Living The Dream

I've started doing something that I've wanted to do since I was 9-years old, to learn to fly. When I was growing up I dreamed of being an Air Force fighter pilot. My adolescent career path had me attending the US Air Force Academy in Colorado Springs, which in my opinion was the most efficient way of getting me into the cockpit of an F-16. When it came time to start getting my ducks in order and to apply for a Congressional nomination, I did not. I chose to listen to people around me stating that it was almost impossible to get in, that my grades were not up to par, that I wasn't doing enough extracurricular "stuff", or that the odds were too long. In the end I walked away from my dreams of being a pilot.

Oddly enough, years later when I was a Green Beret officer I met several Air Force and Naval aviators, only to discover that they were no different than me; not any smarter, no less motivated, and often less skilled. I painfully realized my error of youth, I let someone talk me out of something that I desperately wanted, and since that time I've counseled countless young adults to never let it happen to them. "Never, ever let someone talk you out of your dreams".

So here I am thirty years later making amends and finally living the dream.

Guinness and Atrophy

I completed my last triathlon of the '09 season sixty days ago, and at the end of the race I was not only physically exhausted but mentally burnt out as well. The endless days and weeks of 2-3 workouts a day had taken their toll, and as I crossed the finish line I told myself that I was done, that the next workout will be sometime in January.

For the last two months I've eaten anything that I wished, tipped back a bunch of Guinness and Laphroaig, and worked on other interests like bagpiping and getting my private pilots license. Last night I had a huge bowl of cookie-dough ice cream, the tan lines have all faded and the hair on my legs has returned with abandon.

This morning before dawn I laced up the running shoes for the first time, and headed out on a run that two months ago would have been so inconsequential that I would have passed on it; 4 miles nice and easy. I was shocked to see how much my condition had atrophied in the weeks that I had taken off. My knees hurt due to the muscle imbalance in my legs, my core was all over the map, and leg muscles were string-tight threatening to pull at any moment. At 46-years old I can see now how fleeting physical condition is.

Five to six hours a week; that's what I've now promised myself until January, enough to stop the free-fall of my physical condition. If not, it'll be a long, painful haul back into race shape for an early season half-Ironman.

A Life

“Far better it is to dare mighty things, to win glorious triumphs, even though checkered by failure, than to rank with those poor spirits who neither enjoy much nor suffer much, because they live in that grey twilight that knows neither victory nor defeat.”
-Theodore Roosevelt

Karma's A Bitch

An elderly woman lies strapped to a bed in the emergency room. She's taken a fall at her house and has severe injuries to her face and head. She is alone in the room; tubes and monitor wires run out from underneath the sheet that is supposed to keep her warm. The monitor glows green with her "numbers", and the 1,000 cc bag of normal saline has almost run it's course.

In her loneliness she cries out in pain, begging God, or anyone for that matter, to help her. Tears run down her cheeks. The neck collar prevents her head from moving but her aged eyes move back and forth searching for someone that can alleviate her pain. Moans turn into screams...desperation and agony set in.

I asked the nurse if we couldn't give the elderly lady something to make her more comfortable. Through the backdrop of screams the indignant nurse informs me that "She's 90-something years old, she doesn't feel any pain", and makes her way to another room. Huh?

I walked into the Doctor's Lounge and found the attending physician. "I'm giving the lady in Room 6 five of morphine". The doctor looked up from what he was reading, "OK".

I demanded the morphine from the same nurse, invoking the physician's orders and soon the patient was blissfully asleep.

I've run into this grotesque attitude before from nurses, physicians, paramedics, and all other manner of heath care "professionals"; that of compassion equates to weakness and inexperience. Many try to pretend that they are so endowed with medical knowledge and experience that only they can recognize the true medical emergencies worthy of their limited compassion. All others are pushed to the curb, compassion be damned. Karma's a bitch!

"They'll Fight Over It When You're Dead".

I ran across a signature in a blog the other day that stated, "When discussing the shelf life of Twinkies, the limiting factor is the life of the shelf". This made me laugh because I've always been attracted to things that are designed to last longer than I am.

Not too long ago I discovered Saddleback Leather's briefcase; 100-year guarantee. I think I just bought a present for my great-grandson (or daughter). I hope they enjoy it.

Happy Birthday

Maine in the fall. I love the crisp air that bites at you in the early morning and the leaves under feet.

I was speaking with a fellow paramedic yesterday and we were relating calls that just make you cringe. As a very senior medic, hers won. Apparently she had been called to the scene of a domestic dispute where an intoxicated guy threatened to cut his unborn child out of his 24-week pregnant girlfriend. In his rage he broke a beer bottle and sliced open the girl's abdomen.

When the paramedic arrived the police had the guy in handcuffs, and the girl was taking her last breaths as she lay in a massive sea of blood. The crew quickly loaded the woman in the ambulance and rushed the 30+ miles to the hospital, doing CPR the entire way on the obviously dead woman in an effort to supply enough oxygenated blood to the tiny fetus struggling inside.

When they arrived at the hospital the surgeons completed the cesarian section and delivered the fetus, about the size of a small hand.

