The Blind Men and the Elephant

I haven't written a blog post in a month.  It's not like I haven't been writing every day.  I've written some op-ed pieces (not all published), I've certainly written a ton of emails, many of them with recommendations to those either making policy decisions now or those who may make policy decisions in the future.  I guess that writing is writing, although there is always something therapeutic about my blogs. They generally reflect what I'm thinking or feeling on a particular day.  The past 9 1/2 months have often been defined by the first thing I wake up thinking about, the first email that I read or the first phone call that I get.  Then, it's off to the races!  I was a bit heavy of heart last night when I went to bed.  Today would have been the birthday of my friend Jim Riopelle.  Jim and I did not agree on much when it came to politics.  I admit to being a little angry at him for dying before I had a chance to point out all of the things that the current president is doing that he deplored democrats for in past elections.  Then again, it makes me smile.  That was what I appreciated about my friendship with Jim.  It was honest.  That's a trait that many relationships can benefit from.  I tend to wear many things on my sleeve, including my heart.  I tend to tell it like it is, at least at that moment.  I've learned, sometimes the hard way, that we only know and believe what we know and believe based on the facts that we have before us.  My last job was emblematic of that.  I look at people who still work there and recognize that they can't and don't know all that I do.  In many ways, we all live in our own bubbles.  We all see the world through our own lens.  If we're to understand both ourselves and others, we really need to to appreciate that fact.  

My friend Jim always loved to tell the parable about the blind men and the elephant, which apparently comes from Buddhist, Hindu and Jain texts, sending a message about the limits of perception and the importance of context.  Without repeating the parable, I can reflect on how it is presently playing out in our world, and particularly in mine.  From the onset of this pandemic, I've recognized that my life's experiences have put me in a position that is singularly unique.  Having cared for nursing home residents, having viewed them from the perspective of a quality improvement organization and then finally having seen them from the real inside, I represent many of the blind men appreciating their portion of the elephant.  Many of my colleagues are still feeling the elephant from their side.  Some, have had the opportunity to see it from additional sides.  But few, if any, have been given the true gift.  That gift is having the blind folds taken off and being allowed to view the elephant in its full expanse.  I admit, there are still probably things that I haven't seen.  That is the importance of the parable.  No matter how much we think that we've seen everything, we rarely have.  Furthermore, even if we have somehow seen it all, every day brings new information that we have yet to see, humbling each and every one of us as we try to make sense of the world.

As I begin to sort out the next chapter in my life I will reflect upon my friend Jim and how he often forgot the fact that he had taught me this parable. He was always so certain about so many things.  Nevertheless, over time, at least with certain things, he acknowledged that fact.  I'm sure that I am often the same.  I know what I know, until I don't.  

Decision Making in a Crisis

I have railed against what I call the stakeholder model for some time now.  I really didn't understand it months ago when this pandemic started, but I have come to despise it.  The stakeholder approach to decisioning making is based on speaking to multiple stakeholders in order to try to develop some type of quasi consensus.  I use the term quasi consensus to differentiate the stakeholder model from other consensus models that utilize experts and essentially keep out politics and other motivations.  

During a crisis, and a pandemic qualifies as a crisis, the decisions one makes need to be based as much as possible on facts.  The priorities must be on the greater good, in this case, saving lives.  For example, if a fire was about to engulf a town, would you spend weeks speaking to various stakeholders in order to determine the impact of the fire that is about to burn the town down. Would you speak to the bank owners in order to ascertain what the impact of the fire would be on the bank?  Is there enough federal deposit insurance to not have to worry about whether the bank actually burns down? How fireproof are the safe deposit boxes? Is anyone actually working at the bank right now and might they be in danger if you don't act before the flames engulf the bank?  What's more important, the money and physical assets in the bank or the people who work there? 

How about the restaurant owners?  Do they have insurance that will cover their losses? What about the owners of the restaurant real estate? What type of insurance do they have. The people who eat at the restaurant?  Are there people there now? Are they in danger? Are there restaurant staff preparing the ingredients for later in the day service? Are they in danger? What will be the impact of the fire on the jobs of these people, if they manage to survive the fire? Will they be able to find new jobs? Will they be eligible for unemployment insurance? Are they only part-time workers, who work in a few restaurants, so they won't be eligible for any benefits or support?

What about the nursing home, where low wage workers perform menial tasks while delivering compassionate care for vulnerable older adults? What about the older adults themselves? What type of help will they need to be saved before the nursing home is engulfed in flames? Are there buses available? Do they have the necessary handicapped setup to allow for wheelchairs and gurneys? Are there enough people to move all of the residents out in a timely fashion? What about the real estate? Do the owners have enough insurance to cover their losses? What will happen to the staff if the nursing home burns down? Will they be able to find another job? Will they qualify for unemployment insurance?

Who should be making the decision to evacuate the town? Who should be deciding whether to close the bank and send everyone home? The restaurant? Who should be making the decision as to whether to evacuate the nursing home? Has someone ordered buses? Has someone found "homes" for the residents? Are hospital beds available for those who need specialized care? Who is making these decisions? Is the local government convening an advisory committee composed of bank, restaurant and nursing home real estate owners? Are they asking for recommendations from the unions who represent bank, restaurant and nursing home workers? Are they including the community in the discussions to determine the impact of the bank, restaurant and nursing home being shut down or burned down?

Who is talking to the vulnerable older adults who live in the nursing home? Who is asking their families for to share their thoughts and concerns? Are the clinicians who care for the residents being asked to help the decision makers understand the impact of transfer trauma? On how to effectively move people who have dementia? Are the subject matter experts in the care of vulnerable older adults even being considered as the flames approach the nursing home? For that matter, are the residents and families at the table? Or, are they about to become the meal? 

Decision making during a crisis is poorly informed by a stakeholder model.  Crisis management requires an incident commander to make decisions at the level of the bank, the restaurant and the nursing home. Crisis management dictates that the local fire department and health department look out for the safety and lives of the people who work in the bank and restaurant, and particular for the workers and the vulnerable residents they so compassionately serve.  

As we've observed the response to COVID-19 over the past 9 months at the federal, state and local levels, what type of crisis management have we seen? What has been the decision making process? When we look back, will we discover that a focus on stakeholders has kept us from making the right decisions?

Pacing Myself

I dreamt last night that I was helping a bunch of physicians with their billing codes.  Not sure where that came from or why, but I was really engaged in the details of it. It's been a long time since I've even thought about such things.  While I've been trying to "power down" on the weekends, there's once again too much going on right now. There are too many opportunities to let a day go by without working, though someone did comment that I am the busiest "semi-retired" person that they know.  Touche. Not sure I am really good at pacing myself when it comes to life.

I also got in a run yesterday.  I've backed off running over the last few weeks due to some discomfort in my lower left leg.  I absolutely don't want to end up with a stress fracture, and that's what it was beginning to feel like it might be.  I'm still not sure, so I'll be careful.  I've been focused since June on running volume and not speed, but yesterday, I allowed myself the luxury of running fast.  In fact, after warming up for a couple of miles, I ran the first mile of what is normally my 8 mile route in a personal best time of 7:30. Turns out that was nearly 30 seconds faster than any time I've run that mile in.  I needed to be a little careful, as the first quarter mile is downhill, and then the rest is all uphill.  Pacing. For a couple of reasons.  First, running the first part too fast might have put too much stress on my leg, downhill running can do that.  Second, if I went out too fast, I wouldn't have what was necessary for the end of the mile.

Running 3/4 of a mile uphill hard felt good, it also was hard.  Running a mile hard was something that I felt like doing, although I didn't want to put too much stress on myself. My allergies have been acting up this week, which is usually a sign of fatigue.  This time my fatigue hasn't been from training, it's been from work and lack of sleep.  Pacing.

This past week I've gotten in the habit of starting my day with my blog and then spending some ritualistic time getting myself focused on myself.  I'm trying not to get either too caught up or wound up before the day begins.  I want to begin the the balanced, only that way will I be able to truly pace myself.

COVID-19 Dreaming

There was a time that I used to dream about Ironman. There was definitely a time that I used to dream a out work. In the early days of COVID-19, that was all I dreamed about, but then, for awhile I stopped dreaming. It was for a short while, though, because now my COVID dreams are back.  Sometimes they will guide me through my day, sometimes they'll guide me through my blog.  Other times they will just be a reminder of the world we live in right now.  Last night was probably one of those. Nothing major to do this morning or to think about, except perhaps that I woke up without an alarm clock, because I know that in a few minutes I have an opportunity to be on a call with the office of a United States Senator.  Right now, all any of us can do to make a difference is to try, and I don't know anything else.  

Dreams have meaning.  For me, they've always been about processing my day and sometimes literally thinking about and preparing for the next one.  Not bad, I guess.  It certainly fits into my obsessive personality!  And so, I keep dreaming.  I'd like to have some of those Ironman dreams back, though.

