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.