Thursday, April 30, 2009

The Empowerment of Fear.

I bawled so loudly in the bathroom this morning that I woke up my roommate (a medical student in the class above mine, presently keeping the awful hours of a surgery rotation -- who demonstrated how outstanding a physician she's going to be: so thoughtful and caring, even under these circumstances). She calmed me down enough to focus on being proactive (of which bawling in the bathroom is not an example) -- and enough to appreciate that the single-most important act I can take right now is to write about this. So that I never ever ever ever forget what it's like to be this afraid.

I entered an essay contest a few months ago, where I wrote from a patient's perspective about how it feels when a doctor does not attempt to "inhabit one's existence" -- to translate the 'review of systems' checklist into the practical experience of what it is like to actually go through life with those symptoms. I was pretty graphic, and actually too embarrassed of my crudeness to even share the essay with my own mother or several of even my closest friends. It's ironic that, six weeks later, I've decided to write THIS on a blog read by hundreds of people a week. But I've decided to do it because it'll keep me honest.

Part of seeing the world as a fusion of interconnected parts is that, even in the midst of pure frightfulness, I can see that my experiences this week, appreciating different forms and perspective of fear, have all led up to this moment.

Yesterday at the clinic, I saw a trooper in the hallway. I chalked this up to just another 'thing that happens' -- much like the experience of seeing a random horse outside the window of my preceptor's office. Yes. A horse. A horse that had never been there before. This is my world. Turns out, the trooper wasn't as random. He was there investigating a case of alleged child abuse. 19 year old developmentally disabled woman, charging that her foster mom had split her lip. My preceptor and I were microwaving dinner in the kitchen chatting about heart rate monitors (obviously...) and suddenly, there was this girl telling us this story. I felt helpless. I expected my preceptor to step in and save the day -- to make all of the world's wrongs right, to magically transform fear into peace -- because that's what he does. Turns out, he's human -- who knew? I felt even more helpless.

"I'm scared," the girl said. "They're going to make me go back there, and I'm scared about what's going to happen to me."

We walked away, leaving her with the trooper. We later heard that thorough police investigation had yielded a history of false accusations and secondary motivations, I questioned my ability to discern genuine fear and its implications.

After dinner and an IMMENSELY rewarding discussion with my preceptor about the study I am conducting about heart-rate monitor use and self-efficacy (if you've ever worn a HRM, you can participate here), we saw a patient who again prompted me to ponder how fear/uncertainty translates into the details of everyday functioning.

We saw a woman in her late 20s who had been experiencing freakish distortions of physiology. More than 20 times a day, right before our very eyes, her entire leg would intensely contract and jerk off to one side -- unable to relax for 10+ minutes. When these contractions took place, her face distorted in pain. The same happened to her hands, her arms, her shoulders, even a portion of her abdomen. On the schedule, her chief complaint had been written: "muscle spasms." How understated! This girl couldn't walk, couldn't drive, couldn't sit up or stand up. Couldn't function. I ransacked the pathetic data bin in my brain on muscular spasms, and came up empty for anything that could possibly contribute to this girl's world. One advantage to knowing relatively NOTHING is that my brain is not "cluttered" by extensive knowledge of all the things that SOMETHING could be. So I thought it looked like MS, just because it's a) the only thing I know anything about that resembles this, and b) because I'd just learned about it 48 hours prior. I asked her questions about her vision and her balance. I hated that her responses matched my expectations, even though that's theoretically why I asked the questions.

My preceptor left the room, leaving us alone in the exam room. My 'first-year-medical-student arsenal of questions' had been exhausted. Awkward silence. But it occurred to me that, just maybe, she would feel better to be asked about what it was like to live with these "muscle spasms."

I watched as her eyes widened, softly glossing over as she spoke.
"I'm so scared," she said. "I'm so scared to have no control over my own body. I'm just so scared about what's going to happen to me."

Almost the same exact words as the earlier exchange, except fearing an internal attack as opposed to external.

I asked her to tell me about how she has been managing -- how does she get around, what's it like to wake up and fall asleep and everything in between. What it's like to interact with her family. Her descriptions were awful, and I felt guilty that I had NOTHING to contribute other than an acknowledgment that her descriptions were awful. She told me that she's started to believe that her symptoms are like magic, to indicate to her that a person or a situation is "bad news." She didn't call it divine intervention but that's kinda how she described it. How fascinating to tap into someone's innermost schema that underpinned her coping mechanisms for basic functioning. How fascinating that, had I had more legit medical questions, I would never have had the "space" to learn this about her. And whether it has any bearing on medical management or not is irrelevant: I watched as a wave of peace, almost brightness, spread across her face. I'd given her a forum to tell 'someone in a white coat' about how she saw the world -- and no matter how little I did to earn the privilege of hearing that expression, I was grateful and proud.