That fetus is a 24-year old woman today. Simply awesome.

Sunset

The sun sets into the Jordanian desert.

I just got back from a week of working as a paramedic on the 911 trucks in extreme rural Georgia. To say that it was "eye-opening" would be both a cliché and an understatement. I worked hard, pulling some long shifts on sparsely equipped ambulances; treating and transporting patients to distant, austere emergency rooms.

No one particular patient stands out from the dozens and dozens that I treated. I know that two had died despite my best efforts. I'm still struck by the fact that I don't remember them, even though I was there beside them for the second most important day of their lives. I know that I tried, desperately to breath life back into limp bodies, pushing countless medications, electrical shocks, CPR, oxygen. Repeat over and over again, looking for the right bleep on the cardiac monitor or the faintest of pulses. They never came. The end of someone's life is best described as a whisper and not a thunder clap. They go quietly despite your pleas otherwise.

Don't Do It!

A helmet rests on a the handlebars of a San Francisco police motorcycle. Note that the officer secured the helmet with his handcuffs.

There has been a rash of break-ins in our neighborhood lately. People are forcing their way into homes in the late evenings and quickly taking what they can get their hands on. Fortunately no one has been home during these unfortunate events.

I'm disturbed by what I may have to do should we fall victim to a home invasion like this. I've decided that I would let them take whatever they want, but I will not risk for a moment my family's health and safety over the event. Certainly there must be a better way to make a living as a criminal than entering a dark house with an unknown floor plan, and possibly finding an armed, well-trained home owner inside. I can't imagine such a stupid undertaking.

Michelle

Today is my wife's birthday, and I had this shot framed for her office wall. First day of school, an emotional moment for both Mom and son.

A Buddhist in Church

Turtles sunning themselves on a log inside a San Francisco garden. Does having a buddha nature make the turtles Buddhist?

I attended my brother's wedding this weekend in a small chapel just outside of Raleigh, North Carolina. The ceremony was nice, small and non-denominational; and as I stood there looking around at the trappings of Christendom I examined my own thoughts and feelings. My initial impression was, "I'm Buddhist and not Christian, so I'll just sort of suffer through all of the Bible stuff." I immediately recognized this as 1) not being very Buddhist, and 2) teetering on the edge of religious snobbery at best, and intolerance at worst.

My thoughts and feelings as I stood there embarrassed me, and I believe this stemmed from my attachment to being Buddhist, or moreover, non-Christian. If I had a truly open and receiving mind I would have found the grace in my surroundings and not all of these mixed up feelings of conflict and intolerance. Nice lesson learned. I need to explore it more deeply.

Adventures With A Wiggly Buddha

My son has started kindergarten and is a few weeks into it so far. He's doing well, but finds himself in trouble every once in a while for being "wiggly". I take that to mean that he can't sit still when he's supposed to.

I Googled "wiggly kids" and got back a plethora of ADHD stuff, which astounded me to say the least. I don't think that he needs Ritalin (methylphenidate); he needs to learn to sit in stillness, or relative five-year old stillness. Ahhh, this is something that I can show him how to do.

Every morning before school and at night prior to bedtime the two of us retreat into our home's little tatami-matted meditation space. He climbs up onto a cushion, easily folds his legs underneath himself, and places his tiny hands in the cosmic mudra. There we sit, slowly counting our mutual breaths. When he moves or "wiggles" we quietly start over. After a while he settles into it and sits there waiting for the next breath to appear.

When he's done he gets to sound the gong three times, bows in gasho, and quietly walks out of the room.

Last week he came home with a perfect report card. He was not spoken to once for being "wiggly". This week we're on the same trajectory.

No, I don't think a five-year old is going to grasp the Diamond Sutra any time soon, but he can learn to sit in stillness, to know what it feels like simply to sit and pay attention to what's in front of you. What a great life-skill!!

A Wee Bit Backwards

"If you're young and not a liberal, you have no heart; if you're old and not a conservative, you have no brain."

— Winston Churchill

I appear to be living my life backwards. Sorry Winnie.

When I was younger it was business school, MBA and the like. Now its more akin to medicine in austere environments and Buddhist studies. Growth? I guess it depends on perspective.

#2363 - Final Thoughts

Taken by my wife at the finish line.

Final thoughts on Ironman. I completed the event in the top third of the field, and am happy with that. It was a long and painful day, especially running the marathon after putting out so much effort on the 112-mile bike route. I struggled with every mile, and they seemed to get longer and longer as the race wore on. In the end, I was happy to cross the finish line, to see my wife and five-year old son waiting for me, along with a few thousand other people.

The best part for me is that my triathlon season is finally over. My next scheduled work out is some time in... January. I've spent countless hours training for this season, lately putting in 4-6 hours a day. I'm burnt out and need a break. I hear a set of bagpipes calling me along with their friend, a pint of Guinness.

On a side note:

Jeff posted a comment about Ironman saying, "That's crazy, I could never do that". Sorry buddy but I have to disagree with you. With a certain amount of training anyone can complete the event. Sure you may not win the race, but winning is really a relative thing anyways. Your only opponent is not the girl or guy ahead of you on the bike course, but rather it's the little, nagging voice in your head that is telling you, "This is crazy, I can never do this".

