Graceful

I went to visit a patient after class this afternoon and found out she had passed away. This would have been my eighth visit since I left her to move on to my next rotation. She had been in the first few months of her life when we met, she slipped away on her 96th day. She never saw my face, never looked in my eyes, never would have known how many people cared for her.

I won’t use her name out of respect, but know that she was beautiful. As was her family. A family that wanted her so dearly, and yearned so deeply for her to fight. And fight she did, even with ‘palliation’ hovering in the air, dancing in whispers and wandering through the minds of those who were caring for her. One day I left expecting that I wouldn’t see her again, the next morning I arrived to find her laying calmly in her cot. Miniature tubes twisting their way from beeping machines to a little face that led to a tiny chest, which rose and then fell, gracefully. I was so thankful that day, I wanted her to keep fighting, wanted her to show me the worth in holding out hope.

I don’t know the circumstances of her death, in many ways it may be better that I don’t. But the day I heard of her passing was the day after her funeral, and how I would have liked to have said goodbye. I can’t know how her mum and dad are coping, I haven’t had the chance to say thanks to them. I’d like to say thanks for letting me into their world at a time of such hardship. I feel like I had been one of the team, keeping track of the details of her care, presenting her case each day in the ward round. Moreover, I feel like I was granted access to the heart and soul of the situation, as though each emotion embedded itself in me. Her mother and I spoke often at the bedside, we talked about their young lady, joked about the strain she would place on them by the time she hit her teenage years. She was ‘moody, and demanding’ I think we said. I wish I could remember more of those talks, they would remind me of the girl she could have been.

My wife and I are awaiting the birth of our first baby. I think that’s part of this for me. A taste of reality, though likely a twisted one. I’ve written about these bites of reality before but in that case the baby didn’t make it safely from the womb. This felt different, this baby had taken those early breaths, had made it through those early days. And yet she wasn’t to make it after all, she was too early to join the world. Her little lungs, and her little heart weren’t quite ready, and in spite of her spirit these vital organs soon crumbled under the expectations we were bearing for her.

Gestation is dangerous, birth appears the same. A baby born as early as her will always face a gamble, and I think her parents knew this. They were likely more realistic than I was, and so I shed a tear when I told my wife what had happened. It was hard to face the reality that I missed the news and missed the chance to see her off. I hope I get to speak to her mum and dad at some point. I want them to know how special their little girl was, and how many people will remember her.

It is said that life is short, sadly some are shorter than others. But they are no less important, no less special. Each moment should not be taken for granted, so be thankful for each breath and for each beat.

Yeah I get nervous too. But only sometimes – PART TWO

Well well well. This has been a long time coming.

To recap – I’m starting this post just under 48 hours before the start of my first 100 mile running race…. I’m anticipating elation, pain, belief, doubt, thrill, suffering, love, hate. I’m anticipating the roller coaster that is an ultra-marathon. The trouble is, the one in 48 hours time is not like others I’ve done. It’s bigger and it’s badder. So at this stage, as I sit with that funny feeling in my belly, I’m anticipating everything I dreamed of in a challenge like this.

And so I sat. With anticipation and a funny feeling in my belly. Unfortunately, I also had a funny feeling in my knee.

The 2015 Great North Walk 100 Miler started at 6:00am on a clear and warming morning. The plans were in place and the laces were tied tight. I started quick, trotting along with the second small pack of runners working their way through the early kilometres. It was in those early kilometres, up those first few hills, that the excitement and nervousness faded to a calm focus. I was exactly where I feel most at home, on my feet, in the trees, hearing birds chirp and the gentle pitter patter of trail shoes through the leaves on the track.

It was at about the six kilometre mark that the first inklings of doubt crept in. The knee trouble I briefly mentioned in part one decided to make an appearance. It started as a tightness, a vague, non-descript, relatively boring tightness in the outside of my left knee. I tried the normal tricks, quicken the pace, alter my stride, slow the pace, stop and stretch. Nothing really worked but it also just sat there, never really getting worse, never really trying to stop me. So I pushed on through 10km, then 15km, then 20km. I kept moving but it was alway just there are niggling.

The quick pace was carrying me along and so I hit check point 1 (29km) ahead of schedule. I was running somewhere just inside the top 20 but I was hurting. The knee pain was gnawing away both physically and mentally and it was only the positive words and encouragement from Carly and her Mum that had me leaving the check point in high spirits once again. Those spirits crashed down about 500m later as the knee started to fail under me.

At that time and in that moment, and even now in this moment, I wanted nothing to do with my knee. After all the training, the expense, and the obsession, my knee was trying to put a stop to this endeavour. The frustration was overwhelming, the emotion completely raw. It was anger, it was sadness. And so again, I pushed on. I pushed on through 32km, then 35km, then 37km. I write of smaller increments because the meters began to seem like kilometres. My pace had slowed, my run was barely more than a walk. The niggly knee tightness was now a burning pain that had spread down into the calf, up into the thigh. It started to take over my mind and I struggled to stop it.

It was not long after this point that for the first time, I gave up. Yep, I gave up (it still kind of hurts to write that). I should clarify, I don’t mean that I stopped moving forward. Instead, I had my mum’s words in my head – “…rather than stopping if I’m hurting, I need only slow down.” – so I did. I slowed down and I walked. For the next two hours I alternated between jogging the flats, wincing with each step, and walking anything that resembled a gradient.

