New Feature: Midweek Patient Mania

I am toying with a new feature here at the blog. The name may change, but in the middle of each week, I want to share funny patient stories. They may be dumb things patients have done, or stupid things I have done during patient care. Regardless, I have to present the weird side of medical care and show that we're all not quite right.

I am on my ER rotation so I see a lot of people as they first present to the hospital. I hear a lot of stories. But this was a new one on me. Our hospital is a stroke center, which means that all ambulances with possible stroke patients are routed to our door. Whenever a possible comes in, we call a "Code S." This is not to be confused with a Code Blue (cardiopulmonary arrest) or Code Brown (patient pooped himself). Codes S warrant immedite attention so that we can determine the patient's story. Most strokes are clots (as opposed to bleeds). Clot strokes can be dissolved with a special medicine, but it must be administered within a few hours of the onset of symptoms. Once the stroke starts, the clock is ticking.

Not for my patient B. B came to me one Sunday night. I asked her what's been going on. She said she's had slurred speech, a droopy face, and numbness/weakness in the right side of her body. Let's watch.

Me: Oh no, how long has this been going on?
B: About two days?
Me: You mean two hours?
B: No, it started Friday afternoon.
Me: And it comes and goes?
B: No, it's been constant.
Me: Why didn't you come to the ER immediately?
B: I did. But when I pulled up, the parking lot looked pretty full, so I went to Burger King to get a Whopper, then went home and fell asleep.

I couldn't say anything. I was mortified. Typically our stroke protocol involves vital sign monitoring, EKG, urinalysis, CT scan, oxygen, aspirin, and blood pressure medications if needed. But I couldn't find a Whopper anywhere on the order sheet. Maybe I missed that lecture in med school, how you treat strokes with beef. So I pulled out my pharmacopoeia. Nope, hamburgers weren't in there.

Needless to say, B missed the three hour window for anticlot therapy. But, I am happy to note that she was discharged and made significant recoveries. She is through with physical therapy, and I think even driving again. So maybe Whoppers aren't bad for treating strokes....

Daily Training

Yesterday I did a recovery 45 minute run in Zone 2. This morning I did a recovery bike ride in Zone 1 and will swim this afternoon.

Daddy day!

I am currently in my ER rotation. Shift work is one of the best things about ER. I only have to go to work every other day. Kelsey quickly jumped on this and flew the coop :) We have instituted Daddy Day, where I stay home with Houston and she works all day. Here's a pic of H sleeping while I type.

Daddy Day begins the same way. Kelsey brings Houston from his crib to our bed, and we wake up the same way. We stretch, rub our eyes, then smile. Then Kelsey asks him, "Houston, is it gonna be a good day?"(She asks that every day) But today, I answered, "You bet! Are you ready for Daddy Day?" Then Kelsey leaves and I am all alone. Thje first time she left, it felt like my first night in the hospital, when the nurse turned to me and asked, "Dr., what do we do?"I hesitated and she responded, "You're a doctor, act like one." So I told her to get me some coffee and saved the patient's life :)  But seriously, the isolation of sole responsibility is similarly daunting. Though Houston smells much better than my drunks.

After a few full days alone with Houston, I love it. But it also amazes me how cyclical his life is:

Sleep - Wake - Play - Eat - Sleep - Wake - Play - Eat

I have also realized how hard it is to accomplish items on your own list while at home. The only real break is while he sleeps. And during that time, it is so tempting to sleep while he does... Anyway, the plan for the day is to try and revise a few manuscripts and submit them to journals. I also hope to get some cycling in.

Training in real life

Few of us are fortunate to be paid to train. That is not intended to take anything away from my generous sponsors - check them out to the left. But most of us must balance our athletic aspirations with work responsibilities, not to mention the opportunity to spend time with family, friends, at church, etc. Consequently, we prepare a beautiful training plan with peaks and troughs, hard work and rest, beautifully choreographed... only to have it ruined by reality. As Helmuth von Moltke famously stated, "No battle plan survives contact with the enemy."

Such was my training today. I was scheduled for a 30-hour call. The call started at 7am, when I signed in as the surgical house officer. House officer is an old term for the resident on call, which is a current term for Dumbass, MD who agreed to work for $13 an hour under the auspices of "furthering your education." Well, as the in-house scut monkey, I arrive at 7 with work. YAY!!! The resident leaving her 24-hour call tells me that there is a surgical patient in the ED who needs a history & physical done. She assures me she was only notified of this patient 15 minutes ago. Guess how long it takes me to finish the H&P? Less than 15 minutes...