#2363 - Part II

A worn bike rack sticker marks the location of a previous racer in an Ironman past. I wonder how Tod did?

Fifteen hours before race start, athletes begin to disappear from the streets. No longer are they jetting about on their bikes or running the last few miles. Training is over, it's time to rest, to prepare for the mental and physical challenge that is most rapidly approaching. Most are shrinking within themselves, looking for moments of peace and tranquility.

The Ironman roadies are working to transform Louisville's Fourth Street into the the race's finishing line. Streets are closed off, tents, flags, lights, carpets, music, all worthy of a Hollywood movie production. I looked at the worn carpet that marks the finishing line and couldn't help but wonder how many people have struggled to cross over it. How many people have spent months and months of their lives working and training; countless solo miles, following the endless black line in the pool, all to just arrive at this very same place?

A quiet night tonight. 0430 will come early enough.

#2363

I'm bib number 2363, out of some 2,500 triathletes that have arrived at the shores of the Ohio river here in Louisville, Kentucky. In addition to the racers there are almost 3,000 people volunteering to help out with the race, and an untold number of family members, well-wishers, merchants, and the just plan curious. In total Ironman is a huge spectacle that begins days before the starting gun goes off.

An athlete gives his bike a nervous final check-out.

24-hours before the race begins the city streets and hotels are filled with lycra-clad athletes doing their final tune-ups. Some of the best aero-dynamic carbon fiber that money can buy is zipping up and down the roads, propelled by lean, tan athletes that have poured their heart, soul and wallet into the last several months of training. I joked with one of the locals that, "Yup, Ironman has come to town, and you won't find a single hairy leg for five miles around".

I'm nervous, but then again I've always been that way before any athletic event. I used to be just as anxious before I took my "every six month" Army physical fitness test back when I was serving. I know that once I get into the water and find my stroke that it will become just another long training day for me, albeit with 2,500 of my closest friends.

More to follow.

Practice swim in the Ohio river. I opted not to do this as the conditions of the river are "questionable". It's not complicated... just follow the big orange buoys.

Not An Auspicious Start

The ancient redwoods of Muir Woods outside of San Francisco

First call of the morning. It's early, about 0600. I'm working on a large cup of Dunkin Doughnuts coffee, and my partner for the day is driving the ambulance. We respond to a low-rent "hotel" to a woman with pregnancy complications.

Upon arrival we're met by the fire department who have been on-scene for a few minutes. The patient is in bed on the second floor the hotel, and clearly displeased with more than a few things. She's "insisting" on going to the hospital RIGHT NOW and is demanding an ambulance and a paramedic to take her there. When I tell her that I'm the paramedic she tells me that there's no need for an assessment, exam, or conversation. She wants to go now!

In the ambulance she balks at an IV, but I hold my ground and tell her its required. I decide to let my EMT partner "tech" the call while I drive to the hospital 20+ miles away. During the trip her boyfriend sits next to me in the front seat and insists that we drive faster. "What, no lights and sirens?" In the back I hear the patient criticizing everything that my partner is doing. I know that my partner has a short fuse for rudeness and I'm waiting to hear her go off. She keeps her cool.

In the hospital there's no need for registration or nurses, the patient wants a physician...NOW. She refuses to move off my stretcher onto a bed, which ties me up in the hospital longer than I wanted to be there. The nurses are frustrated because they can't do their job. I reclaim my stretcher and beat feet with my partner.

In the end, the patient will not pay a dime for the care that she received, regardless how substandard she thought it was. No insurance, no job; she will never even see a bill. A half a dozen firemen, a fire engine, an EMT, a paramedic, an ambulance in the early morning; nurses, hospital administration, lab technicians, and a physician... all for free. I'm saddened that there wasn't an ounce of gratitude for anyone's efforts. I failed to hear a "thank you" or a word of appreciation the entire time. Not an auspicious start to the day.

First of Countless

First day of school today for our wee one. He was a champ getting out of the car all by himself and walking in. His mother, on the other hand, was another story.

At times I forget how lucky we are to be able to send our children to school, taking it for granted almost. I know that in many places around the globe the opportunity to sit in a classroom is a luxury; children walking for miles through all sorts of conditions, families burdened by the absence of the child from the daily work. I somehow need to impart this fact on my own little student, but I fear that it's a lesson beyond him right now.

Anger Into Wattage

Street performer in San Francisco

I had an interesting situation today, wrought with all sorts of "teachable moments". Let me preface by saying that triathlon is a lonely sport, it's participants spend endless hours training and competing alone. Sure you can run or ride with other people, but chances are they're not doing the exact workout that you need to do, so you inevitably head out on you're own. Swimming just speaks for itself. Having said that, when triathletes get an opportunity to socialize, they normally jump at it. Contact with other endurance geeks fosters conversation about upcoming races, the latest in lightweight aerodynamic gadgets, and comparing training plans.