The warm morning now had become a hot day and my slow pace had me running low on water. Runner after runner plodded past me. I texted Carly a message of despair. She sent back a message of support. I entered the notoriously hot and barren Congewoi Valley, sweat pouring out of me. Where I had been 15 minutes up on schedule at check point one, I walked into check-point two (53km) well over an hour down. I weighed in 3kg down on my starting weight, another 125km of this wasn’t an option today. With Carly’s arm around me I hobbled to a chair and slumped into the defeat with a tear in my eye. I had just been knocked flat by my first 100 miler.

Michael Jordan attributed all his success to his countless failures. Calvin Coolidge said persistence mattered above all else. These thoughts circled as I pulled the tape from my feet and I soon found my resolve. In my mind I was planning my 2016 attempt, realising that I have failed now so I can succeed later. I will persist, for nothing in this world can take the place of persistence.

Yeah I get nervous. But only sometimes – PART ONE

At what point is nervousness a good thing? Or perhaps as a better question, if you aren’t nervous before something big does that mean it’s not big enough? Should we be chasing the nerves as a sign we are pushing ‘enough’?

Just under two weeks ago I slept soundly the night before a 100km trail walk. I had not an ounce of nervousness. I was relaxed, I was confident. There was no question in head about my ability or that of my team. In the bed next to me my wife tossed and turned. She barely slept. It was Carly’s first Oxfam Trailwalker, it was my third. It was her first big physical challenge, it was simply the next one on my list. There were feelings of doubt, of insecurity, of fear in her heart. I had no such feelings.

And yet here I sit. With a little doubt and some with fear in my heart. I’m nervous.

I’m starting this post just under 48 hours before the start of my first 100 mile running race. I intend to finish part two of the post if I finish the race. Perhaps I will finish it regardless. A good story is a good story right? Today I write to explore my nerves, my fears. I write with a funny feeling in my belly. A feeling I’ve not had for some time. A feeling that I’m on the cusp of something big, something worthwhile, something at the limit of my abilities. I write with excitement.

If I could put this feeling in a single word…. Anticipation.

I’m anticipating elation, pain, belief, doubt, thrill, suffering, love, hate. I’m anticipating the roller coaster that is an ultra-marathon. The trouble is, the one in 48 hours time is not like others I’ve done. It’s bigger and it’s badder. It’s known to be the toughest one we have in Australia and like usual, my lead-up to this race has been less than ideal. For many reasons I wish I could go back in time and ‘re-do’ my training for this race. For many other reasons I know that this would make little difference. So at this stage, as I sit with that funny feeling in my belly, I’m anticipating everything I dreamed of in a challenge like this.

Getting ’nervous’ is a largely forgotten feeling for me to experience before a running race. I’m not sure what level of experience grants this freedom from nerves but I do know that in the past two years the 100km distance no longer floats butterflies. Instead I seem to feel confident, as though I know what to expect, how to cope with the challenge, how to keep my mind and my body together, keep them moving as one.

But a 100 mile race is said to be different. And furthermore, this 100 mile race is actually 108 miles. The total creeps from 160km to 175km and the elevation gain almost doubles that which I’ve faced in a single race before. It is said for this race that you should consider checkpoint four (at the 103km mark) to be the halfway point. More people drop at this point than anywhere else on the trail. Given this, and the fact that last year every 100 mile runner who left CP4 made it to the finish line, it seems as though making it out of CP4 will be the biggest and most important challenge.

I skyped my mum yesterday. I think she could tell something was different. She quizzed me, gently interrogated my mindset, she reassured me. I told her about my knee (but let’s not go into that), my thought process, my goals. Mum offered the advice all mum’s do – ‘listen to your body, it’s ok if you need to stop, be kind to your body’ – but then she added the bits I actually needed to hear. The bits that show she knows me, knows why I’m doing this. Mum told me that she knows I’m driven, and she knows that I won’t simply give up or give in. The ‘atypical mum advice’ was that rather than stopping if I’m hurting, I need only slow down. Mum agreed with me when I said that if all was going terribly wrong I should remember that I can use every second of the 36 hour cut-off to get to that finish line. Patience will pay the dividends.

My dad knows me too. I’ve previously written about the fact that he is a hero of mine. Times like this, when I’m prepping and under a little (self-induced) pressure, Dad takes weight and ensures that I need not worry about the difficult things. He removes logistical concerns and goes above and beyond to make things happen. He printed my maps and directions for the race. He drove across Sydney yesterday tracking down the replacement pair of my new race shoes (why oh why did the sole start to peel on their second ‘break-in’ run on Monday). Beyond what he’s done so far I know he will be there when I need him. He’ll be there at the midnight checkpoint. At the 4am checkpoint. At the finish line.

As I’m writing this I can actually feel my nerves settling. I can feel some confidence brewing. I think perhaps what is changing is the outlook, the expectation. Perhaps I am accepting what will be and embracing the joy, the suffering, the challenge that is to come.

