery in Moss Beach. I was wondering if I pinched one of the waiter's asses, then looked away, if I could blame it on the Blue Lady. The girls gave me a panic-stricken, "Mom! Don't!" Like I would. Like, would I? Hmmmmm…

The trip involved bad hotel TV (Naked and Afraid? This is actually a reality TV show, and I may never get the vision of these people's buttocks out of my head). It involved sitting quietly with and laughing with my girls. It involved a lot of sunshine, and a hell of a lot of tourists. Octopus beauty and monks and prayer flags and coffee on the balcony while looking at a great blue heron in the bay. Runs, walks, and food. I am not at all sure any of it was of any use, but I am so very grateful that I know how to like it.

Saturday, June 21, 2014

What if

Aside from my mother, I worry more than anyone I know. Hopefully, Mom has found a worry free zone in the afterlife. If she is sitting on cloud 9 fretting over whether some angel is home late because she is dead in a ditch somewhere, I am pretty bummed.

I have posted Wendell Berry's poem before. Many times actually. I think of it most days, and the fact that it speaks to me so probably is one of the main reasons I have landed in such a rural, scenic area, despite the lack of things open after 8pm and the tendency for the population to wear socks with sandals.

The Peace of Wild Things
When despair for the world grows in me
and I wake in the night at the least sound
in fear of what my life and my children's lives may be,
I go and lie down where the wood drake
rests in his beauty on the water, and the great heron feeds.
I come into the peace of wild things
who do not tax their lives with forethought
of grief. I come into the presence of still water.
And I feel above me the day-blind stars
waiting with their light. For a time
I rest in the grace of the world, and am free.

— Wendell Berry

Today I ran with my eldest on a trail along the Elk River (or stream, really, as it is in this drought). My foot hurt. What if I cannot run?

What if I never actually learn all of the preludes and fugues at once, and the Beethoven Sonatas? What if I never properly learn how to groom my standard poodle?

What if I chose the wrong profession? What if we go back to war in Iraq? What if my kids never call or write after they leave home?

First world worries, for the most part. I was thinking today about how much I like water. I mean a good, cold glass of water from the tap. It is miraculous, and even though I take things for granted almost every waking second of my life, I almost always say a little prayer of thanks for having clean, cold water, right here in my home, my workplace, wherever really. I don't have to walk 5 miles to get it while being shot at or threatened with rape and kidnapping. I don't have to then build a fire to boil it so my kids don't die of some diarrheal illness that will turn their guts inside out. Sometimes I worry of course, like, what if the "big one" hits? We have not set up a garage full of water supply for this purpose as we probably should. Despite being a worrier, I am not the type to build a bomb shelter or seriously plan for the next quake.

What if my hens don't lay eggs after my husband has so diligently built them a fortress? I mean a fortress. A bear might be able to get those girls, but every other critter will be thwarted. Even the poodle.

I worry about my patients. I worry about my friends. I worry about my family. I worry about that raggedy guy on the corner who looks like he needs a bath and 3 squares, stat. I have been having some dreams with whales lately, and that usually happens right before something big happens. WHAT IS GOING TO HAPPEN????

But I digress. This is about running, and redwoods. Today, I ran in the woods, by the anemic but still lovely river, with my daughter. For a time, I rested in the grace of the world, and was free.

Monday, June 9, 2014

Rock Bottom

Rock Bottom.
That was what I was thinking while I sat in the occupational health office getting my mandatory physical exam for my new job. Weight, blood pressure, pulse, all 10-15 points higher than my healthy baseline. Color me shocked? Not really. I can feel it. That is what 15 hour work days for months does to you. I am no CJ from the West Wing.

But now work life is more reasonable. And I am working with a coach to get my ass in gear for a PR and I am doing hot yoga and swimming and, and, and.

It struck me today, as I was walking on Parnassus, past the statue of Hippocrates and across from the Death Star. My very worst health was in residency. At the end of residency to be exact, when every fiber of my being was beaten into a pulp and my soul was barely intact. Or was it in medical school?

As a pregnant first year, I once walked across campus carrying a see through hefty sized bag of condoms to give a talk on birth control. It hit me that I looked a lot like Santa, only a girl, a doctor-to-be, expecting, and how very ironic to be carrying a bag of condoms in my condition. I wish now I had one of those video cameras people wear on their heads when doing extreme sports, just to capture the looks I got from passers-by. At the time, I was mostly just irritable, and probably did not see the humor. My ankles were swollen and I had a test to study for. And who the heck gets pregnant in medical school anyway?

