Monday, September 24, 2012

I Have Such a Cool Job

Today it really struck me what a cool job I have. After years of struggle, long hours, and really unrewarding, thankless work at near minimum wage pay despite years of post-graduate school and training, in the past year or so I've really begun to see the light at the end of the tunnel. Now as I'm approaching the end of the tunnel (1 year and 9 months until I'm done with training) the light is starting to shine directly on me. My job is really starting to rock.

Currently I spend about 1/2 of my time in outpatient clinic seeing cancer patients and the other 1/2 working on research papers. The research stuff lends flexibility to my schedule, which is great, but I don't find the work very rewarding. It's basically like writing college essays over and over. Boring stuff. Clinic, however, is wonderful. I don't mind going to clinic and when I'm there I'm happy to be there. And clinic is how I will spend 85% of my time when I am done with fellowship so I think I'm in good shape to have a happy, healthy career. I hope so, anyway.

Let me give you a few examples of why my job is so great. All day long I see patients who have recently been diagnosed with cancer (i.e. I'm the one to tell them), to those currently going through treatment that is working (yea!), to those whose treatment was working but is now failing, to those who are dying, to those who are cured. I find each type of patient rewarding in their own way.

The newly diagnosed patients are usually terrified (and rightly so) and hanging on every word you say, so words must be chosen very carefully. At the time of diagnosis, it is important to be realistic but it is also important to give hope. And most of the time, it is not hard to be hopeful. Oncology is a rapidly changing field with new drugs being approved by the FDA (Federal Drug Administration) monthly. If you spend any time at an Oncology conference or meeting, you'll soon see that the pace of change and progress is dizzying. Whenever I get an email with a new FDA approval, I feel like it's Christmas. Patients who have no chemo options one month may have multiple options the next. It's truly incredible. Even for cancers that are "the worst of the worst" like metastatic pancreatic cancer or metastatic melanoma, new drug combinations and new drugs are extending survival by months and even years. There is much to be hopeful about.

One thing I focus on with all my new patients is that everyone is different. No one can predict how one individual person will do. Recently I saw a patient who has had metastatic pancreatic cancer since 2005. He still hasn't required chemo. His quality of life is excellent- he is playing tennis and working out daily. I have many, many metastatic colon cancer patients diagnosed over 5 years ago. All have been on treatment intermittently, and many are still thriving. Metastatic lung cancer is another disease that no longer carries an eminent death sentence. Do many folks die within a few months of diagnosis? Yes, unfortunately they do. But others enjoy fantastic quality of life for years, often by only taking a chemotherapy pill. Yes, a pill. And there are more chemo pills in line to be FDA approved every day. Metastatic breast cancer patients live 5-10 years with their disease with some frequency. I don't mean to make light of these serious, life shattering, diseases. But I will say that being an Oncologist- while occasionally sad- is far from depressing with so many great advances we can offer our patients.

Not to mention the patients themselves. What an amazing privilege to be able to work with and help such strong, inspirational, caring and often hilarious folks. I don't know if nice people are more prone to cancer (I sure hope not) or if something about getting cancer makes you nice but I'm telling you there is something different about cancer patients. And their amazing families. A few quick stories from the past weeks:

