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Wednesday, March 25, 2009

Running on Empty

I went home sick yesterday, and stayed home sick today. I'm feeling better, but started going stir crazy tonight. As the remains of a beautiful sunny day faded away, I looked out the window (making beads for the first time in months) and had to go run.

I hadn't run in 6 days. I started getting sick on Saturday, and that was going to be my next run day. Tonight I didn't care if I barfed up a lung, I had to feel the pavement under my feet. I just couldn't stand it any longer.

I only ran about 1.5 miles, but it felt great. I wasn't 100%, by any means, and my cough was a little ragged by the end, but it was still better than it has been the last few days, and I got out of the house and stretched my legs a little bit.

I'm so glad that I can go outside to run again. I'll still hit the treadmill when it's too rainy to run, but I have to distract myself so much just to get through 30 minutes on the hamster wheel. Outside I can run without any headphones, just my own thoughts. It's usually a very creative time for me. I can get a fresh perspective on whatever has been rumbling through my mind lately, and really enjoy the feeling of being alive and moving my body outside.

I realized this evening that I do need more solitary time than I've been getting lately. I'm used to having a lot more. I just need a bit of space and time to think things over and relax. That's what my runs are great for, that creative alone time to work things through in my head.

So, I'm off to wrap up my evening, in a better frame of mind than I was in this afternoon.

Tuesday, March 24, 2009


I got the crud. Don't feel too bad for me, though. This is my first cold since 2007. In fact, I can't remember being sick since being banded that March, although I think it MUST have happened...

Anyway, I tried to go to clinical today. I did go, and made it through one case (internal defibrillator placement) before realizing that it would be very embarrassing to pass out in the angio suite. The hacking, sneezing, and nose-blowing I can handle, but the dizziness had me worried. So I came to my senses and sent myself home.

I'm all hooked up now with some Benadryl, Kleenex and Throat Coat tea. I always go to Walgreens when I am sick (mainly an excuse to go to the drug store...for some reason I love going to the drug store; office supply store too...) but it's funny because I refuse to take most cold remedies. I can't stand anything with menthol in it, so Halls and Vicks are out. I can't swallow any kind of syrup without gagging. I can't stand how Sudafed feels, even if I could actually get it without an act of Congress. So I get by with ibuprofen and Benadryl and Jolly Ranchers for my throat. It's not that bad. This time I bought some TheraFlu and Mucinex (pills!), but will see if I take them more than once.

Oh yeah, now I remember my last cold. It was November 2007, right before I moved to Spokane. Maybe the Inland Empire is good for my health? Or maybe there is less mildew here and I don't get sick as much. I remember having my baggie of Jolly Ranchers and my Kleenex in our empty Portland apartment after we had moved most of the furniture to Spokane.

I think colds are kind of like life's speed bumps. They force us to slow down when we should have had the sense to do so already. It's no great surprise that I would get sick now; I'm sure my immune system has been limping along for the last two months, waiting for some drop in my cortisol levels indicating that Orange Alert stress levels had finally dropped. And I've finally started feeling somewhat less stressed in the last few weeks, which is when we seem to get sick after prolonged stress.

Anyway, my last run was Thursday, and I'm not taking it up again until I'm sure I'll keep both lungs inside my body for the duration. Also, passing out on a treadmill (or in the street) might be embarassing. I'm all about sparing myself public humiliation. But I am planning on doing Bloomsday this year, which is in 5 weeks. It's 12K (7+ miles). It's huge: until last year it was the world's largest footrace, with around 50,000 participants each year. (Last year, 2 races had over 70,000 participants and surpassed Bloomsday. But it's still the largest in America.) I don't really desire to run any other races, and I've never even run a 5K. But this one is so big that unless you are in the first starting groups, you really can't run the entire distance (at least without being a giant a-hole). So even though I'm not back up to running 7 miles a day, I think I'll be okay with running and walking this.