Today I was out on a solo bike ride and nearing my turn around point on the out-and-back course. Just then, three triathletes came ripping the other way in a tight, fast-moving pace-line. Why triathletes are in a paceline is another issue, as it's illegal in races. My initial thought was to try to catch them and maybe have a chat that would make the remaining miles fly by. As they disappeared up the road I heard a male voice make some snide comment about a piece of gear that I was wearing. I was testing out a new aerodynamic helmet in preparation for a coming race. I felt the pangs of resentment start to rise, but pushed on to see if I could catch up.

Let me say, a solo rider trying to catch a well-organized paceline is no easy feat. The three riders can ride at a high speed using 30% less energy than it would take a soloist ride at the same speed. Nonetheless, after a mile or so I finally grabbed the rear wheel of the trail rider. I noticed that the rider was a female, and so was the lead rider. The middle guy was fit looking, and I identified him as Mr. Snide Comment.

I decided to play nice and introduced myself; I asked if I could join the effort. The guy, to my utter amazement, shook his head, "No". I have never in twenty years of cycling been told that I couldn't join a ride. It's sacrilegious not to allow a lone rider to join a group. The protocol is that if the group is faster, than the rider will eventually fall off the back. If the rider is faster, he/she will eventually push ahead of the group. To be told "no" is unheard of.

One of the girls spoke up and pleaded to Mr. Comment to let me join. He replied that I could if I went to the front and pulled the three of them. On that, I went to the front... and just kept on going. The group fell off my wheel and I contently left them in the hills. I watched my anger seethe and my ego swell as the three of them just couldn't keep up. For the first time I rode with anger, turning it into useful wattage and speed. I struggled with my anger, recognized it, letting it force my pedals around faster and faster. I'm not sure if I did the right thing or not, but it felt good nonetheless.

My Motivation

A runner fights his way across the San Francisco's Golden Gate Bridge.

Ever see those motivational posters with the inspiring photography and pithy sayings? I've always given them a passing glance, testing them, but never really embracing any of them. It got me thinking the other day of what would be my own motivational saying; something that resonates with me? I think if I had to choose I would steal a quote from Lance Armstrong, "Pain is temporary, quitting is forever". I've often thought of this during races when it would be so easy to let off the gas and end the pain, or at least temporarily relieve it. As I suspect with Lance as well, it's gotten me through some tough spots, allowing me to persevere and push through to the very end.

Bug Squishers

Buddha statue in a San Francisco garden.

Empathy is the seed of compassion, the one emotion that I want to imbue on my 5-year old son. I believe that with empathy towards himself and others that he will grow to be a more caring and loving individual; every parent's dream. All that is fine and good, but how do you teach a 5-year old empathy, especially when they're so ego-centric? This is my koan. My wife pointed out that both my son and I can learn empathy together, since we're both equally lacking. It's always reassuring to find out that your spouse thinks you have the emotional maturity of a 5-year old, but that's another subject in it's own right.

The best teacher is experience. Children learn by observing and doing, which means that he must observe empathy before he can practice it. We try hard help him identify his own feelings at any given time, and ask him if he can guess how others feel. "What about the bug that you just squished?" Right now it all comes down to physical discomfort, which is easier for a 5-year old to identify with, everything is black and white. Later we hope that he can identify emotional suffering in both himself and others, and truly associate his feelings' sort of the First Noble Truth for 5-year olds.

Urban Violence

Looking skyward on the Golden Gate Bridge.

Called to a 12-year old boy, gunshot in the chest. Lights and sirens, moving through traffic as quickly as we can; arriving we find three fire engines, four police cars, and fifty some-odd people gathered around on the grass. In the stairwell lies a young African-American boy in a puddle of his own blood. Firemen are viciously pumping on his tiny chest, sweat pouring down their faces. A hole the size of his little fist is evident on the left side of his chest. No pulses, or breaths; pupils are dilated and non-reactive. It seems futile but we work him as hard as we can. He's pronounced in the ER within moments of arrival.

Urban violence was something that I was never exposed to both as a youth and even later as an adult. It's reality is stark and obscene, and you don't know wether to cry or scream as you stare at it's aftermath. You're angry at everyone involved, even the victim himself draws your ire.

A Win-Win For Everyone

I brought a patient into the ER the other night and found myself right in the middle of a classic EMS conundrum; that of a dramatically improved patient. My patient had had a severe allergic reaction and was all but unconscious, laying on the floor when we arrived at the scene. There was no family around that could give me any history to my patient's condition so I was forced to treat based on presentation using my best clinical judgment.

The treatment for anaphylaxis is pretty straight forward and after forming my clinical impression I immediately began administering the appropriate medications. During the 10- minute trip into the hospital the patient began to "come around" and answer my questions; by the time I got her in front of a young (and new) PA she was wide awake and sitting up in bed. The PA then proceeded to take 20 minutes and interview the patient about her current condition and past medical history, a luxury I that never had. In the end the PA, in an entirely too condescending attitude, began to question my treatment as being overly aggressive.

I took this experience as an opportunity to exam my ego. My initial reaction was to become defensive about my treatment of the patient and lash out in a retaliatory attack against the self-important PA. Staying in the moment I recognized what was going on and thanked the PA for her guidance/input, and left to do my paperwork; a win-win for everyone involved.

