Fog Horns

It's a reset weekend.

After doing mostly 6AM to 2PM or midday shifts, my schedule necessitates my transitioning to an inverse circadian rhythm. After two days off, I have one 2PM to 10PM shift, and then five 10PM to 6AMs. Just like flying across country there are a couple of tricks for adjusting that I'm trying to follow. Today, I:

• Slept until 9:00 AM
• Plan to have a late breakfast
• Am contemplating each toot of a distant foghorn
• Will take a midday bike trip (via BART) to my parents in the East Bay
• Plan to eat dinner as my second meal
  
• Anticipate catching up on my writing late into the night

Tomorrow, I plan to:

• Sleep in even later
• Wait for the (forecasted) morning rain to cease before returning to San Francisco
• Take an evening jog
  
• Eat lunch, dinner and a late night snack
• Study some topics in emergency medicine
  
• Sleep from 1AM to 9AM (Monday)
  

Then I'll have to figure out where is the best place to sleep during the day...

A similar plan worked for me when I flipped from 12 hour day shifts to the converse while working at Harborview. Stay tuned for the outcome.

The Daily Commute

or, "How Biking in San Francisco Reminds Me of Rugby"

After a week of commuting between San Francisco's Haight-Ashbury neighborhood and the Mission by bicycle, it occurred to me why I'm having so much fun going to and coming from work: it reminds me of rugby! Some readers may know that I played rugby for three years at the University of Pittsburgh. It was a club sport and I played on the B-side for all but the last 4 months or so, but I stuck with it because it kept me in shape, I was always learning new strategy and it was certainly a good way to release stress during difficult semesters. After I realized the other night that commuting by cycle provided the same thing for me here, the similarities just kept piling in. Here's my running list:

1. Both are excellent sources of aerobic exercise.
2. Biking safely in SF requires the hyper-alert mental status that keeps a rugger from getting clocked.
3. Ruggers and bikers must remain aggressively protective of their space.
4. This is the first time since rugby I've consistently worn stretch pants.
5. I get up really early to ride.
   
6. I work out late at night.
7. Showers twice a day in odd locations.
8. Climbing Haight St. kind of reminds me of running stairs.
9. Avoid taxis at all costs.
10. "Why are all of my clothes sweaty?"
11. There are some rules that must always be followed and there are others that you can get away with breaking most of the time.
12. There will always be folks who are much faster, in better shape, have more skill and are harder core than I.
    

Well, that's all that comes to mind for now. The bottom line is that I'm having a great time in SF, even if it's mostly consisting of working long hours, staying in to study and commuting between the two. By the way, I found this excellent website that plots a course between A and B on a bike that takes into account hill grade, total distance and more.

Diagnose This

For no apparent reason, I've woken up at 5:15 or 5:30 without an alarm for the past week.

I wonder if this application process is taking a toll on my sleep architecture.

Getting By On Metaphor

I take my metaphor extended, not mixed. Need proof? Read my latest post at The Differential. It's about the residency application and interview process. I'm only at the opening round of the process, and I've already had to lean on allegory. If John Bunyan were a senior medical student, I think he'd approve.

I am only slightly comforted by the fact that my understanding metaphor rules out certain psychiatric diseases. Today was day one of my psychiatry clerkship, and I've already determined that I'm one major depressive episode away from a Bipolar Type II. (Anyone who knows me can appreciate the hypomania I've experienced over the years. I guess I'll just have to settle for cyclothymia. And as my psych attending pointed out today, people don't get admitted for cyclothymia - it's just to close to normal!

By the way, look for additional self diagnoses in the next 6-10 weeks. I hear it's pretty common on the psychiatry clerkship!

Typing My Way Through

I've been typing my way through the dark hours in an effort to maintain the night schedule I'm currently assigned to on my emergency medicine clerkship. Only six shifts remain in this 4 week marathon sprint through emergency medicine. My lists from the ER have grown long with procedures learned, diseases treated, and stories both of pain and resilience. This evening I've bounced between editing my residency application's personal statement, that left-over of a paper from grad school that just can't seem to make its way into print, blog posts here and elsewhere, a presentation about blogging in the public sphere for a meeting of the American Scientific Affiliation, and a few case studies for an ethics class I hope to help teach in the Winter quarter. Typing my way through the night, indeed!