Bloomsday is huge in Spokane; it's one of the largest tourist events here, and they make a whole weekend of it, with a trade show and several events around town. The run itself is well-supported, and there is live music all along the route. The one thing I must do in my training in the next month is run Doomsday Hill, which is the famous part of the route that I've never tried before. (Check out this cool slideshow from Bloomsday 2006.) Several of my classmates want to form a team to do this run. We're toying with team names: Team Sweet Dreams, or maybe Gas Passers? We're too poor to make T shirts, though. I have to get well enough to run again this weekend if I hope to run even half of this event. I'm excited about it, though!

Wednesday, March 18, 2009


I've been feeling bloated the last couple of days. We ate really poorly this weekend, for a variety of reasons, and I gained a few pounds. It's weird how gaining just a couple of pounds brings me from feeling pretty thin and successful right back to "fat". I feel like I can see it all over, I feel like none of my clothes fit me or look good on me. 3 pounds did that...wtf?

Those 3 pounds feel like they are right in my belly, my #1 problem area anyway. When my belly feels fat and bloated, there is no way to feel good about my appearance. I feel like I can hardly move. It's so psychological.

Lately I've been examining the way my parents used food when I was growing up. As I think about it, they both really abused food--one parent is a compulsive overeater, the other had a variety of eating disorders all through my childhood. There was no chemical dependency in my family, but there was this kind of addiction. Odd that I didn't really confront this head-on when preparing for bariatric surgery. I looked at my own relationship with food, and decided that I had a tendency to misuse food, and knew I needed to work on that. And I have worked on that; it's not "cured" by any means, but it is better and I have more awareness when I am eating for reasons other than being hungry. But I think there is a bit more work to be done if I am to maintain my weight loss. I think this family history is what made me attracted to a person with addiction issues. Since we didn't have any obvious chemical dependency in my house growing up, it was a bit of a mystery how I could end up this kind of codependent, yet I am.

Things are going better, though. Recovery is happening in our home, slowly but surely. There is no cure, but we can be happy again, and we are.

Moving on to OB

We have finished our pediatric anesthesia unit and have moved on to obstetrics. OB always scared me the most when I thought about anesthesia prior to starting school. Now it kind of excites me. Still scary, having 2 patients to think of instead of one. And of course, when things go wrong in OB, it gets bad fast.

Oddly, listening to our OB lectures makes me want to have a baby more. One would think it would be opposite, since we are talking about all the things that can go wrong. But it makes me think of what I would want.

I have baby anxiety. I'm getting older; I will be 36 years old this year. Yes, I know plenty of people get pregnant and have babies around this age. I hear it all the time. But until I get pregnant and deliver a healthy baby, all the reassurances in the world aren't going to take that anxiety away for me. With all the major revelations that have occured in my marriage this year, it would be best to wait at least another year before considering having a baby. But I am not getting any younger, so this fall is when I will consider whether I can start trying. Come about October, I may decide that it's better for our lives and our marriage to wait longer. But I have so much anxiety that I'm not going to get pregnant, I suspect that I will try anyway at that point. I graduate in May, so getting pregnant anytime after September would probably be okay for finishing school and taking boards and starting a job.

It would be perfect if I could revisit this whole thing a year from now and see what state my marriage is in at that point. And I could do that. But I will turn 37 next year...not when I want to START trying. The few people that I talk about this anxiety with (mostly my hubby, but a few other friends too, mostly ones my age) don't really like to hear about my anxiety. So I don't talk about it much anymore. But it is there, I really want to be a parent, so I will have to make some sacrifices in some areas to ensure that it happens.

Meanwhile, we start practicing epidurals next week (on lab dummies). We've already been doing spinals for several months; I have about 20 so far. Epidurals aren't drastically different; they are a little more difficult. But one nice thing that I never thought about before now is when we do spinals in the OR, say for a hip or knee replacement, the patient is not in pain to start with, so they are more sensitive to the pain of injecting local anesthetic and inserting the spinal needle. Versus a pregnant, laboring woman, who may be sensitized to needle pokes and all that, and may have a difficult time getting into the right position, but if you place a successful epidural, you've just become that woman's new BFF. They start out in pain and end up comfortable, as opposed to the surgical patient who wasn't in a particular amount of pain to start with when you started stabbing their back. (That's said tongue-in-cheek. If done properly, a spinal shouldn't hurt except for the initial local anesthetic injection. Only maybe 2 of my spinal patients have had any pain at all when getting their block. But sometimes it's very hard to do "properly", depending on the patient's anatomy.)