Last night Carly sat with me and read line by line through the detailed course instructions (a new element for this race… No course markings so I need to know the trail well). She did this as I stood at our lounge room wall tracing my finger along the highlighted course maps that currently stretch from floor to ceiling. She’s a very special lady. It was 10:30 at night, she had been at work all day. She was patient with me. Reading and re-reading lines for me as my eye failed to spot the twists and turns my finger was traversing along our wall. Carly knows me too. She is bearing with me as I fail to concentrate on anything but the trails to come. She smiles at me as I hop into bed reading ‘Ultramarathon Man’ each night then placates me as we sit watching ‘Salomon Trail Running’ videos on youtube each morning. I am not simply committed, I am completely consumed. I am lucky that so too is she.

In a 100 mile race safety has a re-affirmed focus. Safety vests for vision, safety gear for warmth. The part I am more grateful for here is the safety people that will accompany me from CP4 onwards. My pacers.

To quote from the race website ‘pacers should be experienced trail runners with ample knowledge of the track and established ultra-distance ability.’ Even if I had read these instructions before recruiting my little brother and my best mates I wouldn’t have considered those things necessary. Brother Nic has been running for about four months and Aidan knocked out one training run about two months back. An old boss of mine said to me ‘experience does not define ability…’ Let’s roll with that.

So I am all set. I packed my gear last night. I do have some nerves, some fear, a funny feeling in my tummy. And yet my mind feels increasingly ready. My crew and friends are in support and as committed as I hope to be. I will move my feet for myself and for them.

One foot in front of the other. Over and over again. Wish me luck.

Gods and men.

I’ve written before about the surge in motivation felt through a moving conference. In this moment that is entirely me. I’ve just made my biggest conference trip to date, charging off to Chicago for the Social Media and Critical Care (SMACC) conference. Now I’m not a devotee of social media but I certainly am of critical care and with SMACC US now done and dusted I’ve learnt an enormous amount and am high on motivation.

But for what am I motivated? That’s the tricky bit.

I can’t pretend to have the skills, knowledge, or experience of those I sit with in the rooms at a conference like this. My use as a doctor isn’t worth a single one of Cliff Reid’s hairs. Sure I can talk to patients reasonably well and I can manage a cannula. But as a third yed student no I haven’t intubated someone, no I haven’t popped in a quick central line, no I will not keep my cool as that first big trauma case rolls towards me. So what is the difference between these people and me? And what can I offer now?

I write today about the difference between gods like them and men like me. I write about my motivation to shrink this gap, and how I plan to do it.

Before I go further I need to set a framework for what I want to achieve. Which questions do I want to answer, or at least explore? For instance, what is ‘god-like’ about these people? What on earth do I mean by that and what is it in them I want to emulate? Further, what is this difference I’m seeing and how on earth do I shrink it? How do I, as a man in a novice state, become a god like that? Is that what I even want, is it even achievable?

This is certainly a can of worms, I will do my best to keep it brief.

Some clarification first, what do I mean by God? To me, these men and women are the epitome of all I see good doctors being. They are, as some would say, brave and bold. They show courage to do what others cannot do while striving to involve and educate those around them. They are fallible, and at the times they do err, they are open, honest and reflective. They strive for perfection, analyse error and unrelentlessly pursue improvement. Importantly, they are not cocky and they do not see themselves as gods, they are human. I want to be like that.

Next, what is this difference between these god-like figures in the world of critical care and those like me, those in the early days? What do I lack that these others have? In a simple sense the difference is time and it’s experience. Looking a little deeper, it’s all the things that this time and experience will provide. It’s a difference that is critical. Both for patient care and for clinician recognition. It is a difference inevitably related to knowledge, skills and understanding but beyond that, it’s the difference in orientation that thousands of patients hours provides. Malcolm Gladwell spoke of ten thousand hours, I expect it might be many more than that in this field.

Here is our snag and my task. Here is the source of the frustration and the point of acceptance. Through the recognition that time is the difference, or at least part of it, I realise that I’m a long way off. Welcome the frustration. But the flip side here is the further recognition that I cannot control this time difference. I can’t, and shouldn’t, fast forward this time nor my expectations. I do not need to be able to do these things yet and to expect them is unfair and unrealistic. Even projecting forwards, I see that there is no need to rush. The sooner you reach the top of the pile the quicker you cut yourself off from further learning and development. To take your time is to enable potential, to build a bigger base. Acceptance.

The follow-on from accepting the time differential is that I can set a framework for the future. A framework that will provide goals and a vision. One that can help me map my attitudes towards life, learning and experience. I may choose to pinch elements of this framework from the gods on stage at SMACC. I can’t have their skills but I can utilise their approach, I can emulate their attitudes, and I will bear witness to their humility.

At the close of SMACC 2015 I am indeed motivated. I’m motivated to pick and choose the traits of those I admire. I’m motivated to experience, to learn, to live. I can’t fast forward my years of experience to come, nor do I want to, and so I will accept where I am now and chart a course for where I want to be. See you along the way.

Juggling.

To start with a cliche, life is like a juggling act. We start with a few balls and at different points along the way accrue new ones. Sometimes we drop or lose balls. Sometimes, if we are clever and self-conscious enough, we consciously put some down or keep them closer. Medical school brings both necessary balls to juggle as well as opportunistic ones, the necessary ones are obvious, the opportunistic ones enticing.