Looking Out for Oneself

It's human nature to look out for oneself.  It's about survival.  It's instinctual, and evolutionary. It's truly hard to get away from. As children, the world revolves around us. We need to be in charge. We need to have what we want to have. For some of us, that evolves in various ways.  Some people grow up to be followers, but in their minds, they're still looking out for themselves. They just fit neatly in the role of a follower.  Others are natural leaders and gravitate to the role of being a leader.  I never really considered myself to be a leader growing up. On the other hand, I was never going to be a follower.  Whether it was nature or nurture, I have always rebelled to any type of authoritarianism.  That includes parental authority. I've always gone my own way.  In that way, I guess I also naturally was always looking out for myself.  

Ironically, caring about others has also been who I am.  It's an interesting dichotomy, that caring about others reflects my need to look out for myself.  If I'm not caring about others, then I'm not happy.  As I grew up and got married and raised a family they became part of that orbit.  Getting a job, earning a living, taking care of them.  For me, however, there has still always been the drive beyond my family to make a difference and to impact the lives of others.  In that regard, becoming a doctor was a natural profession.  At an early stage in my career, however, impacting the life of one patient paled in comparison to impacting the lives of many.  The balance between looking out for my family and trying to change the world has always been a precarious one for me. Which brings me back to the concept of looking out for oneself.

In 2015, I was offered a job.  It was literally the lowest paying job that I could have found, but it offered an opportunity to make a difference.  That difference was in improving quality in nursing homes.  Thus, I reengaged on a journey that I'd started years before. To improve the quality of care of vulnerable older adults.  In its own way, taking the job was looking out for myself. It was just a new part of my journey. I learned to build a team around me by putting all of the successes on them.  The more that I did that, the more the success of our team built, and ironically, the more the perception of my success increased.  What I loved about that job was the fact that I was literally my own boss, not really answering to anyone else. Of course, that had limits, and when I pushed beyond those limits, it was time to leave.  There wasn't much reason to stay in a low paying job when I could not longer enjoy the freedom of doing what I wanted to do.

And so came my next job, which turned out to be a stepping stone to the polar opposite of the job I had just left.  This was the highest paying job that I could have ever found. I was in charge, yet in many ways I wasn't. There were ultimately others calling the shots, leading me into a dark hole where I used every means at my disposal to actually be in charge, and convinced myself that I was.  But, I was never truly convinced. Because, at the end of the day, we're always looking out for oneself.  As I reflect on my life and my work experiences, it strikes me that most people are always going to defer to what they perceive as best for them and their family. Perhaps that's where religion comes in, and the concept of doing unto others? Otherwise, wouldn't society just unravel into the anarchy of every man for themselves?

In looking out for oneself comes the concept of rationalization. We rationalize that what we're doing is for ourselves, or family, or even for a greater good. We do that despite the reality of the circumstances around us. We ignore signs and signals.  We develop excuses and reasons for our actions or the actions of others.  We want to believe.  Ironically, when it comes to religion, we want to believe. Otherwise, how else could we be looking out for ourselves?

Can We Fix Stupid?

I find myself going on to Facebook once a day.  I specifically look for the Ventura County Coronavirus page with it's updates on the status of COVID-19 in our county.  We're actually doing pretty well.  While there has been an uptick in cases, the number of hospitalizations and deaths has been low.  Inevitably, there's someone who comments that this is all a media hoax, and they highlight the low numbers and say that 99% of people recover from the virus.  Every time I see these types of comments, I feel an obligation to respond.  I don't call them stupid.  I don't call them ignorant.  I don't lower myself to the name calling that some of these comments include in their rants.  I actually try to point out where they're correct.  We have been doing well in our county.  That isn't cause to celebrate. Other counties that have taken their eye off the ball, so to speak, are doing much worse.  Now is the time to continue to stay focused.  I also repeatedly let people know that not everyone recovers from this virus, and the risks go up with age.  

Why do I bother? Does it make a difference?  I think I bother for the same reason that I've been obsessed with battling this virus and every entity that doesn't know what it's doing.  If you don't say something, you have no one to blame but yourself.  I have no idea if the people who rant ever read my comment, and if they do, whether it makes a difference.  However, if just one of them stops to think for a second, it would have been worth it.

Maybe not.  As I wrote this, it struck me that if one of the people who go on a rant pauses for a second to reconsider their position...is that one second worth the several minutes that I took to write a response?  One thing is certain, there are only 24 hours in a day, and I have been pushing the limits of that day for 8 1/2 months.  I do need to pace myself.  Life is, after all, just like an Ironman.  The only analogy I can come up with related to doing an Ironman is my propensity to tell other athletes to walk during the run portion, especially when I see them struggling on an uphill portion.  I feel a need to let them know that if they "save their energy" early on, they'll have more at the end.  I've learned that the hard way and have always felt a need to share what I know with others (pretty standard fare for me).  Does it change their behavior?  I don't know.  Maybe. Sometimes.  I still do it.  I guess that's who I am. It doesn't matter if we can fix stupid. I always have to tri.

Being at Peace

I was terribly unsettled yesterday.  I couldn't put my finger on it.  I was definitely not "at peace."  When I was in Kona I felt a "peace" that I have rarely felt.  There was no goal, other than to truly be in the moment.  There's an irony to the need for purpose as it relates to "being in the moment." In its own way, that is also a purpose.  There are so many positive things in the world to be in the moment for.  Children get this. Adults forget. Ironically, in many ways, I was never a child. I was always striving for something. Always striving to "do something." In many ways, Kona was a high point for me.  Yes, it was an accomplishment, but that wasn't the feeling that I had.  I felt like I was able to "rest" on the things that mattered. 

We are not defined by "things." We are not defined by accomplishments. We are defined by who we are and what's inside of us.  I've always been a very goal oriented person, but those goals are not who I am.  We know that there is value in purpose, but purpose doesn't have to be existential.  It doesn't have to be concrete.  It doesn't have to be an act or a "thing." Being "in the moment" is actually a very purposeful act.  The fourteen and a half hours that I spent on the course at the Ironman World Championship over a year ago had meaning beyond numbers.  It was about the experience.  When the numbers and the accomplishments become the priority, there can be no peace.  

Over the course of the last 8 1/2 months, my life has not been my own in many ways.  Every day has been shaped by forces beyond my control, but in fact, that has been my choice.  Everything that we do in life is a choice, whether we choose to accept it or not.  Being at peace is a choice.  Why haven't I been willing to make that choice? 

The choice begins with the rising of the sun. It begins with the purposefulness of the day.  It is not about a single act.  It isn't about a particular accomplishment.  It is the day. That is peace.

Defining Moments: My Third Decade

I turned 20 on June 19, 1979.  Jimmy Carter was President, and in fact, I would have my first opportunity to vote in a presidential election over a year later.  I had already dropped out of college, immigrated to Israel, and returned.  I was dating the only woman who I've ever truly loved, and I knew that I really did want to be a doctor.  Not because my father wanted me to be a doctor,  but because I did.  I decided not to go back to UC San Diego, but to live with my parents and go back to college at UC Irvine, with a major in chemistry, yet again.  One of my defining moments occurred during the summer, where I was a research assistant at Cal State Fullerton.  We were looking at ceruloplasmin in rats.  I don't remember much about the research, but I remember a graduate student who was a bully.  I ultimately made the decision to leave the summer job instead of accepting his bullying behavior.  It's one of the moments in my life that always reminds me that bullying has always been one of my "hot buttons."  I applied to medical school and didn't get in.  Getting into medical school in California wasn't that easy, and I had made the unfortunate decision to apply only to schools in California.  I had a choice.  I could look at foreign medical schools.  I could apply to a large number of schools and try again.

Ironically, I had been overconfident in my test taking ability when it came to Biology.  In fact, despite wanting to be a doctor, I'd never really taken many biology courses.  I thought that I could "wing it." I was wrong.  While scoring exceptionally well on every other area of the MCAT, my Biology score sucked.  I took the Stanley Kaplan preparatory course, improved my Biology score, and applied to about 35 schools, including Texas, which seemed to accept out of state students from California for some reason.  In the meantime, I decided to apply for the PhD program in Chemistry at UC Irvine, being honest with them that if I got into medical school, I'd be leaving.  I got accepted to the University of Texas, Medical Branch (UTMB), in Galveston, the oldest medical school west of the Mississippi.  In the summer of 1981, I flew to Houston, and I remember writing a letter to my then-girlfriend (and now wife) and the ink was literally dripping down the page due to the humidity.  

UTMB had a tradition of having all of their exams every six weeks, on a Monday.  It was called "Black Monday," and it wasn't unusual for students to chill the rest of the week after Black Monday.  During my first six weeks in Galveston, I certainly enjoyed my classes and new friends, but something was missing.  Sherri and I had previously been engaged, but a variety of circumstances led to us calling off the engagement.  My going to medical school in another state was somehow supposed to allow us both time to explore our lives.  Unfortunately, since that moment in 1976 when I first laid eyes on her, I was smitten.  The day after taking my first set of exams, I got on an airplane, flew back to Los Angeles, and proposed.  Were we both ready to get married? Probably not.  I was in medical school and she wasn't sure where she was heading. It's interesting as I look back 39 years and realize that life has a way of turning out ok if you let it.  We were married at the end of my first year of medical school on May 16th, 1982. 

