Fifteen miles into a long run, I arrived at the Rose Bowl stadium to complete two laps tagging along several of the Pasadena Pacers runners. Halfway into the first lap a chubby looking man passes me and yells, "Weak sauce!" He then turns around and says, "Remember me Doc?!"

This man was once my patient 18 months ago in the cardiac care unit. I was the senior resident who treated him while he was hospitalized with a nasty anterior MI that required two drug eluding stents. Adding insult to injury, the hospital course was complicated by an ischemic stroke. I was shocked seeing him now... he'd gone from morbid obesity to 'chubby status,' having lost well over 100 pounds in the span of 1.5 years. He flexed his right arm and made a waveform with his hands to demonstrate how the deficits from his lacunar stroke had resolved.

He gave me a hug, thanked me. He said I looked gaunt... We had a good laugh and talked for another half mile. We even ran together for a bit. I gave him a tap in the back and sprinted away, "Hey! you don't look like Peter Griffith anymore!"

inspiration...

Wishing i could adopt this kid...but i figure his Mama is like my Mama...
If it is important to you, you will find a way. 
 If not, you'll find an excuse.

 

 

last day

Cleaned out my locker.
Turned in my pager.
Returned my 'resident physician' badge.
Gave back my white coat.
Got a fancy diploma.
Taught an intern how to manage and work up an acute splenic infarct.
Walked out of the hospital quietly...
   Holding in my hands a miniature 'The Flash' doll--a treasured gift.
          Thinking most of all...on how things end. How memories last forever.
                  Starkly reminded how the most meaningful part of all happened October 31, 2013-October 31, 2104, precisely.
                        Prayed to Him, 'take me to a place where doors are open, a lovely little place where no one is broken."
                              How I ended somewhere on 34th street, I don't know, but
                                   Instead I ran 15 miles in Santa Monica; running as if fleeing from a ghost from Taiwan
                                        Running--meditating in motion                                         
                                                 Meditating on Neruda's Sonnet XVII, on why its true; why i still believe in it.

                                  
                                      

                            
                     

"Fathers Day Run" (Half Marathon 13.1 miles); Van Nuys, CA

 PR 1:37

Cherishing the memory of my old man on this special day.
Sometimes the most humble, unprivileged man can give his children the priceless most treasured inheritance imaginable.
Thank you Dad... Porque a pesar de todo lo que paso sigo adelante.

"When I was a boy of fourteen, my father was so ignorant I could hardly stand to have the old man around. But when I got to be twenty-one, I was astonished at how much the old man had learned in seven years."     - Mark Twain

http://www.abetterworldrunning.com/#!fathers-day-results-62115/ctmo

My last "overnight call" of residency

Residency is arguably the hardest and most unforgettable phase of someone's medical career:

... the exhaustion... the bonds you create with your fellow trainees... the drama... the way your skin gets thicker... the blunders... the procedures... the tears no one gets to see... the skills... your first needle stick injury... the chaos... the patient you publish into a case report... the miracles... the facial hair phase of my career... the tragedies... families who will love you forever... families who want to crucify you...
The precision... wearing scrubs (aka pajamas) on most days... eating, sleeping, and showering in the hospital... the confusion... the patient who thinks they're in love with you... the patient who blames you for everything... the youngest patient you've lost... the centenarian that never seems to die... being reprimanded for charting "condition at discharge: Alive, but without my permission."...

The patient you wish you'd never seen... the double Facepalm when the Fail is so strong, one Facepalm is not enough... losing your faith in humanity and having it restored... losing the love of your life... realizing that no one looks back on their life and remembers the nights they had plenty of sleep.

They say life is dramatically better as an Attending physician, we'll see about that.
As I look into the future, all I think about these days is October 31, 2015.

found this gem

“Love knows not its own depth until the hour of separation.”

"One day you will ask me which is more important? My life or yours? I will say mine...and you will walk away not knowing that you are my life.” 

"And what is it to work with love? It is to weave the cloth with threads drawn from your heart, even as if your beloved were to wear that cloth."

"Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.”

-Kahlil Gibram

on trail running

Figuratively speaking, all of us have mountains to climb. I've been running up them summits many times ever since that certain solid fragrance left to Santa Monica and beyond... I'd like to think I'm done climbing those kind of mountains but I find a degree of comfort in knowing that some mountains are meant to be climbed.  As you ascend and descend each peak you come to the stark realization that mountains are so unforgiving.

