Running Dreams

I woke up today and the first thing I thought of was running.  Not sure if that's what I was dreaming about. In fact, I don't know what I was dreaming about.  That's probably good, because for most of the last three months my dream have been about anything but running.  There was a time that I'd dream about running, biking and swimming.  That's been awhile.  I'm not sure what type of run I'll do today. That's been the new strategy, just go out and run and see what I feel like.  I've done a few 6 mile runs in the last week. I did some very short, 10 second, sprints one day.  Maybe today will be 40 second uphill sprints.  Those are hard. They get me breathing super hard by the end.  They're not easy, by any stretch of the imagination.  They get the pulse rate up.

That was the workout that first popped into my head.  Not sure what it will feel like once I go outside and start warming up.  Let's see...

Went out and warmed up for 10 minutes before hitting the hills!  Found a fairly steep hill that would take me about 45-50 seconds to run up.  I did it 4 times.  Each time, my breathing got harder at the end, initially taking ~5 seconds to slow down my breathing, but after the last time, taking about 25-30 seconds.  I'm talking really hard breathing.  On a positive note, my pace was consistent up the hill, not sure what it was, but it was solid!

I took about 5 minutes to cool down, which included a quick run down the same hill each time. Then, I did four 10 second all out sprints.  These went well.  I thought about doing more, but decided to end it while still feeling good, albeit a bit more winded after the fourth sprint than the first three.  Still, I felt better after these than I did when I first started doing sprinting months ago.

Now I can start dreaming about running again!

Cynicism

Why shouldn't I be cynical?  I've been trying to have my voice heard for three months.  Am I actually being too much of a perfectionist? Or, am I correctly acknowledging the situation and reacting accordingly?  I often use war analogies, and if I look at this as a battle, we've definitely made progress and taken some ground.  The question is whether it's enough?  Furthermore, how much more of a risk do I want to take to make more progress?  Therein lies the question.

In the last few weeks, a number of things have transpired.  The state is holding weekly calls with the nursing home infection preventionists.  I wanted, and still believe that it would be more productive, to have daily calls.  I could have been pushing to do this, but have chosen not to. Rather, I've just been too busy and in many ways, too tired, to push for daily calls (I had the thought of piloting daily calls for a portion of the state, but haven't proposed it or determined a plan to make it happen).  I think it's time to see about proposing this, though I can't do it myself, and will need help to both propose and achieve it.

The state put forth a "mitigation plan" that requires nursing facilities to lay out all of their plans to combat COVID-19.  The plan literally includes all of the elements that we have been recommending this March 5.  That should be a success, but I am worried on a few fronts.  It puts the onus on the nursing homes, some of which are too small and insufficiently staffed to actually develop such a plan, much less carry it out.  Why couldn't the state have written the plan for them and told them what to do? Perhaps I'm nit picking.  The bottom line is the plan we were suggesting is the plan that the state is requiring.

The state has finally laid out an approach to testing, literally following almost all of our recommendations.  We were given the opportunity to review the plan the day before it was released, once again, we had to ask to see it.  Why?  Why do we have to push every step of the way?  Why can't we just be part of the process?  That's the frustration.  That's why I'm cynical. Nevertheless, all of these things have happened. They've happened slower than I would have liked.  Because of that, many lives have been lost.

I will never regret any of the actions that I've taken over the past three months.  That was one of the things I'd asked myself along the way.  I will not look back.  I will not wonder.  I've given this everything I've had, and then some.  Maybe it's time to let go of the cynicism and just let the efforts take root.  Maybe it's time to water them and see how they can grow.  Maybe it's time for some optimism?

Submitting a Journal Article

I've spent most of my day submitting a paper for publication.  I haven't done that in 32 years!  In some ways, it's probably easier today, being that the last time I did this there wasn't even an internet. All I know is that I've literally spent the last 4 hours doing the submission.  Fortunately, I'd taken an hour nap prior to getting started.  Before that I'd worked 12 straight hours, a good portion of which was getting the document ready for submission.  Now we wait and see.  Hopefully, it will get published and it can have some small impact on what's going on right now.