Truth be told, I felt on top of the world last night. I didn't say anything stupid, didn't bumble any major exam skills, didn't otherwise embarrass myself. Nice. And best of all, my preceptor (my most recent HRM convert) spontaneously advocated HRM use to one of his patients who was trying to lose weight. I felt like I'd truly accomplished something awesome.

That's not how I feel right now.

Now, I feel scared. I'm scared that I have no control over my body. Just so scared about what's going to happen to me.

The point of this post isn't to document the gorey, crude details of my symptoms (a GI bleed unlike any that I have experienced before). The point is to hold myself accountable to internalizing what it means to look down at something that came from one's own body -- and to detach from any rational mechanism for processing reality. This has happened before, though not to this extent. Years of managing unambiguously abnormal, chaotic experiences and developing coping mechanisms for fitting them into a chaos-free existence has afforded me great insight, into both my own motivations/truths and to those of other people. Every episode has meant something, something powerful and positive -- something that's going to make me "get it" when someone needs me to "get it." Something that's going to make me a better doctor.

What made this morning's episode worse, I think, was that it seemingly exhausted my knowledge base. I was no longer the #1 expert of my body. My threshold for "knowledge exhaustion" is higher, both because of my professional training and in the time invested in developing an awareness of the specific anatomical and physiological aspects of my symptions. Nothing within my "life schema" could possibly explain what was happening; it was above and beyond my threshold at which "things that make sense" become "things that do not." The experience of crossing that threshold was tremendously disempowering for me. Processing that 'process' has been helpful, and I need to remember that when I see the opportunity to prompt other people to take that time for their own processing.

They taught us in our earliest training sessions about medical history-taking that the questions "What do you think this is?" and "What is your greatest concern about this?" are tremendously important. When phrased exactly like that, these questions always sound tremendously awkward -- but they really are important. Above and beyond the utility of learning from the #1 expert in the diagnostic issues at hand, these are the questions that prompt these experts (patients) to appreciate that they are experts. To empower people to take a proactive role in their own wellness, to act as their own advocate.

Time for me to do the same.

Sunday, April 26, 2009

The Burden of Generosity.

When I cut off a human head, I was very mindful of how decidedly unnatural, ridiculous, and wholly unearned of an experience this was.

The irony of medical school is that there is a direct correlation between the profoundness of an experience, and how little you've earned the privilege of experiencing it.

Tomorrow, I am speaking at the annual Donor Remembrance Ceremony, to celebrate the lives and the generosity of those who donated their bodies to UVM's Anatomical Gift Program so that my colleagues and I can learn. I've been organizing this event over the past few months, and it has come to mean a lot to me. I've seen it like planning a Spinning training session: structuring a specific experience for an audience -- in this case, to carve out a space in which the 150 audience members (my classmates, key faculty, prospective donors, donors' family members) can "spend time with themselves" sufficient to actively process their own thoughts.

Tonight, I'm trying to process mine.

The truth is, my 3.5 months of Gross Anatomy was one of the most miserable times in my life. I wasn't in control over ANYTHING in my life: my sleeping, my eating, my training, my LEARNING. It was just a nonstop avalanche of incoming stimuli, with the key objectives to not get smothered and/or knocked unconscious. I had never felt like so much of a failure -- so utterly incompetent to navigate the challenges of my world.

The fact that I was even PRESENTED with these challenges -- exclusively through the generosity of 25 men and women from my new community -- seemed to highlight my ineptitude. I hadn't done a THING to earn that kind of generosity.

The audacity of taking a blade to human skin. Cutting away layers and globs and globs of yellow and white fat, shearing muscle planes. The sound of bones crunching beneath my chisel. Driving a probe through the labrinth of bronchi. Scissoring flesh, teasing out the delicate nerves to their origin. The pelvic exam I performed the morning of my first VT snowstorm. You think I earned any of that?

The standardized patient who let me perform a testicular exam. The real patients who let me prod their swollen knees, touch their skin with my hands and stethoscope, feel their prostates. You think I earned any of that?

Entering medical school, I spent -- and spend -- a lot of time thinking about what it means to earn privileges. To engender confidence, to inspire trust. What it would take to earn that. Then when I got here, I was overcome by how little I did to earn ANYTHING. I felt guilty for holding this new "status," which quickly presented itself as automatically inspiring all the trust and generosity that I'd committed my life to work my ass off to earn.

