My Leadbaby

I embrace the Leadville mentality to “dig deep-you’re tougher than you think you are, you can do more than you think you can!” However, finding out I was pregnant four months into my training for the Leadwoman race series made the mental tenacity needed to complete such a challenge seem like an unlikely goal. While I am already a “geriatric pregnancy” by OB standards and don’t have a lot of fresh eggs left to create my beautiful 4-year old a baby sister, the timing frustrated me somewhat since I had already put so much work into training. I already felt the satisfaction of doing back to back long runs easily without pain or week-long recoveries. I felt ready to begin the series. Though I could no longer push myself to the extreme physically, I could participate at a lower-than-max intensity and do the best I could.

Judgment from virtual strangers and friends alike slammed me over and over when mentioning the Leadwoman venture I was continuing to contemplate doing while pregnant. As any mother knows, unsolicited parenting advice abounds about everything that you are clearly doing incorrectly. While most didn’t have any actual medical knowledge, they insisted I was going to cause a miscarriage and would never forgive myself. I stopped telling people I was pregnant because I didn’t want to deal with the judgment. And kept running.

As an Emergency Department physician, avid rock climber, trail runner, ski mountaineer and Wilderness Medicine aficionado, I consider myself more comfortable with calculated risk than many others. Guidelines for pregnancy are very conservative, often based on nothing but opinion. I read every scientific article on exercise during pregnancy. Historical recommendations to limit exercise during pregnancy based on the theoretical risk of preterm labor have proven unfounded. Current recommendations support that continuing pre-pregnancy exercise levels throughout pregnancy is not only safe, but decreases your risk for back pain, diabetes and preeclampsia. The altitude studies are likewise reassuring; for short-term exposures to high altitude during pregnancies, there does not appear to be any increased risk of complications. Basically, the baby is a parasite, taking what it needs before you get what you need. So, if you feel good, your baby is probably fine.

I completed the marathon, the first event in the Leadwoman series at 9 weeks of pregnancy. I kept my heart rate below 140 the whole time, eating and hydrating much more carefully than my typical haphazard style. My training had been suffering a bit with fatigue and morning sickness, but exercise consistently made me feel better, not worse. I listened to my body and kept training, just not to the intensity I had hoped. I quit my training program with Travis Macy, Leadman 2013 winner because I couldn’t keep up such a defined regimen. I just went with how I was feeling on that day.

I was fully prepared to drop out of the Silver Rush 50-mile race, which is not a very good mental state to be in at the start of a such long race. But I again felt good. I had to slow down from what I had hoped, to keep my heart rate below 140 and my effort moderate. And I was much hungrier than normal-I ate sandwiches at every aid station. And I peed about 20 times. But, I still finished in just under 11 hours and was still leading the Leadwoman competition.

The Leadville 100 mountain bike race proved more of a challenge. I had just started mountain biking in March since I wanted to do the event. The race was my first bike race ever, and am not quite comfortable descending such steep rocky terrain. I certainly was more cautious than I otherwise would have been, since I didn’t want to fall for fear of hurting my baby, though she is still only turnip-sized and would probably be just fine. While I passed many people on the uphills, they passed me right back on the downs while I played it safe. That combined with several more than normal pee breaks likely cost me the finish-I missed the 12-hour cutoff by 4 minutes.

I’m ready for the 100-mile run this weekend. I don’t know if I will make it. I know I won’t be psychologically willing to push through those walls I will likely hit for the safety of my baby. At 17 weeks, I am 12 pounds up from my pre-pregnancy weight and getting slower by the day. But I will do my best. And either way, my little Leadbaby will have done this crazy mountain adventure with me before she is even born.

swine flu

I'd been complaining for weeks about the peds ED. I love kids but, damn. How can one not get frustrated when your board says cough, tos, cough, no come nada, fiebre and on and on. So, I decided I didn't care that we had our lovely DG Holiday Party the night before I had to work at 7. I stayed late and allowed the 4th years to accomplish the waste-the-interns mission. And then, of course, I showed up to work to get the sickest patient I have ever seen.

The only history was that she'd had a fever and muscle aches for a few days. That morning, she had had some vomiting and diarrhea. And at around noon, her stepdad found her passed out on the bathroom floor. By the time she arrived at the hospital, she was breathing agonally and vomiting blood. We intubated her, started giving her blood for her hemoglobin of 5, started antibiotics, started lines all within a few minutes of her arrival. By the time her parents arrived, she was coding. There was nothing we could have done to save her.