I'm actually looking forward to doing this again.  In some ways, going through this process has reminded me of a way that I can contribute that I hadn't really thought about in a long time.  I'm sure that there will be many other opportunities in the coming months and years.  It's also a reminder that I need to get back to my textbook, as my time has been consumed with the COVID-19 Pandemic.  That's it for today!

Five Days Running

I ran again today.  That's five days in a row.  This habit is going to come back quickly.  I probably ended up running close to five miles, with a lot of hills.  I only did a little bit of walking on the steepest parts when my breathing definitely got too hard.  I'm sure that my heart rate was higher than I might have "liked," but I felt good.  Every day is better and I can already anticipate feeling up to running longer.  The idea of getting in a twenty mile run has already entered my consciousness, though I'm definitely not close to doing that yet

The best part about my five day running streak is that I'm feeling the desire to run again, and not wanting to let other things get in the way.  For the past 2 1/2 month, it's been easy to let life get in the way.  It's been easy to get distracted by everything going on in the world.  I've been consumed, and that has gotten in the way of my running.  No more, running is now back in my life.  It will be important to maintain the streak for awhile.  That should allow me to fully get that running feeling back.

I've also already noticed that my legs are feeling a little better.  That's always interesting, and I've seen and felt that many times over the years.  If I've been away from running for awhile, I will feel some tightness or soreness for the first few days, but it quickly dissipates and I get my running legs back underneath me.  Five days running.  Looking forward to the next five.

Running Back to My Life

It's hard to believe that it's been over two months since I was considering doing my 16th Ironman.  I had literally started feeling the desire to do another Ironman when COVID-19 struck the United States and my life changed dramatically.  For the last four days I've gotten up in the morning and went for a run.  I haven't run very far, or for very long.  Today, I probably ran somewhere around 3 1/2 miles.  Not a lot, and I included some very short uphill sprints.  I'm not wearing a GPS device, so I'm not tracking my distance or my pace.  I don't want to care about that.  I just want to get back the joy of running.  I'm hoping that biking will be next.  I'm not sure what to do about swimming, as the thought of getting into a public swimming pool is not very appealing at this moment.  I may very well have to depend on upper body strengthening and my long standing good swim form if I choose to do another Ironman. Time will tell.

Running is good for me.  I remember when I was thirteen, I decided to take up running.  It lasted about a day.  I ran down the street at home and back, probably not more than half a mile. It was hard. Funny, I've always gravitated to doing things that were hard, but at the time, running wasn't one of them.  Over the years, running has taken on a sort of a love:hate relationship for me.  I remember thinking about it during medical school, but I never took it up.  It wasn't until I turned 32 that I began running on a treadmill.  I'll always remember that first 5K in Canoga Park.  It was hard.  And then, my first marathon, the Los Angeles Marathon in 1994.  I'm not sure that I really enjoyed or appreciated or even looked forward to running back then.  But at some point that changed.  At some point, I actually did look forward to going out for a run or going to the track to do intervals.

At the beginning of last year, in preparation for Kona, I ran for nearly a month straight.  I don't know if I need to repeat such a streak again, but daily running has some mental and physical value.  I'm not sure what's next in my life when it comes to running or biking or swimming, but the running habit is a healthy one.  When I'm out running, there are times that my mind wanders and I am just enjoying the feeling of running.  I that regard, I miss my twenty mile runs.  Maybe I'll work towards them again.  Maybe it's time to start running back to my life.

Time to be a Resource, I Hope!

I spoke to the Secretary of the Department of Health and Human Services for the State of California today.  I hope that means that I've made progress. If he actually reaches out to me going forward, as he said he would, and he accept my occasional texts, then we're on the right track.  I also realized that it is quite possible that he hasn't been getting the information that we've been supplying to the Department of Public Health. At least not unfiltered.  That's the concern, that the information that he's been receiving has been filtered.  That filter has not allowed him to get actionable information that could have been used to make a greater difference thus far.  It's pretty amazing.  I keep learning.

All along, I've understood how arrogance, ego, power, and greed have played into what's going on. I haven't always completely understood it at each level it exists, and now realize that the person that I've been "fighting" with all along has been a much greater impediment than I even thought.  Or, in reality, I did think this to be true, but allowed my colleagues to influence me in not pushing even harder.  Either way, the results may not have been difference. If I'd pushed harder, I may not have gotten to this point. Now that I'm there, it's time to pivot to focusing on making a difference.