The power of that transformation overcame me. It still does. I don't fully know what to do with it, other than express my gratitude. I can't ever find sufficient words.

So much of medical school thus far has been about carving out my own space, where I can balance the different realms of my life and find a version of reality that makes me feel like I'm doing something meaningful and rewarding. I wonder whether these donors saw the world that way, whether that's what inspired their generosity. I'll never know why they chose to believe in me, someone they have and will never meet. I'll never know why they chose to trust me, to trust that I would develop into the kind of physician who will dedicate her life to earning and re-earning that level of trust. I'll never know why they believed in me -- at the time, much more than I believed in myself.

But I do know that I will spend the rest of my life trying to prove them right.

(I still have no clue what I'm going to say tomorrow... and I'm okay with that.)

EDIT 4/30/09: My speech was awesome. It was pretty close to what I'd written here, barring any reference to cutting off limbs/heads and poking/prodding any orifices.

Sunday, April 12, 2009

The Void.

I wasn't exceptionally motivated to engage in any major life functions this week.

I hit the snooze button every 15 minutes for three hours 4 out of the 5 days, unable to rationalize that anything "out there" (i.e., the world outside of my bed) was worth doing. I didn't want to learn anything in my classes -- so I just... didn't go. The only physical activities in which I engaged were cracking my neck and checking Facebook. Walking down the block from Point A to Point B was EXHAUSTING; I didn't actually care whether I even made it to Point B. Every time I spent time with the new character I've been seeing, I embarrassingly fell asleep within 15 minutes. I was mush. Directionless, uninspired mush.

I knew something was wrong. Very, very wrong. Was I depressed? No; it couldn't be. 48 hours prior, I was declaring that I had the best day of my entire life. Was I just burnt-out -- cognitively overloaded from the nonstop influx of stimuli, both from the classroom and the clinic? Had I fallen out of the rhythm of "learning stuff," after being so consumed with last-minute preparation for my 6-hour Spinathon? Was I still recovering, physiologically, from that? Was I volume-depleted? Did I screw up my electrolytes? Had I compressed something "important" in my neck, as a consequence of hyperextending it for so long looking out at the audience? Was it the weather? (I'm prone to Seasonal Affective Disorder; we hadn't had sun in 5 days... for the first time since I've lived here.) Was I iron-deficient? (I have Celiac Disease and my gut is often a war zone: as a result, prone to all sorts of micronutrient deficiencies...)

I wasn't even excited for my weekly trip to the clinic (see also: my favorite place ever on earth). I forced myself to drive out there (with overcast, sullen, gloomy skies -- of course). I saw some patients, attended some meetings. Longed for my bed like none other. What the hell was going on?

I sat in my preceptor's office, across from him at his desk. It was so exhausting to be pleasant -- to smile, to communicate with enthusiasm about ANYTHING. The sky outside his window seemed darker, gloomier than it had been on my way in. Conveying anything that remotely resembled "personality" was an unbearable struggle. I grimaced to raise the corners of my mouth, meagerly contributing to small-talk. I asked him how his running was going. He gestured behind me, as though to encourage me to turn around.

And there it was. On the desk behind me, my preceptor had left a crisp, vibrantly colored box.
"Look what I got..."



I felt like a real person again for the first time in 96 hours. And in that moment, I knew exactly what was wrong with me:
* I had been "in training" -- both physically and mentally -- for This Big Deal. And now it was over. I no longer had something specific for which I was training. How often do I rant and rave about how important that is for "life?" Now I had this giant vacancy -- in time, in focus, in purpose.
* I had this surreal, out-of-body experience of power and influence -- a moment of perfection, a moment of EVERYTHING I'd ever wanted. I experienced a moment that would never -- COULD never -- be trumped. And, so, I didn't want to bother trying.
* I felt so isolated by my experience of connectedness. When I described to people what last Saturday had been like (in-person, by email, by phone, by blog...), I knew that something was being lost in translation. How could it not have been? To most people, "this thing I do" (i.e., Spinning instruction) is trivial, superficial. Even those who "get" that "this thing" is more than that -- that is, how cycling/mindfulness coaching has broader applicability to life OFF a bike -- were doing more "head-nodding" than anything else. To everyone, it was just another case of "Melissa Being Effusive about... Everything, Always." I'd lost street cred in my ability to distinguish something as legitimately, uniquely special to me.


