NATO-pocalypse in Chicago

There's been so much hubbubaloo about NATO being in Chicago, I thought the non-Chicagoans might appreciate to hear exactly how much turmoil has been exacted on my daily life by the comings and goings of these numerous dignitaries and the trail of protestors they leave in their wake.

On Thursday and Friday I started to notice a distinct hum that rose above the low grade din of Lake Shore Drive. The hum can only be described as bumblecopters. So many helicopters that it sounded like a swarm of very loud bees. Constant. Sometimes louder, sometimes quieter, but always present. Occasionally, a lone copter would make its way over the lake like a lone bee buzzing my ear but soon it would fade back into the general swarm. The humming persists as I write this post Sunday afternoon.



The first thing I noticed Saturday morning was the quiet. And then the birds chirping! I usually cannot hear the birds over the sounds of Lake Shore but because much of South Lake Shore was closed the traffic was minimal. Almost like Bike the Drive day. Or Snowpocalypse of February 2011. So quiet and lovely. All politics aside I say "hooray for NATO" if it brings me some urban quiet!

After days of discussion and warnings of the dreaded protestors (we were told to bring a phone cord, change of clothes and our medications to work in case the protestors barred us in the hospital and a patient who is also a cop told me they'd already confiscated a bin of human feces protestors were collecting to throw at people- what, are we monkeys now?), I spotted one in the flesh in my building on the way to work Saturday morning. Well, I was on the way to work. From my limited understanding of the Occupy so called movement, many of those folks quit their real jobs and now consider protesting their job, so it's up for discussion whether he was going to 'work' as well. But regardless of ones beliefs on that subject, his protest sign I found confusing. It was a pink cardboard cut out of a machine gun with flowers sticking out of the barrel (similar to the one above, but picture flowers too). Huh? I'd consider myself a good feminist but even I must admit that pink and flowers do not indicate a strong message of any kind.....


Next, I realized this NATO business has been a great opportunity to employ people who really want a job where they get to spend 90% of the time sitting around doing nothing. I appreciate that you need a lot of people sitting around doing nothing so there is enough people power for the few times where they need to do something (cops, traffic directors) but man, there are a LOT of people in the city today getting paid to stand around. A LOT. The Occupy so called movement people should be absolutely tickled by the number of folks employed to make this NATO conference happen!

As you may have heard, the museum campus was closed as was part of the lake front path. Quite a production with fences and city trucks blocking the way.  On my run today near one of these blockades (in the clean air, again thanks to closing LSD), I saw a chalk sign that said 'Chicago Police State' and folks were lining up to take a picture next to it. Now I realize it's eerie and frustrating to not be able to move freely about our city since NATO is here. It did weird me out a bit and made me reflect on the people who truly are limited in their movements in their towns due to politics or violence. And I know the cop presence is upsetting to some people. I will be the first to admit that there are cops that are shady and that people are, on occasion (too often), mistreated by Chicago cops. Some of the power trips cops go on can be annoying on a day-to-day basis as well. But, people, let's be honest. The cops are out in force to keep us all safe! There are a few bad eggs in every profession, but the cops are not our enemies! Yes, maybe they overspent on riot gear, yes maybe they all aren't as emotionally mature as one would like someone with a gun to be. But to refer to a few closed streets and crowds of cops trying to protect citizens and private property as a police state is ridiculous and belittles the struggles faced by those in true police states. Even those who think the worst of our cops must admit that their cop-like counterparts in corrupt or poor or desperate or war-torn countries are not comparable. Come on!


I will say, though, that talking about the NATO summit has resulted in many random conversations with my neighbors with whom I don't usually speak. So, that's a plus. As is the quiet, the lack of tourists (no offense), and the utter lack of air pollution. Do I want NATO here every weekend? No, but once in a while, we can and should make some sacrifices so the leaders of countries around the world can talk together. Even if we don't agree with them, even if we accomplish nothing, there is something valuable just in having the talks.

You Are Not Paying Us to Steer!

