Culture & Sensitivity and Tri Coaching

May 15th 2009 marked my one year anniversary of committing to (near-) daily exercise. In my quest for finding the work-exercise- motherhood (and "spousehood") balance and having just bought my first road bike a few months ago (October 2008), I decided to hire a tri coach on May 1st. However, dear friends, have compassion for the tri coach as she will have to deal with this Greek chick's cultural background. Allow me to speak for me and my fellow Greeks: we love challenges... but as soon as we feel we are being herded onto a linear track, we get (and often act upon) an urge to make a zig-zag to the finish line, for no apparent reason whatsoever. I realized this urge when years ago--high school-- I got a D in English b/c I butted heads with the teacher who required an outline submitted 2 weeks prior to submission of any paper. I did not comply-- I would submit them together. (My rationale: not everybody thinks in outlines! Some writers can put thoughts on paper and then organize.) Needless to say, my friends who followed the rules got in to Nat'l Honor Society that year and I did not. However thank God even mediocre public high schools such as mine sometimes have a few truly dedicated teachers who have no interest in imposing a process. Phew! --After that, blew away AP English! Also, thank God, the greatest college on the planet, Vassar, recognized this kind of MO (and it helped to have some great grades after that stalemate) and accepted me. So, sure following the straight and narrow path is the most direct, efficient way, indeed, but not the only way to reach the finish line. Consider the alternative a "scenic route". Perhaps that is why triathlon is so popular--the training doesn't feel "linear". Perhaps that is also why trail running and off-road cycling are so appealing-- no two steps (or pedal strokes) are alike. And perhaps that is why I love my own specialty, Ob/Gyn, as it affords "scenery", albeit within a narrow path--labor (and even surgery) is so interesting because the patient's unique physiology and personality plays a role in making every single event extraordinary.


Now I have a lovely plan set up with a terrific coach. Note to coach: I'll do my best to follow it to a T, but ummmmm... a pseudopod just might sprout to test the waters outside the plan... oh yes, risk for injury, etc (why else would someone voluntarily veer off course-- to be safe?-- um, nooo!). Yes, sure I want to go for Alcatraz and a half-ironman in 2010, but given my track record for having to follow rules to get there ... "You can take the Greek out of Greece..."

My First Medal! April 2009

Gummed up Gears, Parenting, Age and Equilibrium

Several months since last post! The gears were gummed up... literally and figuratively.

It was a period when a line from the Grateful Dead song kept playing back: " Set up like a bowling pin, knocked down-- it gets to wearing thin... Just keep truckin' on..."

Ohhhh, the challenges of parenting -- holidays and then-- (Theme from "Jaws" playing)-- the unleashing of microbes-- head lice (TWICE), Strep and --plantar warts --?! (Yes indeed, son Georgie picked those up-- God knows where) followed by the usual end-of-winter febrile viral infections with lost school days (and obgynmom and daddy being home allowing the microbes to find greener pastures with the parents). Daddy, despite being exposed more hours was able to escape the latest nasty strain, but I found myself on a beautiful Sunday afternoon in the ED with acute bronchospasm. I balked at steroids but 3 days later, back in the ED, I conceded to taking them -- no they didn't cause psychosis or weight gain or hair growth. What I feared and what happened was that if the illness was serious enough to warrant steroids then it was serious enough for me to be forced to rest until the course of medication was complete. (That was my ordeal-- Imagine my husband having to deal with his hyper, non-exercising very, very cranky, endorphin-withdrawing wife). No spinning w/ Betty, no swim sprints, no tempo runs... just sleep, hydration, prednisone, inhalers, and positive self-talk. And self re-evaluation. "Indeed Kitsa, you may backslide.. its okay. Start (nearly all over again) to build your base... it is a- OK. You don't do this for a living, remember?"