Time Management

Triathlon season is going full-force. The immense amount of training is taking up almost all of my free time; what little is left over from working on a 911 ambulance over 40 hours a week. My family is being supportive, seeing me wander into the house after working all night, and then heading off to a scheduled workout. I'm not truly sure why I do this, maybe I need to look deeper into my motivations. It shouldn't be hard to do, I'm not all that complicated.

Restlessness

My first race of the '09 triathlon season is tomorrow morning; the gun goes off at 7:30 on a 70.3-mile endurance event. I'm jittery, I always am before a race regardless of its size or importance.

I started preparing for this season back in November, now all of a sudden its staring me in the face. The normal questions run through my mind and will likely cause a fitful sleep tonight. Did I train enough? Could I have done things better? Is all of my equipment present and in good order? These worries will plague me right up until race start. Once the gun goes off and I'm moving through the water towards the first buoy it'll all be on automatic pilot. The hard part is over, now it's time to just let muscle memory do it's thing.

My biggest concern is leaving my race out there on the bike course. In other words hammering so hard on the bike that I have nothing left for the 13 plus-mile run. I've done this twice before, and frankly its a rookie mistake. I'd love to finish with a strong run, but it means having my ego cede a bit on the bike. That'll be my biggest challenge. We'll see.

Post Script: I went 5:29 for the race, and placed very high in my age group. I may have even won it, I'm not sure. The swim was a mess as I haven't done ANY open water swimming and was drifting all over the place. The bike was very fast and by far my strongest event, even on the extremely hilly course. As predicted I had a hard time tempering myself on the bike and paid for it dearly with one of the most painful and agonizing runs of my triathlon career.

All-in-all I was happy with the race as my season opener. Next weekend I race in Peachtree City, Georgia.

Maybe Not

If you're sitting quietly watching your thoughts as they arise and then fall away, who or what is doing the watching? It adds a twist to Descartes', "I think therefor I am". Not so fast there René.

Attachment To Carbon Fiber

This is a tough one; attachment. In short, the Buddha said that all human suffering results from attachments; not just attachment to things, but also to ideas, points of view, concepts, etc... I'm attached to my bike, which has actually been a good thing as my new hunk of aerodynamic-molded carbon fiber has allowed me to examine my attachments more closely.

The thought of crashing, theft, flipping off the top of the car while driving down the highway have all resulted in excessive worry. The amount of money that I spent equals guilt, and the recognition of my attachment has spawned embarrassment. All of these things are forms of human suffering.

All of this is not to say that Buddhists shouldn't have nice bikes, but rather care and contemplation should be given to the attachments that they may form. This is my current struggle.

Beat Me, Please

A sea lion suns itself on San Francisco's Pier 39. In retrospect, probably not the right image for the title of this post.

I've been an athlete for as long as I can remember, and all of that time I've been balancing my athletic performance against my ego. At times, especially when I was younger, I was wildly unsuccessful and let my ego run amok much to my detriment as a person and a friend.

When given a choice between competing or practicing with those that are better than I was or playing with a group that is not quite as fast or strong, I always chose the later, simply because it made my ego feel better. I remember one evening getting in the pool with the Masters Swimming program at the University of Miami, the pool was filled with ex-Olympic and competitive NCAA swimmers. Needless to say I got my ass handed to me, and never returned; my ego got bent. If I had stuck it out I would surely be a better swimmer today for it.

At 45-years old, I can see what's happening now. If my ego gets slapped around a little; well, that's a good thing. It deserves the beating.

The Big Sit

I've decided to take on Tricycle magazine's 90-day Zen Meditation Challenge. I haven't been sitting much lately, and this "Commit To Sit" seems to strike the right Type-A cords in my life. Here's what it entails:

- Sit in formal meditation (zazen) for 20 minutes each day.
- Listen to one dharma talk online each week.
- Study Dogen's Genjokoan.
- Commit to the sixteen bodhisattva precepts

I try desperately to maintain a balance between my intellectual, physical, and spiritual pursuits, but sometimes I get a bit out of whack, like I am now. I've just spent almost twenty weeks dedicated to my paramedic certifications, I'm training like a fiend for the upcoming triathlon season, but I've let my spiritual side slide a bit. Time to bring things back into shape.

Taking The Tuition Leap

After a bachelor's degree and two different masters degrees I like to tell people that "I'm educated far beyond my intelligence". This normally elicits a chuckle upon the realization of the difference between education and intelligence. I chide my wife that I'm "one up" in the degree count, which annoys her to no end since I'm a proud product of a rural public school system and she comes from many years of elite private schooling. Trust me, she's pretty quick to point out the education-intelligence mismatch as well, and I sometimes think that she would tattoo it on my forehead if she could.

In all honesty I do think the link between formal education and intelligence is tenuous. I've meet some people that just barely got out of high school and can intellectually man-handle me with abandon. On the other hand, I've met PhD candidates that didn't know enough (or care) to brush their teeth in the morning. So what does thousands of dollars of formal education buy you? Firstly, I think there's a bit of "right of passage" there. In other words, "That's the route I came up from, so you have to follow". Secondly, I think that it's a measure of commitment to one's chosen vocation. If you're going to drop untold amounts of money and many years of your life on becoming a physician, then most can rest assured that you're serious about medicine. The final argument is, it's better to be safe than sorry. Few have not gotten hired for being over-educated.