I never realized that there are quite a few options for anesthesia for labor before now. I guess I had the idea that you either get a full block, numb from the waist down, or no anesthesia at all. But in fact, depending on what the mom wants, there are a lot of variations and options, from just "taking the edge off" to complete anesthesia. I think that's pretty cool.

Saturday, March 14, 2009

Happy Bandiversary

I knew there was something about yesterday's date that was striking a bell, besides being Friday the 13th. It was the 2 year anniversary of my band surgery.

At 2 years out, I am just about exactly the weight my surgeon said I would be, having lost 70% of my excess weight. I have been maintaining this weight, within 5 lbs either direction, since last June. I still want to get to 160. Today I am 168. But I'm pretty happy where I am.

The other day I was giving an anesthetic for another band surgery. I have done about 3 or 4 bands so far since I started my clinicals last July. The CRNA I was with asked the surgeon--who has only recently started doing bands, he's mostly a bypass surgeon--about how the band worked and the surgeon was explaining. He ended up saying that gastric bypass patients tend to lose about 70% and band patients lose about 50% of their excess weight. I asked him about the 5 year studies that show the weight loss is the same between the two groups, and he said that those studies were small and he didn't think they were reflective of actual results. I tend to disagree, but I'm not 5 years out yet.

I don't wish to lose 100% of my "excess weight". I think my actual excess weight is a bit less than what they calculate with BMI charts and other methods. If I had a tummy tuck, I don't know that I'd actually want to lose any more weight than where I am now. I'm wearing size 6 jeans (4 different brands, and not stretch either). My tops are either smalls or mediums. I have flab, but that isn't going to get much better without plastic surgery. Most importantly, I'm able to run and do things that were never possible for me before.

I haven't had any heartburn since those 2 times a few months ago. And those were the only 2 times in the past 2 years I have had any. I can eat more than I should be able to. But I think if I was more careful about stopping sooner, I would still stay full at least 3 hours. I can still stop myself when I find myself looking for food and ask, "Am I actually hungry?" Usually, the answer is no, and usually I can redirect myself. Sometimes I still eat something. Old habits die hard. But I'm at least aware that I am eating when I am not hungry, that I'm eating for other reasons.

It's not normal to lose 30 lbs in the first year of anesthesia school. Most people gain at least 10. I had lost 40 before starting, and I'm thankful for continuing to lose despite some good reasons not to. Losing these last 5 lbs is a struggle, and I hope to be successful in the quest. If I am not, if this is the weight that I am able to maintain comfortably, then I can live with that.

Being banded was one of the best things I've ever done for myself. Yay for 2 years!

Sunday, March 8, 2009

Desire and Suffering

In most Buddhist teachings that I have been exposed to, suffering is said to be caused by desire. This is a universal human condition, and one that can be broken, according to the teachings. Thinking of human suffering being caused by desire is a concept that, to me, at once seemed intuitively true and incomprehensible. On the one hand, it is easy to see that the kind of desire that begets mindless consumerism and even addicitve behaviors like overeating, alcoholism, and sex addiction could be the source of suffering. On the other hand, what about the suffering caused by things like physical pain or illness? What about suffering caused by abuse at the hands of another person? These things don't seem as obvious to me, but Buddhism teaches that all suffering is caused at its root by desire.

There is one view that says suffering that we don't obviously cause our selves is caused by desire in others who inflict the harm on us. I think the point of the teaching is not this, though, but rather that we can choose not to desire that things did not happen this way, choose not to see ourselves as something separate from the world and therefore when illness, abuse, harm etc happen to our "selves" this is just a construct of our minds. This is a very esotaric concept, not one that I am at all versed in or experienced in, and one which I think is a rather advanced human condition.

