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.

Wednesday, December 29, 2010

Agoraphobia

The Girl (calling from the bathroom): We might be out of toilet paper!

Me: I'll get you a new roll.

The Girl: No, I don't think we are all out, because I took the last roll the other day.

This conversation meant that there was no getting out of a small foray to a store. With two kids, in Denmark, on December 29th. Why, Universe? I've always had a touch of agoraphobia, but it has been evolving from a personality trait to an actual problem. Feeding on the burdens of life, work, kids, wife; my life has been saturated with stress the last 5 years and my agoraphobia has thrived.

Another problem with me, among the many I have, is extreme impatience with everything. It's always been impatient; I've gotten grief for it from when I was a little kid. We have called it my condition, and I've even been somewhat proud of it, like it was a sign of efficiency. But agoraphobia and impatience don't go well together.

One of the ways I get around my agoraphobia is that I only venture out, when I know there will be no crowds. I shop for our groceries 15 minutes before the stores close. We go swimming on Friday nights in a rural community pool, which we have all to ourselves. Any visit to a theme park or such similar attraction has to happen in the way off-season

But when the Girl announced that we were out of tp, I knew there was no alternative to diving into Danish Christmas craziness. Most Danes have the week off between Christmas and New Year's and it seems like they love to shop all day, every day.

The Lorax was crying most of the time; he screamed "skoldkopper!" (chickenpox) to get my attention and was hard to handle in the busy store. He is through his run of pox, but he still likes to be pitied, apparently. The toilet paper and other necessities were quickly located and I tried wrangling the kids toward the registers. Or, I should say kid, because Natali is actually more help than bother at this point.

In a packed store, with a screaming Lorax, without room to maneuver, it's gotten to the point where I have to control my breathing to prevent getting shivers. It's never bad when I'm alone; it's when I'm with the kids that it really ignites.

The stress is getting to me. There is no other way of looking at it.

At least I have been running well on the treadmill at the gym. I had a winter a few years ago, where I ran almost exclusively on the treadmill. That winter led to my 1:13 half marathon PR, so maybe this Wisconsinesque snow is good for something.