I hope that I'm one step closer to fulfilling my desire to spend most of my time in educational mode.  That's what I've wanted to do from the first day.  It's what makes me the happiest.  I'm not happy fighting.  I'm not happy trying to figure out ways to have reporters get me closer to influence opportunities.  I just want to be a resource.  That's what I hope to be focused on henceforth.

Streaking

I've run for two days in a row.  Not that I'm keeping track, or that I'm going to keep track (though I might). I wonder if a daily run is what I need?  There are a multitude of reasons.  After all, I am OCD. A daily run streak might be a healthy way to feed that obsession (going along with my daily meditation streak).  I need to get back the health benefits of running and working out.

I did get in a run this morning.  I then walked for an additional hour or more while on calls.  I then spent the entire day in meetings, webinars, and calls.  Twelve hours of non-stop work today, and I'm tired.  But, at least I ran for two days in a row.  Not sure whether I'll run again in the morning tomorrow. Maybe I will.  Maybe the day will take on a life of its own.

I continue to struggle with balancing the things that seem to come my way and the things that I bring upon myself.  I know that they're worthwhile, and I have a lot of people praising my efforts.  I really don't care.  I'd much rather hide away for awhile (a long while) and get some rest.  Kona seems so long ago, my fifteen Ironman's seem so long ago.  Maybe that's why I do need to start a streak.  That's why I do need to run every day.

Obsessed

It's all I dream about. It's all I think about.  I wake up to it.  I go to sleep with it.  It's my challenge to deal with.  There was a time last year that my obsession was with training for Kona.  I enjoyed thinking about that.  It seemed like a positive obsession.  Despite getting sick the week of the race, in the end, it was an incredible experience, one that I'd like to feel again right now.  At the same time, I understand why I feel obsessed right now.  My life and COVID-19 have lined up like a jackpot on a slot machine.  I am uniquely trained and suited to understanding the impact of this deadly virus on the very people whom I've dedicated my life to.  Still, do I have to be obsessed?  Can I start breaking away, even for a little while?

Last week I went for a run a couple of times.  I wake up int he morning, thinking about the virus and thinking about whatever I've been "fighting." I don't like fighting.  I want to collaborate.  I want to be positive.  I want to haver just a little bit of fun.  I want to run and bike again, and feel the joy of exercise.  Actually, I just want to feel some joy.  It's difficult, though, knowing what's out there that I can continue to make a difference regarding.  There's the rub.

I spoke to a colleague last night who is a wonderfully eloquent writer.  She told me that, in the early days of COVID-19, my tweets might have been harsh.  She almost emailed me one time, but ultimately didn't.  Those tweets, and some of my more "out there" quotes, have put me on CNN and MSNBC.  Those stronger, more provocative statements, have gotten me quoted in many news articles.  At the same time, they've also led me to be an educator for many reporters and journalists, who are only now learning about nursing homes and COVID-19.

I have always loved teaching others.  That's my great joy.  There are different ways to teach.  Some teachers are more provocative, maybe that's part of who I am.  I truly want to pivot in order to spend the bulk of my time teaching.  Maybe have an opportunity to feel a little bit of joy.  Having some moments that aren't driven by an obsession.  That would be nice.

Tired

I have my days.  Today was up and down.  We had a baby shower for my daughter.  That was nice.  At the same time, today was just one of those days that I struggled with.  There's no question that my passion and emotional investment over the past 10 weeks has taken a toll on me. Today was one of those days that I could feel it.  I'm tired.  I'll try to rest tonight, but I have some work to do the rest of the week.

It's not easy managing the multiple things that I've been managing without any real support.  With that said, I have a lot of friends and people who have been giving me moral support.  Our expert panel will be meeting over the next two days, and hopefully I can finalize the paper that I've been working on.

I continue to talk to reporters.  We're considering having a press conference next week.  Initially, the idea was to use it to push the Governor.  Now, I think we can use it to focus attention on our efforts, and possibly start to set an agenda for the future.  Out of the crisis and chaos, comes opportunities.  That's how I have to look at it.

I continue to struggle with finding time to feel good.  I've just been so invested in everything that I've been doing.  I ran a couple of times last week, but really haven't done much over the last couple of days.  Kona seems like ages ago.  My 15 Ironman races seem like another lifetime.  I'm tired.  I guess that makes some sense.

