Tuesday, December 27, 2011

I'm at the airport waiting to board. An era is over and I have reminisced. Goodbyes were said to colleagues, friends and family and 7 months of laid-back La Crosse lie ahead.

My running is going well, as is the Girl's. We aren't 100% sure which races weare going to do, but the list so far looks something like this:

3 days of Syllamo in March
Ice age 50 (K for me; miles for the Girl.
La Crosse Marathon (Granddad's Marathon).
Voyageur 50 miles

The girl also plans a 100K in Copenhagen in April.

In between, there are plenty of shortsr races in the area. Plenty is not reallt accurate, but there are a few out there, like some half marathons within a few hours' drove and some shorter races in La Crosse.

I plan on running a ton and cross training on my bike and in the pool. For the unlikely reader who knows La Crosse, Bliss Road, which leads to the top of the bluffs, washed away last fall, so the biking will be hampered by that. Who knows, maybe it will be fixed by spring. That road has washed away like 4 times in the 6 or so years I have known La Crosse.

Wow, in 10 hours I will see the Girl and the two boys and tomorrow I will be back with Natali and Andreas. Not bad.

Monday, December 19, 2011

Running Log December 2011

3 bjergmarathon 3:45 or so. Fast last half.
4- some slow stuff. Legs generally tired after two races in 2 weeks.
11-12 long run saturday. 2 lakes with Nikolaj Sunday
14 long run in Copenhagen
15 ran to the hospital and up to the 26th floor a few times
18 forgot about the marathon Saturday. Great long run in the green tunnel and around the usual trails. 30k? Last 10km very fast.
20 Up and down Herlev Hospital. PR frok 2nd to 26th floor: 2:52
22 quick little 5k before going to bed
23 Great legs. Around 10 miles, fartleks. Very fast. Legs hurt the next day.
25 Another great run around Bagsværd Lake. My legs are finally over the back to back races earlier in the month.
27 Femveje in the rain. Legs were a little stale. Leavving for Chicago in an hour.

Sunday, December 18, 2011

Oh no, I didn't!

I ran hard Monday, Wednesday, easy Thursday, and took Friday and Saturday off, because I had a marathon Sunday.

My week was strange, without a wife and kids. Work was hard, with all the research I'm trying to finish up and, unfortunately, no less that three of my clinic patients had relapses within two days.

So I was looking forward to the marathon. It was all planned out; the usual slow start, followed by a fast caffeinated second half.

But. As I was on the phone with the Girl yesterday, she asked "how did the marathon go?" and I realized I had the date wrong. It was yesterday! So that's definitely a strange end to a strange week.

Thursday, December 1, 2011

Running Log November 2011

29: Treadmill 800s in Vangede in 14:36 and 14:16
27: Half-marathon "Næstved Cannonball", Lasse's alternative route. 1:16.02
24: Treadmill 800s in Næstved in 14:26 and 14:15
Skovmaren Marathon 2:55
Several treadmill 800s in 14s
Cross duathlon
40-50K-ish a week, but very intense workouts.
Weight very low (lowest 63.9kg in the morning)

It's December 1st and I'm in great shape.

After probably two years of no injuries, and a few months of decent training, I find myself in really good shape. Sunday, I ran a half marathon in 1:16.02, which is a few minutes off my PR, but it was windy, I ran alone, the course was very hilly, and I got lost twice. I don't know what it translates into but the legs felt like they could go for a PR.

On the treadmill, where I have been doing my speed work, I'm running faster than I remember running during previous peaks.

Only problem is that it's December and we're moving to Wisconsin in three weeks. I don't even know when or where our next race is going to be. Before we leave, I do have two tiny marathons, but these are on crazy hilly trails so the times won't mean anything.

What to do, what to do?

And you may be curious to know that my future will be decided today. I have to choose between two jobs that are as different as night and day. Some may know that I will work as an ER doc in Wisconsin until next summer, but then we come back to Denmark for the final year of the Girl's eye study (and PhD).

One job is in the city, at a university hospital, where I would work as a junior attending. There are about 20 hematologists in the department, the teaching environment is great, opportunities for research are ample, and I would have a group of diseases (plasma cell disorders) that would become my area of expertise. I would learn from an near-retirement plasma cell guru. But it's in Copenhagen, and we live in the burg of Næstved. Commuting isn't really an option in my mind, so we would have to move to the city, away from Natali's school, Christian's day care and the Girl's job.

The other job is in Næstved, in a smaller department, where I have worked previously during my fellowship. It's one of the last (if not the last) combined hematology/oncology departments in Denmark. (For some reason, the combined heme/onc concept has survived in America to this day, and is still found in community hospitals everywhere; but that's another post.) The hematology seen there is generally not overly exciting, as the complex cases are sent to the city for treatment. There are four hematologists, who are all nice, and with whom I would love to work, but I would certainly have to do a little oncology, too. That would be fun to learn, but it would also dilute my hematology skills. I would be a decent-sized fish in a small pond, with the usual pros and cons.

It would be nice to stay in Næstved, with our safe routines waiting for us in Agust, when we come back from Wisconsin. Career-wise, it's a no-brainer, of course.

I am meeting with the deparmtent chair in 3 hours and I still haven't made up my mind what to tell him.

Monday, November 7, 2011

Almost perfect

Everything went according to plan. More or less.

I started out super slowly. Went through 5K in 21:30-ish, which is slower than 3 hour pace. The fast people were long gone and I was ok with that. 10K in 42:17, just a hair under 3 hour pace still.

Then I got anxious and sped up a little. I wish I had held back another few kilometers; maybe next time. Came through halfway in 1:27-something.

I had still held back significantly and finally it was time to run. I drank a caffeine drink I had stashed in the woods and got a huge high almost immediately. I went from 7th at the halfway point to 2nd with 10K to go. I hit the 31K mark at 2:11, which meant that a 38 minute 10K would lead to a small PR. The legs easily felt like I could run that.


With 4 K to go, I got a huge cramp in my hamstrings and had to stop and stretch out. It was really aggravating, because the legs felt great, except for the cramps. But it was what it was. I walked some of the hills the last few Ks and was able to run gingerly on the flats and downhills. Thankfully, I got passed by only one guy and still ended up on the podium with some nice prizes. My time was 2:54 something.

Those last 4K shouldn't spoil the race, though. It was fun to continuously speed up through the race. In retrospect, I probably went too fast from 21 to 37K, but it felt really effortless at the time. At the Milwaukee marathon, everything just got suckier as the race progressed. This was a different kind of collapse; after Milwaukee, I thought, "never again", whereas yesterday, I couldn't wait to come back next year.

The Girl took 2nd after starting out slowly and speeding up at the end. Her time was 3:27.

Saturday, November 5, 2011

Preview of my Perfect Marathon

The stars are aligned. Conditions are perfect. Tomorrow, I'm running my perfect marathon!

Here's a brief list of things that point to perfection:

1. I am light and have been so for over a month. My body is used to it, so I am not "weak light".

2. I am in good shape. Haven't raced much or well, but I feel like I have one coming.

3. This race is all on trails.

4. I have figured out exactly how fast to start out: running the first half in 1:30, the second half in 1:19 for a tiny PR.

5. I have a playlist that will hopefully induce a strong runner's high at the half marathon point.

The only drawback is that there are money prizes and reasonably fast people there. I tend to become too stressed to start slowly, when everyone takes off in the beginning. My last Perfect Marathon, it just so happened that the guy who ended up taking second ran the first half in something like 1:30, so I had a companion for the first half. Tomorrow, a 1:30 first half will probably put me in 10th place at the halfway point.