Or was it in high school, when I felt out of place and bored to the point of despair? I used to leave class to practice piano, with mostly a shrug of "OK, whatever" from my teachers. I tested out of this and that and finally decided to just skip the rest of it and head to music school. I still have nightmares that someone comes to my door, pointing out I cannot be a licensed physician without my high school diploma. They then hand me my old PE uniform and send me out for laps. Or worse: golfing. Once in high school a classmate hit me square in the head with a wooden club (accidentally) (at least I think so). I awoke, on the ground, with my fat, toupeed gym teacher bending over me. From then on, he called me "Hard Head Heidmann". It is possible this injury explains a lot of my short fallings in life. It was not amusing.

Or was it in junior high, when I used to walk to the orthodontist from my downtown brick school, which was well in the aroma-sphere of the local brewery, to get my weekly torture, tightening of the wires? My orthodontist was mean in a way that would not fly in today's litigious, helicopter-parenting society. He was an asshole, actually. Once I bit him on purpose. He asked me at one visit what we did in school that day, and I reported happily about the English Muffin pizzas we had made in home economics class. His reply, and I swear he had a cigarette hanging out the side of his mouth while he drawled this, was "I wouldn't feed that to my dog." That might've been the day I bit him

Or was it during puberty, when my body rebelled and went from wiry thin kid to slightly curvy, menstruating and gawky (braces-wearing) teenager? I hated myself as a teenager. I wanted to be Alberto Salazar, or Grete Waitz, or any of a number of my cuter friends who somehow went through puberty without the freaks and geeks detour. To my credit: never drank, did not do drugs, and ran and ran and ran with the discovery that running was my bliss and my ticket to health.

Which brings me back to this: rock bottom. I am finally not working 15 hours per day. I am sleeping, I am eating well, and my 10-15 point elevation of weight, blood pressure and pulse is starting to drop. But my foot hurts. Plantar fasciitis, probably. A first for me, or at least the first foot pain in a long while. In the grand scheme of tragic events, this ranks low. But I do find myself wondering what God is thinking. Running for me: my meditation, my mental health, my passion (well, other than Beethoven anyway), my mental health, my drug of choice, my mental health, my lifelong, as long as I can remember, THING. I am not and never will be elite, but running is my non-animate soulmate.

My Dad had a heart transplant. My Mom had breast cancer, twice. My kids are strong and they rise up against the BS of adolescence with grace and humor. My husband writes magical books and has raised our children and has been there, all out, for our family from day one. My dear friend had a baby and traveled across the country. My patients face death with astounding grace. My colleagues continue to fight the good fight in a system that promotes insanity. My dogs offer unconditional adoration. Beethoven and Bach beckon.

Rock bottom?

A little foot pain never killed anyone.

That I know of.

Sunday, June 1, 2014

Vultures and Vampires

When I was a kid, one of my best friends lived across the street. We had nighttime neighborhood games, like kick-the-can, and ghost in the graveyard. We had sleepovers in my treehouse and we danced in her basement to the strobe light her super-cool older sister possessed. We commiserated over the "vampires", which was, in our parlance, the people who tried to suck the life-blood out of you. We could just mention the V word and know that someone was trying to sap our power.

Because we were powerful.

Today, when running along this road,

the turkey vultures circled overhead.  It reminded me of the childhood vampires. Now, as then, I scoffed. Do not mistake me for weak and powerless. 

It occurred to me today that this is a mantra for my own misgivings, and not only for those who see me as prey. 

I care for the old and the dying for a living. Dying is inevitable. Old age, well that is just a gift we can hope for. My parents did not get it. Many people will not. We like to think it is a curse, this thing called aging. Aching bodies, wrinkly skin, lesser vision and ears that fail us. 

At age 44 I may only be half way there, and though I feel the years in a new way, no longer oblivious to my body's needs, I don't think I am vulture food. 

Today, when running along the roads, I passed through the tri-kids triathlon course. Signs warned me they may be about, but really just made me think: My once-kid triathlete leaves home in a few months.  