First year of medical school was all about seeing if I could do it. I put my focus there entirely. I reduced the juggle, backing off on my sporting ambitions, choosing not to chase student leadership roles. It worked and I passed.

Second year of medical school I pushed the envelope a little by getting a few more balls in the air. I ran more, I started mountain biking, I got involved with our student society. At times some of the balls hit the ground. Unfortunately those that brushed the ground tended to be the life ones – health, relationship, friends. I got it back together in time and passed again.

Third year has yet again more happening. Two years ago I could not have managed this kind of juggling. Interestingly though, this juggling is different.

I recently went along to our MedSoc’s Well Being Evening and gave some tips and tricks about getting through the early years of medical school. I was asked to speak first so I first assured people that the only tips and advice I could give would be based on the things I had got wrong so far. Some of my senior classmates then spoke, each offering additional approaches. I was struck by the similarity in some of the messages, particularly when it came to managing relationships.

Typical time constraints meant that I hadn’t really gathered all my thoughts before the evening and a lot of them evolved inside my head as different people spoke through the evening. It was through this evolution of thoughts that I pieced together what is different about my current juggle. Let me explain.

Third year for me does indeed have more happening. I’m studying, I’m now married and doing my best to be present at home, I’m the president of our student society, I’m running more and competing in more events, I’m teamed up with my friend Blair building a new project (watch this space), I’m on placements rather than in books, I’ve just been granted a spot on another leadership program, I had a little bout with sickness, I’m writing regularly to keep this blog up to date.

This is a bigger juggle and yet there remain only 168 hours in a week.

When there are fewer balls in the air you can send them higher. More flight time means that down at ground level you have more time with the catching and throwing. Each contact can be more focused, more forceful, each contact can take more time without repercussions. Translating, with few goals or projects you can take your time without detriment to the other goals, you can push each ball to higher points, you can achieve more success in each domain. As you accumulate more tasks or roles, each contact is constrained, each flight time a little shorter, each success harder to come by. Importantly, if you do commit the same time or exert the same force as once before it will be to the detriment of other tasks or roles.

Up to this point I had been slowly realising that my academic performance this year had dropped. Sure I’m still keeping up but I’m not where I have been and it’s been eating at me a little. The thought train chugging through my head starting piecing these things together until suddenly it clicked.

I realise that the study is just one ball among many others. If I want to have a hand on any of these other tasks I have to realise that my energy and time is finite and that through picking them up I inadvertently reduce some potentials and constrain time. A critical point here is that for this to be acceptable I would only drop the standards of the tasks that don’t affect others (I suppose this was happening subconsciously as it was certainly the study ball that was brushing the ground). By putting my hand up for other things I would therefore need to accept a lower standard for a short period. To again state importance, these are tasks and roles that I want to do and to me they are worth a drop in performance in other domains.

I think we inherently know that more tasks means less outright performance. Elite athletes achieve the performances they do because that is all they do. They have a single ball to juggle. The different between a medical specialist and medical generalist illustrates this again. The generalist doesn’t have the depth of knowledge that the specialist has, but they intentionally sacrifice this in order to have the necessary breadth of knowledge. I currently see myself in this category, I am throwing some balls to a lower height because I want to have more tasks and roles. Yes I may drop some balls and yes I may drop standards on the roles that don’t affect others but I am ok with that in the short term. Going further, I see that this juggle can be a fluid system. I see that with exams a long way off I need only keep the study ball in motion while the other balls soar to new heights. As the year rolls on and the exams creep nearer I will shift this balance in favour of academia, pushing myself to the standard necessary for assessment.

Advice for you? Assess which balls need motion at which times. You can’t have them all in full flight. Drop standards on those that can take it so that you have the right ones in motion at the right times.

Good luck with your juggle.

Bed bound to 100km.

I write today about a journey from a hospital bed to the mountains. I write about pushing the limits to see what’s possible, especially when logic insists it isn’t.

I first heard about The North Face 100 (TNF100) in 2010. It was an influential time for me, I was entering the working world and busy setting goals. Open to new ideas, keen for challenge, typical early-20s male I guess. I had read a book called Born to Run and become enthused with a question that has been driving me ever since.

‘How far can my legs take me?’

At the time I had never ventured further up the road than the reasonably standard 21km of a half marathon. I had imagined myself running a marathon one day but was relatively naive about possibilities. My eyes were opened by Born to Run. In the book Christopher Mcdougall wrote of 50 mile races, even 100 mile races. I got hold of Ultramarathon Man and it turned out Dean Karnazes’ had run up to and over 200 miles – non-stop! I read about the UK’s ‘Bob Graham Round’ in Feet in the Clouds and Greece’s ‘Spartathlon’ in Why We Run, each of these covering over 100 miles in some of the most extreme terrain possible. A seed was planted. I had never liked the idea of going faster but I was now hooked on the idea of going further.

Fast forward to late last year. I had now run a few 100km solo events, including the TNF100 in 2011. I’d faced a few Oxfam 100km Trail Walkers as part of some wonderful teams. Each time I toed the line it was the same question at the heart of it, ‘how far?’, each time I’d managed to hit the finish line. At this point I had learnt that my legs could go the 100km. The various events had taught me that it actually had little to do with legs, instead it was all about the head and the heart. The Canberra 101 confirmed this.