So as I stare are my 5-year old's first tuition bill I take heart that he'll at least have a good start. Where he goes from will be influenced by many factors, not the least of which is himself. My wife and I promise to do our part, but in the end I want him to have the tools to be happy in life. It's the intelligent thing to do.

Messengers, Free Runners, and Paramedics

I had one of those life-reflecting ahhhh moments this morning driving to school. In the early morning light a bicycle messenger darted past my Jeep on his fixed-gear and disappeared up the road. It sparked a memory in me; at one time I would have been very happy working as a bicycle messenger, deftly negotiating the streets of a big city, cheating both the laws of physics and traffic. I came to define that romantic dream by using the oft-used Buddhist concept of "being in the world, but not of it". In other words, I exist within the world of traffic, cars, congestion, but I operate on a totally separate plane, one of grace, speed, and finesse.

This brief "ahhhh moment" led to others. During another moment in my life I fell in love with Parkour, also known as Free Running, e.g. the opening scene of Casino Royale; again, being of the world but not necessarily in it.

Now here I stand, ready to begin work as a street paramedic, and I'm coming to the realization that it's nothing more than an extension of the original concept, that of living and working within the cityscape with all of the muck and dirt, but existing on a separate plane. The thought of swooping in to the side of a critical patient, working some medical magic, stealing death, and then moving on again is very enticing. I'm still trying to wrap my head around this oddity that has seemingly connected various pieces of my life together along a common thread.

Of course all of it is meaningless, and nothing more than a misty dream-like desire. I realize that, but I just found the commonalities very interesting.

I Can Smell A Battlefield

Serenity next to the river.

I spent the weekend in Knoxville visiting my family. On the way back to Bloomington I decided to stop off at Louisville and take a look at the venue to the Ironman Louisville triathlon coming up in August of this year. Ironman Louisville will be my biggest race this year, and I wanted to "walk the ground" as it were. Strolling along the river-side swim exit I was reminded of George C Scott's line in the movie Patton, "I can smell a battlefield". I tried to envision the endless rows of bikes lined up on the shore; tens of thousands of spectators, volunteers, and athletes; lights; blaring music; the finishing line; the spectacle that is Ironman. I'm sure that on race day I won't even recognize the serene environment that I strolled through today.

Anger and Tibetan Buddhism

I visited the Dagom Gaden Tensung Ling Tibetan Buddhist Monastery in Bloomington. I would have been very remiss if I had not.

I was having dinner at a local bar and the guy next to me was describing his Alcoholics Anonymous (AA) meeting to a couple of women that were sitting there. Of course the guy had a picture of "leaded" margaritas in front of him. He went on to explain how stupid the whole DUI process was that landed him in court-ordered AA. I think I was the only one sitting there that got the irony of the whole situation. I couldn't help but think, "Yea, you hit my family and court-ordered AA is going to be the least of your worries". Yup, that was anger.

Making The Best Out Of...

Getting ready to head out on a ride.

I've spent all winter on an indoor bicycle trainer, hammering out miles with the assistance of Troy Jacobson's Spinnerval DVDs. The result is that I'm crazy strong on a bike, but can't ride in a straight line to save my life. My bike handling skills are at best, atrocious, and at worst, dangerous.

I braved the blackening skies this afternoon to join a group ride around Bloomington. Two people showed up; a guy on a 1980s spray-painted Cannondale and wearing Ho Chi Ming slippers, and another rider who was working hard to drop a hundred pounds or so. Now I'm not a bike snob, and have been dusted by all sorts of people, but I was really struggling to find a graceful way out of this gathering. The thought of getting caught in the rain, which was definitely coming, with these two lads and being lost miles from home was not very inviting. No good, I was committed and I was going to ride.

The result was just as I predicted; rain, lost, and not a lot else. I decided to use the opportunity, instead of grumbling, to work on my weakness, bike handling. At low speeds I worked on staying in a straight line, breaking and cornering. Even though we barely broke 15 mph, I got something out of what would normally be a bad situation. I'm happy that I did it.

Twlight

The setting sun is reflected on the side of a Bloomington ambulance.

I spent an hour yesterday transporting a 70+ -year old cancer patient to definitive treatment in Indianapolis. We sat in the back of the ambulance and quietly chatted while I kept an eye on the monitor that I had him hooked up to. I listened to his life, and realized that he was coming to grips with his own mortality. This still robust man had worked hard all of his life trying to make ends meet, never really traveling outside the state of Indiana; working in the stone quarries, as a farmer, and as an auto mechanic. He spoke about wishing that he had gotten an education; equating that to making a better life for himself and his family.

I felt honored to sit and listen to his story. It saddened me a little, for what reason I haven't really come to grips with yet. Maybe its a man who is looking at the end of his life rushing at him and he is still filled with so many regrets. This scares me.

Ahhhhh Moments

A paramedic student works on his intubation technique.