Homes in communist cities receive heat and hot water from
central facilities too.... http://ruskidays.blogspot.com/

But the first few hours of my shift proceed uneventfully. So I decide to deploy my master plan. I pull my trusty triathlon bike (Name: Your mom) and trainer out of my car and set up shop in the call room. Like any major institution, our hospital is centrally controlled (see picture to right). Any major decision comes from the top down, from far away places... so far away, we are told, that our complaints cannot be heard, so best to save our breath and keep our noses to the grindstone. Well this is fine during the winter and summer when the weather is -20F or 110F outside. But what about today, March 20, when it's still technically winter, but 70F outside, and the frickin heat is on?!? Doesn't make for a pleasant ride.

But I ride [At this point in my typing, I am paged by a nurse to call x6025 with the note, "Call Immediately"... and the phone is frickin busy. That should be a hanging offense.] so anyway, I ride, grateful that I get some exercise. Our predecessors, the residents of yesteryear, had to work 90+ hour days with only gruel paste for nutrition and defibrillations for punishment. So yeah, 30-hour calls with the possibility of exercise aint so bad.

I make it through the first of my two hour workout fine. But into my second hour, I am called by two nurses about URGENT!!! matters. The first patient is having a muscle spasm. OH THE HUMANITY!!! Guess which magical potion I pull from my armamentarium?

Me: Let's give him a muscle relaxant.
Nurse: Are you sure?
My Id: You f***ing called me for advice, didn't you?
Me: Yes, thank you.

Quickly, another nurse calls me...

Nurse: Hi, Dr. So-and-so's patient is a little girl who needs more pain meds because she is 180 lbs.
Me: [I interject] Well she isn't really a little girl, now is she?
Nurse: No sir, I guess not. Anyway, Dr. So-and-so's patient is overweight and he only wrote for X, can we give her X + Y?
Me: You really should call Dr. So-and-so, since it's his patient.

But, after that, I finished my ride and I'm having a great call so far.

Daily workout:

Two hour cruise intervals on the trainer, with Zone 5 pickups in last 15 minutes.

Maybe this whole baby thing wasn't such a bad idea after all

Let me begin by saying that I love my little guy, Houston. He is wonderful. But he was not at first what I expected. If we go way back, Kelsey told me she was pregnant on the phone (not in person, but on the phone!!!). Had to throw that jab in there. Still bitter. After a few months, we found out that we were having a little boy. I was ecstatic! While a girl would have also been fine, there's something about the father-son relationship. I immediately started thinking of all the things I would teach him: how to fish, how to hunt, how to scale a fish, how to cut grass (very important), how to drive, how to ride a bike (this list may not be in order). I also thought of all the awesome things we'd do. I've always needed an activities buddy. Someone to do Race Across America (http://www.raceacrossamerica.org) or hike the Appalachian Trail or swim the English Channel with me. Kelsey's just not as enthusiastic about these things.

You'd think my pediatrics and OBGYN experience would have better prepared me, but I was somewhat disappointed when Houston arrived. For the first month or so, all he did was lay there, eat, and crap on EVERYTHING!!! He also seemed pleased to pee on me whenever I changed his diaper. But he also peed on Kelsey, so that was worth it.

But I tell you what! For all you first-time dads out there, keep the faith. Sometime around month 3, 4, or 5, things change. Just when you're about fed up with waking up at night, or being peed on, they smile at you. Then they start cooing to you. My attending on peds thought that evolution held off until the last minute, until right before you discard your baby, then bam, the baby charms its way back.

Well, Houston keeps getting awesomer and awesomer each day. Today, we were playing on the floor and he grabbed at his toys!!! That tongue sticking out is a sign of intense focus.

Daily workout:

I'm supposed to ride today and rest tomorrow, but I think I'll flip them. Yay day off!!!

Training plan in flux

I've tried to read more triathlon, running, and nutrition books lately. Perhaps I'll follow up with book reviews in ensuing posts. Some of these books include: Brain Training for Runners, Racing Weight, Run Faster from the 5k to the Marathon, among others.