Another Appearance on Rachel Maddow

I was having a somewhat unremarkable day, and then the VP announced testing in nursing homes and the Rachel Maddow Show called and my day changed.

All good, but that's it for todays blog!

Thirty two years between scientific publications

It's been 32 years since I actually wrote a scientific paper for publication.  Ironically, one of my coauthors from that journal publication is participating in the project that I spent my day writing about.  I have to admit to being a little nervous about writing a paper that will be submitted to a peer reviewed journal.  When I made my decision not to enter academics over thirty years ago, I moved into a very different realm. My journey that has led me to being the editor-in-chief of a major geriatric textbook has "softened me up" a bit in regards to whatever reticence I may have.  Nevertheless, after spending the day today writing the first draft of a 3000 word plus paper was a bit daunting.  I've sent it to one of my colleagues for a first review, and I admit to being nervous.  It's kind of funny how that happens.

At the same time, I'm excited by the fact that we'll be writing about something that is quickly becoming news worthy.  That is the importance of testing both the residents and staff of nursing homes and assisted living facilities for the COVID-19 infection.  To lay people whom I've spoken to, this seems pretty obvious.  However, even as of last Friday, I heard reports of nursing facilities that were still resisting testing.  It's crazy.  Publishing an expert driven consensus panel on the topic should solidify the decisions that seem to be happening around the country.  Many of these decisions seem to have a "CYA" theme.  Suddenly, something that wasn't being strongly recommended a few weeks ago is about to become the law of the land.  Crazier still is the fact that the language I've seen in the last twenty four hours put a large degree of accountability on adhering to these new recommendations.  Where was everyone three weeks ago?

I have been so frustrated for the past two months by the fact that both the senior living industry and the governmental agencies that regulate and monitor them have been playing a game of chicken.  Unfortunately, those who suffer are the residents themselves.  I guess I'll have to let the facts sort themselves out over the coming months as others look back at what has transpired.  As usual, history will become clearer in the light of day.  In the meantime, I hope that my first draft survives relatively unscathed. No matter what, the experience of putting it together has been worth it.  It's always about the journey!

Terrifying Trips to the Supermarket

Who would have thought that going to the supermarket would be a terrifying experience.  I made my weekly trip to the supermarket this morning.  It's the most stressful thing that I do all week.  I used to go to the supermarket almost daily.  My wife and I try to buy what we need, and not keep our refrigerator fully stocked (during normal times). It reduces waste.  Now, we keep fully stocked and I literally go to the supermarket once a week.  I'm there when Ralphs opens at 6am and then on to Whole Food for their opening at 7am.  The inner stress is not insignificant, as I wear my N-95 mask and try to stay out of the way of others in the market.

I try to make sure that I'm moving in one direction, and avoiding aisles with other people.  It's scary, although I'm not sure it really needs to be all that frightening.  I've got my mask on and I'm not staying in close contact with anyone during my trip.  Still, being in an inclosed market, being in any inclosed space, concerns me these days.  In some regards, I shouldn't be that worried.  As a society, people are far more cognizant of transmitting a virus today than they were three months ago.  While this virus is insidious, I know that good hand hygiene, wearing of masks and physical distancing, makes a significant difference.  Our community has been left relatively unscathed.  Still, I guess that I don't feel that I'm ready to get this virus, nor do I want to pass it on to any of my family.  And so, the trips to the supermarket will continue to be terrifying.

The Overwhelming Power of Purpose

Over the last few years I've come to look at purpose as an important and necessary part of life.  There is actually literature on how purpose has a positive impact on our lives.  There is also a darker side to purpose.  It can be overwhelming.  I've never fully understood this until today.  Much of my life has been driven by purpose.  In fact, I'm a very purposeful person.  As I wrote about last night, for the past two months, I've literally had a singular, all encompassing, purpose.  That isn't a good thing.  Everything in moderation, even purpose.  If a purpose becomes an obsession, if it acts to the exclusion of everything else, it is not healthy.  That's when I realized where meditation comes in.