This case doesn't bother me because I wish we had done something different, because I fully believe that there was nothing we could have done; she was too sick when she arrived. However, this case bothers me because I really want to know what she had and I can't wait for the autopsy results to come back. Some of her blood culture results came back, which were positive for e. coli. I just think that this is bizarre. She was a young, healthy girl. Why would she get a gram negative sepsis without any preceding symptoms of UTI? I think that maybe she had H1N1 and that she got ARDS and DIC from the H1N1 and then seeded her blood from her gut, which was obviously bleeding by the time she got to the ER and by the time we took the cultures. I want to be able to explain this, and I think that this is a plausible explanation.

H1N1 has taken quite a few young, healthy people this year. It is much more virulent than the typical seasonal influenza. In fact, young healthy people don't have immunity to it because the last time a similar strain was seen was around 30 years ago. People under 30 don't have immunity.

I also think this case is interesting because it is completely parallel to Brittany Murphy's case, who also recently died after a few days of flu-like illness. The cause of her death is, as well, unknown. People are trying to pin it down to drugs, but the only hard facts are that she had a flu-like syndrome and that she went into cardiopulmonary failure and shock and died very quickly.

I will have to leave it as a theory at this point.

Bishop Christmas Crush

We planned to avoid the snowy weather by driving South and avoiding the high elevation passes that were sure to delay us as we headed cross-country on a time limit. We left immediately after Joel's final and had to make it to my interview in Las Vegas less than 2 days later. Murphy's law held true, and just about everything possible went wrong. The giant red pickle van lost power only about 100 miles south of the cities. Was it broken? Was it out of gas? Was something frozen? We didn't know. The gas gauge was broken and it was -20; our calculated mileage was around 8mpg. We gambled optimistically and kept going. We then hit snow and ice storms through Kansas, Oklahoma, New Mexico and Arizona, stressing a bit as we saw about 30 cars in the ditch. We stopped at a truck stop to shower, I changed into my suit in the van, Joel de-Rocco-haired me with a tape roller as I rolled into my interview only 5 minutes late and on a few hours of quality van sleep. Maybe in retrospect, we might have planned it a bit differently. But, we made it, safe and happy, to Bishop, CA. We joined Team Minnesota in the Bishop Christmas Crush!!

Danette on "The Hulk," a super-classic 4 star boulder problem at the Happies that is really sweet. But hard.




Mike on Red Rum, his proj.











Lynn at the optimal angle to photograph Joel in the silly furry hat Danielle gave him on the problem next to Red Rum. I forgot what its called.











Trinh on The Cave Problem, V6. I loved this problem, and worked on it my entire time in Bishop, but never sent it. I've got some unfinished business; all the more reason to make a return trip to this beautiful place.

Joel, getting the butt spot on Kyle as he tries The Mandala, V12, his proj.















Alex flashing High Plains Drifter, V7, on her first day in Bishop.

Interview Trips

I heard someone refer to residency interview trips as our victory lap around the country for doing well in medical school. I suppose you could say that . . . the interviews were mostly relaxed and low-key and I did get to visit some really cool places and mix a bit of business and pleasure. Here is Lisa, one of the British girls I climbed with during my one-day stop in Hueco. She is proving that short people can indeed do the first move on Babyface, though maybe not the second.

This is Hueco, the cutie pie little pup that George, one of the guys staying at the Rock Ranch this season, adopted. He has the exact same shape, pencil tail and giant bat ears as Rocco when he was a baby. Awww.

My first look at the amazingly majestic Yosemite Valley. Someday, someday, I will climb these granite behemoths. First, I've got some work to do on my weak sauce crack climbing skills.










The boulders, too, were awesome. I didn't actually see anybody bouldering at the Camp Four boulders, which kind of surprised me because there were a lot of tents. So, I had to boulder sans-pad on the short ones so as not to re-break myself. But, I'll be back . . . mwahaha.







I think this may be the first time ever in my life that I've taken a picture of a rainbow and it has actually showed up in the picture. This is Yosemite Falls, which I hiked up to when I got bored of bouldering by myself with no crash pad. It is absolutely beautiful and gives you some amazing views of the valley, especially Half Dome.



Portland, Maine is a really, really cute and picturesque little city. Really, with all the cobbles and tranquility, its hard to imagine a crime being committed there. Which makes it probably not the ideal place to train for Emergency Medicine. However, I think it would be a fun place to live. The residents all have Maine Medical Center biking jerseys and go on long rides twice a week. They pride themselves on being the happiest residents in the nation. It would be a fun group of people to train with.

I mean, really, is this even real? It looks like a painting. Or a postcard. I think my mom would paint a lot more if she lived in Maine.

Winter at Sandstone

It was a sunny, snowy November day at Sandstone. About 25 degrees. Climbing weather, right? I did boulder with my socks on and my wingers were just a bit chilly, but we had a great time. I was afraid the little Rocco man would fall through the thin ice, though. He really did not understand about the ice, even when it was cracking.