As you may recall from past 'Medical Madness' posts, in academic medicine we spend most of the morning going from patient room to patient room on "rounds". This is when we talk about each patient and make decisions about the plan going forward. As you can imagine, there is a lot of information we'd like at our fingertips as we discuss the more complicated cases. Labs, imaging, pathology, medical history in the case of the "bad historian"(**see below)...we really need a computer with us at all times.

Enter COWs. Computers On Wheels.

Since we are constantly on our feet we must push our computers (i.e. peripheral brains) around with us. Some places such as my alma mater, University of Chicago, are giving physicians their own iPads and I'm sure this will be the wave of the future, but for now, enter the COW:

Much like their bovine counterparts, these cows are far from perfect. They occasionally make loud incessant beeps, similar to, but more ear-piercing than, a more traditional 'moo'. Their tails (i.e. cords) can get in the way and drag behind them in a disorganized fashion. If they aren't given enough food (i.e. electric charge) they will die. And, like our farmyard friends, they can be very stubborn and difficult to move. They always seem to have a bum wheel- kinda like that grocery cart you don't want w/ the wheel that spins in circles. It can require the full attention of a highly trained medical professional to not crash these guys into the wall, our patients and each other.

Lately, our main COW has had a mean veer to the left. We take turns pushing it. We call her the Core Workout. And like most things in life, it's all fun and games until someone gets their foot rolled over...which happens...frequently.

A few weeks ago as my friend and esteemed colleague Dr Shah was pushing ole Core Workout, she had to make a right turn which is next to impossible with this particular COW. Just as she tries to make the corner a lovely elderly patient comes barreling around the corner with her IV pole getting in her daily laps for exercise. Rather than risk hitting said patient Dr. Shah aborts mission and lets the COW veer left....directly into the wall. As the patient walks by, she apologizes for the near collision. The nice lady with her IV pole with her chemo, smiles sweetly and forgivingly to Dr Shah and says "It's okay dear. We all have our problems."

Dr Shah's problem:

(Disclaimer- no physicians, patients, or computers were harmed in this re-enactment.)

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(**More medical madness style details the "bad historian". The "bad historian" is the patient who has no idea what their medical problems are or often whey they are even in the hospital. This doesn't happen as often in Oncology as it does in General Medicine, but from time to time you will come across a patient who has no idea if/what chemo they've had in the past, when they were diagnosed, etc. And there are plenty of patients who will insist, absolutely insist, that they do not have high blood pressure, only to find that they take 3 or 4 anti-hypertensive (blood pressure controlling) meds. Hmmm....For the laypeople in my audience, I implore you to make a list of your medical problems and medications to carry with you at all times. It makes us that much harder to help you if you don't!

The "bad historian" is different, but often related to, the "pan-positive review of systems" patient. The "review of systems" is the part of history taking when we ask various relevant questions that may pertain to the patient's chief complaint. For example, if someone presents with shortness of breath (which we abbreviate SOB....don't be offended, we are not calling our patients bad names.....unless we say "that sob is SOB",  just kidding of course), we will ask questions like

"have you had fevers" - might point to infection
"have you had a cough"- might point to infection or chronic lung disease
"have you had chest pain"- might point to blood clot in the lungs or heart disease
"have you had leg swelling"- again, blood clot or heart disease

We also ask about every other body system just to be sure we don't miss anything. We ask about vision, hearing, headaches, abdominal pain, constipation, diarrhea, urinary symptoms, rashes, joint pain etc, etc, etc. This line of questioning is of various utility depending on the patient. The "pan-positive review of systems" patient says yes to EVERY SINGLE QUESTION thus making the entire evaluation completely useless. Like the "bad historian" this patient has a lack of insight into what is going on in their bodies (or too much insight) which makes it a bit more difficult to hone in on the primary problem. It's important for the team to be aware that a patient is either a "bad historian" or has a "pan-positive review of systems" otherwise things they say may be given too much weight to the detriment of good clinical decision making. And when you run into these problems it is even more important to have a COW to look up the facts!