That's my plan. Wish me luck.

The Girl is talking about a PR, too.

Saturday, October 15, 2011

Beautiful Wisconsin

Hi all. It's been a while, but we're on vacation here in La Crosse and life has been busy.

The overall project has been to set up shop for when we move here in December. We found a nice place to live (bottom floor of an old house). We have moved our stuff in and it already feels like home, although we haven't yet slept there. It's a wonderful old house, with a breakfast nook and creaky wooden floors. Unfortunately, so far, it's been nothing but trouble, with a gas leak that needed emergent fixing and a bathroom that was being remodeled the first few days of our moving in. But it's in the part of La Crosse that we wanted to live; right on the "grid", within walking distance of downtown and the bluffs.

It's going to be fun living here again. I know Natali is excited and even Andreas has indicated some satisfaction with having us around.

Christian is learning English the hard way - at the YMCA day care and by talking to his grandparents. It's amazing how he figures out how to say things, when it's something he really needs. He is so fascinated by everything, from the "Chucks" (trucks) to the "Punkins" outside people's houses.

I'm getting back into the world of the ER. Hematology is such a small field that we tend to consult on every little non-hematologic problem. That's just the culture at an academic center. In a small town ER, it's the exact opposite. No problem is too big or too small to be dealt with by me. I like this small town and the people in it, so I love working here. But, honestly, I miss that uber-specialized scope of hematology sometimes.

Running, you ask? Well, I completely tanked at the Milwaukee Lakefront Marathon. Again, an unsuccesful road marathon for me. I was going for 2:45 but my private hope was low 2:40s. I ran the first half very slowly (1:24.xx), hoping it was slow enough to preserve my typical fast finish. But, as it turned out, the last few miles were terrible and I didn't even run a negative split (or, if I did, it wasn't very negative). My time was 2:49 something, which is a PR by 10 or 20 seconds.

I had lost a lot of weight, which had helped me PR on all my training runs, but the low weight didn't feel like a great advantage at the marathon. In any case, being here has made me put on a pound or two of fat, so I'm back in my "normal" weight range. I felt a little sub-manic for a few weeks, being so skinny, but it's very hard to maintain for me, especially being away from a routine.

Another problem with big marathons is running on pavement. Since I train on trails only, my legs were beginning to feel stale much sooner than I would have expected (probably around halfway). Afterwards, I made up my mind to race a trail marathon later this fall with a strategy of going out super hard, just to see what would happen. Now, that plan seems a little naive, but we shall see. I would need a marathon where I could easily drop out, like one with multiple loops, and I would need someone pacing me during the last half. It would be a fun experiment.

Training is going well. How could it not, in gorgeous La Crosse? I discovered a new trail that goes from the valley floor to the top of the bluffs. If you have seen La Crosse, it looks like the bluffs over the town are nothing but one big park, but that's unfortunately not the case. There is Hixon Forest, which has some amazing running trails, but there is also some private land up there. In between, there is the conservancy, which is a mix of private and public land, with undeveloped trails. Very few people go in there, so finding a runnable trail that goes all the way up to the top of the bluffs was very cool. I took the Girl out on it, and we had a nice run up it.

Well, the ER is quiet, so it's time for me to get some sleep.

Wednesday, September 14, 2011

Race Report and "What if I Died Today?"

First, a crazy little race report. Yesterday, I tried my hand at a duathlon. For those of you who don’t know, that’s a triathlon in which the swim has been replaced by a run. So you run-bike-run.

The race was pretty small. Of the 50 or so participants, there were only one guy with really flashy time trial bike. There were two distances, out of which mine (the sprint) turned out to be more of a fun run. Only a few people warmed up and people gave me the “Jeez, Focker, it’s only a game"-look, when I started doing strides.

Anyway, the race was so small that they had decided not to place volunteers on the bike course, which worried me before the start. I had a hunch that I would be the fastest runner, and this turned out to be very true. After the 4K run, I had almost a 5-minute lead to the next person on the short course (this turned out to be a woman, actually). Then, I had to time trial into the unmarked, unknown course into normal Danish Sunday traffic, with cars, bikes and pedestrians everywhere. I knew immediately that I would get lost, and I did. A guy, who I thought was from the organizing club, passed me in a car and told me to turn left at some point, which, unfortunately, turned out to be wrong. Anyway, I got off course, biked around for a bit and then found my way back to the transition and ran the final leg.

I felt ok the whole time, and doing a competitive duathlon one day might be fun. The organizers were pretty nice about the whole thing. No one could figure out why I had been shown down the wrong road.

Oh well. Which leads me to the question of “what if I died today?”

It’s 9-11. I’m waiting to board a plane to London for a hematology meeting. 9-11 and a flight from Copenhagen to London, both cities high on the terror target list.

Let me just say, though, that it annoys me to look up and see BBC and CNN broadcast 9-11 accounts and speeches all day long. When 50 Pakistani or Afghan civilians are killed by errant missiles, we shrug our shoulders and move on. And this happens almost daily. Of the hundreds of thousands of family members of those killed by Western missiles during this war on terror, no one got a second's public grieving on CNN. No grieving husband or son gets to slowly publicize their memories of the death of their loved one. It’s hypocritical, to say the least, to pretend all these hundreds of thousands (by some accounts, millions) of lives matter less than the ones lost on 9-11.

With that off my chest, just what would happen if I died today? I would be gone, which wouldn’t matter to me (me being gone and all), but a good number of people would be affected.

What would their 9-11 speeches in 2021 be about? Probably tangible stuff, like what I said in a final call or text message from inside the crashing plane. But drama aside, how would they fare without me?

Andreas, at 8, is so estranged from me that it wouldn’t matter tremendously to him. I aim to change that dramatically in the next few years, starting just a few months from now, but if I died now, he would feel nothing more than a symbolic loss of a faraway father figure. In the last three years, I have seen one single sign of sadness from him during all those goodbyes. And I say don't say this jokingly: that one time may be because he learned at the same time that he wasn't getting pizza for dinner! But I hope it was me leaving, not the pizza. I wonder what he would tell his kids 30 years from now about the father who left him for no particular reason, and then died on 9-11-11. In fact, even if I don't die today, I wonder what he will say about me!

El Guapo, at 7 weeks, would grow up without a dad, of course. He would hear more about me than Andreas, and , through that, would end up at least somewhat influenced by me.

What would Christian remember? This morning, he begged me to take him along to London. We played outside in the sun, with a very palpable sense on his part that I was leaving. When I told him it was time to go inside, he pointed at everything at said, “but we haven’t tried the sandbox... or the playhouse... or the other sandbox!”. If I die, he will remember this morning like John Wheelwright remembers the day his mother gets hit with the baseball in A Prayer for Owen Meany. I imagine them talking about me at family dinners, after a while only remembering the extremes of me, like the crazy things I said or did. Christian would look at pictures and be amazed that I was yet so young when I died (he would remember me as an ancient father, of course, as all kids do).

Natali would suffer most, I think. She would receive the news and cry inconsolable, as she has so many times over the last three years, saying her histrionic goodbyes. But over time, she would settle into normal Wisconsin life, her bi-cultural edges wearing off, her unique personality disappearing behind reruns of Glee and How I Met Your Mother. She is the one I worry the most about; the one I feel the need to protect the most.