My defining moment of medical school is still that moment while on my cardiothoracic surgery rotation, I would wake up an older woman every morning at 4:30am to start my rounds at St. Mary's Hospital.  On the last day of my rotation, after having cussed me out almost every day for waking her up, she apologized to me.  The feeling I had then I remember like it was yesterday.  She had no reason to apologize.  I was waking her up every morning!  I genuinely felt bad that she felt the need to apologize.  To this day, I dissuade anyone I work with from saying that a patient or family are "difficult." As physicians, we have a responsibility.  It's not easy being the one who is ill.  We must always be empathetic and demonstrate compassion.  That very moment, standing at the door of her room, I had my first inkling that my future would be in the field of geriatric medicine.

The other defining moment that occurred during medical school happened when I came home excited to tell Sherri about "case" that I'd seen in the hospital.  She admonished me for looking at the person as a disease, and not as a human being.  That has stuck with me through my entire career and has guided me along the path that I took.  We are taking care of human beings.  As I say now, you can't deliver person centered care if you don't know the person!

I always tell medical students that there are two years in their education where they need to pretty much ignore everything else in their lives and give learning a 100% focus.  That is the third year of medical school and the first year of residency, otherwise known as one's internship year.  There was no year in my life that was comparable to my internship year, until over 30 years later when I took the helm of a very dysfunction nursing home chain.  I had only applied to three residency programs, Dallas (Parkland Memorial), Cedars-Sinai, and Galveston.  My grandfather told me that he'd had a talk with "the man" and willed me to getting accepted at Cedars, which was literally around the corner from my grandparents apartment.  I will always remember my first patient, in some ways channeling the author of the book, The Intern, which I'd read as a kid, and was always in the back of my mind in relation to my decision to become a physician.  

His name was Simon Grace.  I don't remember much about him, which is sad, and I've tried to find information about him online, but to no avail.  Simon was a young white male, who happened to be gay.  He was admitted with a dry cough and what turned out to be pneumocystis pneumonia.  As a 4th year medical student, we had learned about a new illness that seemed to be predominantly impacting young gay men.  By the time I started my internship, this illness had a name, and that was AIDS.  A former Cedars resident had gone on to do his infectious disease fellowship at Mass General, and had come back to UCLA and Cedars. His name was David Ho.  He would become the Times Man of the Year in 1996 for his work on HIV/AIDS.  I completed my first History and Physical, admitting Simon to the hospital.  He would return intermittently as his condition declined over the course of the next couple of years.  He would die during my residency.  AIDS was a death sentence at the time.  As I've gotten more in tune with the concept of "person centered care," I've often wished that I remembered more about Simon as a person.  I still carry part of that experience with me to this day.  

My Internal Medicine residency at Cedars quickly became a Geriatrics residency.  I'd already decided that was my field of choice and I wanted to know everything about it.  I sought out mentors, I read everything I could. I looked at each older patient as if they were a learning opportunity in my field of choice.  The natural progression of this was to do a geriatric medicine fellowship, which I did at UCLA.  The fellowship provided a perfect bookend to my third decade, which began dealing with a bully, and ended also dealing with a bully.

During my internal medicine residency, I began "moonlighting" at Kaiser in Woodland Hills, California.  I still didn't know what direction I wanted to go in after completing my geriatric medicine fellowship, which was a two year program.  Six months into my fellowship, the chief of internal medicine at Kaiser, Woodland Hills, made me a job offer.  If I left my fellowship after one year, I could join Kaiser and start a geriatrics program.  As during many of the defining moments in my life, I immediately knew the this was the path I wanted to take.  While I've always loved teaching, and I enjoy the critical thinking of academics, I was also pulled towards both leadership and business.  I decided to accept the offer.  No sooner than I accepted and let my fellowship program know of my plans to leave at the end of my first year, than of the the faculty, an eminent internist and geriatrician, Dr. John Beck, told me that if I left the program, I couldn't get board certified in geriatrics. There were a few more "threats," but I had made up my mind.  I researched everything that he had threatened me with, found none of them to be true, and suggested to the head of the program that I'd be engaging an attorney.  I was told not to worry, that I should move forward with my life and that was just John's way. In reading his biography, I'd never know that he was in the Canadian army during WWII, starting as a private and moving up to become a company commander.  It all makes sense now.  John and I often tangled, as I was never one to submit to an authoritative figure.  I also never took well to being bullied.  I've often shared my story about this experience during leadership presentations, and I title it "Stand Your Ground."  The willingness to stand my ground is something that has often defined me over my life.

While much of my third decade was defined by everything that went into my becoming a doctor, there were two personal moments that were also everything to me.  First, as I already noted, was getting married.  The second occurred on August 21st, 1987, when our first daughter, Raishel, was born.  I remember that moment like it was yesterday.  My wife was in labor for 24 straight hours and at the last minute required a C-Section.  I sat in the corner of the operating room, as our baby was born.  I was scared.  I knew that everything would be ok, but I'd never felt so helpless as I did at that moment.  Out of such a helpless moment came such a wondrous outcome.  It's a good thing to reflect on from a life perspective.

Defining Moments: My Second Decade

We moved to Cerritos as I entered the sixth grade, which actually brought me into junior high school.  For some reason, I decided to run for Treasurer of the student body.  I was shy, relatively introverted, and definitely a nerd. But I was already putting myself out there.  By the time I was in the seventh grade I had decided to run for student body president.  I wasn't popular, didn't know that many kids, but I remember giving my speech.  One of the teachers told me it was an excellent speech.  I lost to the popular girl.  I liked to play basketball, although I wasn't very good.  School was boring to me, and I learned to speed read.  This allowed me to read books in 10 minutes and write decent book reports.  

Near the end of seventh grade, I decided that junior high school was a waste of time and I came home one day and told my parents that I wanted to skip the eighth grade and go right in to high school.  It's funny, I don't really remember much about that decision.  However, my drive to push forward has always been strong.  I really didn't feel like the eighth grade had much to offer me.  We decided that I'd take a couple of classes at the high school that summer, and if I did well, I could skip the eighth grade.  The two classes turned out to be Oceanography and Ecology.  My teacher for both was Mr. McNally.  He was also the Chemistry teacher at the brand new, not even built yet, Cerritos High School.  

I have vague recollections of a field trip with older kids, but that I somehow managed to fit in.  I was the smart kid. Fortunately, I'd had a growth spurt, which meant at least I wasn't too short or slight.  Summer school went well and in September of 1972 I started high school.  Ninth grade was actually in the afternoons at Gahr High, as Cerritos High wouldn't be built until the following year.  I often rode my 3 speed Sears bike to school.  Some mornings I attended the morning minyan with the old men at Temple in preparation for my Bar Mitzvah.  My Bar Mitzvah speech became controversial as I wanted to talk about social justice issues and the rabbi resisted my efforts.  I won out, if I recall correctly.  I don't know what happened to that speech, I'd love to read it again.

I'd already set my mind on graduating high school early, but during the summer after my second year I changed my mind.  Maybe I realized that I wasn't quite ready and that I might as well "enjoy" the full four years of high school.  

September of 1976 brought what is arguably the most defining moment of my life.  It was the week before starting classes at UC San Diego.  I was in my dorm room in Discovery Hall when one of my suite mates brought a girl upstairs to meet us.  Her name was Sherri. I could have been Michael Corleone in The Godfather as I was literally struck by a lightning bolt. There was something about her.  In fact, the first thing that I thought was that she was way out of my league.  She had long hair and was wearing overalls.  My heart definitely skipped a beat.  Who would have known that six years later we would be married, and 44 years later we would have two wonderful daughters and two grandchildren.

During my second year of college I became confused in regards to what I wanted to do in life.  I changed my major a few times.  I stopped studying and focused on practicing and playing intramural floor hockey.  It was in the spring of 1978 when I realized that I was failing all of my classes.  I went to the Deans office and asked what my options were. They told me I could withdraw.  Even today, I remember thinking,"you're kidding me, that's all?" I took the opportunity to withdraw, knowing then that my record would only show that I withdrew.  My grades would never be known.  I also made a momentous decision. I would immigrate to Israel.  This was something that had been swirling in my head for some time.  I'd always felt a connection to Israel, especially after I visited during the summer before starting college.  

Before I left the country, I visited Sherri.  We had broken up earlier in the year, but something made me want to see her before leaving.  We had a nice visit and I hugged her in the driveway of her parents house before getting in my parents Ford station wagon to drive home.  For a moment, I hesitated.  There was still something there. But, I was destined to travel across the world for an experience that could impact my life in many ways.  