I'm in the middle of what I term as "clinical sprints"; every day I work on a different 911 ambulance as the lead paramedic often for 14-24 hours per shift. This grueling schedule will go on for the next week or so until I graduate the course.

During these clinicals I feel myself learning and maturing as a new street medic. Today we responded to a 96-year old woman who had fallen outside on her deck and fractured her hip. When we arrived I found her sitting up against a hot-tub with her left leg rotated inward and shortened in length, a tell tale sign of a fracture. Normally these injuries are excruciatingly painful and have catastrophic results for the elderly. A week ago I would have splinted the leg, started and IV, and began pushing narcotics for pain management. Today I stepped back and realized that the woman was not, for some reason, in a great deal of pain. This is often the case with elderly women; maybe they've seen so much in their lives that pain is often relative.

I withheld the IV and the narcotics, realizing that I don't need to do some procedures just because I am able to, but rather its better to use my clinical judgment and make the best choice for my patient. There was no need to start what could have been a painful IV in the arm of my patient while bouncing down the road in the back of an ambulance for nothing more than to push a pain medication that this lady really didn't need in the first place. If the ER wants an IV they can start one themselves in a more clean and stable environment.

I was happy with my decision, and believe that it was a step forward for me; sort of an "ahhhh moment" Realization comes in small steps.

Incongruences

Saturday night in my apartment. Try sleeping through this. I'm working on my patience :)

Bloomington has a very large and active Buddhist community, and I'm sure that my biggest regret once I leave here will be not exploring and participating in that opportunity more. I need to find a way to make time in my remaining schedule; I've heard so many great things.

I became part of a conversation yesterday as a paramedic was describing a mutual acquaintance of ours to me, "He's a Buddhist, but a little extreme at times. If someone kills a spider or a fly he gets upset and will say something". I smiled and acknowledged the fact that I'm also a practicing Buddhist. The paramedic asked me if I thought the fact that killing a bug was 'extreme'. "No, I stated, that's pretty much it".

All of this led into a discussion on how I could have been a Buddhist and a Army Special Forces soldier at the same time. I often get asked this. I really don't have a good answer, and I never did. Certainly I was not the only one, clearly there are Buddhist police officers, doctors, and others that make life and death decisions on a daily basis. Somehow answering that particular question was never very important to me. I'm at peace with my spirituality and my profession. They may seem incongruent to some, but to me they just... are.

Pushing Hard and Fast

I've got almost two weeks to straight "clinicals" ahead of me, where I'm functioning as the lead paramedic on a 911 ambulance. The didactic portion of the paramedic class is over and now it's just a matter of finishing up the hours that we need on the ambulances before we test out. These clinical rotations are normally a lot of fun, albeit hectic and grueling as they're stacked back-to-back offering little or no time to rest and recover. Each 24-hour period I will move to a different ambulance service somewhere around the state, quickly learning and adapting to new "truck set-ups" and treatment protocols. I'm expected to be proficient in all of them.

What I've found thus far:

Nursing homes depress me. The smell is always the same. Eyes follow us as we arrive with our equipment to treat and transport one of their own; knowing that someday it will be them on the stretcher- IV lines, oxygen, cardiac monitors, drugs, etc. Elderly, paper-thin skin; mouths so dry that they stick, eyes uncomprehending what is happening to them.

Kids make me nervous. Little people de-compensate so quickly; one minute they're fine and the next they're limp and lifeless. As a parent myself I can feel the unspeakable panic of mothers and fathers as they watch their whole world stop breathing and turn blue in their own quivering arms. They offer you the lifeless little body; tears and screams of desperation follow.

I do not understand drug seekers, but am amazed at the lengths they will go through to get 4 mg. of morphine from me. They know all the right things to say, the coded phrases that almost force me to treat them with narcotics. It's a game to them. When they're found out they go off in a huff, looking for a new source; no embarrassment or remorse, the game goes on.

My Take-Away

This is the one post that, for quite a while, I've known that I would write. For the past three months I've been living with three 21-year old college students and their associated friends. I fell into this situation by sub-letting a room, in their four-bedroom suite, from one of their friends who was traveling for the semester. It's been an interesting and often entertaining experiment.

Firstly, these guys are no different than when I was a college senior back in '86. Nothing has changed in the past 23 years, and most likely going back a lot longer than that. There is still copious amounts of alcohol, good friends, girls/boys, sports, classes, and an over-all attitude of reckless invincibility. The only notable difference, however, is the advent of video games; my suite-mates sit for hours playing all manner of games, including Rock Band, which can be very annoying when you're trying to sleep at 3:00 a.m. I've found this to be the only game that can penetrate the protective cocoon of my Bose noise canceling headphones.

My only epiphany during the entire experience came when realized that these kids are often inebriated, loud, and "out-of-control" only because society allows them to be that way. They're cut free from the confines of home and allowed to rapidly grow and expand with almost no tempering force. The college culture expects/encourages/demands them to act in this manner.

On a side note, what happens when you re-introduce a dampening or controlling force, e.g. you remove the kid from college and enlist him or her in the military? My experience has been that they still grow and mature but not at such an exponential rate. The environment is more supervised, and prone to a lot less recklessness; but that's another post.