It was in this race that I had my lowest ever point in a race. I was 45km in and my legs were cooked. I was simultaneously cramping in the calves, quads and hamstrings. I’d run out of water, was moving very slow, and was 10km out from the next check point. For the first time ever I wanted to quit in a race. For the first time ever I realised my legs weren’t going to get me there. As the sun beat down on me my mind was pretty keen to agree.

I hadn’t seen another runner for over an hour, at times I wondered if I was actually lost. I was still following markers so was chugged on. ‘Just get to check point two. It can be all over then. No one will think less of you, it’s hot, you’re just not fit enough today. I’ll train harder for the next one.’ It was a long and lonely conversation full of self assurance that quitting would be perfectly acceptable. Too bad my wife, my dad and my friend Blair had other ideas.

I walked into check point two barely managing words. I wouldn’t remember this bit if not for the stark contrast to the wall of cheer and excitement I was slapped with as my crew threw me into a chair and went into pit-stop mode. Blair was on shoulder massage, Dad re-stocked my food and water supply, Carly took control of the foot situation. All I could think to myself was ‘Holy shit. I’m gonna have to keep going.’

At first this was demoralising and I went into bargaining mode with Carly. ‘Please can I just sit for a bit?’. The response I got was something along the lines of ‘You can have an extra 5 minutes but then you’re out.’ This sounds tough but it’s what we’d rehearsed, what I’d warned her I might say. She knew I’d regret giving up, knew I wouldn’t truly want to give in to negative thoughts so she pushed me. I love her for that. Carly would later say that she’d never seen me look so terrible in a race, never seen me so withdrawn.

What happened next is the reason I now firmly believe these races are about the head and the heart and have only a touch of legs involved. My crew urged me up out of the chair and I started putting one foot in front of the other again. I was forced to accept where I was, what I was feeling, and push on anyway. My legs were stiff and terrible but the change in mindset gave a new spring in my step. I started to run again. Sure my pace was slow but I had accepted the pain I was in and accepted the fact that I was simply not going to stop. I was going to do whatever it took to finish this race. I crossed the line about 6 hours later.

In March this year I got appendicitis. I wrote about it at the time, reflecting on what I had learnt being on the other side of medicine, as a consumer rather than a provider. What I didn’t write about at the time was my running. I mentioned that I missed days on my feet but not that I had just finalised my entry for the 2015 TNF100. This posed a new question, one that I tried to suppress but couldn’t seem to let go.

‘Can I make a 100 after all that?’

Logic dictated that the ‘appendiceal issues’ and the saga that was my hospital stay (the double crack at surgery, the 10% of my body weight melting away in a week etc etc) ensured there was no way I could line up for 100km eight weeks post discharge. Carly agreed with logic. So did Mum and Dad, my new running sponsor Sensecore, my mate Blair. ‘Definitely not a good idea, definitely should sell-off my entry.’ I could see the logic too but I couldn’t quite accept it so I quietly held off on ditching my entry and let the question keep floating inside my head.

Over the week after my discharge I worked my way up to walking around the block, I think I even managed a few hundred meters of jogging at a time by that seventh day. I was sore in the belly but was very pleased to have some normal bowel and bladder function back. The new Sensecore tracking system would ask me my daily energy levels and although they were low they started to pick-up. I got back to school and resumed my daily study routine and then picked up a few short trail runs. I put-off any decisions about TNF100, seven weeks to go after all.

I then flew off to the Norther Territory for a six week placement in Tennant Creek. Medically this was an awesome time, socially it was equally so. I made great friends, ate too many schnitzels at the pub and celebrated a birthday in there somewhere. In terms of running and prepping for a 100km race with 4300m elevation gain….. Not great. I started clocking up daily runs, growing the distances so by the end of week two I knocked out 15km. But with one hill in town I got no upward meters in my legs. ‘Ah well, I’ll just work on the volume.’ I managed a 25km run. Then stepped it up to a 35km run. Somewhere in there I bit the bullet and accepted I was headed to the start line. Ideally I would have liked to have had a 45km run under the belt heading back to the mountains but time wouldn’t allow. A fortnight to go.

Getting back to the cold of Canberra was a shock. With one week to go I planned a week of hills for some last minute conditioning. Sunday was up and down Black Mountain. Monday night Mount Ainslie. Back to Black late Tuesday night. Wednesday night was a final blast around Ainslie again. I was out each night because I was back on placement in the hospital, trying to re-adjust to a very different population, a very different medical world, than where I’d been in Tennant Creek. No time to run during the day so nights doubled as practical timing and a chance to re-learn running with a head torch.

I last ran the TNF100 back in 2011. In that year the 24 year old Spaniard Kilian Jornet blew everyone away in a record time. Sure I trailed him by around five hours but I was very proud. In my first 100km I’d clocked 14 hours 37 minutes and was actually credited with a win in the under 25 class (given Kilian was outright winner he got excluded from the younger class). It was a heck of a run for me, the hills were shocking, the sense of absolute exhaustion at the finish line was unimaginable.