In Israel, I lived on an Ulpan (a Kibbutz where new immigrants stayed), where we were to learn Hebrew, and work part-time.  My work was in the dairy, where I learned to milk cows, though I mostly cleaned up after them.  One day, I visited the Kibbutz library and happened to see a thermodynamics textbook that I'd had in college.  Something clicked and I realized that I didn't want to milk cows for the rest of my life.  I also knew then that I really did want to be a doctor, something that I'd decided when I was nine years old (hmm, maybe should have listed that in my first decade of defining moments).  I flew home after having been in Israel for 3 months, and one of my first calls was to Sherri.  We started dating again shortly thereafter. 

Defining Moments: My First Decade

One year ago, I wrote about a defining moment in my life.  At the time, I noted that I'd write about other defining moments another day.  Today is as good as any.  The moment I wrote about a year ago was Ironman Chattanooga in 2014, where I achieved my best Ironman time ever, and my best age group placement ever at the time.  I've subsequently had better placements in my age group, but I've never gone faster.  Rereading my race report reminds me of what that day felt like and sets its own bar for defining moments.  The past 7 months has been a defining moment kaleidoscope. though I think I'll keep these months out of my reflections until I get through my first six decades on this earth.  Today, I'll start with my first decade of life.

I've always had a good memory, especially visual ones.  My first recollection of life comes from around the time that I was 3 or 4 years old.  We were camping and it was raining.  I remember eating hot dogs.  Since It's my first recollection of life as a human being, I'll consider it to be a defining moment.  Going forward, I'll try to hone in on moments that have stayed with me my whole life and serve to define me.  I have a feeling that the concept may evolve as I write about it, but that's what this blog is for!

When I was around five years old, one of my neighbors, Ray Lippert, ran into me with his bicycle.  I'll always remember the scab on my chest.  Ray wasn't the nicest kid, and years later my wife would actually be his middle school classmate.  Apparently he committed suicide in college.  Odd how the currents of our lives pass.  

When I was in the third grade, my teacher Mrs. Kantor, told my parents that I was preoccupied with the war in Vietnam.  While that preoccupation was clearly influenced by my father, I definitely had a predilection for both worrying about world events and wanting to make a difference in the world.  In 1968, at the age of nine, I wrote a letter to President Johnson, asking him to end the war.  I am definitely my father's son.  As I look at the rest of my life, I've written letters to Jimmy Carter, Menachem Begin, Ronald Reagan and Bill Clinton.  I've written other letters to advocate for something that I believed in.  I've written Letters to the Editor.  It all seems to have begun in the third grade.  I'm not sure that my first decade was spent like other kids, but I've rarely followed the path of others.  

 I was also enthralled by the space program.  I actually took a polaroid of Neil Armstrong's first step on the moon.  I'd wake up early in the morning to watch the blast off of the Apollo rockets.  I'd exaggerate a stomach ache in order to stay home from school to watch the World Series between the Tigers and the Cardinals.  Those exaggerated stomach aches got me a trip to the hospital for a barium enema.  Now, that was a defining moment!  I'll never forget going to the bathroom after the procedure. It seemed like the barium would never stop coming out!  I think my stomach aches were cured as well.

I believe that I read Martin Eden for the first time in the fourth grade.  As was to become standard for my whole life, I'm not sure how much I really understood, but I always set the bar high.  I would always reach to do things that were beyond my capabilities...until they weren't.  Over the years, each time I would read Martin Eden, I'd gain a new understanding.  

June 19, 1969 would be the end of my first decade of life.  My Side of the Mountain was one of the most viewed movies that year.  I loved that movie! A thirteen year old runs away to live in the mountains.  I connected with something.  Perhaps it was the need to be different from everyone else.  Perhaps it was the need to be an individual.  In some ways that movie was emblematic of my first decade.  

Getting Kicked in the Head

I read my blog from one year ago this morning.  It's been nearly one year since I completed the Ironman World Championship in Kona.  At this time last year I was counting down every day, reflecting on my preceding Ironman events.  This day's reflection was on Ironman St. George 2012, and my daughter asked me if my favorite line that Ironman is a metaphor for life was about "getting kicked in the head every day."  Wow!  A year later, dealing with COVID-19 and everything it has wrought to upend the lives of everyone throughout the world, that thought rings true.  

I was pretty tired last night.  I should know why.  I've run 197 miles in the month of September, nearly 30 of which were over this past weekend.  The fatigue finally added up and slammed me last night.  I guess that's my kick in the head, for the week.  I have a decision to make this morning.  Do I run three miles, so that I can be proud of achieving a 200 mile month, or do I scrap the idea and focus solely on recovering?  Can I do both?  I realized last night that my slow run yesterday expended too much energy.  I suppose that means that I really was still carrying around a significant amount of fatigue, but was either ignoring it, or just not recognizing it.  That's always the challenge.

My right glutei tightened up yesterday at the end of my run.  That means I need to do Romanian dead lifts, the cure for my glute tightness.  A massage helped, but the tightness is still there this morning.  Nothing that I haven't lived with before.  

I'm going to avoid blogging about last night's debate, with one exception, my tweet regarding the cognitive function of Vice President Biden has already garnered over 450 likes.  I think that's a record for me.  More importantly, I was proud of his performance on multiple levels.  He took what a bully kept throwing at him and responded with grace, poise and toughness.  I really don't like bullies, and watching the debate was emotionally exhausting.  Another day of getting kicked in the head.

Trusting How You Feel

Yesterday, I had an idea. To run from my home to the ocean and back.  I'd been thinking about it for over a week.  The idea of running on the trails was really at the heart of the idea.  In some ways, the distance was somewhat of an afterthought.  I'm really at a point in my running, where going out and running over twenty miles probably wouldn't add too much value, but also wouldn't prove anything to myself either.  Yet, I had the idea.  There is something about trail running that is freeing.  For me, sometimes too freeing. I get so lost in the run that I've tripped and fallen on more than one occasion.  I stubbed my toe once yesterday, early in my run, reminding myself to pay attention to the ground in front of me.  It's actually not too hard to pay attention to the ground in front, while enjoying and taking in the surroundings. It's all about trusting how you feel.  

The one thing I did compromise on yesterday was to start walking steep climbs very early into my run.  Of note, it really didn't slow me down much, which is something I learned from my friend Robert Key.  In fact I found myself maintaining a rather comfortable 10 minute per mile pace throughout the first half of my run.  Of course, in total, that part of the run had a gentle decline throughout, except for one mile with a pretty steep decline.  In fact, just before starting that portion of the run, at about 4 miles, I took a photo. 

Off on my run, I enjoyed the mountains and the trail.  I got lost in the feeling of running.  This was really important, as it's something I've struggled with over the past 6 1/2 months.  Getting lost outside of my obsession for everything COVID-19 has been a challenge.  But I knew that I was ready to appreciate the surroundings and the feeling of running.  When I got to the 8 mile mark, I thought it was worth stopping for a photo.  This was where I'd normally be done with my daily run.  Today, my run was just starting. 

I had brought my mask along and put it over my face whenever I came across another hiker or mountain biker or runner.  The only runners I happened upon were four young men who clearly were competitive runners.  I had brought along four bottles of fluids in a fanny pack.  I didn't quite appreciate the impact that would have on my back until I went to bed and noticed how much my back had been bothering me, while the rest of my body had tolerated the run pretty well.  There was a time when my legs would have been quite sore from this type of run.  I will admit that my quads felt a little sore as I got near the beach, which was ~11.25 miles from the start of my run.

I almost walked, on the sand, to the ocean, but didn't want to grapple with sand in my shoes for the run back.  So I just took a few minutes to enjoy where I was, before heading back home.  As expected, the quad soreness disappeared the moment I began the return, and primarily uphill trip home.  It quickly became apparent to me that my pace on the way back was no slower than 11 minute pace, making my average pace for the whole run somewhere around 10:30.  Ironically, this was the pace of my 8 mile hilly runs when I began doing them nearly 3 months ago.  Running at this pace was comfortable, and that was the point.  There was never a time during this run, at least until the one major climb coming up, when I ran hard.  It was all about trusting how I felt.

This photo doesn't begin to capture the steepness of the climb ahead.  I power walked up the climb and intermingled some short bouts of running.  I didn't want this to be easy.  I was 18 miles into my run and I felt the need to show myself that I could run up a steep climb.  When I crested the top, I kept running for the next couple of miles, getting off the trail as I neared mile 20.  I had another half a mile to go before I got to a climb that I do every day.  Today, however, I was going to treat myself to walking up the climb.  I'd already done 20.5 miles of running, and I knew that when I got to the top of the climb, I had a mile of downhill running that I could test myself out on.  Which I did, managing to run down "mile 8" of my daily 8 mile run at around 9 minute pace.  That was ok today.  I walked up my short climb at the end to my house and sat down in my front yard, caked in dirt. 

I still haven't decided what to do today.  Another routine 8 mile run? Rest? Walking? A shorter run? I don't know, even after writing my blog.  I'll just have to trust how I feel.