I decided that my coping mechanism would be to turn this into something constructive. I created training sessions for my classes based on these very experiences. I'll write about them on Spintastic soon...

I also decided I'd go see a doctor to get tested for deficiencies in iron, vitamins B12 and D. Fast-forward a few days. Went to see a doctor. Despite having entertained iron-deficiency on my own differential, I never examined myself. I know how to work up iron-deficiency, yet checked NOTHING. I had all the major clinical findings: pale mucous membranes (my eyelids are SCARY-white!), white flecks and scooping of the fingernails, easy bruising. Had labs drawn.


It's a relief to have a physiological explanation for feeling so unlike myself. While this presents the question of why I'm iron-deficient, of course, but it feels rewarding to have something concrete to account for my experience. But the Post-Actualization Void theory really does have merit, in and of itself. Finding a way to channel a very personal, powerful experience into something that can be shared with the people around me is a huge challenge with which I'm struggling. And I really do need a new physical goal -- something to work to get better at, just for the sake of getting better at it. I can do that.

In the meantime, I'm still too exhausted to do many of the things I know I love. I'd love to write, for example, about how cool my experience at the clinic really WAS this week -- once I helped my preceptor set up his heart rate monitor, I seemingly 'woke up' and started soaking up the world around me again. I saw two patients with the clinic's dietitian. I performed three prostate exams on actual patients, despite having never been formally "taught" how to do one. Such inconceivable generosity on the part of these three men, contributing directly to my education and development.

I'd also love to write about how it felt yesterday to conquer my first road trip as a licensed driver -- I drove 6 hours from Burlington, VT to Long Island, NY. My first time driving more than 90 minutes, my first time on a 4-lane highway, my first time on a bridge or in a tunnel. All of this in a RIDICULOUSLY bad rainstorm. I rocked it. I "breathed my heart rate down," managed my attitude and responses (squashing most temptations to be reactive), and all the things I talk about ad nauseum. Turns out, when you're scared as hell, that stuff legitimately works. UNBELIEVABLY empowering.

I probably won't take the time to reflect on any of these more thoughtfully, expecting that they will be trumped by other experiences by the time I am able to write further. I need to be okay with that. And I need to go pop another Gentle Iron (BTW - if one ever needs an oral iron supplement, Gentle Iron = no constipation) and go to bed.

Monday, April 6, 2009

The Best Day of My Life - On the Bike AND Off.

I'm posting this entry on BOTH blogs, for the first time in my life. If you follow both, I apologize! Hopefully you'll see why I chose to do this... I'll probably never ever do this again; it just seemed to be the logical choice here.

See, I've never been terribly good at compartmentalization. It's why I used to sleep in my office and accept 2AM phone calls from my boss; why I can't go ANYWHERE (bar, bowling alley, movie theater...) without evaluating every sound for its potential to contribute to a Spinning class; why I'm skipping class to be able to blog on a Monday morning. Recently, I gave up trying to improve my compartmentalization skills; I decided it wasn't important enough to me. I'd been striving for compartmentalization because 'society' says I'm supposed to -- I didn't have my own independent reason worth investing in.

Screw that. Instead, I've been investing time and energy this year to Anti-Compartmentalization, if you will: that is, carving out a fusion that reflects my multiple roles, responsibilities, passions, and inspirations. Physician-in-training vs. Coach. Learner vs. Teacher. Observer vs. Doer. They're not mutually exclusive, so why treat them as such? Still, the only pseudo-line I've drawn in the sand through my relatively new public reflections is between: "A 'SPINTASTIC' READER MIIIIIIIGHT CARE ABOUT THIS" vs. "THERE'S A GOOD CHANCE NOBODY ONE EARTH WILL CARE ABOUT THIS." Reflections categorized into the latter wind up on Feel the Road (the "life blog," if you will).

Well, you know you've had a pretty damned good day if you have an experience that cannot be categorized. It was one of the best, most affirming days of my life as a cyclist, as a coach, as a leader, as a mentor, as a learner, as a friend, as a human being. At Saturday's 6-Hour Special Olympics Spinathon, for me, they were one and the same. So, it seemed only fitting to post on both blogs.