I've meditated every day this year.  But have I? Has my mind truly mastered the art of meditation?  Or, have I often been going through the motions, completing my daily meditation because it's been a goal?  In a way, this isn't unlike the conversation I had with my coach a couple of days ago about working out.  Whether it be running, or doing pushups and squats, I haven't been able to "get into it" lately.  Of course not, my mind has been consumed with one singular purpose, and there's been no room for anything else.  That's where meditation comes in.

Meditation is about being in the moment.  Meditation is about not letting any one thing take over our minds.  Meditation is about letting thoughts pass through our brains, but not allowing them to take control.  Meditation is about being at peace.  

When ones sense of purpose becomes all consuming, we actually lose control of ourselves.  It's like control over driving the car is taken over by an outside force (or, in this case, an inside force).  The force is purpose, but it's only one force amongst many that we live our lives with and for.  That's the point.  Purpose is important, but it should'd be all consuming.  It should be a balanced part of our lives.  

I've had the habit since I was a child to watch television while doing other work.  I never realized the reason that I do this.  My brain is often working in multiple directions at one time.  Ironically, right now, my brain is focused in a singular direction. The idea of meditation, and the counter intuitive idea of not letting my purpose overwhelm me, is that the true importance of "being in the moment" is actually being in the moment, regardless of purpose.

What's Next?

It's now been two months since my obsession with protecting the lives of vulnerable older adults began to consume my daily life.  Nothing has been the same for those two months.  Every day I wake up thinking about how to protect the frail older adults that I've spent the last thirty two years of my life trying to serve.  Every night I go to sleep thinking about this topic.  I've never been consumed with something so much during my life.  Even my focus on preparing for the Ironman World Championship pales in comparison to this.  The challenging part of this is that I've truly had trouble thinking about anything else.  This has hit the workaholic in me in a way like nothing I've ever encountered.  It's time to start moving on.  I've done my part, an it's time to start moving on to the next phase of my life.

I've got plenty to do.  I want to keep educating others.  In fact, the opportunity to teach others about geriatrics and what we're all about is presently enhanced in ways it never has been.  I need to look at this as an opportunity that can't be ignored.  I still have a textbook to edit.  I even have a new chapter to deal with.  It's hard to let go but it's necessary.  It's also time.  Time to move on to what's next.

Wearing Us Down

I worry that the less than savory elements in government and the nursing home industry are at the point of trying to "wear us down."  Fatigue has set in, people are getting "used to" the dying and the devastation.  Many people are tired of it, and they want it to go away.  This is not a time for complacency.  It's a time to sharpen our senses and become aware of what the "enemy" is trying to do.  They're trying to wear us down.  It's not unlike the end of an ironman or any race.  If your opponent shows weakness or fatigue, that's when you surge ahead, regardless of how you feel.  When your opponent is tired, that's when you make your move.  It doesn't matter how you feel, you have to "suck it up" and push forward.

This has been the remarkable thing about what I've gone through over the past two months.  Every day is an adventure in and of itself.  I've worked hard to stay focused and to stay "on point" with whatever I'm working on.  It's been a bit of a challenge, especially the part that has to do with maintaining my own health and well being.  I'm obsessed, and nothing else really matters. But there's a reason, and that reason is that lots of people are dying.  But that's how and why they'll try to wear us down.  I won't let it happen.  It's actually not that hard to stay focused, as crazy things happen every day to remind me of why I'm obsessed with this.

Literally a day doesn't pass where the state or federal government doesn't do something stupid in regards to our response to COVID-19.  If I wanted to chill or take a day off, it's hard to do.  At the same time, it's hard to allow myself to become complacent.  I'll let the other side wear down, and I'll try to surge past them as well work our way to the finish line!

Slow Day, Not Really

Not much on my calendar today, but I was still busy most of the day.  Talking to colleagues, preparing for an expert panel discussion, speaking to reporters reading articles with my quotes in them.  Just another day during the COVID-19 pandemic.  Waiting for a response from government officials.  Trying to figure out how to proceed strategically and tactically.  It's been two months since this began.  A lot has happened.  A lot has been accomplished, a lot hasn't been addressed, a lot more is yet to be done.

Two major stories came out today the had some serious quotes from me.  I'm still waiting or some responses to some outstanding emails.  I follow my colleagues on twitter.  I know that many of them struggle every day with the challenges of this scourge.  They're tired.  I'm tired.  A lot of people are tired.  Yet, we all fight on, slow day or not.