I read a humorous post the other day about having a special category for older triathletes who are parents of young children... some sort of handicap due to sleep deprivation, illness etc. Unfortunately swimmer Dara Torres is a good counter- argument to the parent thing. Let me just say that Ms. Torres is the newest initiate in my pantheon for being an elite, competitive athlete as well as a mother. So, in self-pity, I thought of a different tack: How about having a different category for OB's (and midwives)? -- Unlike our cardiology, orthopedic and other specialty counterparts (since these docs have ED docs and hospitalists to cover them for call) there is no buffer, no physician between a patient at the hospital and the OB. Just think--36 continuous hours of no sleep once a week (sometimes more) has GOT to wear anybody down. Most recently a continuous 68-hour stint flattened me-- but yet I also found it a challenge-- I managed to get back in the saddle after two nights in my own bed and yesterday I even had a great 10K run. Did I feel invincible. And, now being out of the haze, I remind myself, in spite of the field obstetrics "handicapping" one's athletic training and performance, it really IS a blessing to be an obstetrician. It is like being at the finishing line of a women's race-- I find myself cheering women in the delivery room in exactly the same way. "You are so strong", I often find myself telling the Mom-- she should feel invincible too.

Ok, how to re-establish equilibrium with the current schedule?

Current Obgynmom week:

Mon: 5am wake up; lollygag til 5:10am. First cup of joe, throw laundry in, change into work out clothes. Kiss son and spouse (daughter getting beauty sleep), get to gym no later than 6am-- treadmill or outdoor run, depending upon weather. Core work. Coffee cup #2; 8am-8am call. Just 'cause L&D 'aint busy don't mean the ED 'aint busy with women with various pelvic pain and/or bleeding complaints. Possible C/S or laparoscopy in the wee hours of the morning-- a crapshoot.

Tue: Post-call. No exercise-- even if good call night (mantra to self: it is your REST day). Rush from hospital to start office hours 9 til 5. By 3pm, deeply wallowing in self-pity-- status post 4 cups of coffee and 1/4 lb M& M's. Leave office at 5:10pm- rush for pick up of 7-going- on-14 year old daughter from gymnastics. Daughter complains about my tardiness, her hair, piercing her ears and why can't I buy her Gatorade? Argument ensues. Get cranky. Ask husband to please make me his amazing Appletini which has been modified to include ONLY alcohol, no apple juice. Throw laundry into dryer. Coax/cajole/threaten son to practice piano and violin; more forceful threats for daughter to do homework before dinner. Cajole/coax/ threaten both children over dental hygiene at bedtime. Then read bedtime stories and fall in love with kids all over again, lights out at 9pm. Stretching x10 min. Fold laundry. Collapse in bed at 9:30 pm. Promise husband that weekend plans to be discussed on a non-post-call evening.

Wed: 6 am Spin Class with Betty, who is an undercover trainer for the US Navy Seals. Simultaneously love her and hate her as she pushes me so way out of my comfort zone with her exhortations , her motivating music and well-planned work outs. Drink 20 oz Gatorade and still thirsty. End up cursing myself and swearing off Appletinis. Off to hospital for grand rounds, rush back to office til 5. Finish 4 cups coffee by 3 pm. Cub scouts, late dinner, lots of seltzer water in penitence. Sneak Gatorade bottle in trunk so no evidence for daughter. Cajole/coax/threaten... Bedtime stories, fall in love with kids all over again. Stretch x10 min. Fall asleep early again.

Thu: Pool by 5:30 am. Rush to get back to kiss kids goodbye and see them off on school bus. Rush to work. 5:10 pm, running out door, renewed promise to pick up daughter from gymnastics on time. Since it ends at 6:30pm, actually make it on time, or at least no more than 5 min late. Daughter somewhat mollified, but asking for playdates, pierced ears, Gatorade, plans for weekend. Coax/cajole/ threaten ... Bedtime stories... Stretch x10 min, manage to make last minute weekend plans with spouse, collapse in bed by 10 pm.

Fri: Hooray no office today! TM or run by 8am. Kiss kids off at 8:10 am. Errands, laundry, lunch date with spouse. Kids and movie night. Computer games, movies motivate kids to brush teeth for EXACTLY 2 min. Yiayia over for dinner; she reminds me as my mother she feels free to remark on hair/clothes/weight... as well as the non-mundane issues of life-- marriage, career, etc

Sat: 6am bicycle outside or if bad weather, bike on trainer in basement. Kids decide to "give company" in basement. Fight ensues, tears, accusations, he/she said... SLDs ("single leg drills") interrupted. I turn on TV (PBS) in basement. Both kids quiet. Word Girl, Planet Zulu... Thank God. Resume workout-- now do I start those 30 sec intervals all over again? Husband disappointed that TV is on... states it stifles creativity. "Oh yeah? I'll show you creativity."
If it is a non-call day, perform shuttle service-- divide and conquer-- husband goes east w/son, for violin I go west w/daughter for horseback. Meet back at home for piano lessons.