If you've been following either blog, you might remember that the 9th Annual Ride for a Reason has been a major "life construct" for so many reasons:
* It marked my first 'community integration' effort in the city of Burlington, my new home, independent of medical school. Through serving on the event's planning committee at the invitation of EpicRides' Allen Jones (creator of pretty neat ride-along cycling DVDs, for those of you into that scene...) in the fall, I developed a true sense of feeling "at home" in this new chapter of my life. It gave me an opportunity to build that part of my identity. My trips back to NYC stopped being so regular (I was going back every 3 weeks, at one point...); I didn't need as many "life snuggles" from My Former World. I belonged in my new one.
* OBVIOUSLY the hugest opportunity of my coaching career. Being able to shape an experience for 100 riders, from atop a huge stage with life-altering broadcast capacity: my music and my words and my particular way of seeing the world echoing off the walls of a huge ballroom, with the hope that some subtle aspect of ANY of it would strike the ears, the minds, and the hearts of the people before me... united in their passion and energy for the cause at hand, but each having a truly individualized experience.
* I would be co-leading the event with Spinning Master Instructors Anthony Musemici (who certified me! I invited him a) because he's an AWESOME coach, independent of any other factors; b) symbolically, he started me on this journey that I never ever ever anticipated leading to such rewarding sense of self through my opportunity to connect with so many people about my greatest passion) and Angie Scott. Anthony, who hasn't been in touch with me in 2.5 years and didn't know me from a hole in the head, flew up from NYC on his own dime -- and not only led amazingly inspiring portions of the ride, but was such a tremendous influence over my anxiety- and expectations-management leading up to this big day for me. Angie, from Montpelier, has been such a tremendous resource to me upon my transition to Vermont cycling life, always generous with her time and insights -- and even gave me the opportunity to co-teach a 2-hour endurance ride with her, my first time working with Vermonters of the age/experience-level to which I was accustomed in NYC... quite different from my university campus population, a change I found disorienting for several months. Angie gave me an opportunity to re-connect with myself, through connecting with her riders.) It was a daunting but invigorating honor to share the stage with two people who inspire me so much.
* I had friends and NYC "regulars" coming up just to ride this event. They literally drove up for less than 12 hours, just to be here for this with me!
* I trained six of my UVM riders to participate in what ALL of them had previously regarded as an impossible task. Some rode 2 hours, some rode 4. Some rode 6 hours. 4 of the 6 had never been on a bike (stationary or the kind prone to falling over) before they met me. I tried to do everything in my power to make them successful, and I'd feared that my imperfections as a coach would limit them. What if I hadn't conveyed the things I thought I was conveying? How would they feel about themselves when it was over? What would happen next. This was my responsibility to set them up for success. They rocked it. They all friggin' rocked it.
* This was a major training goal for me as an athlete. I was committed to riding all six hours (the estimated equivalent of 120 miles, per measurements I'd taken during my 2-hour training blocks -- and I was riding on "Game Day" at comparable cadences), and I was committed to improving over the last time I had done this. I rode two 6-hour rides in Jan/Feb 2008 -- and as I described in my last posting, identified specific things I wanted to improve. I designed my own training plans to accomplish these specific tasks, and translated them into Spinning classes to share with my riders. Allow me a small dose of arrogance (I did just ride 6 hours, after all): 1) I got INSANELY good at holding 70% MHR for hours, persisting through changes in resistance, speed, and position via breathing control (biofeedback via HRM); 2) I got even more INSANELY good at getting a TON of work done at 70% MHR, both through Accomplishment #1 and by investing time in my first religious lower body strength-training regimen ever; 3) my proudest training accomplishment: I got good ENOUGH at alleviating "hot feet" (nerve compression), which had been the bane of my existence during the last two Spinathons. I actually bawled, siething in pain during the Jan '08 ride. It just hurt so bad. It wasn't enough to be mindful of my pedal stroke: lifting
up on the pedals, keeping my foot at the top of my shoe. I knew all that. SPD cleats are so damned small that the concentrated pressure is just awful after a few hours -- and I knew I wasn't going to build up training time long enough to simulate Game Day conditions (I'm a medical student: I knew I'd train to ride two hours, develop solid techniques, and then on Game Day, shift my heart rate lower and blast out another four from pure adrenaline). So I trained to cope with "hot feet" on the elliptical. I'd argue that Hour 4 on a Spinner feels like Minute 25 on an elliptical; the pressure is just brutal. Not AS brutal as a Stepper -- but "Stepper hot feet" do not feel, to me, like "cycling hot feet": they don't stop upon cessation of activity; they screw with the ankles; and, most importantly, the skills associated with prolonging onset of cycling hot feet simply don't apply to the Stepper. It's a different movement, biomechanically. On the elliptical, though, I got pretty good at "top of the shoe shuffling" on a bike (again, why I was practicing this on the elliptical is that it didn't take 4 hours before I was in pain -- the goal was to get good at alleviating pain!). I also found elliptical training to be great mental focus training -- given how friggin' boring and awful it is (Justification to assure you I'm not being dismissive: I train on an elliptical 2-3x a week, and credit it entirely with how much work I can get done at "70%" -- even
though it's a different 70% than my cycling 70%, it's close enough to translate well).