And the Girl? It’s a difficult question. She is more of an island than the kids. I would miss her more if she died, than vice versa. Her life’s trajectory has been pulled so much off course by meeting me that if I died, leaving her with two little kids, she may even end up resenting me. Sometimes, I sense that her idea of me is more important than the actual me, our lives a homeopathic version of what it would be like with me dead. Again, it hard to imagine exactly what would happen. She is not nostalgic, as I am, and I worry her memories of me would be kept alive mostly to please the kids.

Addendum: I lived!

Wednesday, August 31, 2011

Half marathon race report

I thought I was in 1:15 to 1:16 shape and the Girl wanted to PR. There were some good prizes, so the main objective was to win.

We have had terrible storms in Denmark this last month, and 20 seconds into the race it started thundering all around us. The RD, Charley Proedel, had stated before the race that no matter how bad the lightning got, he wouldn't cancel. Still, when lightning struck a few hundred yards to the left, I was wondering whether the lead-out bike would pull over and seek cover.

He didn't, and I was able to stay in the lead the whole race. I started out slowly, hoping that we could get a little group going, but no one wanted to come with me. A number of the runners looked really fit, including a lean, mean triathlete.

My time was 1:19 something. I lost some time from starting really slowly and had a crisis at 12-16K as the storm came from straight ahead. Still, 1:19 is a little disappointing.

Here I am, confused about what to with the finish line tape. It didn't seem like it was something I could run through, so I stood there looking stupid. Stupid and lean as hell, you have to admit.

The Girl ran in 1:39 and won. Her hip hurts a little, but she is in great shape.

She checks her Garmin every 20 seconds, which drives me nuts. She looks like this when she runs intervals:

Life outside running is good. El Guapo is gaining a pound a week and is almost able to defend himself when Christian tries to kill him in various ways. The Girl's mother is here to help us out, which makes all the difference. The Girl continues to work part time, which is very unusual for Denmark. Most women take a year off, where they focus solely on being mothers. This may be more unique to Northern Europe/Scandinavia than I had previously realized. My cousin, an ambitious star biochemist, took a whole year off with both her boys, and apparently loved that life.

The Girl hates that life. She is thinking about going back to Wisconsin early, just so she can find a daycare that accepts babies. It probably won't come to that, though, and we'll have to use our baby-sitters a lot, so she doesn't go crazy.

This weekend, we are running "Skovloeberen", a trail race. I'll do the half marathon and the Girl does the full. It's pretty competitive, but top 3 or 5 should be doable.

Saturday, August 6, 2011

Running log August 2011

27: Half marathon in a terrible storm. Won in 1:19. Slow time, but hard course/conditions.
25: 5k very slowly
21: Tri club championships
19: Fartleks
17: 10 hills in 21:18 PR!
9-16: Can't remember. Decent training with hard sessions every other day.
8: Long run. 2:09. Steady, decent pace. Ran 5 x perimeter loop.
7: Some core stuff while watching TV. Last night of paternity leave.
6: Hill loops. 39 laps under 2:20 average. New PR!!
4: Long run. 40 minutes in the morning, 2:10 in the afternoon.
2: Back to reality. 6 x 1 mile. 29:38. This is probably around 40 seconds slower than my fastest time from last year and 20 seconds slower than my best time from 2 years ago. On the other hand, it may be the 4th or 5th fastest time out of 30 tries. So, although I was hoping for a little more, I'm not far off being in really good shape.

Sunday, July 31, 2011

Running log July 2011

31: Two hours at night. Last 5K with great legs. Engine is running a little hot; maybe it's time to back off a little before I get injured.

30: 5 (five!) runs throughout the day, to the playground, to the store, with Christian etc. PR on 10xHills: 21:16!

29: 5K jog with the Girl and the Dualie jogger. Weight: 65.7kg

28: Long run: 2:15. Five loops on the perimerter trail.

27; Mixed stuff. Can't really remember. 1X Stenskoven

26: PR on 10XHills: 21:28!

25: Biked 3xStenskoven. Ran a little bit?

24: Treadmill intervals (in the rain). Couldn't remember how I did them last year. Now, I run 4000 twice, like this: 3X800 fast with 200m at 12.5kmph in between. The last 1000 I run at 0% incline (the rest at 1%). Got 15:11 and 14:55, I think.

23: Hill loops under 2:20: 35 loops!! New PR

19: Hills loops under 2:20: 29 loops. New PR

17: 10x Hills: 21:35. I think close to a PR, but I'm not sure.

The early part of the month, I ran in Sweden and in Denmark, but nothing was timed.

Saturday, July 30, 2011

A good day

It's hard to complain about life right now. Getting back into shape should be my priority number 6 or 7, or whatever number sounds good to you. Without a doubt, there are bigger things on my plate right now, like the Girl, the kids and work.

But I have to admit I've been waiting to get fast since last fall, and finally being able to train hard feels great. This winter and spring, my work (and commute) and being a dad to Natali took too much time to seriously train. One would think that exchanging a 10-year old for a new-born would add more work, but I was more or less a single parent to Natali for most of the time. Most nights, it was a question of going for a run or spending time with her, and she could manipulate me very effectively.

So I'm coming into this late summer very undertrained but perhaps the most excited about running and competing I have ever been. And I'm not even that undertrained. Sure, the miles have been low, but I've run 4 or 5 marathons around 3:10 to 3:15 and they should be able to count for long runs through spring and winter. So, I'm not starting from scratch.

These last weeks, I've gotten serious. I've lost weight and I'm improving quickly. With everything else going on in life, it's intoxicating to feel myself getting faster almost daily. Maybe it's escapism, but at least it's a healthy form of it.

So what am I training for?

I still have enough track runner in me to think of ultras as just a little bit of a cop-out. You can't really compare the times in those races, not to races of equal distance or, really, to the same race previous years.

On the other hand, I train almost 100% on trails, and when the Girl and I talk about races for the fall and next year, they are all trail races and/or ultras. I think a compromise will be to run a few "real" races, just to post some times to show (myself) that I am fit, and then run the trail ultras for the awesome experiences they can be.

This evening, a solid PR on my hilly route capped off a perfect day of paternity leave. I've gotten so incredibly close to Christian since the baby was born. It's a combination of having time for him, while also wanting him to know that the new baby isn't going to replace him. He is such funny age (three and a half), and his language is such a comedic treasure trove. I can feel that just this last week I have changed the way he looks at things, and I love getting that feedback from him.

The baby is perfect, meaning that he is cute, eats and sleeps well and holds the promise of becoming someone with a personality soon. The Girl is a superwoman, for good and for bad. She is being watched, both in real life and on her blog, while she pushes the envelope for what's possible post-partum. She would do well to take a day off now and then and enjoy her maternity leave but I have very little to say in that matter.

And the two kids in America are doing well. Andreas is spending the week in northern Wisconsin and Natali is about to start soccer camp.

Friday, July 22, 2011

A Baby is Born!

Mattias was born yesterday. Everything went well and we were back in our apartment with a perfect brand-new baby 5 hours after we left home. The epic details can be found on the Girl's blog, of course. She is already at the gym working out and showing off her newborn son.

Becoming a dad for the fourth time has released a lot of strange emotions in me. I've thought even more than usually about my two kids in La Crosse. We skyped yesterday and Natali was very interested in everything. Andreas took a quick look at the baby and promptly went back to playing Wii Mario.

Christian had been with my parents for a few days and already knew that the baby had been born. When my parents brought him to our house, we had put the baby in the back bedroom, so we could "discover" him together. He exclaimed, "there is my baby" and ran over to look him over dilligently. He did poke at the little eyes, and a few times an elbow found its way drilling heavily into the defenseless baby, but he seemed genuinely excited to meet his little brother.

