March 20, 2017

Health : Endurance

Two of my brothers, and my niece and two nephews, live in Denver so I've visited Colorado a bunch of times.  It's such a beautiful state, and I try to take advantage of its nature by doing something outdoors whenever I visit.  Since this year I visited in March for my niece's birthday, it was obvious to choose something snow-related.  But having snowboarded a few times now and not having any natural or acquired skill for it, and having already snowshoed recently in Yosemite, I thought I'd try cross-country skiing.  My only expectation for the experience was to get tired, as everyone warned me about what a workout it would be.

I didn't expect to immediately love it as much as I did. I'm not prone to liking things right away--all the sports I love now took some time to get to that passion.  And it's not that I'm naturally good at skiing--I'm actually not entirely sure I did it right, and downhill terrifies me and I fell a ton on the green trails.  It's that it encompassed the element of endurance that I've already grown to love in so many parts of life.

And it's the hours of meditative movement that gave me the space to reflect on this.  I like activities and experiences that take a long time, and generally avoid their shorter counterparts.  Novels, not short stories.  Audiobooks, not podcasts.  Rope-climbing, not bouldering (though we know the truth is that that I'm just too scared to boulder).  And this is why I love all things cross-country.  I find that when I'm doing the same thing for a really long time, a rhythm develops that relaxes a lot of my day-to-day tensions, and my focus on things outside of myself sharpens.  There's so much time and room to really absorb open space, and process what to do with it.  During my first drive cross-country from California to Connecticut, we talked about how there are so many different kinds of emptiness.  I realized for the first time how many ways there are to occupy space.  There's so much to be had when driving hours across big skies, empty plains, and unassuming mountains. 

Bear Creek Lake State Park, Lakewood Colorado

Long distance running and cross-country skiing (which feels a lot like distance running in snow) add the awesome element of being outside, and physically feeling how much you can cover.  There's this amazing mix of feeling like you can go really far, and that there's so much more you'll never reach.  From developing visceral stamina, you internalize the benefits of sticking with something, of committing to things that seem really hard to continue for so long. 

During the hours of skiing, I also considered how my choice of career has a lot to do with my appreciation for endurance.  I've never been built for acute care and immediate fixes, which is why I hated working in the hospital during my medical residency.  I really value the need for hospital care, and the talent it takes to deliver it well. I never developed those skills the way my colleagues did, and what I wanted was something that required long periods of time.  I can't really think of anything in medicine more suited to that than primary care (except psychiatry, which is a second love), where you get to know patients over years and come to terms with the fact that it really does take that long to even just understand their health and personal lives.

Eldora Mountains, Colorado

Now having been at my clinic for a year and a half, I'm starting to glimpse the tiny changes that can accumulate over time.  And these changes aren't always visible when meeting a person for the first time. Recently, another provider saw a patient of mine in clinic who is wheel-chair bound due to a previous stroke, dependent on insulin for his diabetes, on four medications for his high blood pressure, suffering from obesity given the inability to move.  Overwhelmed, the provider commented on how depressed the patient was and how difficult it must be for that to change given all of his medical issues.  

And so I thought back to when I first met the patient almost two years ago.  Two years ago, he had no faith that anything could get better, saying that no matter what he did, his blood pressure ran at a level where his doctors feared for a repeat stroke.  He was so depressed by this that he avoided coming to visits to check.  Now he's so proud of his pressure that he checks it at home regularly.  Two years ago, he was so frustrated with his diabetes that he never checked his blood sugars and would give up on taking his insulin for months at a time, and wouldn't even talk to me about it.  Now he brings in his blood sugar logs every two weeks, and when I suggested that we could discuss the logs by phone if he wanted to space out his clinic visits, he said he wanted to keep coming to clinic.

He's still on a lot of medications, unable to use his left arm, and unhappy in many ways and relunctant to directly address this unhappiness.  But he is palpably different from before.  

I totally feel the frustration with the things that don't change.  Sometimes our victories are much smaller than these.  Sometimes I'm ecstatic when a patient finally brings his medications to a visit after forgetting half a dozen times. Sometimes I'm so happy that a patient just showed up.  And often those smaller victories don't lead to larger outcomes that I am present to see.  It's true that many patients don't stop smoking cigarettes or cocaine, that many will not show up.  It's true that I still get super irritated and impatient, that there are days we are all so tired.  During these moments, it's especially helpful for me to immerse myself in an endurance activity.

Because I think that my faith in this process of change comes in large part from engaging in things outside of work that take a long time.  Physically traveling long distances makes me feel in my bones how deeply fulfilling it is to persevere in increments.  I know what it seems like from the outside.  Like the landscapes haven't changed much over hours of motion. Like the distance covered seems so small compared to what's possible to travel.  Like it's pretty damn exhausting to go for so long.  And this is all true.  

But I know from physical experience that there's nothing more satisfying than witnessing what we're capable of doing, and what the world is capable of offering, if we invest the time.  

Morning run in Denver


  1. beautifully written.. I love your endurance and commitment and courage to grow and learn. It's interesting to hear how endurance activities help you physically and also mentally as you apply it to your caregiving. On another note, what comes to me is that change happens constantly.. at every moment, and yet the change may not be noticeable.

    1. That's so true! I think it feels that way on these endurance activities too..things look the same for a long time before you realize they're not.

  2. First of all, for public record, you are *not* too afraid to boulder--I've seen you do it and completely kick its butt!

    But second, I am so grateful that the medical profession has people like you, Kim. Most people do not have your endurance and patience but even more your ability to see progress in the small increments and celebrate it. Your patients are lucky to have you.

    1. I can't do it outside :)

      I think writing is largely a reminder to see that progress, because day to day it can be super hard to remember and I get frusrated/impatient ALL...THE...TIME :)


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