Chicago Spring Half Marathon Race Report

Yesterday, Adam and I ran the Chicago Spring Half Marathon. The start and finish of the race are literally steps from our apartment so it's super convenient for us! In past years, the race fell on the same day as the Rockford Marathon/Half so we've not been able to run it. Too many races, too little time!

The race headquarters is in the Lakeshore East park which is this hidden gem of a park in our neighborhood. Here's the view of it from our side window:

There's a playground, waterfalls, a dog park, tons of trees and flowers. There's a coffee-shop, grocery store, steak house and brand new brunch place. Despite being steps from Navy Pier and Millennium Park, it is mostly locals in this quiet, well-kept park. I almost don't want to post about it because the secret might get out but I assume (hope) most of my readers are the kinds of folks who will keep our park nice:)

The race started on a good foot (pun intended). Mild breeze, 60 degree temps. The southern sky looked mighty threatening but we all discussed how surely the weather would stay south of us and we'd be just fine. Ah, runners' eternal optimism. My goal was to PR. I generally try not to have super ambitious goals on race day because I psych myself out too easily, but seeing as a PR for me would be "simply" running all sub-9 minute miles, I thought it was perfectly realistic and shouldn't cause undue stress.

Here's a picture of the park through my Sunday happy
hour wine glass;) I love the refection of the buildings in my
New Zealand Sauvignon Blanc.

I say "simply" only because at my last half marathon, the Chicago Monster Dash in October 2011, I ran my first (official) sub-2 half with negative splits and overall 9:03 pace and was less well trained than I am now. Running a half-marathon is never "simple". I just knew that my goal was doable if I worked hard.

The first 2 miles were great (8:22, 8:23). I was flying and felt good. I knew that I probably was running faster than I should be, but I'm of the mind that for a marathoner, a half-marathon is a "short" race so I shouldn't worry about crashing and burning, I should just RUN! My natural tendency is to leave way too much left in the tank anyway, so holding back in "short" races just doesn't make sense. Despite the run being on the lakefront path, it wasn't too crowded.

I started breathing a bit more heavily than I'd like around mile 3 so I slowed the pace to catch my breath. Miles three and four went okay (8:50, 8:34) but I wouldn't say I was enjoying myself. Too many miles still ahead. Around mile four Adam caught up to me which was both a nice distraction and a bit demoralizing since he was just using this as a long run rather than a race since he hasn't been training. Adam holds the Nelson Lilly family record in the half marathon which he set at the Illinois Half Marathon in 2011 (1:54:14!!) which I'll freely admit, I'd LOVE to beat! I'm not very competitive in my daily life but for some reason I want to be the faster runner in our marriage. Silly, but true!

I trudged along until the turn-around at 6.5 (8:25, 8:59). Since it was an out-and-back we got to watch the winners. The male leader was cruising, looking great, even smiling a bit. The female leader looked good as well. She had an amazingly short stride. I'm definitely a believer in the short stride, fast turnover physiologic philosophy of running.

It started raining around mile 4 which was okay. I welcomed the distraction. Thunder and lightning? All the better! Until we turned around and headed north at 6.5. Then, the rain water which hitherto had been nice and cooling, became painful. Yes, physically painful. It wasn't hail, exactly, but the drops of water were so sharp and the wind so fierce that it hurt my eyes and face as it hit me. I resorted to keeping one eye open at at time because the water literally stung my eyeballs.

Miles 7 to 11 were ho-hum (8:47, 9:28, 8:57, 9:24, 9:17). I wasn't totally dying. I wasn't totally miserable. But I wasn't enjoying myself and there was no race day magic. Could I have run faster? Probably. Could I have run slower? Definitely.   Did I have multiple moments where I thought I should phone it in? For sure. But I figured I'd be just as wet and miserable if I ran slowly....actually more so because it would take that much longer to get to the finish.