  • "Thank you for telling me I have cancer". Back when I was consulting on the inpatient service, I had a lovely middle aged female patient who had melanoma (skin cancer) years ago, that was surgically removed. She came to the hospital with fatigue, vomiting, weight loss. Evaluation showed masses in her brain and her liver, places somewhat typical for recurrent- and now metastatic- melanoma. She was a savvy lady and knew what was coming from the get go, but after a few days of tests and the biopsy of the liver lesion, finally the pathology results came back so I headed to her room to officially give her and her husband the bad news. Like I said, they knew it was coming, so I didn't mince words and explained the diagnosis and what it meant in terms of treatment options at this point. I went through my careful spiel about how her disease at this point is not curable, but is certainly treatable. I gave them time to digest. I answered their questions. I passed her the Kleenex box. I held her hand. They were such a sweet couple. When we were done and I got up to leave the room, she called me back. She grabbed my hand again, looked directly in my eyes, and said "Thank you for telling me I have cancer. That must have been hard for you." Tears sprung to my eyes. Here this lovely lady has heard the worst news probably of her life and she is thanking me for telling her!! Where does she have this reserve of kindness and empathy? Absolutely incredible. I told her she was an amazing woman. She was. I'll remember her and those simple sentences for the rest of my life.
  • "Time for renovation." A few weeks ago I had a clinic patient with metastatic lung cancer. She was initially diagnosed about 2 years ago with a mass in a very dangerous place- nearly invading her heart. She responded so well to initial chemotherapy that she was able to take a chemotherapy "holiday"- a period of time off chemo where we pursue "active surveillance" with doctor visits to access for symptoms and frequent CT scans to look for disease growth. One of these scans showed a new site of metastatic disease outside of her lung, indicating disease progression. Her and her husband took this news in stride, joking that they'd have to schedule the biopsy of this new lesion around their home renovation schedule. She turned to me and said "After I was diagnosed, I never thought I'd live this long, so I decided to deal with the nasty windows and closed floor plan of our house. But now here I am, two years later, so I decided it was time to renovate!" Her husband then quipped, "Yeah, and our son borrowed money from her promising to pay it back in 3 years.....turns out he's going to have to pay up!" We all shared in a big chuckle, overjoyed that she's continuing to exceed all expectations.
  • "I have cancer, let me help you." Sadly, I have multiple, young, 20-something patients with incurable cancer of may kinds. Leukemia, colon cancer, liver cancer. It is indeed very, very sad. However, the sadness of these young adults' stories is completely overshadowed by the amazing things that they are doing with their lives. They are not sad folks to be pitied. Quite the contrary, most of them are motivating, inspirational examples of how to live the life you've been given. One of my patients is a cancer nurse, many others are actively involved in not-for-profits for adults and kids with cancer even as they continue to fight their own diseases. The grace with which these patients juggle jobs, kids, side effects and tough treatment decisions when they should be enjoying the prime of their live is amazing. Absolutely amazing. Uplifting>>sad.
I hope these stories show a bit of the empathy, wisdom, humor and selflessness of the folks I get to work with each and every day. My job is easy compared to their daily struggles. They motivate me to learn everything I can so I am best prepared to help each patient that walks through my door for the next 30 years.

So, sad? Sometimes. Depressing? Definitely not. Rewarding? Every single day. Every day I'm reminded how lucky I am to be healthy and how privileged I am to work with such great patients. I just might have the best job in the world.

Sunday, September 23, 2012

A couple more Lake Geneva Photos

Remember that crazy I'm-done-with-the-swim grin I mentioned in my race report? Well, here it is. I look mighty crazy in this photo, but I guess that's what it looks like when you are joyfully trying to run in a wet suit after a crazy swim at 7:30 in the morning in 50 degree weather.

And they found another finish line photo of me as well. Yeah, I'm that hated person who likes to sprint to the finish even if it means passing someone in the process. It's the only few minutes of the race where I'm competitive, usually I'm just lolly gagging along, enjoying myself:) I don't appear to be enjoying myself in this photo!

Tuesday, September 18, 2012

Swimming with My Arms

Saturday was my second triathlon- the TriRock Lake Geneva sprint triathlon. Immediately after my Chicago Triathlon swim (and I use that term loosely) debacle, I signed up for my next tri. Get back on the horse and all that. In reality I was very concerned that if I started and ended my first ever triathlon season with a failed effort then my fear would have all fall, winter and spring to grow and grow and I'd be a complete mess before my next tri swim effort. So I wanted, needed, to do another tri and fast. So Lake Geneva was a perfect opportunity!

Originally my father was going to do the tri with me (he actually WON the Freeport Triathlon some years ago, but hasn't done one in many years) but he wounded himself in an unfortunate cat incident. And I didn't want Adam to have to get up so early for an event that is rather hard to spectate (plus he had to work). So I ended up going up to Lake Geneva solo, which was fine. Just me versus the swim. I stayed at the French Country Inn (seperate post to follow) on Lake Como which was lovely.

Making friends while waiting for the race to start.
The tempeature when I headed to transition at 5 am was not lovely. 41 degrees. 41 degrees! I had many low points pre-race where I questioned why on earth I do this myself. Getting up early in the cold and dark, dragging my gear from a cold dark parking lot down a cold dark 1/2 mile walk to transition, trying to set up my gear with frozen fingers. I wasn't feeling very optimistic. But plenty of people knew I was doing this race and my husband had spent all this money on the hotel for me so I just couldn't let the experience go to waste. But, boy, I thought about bailing on the race almost every minute from arriving in Lake Geneva the night before to the minute I put my face in the water in the lake. All this is to say that one can be full of dread and fear and still end up having a great experience. Things worth doing are usually hard to do. But I sure hope it is easier next time!