During my stay here I've treated several college kids in the ER, one for a very serious alcohol intoxication. The sad part was that her mother came to the ER and had to see her near-naked daughter lying on the table engulfed in an octopus of tubes, wires, pumps, and monitors. I first tried to empathize with the mother, but found it difficult as she viciously blamed everyone for her daughter's condition except the young girl lying before her reeking of vomit and alcohol.

My "take away" has been that if left unchecked these kids will eagerly sprint down an often dangerous path, just as we did at their age; as most of us are lucky to still be walking this earth. There must be some sort of societal, peer, family, organizational, tempering force that allows them to grow and mature, but at a reasonable and less self-destructive rate. When I get home to my five-year old, we're going to work on that one pdq.

Levity In The Final Stretch

Taking a moment to goof around in medic class. Levity and a sense of humor are all-important.


I have a month of paramedic training left; I'm almost done and can see the light at the end of the proverbial tunnel. I'm anxious to get home again and spend some quality time with my family. What's the next step is after that, I'm not exactly sure. I have several options that I'm looking at, one of which is working full-time as a medic in Atlanta. I have some security options, as well, that I'm looking at, but right now the priority is to successfully finish up and to get myself home.

Hanging In There

Little boys, a shovel, and dirt... perfect

OK... I've been blog-lazy for the past few months. I haven't even taken a single picture. My camera lays on my apartment desk, dead batteries and all. I'll fix that.

I'm currently in Bloomington, Indiana attending a paramedic course, and living in an apartment with three 21-year old students. Life is indeed interesting. I spend my days either attending class learning about advanced emergency medicine, or doing clinical rotations on a 911 ambulance or in an emergency room. I've met hundreds of patients with countless illnesses and problems. The fact of the matter is that I quickly forget most of them, however I've come to learn that I'm the most important person in their lives at that particular moment in time, and they will often not forget what I end up doing for them. This is the nature of emergency medicine. I love being a paramedic; mostly because I can have a direct and often monumentous impact on someone's life; someone who is a father, a daughter, a girlfriend. With every patient that I touch, I effect countless others. What a great job!

As I mentioned I'm living amidst college students, which creates its own set of challenges and observations. I look at theses kids, all are 21-years old, and I have to believe that I was once that "innocent"; a word that is a analogous to whatever concept that you want to apply. On a whole they're great guys, and treat me with a bit of awe and wonder. I tell them that I'm not anything special, I've just lived longer than they have.

More to follow in the coming days. I hesitate writing about many of the patients I meet because I'm entrusted with their privacy and confidence, an honor and a privilege that I take very seriously. Nonetheless, I'll try, in the future, to provide some colorful stories and insight as I progress along this path.

College Again

Bike porn: My new Cervelo P2 set up in my room in Bloomington. It'll be trainer rides for a while. It's snowing out here today.

I just arrived in Bloomington, Indiana for a paramedic course that I need to take. Bloomington is a college town, home of the University of Indiana, and I'm staying at a large apartment building that houses hundreds of college students. I ended up getting a sub-let off a kid that was going abroad for the semester and needed to get out from under his lease. Subsequently I'm sharing a suite with three students. I can't tell you what an educational experience THIS is going to be.

Last night one of the 20-something students told me that he was going to travel Europe after he graduated so that he could enjoy the experience "before he got too old". "You're kidding me, right?"

The medic course is going to take up the vast, vast majority of my time, demanding 14-16 hours every day. Added on to that are twice daily triathlon workouts amounting to 14 hours a week. I don't expect to see much of my student room mates, but I'm sure there will be the occasional entertaining episode. More to follow.

The Fixer

An Iraqi father poses with his two sons.

"Fixer" is apparently an Arabic word that means, "I don't wait in lines". Like almost all western companies in Iraq, we employ locals to act as "fixers; to get us through the snags and complications of operating in a foreign land. They use any means at their disposal, some of which can be pretty unsavory, to get us in a position to do our job.

I went to the airport this morning, our lead fixer and I were flying out of Baghdad on the same flight to Amman. At the first sight of a line he didn't even break stride, walking purposefully right the the front of the 30-person line, grabbing my passport as he went. The cacophony of groans and gripes was deafening to my sensitive western ears. The fixer seemed to be energized by it, and pressed on; business class seats, boarding passes, luggage tags all within seconds. I was looking for a corner to hide in as the symphony of disgruntled passengers grew.

This scene transpired not only at the check-in desk but also at Immigration, the boarding ramp, and the bus taking us to the plane. Nothing would deter him. He was like a pitbull. I meekly followed along, afraid to get lost in the throngs of unhappy (pissed off) travelers. I secretly reveled in the "fast track", but was painfully embarrassed at the means to get there.

On a side note, while on the airplane we were handed a form, what at first I thought was an Immigration form for Jordan. Dutifully filling in the blanks I got to the question, "Do you have diarrhea?" It went on from there; "How long have you had it? Medications? Doctor's note?" Not something that you see everyday. They were apparently looking for cholera coming out of Iraq.