What I CAN see is how my own desire causes suffering for me. First there is the endless desire for things, which always begets more desire for things. I get an idea in my head that I need a new pair of jeans, for example. I think about it for a while, decide exactly what to look for, and where to get it. I finally go and get the pair of jeans. You would think that my desire would thus be sated. But no, soon I am finding myself desiring some other thing. There isn't relief from this desire, only repeating of the cycle.

This happens to us with food, too. We decide: I want some ice cream. We obsess about it for a while, think about which flavor and brand we want, when and how to get it. We get the ice cream, and we eat it. And soon we are finding ourselves not fulfilled by having this desire met, but rather, right back in the throes of a new food craving. Sugar totally does this, for reasons that science has at least partially explained with insulin levels and other hormones. But anything that can be craved can cause this same reaction, with or without fluctuating levels of insulin.

Other kinds of desire can cause or perpetuate suffering. I am learning recently that one kind of desire is the desire for a different reality. Wishing that something was not true so much causes us to become stuck in the bitterness and anger and resentment that goes along with that desire. It can even cause denial of reality, which creates another kind of suffering.

I often find that I desire to be seen a certain way: as the winner of the argument, the "better" person, the morally or intellectually superior one. My desire to not have my flaws seen is, of course, useless: not only am I creating my own suffering by holding onto that supposed superiority, but my flaws are seen in sharper relief as someone who thinks she is better than the other person, and I create suffering for the person I am trying to seem better than.

Samsara is a state that is referred to in many different religions. Often it is described as the cycle of suffering and reincarnation. The idea of reincarnation itself isn't really what I used to think it was, literally being born again as yourself but in another form. If you're "good", you are reborn as a more evolved being; if you are "bad" you are reborn as something lesser and further away from nirvana, like an insect. I guess first you have to sign off on the idea that there is a hierarchy of beings that are certain distances away from nirvana. Then you have to accept that we have a bank of good and bad karma and the end of our lives is an accounting of what your balance adds up to. I don't think this is really the essence of samsara. It seems to me that it is more like the effect of desire and longing and suffering in the world. These things are self-perpetuating and affect the entire web of existance. I don't know how to reduce suffering in human existance, but I do find that being mindful of my own desires and how they are harmful to myself and those that I affect helps me.

If you are thinking that this is some radical new direction that my blog is taking, please take heart. These aren't radical new thoughts for me, only new blogging topics that seem more relevent to my life these days. It's not becoming a spiritual or religious or Buddhist blog. (Although if it did that would be fine; it's my blog after all.) I'm just feeling a little more contemplative today than usual. It is so much better than some of the mental spaces I've been in so far this year. I hope it is interesting or helpful to someone.

The White Path to Recovery

Today we went to our local Buddhist temple again. It was a simple service. Our temple does not have a dedicated minister; instead, a minister from Seattle flies to Spokane once a month for an afternoon service. The rest of the month the services are "MC'd" by members of the temple. An assistant minister gives a dharma talk (like a sermon, sort of) and there is chanting and a few simple rituals.

The dharma talk today detailed the parable of the White Path, as taught by Shao-tao. It is somewhat lengthy, so I've included the link. It is basically about reaching the place of enlightenment via a narrow path that separates two rivers, a river of fire and a river of water, and connects the east bank, which is our world of samsara, or suffering, and the west bank, the Pure Land, or afterlife. The river of fire represents our anger and resentment, and the river of water represents our unceasing human desire, which continues our suffering (as the Buddhists teach that desire is the source of human suffering). The character in the parable is urged along the path by two voices, that of Shakyamuni Buddha, the historical Buddha, calling from within the river and telling him not to fear, and that of Amida Buddha, from the West Bank, urging him forward. From the East Bank, there are bandits and wild beasts pursuing the character in the parable, from which he is trying to escape. These bandits and beasts represent essentially the elements of what we call "self".

This parable is described to represent our movement through this life towards enlightenment. I think it also serves as a good metaphor for recovery. You have to get through the anger and resentment and the desire for things to be different than they really are in order to reach the place of serenity. The path is narrow but can be traversed if you approach it with purpose.

I take a lot of comfort in Buddhism, a tradition that I am just beginning to learn about. I was raised a Christian, but eventually I realized that it doesn't feel true to me in my mind or in my heart. Still, I am a spiritual person, as I think most people are in some sense.