Writing, Blogging, Running and Meditating

Perhaps it isn't a surprise that I haven't blogged since I wrote about Pete.  Death has been something that I've struggled with, though the COVID-19 Pandemic has somehow brought me to a place of greater comfort with the concept.  My daily blog is supposed to be a habit, and when I wake up knowing what I want to blog about, it's quite easy.  Over the past 10 days, I'm not sure that I've woken up with that knowledge.  Instead, I've awakened with any number of actionable tasks, many of which include writing of some sort, whether it be sending email thank you's to people who attended our Zoom Biden/Harris Campaign Event, or just catching up on the countless emails I have to respond to.  Nevertheless, there is a difference between writing and blogging, and today I'm back to blogging.  Maybe that's good, maybe that is a reminder to me. Writing and blogging might have something in common with running and meditating.

Over the past couple of weeks, I've encountered the feeling that I've wanted to run more.  In fact, one of those feelings coincided with the desire to get out and run on the trails.  Moreover, running on the trails was associated with the idea of running long.  Since early July, my runs have been limited to 8 miles.  Granted, running 8 miles every day has been its own challenge.  Some of those runs include some degree of mental intensity, others allow me to think about things I have to do that day, and others might actually be meditative in nature.  There's no question that doing a long run on the trails will have a meditative component.  At least, that's why I think the trails are calling me.

Just like not blogging, I really haven't been meditating.  True meditation really allows one to let the mind relax and be free.  It's something that I've definitely struggled with since the outbreak of COVID-19.  I have a hard time freeing my mind from the many tasks and pressures at hand.  Trail running, with the caveat that I can't trip and fall, could be just the right thing for me. There's also a matter of numbers.  I've been really good about not being a slave to numbers, but I've run 35 miles this week, and a long trail run will allow me to push my weekly numbers to heights they've rarely been to.  That is, of course, if I top off today's long run with another run tomorrow.  I diverge from being in the moment. That, after all, is the point of meditating and blogging. 

We'll see what the day brings.  I know a route to the beach, and I'll see how far my legs take me.  I might just end up doing a lot of walking on the way back.  That would be ok too.  It's not about numbers, it's not even about goals.  It's about feeling.

Ode to Pete

Avery "Pete" Peterson passed away yesterday.  He and his wife were one of my first patients after I opened my clinic in Colorado. Over the years, he became my friend.  After I moved away, I'd visit his when I visited Colorado, and I'd call him every few months or so.  He apparently got pneumonia and went to the hospital, a place that was pretty foreign to him.  His condition improved.  Then he passed away.  Which is as it should have been.  It wouldn't have been right for Pete to die while suffering.  He "suffered" most of the time that I knew him.  Pete lived through the Spanish Flu of 1919 and got through 6 months of the COVID-19 Pandemic.  My grandson and I attended Pete's 100th Birthday two years ago.  Pete died at the age of 102 years and 4 months.

Pete was unique, as we all are.  To the end, he would walk with his walker as much as he could every day. Pete was always complaining about some physical or emotional ailment.  He was often anxious, he had reflux, he had a tremor.  I barely remember a time that I saw or spoke to him that he didn't talk about these maladies.  But, they were part of who Pete was.  Pete had been in human resources, like my good friend Ray.  I must have an affinity for people who work in human resources.  

Pete's wife died many years ago.  He had prostate cancer, and is the patient that I often tell the story of who was hospitalized with pneumonia at the age of 88.  That was when I realized that the treatment for his prostate cancer was killing him as well.  We stopped the treatment and actually put him on testosterone for a year.  He began making his own testosterone within that year and never needed it again.  His PSA got up to 17 and stabilized after a few years and we never checked it again.  

Not long after Pete was hospitalized, he realized that he couldn't live at home anymore.  He made the tortured decision to move into a continuing care retirement community.  He ultimately decided, with my help, to move into the assisted living section.  He didn't want to move again, and his physical limitations dictated that he might need some more help sooner rather than later.  That was over a decade ago.  Pete lived in his room in the assisted living facility all of those years since.  Other residents passed away, but Pete persevered.

Pete loved to tell people about his friend, Doctor Wasserman.  That's how I found out about his death, with one of my former physician assistants messaging me yesterday about his death.  I know that he was proud of me, but I was proud to be a friend of Pete's.  Rest in Peace, Avery "Pete" Peterson.

Chasing Numbers

I'm not sure if I'll run today.  Sleeping in was a greater priority.  Getting in 32 miles of running for the week versus 24 miles is just a number.  Getting another day of rest might be a greater priority.  I won't know until the day unfolds.  I have a call this morning, so I've already missed my morning "window" to run.  That might actually be ok, if it gets me to focus on how I feel and what my body wants and needs today.  Since I went to sleep later than usual last night, at least my body knew enough to get a good night's sleep.  That is absolutely critical for me these days.  

It really shouldn't be about a number.  As I try to find the balance in my life, what I do from a running, and ultimately triathlon, perspective, should not be about chasing numbers. It should be about how I feel.  It shouldn't be about what I do on any particular day, but how the flow of my life feels.  I've been allowing myself to watch the Tour de France this week. I say allow, because it feels like I'm giving myself a treat, or letting myself step away from the seriousness that has become my life in the past six months.  I've always been a very serious person, but there must be a balance to that.  Chasing numbers is part of that seriousness.  

I had wanted to assert myself and achieve the best time possible at Kona last year. It's been eleven months since I finished the Kona Ironman World Championship.  I got sick the week of the race and, on race day, was really unable to chase a number.  The day became about the experience, as well it should be.  I remember reminding myself, as I rode my bike down the Queen K, that I had a front row seat, no, I was on the field, of the biggest event in triathlon.  It was like being on the field at the Super Bowl.  As I came on the finish line, it wasn't about chasing a number, it was about patting the 75 year old gentlemen in front of me on the back, proud of what he'd achieved.  That's what it's all about!

Reflections

19 years ago today, I was rounding in the early morning at Garden Terrace in Aurora, CO, an Alzheimer's Nursing Facility. The television was on and the news of the first plane crashing into the Twin Towers was playing.  The tension in the facility was palpable and it was one of those moments when it became clear that a facility full of people with dementia took their cues from the staff and the television set.  It didn't take me long to order the television sets turned off.  I happened to be the medical director of the facility and it was obvious to me that this was not healthy for the residents.  They couldn't understand what was going on.  Not that any of us could either.  

Today is a reminder that we are all Americans.  We are one people who live in a country founded on certain principles.  We talk about liberty. We talk about freedom.  We only have these things if we have each other.  And we must also have each others backs.  Of all of the days in the year, I will reflect today on the importance of looking forward and approaching life positively.  Every day can be a challenge, but that's life.  

The residents in my facility nineteen years ago did not understand what was happening.  I did, but I also understood that they didn't.  We are all Americans and we have to look out for each other. 

Breaking Barriers

Well, I really did end up going after a bunch of records yesterday.  Not in the morning, when I usually run, but in the early evening, when I'm usually too tired to run.  I really was feeling unsettled, which I've been the last few days, and needed to release some energy.  So I took off and just let the run come to me.  I thought that I might have to back down at some point, but never did.  The result? A two minute personal best for my 8 mile hilly course!  Wow!  Miles 3, 4, and 6 were all-time bests, and Miles 2 and 7 were right up there.  Miles 1 and 8 were solid, reflecting the fact that I paced myself much better than I might have thought.  More importantly, it felt good to run hard.  My mind and body needed it.  I guess the need to break barriers is an important one for me.

Starting my run hard is always a challenge for two reasons.  First, there is definitely a need to warm up effectively, for which, if I don't, I will pay for it in many ways.  Second, the first few hundred meters are a fairly steep downhill, but then, the next mile is all uphill, fortunately not getting too steep until I get to the end of it, by which time I'm usually ready to start pushing harder.  I try to take advantage of the initial downhill to get some speed without hammering my body, and then I try to gradually increase my pace and effort as I start the uphill portion in a way that allows me to work myself into the run.  Yesterday went great, as my time for the first mile was definitely in the upper range, but not my fastest.  In fact, I think that I've managed to get under 8 minutes one time, fully warmed up and going all out.  My time yesterday was 9:20.  I actually have only gone under 9 minutes when I'm going hard just for the one mile, and my fastest time during my 8 mile runs has been 9:07.  Perfect.  

The second mile is where the real effort to go fast starts.  It starts with a steep 500 meter uphill and then flattens before gradually going downhill.  Getting a fast time here is all about pacing and achieving a solid effort.  My PR for this mile was a couple of weeks ago, when I only ran this mile hard and managed to go 8:47, my first time under 9 minutes, until I managed 8:57 today.  Miles 3, 4 and 5 were all ~8:25, all essentially my fastest miles for these, and then Mile 6 was also my fastest ever at 9:05, a full 20 seconds faster than anything I've done before.  This was significant in lieu of the fact that it's mile 6, a net uphill, finishing with a short, steep 200 meters and beginning another long climb at the beginning of mile 7.  How I enter Mile 7 is key, and yesterday, I pushed Mile 6, backing off slightly on the steep uphill at the end in order to make sure I had both the breathing and the legs to finish strong.  Really happy with my pacing and effort.  I was toggling between a very hard Zone 2 and a strong Tempo effort.  