The impending delivery and all its uncertainties, like whether it would produce a normal, healthy baby, had blocked our view of the future a bit. But now it seems realistic to start planning the life that starts after my fellowship ends on December 31st.

We had talked about moving to Madison, but it turns out that we'll be in La Crosse next year. No doubt Madison would have been cool, but I'll be working a lot closer to La Crosse and it will be great to live right by the kids. Also, La Crosse has somewhat better running and much better biking opportunities than Madison.

Which leads me to our racing schedule for next year. For the first time in months, I am starting to train seriously. I have already dropped 3 or 4 pounds and I can feel that I am getting faster every day. We have Skovløberen, a trail marathon, and the Milwaukee marathon planned. I don't think neither I nor the Girl will be able to hit peak shake so early though, so hopefully we can find a race in late October/early November. Maybe the Copenhagen 6 Hours? I will have to look into that; for now I just enjoy getting back in shape.

The plans, in terms of race schedule, are also solidifying for next year. I think Ice Age (50k for me, 50m for the Girl) and Voyageur are pretty certain as is a little triathlon near La Crosse (the first triathlon we ever did in 2008). La Crosse has a marathon now, called Granddad's Marathon (named after the big bluff towering over the city), but it's all on roads and the level of competition has varied a lot in its first two years. We may run the Tuscobia race, which is put on by my ex brother-in-law, Tim Roe. And we're talking about the Birkie, although the Girl has never cross-country skied.

The Girl is home, beaming from being able to exercise the day after giving birth.

Thursday, June 23, 2011

Awash in Nostalgia

Natali bent down and cried a little when she said goodbye to the Lorax. They have lived together for two years and won't see each other until October. My ex made a point of not inviting me inside, instead insisting on being friendly enough outside her house. Andreas was already inside, so he didn't get to say goodbye to his brother, and probably didn't care. I talked for a while with my ex, while the Lorax looked at her dogs and wondered aloud where Natali had gone to. It was like he knew she was more gone than when she usually disappears from sight.

I get to spend one more day with them, when I get off from work after this weekend, but the Lorax will head back to Milwaukee with his grandmother tomorrow.

I took Christian for a walk around downtown La Crosse. He marvelled at the same things Natali and Andreas did five years ago, when we first moved here. It's such a beautiful, cool night here; the Lorax shrieked as he chased sticks down the little stream that flows from one of the statues. He got too excited and stepped in the little river, just as his brother did 4 years ago.

I could have cried, but I haven't yet. The Lorax sleeps with his grandmother and I just got back from a run. I planned to go running around town and to thicken the nostalgia I ran around the hospital where we used to live. Many of the houses were hit by a tornado this spring and ours is marked with a neon orange box. Some houses have x's inside the boxes, and they seem to be condemned, but ours had a family moving in. It struck me that the new interns are probably starting next week.

I snuck around the back and almost couldn't breathe as I looked into our old kitchen. Birthdays with the kids, our first Christmas in La Crosse, my early romance with the Girl, the kids running out the back door; it all came back to me. It felt so close, like I could reach back in time and walk in there to a life that resembled normalcy.

I could see the bedroom ceiling and imagined all our things on the floor. I imagined waking up there with the Girl on a warm summer morning, listening to the birds outside.

It's an end of an era. Natali has been a light in my life these last two years and she has been a major positive force in Christian's life. She is very proud of what she has accomplished in Denmark and talks about keeping a similar lifestyle in La Crosse. I hope she succeeds.

Now that she is gone, there are a few positives. I will have more time for Christian and the Girl, not to mention the new baby. Natali and the Girl have a step-mother, step-daughter relationship that I don't understand. Seeing their disagreements move into the background will be nice.

But even with a myopic focus on the positives, I am already counting down the days till we move back here.

Wednesday, June 8, 2011

I felt moved to write a blog post just now. I'm on the train home and was reading World According to Garp. Garp's kid just died and I was starting to water up so bad I couldn't pass it off as allergies. The girl opposite me was looking at me, trying to figure out what was going on.

What's going on is that I am a mess. Natali has 10 days left here and she is doing everything once last time. Everything is a panicky realization that " dad, we won't be able to do that before we leave!". She is planning things with each of her friends, exchanging email addresses and Skype info. She hasn't started packing yet; in fact, she still decorates her room, pretending she will be in it forever.

I have resolved not to wallow. The Girl blames me for being too nostalgic, and she is right. If I started grieving, I would take it too far, and ruin Natali's last weeks here.

It's six months and we'll be in Wisconsin for The Girl's maternity leave (likely Madison, but we not 100% sure). But I'm not built for these long waits, at least not anymore. She will grow up without me there for an entire half year, making new friends, changing, learning, opining.

The critical reader may say that I have another son, who I readily left for three whole years. And that read would be right; my only explanation is that people adapt to anything, and my adaptation was to dote on Natali. I look forward to spending time with both of them this winter, so all is not bad.

The fact that the new baby is not growing adequately is making this time worse. I couldn't believe that the Girl returned from the doctor's yesterday with scary information and less that half-assed reassurance that "things are probably ok". An u
Ultrasound will tell us if things are ok, not a nurse who is behind schedule and wants to "move the meat" (which happened to be something I said all the time as a senior resident, but it seemed cool then). Goddamn Danish health care. Especially primary care is so dangerously incompetent that one always has to hope for a quick referral to a specialist.

So on the positive side,

The weather is good
Work is good
I'll be a hematologist in 6 short months, ending my life-crippling commute.
The kids don't have leukemia
The Girl is slowly starting her maternity leave. She is happy and healthy.
Natali loves it here and will think of these two years as the best of her life.

on the other hand,

I have a life-crippling commute
I'm too emotionally labile to read Garp in public
I'm fat (ran a 3:19 marathon that felt like a 3:05 marathon should)
Natti is leaving
I worry about the baby

Monday, May 16, 2011

A day in the life of Danish Health Care

A young man is getting chemo for his cancer. He has about a 60% chance of cure and it's very important that he gets scanned on time between his chemo treatments.

His chance of cure may fall to 59% or 59.5% if he doesn't get scanned on time, or it may not fall at all, statistically. But for his kind of cancer, having spread the way it has, this particular scan and this very particular time will guide which chemo he gets next.

But Denmark needs money. So the health care budget grew less than it should, meaning each hospital got less money. At our hospital, the radiology department was hit unreasonably hard. CT slots were cut. Nurses, techs and radiologists were no longer allowed to work overtime, as this is usually very well-paid in Denmark.

The wait-lists grew, but since our patients tend to be very sick and very salvagable, they tend to get the scans they need, and I have only been vaguely aware of the problem.

Until Thursday, when I realized my patient hadn't gotten his scheduled scan. My first thought (my first fear, rather) was that I had forgotten to schedule it. But no; there it was, clearly ordered for a specific week. I called radiology and was told it couldn't be done on time. I had to tell this to the patient. He is a nice guy, with a warm smile, but he was visibly worried about the delayed scan. I had to walk a tight line between blaming "the system" (and keeping his faith in me) and pretending the scan could easily wait (keeping his faith in the system).

I got his scan scheduled today, after reaching an onco-radiologist, who sympathized with my plight. Still, the scan will be a week late.

For those interested, here are my thoughts on the future of the Danish health care system.