I did come up with a new mantra, though. At the 8 mile mark I became very confused by the race clock. It said 1:10 so I couldn't figure out for the life of me how I had been running so hard for so long but still didn't have a comfortable time cushion to ensure I'd get a sub-2 hour marathon. Spend some time in my water logged brain:

 "5 miles left......10 minute miles.....5 x 10 is 50 minutes. But what about that 0.1 mile at the end? Why don't I have a cushion? Oh, wait, I'm not supposed to run 10 minute miles anymore, I'm supposed to run faster....Why do I have to run faster? Cuz I'm a better runner than I used to be?.....I don't feel like a better runner. I feel wet and semi-blinded by the rain. And I sure can't do math that involves numbers more complicated than 10. Like 9:30 minute miles x 5 miles. What's that?....Oh forget it. No math, just run."


And no math, just run is what I did. I did what I could and I ended up with a respectable 1:56:44 (final miles: 9:11, 8:58). A PR. Sub-9 minute miles! (8:54.27 min/miles).

I still have a ways to go to beat that Adam, though:)

The post race was quite respectable with hot pancakes, eggs and potatoes in addition the usual gatorade, water and fruit. I'd recommend this race. I'm not sure how many runners there ended up being but it was definitely less crowded than the other Chicago 1/2's I've done in the past (Monster, Rock and Roll, Chicago Half).

All in all a good day, and merely steps from our front door:)

With the finish line in sight.....time for a new goal!

Seven weeks left! Only 49 days until I can start a normal life schedule with most of my weekends off, the ability to work-out without my pager in tow, and the ability to sleep through a night without being paged! Can you believe it? I can. It's been a long 4 years. This post, however, is not about the fact that I am nearly done with my first year of fellowship and about to start the more reasonable, controlled, independently driven schedule of a 2nd year fellow. It's about what I'm going to do with some of that new free time. It's time to start thinking about the Ironman.

When it comes to exercise, I have no shortage of goals. Some I succeed at every day (run at least 1 mile daily), some I am working towards at a turtle's pace (qualify for Boston) and some are in the back of my mind but I've made no outward moves to achieve (finish an Ironman). And there are others, like numbers of work-outs a week, number of marathons in new states a year, improvement in strength, etc, etc that I variably work towards with mixed success. But the Ironman goal has never really gotten much attention. Until now.

After years of ridiculous work-weeks, the next two years I will have fabulous amounts of flexibility in my job. Of course I'll work hard. It's not like I'm working part-time or something (wow, that could be great though). But I'll have some control over when I go to work and when I go home which is a crazy new concept for me.

So it's now or never.

When I started running, I went from couch potato to marathoner. There's something really tempting about the idea of jumping straight into full Ironman training. However, since I just learned to swim with my face under water last year and I don't even own a road bike, I don't think going straight from marathoner to Ironman is a good plan. I'll need an intermediary step, like a shorter Triathlon, just to make sure I a) don't drown, b) am willing to spend money on a road bike and c) don't spend hundreds of dollars on a race that I can't finish. Cuz if I do drown it will have been an absolute shame to have spent money on a bike and a race that I won't finish:)

Last week was kinda sorta supposed to be my first triathlon training week but I didn't get any swims in so I'm going to officially declare this week the first week. I figure if I make a big show about it, blog post and all, I'll be more likely to succeed.

I'm using this book that showed up in our apartment. I think Adam borrowed it from a friend. It's not like me to start a new training schedule without purchasing a new training book all my own, but heck, it's here in front of me so I might as well use it.

I'm following the Level 1 Half-Ironman program to start. I'm in marathon shape and have 2 marathons in the next five weeks so it's strange to see such short running segments. They call running for 35 minutes a training run? So short! So I'll be making some modifications, doing more running that I'm "supposed" to. I'm not sure I'll ever be able to view myself as a triathlete rather than a marathoner who is doing a triathlon!