Mile 7 is uphill until the last 500 meters which is a steep downhill, where I typically make up time.  That's the challenge, going fast for 500 meters, which is more related to my legs than my breathing.  My fastest time ever on this section is 8:12, and so I was thrilled to see 8:24 on my watch as I completed the mile.  Mile 8 is always about hanging tough on a long downhill, until the last 400 meters, which flattens out to finish with 200 meters steeply uphill to the finish.  I've gotten pretty good about being able to finish strong over the last 200 meters, no matter how I feel, and yesterday was no exception.  I kept a solid pace on the downhill, making sure I didn't blow up and leaving myself some energy for the final climb.  My PR for this mile is 7:55 and I was also thrilled to manage 8:08 yesterday.  

I literally took two full minutes off my fastest time on my hilly 8 mile course.  Could I have gone faster? Maybe.  But, in the context of what I was trying to do, this was perfect.  It wasn't a race, it was a very, very solid hard effort for 69 minutes.  Being 8 miles, and being more than an hour, it shouldn't be either a 10K or a lactic threshold effort.  Most likely, I pretty much nailed the effort.  The other positive was that it just felt good.  It was hard, definitely hard, but it felt good.  I got my broken barrier and I got the endorphins that I think I needed yesterday!

Setting Records

My daily runs follow a pattern. I set out with the goal of just having a comfortable run.  Shortly into my run I assess how I feel.  If I'm feeling good, I start thinking about pushing harder during certain parts of my run where I can compare my time over a segment.  Can I set a record today?  The good thing about my 8 mile course is that I have many segments with which to set records.  At the same time, I'm endeavoring not to push too hard on any given day.  That's the key.  Pushing too hard saps me of needed energy.  Energy that I need to accomplish the other things that are always piling up in my life.  Yet, the records beckon.  It's interesting that I rarely actually set a record anymore.  I've run hard on my eight mile course enough times now that breaking a record for a segment is increasingly difficult, though not impossible.

I've been really patient over the past week or so, insofar as I've not pushed too hard during my runs, except when I do.  While I may not push hard enough to set a record on a segment of my course, I have "mini-goals" in my head as I run.  Can I finish the course in under 80 minutes? 79 minutes? 77 minutes? Can I run Mile 7 faster than normal?  I guess that's what keeps us going.  It's what keeps us motivated.  I set out yesterday to just run comfortably, but somehow decided to push hard during the 7th mile.  Did it tire me out a little more than I had planned? Perhaps?  Was it worth it? Definitely.

I guess that's what it's all about.  Motivation.  On the other hand, I have other things motivating me on a daily basis.  That's actually part of my problem.  Once again, the other things have quickly piled up and are putting pressure on me.  My run gives me a place to let off steam, to be motivated and get things done where I may not get the same feeling in the rest of my day.  During the first two months of COVID-19 I was getting a lot of things done but wasn't running, wasn't working out.  I was setting other records.  But I needed some balance.  Balance.  Setting records. 

Taking Care of the Mind, and Body

I slept 12 hours last night.  Really.  That was enough to answer the question of what I was supposed to do today. Rest. First, rest my body. That's easier for me to do.  No running. No walking (there's poor air quality anyway today). I might do some pushups as I've begun to wonder whether my lack of core training over the past six months has contributed to my recent back issues.  I am getting a massage today. I can take care of my body.  Seven straight days of 8 mile runs, in the heat, have certainly added positive stress to my physiology.  What about my mind?

As I caught up on emails this morning, I felt anxiety.  Why? Simple, there's so much to do and that's been my problem.  I've been pretty good the past two days insofar as staying away from too much mental stress and activity.  I've been enjoying golf and the Tour de France.  I've done some reading.  I think that my mind, and body, are telling me that's a good idea, and I need to continue to do it.  Fortunately, I still have most of the day ahead of me if I pay attention to taking care of myself.  I am getting a massage, and I certainly have time to meditate (I think I wrote about that the other day, but didn't avail myself of the modality).

We live in a world where information abounds.  Too much for that matter.  It puts a strain on the brain.  There should be only so much that we need to know.  Getting into those habits are the key.  It should be about taking care of the mind and the body.

Another Week of Running

I've struggled the last three weeks with putting together seven straight days of running.  I've had back spasms, fatigue, more fatigue.  For the past week, I've managed to run my 8 miles every day.  Today will be my seventh straight day.  I woke up a little tired.  But, the seventh straight day beckons.  The air quality is once again moderate, albeit, just on the border of good and moderate, so I have a choice in terms of wearing a mask.  It's going to be another hot day, but, if I get out on the road soon, at least I can run in 80 degree temperatures and avoid seeing 90 by the time I finish.  Writing about today's run only serves to encourage me to get out the door. If I complete today's run, it will actually be my 5th week of running 8 miles seven days in a row in the past 8 weeks.  On the other hand, in those 56 days (including today), I will have run 44 days.  That's 352 miles.  That's 44 miles a week.  That's Jerry West's old number.  I've got to love it!  

It's kind of funny.  There are people who put a lot of stock in numbers.  Our family loves numbers like 11 and we love time's on the clock like "11:11."  44 is symmetrical. It also adds up to eight!  So, there we are.  I don't really know what any of this means, but it's fun to play with it.  That's the approach I need to take today. Playful.  Yesterday, I ran comfortably, but it still took a lot out of me due to the oppressive heat.  Today will be warm again, and even warmer if I don't finish this blog and get outside to run!

Habits are good, but they need to be healthy.  I promised myself last week to start meditating again, and I haven't done so.  Maybe focusing on one to two habits at a time is all that the human mind and body can tolerate.  This week has been focused on getting in my runs again.  I'm feeling a little tired, but I'm going to make it happen.  No stress, no strain, just putting one foot in front of the other for eight miles.  Another week of running.

Staying Within My Limits

 It's been a week of pacing myself.  I've run 8 miles each of the first three days of the week, each day making the effort not to give too much effort.  As my coach noted this week, I've actually been pretty consistent for the past few months, and have developed solid base from which to work off.  When I have such a base, I tend to get a little antsy and I start pushing a little (too) hard.  When pushing too hard comes in the context of the rest of my life, that's when I start feeling the fatigue.  This week has become about staying within my limits.  I've really tried hard not to try hard.  So far, I've been successful. Each day's run has unfolded to be a little different, but I've really stayed within my limits for the first seven miles.  I play around a little over the last mile, but not to the degree that I'm going to put myself over my limits.  With one exception. I do take the last uphill 150m to my house pretty hard.  That's ok.  I can stand 50 seconds of intensity at the end of my run.  

When comparing the last few days to my 8 mile runs at the beginning of this endeavor just 8 weeks ago, I'm completing the run in about 75-77 minutes, at a comfortable to solid Zone 2 effort, which just couple of months ago translated to 82-85 minutes.  That's a pretty considerable improvement over two months, and also reflects that I restarted my running nearly three months ago.  It's been a long time since I've only been a runner.  It's also been a long time since I've run nearly every day.  For now, the key is to stay within my limits, until I feel the urge not to.  

My leaning right now is to keep this entire week calm and relatively easy, and decide on Sunday whether I want to break out with a harder run.  If I look back at my training logs over the past several weeks, at certain points, I just start pushing harder during my runs.  That's me.  On a certain level, I run based on how I feel, which is great.  On another level, I sometimes have the need to test my limits.  On yet another level, I strive not to have limits!   I guess, like Ironman, running can be a metaphor for life!

Perspective

1,000 People a day dying from COVID-19. One thousand. Why isn't this on the front page. Every day.  Perspective. When something becomes commonplace, people get used to it.  Older adults in nursing homes are dying every day from COVID-19. It's not on the front page. It's happening every day. Perspective. I woke up today worrying about the fact that I've been worrying about COVID-19 and it's impact on older adults for six months. Perspective.  From my perspective, this is still a big deal.  To a lot of people, it's become commonplace.

How do we change people's perspective? That may actually be the overriding question at this time.  If we're actually going to do something about this problem, if we're actually going to reduce the number of deaths, we first have to change the way the average person looks at the situation.  It's sad, but true.  It's also the same reason that journalists aren't writing about nursing home deaths anymore.  It's not a story.  Not only do the deaths need to be messaged, but they need to be messaged in a way that gets people's attention. That tugs at their heartstrings.  

It's unfortunate that our society is steeped in ageism  Nursing home residents don't really matter to anyone but their families.  Their families can't even visit their loved ones.  There's an "outcry" amongst a small group of people.  Are nursing home parking lots every overflowing with visitors? No. That's the irony. In normal times, nursing homes don't have a lot of visitors.  Neither do assisted living facilities.  We dealt with that when our neighbors were worried about the traffic from an assisted living facility being built near our last house.  I thought it was "funny." No one comes to visit.  Perspective.

Perhaps we shouldn't be surprised that no one cares about people during COVID-19 whom no one cared about prior to COVID-19.  Even if they're dying.  It's all about perspective.