I think the standard of care is running away from Denmark. So far, we have been saved by our wealth and a health care system that offered high-level care in bare-bones surroundings. In Denmark, we have been able to treat people with $100,000 biologic agents, while they sleep in 3-bed hospital rooms with a shared bathroom (if they are lucky; sometimes, they sleep in the hallway). But the growth in the number of, and duration of, treatments have outpaced economic growth. Where, just 10 years ago, some diseases had very cheap, palliative treatments, there are now piles of novel, or biologic, agents to try. They are without serious side effects, so you can use them in everyone.

We're seeing some rationing, but it's politically impossible for anyone to devise a list of who can receice which drugs, and who can't. Drug costs will rise exponentially and the health care budget will stay steady.

I'm not optimistic. The Scandinavian credo has always been that everyone deserves the same care, rich or poor. In ten years, a wealthy American (or a wealthy Chinese, for that matter) will receive care that is unavailable in Denmark. Can we stand that?

Now, I'm not neccesarily a fan of the American health care system. Where I frequently work, it's not unusual to see people in their twenties with dentures, because their parents couldn't afford dental care (or the one medicaid dentist in the area moved). I have seen old couples ration out pills between them, because they couldn't afford meds for two.

I don't know what's right, but I don't like what I see.

In other news, I'm fat. Natali thought it was funny that my man boobs jumped up and down last night. I am so miserably out of shape.

In other, other news, the Girl and I have a plan. It's great; it's a dream, and my spirits are high. The plan? I can't reveal it, for fear of the Girl changing her mind.

Tuesday, May 10, 2011

All over again

We're back from an almost month-long vacation. First, it was two weeks in America; then, half a week back at work and off again to Mallorca for our triathlon training camp.

We had a great week there. The island is mostly known for its white sandy beaches, but cycling is another major source of tourism. We didn't train as intensively as the other members of our group, who are all accomplished triathletes (most of whom have completed Ironmen (Ironmans?) in 10-11 hours).

They would get up and swim every morning at 7 and then ride around a hundred miles a day.

The mountains on Mallorca go up to 1400 meters, with the highest paved mountain pass at 1100 meters. The longest climb is 13K at 7.4%. I've never climbed real mountains before and loved every minute of it. If I lived by mountains, I doubt I would be a runner.

Christian has no idea whether he is in Denmark, America or Spain. He liked the beach and the fact that we bought him toy cars and ice cream. He loves Lightning McQueen and screams "Lamma Queen!", when he sees anything related to Cars (which is all the time on the Mallorcan tourist strips).

Because of our peculiar life, Natali travels a lot, but she only sees the same two countries, and most of her vacations are spent at her mom's house. She lapped up the sights and sounds of Mallorca and tried speaking a little Spanish here and there. She is such a thinker; she notices and questions everything.

After we got back from America a few weeks ago, she missed her mom so much that she would wail in frustrated despair. It was difficult for a few days, but it got better. She has always stated that she wants to stay with her mom, and she smiles when I go on about how much I'm going to miss her. I think she considers me the strong parent; the one who will stay a constant in her life, no matter what. She often mentions that her mom does not miss her enough, and that she never seems sad when she says goodbye.

Now, her move back to La Crosse is just a month away, and she can see it coming. I realized that I have no more weekdays off until we leave for America in June. I told her, and the realization that we wouldn't have any more afternoons together dawned on her. I won't be biking her to school or picking her up - ever. Not for the foreseeable future, anyway.

Yesterday evening, we played soccer with the neighbor girls. She wore her new Barcelona jersey (number 10 Lionel Messi, away colors) and did the Messi cheer when she scored. She asked me whether I thought she would play soccer in America and if I would pay for it, if her mom couldn't. Later, she asked when our annual spring day in Tivoli (the old amusement park in downtown Copenhagen) was going to be. She perfectly well knew that no such day will happen this year, as I have no days off. And then, trying to pretend all her questions were unrelated, she wanted to make sure I would call her every day. She figured out that I could stay up till 11 and she would hurry back from school, and we could talk that way, despite the time difference.

It's horrible that she is leaving. I dread it and it clouds my mind.

Tuesday, April 26, 2011

Chippewa Moraine 50K -report

The ending is really exciting, so keep reading...

After my scarlet fever and subsequent antibiotic treatment, my plan for the race was to start easy and see how I felt. I didn't really think I could win, and when Brian Peterson showed up to register, it was no longer an option.

Before the race, I was recognized by many as the husband of "that crazy pregnant doctor with the blog". At least that's what I took their double-takes to mean.

We started off in a pack of 6, with Brian Peterson already running way out in front. The pack included John Storkamp and Joe Ziegenfuss, with whom I have raced (or have seen race) a few times. A young guy from Duluth, Craig Hertz, looked really strong. Jonas Ryttie was yo-yo'ing a little ahead and behind the pack, whereas Rob Semelroth followed the pace.

I didn't feel good and was noticably more out of breath than the others. At maybe 8 miles, I was spit out the back of the group with Joe Ziegenfuss and then Jonas Ryttie. The front group seemed long gone. Before the turn-around, I got lost going up a hill to a house, and didn't realize that I was off course until I was running over a buried septic tank. I Ran back down the hill to see the front group (including Brian Peterson) coming back from the turn-around.

On the way back, the two-way traffic made the trail a little crowded. On the other hand, it was fun to see how close the women's race was. The Girl was near the back, going a steady pace, still without contractions. We talked for a little while, during which Joans Ryttie, whom I had run with since the turn-around, got out of sight.

The course is so undulating that it's hard to spot other runners. Even if you see other runners, the trail twists so much that they could be ten seconds or two minutes ahead. I settled into a content pace for the next ten miles, during which I didn't see another runner. I was starting to feel pretty good and felt a little runner's high. On the one hand, it seemed like I was in for a typical strong finish, but on the other hand, it seemed like it was going to be a very lonely fast finish.

And now it gets exciting. With a few miles to go, I passed John Storkamp, and then saw two spectators, who shouted "there are a couple of runners up there you can probably catch!". Interesting. Suddenly it felt like I was in a race again, and I sped up. Almost immediately, Rob Semelroth came into view. When I passed him, I saw that both Craig Hertz and Jonas Ryttie were up ahead in the distance. The former was being passed by the latter. I figured I could catch them, if I dug deep and started surging ahead.

The last mile is a long sweep around the perimeter of the field below the park headquarters. I could see that I was getting closer, and for a moment it seemed like I would get up to Craig and Jonas, but then they started surging up the hill, starting a long sprint. They were halfway up the last long hill when I got to the bottom, and a large part of me was quietly happy I didn't quite catch them. The two of them were forced to sprint/powerhike up the steep wall leading to the finish line. It was crazy to watch. Craig used long classic-ski style steps, whereas Jonas hiked with choppy, fast, short steps. Craig pulled ahead to take second and seconds later they were both rolling on the ground deep in oxygen-debt.

I thought the hill was terrible at an easy no-pressure power-hike and I can only imagine what if would be like to have to sprint against someone else in front of 50 or so spectators on a hill that steep.

I got fourth with a time of 4:15. All in all, a decent race. I've been regretting not speeding up earlier; I had a lot left at the end, and would have loved it if they turned it into a 60K. It's that feeling of "running out of trail to catch people". Maybe if I hadn't gotten lost, if I hadn't chatted with the Girl or if someone had shouted "you're about to catch a couple runners" a mile or two earlier...

Oh well, excuses and retrospections are always aplenty, and it's possible the other guys got more lost than me (after all, one little detour in a 50K is pretty good for me).

The Girl's very sensible DNF is well-described on her blog, of course. She had a good time, all things considered. We will definitely be back next year.