Sun: Call best friend and neighbor (oh and by the way a pedi orthopedic surgeon and accomplished athlete-- ok, so who is not intimidated???!). Beg her to take me on a bike ride with her today... 20 miles of her leading pulls me along. She is a mother of two (smaller children) so we negotiate around nap times. I continue to beg. Husband rolling eyes but ready to beg for me since he knows crankiness is on the menu if nothing done soon. If no go w/friend -- I go out for a LSD (long slow distance) run. Waffles and kids waiting after run-- so very motivated to keep running (and improve PB). Family time, evening resumes with cajole/coax/threaten (homework, dental hygiene)... bedtime stories, stretching, sleep.

Maybe this is as good as it gets in terms of finding a schedule/ balance. A very close friend from med school, residency and now a high risk OB recently stated to me that I seem to create and thrive on disequilibrium. (So that I may find a challenge?). But I have noticed this behavior in friends my age and older-- is this not the upside of midlife? Let's go kayaking, Nora!

Surgery, transformation

I had the great luck to watch an exquisite surgeon, Dr. Stefan Karos, in action a few months ago. It was a Saturday and it was rather slow on labor and delivery. I wandered down to the OR. My fellow Greek colleague had a case and was open to my observing him in the OR. That morning I really envied urologists-- it was a clear that the gentleman- patient was going to need surgery. Clearly a significantly diseased kidney was the source of this man's admission into the ICU. The hardest decision to make, when you are a surgeon is when NOT to operate, (and more so when you are an obstetrician because it is rarely clear cut, no pun intended). No question here, though, a nephrectomy was necessary for this man's survival. (Reminded me of a med school classmate-- now a urologist by the way-- "Nothing heals like cold hard steel", he would say-- and I would shudder at his eagerness. ) Dr. Karos-- and this is how you can tell who is really a GOOD surgeon-- was eager to explain the procedure in detail in the OR and it was an amazing experience. Having only ever seen kidneys in cadavers and formalin, my examination of the specimen was anticlimactic-- the excised "offending" organ looked like a big piece of fat. (Where in the world was the fleshy part?! I did not pursue the pathologic examination for fear of looking completely ignorant. Perhaps the disease itself made the kidney look so alien...?)

Indeed, sometimes it does not take an earth-shattering event or a transcendental meditative experience to transform oneself. The banter in the OR influenced me significantly, not in a medical sense (OK , a bit of that too-- how many times does one get to see removal of a kidney?). The surgical assistant was the chief of surgery. Both surgeons were avid cyclists. I had a one -year old hybrid bicycle which I had intended to use, oh y'know-- "someday", but never got around to it. I couldn't make up my mind-- commuter bicycle vs sport cycle so I had settled on a hybrid a year earlier. It was used maybe two times. The OR banter by the surgeon-cyclists was about the fun of mountain biking and the great trails in the area (Leominster, Groton, etc). Their enthusiasm was infectious. I thought, boy would I like to do that and boy would I like to bike with these guys! They'd be better than me but it would be awwwwwesome. I love the outdoors, I live in an area with tons of trails and... say whaaaaaat-- I am not afraid of speeding down the trails??! My BMI was creeping down below 19 kg/m2 from inactivity so I needed to do something physical... So, within two weeks I swapped my hybrid, panniers and all for a mtn bike. (Wheelworks was gracious to remove a small percentage for "stocking fee" for the swap) . I got myself a Gary Fischer mtn bike. Sturdy, good shocks, good knobby tires.
Can I just say that mountain biking was fun beyond belief? It was early spring, crisp with bright skies. The trails varied tremendously and I still have that "I''ll be back", in Schwarzenegger speak-- mentality of returning to attack some trails (My nemesis: Hell's Highway, first and foremost; other-- Heartbreak Ridge... well named). MB led to my thinking of heck, try not a triathlon (which I did-- on my mtn bike-- and I felt like a dwarf, spinning my wheels up those hills!). And now the infection for cycling has permeated my life. I just bought a road bike (with Sidi road bike shoes...). Thanks, Stefan & Les! Just know that my bank does NOT thank you!

First tri with my "biggest" fan, daughter Nicole