Fear

The thing about COVID-19 is that it is scary.  Allergies that cause a little nasal drip or scratchy throat, feeling warm because the temperature is in the house is up, these mundane feelings take on a greater level of gravity in the world of COVID-19.  The human mind is challenged by these types of feelings.  We inherently want to live, that's human nature.  We certainly don't want to die due to unnatural reasons.  COVID-19 lurks in the background, making one question there every move.  Could I have come in contact with the virus? The questions lurk.  Fear is a strong emotion.

When the  COVID-19 pandemic broke out, I'd been meditating daily for two months.  I kept that going for another three before breaking my habit, and now it's time to get back to daily meditation.  It's arguably the number one antidote to fear.  We all fight uncertainty.  It can grab ahold of our mind and take over.  You think about opportunities where you might have been exposed to the virus, and replay them in your mind.  Fear.  All one can do is rest and recognize that you can't control every circumstance.  Yet this lethal virus lurks, and creates more fear.

I ran yesterday.  It was a good run, with the exception of taking a misstep off the curb which caused me to land awkwardly on one foot.  I think this tweaked my back a bit, but we'll know more later today.  I my have dodged a bullet.  Running is the one thing that has been taking the place of meditation, although I believe that I need to do both.  Fortunately, there's been less smoke in the air, although I do believe that the weed pollens are out in force. Fear. We can't let it take over. 

Being Me

My wife said something to me this morning that resonated with me during my meditation.  It also flowed with what I woke up thinking.  I think that during my life, for a variety of reasons, I've sometimes felt the need to fit in.  It's somewhat ironic, especially since I'm an iconoclast, and tend to be my own person.  Maybe, it's not so ironic.  There's a yin and yang to everything in life.  I spend so much time being me, maybe I'm pulled in another direction at times.

I've been struggling for some time to fit everything into my life.  I've got so many irons in the fire.  I look back on last year, being the year I focused my life on Kona, and find some peace within the year.  I had a singular focus, and I followed it.  During the first couple of months of COVID-19, I had a singular focus, and I followed it.  Of course, that was different from anything in my life, perhaps since my internship year.  Or, maybe it wasn't, it was a microcosm of many aspects of my life.  My 15 months as the CEO of Rockport, those months were pretty focused.  I certainly can get lost in my own priorities.  

I thought that I'd run again today. Yesterday was a very solid effort that left me feeling a little tired throughout the day.  I also felt like I had some allergies coming on, which is always little challenging and off-putting during the time of COVID-19.  You really don't want to feel like you've got a scratchy throat, itchy eyes or stuffy nose.  It messes too much with ones head.  On the other hand, feeling allergies coming on has always been a sign for me that I've pushed the limits of training, or that I've pushed my body a little too hard.  

I have work to do.  I definitely have too many projects going on at once.  I need to spend the day today catching up and reprioritizing.  Running will only add stress and fatigue.  I need to be sharp.  I need to be focused.  I need to be me.

Hanging By a Thread

There are some days that I feel like our country is hanging by a thread.  My focus on the COVID-19 Pandemic has kept me focused, and obsessed, for nearly 6 months.  I try not to mix up my messaging on social media, lest the importance of the fight to protect older adults is lost.  Nevertheless, I can't get away from what is happening around the country.  How can we live in a country where a white police officer can shoot a black man in the back 7 times in front of his three children.  What kind of world is this?  How can we live in a country where a 17 year old can bring an automatic weapon to a protest and shoot innocent people?  That is premeditated murder.  This country is truly hanging by a thread.

I was quite satisfied to hear that professional sports players were boycotting their own games.  It's time.  It's time that we stop playing games and change the system.  It's time that we stop playing games and do the right things for our country.  While I didn't think that outdoor protests were the safest thing to do during COVID-19, I also understood that the people going had a right to protest injustice at the risk of death from a deadly virus.  That was very different from hiding a political rally in an indoor arena with few people wearing masks.  That was a super spreading event that killed Herman Cain.  This country is truly hanging by a thread.

What's next? I shudder to think.  Every day I say that the words uttered by donald trump can not be worse or crazier.  That the republican convention can't be any worse.  Having a few people of color claim that there is no racism in America doesn't change reality.  The best meme I saw yesterday noted that half of the main speakers were trump's family.  They compared it to North Korea.  Point taken.  When trump ran for president I compared him to Adolph Hitler.  I was right.  The question is whether our country can take this punch and remain standing.  I hope so. I pray so.  This country is truly hanging by a thread.

Steady as She Goes

 Today is one of those days that I truly need to get my arms around.  I was feeling tired last night.  It was probably a combination of the past few days and my solid run in warm, humid conditions as well as some residual smoke in the air (I didn't run with a mask yesterday).  I realized that there must have still been some smoke because my nose was a little "out of sorts" last night.  It's interesting, but "allergies" have always been a sign of overtraining for me.  So, when it seems like I'm having more allergy symptoms, I need to pay attention.  I also have a project that MUST get done today.  I delayed it over the weekend due to the legal case, and it will need my thinking and analytical skills.  In fact, that's primarily what it will need, as it is a budget for the grant proposal.  

Getting out on the road first thing this morning has its appeal, but that will add fatigue to my day.  I ran yesterday and realized that I no longer had to be a slave to a goal, to a number, to a streak.  I just have to listen to my body. My body is telling me not to push today and to get my project done. With that, I'll also not be a slave to my blog.  Steady as she goes.

Too Much, Again

Yesterday was a very long day.  Woke up from my alarm, never a good thing, to participate in a legal hearing.  We started at 6:30 am, and it took nearly a half an hour to get the proceedings started because of challenges with the internet and technology for one of the witnesses and the judge.  The next 2 1/2 hours was spent listening to the first witness, which mattered for me, because their testimony had pertinence to mine.  I was the expert witness.  We got a 5 minute break.  Then came my testimony.

The first objection had to do with whether my attorney could even call me as an expert.  The case had been going on for 7 months, and I was being introduced as an expert on the day of the hearing.  Actually, not being privy to the case prior to this weekend, and not really knowing the legalities of this issue, I was wondering myself, but I was allowed to testify.  Then came the voir dire.  That was fun.  The attorney who hired me spent time qualifying me in three areas of expertise.  The judge got tired and a little perturbed after the second, wondering why he needed to go onto the third (which she ultimately concluded was implied by the first two).  My attorney didn't seem to take the hints that the judge gave very well.  Of course, the opposing counsel kept objecting to my being an expert, but, of course, I was.  

My attorney then questioned me.  I did most of the talking, except when there were objections.  With an internet hearing, you really need to just stop talking after an objection and wait until the judge rules before answering a question.  My testimony went on for a couple of hours.  Then we took another 5 minute break. Now came the cross examination.  That's always hard.  As I said in yesterday's blog, the lawyer was just doing his job.  Still, getting cross examined is stressful, though hopefully, I'll chill more in the future. Two more hours and we were done.  7 hours of trial testimony, sitting in front of a computer.  I then had other work to do, or rather, I chose to do other work.  I spoke to a reporter, as is my daily custom.  I worked on emails and other items and ended up speaking with the opposing attorney and the person who'd hired me to testify.  Oh yes, I participated in a webinar that I volunteered to help with at the last minute.

I finished the day by working on a very detailed grant proposal.  By the time I went to bed, it was 11 pm.  Too much, again.

Lawyers Are Just Doing Their Job

I testified today in a court proceeding.  The lawyer who cross-examined me was tough and unsparing, but that's his job.  My job as an expert witness is to share my expertise.  There are other witnesses and ultimately, in this case, the judge made a decision.  Everyone was doing their job.  The decision wasn't dependent fully on my testimony and I ultimately had no responsibility for the decision.  My responsibility was in being honest and transparent and sharing my expertise.  That's what an expert witness is supposed to do.  While the other attorney had a responsibility to question my role as an expert (which was very hard to do in this case), he tried.  Of course it didn't work.  Without going into details, it was his job to try to poke holes in what I was testifying to.  

Imagine my surprise when, about two hours after I had testified, I got a phone call from the opposing attorney telling me that he didn't want me to take his cross-examination personally and that he had been impressed with my testimony!  It turns out that the judge ruled in his favor, but he still didn't have to reach out and commend me.  He was also very complementary as to my honesty and sincerity, traits that I pride myself on and which I'm glad come through in my testimony.  I'm sure that I made it more difficult for the judge to make her decision, but that discussion is for another blog on another day.

Today, I remind myself, that while I'm doing expert witness work, my role is purely educational.  I can not take my responsibility too seriously, and I certainly can't be bothered by the cross-examination. Lawyers are just doing their job.

Breathing Hard

I did my typical 8 mile run today.  Only it wasn't typical.  There was poor air quality, so I wore my N95 mask.  Remarkably, it really wasn't that hard, except that it was.  Wearing a mask adds an additional stress to the run.  There's no question that stress added a distinct element of additional challenge.  Then there was the 80 degree temperature and significant humidity.  Once more, by the time I finished, I was drenched in sweat.  I was breathing hard.  Ironically, the actual running effort for today's run was comfortable.  My breathing was hard, but my legs were fine.

