G2G continued, and Wow!

First off, I just want to say wow, and thanks.  My blog has gotten a record number of hits over the past few days.  I’m glad to have so many new readers.  I don’t know if someone put a link to my site on the Facebook or what, but I’m thrilled!  Welcome to my wild adventure of a life!

Without further ado, here is the continuation of my musings on the Grand to Grand ultra.

Stage 3

So this is the long day(s). Apparently we will be sleeping at our checkpoints which was a fact that I was not privvy to previously. I started out at checkpoint 2 and then the plan was to shuttle over to checkpoint 6 once all runners had been through. The day started with loading up the Mitsubishi SUV that Andy (the astrophysicist – who incidentally didn’t tie up the duffel bags properly and one ended up flying off on the highway; apparently some things do (don’t?) require a rocket scientist…) drove for the race. Our checkpoint was nondescript except for the fact that it had a picnic table situated in the shade. Which was chained to a concrete block – who the hell would steal a picnic table located 12 miles down a dirt road in remote Utah??? (Who the hell would steal 30 bagged lunches – movie reference anyone?) We had some time before runners would arrive so I started a new book about a family practice doc who enrolls in the military as a trauma doc when he is in his 40’s. I also got to take a hike up to a beautiful viewpoint. The lines of pastel cliffs never gets less awe inspiring. Andy was reading a book about quantum theory and I tried to wrap my brain around his explanation of string theory and other intimdating topics.  Turns out Andy is a super cool guy and was part of the experiement that discovered that there is water on the moon.  Not bad for a race volunteer…

Most of the racers looked pretty good coming through. We had the usual bane of my existence – f-ing feet. There were a few people who were pretty nauseous. And we had one gentleman who unfortunately had continued to take his blood pressure medications despite advice to the contrary and was, I suspect, quite hypotensive out on the course. He was dizzy when going from sitting to standing and his peripheral vision was starting to close in. After some rest, he was feeling better and wisely made the decision to DNF. Another very nice gentleman hurt his ankle and ended up dropping. He became a pseudo-volunteer the rest of the race to support his wife, and was always a pleasure to have hanging out at our checkpoint.  Because we now had too many people to fit in our already overloaded car, we had to try to make arrangements to get another vehicle to come out. Which is tough to do when no one has cell phone service or radio reception. We finally were told that there was a car coming but they wanted to leave our DNF runners alone at the checkpoint to wait!?! That seemed like a horrible idea to me so I stayed with them. We were picked up by a retired airline pilot who must have had dreams of being a fighter pilot when he was younger because he drove like a maniac. But we got everyone out safely and got to see some really cool off-road jeep trails. 
We eventually made our way to checkpoint 6. It was a beautiful vista of the cliffs in the distance. Our checkpoint was meant to sleep at so we had vast amenities: portable toilet, hot water, fire, tents, etc. Which was great for the runners but also took a lot of scrambling to get all set up. It was pretty relaxed waiting for the first folks to come through. It wasn’t until close to sunset that the leaders came striding in. The trickle continued until 3am. Thankfully we were delivered dinner and even firewood to help get us through the long night. Most people were exhausted but determined to finish. Maybe 20 racers spent the night with us. I finally laid down in the “on call” room around 1:30am. I spread my sleeping bag and pad out on the sand under the stars. The moon was incredibly bright and I could see the milky way scattered among the stars. Two shooting stars abruptly lit up the night sky. I think I finally dozed off for about an hour when Lindsey came trudging up from the previous checkpoint with the last runners. She laid out her bag next to me and was sleeping within minutes. I was surprised to wake up a little later with a very wet sleeping bag. Isn’t this the desert?  
   