Fast forward to now and the track had changed. There were more climbs and longer legs in the final stages so it was said to be a slower track, a harder run. In terms of belt buckles (the awards given for hitting different time targets) I had originally planned to come back chasing a silver buckle. My 14:37 in 2011 was well within the 20 hour limit to get a bronze buckle and just shy of the 14 hour limit for a silver buckle. Given my less than ideal prep I lined up this year without concern about finish times and belt buckles. I lined up only with the new question in mind, ‘Can I make a 100 after all that?’

I started quick but sensible. It was a crisp morning and I was in the second of seven waves of starters for the 100km. There were ~850 runners all up this year, another 1200 or so in the 50km event. Through legs one and two I walked all the hills, ran the flats at a comfy pace and blasted the downhills when the legs could handle it. The newbies stood out as they always do. They ran the early hills, a clear sign they were yet to comprehend the distance and shear volume of climbing. I must confess that I too had been naive and forgotten what these hills were like. In a word, they’re brutal. I got a good luck text from Blair in the early kms and managed to shoot back ‘I forgot how many hills there are…’

Check point three is 46km in and is the first time you see your support crew. I’d thankfully gotten my early low patch out of the way between 30 and 40kms. This free’d my legs up and I trotted along the trail with a solid smile on my face. Maybe a little ambitiously I was knocking out four minute k’s as I neared the checkpoint. I was drenched in sweat as I dropped into the camp chair at the check point. Once again I had a stellar support crew, Dad and Carly looking after the practicalities, my best man Aidan on pep-talk duty and his wife Gem dishing out the food and taking some photos.

At this stage I was feeling good. Clearing that early crappy patch had boosted my confidence. I was already well beyond the furthest I’d knocked out in a training run so I was sure I just had to keep it in a low gear and keep moving forward. Gem was the first to mention timing. Apparently I was about two hours quicker than what I’d scribbled down as a rough timeline for my checkpoints. ‘Sh*t. Am I going too quick?’ I couldn’t be sure. I was sure that I’d been sensible on the hills, I’d been running my own race and forgetting what people were doing around me. I went back to one of my running mantra’s, ‘When you feel good, go fast.’ – because when you don’t feel good you sure as hell can’t. I better keep moving.

Check point two to three is only 11km but it’s deceiving as one of the nastiest climbs in the race makes up about 3km of it. Nellie’s Glen is the culprit and it’s first real kick in the teeth of the race. At a few spots on the way up the stairs I passed blokes sitting on rocks looking defeated. At a few other points I was using my hands to help me up the hill (yes, it’s that steep). Thankfully time can sometimes warp during an ultra. For me, with August Burns Red blasting in my headphones, time warped at the right time and I was heading into the next check point before I knew it.

Check point four was when I’d been telling myself the race would start. At that point you’re 43km from the finish and with the toughest climb still to come. It’s here that you can start to dip into your energy stores and push the envelope, run a little harder when the legs allow, bomb the hills when you’re feeling brave.

I was still going quick it seemed. An hour and a half ahead of my estimates and to be heading out from check point four with many more hours of daylight left than I thought possible given my prep. There were a few moans of complaint coming from a knee and an ankle somewhere down below, unsurprising to say the least. The last two legs of the race are the longest of the race, 21km and 22km each. That question was back bouncing around in my head, ‘will I make it?’, definitely only one way to find out so I after more pep-talks and a surprise check-point visit from Alison my old flat mate I plodded on.

If I’m honest I don’t remember a great deal from the next leg. There is hill after hill after hill after hill. Each one breaking your rhythm but also giving a respite from running. I nearly elbowed my way through the crowds of tourists before making a toilet stop in the most luxurious loo’s of the track at the Three Sister’s look out. It is such a strange sensation to weave through crowds of people who clearly have no idea what you are in the midst of. There is the occasional ‘good luck’ from a blurred face but for the most part I offer apology after apology as I cut people off trying to get back to the trail.

The final kms into the last check point are rough. Those noises of complaint from the knee and ankle are a little louder and it’s a long road stretch that takes us to this last post. This far into my previous TNF100 attempt I was in the dark but I was feeling strong. I answered the question that time with the legs, this time was to be a head and heart effort again it seemed.

Words of support and smiling faces had me feeling good as I donned my backpack for the last 22km. This was a where things would get mores serious. Typically the further into an ultra the worse the downhills are and this I was about to face 10km of solid down as the sunlight evaporated.

I’ve always found downhills the hardest to run in terms of technique. You need to be brave to do it well, you need to switch off the brakes and let gravity pull you downhill, lean further to go faster. I tried to take the brakes off. I had a few people pass me along the way, each time I prompted myself to up the bravery, ‘come on, last leg, are you gonna make it?’. I pushed on.

What can be worse than 10km of down? You guessed it, 10km of up. That’s the final stretch for the race. About 10% of the total elevation gain is in this final 10km. And it’s rough. It’s dark by now, the track traverses and climbs in the shadows of the Three Sisters and Echo Point so it’s wet. We trudge through ankle deep mud, up stairs, over logs, visible only as a row of headlights from the valleys below.