In moments of weakness (and certainly there were many...), I was mindful of all of those things -- acknowledging them, appreciating them gave me a very profound surge of strength at these key points of exhaustion. My "grand idea" of not instructing until Hour 5, well, had its limits. When I looked down at my heart rate monitor on my left wrist or my eating disorder awareness bracelet on my right (an important symbol of my history that led me to the place at which I am now), I felt so supremely strong. I closed my eyes, felt the warmth and glow of the hot stage lights, the effortless flow of the rhythm... and just WAS.

The irony was that, when I am up in front of my classes, I am never riding for me. I ride to demonstrate form and breathing efforts, then I get the hell off the bike most of the time. It's all about the riders in the room. Now here on this huge stage (before it was my turn to lead), I was absolutely riding for me. I was OBSESSIVE about my form (given that hundreds of people were watching me), and I frequently made crowd-encouraging gestures -- but other than that, I was having as personal and individualized an experience -- feeding off of the energy, the rhythms, the infusions of truth and light expounding from my colleagues' mouths -- as anyone on the floor. It was powerful. It was wonderful. It was everything I loved about the Spinning program.

Then came Hour 5. The hardest part, cue-wise, was the first 1 minute 8 seconds. It was a dramatic instrumental intro, with a very specific and abrupt change in the rhythm that ABSOLUTELY needed to coincide with a very specific and abrupt phrase. "Absolutely needed to," of course, was a completely self-imposed (STUPID) construct. But it was important to me. When I practiced it over time (since NOVEMBER!), I'd repeat it at least 10 times a pop. No joke. 10x a day, maybe 2-3x a week, since NOVEMBER? Am I serious? YES. That's the sickest part. Dead serious. I'd nailed it maybe ONCE when I was practicing. Other than that, always off -- I'd either finish speaking too early or too late. Dead space during this creepy music would have been killer. The stakes were high -- artificially high but high nonetheless.

The room was dark. I was blinded by the spotlights. I heard my creepy piano chords, and took the deepest breath I'd taken in weeks. I asked my 100 riders to close their eyes; I couldn't see them do it, but I could feel it. I began to speak.

I've got good news and bad. The good news is: this is your hardest hour. You get through this, and it's smooth sailin'. Pause. Smile. Hear key creepy piano chord. I think I'm "on track," but have no idea. The bad news is... this is your hardest hour. I smile, ironically. I could feel smiles break out across the room. I hadn't screwed up yet.

It's not any physically harder than what you've done already. In fact, it's a bit easier. But it's mentally grueling. By Hour #5, you don't want to do this anymore. You're exhausted. Your feet hurt. You don't even remember why you started doing this crazy thing in the first place. But you had a reason -- every one of you had a specific reason you came out today. Key dramatic chord. Still "on." Nobody woke up arbitrarily and said to themselves, 'Hey, I'm going to go ride a stationary bike for 6 hours... just for the heck of it.'You did it because it meant SOMETHING to you. Many of you did it because every pedal stroke contributes to the lives of the Special Olympics athletes. Many of you did it because you saw it as a commitment to yourselves, your goals, your values, the very things you hold important. So here during Hour 5, my job is going to be to help you to use your mind clearly to reconnect with those values -- to reconnect with WHY you started this ride in the first place....

Oh no. I don't recognize the music. Where am I? Did I say too much? Is the transition coming? Ohhhhh no. Breathe. No, really, breathe.

... and, hey, while we're at it... maybe we'll have to go ahead and have a good time...."

BOOM. MUSIC CHANGE. BAM. Right there. NAILED it. Cannot believe I nailed it. No way. NO way.

And, just like that, the last six months were for something. I could feel a wave of calmness overcome my entire body. Everything was going to be okay. Not just okay; everything was going to be awesome.