It wasn't really a slow day, not really.  It was just another day during the COVID-19 pandemic.

I Guess I didn't Rest Today

I was supposed to rest today.  At least I babysat my grandson for about an hour and a half.  I even watched some mindless television.  But, I also did a lot of work, most of which was quite productive. I'm making progress.  Also, I'll be featured pretty heavily in the Los Angeles Times tomorrow in a story that's bound to get a fair amount of notice. It also brings me to a point of peace that I've been waiting to achieve for well over a year.

Remarkable that so many things happened on a day that I was supposed to rest. The day ended with a story that I've been concerned about since this pandemic started being published in the Los Angeles Times.  I was only one of the people quoted in the story, and my quotes were accurate.  That's what matters.  Facts matter.  Words matter. Actions matter.  I also "called out" the Los Angeles Department of Public Health, which has been literally worse than missing in action since this pandemic began.

On a positive note, I actually communicated with the Chief Medical Officer for the Centers for Medicare and Medicaid on the topic of testing, which I've been highly focused on for the past few weeks.  On a actionable note, I'm working to solidify "best practices" around testing in the coming days.

One of the things that I pride myself on is that I validate everything I think with multiple other experts.  I learned long ago that I don't know everything.  In fact, I often say that I learn every day, how little I know.  I never espouse a view without speaking first to other experts and letting them question my ideas and opinions.

So, I guess that I didn't rest today, but it seems a lot got done.

Time to Rest

I'm really trying hard to rest.  This is yesterday's blog, as I really tried hard not to do too much yesterday.  I've been observing Shabbat, as a means of turning off all electronics for 24 hours.  It definitely helps, but doesn't completely quiet my mind.  I caught up on emails last night, but tried not to do too much.  I woke up early today, yet again (about 4am), have written my next letter trying to get the Governor's attention, and have further caught up on what's going on with this pandemic.

Yet, if I keep pushing too hard, I will suffer.  I've lost weight. My blood pressure is lower than normal, which I can tell because I get dizzy when I stand up.  There's no question that my obsession has impacted my adrenal glands.  I know my body and it's telling me that I need to rest.  I also need to start focusing on getting back into shape.  Being fit has been something that is very important to me.  While I'm walking a ton, I'm not doing anything else.  I haven't cared about doing anything else.

It's time to start caring a little bit about myself.  Time to rest.

Time to Take Action

Today's "pitch" to the Rachel Maddow Show:

It's been a week since I commented on the fact that "outbreaks will occur, it's what you do about them that matters."  Since then, Federal, State, local officials, as well as the nursing home and assisted living industry have called for widespread testing in these settings where vulnerable older adults live. It sounds great. It's also called "plausible deniability."  Everyone is talking about testing the staff and residents in nursing homes and assisted living facilities across the country, but it's not happening.  Even worse, there are still countless facilities that continue to literally resist testing.  I've heard a multitude of stories about doctors ordering testing, only to have their orders countermanded by non-physicians.  It borders on criminal.  In fact, if testing is readily available to a nursing home or assisted living facility, and they are not testing all of the staff right away, it is criminal!

Why aren't we testing?  Why isn't the federal, state and county assuring testing?  Simply put, it's fear. Nursing home and assisted living facility owners are afraid that people will find out that they've had an outbreak, and that they'll be blamed for it. Government officials are afraid that the public will find out that there's been an outbreak, and that they'll be blamed for it.  Who the hell cares if anyone is blamed for this?!  This is a virus, that when it runs rampant in a nursing home or assisted living facility, 30-40% of the people who get it can die!  The staff are the main vector, and we're now talking about "opening up" again.

Here's the most sobering part of this.  A year from now, when the epidemiologists unpack this, we will discover that well over 250,000 older adults in congregate living settings died!  It literally makes me sick to think that we have the potential to test all staff at most nursing and assisted living facilities, and we're not doing it!  Early testing allows us to take action before the virus gets out of hand.  Once that happens, the virus wins.  We can't wait another week or two to start testing the staff in all of these facilities.  It needs to start today!  There's no time for blame. There's no time for excuses.  It's time to take action!