Race delayed due to fog. Here it's just about cleared.
After setting up in transition (which was very well organized, great job, TriRock!), I headed over the swim start and made some new friends who I chatted and shivered with for the next 1.5 hours. It was still so cold. I had on my wetsuit and two sweatshirts but my hands and feet were numb. The idea of getting into the water when I was already so cold was devastating. I really didn't know how I was going to do it. I knew the water with a temperature in the 70s might feel warm in comparison to the air but that thought wasn't all that comforting. The race start ended up being delayed by about an hour due to fog over the lake. The swimmers couldn't see the buoys and the lifeguards couldn't see the swimmers so all in all a bad combination. We were so relieved about the delay. An extra hour for the sun to come up! I just kept chatting with my little group, trying to be upbeat. No one likes and Eeyore (but internally I was a steady stream of negativity, I'm sorry to report).

A new wave of fog rolled over right as the first wave started.
The Olympic distance started first, giving the sun even more time to rise (hurrah!). Then, my first break of the day- once the Olympic athletes were done, they had some folks swim the spring course to show us the route. And it just didn't seem that far! Out to the green buoy and back? No big deal? Then I heard him announce it was 500m. Wait, I thought sprint tri's had a 1/2 mile swim? Not this one! (I now know the distance can be variable.) 500m is just over my usual practice warm up! That's nothing! So I began to think, okay, I can do this.

Feeling like an Eeyore but trying
to put up a brave front
My whole goal for this triathlon was to swim the swim. It may sound silly to do all this traveling not to mention a bike and a run for a 500 m swim, but a good 50% of racing and athleticism is psychological and I needed to show myself that I can swim in open water in a race situation. The only point of this whole operation was to swim the swim, freestyle, with my arms, without stopping. The bike and the run were just "for fun".

As my wave got closer and closer to the front, I became nauseated from the nerves. I was staying quiet, because again no one likes the person who is vocally nervous, but I was so nervous. I've never, ever been this nervous before a marathon. In fact, most of the morning I was wishing I was about to start a marathon! When we got in the water I saw a Chicago acquaintance, Anna- it was so good to see a friendly face. I admitted my terror to her and she smilingly said it would be fine. The conversation distracted me enough from my nerves that when the horn went off, my nausea was gone.

With Anna before the swim.
I started at the back of the pack to avoid being kicked, punched, etc. I still got jostled around a bit but it wasn't too bad. There is a HUGE difference between mixed gender waves and all female waves and I GREATLY prefer the latter. Some of the men in my Chicago Triathlon wave were aggressive, repeatedly pulling down my legs and punching (accidnetally I'm sure but still forcefully!), whereas the women just occassionaly nudged me or touched my toes. Much easier to handle. I just relaxed, pretended I was in the pool and kept my breathing consistent. I glanced up every few strokes to make sure I wasn't about to crash into anyone or anything. My goggles completely fogged up almost immediatey and it was to the point where I couldn't see the green buoy I was shooting for. So I had to stop to fix them. Maybe Micheal Phelps can swim blind (his coach routinely messes with his goggles so he'll be prepared for anything during competitions) but I can't. So I stopped and fixed them at a paddle boarder about 1/2 way through. But then I kept going and I didn't stop until I reached the end. I DID IT! I was grinning ear to ear as I ran to T1. I DID IT! I swam (basically) the whole way! Freestyle!! And I was fine!! FINE! Seaweed coming up from the lake floor all the way to my face? FINE! People grabbing my toes? FINE! I kept good breathing form the whole time. My stroke form probably sufferred near the end but who the heck cares? I SWAM THE WHOLE WAY! I wish the photographer had gotten a picture of my grin at the end:)

I am one of these SWIMMERS! Not back floaters, not
hanging on the edge of the boaters, but a SWIMMER!
T1 was okay. I have a heck of a time getting off my wetsuit, not sure how to shorten that time up. I didn't work too hard on the bike. I considered it more of a celebratory ride than anything else. I was just so happy about the swim! I ended up averaging 15.4 mph which was a little faster than in Chicago. And this with my Mom's bike that a) I've never ridden before, b) has a side mirror (yeah I'm that cool) and c) has a little post-it sticker shaped like a kitten that says 'laces?' to remind riders to tuck their laces into their shoes. Since the Olympic racers were already on the course and had 2 loops to our 1, I was riding amoungst some fancy bikes and helmets which was fun. During the Chicago tri, I passed mostly people I would "expect" to pass. Others on not-so-serious bikes like mine, for example. But yesterday, I actually passed a couple people with aero-helmets. I assume they were having absolutely awful days (aren't you supposed to be super fast if you go to all the trouble to buy disc wheels and aero helmets?), but still it was nice to pass folks.