Shirtless on the river boulder, Joel tries voraciously to prove that Minnesota really is seasonless in its incredible climbability.











Me, with my 4 toplayer, two bottom layers and socks in my climbing shoes. A little more of a freeze baby. Or a seasonal realist, see it as you will.

The Amazing Case

The Amazing Case is a sweet urban treasure hunt/pub crawl sponsored by Summit brewing company. Janet and I did it two years ago with her brother and sister in law and had a ton of fun. This time, we were back in business with our team, the "Cheesy Poofs." My bro, Derek, Janet, Mitch and I ran from bar to bar and did various challenges ranging from pole dancing to pin the tap on the keg. There was also a photo scavenger hunt where the boys got a Hooters girl while Janet and I coaxed the valet at a fancy hotel to let us in to photograph some fancy cars.

We had a great day and made it successfully to the finish line. I should have stopped drinking a little bit earlier, though, because I was hurting the next morning at work. Also, I hadn't thought about the fact that it was night and I had biked there, leaving my car at my brother's house. Which I was far too drunk to drive. Luckily, Joel went to get my car and pick me up!

Tracy came out to meet us at the finish line and celebrate.

Halloween Comp

Lynn as "Dot" in the first annual Halloween Costume Comp at Lynn and Kris's wall. Kris set a ton of awesome problems for the comp and we had an absolutely perfect day for it.












Jess and Trinh (the Asian beetle).

















Rocco as the cutest little dinosaur monster ever.






The wall may not have won the "best woody" contest in Urban Climber, but it is surely way cooler than most of the ones I have ever seen. Or the ones that won for that matter, although apparently painting clouds on it makes it better.

"Hula Joel" did win best costume with my bikini top on.














And my M&M costume was awfully hard to climb in. But the day was super fun!! If I'm not in MN next year, I'll have to try to come back for the tradition . . .

Med II, My Last Rotation!

Whoo hoo!! I am done with medical school! It has been a long haul, occasionally rough but mostly pretty fun. Inventing the exclamation point t-shirt, though, might have been an easier way to make money and make people feel better. My last rotation was half ICU, which was fun because to try to manage the Uncle George's that come in and still kind of overwhelm me when I see them in the ER. I got to practice breaking down their problems into manageable problems. Working in the ICU makes you REALLY not want to be full code, after seeing so much money and resources be spent on patients with a maximum of 6 months left to live. The thing is, it is great to be able to prolong life. But medicine can't fix everything and ultimately, you have to accept death. And I don't want a tube down my throat so I can stay in the ICU for thousands of dollars a day too doped up to be conscious of my last 6 months of life. I'd rather accept death. I know I can't make that decision for everyone, but I do know that its frustrating when you try to ask patients' families if they are full code and they get all offended, like you are telling them that their grandmother's life isn't worth saving. I want very much for their grandmother to live, but the fact is she's going to die soon. I may be able to give her a short artificially prolonged indian summer of life before death, but . . .

Fall Climbing

Newly legal, Sandstone is some of the best bouldering in MN. Some of the boulders are located on private land and access is a bit tenuous, but how can you help but get obsessed with these sweet lines? Here is Lynn on a cool V5ish problem.

Me on the same problem, I don't know the name. The area can be kind of wet and mossy, but its really beautiful.



Here's Joel on the 30 degree wall. The wall itself isn't especially photogenic, but look at the gorgeous forest you are climbing in!!











Here's Lynn on our favorite proj, Pocket Hercules, V8. So good.















Brotherman at Taylor's Falls, tearing it up.



















He's more powerful than I am at bouldering for sure. If he worked on a little finger strength, he'd outclimb me one of these days ;)













Rocco at Willow River State Park, one of his favorite places second only to Hueco Tanks and Petie's house. He can smell when we're getting there, he huffs his little nose in the vent and when he figures out where we're going, he stands up and gets all psyched.






Jess at Sandstone on the warm up boulder.

















Lynn and Jess hiking in on the beautiful banks of the kettle river.