Everything else went exactly according to plan. It was perfect. With every spontaneous hoot and holler from a rider (or two... or twenty!), I felt like my whole life had magically come together in this very specific moment. The music I'd selected, the themes/concepts I'd integrated, the profile I'd developed -- it meant something to me, and it so readily enveloped the crowd. It meant something to people. When I asked them questions, I got the most enthusiastic answers of which I'd ever dreamed. I'd go so far as to describe it as a "roar." A roaring crowd? No way. I felt like some kind of rock star. It was RIDICULOUS. Even in the moment, I was so mindful of how completely unentitled I was to be having this magical experience. This magical experience that I ate, slept, and breathed for the past six months. This moment of which's mere anticipation brought tears to my eyes -- whenever I played one of my to-be-used songs in a Spin class or in the car, sometimes I'd just be so struck with the powerful image
of what it was going to feel like. Of course, I had no idea what it was going to feel like. My brain had no way of wrapping itself around the concept of just how powerful this was going to be, to feel this intense external AND internal connectivity.

There were moments where I couldn't even believe what was coming out of my mouth. They were things I'd said before, sure, but never quite like this. They were the kinds of things I say and think -- and KEEP -- to myself about the way "one" might see the world, connecting with their deepest-rooted motivations and passions... the things that give one a sense of meaning and purpose, how to use the subtle opportunities to connect with and learn from that, how to apply it towards their self-development. Finding excellence in the details. Finding peace in the awareness, the control. Finding a place that is theirs, and nobody else's.

I joke often, citing experiences as "being in my element" -- big dance parties with DJs, waxing philosophical to cheesy techno remixes or booming ridiculous soundtrack music, motivational interviewing lectures. I had NO friggin' idea what "being in my element" really was until Hour #5.

But Hour #5 wasn't what I'd hyped up most. My big finish - the last 20 minutes of Hour #6, thaaaaaaaaaaat I'd really hyped up. I probably irritated my colleagues with how damned excited I was for this simple, no-big-deal finish. I'd done it with my classes at the tail end of at least three rides between January and present. Totally overhyped... and totally anticlimactic. I learned an important lesson: striking a balance between preparation and feeding off the subtleties of being in the moment. My obsession over details, perhaps even for the sake of the details alone, turned out to be pretty lame. Expectations management had failed. But that's ok.

Ironically, the best part of Hour #5 was the one part I hadn't planned. At the last minute (the night before), I swapped out the end of the profile (3 "surges" to a techno remix of Don't Stop Believin' -- Anthony's nose wrinkled while we were prepping, and I was embarassed!) In its place, I weaved in Tiesto's remix of "He's a Pirate" -- wove it into the tail end of the preceding climb, quick recovery, then 90 second surge to the end of the hour. Except in the moment, I was struck by the opportunity to do something really "me." I gave a fat-burning pitch! I asked the crowd who likes to burn fat. Again, the "roar." Heh. I challenged them to keep their heart rates where they could talk when they hit the surge. Maybe they did, maybe they didn't -- but it sure looked like most of the crowd stayed seated (and they hadn't been, before). Whatever. It was still pretty cool to be able to make a pitch for perhaps my #2 priority as a coach.

At the end of Hour #6, I played one of my favorite-ever songs (that I'd used once *completely unsuccessfully* in a Spin class), "Our Lives" by Lifehouse. I listen to it on the drive to school most days, overlooking the mountains -- and, no joke, get tearful every time. So I ballsily just WENT for it. On stage, the instructors linked hands. I called for the riders to do the same. And right there, 100 people, hands linked -- my cheese infusing through the speakers, images of Special Olympics athletes broadcasted on the walls.

I started crying.

I cannot believe I've been writing/ranting so long -- I haven't taken the time to reflect on ANY of this until now, really. So I'll wrap it up with perhaps the coolest part of the experience.

Yesterday, I sent an email to my UVM riders who had participated -- to ask themhow they felt, offer my assistance with anything troubling them, and to ask them a few questions about their experience. I was inspired to want to learn just as much from others' experiences as I could from my own.

I asked them about what they remembered thinking about at certain points, how they approached training, intensity monitoring, fueling/hydration, and what they took away.

I was BLOWN away by some of the responses I got.

* "This was the most invigorating experience of my life. I've never been so proud of myself."
* "I was surprised at how much control I had over my breathing - just focusing on breathing out longer than on the way in" (I got tearful when I read that; that's a "me" line).
* "When my mind wandered, I closed my eyes" (same)
* "I challenged myself to drop my heels a little bit lower, to breathe a little bit deeper" (SAME - OH my goodness. Really? Were people really coaching themselves with the very language I tried so hard to teach them?)
* "I tried to imagine what you'd be encouraging us to think about -- checking in with myself, my heart rate, my form..." (no joke... apparently they do.)
* "I was proud of myself for being able to keep my heart rate so low for so long."
* "When I started taking your classes, I sure liked them -- but I had no idea what this was all about until I was surrounded by so many people, feeding off so much energy."
* "I would look around, absorb the energy and the room, look up at the stage... and remember my goals. I'd find myself readjusting to a better intensity for me."
* "I was so proud of how I was able to push myself past my limits -- I was motivated to keep going... because I can."