Results here

Sunday, April 17, 2011

10 vacation stories

1. Plane fever.

Rigors, high fever set in while waiting for the plane. About an hour into it, I am shaking and feeling like I could pass out if I moved my head too quickly. Natali watches the Lorax for two hours and I'm able to take max amounts of tylenol and ibuprofen and take a nap. I feel a little better after that and don't have another attack until we roll into the driveway at the Girl's parents house. Scary.

2. Madison Rendezvous.

The Lorax rus over to give Andreas a big hug. Andreas looks embarrassed, and he doesn't feel like hugging me either. I have lunch with the Ex, our two shared kids, their new step-sisters and the Lorax. It it pleasant, although disagreements are always breewing under the surface.

3. Is my son retarded?

Andreas is 7 and can't zip up his jacket (he can zip up everything else, but the jacket is apparently very challenging. He doesn't hear anything I tell him, stops mid-sentence, stops mid-putting on socks, mid-everything. When I bring anywhere public, he bumps into everything and everyone.

4. In the onions.

We're at the children's museum in Madison. The power-moms, who are done feeding their kids organic snacks, eye us sceptically as I let Andreas into the kiddie-area. It looked so appealing, and both he and the Lorax wanted in. I figure I can pretend we are both playing with the Lorax. Two minutes later, Andreas is hiding in a mud hut, banging fake fruits and breads together. With me 104 degree fever spiking at this moment, I feel unable to get in through the opening to yank him out of the hut (and the kiddie area). Instead, out steps Andreas, holding a some rubber fruit (a large plum?), which he proceeds to hurl at me.

It hits me square in the nut-sack.

I point at him, letting him know that he'd better follow orders, or there will be hell. He ducks into the hut, re-emerges with another fruit (this time a yam?) and hurls it at me.

You guessed it; direct shot to the onions.

He runs away, onto some swinging bridge, where I finally catch up to him. I grab him so hard, he starts crying. and pulled him out of the kiddie area. I get him into the back area and gave him a scolding he won't soon forget.

Of course I realize that this is all my fault. How did my life end up like this?

5. So Many Kisses

I am buying some shirts for Andreas at Dick's sporting goods. The Lorax is tired and getting ill, too. He keeps begging for stuff, as he sits on my shoulders, resting his snotty face on my head. I speak English to Andreas in front of the guy at the register but then the Lorax yells that he wants to ride in the bus outside the store. I say "only if I get a kiss". He bends down precariously to give me a snotty kiss and murmurs "dad, I give you so many kisses today". The register guy looks at us with a bewildered look.

6. Is my son a genius?

Jeebus. We are playing chess and Andreas knows how to play! Not just that; he concentrates, and he is good. I play without my queen, and with that handicap we have an even game until he makes a couple of mistakes. We rewind some moves so he can see how he can better defend himself, and he learns from his mistakes. Hmm?

He draws and writes stories. He focuses on robots and monsters with an excessive amount of weapons and powers, but there are intricate details in each drawing and his stories are good. One year ago, he couldn't even read, and now he writes full stories about heroes and dragons. Not hmm. Wow.

7. I Narrowly Miss Sarah Palin.

We almost got stuck in the protests around the Capitol, which have been simmering all week, We are on our way to see Rango, so this political stuff is inconsequential. Turns out Sarah Palin was there speaking to the Tea Partiers of Wisconsin.

8. My trail in La Crosse.

The Lorax got picked up by my mother-in-law, whereas the two other kids were at my Ex's house. My illness had been retreating for the last few days, and I go out for my first run in 6 days. Whew, the first few miles are rusty, then the legs get golden. The trail is the same; I run it without thinking. My feet know all the roots and rocks. One section washed away, but that has happened several times in the last few years.

9. I am in Love.

I miss the Girl more than I had expected. A vacation just isn't the same without her. We Skype and she flashed me. I feel ten years younger.

10. The Doctor Gets Ill part Deux.

I get back from my run, and prepare to shower. I have vaguely been aware of a rash on my forearms all day. My arms are all freckles and moles and hair, so a rash doesn't stand out like it does on, say, other humans. I take off my shirt and - BOOM! - I see a massive maculo-papular rash on my arms, chest, neck and back. And face, I realize! Shit, a rash like this a short week after getting a sore throat! Add to this the fact that Natali was diagnosed with strep throat the day before and this screams... Scarlet fever!

Jeebus. I called in some amoxicillin for myself three minutes later.

As always, my vacations are never boring. And I should add that the last 48 hours with Andreas have been the best we have had in years.

Monday, April 4, 2011

Preview of Chippewa 50K and Life in General

First, my running. I am impressively out of shape. My training reminds me out my intern year, the other year in recent memory, when I have been this undertrained. I can't remember another time, other than intern year, when I have been this un-injured and permanently feeling fresh. Every workout is a treat to be savored.

That's the positive spin on it. The negative is that I am 5 pounds overweight and 10-15 minutes slower over 50K than I should, or could, be. I can feel in my workouts that the typical spring "pep in my step" hasn't come. I can hold a decent pace for a decent amount of time, but it's not better or worse than it has been the whole winter.

Chippewa is my big spring goal race. Let there be no mistake about it. I am no ultrarunning hipster; and I won't pretend that it's just a fun run or a training race. But, on the other hand, my current form dictates that I will have to run my own race and get whatever place falls into my lap. Ironically, Chippewa in 2008 continues to be the race where I have most severely bonked, and the 2011 version could surpass that, if I started out too fast. Besides, Joe Ziegenfuss, who probably runs a 50K on par with a very in-shape me, has signed up, so there is no realistic chance of winning.

But, again I have to be honest, one can always dream, a la Jim Carrey's "so there IS a chance!". Who knows what kind of shape this Ziegenfuss fellow is in, and who knows if he will even show up. And as people think "but there are so many other people, who could beat you", I remind you all that I do not read minds. There is a chance of winning ,however small it might be. And as I always tell people, the fun races and the ones where I have a decent chance of winning, placing, finishing in the money, or getting a PR.

Hmm, the bravado is getting me excited. Too bad it's too late to train. Maybe I could drop a pound or two?

Now, to life in general. Denmark is enjoying the first few days of spring, and the effects are everywhere. Nurses are flirting with paramedics, stroke patients are learning how to wink with their good eye, and my recently divorced friend and future hematologist started dating one of the nurses on the leukemia floor.

And yours truly is feeling it, too. Reader(s?) will know that I tend to get melancholy when I think of the uncertainties of the future. Last week, we hit a low in that regard. The Girl suggested that we move close to La Corsse, so Natali live with her mom (my Ex), which suddenly meant that our, admittedly tentative and perhaps realistic, plans for moving to Oregon or Alaska had to be cancelled. From one moment to the next, we had quasi-settled on four possible locales: Madison, Twin Cities, Rochester and Iowa City (in that order of preference). The cities with med schools, that is.

I had looked forward to living with Natali and exchanging her for Andreas (who was always going to live with my Ex, anyway) duting school breaks. But our new plan will work, too, although I was depressed for a few days after this new decision. Not because of the plan, just because something so basic to my happiness can change so rapidly, beyond my control. Natali would prefer living with both her parents within a few hours drive0
, too, so she and the Girl are actually agreeing for once.

So once we had our new plans settled, and a fair amount of pointing at the Girl going "you're not going to change your mind again, are you, because 15% of my brain is constantly is constantly thinking about this!" had occured, things started getting good. The weather happened upon us, as we ran an almost-marathon in a beautiful forest on Sunday.

It's almost to the point where I feel optimistic about life.