Psychiatry Madness

So, I can't really put up a picture of the awesome psychiatrist that I worked with because of HIPPAA and privacy and laws and such. So, let it be known that all names and details have been changed and modified to protect the identities of my fair colleagues and patients. But, I thought the comic was pretty good.
"They'll never find me, I'll just tell them you're Dr. Martin and I'm Dr. Chang," Dr. Martin joked, pitting me against a patient's pugnacious family. Their son was in here against his will, it was illegal, this place was a crap-hole, he didn't do anything wrong . . . of course, I think by now in his career, there is absolutely nothing that Dr. Martin has not heard. And he maintains the same acidly unaffected sarcasm throughout. His patients seem to be unable to affect him, yet he is somehow able to change his patients in the course of 15 minutes. He is of the school of dialectical behavioral therapy, wherein he gives his patients back exactly what they give to him and teaches them to modify the way that they interact in order to have more interpersonal success. So, he is bold and sassy. He will swear back at patients. And by the end, the belligerent youth with an attitude problem who made the ER doc cry and was yelling at half the nursing staff was repeating the words, "Keep my words sweet like sugar in case I have to eat them" and writing an apology letter to the ER doc. Talk about an abrupt change. I think Dr. Martin is amazing.
And he deals with some amazing and amazingly difficult individuals. He wanted us to really just "marinate in the craziness" of the psych ward. And that we did. Sheila had pickled her brain with alcohol and couldn't walk without her walker, but was so excited that she was going to join a basketball team. And there was Peter, who had his first schizophrenic break and was a cybertronic robot with metal for bones who you might catch near the wall "recharging." And Sally's make-up and outfits typically got darker and more flamboyant as the day went on--in parallel with her emotions. And Kara's hypersexuality, where you might find her naked on the bed screaming at the demons to "get off her." There is never a dull moment in the Regions psych ward. I learned a ton and I definitely have a lot of respect for both the people who struggle with mental illness and the doctors, nurses and support staff who help them in their struggle. My favorite image, of course given to me by Dr. Martin, is that of dreams invading your reality. And how sometimes you need drugs to help keep those thoughts in your dreams where they belong. Or you can write a book about it.

Joel Reunion

Though Joel was not so psyched to be back from Squamish, we had a nice reunion weekend of fun before "the grind" starts up again. We relaxed on the lake at Joel's brother-in-law's cabin near Hudson where Rocco was excited to see the water again! He swam like a mad-man, this time of his own volition.

He's always liked the water, but would never swim on his own until Joel and I left him on the shore while we went sailing last year. He howled for awhile, then decided he was a swimmer and would swim across the lake to the boat. And he did. Now, he loves the water and it was fun to watch him swim again. Although sometimes, its literally a pain in the ass when he decides he doesn't want to swim anymore and decides to climb onto your butt.



That night, we enjoyed the chill music of the Solstice Festival. The bands rocked and the atmosphere was really relaxed with people just chilling on blankets. Perfect for a broken foot.












Rocco had a crazy tiring weekend with swimming and skateboarding with Joel and wrestling with his new doggie roommate Petie. They get along wonderfully and like to play nonstop in the giant backyard that is now my own.










Joel and I (well, mostly Joel) climbed on Lynn and Kris's sweet bouldering cave that is now my backyard while Rocco and Petie ran circles around us.

Rocco Reunion!!

While I was out of the country, my wonderful Aunt Cindy and Uncle Jeff took care of my beautiful baby dog, Rocco, and gave him so much love that I was afraid he wouldn't want to come back with me. I drove down with my mom to pick up my baby monster and our reunion was momentous. He saw me out the window and couldn't contain himself. My mom held him back so that he wouldn't knock the gimpy me, still on crutches, down. I sat on the couch and he showered me with sandpaper tongue doggy kisses until my face was raw. He definitely remembered me! Here is him in his favorite chair at my aunt's house, looking out the window.

and here he is leaning over the back of the couch as he likes to do. he was so happy to have all of his people in one place at the same time. he followed me everywhere, afraid i was going to leave again. he remembered all of his tricks, even the ones that my aunt and uncle hadn't been practicing with him (i guess i forgot to tell them). he has a ridiculous memory!

Here's everyone (Aunt Cindy, Uncle Jeff, Aunt Rita, Uncle Jim, Pat, Mom and me) at the Apple Haus, one of the shops in this cute little German village that we visited called . . . I forgot what its called. Long something. We had a great time visiting and it made Aunt Cindy feel a little bit better that Rocco seemed to want to go with me. He didn't even want to go to the bathroom before he left; he just kept pulling towards our car, afraid he was going to get left behind. I promised I would take good care of the Rocco pie and take him back to visit soon.

D and EZ's Engagement Party

The picture doesn't do it justice; Danielle and EZ's house looked lovely decked in lavender and white, the wedding colors. We all matched the party, including EZ, who we'd found a button down shirt with purple and grey pinstripes.

Danielle, Kelly and I, sporting heart bindis.










Lots of crazy fun going on in the kitchen . . .










. . . while I tried to chill a bit more in the living room to keep my foot up so my toes didn't turn purple again.






Peanut enjoying the party with her lei.











Danielle's brother, Corey, and his girlfriend Shana making margaritas and being jolly.






Danielle's mom and grandma taking jello shots.








Danielle, Deb (neighbor) and Chuck with the funky sky in the background.







Peanut, cashed after a long night of entertaining and being fed pork bits and rice krispie treats.