While I was absolutely proud of what I accomplished both riding and co-leading on Saturday, my proudest moment of my coaching career -- and one of the proudest moments of my life -- has been watching these email responses flood in, and seeing what this experience has meant to the people whom I've tried my darnedest to help inspire THEMSELVES to accept this challenge and take stock of how it contributes to their personal and spiritual growth, their very self-concept.

No wonder I can't compartmentalize this.

Thursday, April 2, 2009

"You Are What You Think About All Day Long..."

One of my 2009 life policies has been that, if I have a thought that excites me, I will act on it within 12 hours of conception. Given my propensity to be distracted by the nonstop influx of stimuli that pelt me throughout my day life, let alone by the thoughts inspired by said stimuli, this life policy is essential.

It sounds crazy -- but already, look where it's got me:
* Started legit scientific investigation of the psychological effects of HR training
* Started new personal cycling/mindfulness coaching program
* For some crazy reason, I now get 50-100 hits a day on my Spinning blog -- most of which come from random far-off geographic areas, reflective of the fact that most readers have no personal relationship with me. This strikes me as completely crazy that this many strangers would want to take time to read about what's on my mind.
* I'm having the medical training experience of my dreams, as a direct consequence of instantly moving on a "good idea."
* I'm attending a super-valuable conference in Chicago next month, might actually have funding for it, and actually do get to see my former boss/mentor for the first time in a year, and a host of key life contacts.

A month ago, I decided it'd be neat to hold a panel of physicians to talk about practical considerations for discussing nutrition/exercise with patients. I decided I was sick of the usual bullshit: "You should exercise." Uh, what does THAT mean? Do any of them even know? It was completely unacceptable to me that my knowledge as a cycling coach would supersede my training as a physician. I should be learning more. It's MEDICAL SCHOOL. Not okay. People kinda poo-poo'd my idea for a while, and I got distracted by life.... until I took a step back and thought: Hey. This WAS a good idea. You really wanted this. It was important to you. Go. Do it.. So I did it. It was today. There were 50 people in attendance, and many approached me afterwards and said it was the best panel of their medical school experience to date. Symbolically, it was such a big deal to look around the room and see all these people gathered to breathe life into my idea.

To balance this somewhat grandiosely self-enamored sense of pride, I was really lame at the clinic yesterday. I was awkward and shy and stumbled over my words. I did make a treatment recommendation for a patient to my preceptor, who really dug it and actually prescribed it. Electric stimulation for chronic back pain. To see my idea on an actual prescription pad for an actual person was HUGE. But other than that, I was a huge loser. As much as I learn, I continuously am reminded of how little I know -- which undermines my self-concept of having any value in that context. I see myself, rather, as a "knowledge/experience leech" - not really contributing anything.

This may also be behind my blatant self-handicapping right now to develop my coaching cues for the 6-hour Spinathon I am co-leading in just over a day! I am petrified and anxious. Not in control of my element, mostly because I am also organizing many of the key logistics (i.e., the actual instructors, the actual programming, the music, all that... all of this can be dramatically screwed up!). I wrote an entry yesterday on Spintastic about my approach to fleshing out my concept for the ride. I felt okay about it, yet the self-handicapping continues. Too many half-baked messages and themes and fragments. Where is the confident appreciation of myself as a resource? For all the spurts of grandiosity, where are they when I need them?

My ride, in theory, is going to be about the power of self-talk. The idea that one is completely in control of one's attitude, the lens through which all experiences are processed and interpreted. The idea that by mindfully focusing on the processes in which one engages as one navigates the challenges of one's world, one can accomplish one's goal with fluidity, poise, and strength.

I am so aware of how cluttered my brain is right now. All the things I could say, jumbled together. I need to de-clutter. Need to reacquaint myself with the structure I have often been so good at imposing. I need to read my own words, need to inhabit them fresh. I need to re-experience their meaning. I have so enjoyed feeling like I have truly LIVED the stuff I talk about all day long in my cycling classes -- but I'm not living it now. I am in complete control over how prepared I feel. But, alas, I do nothing.

This experience I have hyped up for almost eight months... all of it will be over soon. It might come together in the moment -- but I need it to come together right now...