This weeks plan:
Monday: 1200 yd swim in AM (ha! I think the longest I've ever swam is 200 yes so this seems unlikely!), 45 min cycle (6:30 PM Equinox spinning)
Tuesday: 30 min run w/ 6 x 30 sec fartleks in AM
Wednesday: 60 min cycle (6:30 AM Equinox spinning), 1200 yd swim in PM
Thursday: 5:45 PM Shockwave class @ Equinox
Friday: 35 minute run PM
Saturday: 60 minute cycle, 1500 yd swim
Sunday: 40 minute run

Yikes. That sounds super ambitious. Next up, making my menu for the week to fuel me through this madness!

Ah...a Long Run

I haven't written a running related post in a while so here goes. I ran 18 today at an overall pace of 9:15 which I'm quite happy with, especially given the circumstances. The wind was INTENSE. And since I was on the lakefront I fought it the entire way home without any breaks. Yes, I had the wind at my back on the way South but I think fighting 25 mph wind for 8.5 miles straight more than overtook any benefit I may have had from the wind helping me up front. I generally don't mind "the elements". Wind, rain, snow, cold, hills (not really an element)- they all serve to add variety to a run, which is good. (Heat and humidity, however, add nothing but pain and suffering.) My marathon PR was on a windy, windy day. But the course meandered back and forth into and out of the wind so it was tolerable. This straight into the wind non-stop situation was brutal. I imagine that's how the marathon in Antarctica is. That will be a tough one, but it will happen one day, I have no doubt.

So not surprisingly there were no negative splits today. The first 10 miles I did in sub-9 minute miles, but they way back I fought to keep each mile under 10 minutes and I succeeded in all but 1 mile.

In general though, I felt strong and any time there was even a 2 second break in the wind I felt myself surging ahead. If this was a calm day I could have keep all sub-9 splits easy.

I hope/think a sub-4:00 marathon is not too far away!

Very Tardy Puerto Vallarta Restaurants Post

Our view of the kitchen from our table.

Sara did some great research into which restaurants in Peurto Vallarta were fabulous and worth our time, money, and tastebuds. Both of her picks were wonderful. The first was Teatro Limon, an open kitchen restaurant run by an American ex-pat named Bruce and his wonderful British ex-pat wife, Julia. Bruce is one of those guys who is wildly inappropriate, completely ADD, but so well intentioned and goofy that he wins you over despite the riduculous things he does and says. The restaurant concept is essentially "open-kitchen, open-menu". There is no set menu, rather Bruce and his gang find the freshest ingredients they can and make whatever the heck Bruce feels like making. He simply asked if we had food allergies then let the food flow. (Without me telling him my love for bison, that's what he choose for my main course!)

Us w/ Bruce. We had no idea he had his shirt open. Hilarious!

It's been over a month since this tasty dinner so I don't remember all the details of our meal, but it was all very good. The mojito we had to start with was out-of-this-world. Bruce and his wife essentially worked the room (all 6 tables) and we got to learn a bit of their history. They both ended up in Mexico for different reasons. Bruce was actually working for Paul Newman in Canada and came to PV on vacation and never left. They ended up together when Julia had a fall, breaking a bone, and required some help. She didn't know many people in PV at that time and Bruce ended up taking care of her despite not knowing her very well. Let's just say they know each other well now!


While we were eating our dinner, a group of 3 ladies walked in and by the way they were joking w/ Bruce, we could tell they knew each other. She we ended up chatting w/ them a bit and eventually Bruce invitied us over to their table and we ended up sharing (complimentary) cognac and hearing how this eccletic group of Americans ended up in PV (two of the ladies were in their 60s, very happily married and the 3rd was a young lady Air Force vet they met through a theatre group called The Best Little Whorehouse in Texas). A wierd and wonderous group, they were.

When they found out we are physicians, out came the BP cuff! When people hear I'm a doc it's pretty common for them to start assailing me with the health issues of themselves and their loved ones, but I've never seen anyone whip out a BP cuff! That was a new one. Apparently Bruce's BP is high and he's been taking his pressures regularly. Of course, we then all had to take our pressures. Yes, this is what you do at a high end restaurant in PV Mexico in the middle of the night!

Between the restaurant, Bruce, his wife and their goofy friends, the night ended up being quite an adventure!