Work is okay.
We found a name for the baby: Mattias.
Natali is doing well.
Andreas is doing well.
Christian is speaking fluently now, and is making slow progress in his potty training.
Mattias is healthy, as far as we know.
The Girl's research is going well.
Our plans for next year are solidifying.
Our plans for life are solidifying.

And in ten minutes the Girl will bring back the Lorax from music class. I will bike with him to pick up Natali at the gym, where she is currently in her "young fitness" program. We'll have a few minutes before the emerges from the gym, and to pass the time, the Tallest Slide in Næstved awaits us; he shrieks as he slides down, his long blond hair flying behind him. He knows that I, on occasion, will have a few gummi bears in my pocket to reward him for particularly spectacular descends, and he looks up optimistically the moment his feet hit the sand.

Life is all right.

Thursday, March 24, 2011

We have been thinking hard about a name for the baby. I have always felt that picking a girl's name is so much easier that a boy's.

We want a name that's primarily Scandinavian but will also work in America. A name that makes people go, "yeah, that's right, he was born in Denmark", but not one that he will spend a lifetime spelling and explaining.

For the readers who know my name, it's very unusual for America, but the corresponding last night is pretty common. So it's not completely unfamiliar to most Americans, but probably a little bit on the weird side, if I'm to be completely honest. So that's a consideration.

Here's a top 10 (and this will be fun to read in ten years):

1. Mattias

2. Tobias

3. Carl-Mattis

4. Anakin (yes, like Skywalker)

5. Mats (like Wilander, the tennis star)

6. Samson

7. Isak (probably a little higher than 7th)

8. Lukas

9. Eric

10. Emil

I was discussing my unusual family structure with my department's professor. We were talking careers, and I mentioned that going back to Wisconsin/Minnesota isn't so much a work thing as it is a kid thing. The professor understood and confessed that he too had step-kids and kids with step-parents. I told him how Andreas had looked at me and called me Jeff (my ex's new husband) and I swear the professor got a little bit of a tear in his eye.

Another attending is on his third marriage and has a complicated structure of kids and step-kids, so he is another person who can relate.

The truth is that Andreas is doing better than ever. He has always been an introverted, shy kid. He has always been well-liked, though, and he is a handsome, tall boy. His favorite things to do is play video games and draw robots. He doesn't like Skyping, so I don't get to talk to him very much, but the other day he read to me from a book about Christopher Columbus. I didn't even know he could read more than a few words, and now it turns out he reads like a 4th grader (he is 7). Jeebus. He was in summer school last summer, because his reading was subpar. So he is doing well, no thanks to me.

I don't miss him the way I missed him and Natali when we first moved here. when Natali came to live here, I was ecstatic that I had at least one of them, so the desperate feeling disappeared. But I think about him every day, and there is a constant sense in my mind that things didn't turn out like they were supposed to.

So there's another sappy post in a long line of sappy posts.

But I do like the name Andreas. I felt it was a little too Germanic, when my ex insisted on it, but I like it more and more. When Andreas watches the Tour de France with me, he is fascinated that there are other Andreases out there (like Kloeden from Radioshack). In a tiny, but palpable, way it connects him to the Old Country.

Monday, March 14, 2011

It's a bois!

The Girl carries a sonographically normal little Lorax!

She's a little more than halfway through her pregnancy, juggling her monster PhD, her multiple other projects, two kids, me, running, swimming, biking, bills, her Green Card (it's approved for another two years), our taxes (Danish and American), dishes, painful breasts, minimalist hipsterism and smoky gourds forgotten in the oven.

It's not easy to be the Girl right now and I should work harder to keep her happy. The Girl, if you read this, this quest for your happiness will start after my guys' soccer night on Wednesday!

Wednesday, March 2, 2011

Two patients with leukemia

These two patients are examples of why hematology is such a crazy, unique specialty.

Patient one has an incredible story. As a teenager, he developed leukemia while living in tribal Pakistan. His family must have been wealthy, because he had access to several expensive medications that kept the disease at bay for a year or so. Then, his family's business was extorted by the Taliban and/or the local warlord but refused to pay. His parents were killed and he fled through Asia to Europe.

When he got to Denmark, he may have had to lie about his age. He had no papers and it's slightly less impossible to gain political asylum if you are a minor. So we're not sure exactly how old he is.

He has no family and no friends in Denmark. He lives in a refugee center, while his case is being processed, but spends most of his time in the hospital. The leukemia is mutating, so over the last 9 months, it has progressed despite all the possible and impossible combinations of medicines we have tried on him. He now has what amounts to a second or third body's metabolism from the leukemia cells. He sweats and hurts and his spleen weighs 15 pounds.

He is dying, but has one shot left. There is a clinical trial in Sweden testing out a new drug that happens to target his main mutation. So he rides an ambulance to Lund, Sweden, across the bridge, once a week, with his refugee passport that took a million phone calls to push through.

He has such an incredible story that touches everyone in our department. He speaks halting English and, by now, understandable Danish. He has a naive optimism that the Danish teenagers with leukemia don't seem to share. When they sit with earphones on, typing on their laptops, he talks to the other patients. Everyone, doctors, nurses, janitors, patients all know who he is, because he is always there. He is the only patient I have ever seen being allowed into the nurses' station to eat ice cream. The other day, he looked one of my colleagues in the eye and said "I am so scared that I'm not going to live long enough to have a family" and 6 of us were in tears during noon conference.

He should have been dead 5 times over already. Killed by the Taliban and four more times by leukemia. Hundreds of thousands of people die from poverty and cruelty and misery every year all over the world. This guy has beaten the odds in such a way that he might even pull through.

Patient number two is an 87-year old woman who, by all accounts, lived a good life. Two sons, an unknown number of grandkids, and 10 great-grandkids. She has had enough and is in the hospital to die. Her hemoglobin is dropping but she has chosen that she doesn't want any more transfusions. In the next few days, she will lose consciousness and die, while being kept comfortable by morphine and tranquilizers.

I thought her plan was reasonable, when she told me how she wanted to die. Patients are rarely as straight-forward about death as she was; she was very clear about not wanting transfusions. I called her sons and they were equally reasonable.

If this were Chicago Hope or ER, some emotional tune would play as the camera scans the hospital floor. Our old lady would pass away quietly, while at the same time, the new study drug would start working on our teenager.

We'll see.

Monday, February 21, 2011

9 little things

1. The baby is kicking. We talked about whether we wanted a boy or a girl this time, and I can honestly say that I would be equally happy either way. We'll find out at the ultrasound in a few weeks.

2. I'm fat and undertrained. I leave for work at 6:20 and comes home 11-12 hours later. There is just no time to train. I ran a training marathon in 3:09 a few weeks ago; this compares to a training marathon in 3:02 same time last year. Overall, I'm probably running half the miles I did last year.

3. Natali turned 10. She is so at peace with her life here, and I wish she didn't have to move this summer.

4. I had my all-time worst conversation with a patient a few weeks ago. It's been a big deal in Denmark lately that all patients must be told whether we plan to rescussitate them and/or transfer them to the ICU. An elderly lady with advanced cancer was seriously ill on the floor; in the past I would have written in the chart that she was incurably ill and that she shouldn't be resucssitated or brought to the ICU. Instead, I had to tell her, and it completely took the wind out of her sails. Sometimes, people need to cling to hope during their last days; you could call it denial or misguided optimism, but I took that away from her.

5. We are thinking about doing a month or two of international medicine in rural Guatemala next year. The Girl volunteered at the clinic as a med student; it's very rudimentary.