I really enjoyed riding out in the country. Much more fun than on Lake Shore Drive. The running path in Chicago is so nice and convenient for running. But for biking I much prefer open spaces and new sights. I really had a good time.

Suffering right before the finish.

By the time the run started I really had to use the facilities. I had a cup of coffee while waiting for the swim start and it was weighing heavy on me since before the race started. (I know folks like to pee in the water, but I just don't find it civilized to pee amoungst a group of people who are about to breathe in that very water. It's gross. I refuse.)  So I had to waste 45 seconds (it was a lot of coffee, and believe me I counted out every second wishing I could pee faster) in a port a potty which was part of my run time. I would have had a kick-ass run time if it weren't for that! I ended up running 9:13 minute miles- would have been 8:30s if not for the peeing! Maybe I should have kept it in:( Or just learn how to run even faster! The run was quite hilly and I was breathing pretty heavy. I didn't love it. But I finished strong, breezing past someone who from behind appeared to be in my age group in the final 100m.

Overall, my bike and run times were pretty equivalent to Chicago. But the whole purpose of the Lake Geneva effort was to improve the swim and boy did I do that! I'm very happy with my perfomance. I'm looking forward to quality time in the pool over the next 6 months and jumping back into the triathlon circuit next summer, maybe starting in July once the mid-west waters warm up again!

At my hotel- this was the view from my balcony!

Monday, September 3, 2012

Eating with my girlfriends

There are many oddities in medical training. One is that every 3-4 years we finish a phase of training and a good percentage of our co-workers move on, to new training programs, to new jobs, en masse. The end result of this for me is that most of my closest friends are now scattered across the country from the Atlantic to the Pacific with countless stops in between. This week I was lucky enough to have two of my closest girl friends here in Chicago with me! It was great! So what did we do with ourselves? We laughed. We ate. We exercised. We didn't really sleep. Repeat.

Here are some of the places we visited.

We started Wednesday with a night at Bar Toma with my dear friend from medical school, Bonnie. Also in town was her (and our) friend Eric. It was an absolutely perfect Chicago night. Pleasant temperature in the sun, pleasant temperature after sundown, just perfect! Bar Toma is a great spot, flush with all the usual accolades of a fabulous chicago spot including Time Out Chicago Eat Out Award 2012 best new pizza, Food and Wine best new pizza, Chicago Magazine's 20 best new restaurants. The chef is Tony Mantuano from Spiaggia which is the only 4 star Italian restaurant in Chicago. He's also the chef at Terzo Piano (see my review here) on the roof of the Modern Wing of the Art Institute. Bottom line: the pizza is fabulous with interesting fresh ingredients and the place walks the walk in addition to talking the talk as noted above.

The sauce parade on every table.

Thursday night we headed to an old favorite (actually, I think it's only been around for a few years but we go there so frequently it seems like it's 'old' in the best sense of the word!), Lillie's Q on North Avenue. This is a BBQ joint. The next question out of any self-respecting BBQ lover would then be what kind of BBQ? The answer is ALL! Texas style focuses on the meat preparation with lots of wood  cooked meats and often no sauce. North Carolina style involves vinegar or mustard based sauces. And Memphis style (my personal favorite) involves sweeter, tomato based sauces with variable amounts of heat. All are good and in the hands of Lillie's Q chefs, all are great! Other amazing tastes include the fried pickles and the shrimp and grits. So good!

Oh, and they have moonshine! Adam enjoyed many a moonshine cocktail waiting for us gals to arrive and he definitely recommends the adult 'Cherry Coke'. I was lucky enough to have a night with two of my very favorite women in the world as Sara joined us direct from San Francisco. I'm so lucky to have such great friends from different phases of my life who get along so well. I swear they were planning a vacation together and they weren't planning on inviting me! (Don't worry, I invited myself.)