As I had done in my 2011 attempt I attacked in the dying stages. I dug a little deeper, pushing myself to run all those slight hills I’d walked earlier in the day. I passed person after person, pulling away from those I’d been chasing earlier in the day. I was shocked to be able to push this hard so close to the finish. Up the final flights of the Furber steps you can hear the crowd cheering runners across the line, it’s an intoxicating sensation that pushes you along the track irrespective of will power or personal desire. I now had an answer to my question.

I approached the line, the crowd, my crew. I was going to make it. I looked up at the clock in awe. An hour and 26 minutes faster than my first TNF100. I crossed the line and was handed a silver belt buckle. The elation was immense, the exhaustion overwhelming. I turned to see my crew, Carly, Dad, Aidan and Gem. They were beaming. I could hardly speak. They guided me to a chair and sat me down. A blanket was soon around me and cup of soup in hand.

I had made it. From bed bound to 100km in eight weeks. Woah.

What next?

Conviction.

Three months of clinical medicine are in the books, roughly 18 to go before graduation. Some of my classmates are likely starting to ponder the great unknown. Which specialty is right for me? Where will I go for an internship? I get it because I know I’m doing it. I know it feels like a monkey clinging tight. Pondering life plans is the most bizarre mix between excitement of things to come and fear of the unknown.

I write tonight as someone lacking conviction. But also about why I’m ok with that for the time being.

Laying a path for the years to come seems like combing knotted hair with a dessert spoon. The tool I have for the job, my current understanding of the medical world and my potential, is completely inadequate for the task at hand. My Dad has always said to me that you can only make the best decisions with the information you have right now. Well shit. While I love and frequently offer this piece of advice I simply do not know which roles will be challenging and satisfying in 10 or 20 years time. I cannot foresee which training pathways will view me as a viable candidate, nor which ones I will want to pursue.

I’ve spent very little time in practice so you must take all I say with a grain of salt. Understand that my opinions and desires have and will continue to change. This seems a normal path for a medical student. The career of choice for most medical students is the one they are doing right now. The exception is when it’s the one they did last rotation. My point here is that we are malleable, we adapt to the environment around us. As in infancy, we respond to pleasant stimulus. We giggle and smile at a new and enjoyable experience, then we want to do it again.

“The only constant is change.”

Wikipedia tells me these words come from the ancient Greek philosopher Heraclitus. As someone in perpetual motion I can understand the sentiment. Whether it’s the need to run or the need for challenge I aim to embrace change, to feel the fear of the unknown and boldly step forward regardless. Despite that aim, I sit feeling anxious about the idea of changing my mind or choosing the wrong path as I walk the medical road. On reflection this is not helpful. At least, I need to be accepting of the changes. At most, I need to seek them.

“I have been through some terrible things in my life. Some of them even happened.”

These were written by Mark Twain in more recent times yet they are equally wise and applicable to my current train of thought. Our fears and worries rarely come to pass. And yet we brood on them. We let them direct our actions, keeping us from things we desire and sending us to places we do not wish to go. We let ourselves flinch at potential outcomes rather than reserving that response for the actual exposure. Worrying about all eventualities is both exhausting and terrifying. The relevance here is that we might let a fear of making the wrong decision hold us back from making a decision at all. Flinching with fear holds us back so although I needn’t yet make career decisions I know that when the time comes I must be brave and show conviction.

So as the saying goes, the world is your oyster. But as an addition, please remember that your favourite way to have this oyster will change as you try different options. And lastly, allow yourself to ponder options at the appropriate times but when the waitress arrives you must be decisive. Without an order you will go hungry.

Happy pondering.

Connection.

I felt some true connection today. It was simple and immediate, completely authentic. Jack was a young Indigenous boy living in a remote community. He and his sidekick Max told me of their adventures. They told me of a simple life filled with a little school and a lot of play. They had the ‘jungle’, a herd of beasts to roam with, and one simple rule, ‘be home by dark’.

I have called this connection because in the half hour I spent with these boys I was part of the gang. I got the goss on which building were the ones to climb on, which dogs were the cheeky ones who’ll give you a nip. There was no complication, no fear of strangers, just a drive for a simple relationship built around play and aided by imagination.

I’m not sure what it was about them, or what it was about me, that enabled the connection. Perhaps the location, if not for the health workers visiting once a week few would see this patch of a half dozen houses on the side of the highway. Perhaps it was a loneliness, in their age bracket they seemed to be the bulk of the cohort and so anyone new to play with is good. Perhaps it was me, I’m a sucker for kids and the chance to go roaming around town with a few boys is pretty up there. Whatever it was the effect was stark, they wrapped arms around me like only best mates do.

I don’t wish to complicate this reflection by looking into the why’s and how’s too much, it would be a travesty to piece apart something so organic. I waved goodbye to Jack and Max, Batman and Robin as it were, and was struck by the realisation that I would never see them again. The profound part of this situation was the complete acceptance of this from both sides. As simply and immediately as it began, it was over. While I was there, the gang was three. Without me the adventure would continue, these boys embodied the ‘eyes forward’ approach I try to live by.

I was reminded to live in the moment. Accept those around you into your adventures. Don’t shed a tear at the end, smile at what was. Eyes forward always.

Strong foundations.