I'm a sucker for punishment, i don't know, but the devil on my shoulder says, "the perfect place to fight your demons is running up a mountain." You'd think that when you're alone, the monsters in your head would come to say "Hello," but this is not true... In most instances you're a victim of your own mind. There is never a dull moment up there; there are no distractions, rattlesnakes will keep you vigilant. It's true what they say-- the best views come after the hardest climbs.
Without realizing it, I've been training for my next marathon.
What fuels the fire inside us?

subconjunctival hemorrhages

The most beautiful brutality I have ever seen has taken place inside a boxing ring.
I'm not embarrassed to admit that I've been put to sleep in the past, and by the very same token, I've brought others to their knees. I'm neither proud or ashamed of it. I admire the courage and grit of the pugilist and I can watch or partake in a match with reverence and humility, but as to why people rejoice in the suffering of another human being is beyond me... It is true that in the heat of the moment one can become numb or unperturbed to pain inflicted upon others, but still there is nothing noble in being superior to your opponent. At one time, in my search of something higher, I thought boxing could help me in some twisted way. For a very long time, I've associated boxing to the realm of redemption or second chances and with defeating opponents to prove ones worth-- a reason for why I've felt strangely attracted to it. But I was mistaken. 

First, true nobility lies only in being superior to your former self, and secondly, you can't redeem your past inside a boxing ring. Besides, it must look ridiculous to have a doctor counsel you on healthy lifestyle habits with subconjunctival hemorrhages and cuts above his eyebrow.

lost heart beats

As internal medicine physicians we have many drugs at our disposal-- medicines to treat, diagnose, and prevent countless diseases. But amid all the emotional suffering and physical pain, the spirit of a man can only endure so much and when it is broken only a miracle can mend it. If only there was a drug that could heal a broken spirit...perhaps the most effective medicine we have is what some call "Love unconditional." I lost a young patient this week...

There are things in life that once they've been lost, you can't recover-- each lost heartbeat after minutes of CPR... the trust after its lost.

Still, I wonder what is redemption and its relationship to Love-- the kind which JC talks about in the gospels-- where does it come from and how does it work?

Memories flash incessantly throughout most of my long runs 
Like in the marathon
 each time at the intersection of Santa Monica and N Crescent Drive
my chest feels tight and my eyes began tear
-Learning so much over the past 5 months-

early morning ascent

During a 4:30am night run to Mount Lowe, on my steady ascent to the summit, I began to think about the strange presence in my apartment--it must be a ghost. Indeed, it is a ghost from Taiwan. A beautiful ghost with more soul and love than the hollow substance that beats within my chest. As I watch the sunrise from 5600ft above sea level and I ponder whether to jump into new waters, I realize with a most heavy heart how much this ghost means to me...  I'm attached to it, for better or worse. A reckless man who searches for redemption realizes that to live with ghosts requires solitude.

Gems

 



Old used book stores and thrift/antique stores are amazing places...the randomness and intrigue that comes with finding a literary gem makes it a worthwhile experience. These days on my spare time I'll dedicate a few hours looking for these "gems." For example, to the left is the fascinating back cover of a random book--  I still couldn't tell you what this book is about lol... or whether its truly a gem or not, but inside it was a remarkable quote that stayed with me:

Los Angeles Marathon (26.2 miles)

Look I'll be honest, at mile 23 I'm not thinking very clear. The blisters on my feet sting, my right knee is locking up, and my stomach is aching. At the intersection of Santa Monica and N Crescent Drive my chest felt tight and my eyes began tear. From mile 24 onwards I'm reliving a boat ride across the Coronado Bay in the presence of an Angel--the beauty of the ocean and the sound of her voice. Around mile 25 I began to wonder why the hell Michael Buble was singing on my ipod Nano, then i remembered why...can man destroy that which destroys him? I'm working on it relentlessly.

I've been running so much that the skin on the soles of my feet has torn apart. Blisters have formed. I've embraced the pain for no real reason, but for reasons known only to my remorseful heart-- every time i run (though i do it without purpose or direction) these damaged feet take me toward Santa Monica.  As if someone was there...waiting, praying. 