Bonnie, me, Sara

Friday, after Sara and I went to the Triathlon expo, we headed down to the South Loop to meet up with a friend from residency. We stopped at a casual but delicious pizza sports bar called Flo & Santos. They do one thing and they do it well. We paired our pizza with a super nutritious (but absolutely delicious) basket of onion rings (don't judge- we were preparing for our triathlon!) and a couple (few?) glasses of Allegash Whites. F & S is a Polish themed sports bar with exposed brick, 'tavern style' pizza, peirogies and plenty of friendly bartenders. The chef/owner was intrigued by our body marking and after chatting with us a while kept our steady supply of beer going gratis:)

Saturday night after making all our triathlon preparations, working out, and napping, Sara and I rallied to check out the brand new City Winery. This is a great spot on Randolph- one of a string of many good spots on Randolph, but definitely one worth checking out. It's a HUGE space, with a great outdoor eatery, a large bar area, a really huge main eating area as well as cute eating nooks on an upper level and by the fireplace, and more tables in a separate room with a stage where small bands and comedians put on shows. They make their own wine with grapes from various regions. I had a great Cabernet Franc from some Russian River (CA) grapes, delicious! We started with Risotto Balls, which were good but fried to my surprise. For meals, Sara tried the Seawater Tofu Steak and I had the duck breast. Both were very good. We then had the lava filled chocolate cake for dessert. The food was as good as expected, but not better than expected. But the great space and the excellent house wines make it worth a visit.

I almost forgot to mention brunches! Yes, the girls and I became ladies who lunched/brunched for a few days. Twice we visited the very convenient and almost impossibly popular Wildberry just down the street from our apartment. This is a solid brunch spot with something for everyone. It's not super chic and not super unique but has all the usual offerings including omelets, skillets, specialty benedicts, with plenty of dessert type offerings such as tiramisu pancakes and red velvet french toasts. The place often has a huge gathering of people outside but has many tables both inside and out thus the line moves quickly.

Perennial-Virant is another good brunch spot especially for those in the Old Town area. It's a trendy spot for dinner and increasingly becoming a top ten brunch spot in Chicago, which is a competitive space in which to excel. Adam had the 2 egg skillet with black beans, chow-chow, spiced onion, smoked capriko cheese, and cilantro. I had the local tomato salad with cantaloupe, pickled watermelon vinaigrette, candied pistachios and basil with a side of cheesy grits. Sara had the omelette w/ mouton frays, shaved summer vegetables and pesto. Oh, and we of course sampled both the mimosas and the bloody mary's and we were all satisfied:)

It was a great week of socializing, eating and drinking. I must admit, though, I'm ready for some home (Adam) cooked meals:)

Saturday, September 1, 2012

A Wet Run

Today I had a wet 17 mile run. No, not because it rained. Shockingly, it didn't rain. The radar showed this huge swatch of rain coming our way about 1 hour into my run, so every minute after the first 60 that it didn't rain I considered a win. But it never did rain. No, instead I was soaked with sweat from the 74% humidity. Like wring your cloths out soaked. Like if it had rained, I probably couldn't get any wetter soaked. (If you're thinking 'Ew, gross, she just wrote that?' Yes, I did. It's a runner's blog for pete's sake!)

But the low-70 degree temps and steady breeze more than made up for the humidity so it ended up being a nice run. I did the Northerly Island Loop then added on the extra 11 miles on the Lake Front Path going north.The path wasn't as busy as usual (probably because of the threatening radar) which was nice.

Overall, it was a good run. Building up the long runs is not very fun, the whole goal being to suffer now so you don't suffer as much in the race. To be honest, today I really had minimal suffering. I hope I'm not jinxing myself by saying I think I'm in better marathon shape than maybe ever before. I didn't really have any soreness until the last mile and even that was minimal. Sure I got tired at various points but usually a goo chomp or two would perk me up pretty well for a few more miles. I kept thinking "relax, stay strong, and keep running" as my mantra for the day. At mile 11 (the north end turn around for this particular run), I certainly would have preferred for the run to be over but I wasn't completely miserable about the remaining 6 miles either.

I ended up running 17 miles @ 9:39 pace for total time of 2:44:15. I did not turn my Garmin off at water fountains except when there was a line (3 times). I also turned it off briefly at 3 red lights. I could have ran faster if it was a race situation. So I think I may be right about where I should be for an attempt at a sub-4 hour marathon on a day where everything comes together. I sorta hope that happens this November at the Outer Banks. I guess we'll see!

Happy Running to All!