I might want to add wearing a mask to my running regimen at times.  It is probably good for my breathing muscles.  There's no question that running in the heat and humidity also builds, just as it drains me.  I've had multiple runs this week in heat and humidity, leaving me wrung out and tired.  I'd recovered for today's run, but certainly got worn out again.

I continue to try to listen to my body and decide what to do on a daily basis.  Today that meant adding a new layer of stress to my run.  Breathing hard can come about for different reasons.  

Without Limits

One of my favorite movies is Without Limits, which is about Steve Prefontaine, a runner who ran with abandon.  He didn't believe in pacing himself.  He believed in pushing himself beyond his limits.  It's one of my favorite pre-race movies to watch, as it reminds me of my approach to life.  With that said, there's a balance.  I didn't run yesterday, and I'm not going to run today.  Sleeping for 10 1/2 hours two days in a row (and not getting out of bed until 11 1/2 hours today), is definitely a signal to me.  It's possible that, rather than absorbing my training and getting stronger, that the cumulative fatigue from training, work and life, have pushed me beyond my limits.  I was definitely feeling that this past week.  

I actually considered running today when I went to sleep last night.  Not only running, but running long to catch up with my miles for the week.  That would have been a big mistake.  At least my body decided to send me a message and discourage me from even considering it.  Yesterday was my daughter's birthday, and was supposed to be a day off.  It wasn't, by any stretch of the imagination.  Between phone calls and meetings, as well as mental engagement, I literally put in a full day.  That's not resting.  I really do have trouble with setting limits for myself.

I am who I am, and I always appreciated the Steve Prefontaine approach to life and racing.  I will always be someone who lives life without limits, but I need to be cognizant of the potential impact of that approach.  Burning out is not an acceptable approach.  It's ironic, that while I talk about not pushing too hard with my consecutive 8 mile runs, I still manage to push a bit, possibly a bit more than I should if the goal is to maintain the daily runs.  On the other hand, I've definitely made progress in the last several weeks.  There's the rub.  I make more progress when I'm pushing my limits, and I just need to know when to back off.  Maybe it's ok to maintain an approach without limits?

Time for More Rest

Today is my daughter's 33rd birthday.  Wow.  I remember the day that she was born, almost like it was yesterday. The plan was to run this morning for the fourth straight day, putting me over the half way point for the seven straight days of running 8 miles.  I went to bed at 10pm last night, and when I woke for the first time today, I was still tired.  I went back to sleep.  When I awakened at 8am, I knew that my body was sending me a message. I fell back for another half an hour of sleep.  Today is my daughter's birthday.  It's bad enough that I have a three hour meeting in the middle of her birthday party.  It's bad enough that all I think about is work.  I've been tired all week, which hasn't been helped by daily runs in heat and humidity. Which hasn't been helped by the feeling of being a bit overwhelmed with my life.  Today is a day to celebrate and to savor.  It's time for more rest.

My coach and I often talk about the importance of listening to my body.  My body was definitely talking to me this morning.  A fifth straight week of 8 mile runs will not happen.  My body has pressed against its limits and knows what they are.  Numbers don't matter.  Extra data points don't matter. Rest and recovery matter.  Peace matters.  Ironically, in the back of my head, I'm already considering turning tomorrow's 8 mile run into a 16 mile run, in order to catch up.  Of course, that might only lead to fatigue doing the catching up.  We'll see how I feel after another day of rest.  We'll see what my mind and body want to do tomorrow.  

The one fascinating thing about Ironman training is that feeling of training despite, or rather in spite, of the fatigue.  I've had many days where I've run on Ironman legs, or run with an Ironman body, feeling the fatigue, but letting it bathe me rather than sink me.  I'm not sure what that means, except that it's a valuable part of Ironman training.  However, I'm not training for an Ironman right now.  I've got a long way to go before I begin that process again.  Right now, I've become a runner.  I've been looking for the feeling of being a runner.  With that in mind, I'll get some more rest today, and see what tomorrow brings.

Cooler Running

I woke up too early yesterday and went back to sleep.  That was good.  I went for my morning run in heat that was nearing 90 degrees.  That wasn't good.  I wasn't sure how hard I wanted to run when I started, which is often the case, so I ran the first mile comfortably before pushing up the steepest part of the first climb.  That was also ok, or so it seemed.  What I really didn't catch on to was the added stress of the heat, which, by the time I pushed up the climb at the end of Mile 4 and the beginning of Mile 5, began to take its toll.  It actually reminded me of Ironman Chattanooga in 2016, when I thought I felt fine at the beginning of the run and forgot to take in fluids (not sure if it would have mattered, since I was probably already dehydrated from the bike ride with temperatures up to 104).  

I thought I was fine until I realized that I wasn't.  Ironically, while I backed off the rest of the fifth mile and just got back to running comfortably, I knew by the end of the mile, where it gets steeper again, that instead of pushing up the hill, which I often do, that it was actually time to walk.  The stress every day is a different stress.  Sometimes it's running hard.  Sometimes it's emotional stress.  Sometimes it's mental stress.  Yesterday, it was just hot, pure and simple.  A couple of more walking breaks, including a decision to walk the last 200m uphill to my house, before sitting down and not moving for about 5-10 minutes, drenched in sweat, before I could get myself up to go inside and drink two large glasses of fluids.  

I'm up earlier today and ready to run.  A little washed out from yesterday, but I should be fine.  It's going to be another warm day, but if I get out soon I'll avoid the worst of the heat.  It will be interesting to see how my body responds to the stress of yesterday's run.  I'm looking forward to cooler running.

Getting Settled

 I'm not sure what got me settled  yesterday.   I woke up in a very unsettled state, but everything seemed  lot better after my run.  I didn't run hard. Once again, I just ran comfortably.  It's a good feeling. In its own way, it's a settling feeling.  There is certainly something natural about running and making my morning run a regular habit.  I also really need to hone in on what I'm going to focus on in the coming weeks, months, and years.  That has certainly been unsettling.  Not knowing, literally on a daily basis, what I'm focusing on, can't be very settling.  That's been the crazy part of the past five and a half months.  Some days just take on a life of their own.  That's ok, kind of.  It's not really a long term plan.  It doesn't really allow me to get settled.  

So begins another day.  I know that in many of my blogs I write about finding peace.  That has become a constant refrain for me.  It really goes hand in hand with feeling settled.  There are days when things are just off.  That's how I woke up yesterday, but somewhere during my run, and perhaps even after writing my blog, I started to feel like I was settling in  for the day.  

Another day comes and another day goes.  Peace is an illusory concept, but one that I seem to crave. Yet, I also seem to embrace change and challenge.  How can one settle in in the midst of swirling winds and waves.  I hearken back to Ironman St. George in 2012, with the waves around me, not knowing for a moment whether I'd survive the experience.  In that moment, I recognized that I had to settle in, I had to make my own peace.  I needed to be in the moment. That's one place I often try to go back to, when I'm having trouble finding my way.  It's one way for me to get settled.

Unsettled

I had a rough night.  I shouldn't have been surprised, since I felt off yesterday.  I'm not sure why.  Sometimes, this type of feeling is related to my training and fatigue.  It didn't feel like that, however.  I was just off.  Maybe the universe was out of alignment yesterday.  I also have an important phone call today that might have me being a little nervous.  Nervous isn't something I feel very often.  It definitely goes against my grain.  So, I have my morning run to look forward to. Maybe that will settle me down.

There's definitely been too much going on in my life lately.  I look back three years and I'm coming up on the anniversary of when my life completely changed.  I thought that I was pretty satisfied at the time.  I was working part-time, mostly educating others, and under relatively little stress.  And then, in a weeks time, I made a decision that completely changed my life.  That decision fully came to bear when COVID hit our country, and I've intermittently had days like this over the past five months.  In truth, however, I've had days like this for the past 2 1/2 years. 

Finding peace is what I seek.  How that peace comes about is something that I continue to struggle with.  Writing about it actually helps in some way, perhaps just by acknowledging it,  or by releasing it.  I'm not sure which, or perhaps both.  I know that running helps.  Today's run will be interesting.  I had a day off yesterday, which could contribute to my being unsettled, but somehow I think not.  There were too many other things that were unsettling to me yesterday.  Will my run clear these out of my head? Can I focus on the beginning of my fifth week of daily 8 mile runs?  When will these daily runs become perfectly routine?  Will I reach a point where I will feel the same at the end of the week as I do at the beginning?  

When I did my 20 weeks of 20 mile runs in 2016, the first few runs were hard and left me feeling sore.  It was around the 15th week where the runs began to feel ho-hum, and I began to think about what came next.  Running 8 miles a day for 8 straight days is different.  Every run is a little different.  Some days I run easy, some days I run hard.  Other days are a mixture.  The combinations keep any of these runs from becoming too routine, any of the weeks from becoming too routine.  Maybe that's what I need?  Routine? In order to be settled?  I don't know.