College. To learn and grow and live in a dorm and run D3 cross country and likely steal into Portland for  Voodoo doughnuts now and then. How and when did I become the parent of an adult? Should parents of adults still be attempting PR's? Or is that akin to shopping in the juniors section after age 40, whilst clerks less than half your age pop gum on one side of their mouths while sneering at you from the other? What is truth, and if they are calling my child an adult, does that make me one too? Do I like get a badge, or something?

I am going to miss that kiddo. 

There is nothing more true and visceral than running. Than running on a road that evokes memories of vampires of youth. That evokes the certainty of death through vulturous eyes and those ugly-beautiful wrinkly red heads, turkey-like, yet not.  That brings the ugly-beautiful truth of the limitations of a body no longer young, but not quite old either, right to the forefront. That criss-crosses the path of the next generation of tri-kids. That promises health of mind, maybe of body, certainly of soul, and offers proof of what we all know to be true:

what doesn't kill you makes you stronger.

Win some, lose some. Age. Or not. But whatever else happens, don't let the vampires or vultures get you down. Probably you can outrun them anyhow.

Thursday, May 22, 2014


When we moved into our house, I was about 6. My Dad very firmly told me, this being the first (and last) non-rental house for my parents, "NO POSTERS ON THE WALLS." Therefore, I proceeded to completely cover my walls with posters. I think there were several on the ceiling too. I vaguely remember my Mom running interference regarding my Dad's initial fuming response to this. My Mom was also very good at closing the door to my room to avoid looking at the mess. My Mom kept a very clean house.

I am reflecting on this as my high school coach is retiring and I look back at those days of running, when my wall was plastered with inspirational quotes and pictures of runners and newspaper clippings about our cross country team. My Dad, who clearly knew this battle was lost, even contributed one thing to add to my wall to ceiling to wall collection, which was a litany of failures Abe Lincoln had prior to becoming one of the most revered Presidents ever. The guy lost. A lot. This was somehow reassuring to me, as I was never the star of running on a team of very fast girls. I was usually in the top 5, but never the one that won. And I had braces and was really awkward. Even more awkward than I am now!

One of my posters was of Alberto Salazar. First of all: cute. Second of all: fast. Third of all: tough as nails. I just listened to his book 14 Minutes. I came away from it thinking he is kind of intense. Sort of how Mount Everest is kind of tall. The book is advertised as some sort of treatise on cheating death, but it really is not. He beat the odds, no doubt, but it seems to me that the book is finally about passion and presence. Closeness to God, awareness of what is beautiful and real, and never taking it for granted.
Also, it is about running, and he was such an animal! He would define me as a "citizen runner". I am thinking of getting a t-shirt made.

Alberto Salazar says something in his book that more than any of the other stuff (living through cardiac arrest, mystical Catholicism, 4:20 mile repeats) stuck with me. It is that you have to state a goal to reach it. Yes, stating a goal does not guarantee success, but until you state it, there is no skin in the game.

I just want to run a PR in the marathon. That's all. Also likely a more realistic goal than keeping as clean a house as my Mom.

Friday, May 2, 2014

The Best Part

For some reason I have that Folger's commercial running through my head.

Maybe it came from this thought that sprung up yesterday while running, which was something like: "The best part of being out of shape, is the sky is the limit in terms of improvement." Seriously, it is like a clean slate. When you are in top form, it is difficult to improve. When you are a jiggly sloth with those little stir straws for bronchial tubes, well, look out world! Obviously, being a jiggly sloth precludes any thoughts of running in the upcoming local marathon. But the next big race, in October? For sure.

Unless jiggliness turns into waddliness in which case I may take up being a professional lounger.

I ran in Tahoe last weekend, and the air was thin. It also snowed. I had a blast, but who forgot the air? I was hoping to come back to sea level with a new pair of lungs but my short time at altitude did not quite do the trick.

How did this happen, this state of sloth, this foreign body attached to my brain which still sees me as a real runner?

Doesn't matter. The best part now is starting over. My teens were bemoaning teendom yesterday. One of them was also overheard saying "once you get past 30, you can't do anything anymore." Bullshit says I!


The best part of aging is you pay better attention. To your body (what is that little nagging pain? serious? no, it'll pass, back to it now….). To pretty things. To goofy things. To the suffering of others, not just yourself. To how the coffee tastes and how nice it feels to have your beloved up against you.