It's wishful thinking...and so it happens that running these past 5 months has taught me several things-- mainly that the mix of tears and sweat tastes exactly the same. There is so much more I need to learn from my mistakes.

In Loving Memory

It's been five years since you passed away.
Your absence still stings.
You filled a space that no one will ever replace.
What I would give, if I could say, "Hello Dad" in the same old way.
The greatest gift I've ever received came from you...
You believed in me.


"What was silent in the father speaks in the son, and often I have found in the son the unveiled secret of the father."
.

Hiking Echo Mountain

So i started logging some miles this week, I've been averaging 6 miles/day running on a boring treadmill like a manic hamster. To mix it up a little I decided to hike a local mountain- Echo Mountain.

The trail head located on Lake Ave.

First is finding the Trailhead: From the I-210 Foothill Freeway in Pasadena, you exit at Lake Avenue. Drive north for 3.4 miles to the end of Lake Avenue. Park along the street. The hike begins to the left of the stone gateway on the east side of the street. There is an old post pointing the direction to the old peak. 

The total distance is roughly 5 miles roundtrip with an elevation of 1400 ft. I would say the difficulty of this hike was "mild to moderate"-- the trail is well maintained without much wildlife (i.e. not many snakes or cougars crawling around). I say this because a few months back I hiked Mt. Wilson in the Los Angeles National Forest from the trailhead in Sierra Madre and came across two rattle snakes and one brown bear on the way up the peak-- i contemplated terminating my hike that time but meh...finished it anyways with many catecholamines circulating in my blood.

Echo Mountain Megaphone

The total hike time for Echo Mountain is roughly 3 hours at a moderate pace. Once you reach the top you will encounter the amazing echo megaphone. Scattered along the top are various posts detailing the rich history of the mountain, specifically the ruins of an old resort. This particular day had overcast weather but on a clear day, you can see the Pacific Ocean, downtown LA, Santa Monica, and even Catalina -- all gorgeous views.

I must say that i was impressed by the large number of senior citizens that were hiking this particular mountain, particularly Korean folks, lol. They were hiking like pros while I was sweating bullets. At any rate the best part of the hike was reaching the top and eating my sandwich.   

"No one ever drowned in sweat" - Lou Holtz

"That day, for no particular reason, I decided to go for a little run..."

I woke up this morning with a powerful urge to run, so i ran. 

I donned my pajamas (sweatpants and an old Jesus T-shirt I had won in a raffle a long time ago...) and ran alongside the Los Angeles river ... no thinking, no worries, no distractions, no depressing thoughts... just running. Somewhere around mile #4 it dawned on me--- this is something I've been missing greatly.
 
This blog is bound to change from a log of my experiences through medical school and residency into a log of running in Los Angeles. There are beaches, mountains, rivers, and plenty of trails in this great city. 

Lets explore.

Long days in the ICU

There is a methodical approach to pronouncing someone as "Dead." This in itself isn't very difficult to do once you've done it more than a few times. Pondering on the existential or metaphysical meaning of being "dead" is more complex and doing so might take you to uncomfortable places. Still each of us can embrace its meaning depending on our religious or existential stance. However, by far the most uncomfortable and difficult part of all is standing in front of a grieving family and explaining how despite all efforts, you have failed at "saving" their love one. The family standing there expecting you to save them as if it's possible to turn back time-- like if you're some kind of god.

After breaking bones and inserting tubes in every hole you can imagine... You walk out from these rooms feeling defeated.

Then it happens that just when you're about to sit and ponder with hindsight how differently you could've managed the patient, you're interrupted by a loud intercom calling, "Code Blue, room XXX." Someone is about to pass into that bright light and you're being summoned to bring them back---for better or worse... I reckon it's better to remain occupied and physically exhausted than sitting down feeling sorry for yourself. I'm reminded of that box from two years ago...

I never saw a wild thing sorry for itself.
A small bird will drop frozen dead from a bough
without ever having felt sorry for itself

                          -DH Lawrence

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Regrese

So it’s been six months since I last posted anything on this blog...

Although I anticipated ending my experience as a blogger six months ago in lieu of the crazy grind that marks the beginning of residency, writing on this site has cemented my belief in the value of cathartic writing. Also to my surprise, these posts have on occasions helped folks who are curious about random medical topics.

I’m back.