I recently finished Brain Training. It's an interesting book by Matt Fitzgerald, an exercise author I respect and follow. From the book, I picked up this tidbit. In short, Fitzgerald urged athletes to plan their weekly, even monthly schedules. However, we shouldn't be slaves to these schedules. Listen to your bodies and what they're telling you about your training. For example, waking up tired, sluggish, sore, etc. might lead you to back off scheduled workouts. One important point is to prevent injuries before they happen.

I've been trying to break in a pair of Newtons. According to the Newton website itself, these shoes can take several weeks to break in. So I ran on Monday, much to the dismay of my calves. I couldn't finish the hour run, as my calves and achilles tendons mutinied. On Wednesday, I switched back to my old running shoes and repeated the hour workout. While I finished the run this time, my legs still hurt. Today I listened to my great coach, Jeff Geloneck (check out his blog at http://thetriathlonlife.blogspot.com) and scrubbed run workouts.

So for the rest of the week, I'll be focusing on swimming and biking.

Daily Workout:

1 hour ride on cycling trainer in Zones 2-3

Wildman Triathlon Festival: Race Report

After a long winter layoff, my first full triathlon season came roaring to life this last weekend in Orlando, Florida at the 6th Annual Wildman Triathlon Festival, sponsored by Epic Sports Marketing. The festival consists of multiple races, spanning Saturday and Sunday. Saturday featured the sprint triathlon, sprint duathlon, aquabike, and "My first triathlon", with the olympic duathlon, aquabike, and triathlon on Sunday. Below is a report on the race overall and my performance individually.


Saturday morning, 6 AM in mid-March was mighty cold, even for Orlando. Temperatures started in the 50s. Fortunately, the race was very organize and prerace setup went off without a hitch. I wished I had picked up my packet earlier, as bike racking in the transition zone was first come first serve. Nonetheless, I found a good spot next to some great guys. This was their first triathlon, so it was interesting to seem them buzzing around as I had been only a few months ago. I quietly put on my wetsuit as I watched them fumble with this or that. One guy was putting on his brand new upper body swim skin. He'd never worn it before, but freaked out when he saw the weather this week and bought it last minute. That's a big no-no in competitive racing, so I've been told. Never try anything new on raceday. After the race, he would prove me right. He said the skin was too tight and he couldn't lift his arms above his shoulders. He had to lay on his back and kick with his legs. He was last out of the water but ended up in the middle 1/3 of his age group.

The walk from the transition zone to the start sucked. It was a good 400 yards. Would we really have to run this back to our bikes after swimming half a mile?!? Unfortunately, yes. But first, we all gathered together on the beach and waited a good while for the fog to clear so we could see the buoys. The air was still pretty cold, but fortunately, the water was warm. Most of us swam around to "loosen up," but mostly we just tried to stay warm. After what seemed like an eternity, we finally started.

Swims for me (at least in my first three triathlons) seem to have two phases. The first phase consists of anger and regret. I am angry that the mass start does not resembled my pristine, quiet training pool. I also immediately regret investing so much time and money in triathlons. Why in the fudge world did I decide to do this? But sometime around halfway through the swim, something clicks. I get my rhythm and start pounding away. I wish I could measure my pace in the first half and second half. Overall, my swim was disappointed: 14+ min half mile. But many people I spoke with had similar frustrations. We decided the course was much more than half a mile. Yeah, that's the ticket! The course was too long!

Sure enough, the run from the lake to the transition zone was still about 400 yards. Dizzy and disoriented, I jogged it as I pulled down the top half of my sleeveless wetsuit and remove my goggles and cap. I make it to my bike, gather my gear, and take off. The bike route is FLAT. However, there were a few places where the road was covered in sand. On one turn, I nearly spun out and slid. Somehow I managed to steady myself. But I was disappointed throughout the whole ride. Despite my off-season training, my speed hadn't improved much at all over last fall. Or at least I thought. According to the official time, my pace had improved from 18 mph to 21 mph. Apparently my computer is off. Time to switch fully to the garmin...

The run after the bike was fantastic. It was on a road traveling through a campground, so there were lots of on lookers and plenty of shade. I was a little upset the run was only 2.8 miles instead of a full 5k. Otherwise, I had no complaints. My goal for the season was an 8:00 min/mile pace on the run, so my 7:20 pace pleasantly surprised me.

After the race, the festival offered free massages and all you could eat bagels and fruit, along with sports drink and water. Very nice set up. Overall, the Wildman Triathlon Festival is a great way to start the triathlon season. I highly recommend it for anyone in and around the Orlando (or Valley, AL) area.