I have always wanted to be in Runner's World magazine. It has become fairly clear to me that the only hope of that at this point is keep running till I am 105. I am thinking I can demand some space in that magazine if I succeed. The fastest 105 year old ever. What's her secret? Read all about it, page 72.

In my work now, I am focusing much more on seniors. This I have learned:

The best part of growing older? More appreciation for how good it feels to kick ass.

More appreciation.

Sunday, April 13, 2014

This Life: Do Your Realize??

Chickens. Also organ music. Chorale Preludes and some stuff with a brass choir. Daily runs. That Edward Gorey puzzle. House cleaning. Perhaps meeting my friend's newborn son, if he decides to arrive. Listening to my playlist, compliments of Martha. Learning a new job or two. Buying new organ shoes. Yes, organ shoes exist.

Daily runs, to be recorded with pictures or sketches and something memorably descriptive. I am not traditionally a diarist but I am a letter writer, and apparently I write this blog. I have this book that is blank and in it will go my daily run.

Daily runs, rain or shine, with dog or without. Today was: Miles and I on the Hammond Trail, and he was mostly a perfect gentleman, even when some wacko lab came viciously running at him headlong. Poodles, they don't like surprises, but Miles is learning that as a team we can deal with pretty much everything.

Teams. That will be the theme of my new work. My old work (which ended yesterday, except for the fact I had to go in this morning and help them with some stuff unexpectedly, but I swear that was the last time! I swear!) also had teams. Like the nurses and the other doctors, when things were working the way they should, would all be on a team to care for the unbelievably ill on our wards. It seemed fitting this week be my last, as I felt shot through and hollowed out by the loss of Steve,whose voice was like he had a microphone in hand at every second and truly drove me insane but also made me feel like I was in a familiar place, and I knew he cared and he also made me feel special. He did not lie, once ever, as far as I could tell. And he filled the ward with A Voice that must have certainly made his higher ups quake in their boots. Some of us whisper and find other ways of making our presence known. But he exuded joy and an absolute lack of bull shit. This, I might add, is depressingly lacking in most workplaces.

It is amazing that any of us get out of bed in the morning. I can think of a half a dozen things that could kill you before you even get your first cup of coffee. Not to mention the terror and embarrassment of failure and being judged. I was thinking, as I ran today, that I am as slow as molasses right now and God forbid any of my athletic friends see me sucking air. But Miles was fairly content, tongue lolling to the west and taking in the smells of the ocean air, the fumes of 101 next to the trail and the horse poop on the rabbit trail begging to be devoured. Why worry?

This week, I am starting anew, but also really just continuing on my path. I plan to raise some chickens, and had a fairly amazing tutorial in the step down unit at the hospital the other day with one of my favorite neurologists regarding the best breeds to choose. Ameraucana is on my list, because who doesn't need blue eggs? Barred Rocks too. Among others.

Chickens, organ (the instrument, not the innards), the puzzle I bought in San Francisco, a finally clean room and childbirth. That is all I need. Also the playlist. I have a friend who has sent me at least a song a day for a few months now, to help me cope with this transition and the incredible hours I have been working. Why am I so blessed? And my other dear friend, so soon to start on being a Mom. And my oldest daughter, about to turn 18.

18 years ago, surrounded by friends and my doula and my husband, Vera arrived. I remember that day, when my medical school professor was quite miffed that I called to cancel my OSCE. "No really, I will not be there today." said I. Their disbelief should've been my first red flag regarding the priorities of the medical world. WHAT DO YOU MEAN YOU WILL NOT BE WORKING WHILE GIVING BIRTH???????????

Despite all that, I do like doctoring. One of my patients this past week called me Dr Sweet Potato.  When they found out my last day ("no actually my LAST day") was yesterday, they burst into tears. I do enjoy connecting with people. It is just time to reconnect with my own, including the OSCE crasher, the Boy with curl in the middle of his forehead and the dancing Dragon. And the Man who is already plotting my chicken coop and run. And my legs, which, come hell or high water, will break a 3 in the marathon. Unless something kills me before that, in which case, I will die happy and knowing I tried my best to engage with This Life.

