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.

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.

Alberto

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.

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.

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.

Power

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
fat
stupid
a stay at home parent
a working mother
nice
too short
too tall
eccentric
trusting

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)

In the Dark

Woods Run at Dusk, March 2014

It is best to have a goal which puts you solidly in control of your days and minutes and longterm future. It is best to aim high and to just smile and look away when people doubt you and make you wonder whether you should even try. Look up at the ceiling like something is interesting there and sigh. I used to believe this and without it might not be a doctor or marathoner or half decent pianist or be growing my hair long again. Maybe I still do believe it except I know now that control is remote at best and I pine away for the days when one had to get up out of their chair and change the channel, with a finality and commitment that is foreign to modern times. We think we are aware like we invented Zen and with regular runs everything can be right again and we won't need to buy new jeans for an expanding waist line or start lipitor. We go to the gym to strengthen our core. 

Goals can change, but  mine remain a sub 3 marathon and memorizing and performing the entire Well Tempered Clavier, though I cannot imagine who would want to sit and listen to all of that. I might have a recital where beer is served and people can chat during the boring moments. I could finish with some Liszt or Rachmaninoff or finally learn to play jazz and people could dance to stretch their legs after the long night of fugues. My kids walk by when I am playing impossibly magnificent passages on my piano and don't really even notice or so it seems. One woman said to me she remembers her concert pianist mother playing all the time and it is a source of inner comfort, that memory. Mostly though I think they see it as a bother or distraction. Except the one time my little Dragon was suddenly behind me while I played, thin arms wrapped around my waist and her face nestled by my ear, whispering "Mom, you are really good." I will take that to my grave.

To reach a goal once seemed a linear path of fighting resistance when it threatened progress. I did this with mathematics which I had to do to become a medical doctor, for some reason I will never understand. I did this with birth and adoption which both require strength and tenacity and ignoring the noise which gets in the way of your purpose: to love and hold your child. To love and hold your children who eventually leave and live their own lives, with their own goals, and their own beautifully delusional sense of control. I dream of my eldest who is off to college all too soon, and in my dreams she keeps disappearing and I cannot find her, but she is small and vulnerable. Now she is a young woman and astounding in her presence and gifts. She will write her way into the future and she will not disappear so much as reappear at my side as a woman and not the newly-minted toddler who needed to be walked with two hands in a back-breaking several weeks of bent-over mothering. Linearity is rare, and I am glad I took algebra, when all is said and done.

Physics I am less certain about and as I watch my body age I sometimes fill with a certain rage I cannot explain. If I had it to do over, I would've tried for that sub 3 marathon in my 20's, but was too busy planning my longterm future. I tolerate less now, physically anyway. I tolerate much more in terms of disappointment and surprise. I am lucky to have a wise husband who makes me my PB & J for my long work day and a son who constantly makes me feel alive. With worry, with wonder, with anticipation. What will he be? No hurry to answer that because he already is and I love him for it. What will any of us be after all? When you hit the wall in a marathon or life, nothing else exists. It is the most Zen place to be, because you cannot be bothered with thoughts of anything else. Your mind is clear. Shot through with pain and certain failure. But failure is my favorite motivational speech, "nowhere to go but up from here", and it is the best catapult into the next moment when hope sneaks under your skin and makes you tingle with power. This. I. Can. Do.

I ran in the near dark in my woods after a long day and week treating patients who hit the wall. In my experience, one either gets smushed and slides in a cartoon heap to the floor, or stops and is still for a moment, says some choice words, then sees the wall for what it really is: a facade that one can simply walk right through. On the other side is some more living or perhaps some dying. It might be birthing or it might be a trip to the ICU. Chemotherapy or hospice or an earnest hospitalist hovering over you. My run in the dark after my long day and week was with JS Bach plugged into my ears. The Well Tempered Clavier, book I, Glenn Gould's young years. I ran in the dusk in my redwood temple, and the walls came tumbling down. 

I can do this. Sub 3, maybe, but to try is where life is. And Bach? Well every self-respecting pianist knows the WTC like the back of their hand. The answers reside within preludes and fugues and the creepy sounds of Glenn Gould humming along to his singular interpretation. He brings out voices from dead Baroque notes on a page. His choices are not always appreciated by the mainstream musicologist. 

Run in the woods in the near-dark. Play Bach so people listen. Fuck the critics. Look at the ceiling and smile.