The list of forgotten facts often feels longer than those retained. Retention is hard, the curse of the forgetting curve is against us. Undoubtedly the forgetting curve aids our ability to shed unwanted information. Unfortunately there is great difficulty asking your brain to shed the majority in favour of maintaining the minority that are the important things – the needles in the hay stack of everyday working memory.

I won’t write too much more on the forgetting curve or the means of overcoming it’s deleterious effects. For that, try the Learning Solutions magazine article ‘Brain Science Overcoming the Forgetting Curve’ (http://www.learningsolutionsmag.com/articles/1400/brain-science-overcoming-the-forgetting-curve). Also refer back to ‘How to Study.’ (https://wildermedicine.wordpress.com/2015/01/12/how-to-study-effectively/) for study tips.

For today, I write about what retention of knowledge means.

The other morning I got grilled on the mechanism of alteplase as a thrombolytic. The required details had unfortunately fallen victim to the forgetting curve. The conversation slowed, coughed a few times and stalled like a clapped out 2-stroke. The forgetting curve, the failure to retain, meant that the next step forward was halted. I sit now with a to-learn list based around things I’ve already done. Things I now need to re-learn and try to retain.

Don’t get me wrong, as student we are supposed to make use of our forgetting curve. I recognise that this predicament is inevitable and arguably important. What I am asking for is very straight forward and well known. As students, as junior doctors, as future senior in a variety of fields – we need to review and revise in order to retain.

Why retain?

Because our goal is to build knowledge.

Building knowledge, as with building anything, needs a stable foundation. I needn’t explain what happens to a building with poorly built or crumbling foundations. If the foundations of our knowledge aren’t established or are lost to the forgetting curve the height of our knowledge is inherently capped. Without a strong foundation we cannot go up, without a wide base we cannot go out. We need to retain a base of knowledge to elevate ourselves, we need to establish a breadth of knowledge to be able to think broadly. As future doctors we need to be able to do both of these things.

This sequence of thoughts is by no means novel. However, this morning it was indeed relevant. It caught me unaware and I stumbled. I now recall that the need for alteplase within the early stages of clot formation is because it’s mechanism is ineffective after the irreversible action of factor XIII in stabilising fibrin cross-bridging and strengthening clot formation. The foundation bricks of that gem are firmly back in place now and I am grateful.

The unashamed goal of all medical students is to build a tower of knowledge. A tower with a base that is strong enough and a reach that is wide enough that we might perform as competent doctors. What we need to recognise is that the forgetting curve continually erodes our base. It chips away at the hidden corners, the quiet unvisited depths of anatomy and pharmacology. Sure we can let some bricks go without harm or limitation (looking your way kreb’s cycle). But others, the true foundation bricks, the ones with the weight of towers upon them, must be maintained. Until the point where they are firmly locked in our memory we must re-visit them regularly, carefully patching new gaps, to prevent collapse and ensure continued growth.

Re-visit your foundations. Patch them, care for them, build upon them. Good luck.

JFPP 2015 – A South Oz Adventure

In January 2015 I spent two weeks in a little town called Cleve. For many reasons those two weeks felt like two months. Almost all of the reasons were good, one wasn’t. Like the people I met in Cleve, I try to be a ‘glass-half-full’ kind of person so will focus on the good and touch on the bad only briefly. Let me tell you about my South Australian adventure.

When my location assignment email came through from Sean, on behalf of ACRRM, ‘Where?!?’ was my first thought. I had visited South Australia a few times but never made it far from Adelaide and certainly never taken the extra flight over to the Eyre Peninsula (nor the bus that followed the preceding three flights). I met Donna-marie, or Dolce, as I jumped of the bus in the centre of town. I soon learnt that Dolce was all motherly character and warm smiles. She was my ‘Placement Mum’ and I felt at home immediately.

That afternoon Dolce showed me around town (this took about 12 minutes) and said she be back in an hour to take me out to dinner. I checked into the nurses quarter, without the knowledge that they were haunted of course, and unloaded my suitcase. I had the famous chicken schnitzel for dinner, falling a little more in love with Cleve as I took each bite. Day two was filled with paddle-boarding, a walk on the beach and spectacular views. I met my mentor Gail and her family that afternoon. Her husband Hitchy and I got stuck into home made whisky and he taught me to shuck oysters. I was assured that the medical side of the placement would start soon. Yep, falling in love with Cleve.

Now to the medicine, I was spread between three towns with three different doctors on rotating shifts. I was thrown in the deep end but I was handed floaties as I bobbed up gasping. The support and teaching was fantastic, it was the definition of ‘hands-on’. I learnt skills, I practiced examinations, I spoke to patients, I saw the best of some and the worst of others. It was an amazing two weeks and on reflection, it’s clear I hit the jackpot with my allocation to Cleve.

I’ve completed two of my eight weeks and honestly can’t wait to go back. I miss my placement mum and mentor, I miss the teaching and the community. I have no doubt the good is the bulk of the reason my trip felt far longer than the dates on the calendar. To make brief mention of the bad, I had been married for a total of two weeks when I jumped on the plane to head away. The bad was that I missed my new wife.

The John Flynn Placement Program is a truly wonderful thing. I left Cleve all smiles, both because I had a wonderful experience and because I was on the way home.