Monday, March 31, 2014


Joan Benoit Samuelson. They said:
a month out from knee surgery, no way
let her go, she will never keep up that pace
women running marathons?

Mostly things conspire to make one feel small. This is especially true if you are any of the following:
a child
an orphan
a teenager
a woman
not rich
not white
not in charge
a stay at home parent
a working mother
too short
too tall

The list is probably nearly infinite. I suppose every person has felt small at some point. Even Charles Foster Kane was heartbroken.

In general, I believe power is dangerous (corrupts, absolutely, yada yada). However, I also believe power is essential. I was trying to explain this to one of my teenagers in the middle of the night last night, a teenager who sees no power within and sees the world as enemy territory. Everything that goes wrong is someone else's fault. Disempowerment is not always a choice, but sometimes it is, and here are a few good ways to become disempowered:

do not read books
believe everything on TV, the internet and Fox News
do drugs
blame someone else
let more powerful people do harmful things to less powerful people
never exercise
complain but don't change your circumstances
be influenced by what other people think is cool
take Facebook at Face Value
allow "friends" to treat you poorly
allow anger to guide your response to those "friends"
give up on your dreams
lose track of the beauty in the world

When I left high school without graduating and went to college, I was told I was not going to make it. When I left music to become a doctor, I was told I was not going to make it. When I had a baby during medical school, I was told I was not going to make it. When I adopted a child with "special needs" I was told I was not going to make it. When I adopted a 6 year child who spoke no English, I was told I was not going to make it. When I decided to run a marathon, I was told I was not a real athlete. When I left outpatient medicine to be a hospitalist, I was told I was too meticulous (AKA anal) to survive it. And now, as I leave hospital medicine to become a palliative care and geriatric specialist, once again there is the general opinion that what I am doing is meant to be an "escape", a "break", and for some, a job that will make me "lose my skills".

I dreamt the other night that my piano tuner came over and was looking at my Bach piano books. They were all so covered in mold that the music was unreadable. My piano tuner was upset. I was upset. I get that I haven't played my instrument much, because I am working as much as I can to make money to pay for my medical training and my house and my bills left over from a residency at one of the finest hospitals in America, unfortunately also in one of the most expensive cities in which to live in America. Where I gained my skills. Where one mentor said I was "a natural palliative care physician." But, for those in power (not me), I am just a middle aged chick with absolutely no power.

And what does this have to do with running? Well, I can still run. I am not the fastest. I am certainly not the cutest. But I know how to dig down deep and find my inner strength. Tomorrow is the beginning of my 12 day count down as a hospitalist. Twelve 12-15 hour days, where I am looked down upon by a system that sees me as less than (fill in the blank):
Less than the specialist
Less than the man doctor
Less than the righteous stay-at-home-mother
Less than.

I am not rich. I am not young. I am not sexy. I am not a perfect mother. I am not a perfect wife.

But I do care, and I do have some skills which even those who see me as small can not take away from me. Hey! Psst: if you are sick, you want me at your side. I show up and I study hard and I am a powerful advocate for you.

Here's the thing. Power resides in supporting others. Even when they treat you like shit in return. Power resides in loving others. Power resides in forgiveness. It resides in that feeling when you are rounding the 3rd turn on the oval of the track and your lungs are exploding, but you push on. It resides in reading. Learning. And opening your heart. It resides in recognizing the need for a change. Humor and self doubt peppered with an occasional fuck you helps too. There is a reason Frozen is so freaking popular.

Twelve more days.

"I have power. They don't. This bothers them."
-Buffy the Vampire Slayer

The Master doesn't try to be powerful;
thus he is truly powerful.
The ordinary man keeps reaching for power;
thus he never has enough.

The Master does nothing,
yet he leaves nothing undone.
The ordinary man is always doing things,
yet many more are left to be done.

The kind man does something,
yet something remains undone.
The just man does something,
and leaves many things to be done.
The moral man does something,
and when no one responds
he rolls up his sleeves and uses force.

When the Tao is lost, there is goodness.
When goodness is lost, there is morality.
When morality is lost, there is ritual.
Ritual is the husk of true faith,
the beginning of chaos.

Therefore the Master concerns himself
with the depths and not the surface,
with the fruit and not the flower.
He has no will of his own.
He dwells in reality,
and lets all illusions go.

the Tao (Stephen Mitchell, transl)