Buddhism isn't a theistic tradition and many would say it isn't even a religion. Buddha isn't a god. In fact, Buddha simply means "awake" or "enlightened". It is said that upon his enlightenment, Siddhartha, the prince who became the Buddha, was asked if he was a man, and he replied "no". He was then asked if he was a god, and he again replied "no". Then he was asked, "What are you?" And he replied, "I am awake." Hence he became known as Buddha, and he has a few other names: Shakyamuni Buddha, and Gautama Buddha are a few of them. He is not worshiped, but rather his example is followed and his teachings are studied in order to learn how to live this life and attain enlightenment. This sounds much more lofty than I think it is in practice. In reality, the Buddhists I have read and met seek simply to live without increasing or causing suffering in anyone, and to follow the teachings, which are fairly common-sense and practical.

The temple we go to is the only one in Spokane, and it is in the Jodo Shinshu tradition of Buddhism. There are so many different schools and traditions in Buddhism that I haven't even begun to understand the exact workings even of the one we attend, but the one difference I do know is that Jodo Shinshu discarded the monastic tradition. They do not have any monks; all lay people have direct access to all the teachings. The beliefs that tie all Buddhists together are the Four Noble Truths and the Eightfold Path. These are the things that all Buddhists agree upon.

This year has presented me with some tremendous challenges, and many of those I think are spiritual challenges. I have been trying to meet these with a spiritual tradition that feels honest and practical to me. In all Twelve Step programs, they speak of "the God of our understanding." This can be a real stumbling block to those of us who consider ourselves atheist, or agnostic, or are just turned off by religion. But one thing they teach is that it doesn't matter what that "God" is or even if it is a "God", just that you acknowledge that there is something outside of yourself that can restore you to sanity. To me, that is the Universe. Reading about these teachings and hearing the simple, profound Dharma at the temple really helps me to focus and strive to see the world outside of myself and my seemingly important problems that really are just a part of this world of samsara.

Saturday, March 7, 2009


I'm getting used to living in post-crisis now. It's not the same as pre-crisis, when I thought things were pretty normal. Now I know they aren't, and my life is different in a number of inconvenient and irritating, and in some cases frightening, ways. Looking toward the future, I'm uncertain of what it holds. But I am working on living in the moment, being appreciative of 'now'.

I'm thankful that the crisis has passed. I know what is going on now, and it's better than waking up every day uncertain of what else is going to happen or what else I am going to discover that changes everything. I think I'm so thankful to be out of crisis mode that I might accept anything else that passes for normal in my life, which is a risk. I want to decide what is acceptable in my life.

What is left for me now is a deep fatigue. I am tired all the time. My days are filled with administering anesthetics and getting through school. My nights are filled with studying or going to meetings. People ask me normal things, like "how are you", and I am too tired to answer. I try to deflect the conversation back to them as quickly as possible, asking about their kids or anything I can remember that is going on in their lives.

In recovery-speak, this is a family disease, and I am in as much need for recovery as my husband is. But I am often resentful of how consuming "recovery" is, especially since I haven't yet reconciled myself with my own need for recovery. I feel like my circumstances are special or different: how can I be enabling behavior when I wasn't living with the addict, and couldn't see anything happening? Yet I don't think I am logically any different from the other spouses, so I am trying to analyze my situation and see what I can improve in myself--after all, this will only make my life better. But it's exhausting.

I run for stress relief. My eating is not great this week; I've been eating more sugar than I should, and bread and carby stuff. I've been noticing that I get hungry sooner than I used to, like 3 hours after eating. I haven't been super careful about stopping eating after a "small" amount of food, and it's possible that I've dilated my esophagus or pouch or even had a small slip. But I have no other symptoms. Or do I? Sometimes I get kind of a "cramp" in my stomach, not exactly a sharp pain. It doesn't seem to be related to anything I do or eat. Twice I've had a sour stomach when I wake up in the morning, but both times I had eaten right before going to bed, a big no-no for banded folks. I can't see my surgeon until my husband is working again. Hopefully this isn't anything serious.