As the morning dusk transitions into the early hues of dawn, I realize that there's more than just productive work going on here. Sunrise has always inspired reflection in me. Context is an important historical factor here: 2 AM weariness has been reliably rewarded with 5 AM ebullience secondary to completing a project or assignment; early rising is often associated with an exciting day's activity; waking up with the sun reminds me of fond camping memories.

Today seems different to me, however. The sun is rising on my day in the context of deliberate introspection. Whether it be blogging recent experiences in the emergency room or dissecting (massacring?) the one-page personal statement, tonight prepped me to reflect on more than just why I do medicine. Why do I write? Why do I love? Why teach? Why make art? Why work so hard?

Maybe it's that built-in ecstasy of the morning, but today the answers to each of these for me is all so clear. And I think it's the same for many people, and especially health care workers.

I seek to make a difference.

In family life. In students' learning. In patients' health. In my own health. In my community. In...

Sure, there are other subtle or specific reasons for doing the things I do, and other large parallel motivations exist for how I carry on and prioritize my activities. My personal faith, for example is a dominating motivator and inspiration for me.

My "a-ha" this morning was due to my realization that each of the major pillars of my sense of self is linked to the other. I write to help myself through the trials of medicine or love. I teach to build understanding - in myself and others - of the interrelation of the human condition through art, science and medicine. Medicine helps inform my writing, teaching, and how I love friends, family and fellow man. I work to fill in gaps that will always persist - in my own understanding, between rich and poor, and between sickness and health.

All of this is too vague and flowery for a personal statement, but nothing's off limits for blogs, right? When it comes down to it, I'm training to be a doctor because I love. Walking along side people for a little while in times when they need help doesn't sound so bad to me as a profession. But balancing self-care and care for others is a trick for anyone invested in others' personal lives. For me, it's a lot easier when the facets of life are tied to central principles.

Interconnectivity of personal purpose has worked for me. Is there a reason I do this or that? For me, the answer is yes even though I'm be able to put my finger on it at the time. For example, I started blogging in the dark days (they usually hit around the third year) of graduate school; writing generated in me a greater comprehension of calling. If only because it was so helpful then, you can expect to find me typing my way through future joys and struggles as well.

And now, I must go wake my wife. My goodnight kiss is her good morning. Today, I'm an alarm clock, too.

If...

If I didn't have sensitive hands...
If I were 5 years younger...
If I wasn't married...
If I could be content doing one thing at a time...
If I could put up with the hierarchy just a little longer...

I would totally pursue a career in cardiac or vascular surgery. In its favor is:

The 'get in there and fix it' mentality,
The meticulous microsurgery,
The dependence on bioengineered technologies,
The adrenaline of cutting open the aorta (on purpose), and
Working on a team.

I suppose I can find those things and a lot more elsewhere. Well except for the cutting open the aorta part...

Religious Man

So I think I have a biphasic energy profile. I wake up pretty easily and am a morning person without caffeine. Then come 5:00 PM, I hit a second wind that may last late into the night. Let's not talk about the hours between Noon and 5... Anyway, I typically hum or whistle under my breath in the morning. Yes - I am one of those people.

One of the interns (a first year resident) on my medical floor team came up to me the other day, and said, "You must be a religious man." Now, I like this doctor. He's a guy from Eastern Washington with whom I can lament our respective alma maters' losing football records. Evidently there's a saying somewhere that, "He who hums is a religious man." Anyone out there know this one? It could be en espanol.

His proverb was accurate, but what about the secular and non-religious hummers out there?

Want to know what I was humming?

If you're going to San Francisco
Be sure to wear some flowers in your hair
If you're going to San Francisco
You're gonna meet some gentle people there

Not exactly a religious song...