Our table was the one in the middle-left.

The second restaurant we tried was called Vista Grill. The main draw of this place was the view. Absolutely beautiful. Hence the name. The food was very good as well. We both had pistachio encrusted Chilean Sea Bass and it was so wonderful. Since Sara is a wonderful friend and is willing to humor me with my 'early bird special' eating habits, we were some of the first customers there. But I like to think that's not the only reason the young male servers were flocking around our table. We were right on the edge of the balcony and it was a windy night, but they insisted on repeat attempts at lighting our table candles. First one guy came over and lit them repeatedly, immediately to see them blow out. A second guy came over and did the same. We tried to explain that a) someone already tried to light them, b) the wind was the problem and c) we were fine without romantic lighting. Knowing Spanish might have helped in that conversation, I suppose.

Yummy dessert.

Then a third young man came over with a votive and tried to light the candle then place the votive around it. That worked for a few minutes. The whole thing was quite humorous. Even more humorous was a ridiculous comedy of errors that resulted in one of our water glasses flying over the balcony. Sara moved her chair closer to the table and bumped it. One of the glasses started to tip and in my attempt to save the wine (priorities, right?) I further pushed the glass in jeopardy and it landed on the table, broke, then bounced over the balcony.

We immediately froze and listened waiting for someone on the lower balcony to scream or curse or something. When nothing happened, I peered over the balcony and saw the broken class on the awning below. Phew.

You can't take us anywhere.

All in all, two wonderful nights and I'm so grateful for Sara for taking the time to find these great spots!

Sara and I. Happy campers.

The Stinky Fish

Half way through watching the Muppet's movie today (which is incredible, btw), Adam and I both noted the distinct scent of stinky fish. You know, cheap fish that someone was cooking on their stove. I noted the smell first, saying "do you smell the stinky fish?", to which Adam, being a classic boy, smelled himself to ensure he wasn't the source of the stinky fish. He wasn't. We puzzled over this for a few minutes, but let's face it the Muppets are hilarious and what were we going to do? Find the source of the stinky fish? I think not.

At the end of the movie we heard an announcement coming from the hallway. Something about the Fire Department but we couldn't quite make it out. Adam thought maybe they were imploring our neighbors to throw away the stinky fish. As Adam hung out in the hallway trying to catch the full message I made a mental list of the things to grab if we needed to evacuate. I had it down to 2 things- the wedding photos and the photo hard drive. Living in downtown Chicago really serves to limit the amount of "stuff" one gets attached to- there's just not enough room in a two bedroom place to acquire mounds of junk. I did NOT plan to rescue the stinky fish.



Then I glanced out the window and saw 10 full fire engines and a few cop cars. The firemen were walking away from our driveway in full fire gear so the whole thing looked pretty legit. So we began hypothesizing as to the cause of the fire:

Hypothesis #1 Someone burned their stinky fish

Since we weren't being evacuated, however, we began to consider what else would bring so many emergency personal to our neck of the woods. Since living in Chicago, I've personally witnessed at least 3 would be "jumpers", you know people who poise themselves to jump off building, balconies and interstate overpasses. Again we hypothesized:

Hypothesis #2 Someone's significant other made them such stinky fish that they decided life just wasn't worth living if they were forced to eat such stinky fish

Finally, the fire department announcement replayed, this time saying there had indeed been a fire. It was in the laundry room in the basement and it had been put out successfully. After congratulating myself on having a) not worked out in the gym tonight (it's next to the laundry room and would have been HOT!) and b) having a laundry service so we don't slave away in the laundry room, we contemplated what must be the final answer to the puzzle of how this fire occurred. (Like how I came up with good reasons for being lazy?) Anyhoo, we have the cause of the fire narrowed down to two possibilities:

Hypothesis #3 Someone was washing their clothes after the stinky fish meal stunk them up

Or, our final answer:

Hypothesis #4 Someone was cooking the stinky fish by putting it in the dryer (bringing new meaning to the term tuna roll)

Either way, next time they should try some less stinky fish!