6. After two months of being, effectively, an illegal immigrant, the girl was forgiven for letting her green card lapse. We applied a month late for a renewal, which often means an automatic denial, but we were forgiven.

7. First Cairo, now Madison. Andreas has missed three days of school because of the teacher walk-out. I don't know what to think about the Walker bill; the cost-cutting seems necessary, but curbing union bargaining rights seems wrong. The odd part, to me, is that the workers aren't officially on strike yet. The unions' very existence is threatened and they aren't striking? Interesting.

8. I'm trying to get a Jehova's Witness through chemo. Her bone marrow was packed with cancer cells, so she was anemic to start with, and chemo will make her more anemic. We would transfuse most people once a week, or once every two weeks, to keep them "tanked up", but we can't with this lady. Instead, we gave her EPO to boost her blood prodution to the max before starting chemo. This type of cancer is very treatable, so you'd hate to have to back off chemo because of anemia.

9. We're going to a triathlon training camp in Mallorca, Spain, for a week in May. Nice.

Monday, January 24, 2011

Natali, the Girl and Denmark

The Girl wrote a great post yesterday about being foreign in Denmark. She has come here with ambitions of becoming as Danish as possible; she is hoping to learn to speak completely accent-free, something that's nearly impossible for Americans.

She has learned to speak almost perfect Danish. There is an accent that some people mistake for Faroese or Icelandic, but only rarely do they guess that she is American. Even more impressively, she is writing Danish better than many Danes. Danish grammar is hard, especially punctuation, and she has learned to master it.

I notice how she has failed to become Danish in other ways, however. Everything is so hurried here; the slow pace of everything that exists in the US is still in her bones, and it causes problems. The example that always comes up is when she is at the register at the grocery store. Danes expect you to get our stuff off the belt very quickly, so you don't slow down the next person. The Girl is famous for forgetting her bags and fumbling to get her wallet. If looks could kill, she would have been buried a long time ago.

She is getting better at driving, but she is still annoying the Danes. On the freeway, the passing lane is not a place to linger like it is in America. The Girl passes a car, sings along with the radio, slows down a little (while still in the passing lane). Someone is forced to pass her on the inside and glances over with an icy look.

That look. She writes about the way people look at her, when her behavior slows down the frantic Danish pace. It's the look someone gets when they stop to look at a store window, and the person behind them is slowed down, perhaps a fraction of a second. It's that exasparated look. I know the look; hell, I give that look sometimes.

Natali, on the other hand, has become 100% Danish. It's been wonderful to see her grow here. Not like a foreign exhange student might pick up a new fashion sense or a new taste in music. It's truly 100%. She hasn't forgotten her American side, but her frame of reference is Danish now.

She is moving back this summer, 6 months before we are, to stay with her mom. I tell myself she will do fine, but I wonder how fast she will become more American than Danish. I am curious to see what she will miss the most; my guess is the freedom she enjoys here. She has a white bike with three gears and a basket that she takes to school and to town. Going up hills, she stands up to pump, just because is feels good. She parks her bike and walks around the old downtown, browsing for new clothes; sometimes buying a hotdog or cathcing a movie with her friends. She could do that in La Crosse, but she won't. I would worry about her biking there, anyway. She lives close enough to walk downtown, but it's not in the culture to do so there. The sidewalks stop at one point, and she would have to cross a busy street to pick up another sidewalk.

But a 9-(soon 10-)year old doesn't sit down to complain about car culture or the lack of bike lanes. She will get a ride to the mall with her step-sisters - and she'll have a great time. Because Natali is a child of both countries and she will be happy in either place - or both. Right now, she wants to move to Africa to help people, and then open a restaurant in Næstved with her friend. We shall see. The whole world is her oyster.

As readers of this blog know, I feel guilty about leaving my son, Andreas, for 3 whole years. Had I known how that would feel, I wouldn't have done it. But for the Girl and Natali (and the Lorax) to be able to live here for a while, for them both to grow and learn, and for me to witness it, has been wonderful. It's an experience we'll all take with us, and I am very thankful for that.

Sunday, January 9, 2011

The Ultrarunning Hipster

It's odd how sports that are 95% similar attract (or foster) such different personality types. Take the three sports I dabble at: triathlons, long-distance running and ultrarunning.

Triathletes are just complete dorks. Look at this video and try to disagree (mind you, these are elite triathletes):

Some people refer to these videos as bike mounting porn.

Triathletes are generally fitter and better looking than runners, but there is something about the outfits and the emphasis on overly expensive equipment that is so inherently uncool. Both aspects are captured here:

And, mind you, this guy could swim, run and THEN kick my ass in a 10K.

Long-distance runners are pretty normal. It's a sport one can do without being a fanatic. Ambitious long-distance runners become geeky in their pursuit of losing weight and hitting their workouts. I had a few years, where 100 grams or a few seconds off on my 800m intervals would worry me. But all in all, long-distance runners are pretty normal.

One funny thing, though. Long-distance runners often look at marathoners as people, who are too slow or old to do well in the shorter races. In track, the 10,000 is the same; not a very cool distance to race. The cool people race the mile, and moving up in distance is done out of necessity. Compare that to ultras in a bit.

Ultarunners are very different from long-distance runners. I should emphasize that I speak of trail ultrarunning here. Ultrarunners are less competitive, at least on the surface. The clothing does border on the ridiculous, sometimes. From the minimalist:

To the "Ultra Triad", ie. sleeves, gaiters and an elaborate hydration system:

Ultrarunners are also oddly into New Age stuff. Take this VESPA quote:

"For the really long Ultras the 2-4 hour rule is still a good one to go by, however, later in the event as your hemoglobin get utilized and fatigue and other factors kick in to diminish oxygen delivery you will need to increase your intake of sugars/carbs with something like GU etc. as you are simply fatigued and your body cannot oxidize fats because it can’t deliver enough oxygen like it could earlier in the day when hemoglobin levels are fresh and high. You still take the VESPA but you also take in the sugars at a higher rate."

Really? Really. Damn that fatigued hemoglobin in the really long ultras!

But, seriously, people buy into that stuff. Or maybe the top runners pretend to be into it, so they get sponsored. Who knows?

The VESPA phenomenon repeats itself in the way ultrarunners talk about electrolytes. Electrolytes are hard to understand and very unpredictable. I check electrolytes on patients all the time and they are very hard to correct, even with IV access. People all over the internet talk about potassium, sodium and magnesium as though it's common knowledge how they behave in ultras. I admit to not having looked at the research (if there is any) but I bet it's not nearly as simple as ultra hipsters make it out to be.

Another thing is barefoot running. Real ultra hipsters love to talk about running barefoot, like it's this new thing that Chris McDougal discovered from the Tamahura Indians. Of course, it's not new. Abebe Bikila won the Rome Olympic Marathon running barefoot. Roger Bannister ran a four minute mile in what looked like a lightweight bowling shoe. Today, an ultra hipster would call it a "minimalist shoe".

No doubt the shoe companies have tricked us into believing that overly expensive shoes prevent injuries; they have capitalized on this these last three decades. But now these same, or related, shoe companies are selling a hipster fad based around running free and being close to nature. Another way of saying it: the only people who consider running barefoot cool, are people who can easily afford not to. I certainly don't imagine kids in Ethiopia dumping their shoes on the way to school to be cool.

Yes, the Girl, this is aimed at you, you budding hipster, as you sit at home shopping for "minimalist shoes" with good traction, so you can run a trail marathon 9 months pregnant. Wearing nothing but gaiters and sleeves.