A moment of revelation

In an effort to improve my over all health, I decided to plunge back in to the world of regular exercise. It is amazing how poorly us doctors do at taking care of ourselves. The medical field has created this culture of self-neglect. In some aspects, I think the pendulum is swinging a bit. However, life as a resident is built on a firm dictatorial foundation. As in you dictate next to nothing about your life. However, as this year is my "research" year, I felt it was the best time to establish some healthier habits, ones that hopefully I can carry through the next two years after this until I am done and (hopefully) have a little more control over my schedule. As such, I have rediscovered that perhaps running isn't just as insane as I used to think it was. Here is a little secret: I used to hate running. In fact, hate may just not be sufficiently strong to convey my feelings about it. I loathed it. I thought it was evil, a beast that should be chained in the deepest pit of Tartarus. Yeah, not a fan. But biking just wasn't doing it for me. It didn't feel like enough of a workout unless I really went for a while. Still fun, but just not what I was looking for. So I decided I would try running again. I have flirted with running in the past. I have even reached a point where I didn't despise the very thought of it. But I never honestly could say I liked it. Until this morning. Getting back in the swing of things after some sickness and some stress at work, Thanksgiving morning I went for a 5.5 mile run. The most I have done in at least 4 years or so. It hurt. But mentally I was pleased I had done it, even if it was not fun. I have done pretty well since then, running regularly (a well as some cross training with weights, jump rope, etc.) with one other >5 mile run.

I planned to do a 10k this morning.

10k isn't a lot for people who actually run. You know, people who are healthy and in shape. Those sorts of people. But for those like me, you know, us fatties, 10k is a long freaking distance. I mean seriously, moving my meaty frame at a constant jog for 6.2 miles is a pretty big deal. So it took some mental preparation. I knew how far to go, where to turn around and had a sound plan.

0630 this morning I set out. A tad later than I was initially planning, but still early enough. As usual, it felt a little rough for the first kilometer or so. But I kept going and eventually it stopped hurting, and if it didn't feel good, it wasn't at least feeling awful.

Then "it" happened. For the past week the Nike+ sensor in my shoe had been telling me the battery was low. But it had still been working, recording my mileage and telling me when to turn around. Alas, at 3.92k my iPod told me it had stopped recording activity. Yep, my sensor was dead.

I won't lie. There was a part of me that just about turned around then. It would have been 8k, not bad and still a good run.

But I still could listen to music, and I knew when to turn around to make it the full 10k. So I decided to press on. I hit the half-way point and a funny thing happened. I decided to go a little farther. I knew how far to go to add another half mile out, adding a full additional mile to the run. 7.2 miles was sounding pretty good. Still, sitting in the back of my mind was the fact that however far I went away from home, I had that far to go on the return trip.

But I made it. Then another funny thing happened. I decided to go a bit farther. Up, over the pasarela (overpass, but for some reason they will always be pasarelas to me) and up to the High School. There I decided to turn around. I was actually feeling pretty good. Granted, I wasn't setting any speed records, but I was still running my pace and in a groove.

Five miles into the run, with a way to go still the weirdest thing happened. Something I have never felt before. I felt great. Not just good, but great. I'm talking grinning from ear to ear, breathlessly singing along with my iPod, giving high-fives to the low hanging tree branches great. I felt giddy.

I have heard about a "runner's high". Lis talks about them and my dad has even made mention of it. I thought it was fiction. You know, something that runners talk about to fool us regular folk in to running, telling us eventually we will feel it just to keep us going. In short, I thought it was a lie.

Not any more.

I felt higher than a kite this morning. I don't regularly use mind or mood altering substances. I have, on very few occasions, used narcotics while in the throws of passing kidney stones. I hated those. No idea why people would pay good money to feel that way.

But this was different. If I could have bottled this feeling to sell, I would be a millionaire. I felt invincible. I loved it. I crave feeling it again.

Oh dear. Looks like I got my first hit today, and now I am hooked. I just may become something of a junkie. 7.8 miles done, and I was already planning next week's runs. And, yes, I bought a new sensor today.

A healthy dose of empathy

The time quickly approaches. I really only have a few months left as a General Surgery resident. Then I make the transition to Urology resident. To be quite honest, I am incredibly excited. Not only am I incredibly tired of General Surgery, I look forward to focusing my time and energy on what I will be practising for the rest of my life. But yesterday I gained a whole new ability to empathize with my future patients. It was about 8:45 in the morning. I was working on writing some transfer orders for one of our patients. Getting ready to move her out of the ICU, I sat down at the desk with a pile of forms (we can't seem to do anything without forms) and started to write. Then it hit me. Pain. Pain like nothing I have ever experienced. In my right flank. It radiated down, around the side and to my left groin. Maybe that is too much information. Oh well, there it is. I couldn't sit still. Walking hurt, sitting hurt. Anything I did hurt. I knew exactly what it was. I had a kidney stone. I paged the chief resident on our service and told him I thought I had a stone. After I told him my symptoms he agreed. Time to go to the ER. About 30-40 minutes had passed and it was just getting worse. I walked down to the ER, hobbling a bit, and went to the check in desk. They gave me a funny look, here I was, in my scrubs and white coat, embroidered with "Peter J Jones MD" right there on the front. The triage nurse called my name and immediately looked at me with a quizical look. "What are you doing here?" she asked. Yeah, we know each other. See, the General Surgery resident is in the ER a lot. Seeing consults, running traumas, etc. They get to know us pretty well. "I think I have a stone," I told her. I mentioned the symptoms and she took me right to a room. I won't lie, they took really good care of me. Sort of that "care for our own" attitude. The nurse was in immediately, and IV was in my arm along with 30 mg of Toradol. They even went and got me a mobile IV pole, since I just couldn't stand to sit still. A few minutes passed, things were getting worse and I called the nurse back in. "I'm ready for the morphine," I said. He pulled the syringe out of his pocket and I had 4 mg of morphine on board. Holy crap, that is good stuff. I didn't get a buzz (I don't think you really can when you are in real pain), but I felt a lot better. All this happened before the ER doc had even seen me. Honestly, the nurses and aides were great. I gave them a urine sample, and within minutes I was on the table of the CT scanner. I walked back to my room (walking was still preferable to holding still) and grabbed a C.O.W. (computer on wheels), logged in to the medical record system, and pulled up my own CT scan. Maybe there is some HIPAA violation in there. Frankly, I didn't care. I just wanted to know if there truly was a stone or not. As I scroll down the scan, I spot one. A little 2-3 mm white kidney stone. But there was one problem. This was in the upper pole of my left kidney, no the right, where the pain was. I look over at the right side and notice that the right renal pelvis is dilated. So is the right ureter. That means there is something further down the line. I keep scrolling through the scan and sure enough, there it is. Another 2-3 mm stone in the right junction of the ureter and the bladder. Great. Well, at least I knew why I hurt so bad. At least I knew it was real. A few more doses of morphine, a prescription for ibuprofen (the 800 mg tablets) and some Percocet, and a couple of liters of IV fluid later and I was headed home. The pain continued, off and on the rest of the day and into the night. As it is right now, the pain is better, but I still haven't caught that little bugger in my strainer. I have puked a couple of times (first time since High School), and didn't really sleep at all last night. Hopefully tonight will be better. At least I don't hurt nearly as bad. Next time I have a patient with a kidney stone, now I can truly empathize with them. I suppose that is good. Right?