 The checkpoint was bustling at 6am with runners trying to get themselves together enough for the next stage and the team trying to get packed up. After a little foot care, I was off to sweep. We left about 20 minutes after the final runners so we kept a hustle up for the next 6 miles. This was the sand dunes. Rolling red sand stretched as far as the eye could see. There was a particularly steep dune with tiny little footprints cut into it. It was hard work going through the sand and within 10 minutes I felt like there was a beach in my shoes. I took my shoes and socks off and hoofed it through the sand barefoot up and over and up and over again. It was one of those scenes where it was absolutely gorgeous and just so interesting to the eyes but the pictures just do not do it justice. It was great to see white styrofoam boxes at the next checkpoint which contained the makings of our breakfast burritos. There were two female races hanging out that were just a pleasure to hang out with. They had both made up their minds that they were going to finish, albeit last, and they were embracing their new position. We joked that they were definitely getting their money’s worth on that stage. We also came up with a brilliant idea for a running group called TIATB – The Idiots at the Back. They were cool and it was touching to see them walk into camp later.
 

That’s me!!  
 After the checkpoint closed it was back to camp. A pit stop was made to get water at a campground. Everyone was pumped about a shower but honestly, after a few days, the dirt and grime no longer really faze me. Plus I had no soap, shampoo, or conditioner ( a must for this girl’s crazy hair) not to mention any clean clothes so a quick rinse off was the best I could do.  Once I got back to camp (which had incredible views by the way), I was once again greeted with a full medical tent. At one point, I pulled my cot out into the shade next to the medical tent and tried to sleep but despite my exhaustion, it just was not happening. So it was back into the sweltering medical tent to continue to treat our runners. We worked through the evening with a quick dinner break. Luckily we were able to close down the tent early (by not turning on the lights, shhhhh, don’t tell) and we were closed for business by 8:30pm instead of 8:45pm. It felt absolutely amazing to put on my jammies and crawl into my sleeping bag. After 5 minutes of reading, I was fast asleep. I’m so glad to be through this long day.

Stage 4-
Finally beginning to feel that this race will indeed eventually end. The morning started early once again to the sounds of that song with the “hey, hey, hey” in it. Come on, you know which one I mean.  Another breakfast was provided by the cowboys and we hit the road. We had to stop at the gas station but unfortunately I had no idea where my wallet was so I reveled in having 4G internet service instead of getting any snacks. Our checkpoint was actually right below the highway and the entire day was accompanied by the shush of cars driving by. It seemed a bit out of place but it was quite the luxury to have phone service and internet all day. Checkpoint set up went smoothly and soon I was reading my previously mentioned really interesting book.

Runners started rolling in a little sooner than expected and for the most part everyone looked great. I think that once people get past the really long stage, they are mentally in a much better place. Everyone knows that they will finish. It would be silly not to really after going through the suffering of a 50+ mile run. The time at the checkpoint actually went by relatively quickly and then there was a big hurry to get ready to sweep. The last 3 runners in were either part of the “challenge” (shorter distance race) or going to stop at that checkpoint because they had previously DNF’ed. So we were about 45 minutes behind the last racer.

The sweep started with a tentative walk through a tunnel. It was blessedly cool and dark in the tunnel. It didn’t last long though and soon we were squinting and sweating in the blazing desert sun. We clambered up a rock face with the assistance of a rope and then walked uphill through the sand and rock and sagebrush. The trail turned into a deeper sand double-track. We went up and up and up. I hadn’t realized that the entire sweep would be uphill so it began to be disheartening to see red sand winding up ahead us at each turn. Every time that I am actually out on the course I always have a new respect for what the runners are able to power through.  The reward for the sore feet and quads was 360 views of craggy rock formations in shades from light tan to pink to deep orange. The relief I felt when I saw the next checkpoint was short-lived when I heard the shout, “Is there a runner in front of you?” Someone had been unaccounted for. After a lot of back and forth on the radio it was finally determined that there had been a clerical error. The runners in matched the runners out. But somehow in the confusion I got tasked with sweeping again. So my sweaty pack went back on and I went back out. I do love to walk though, I always have.  The sun faded into greys and blues over the horizon. The air cooled quickly. The sounds of camp came into earshot and I could not wait to sit, take my pack off, and dump the beach of sand out of my shoes.

   
 
  
The only good part about being out so late is that the medical tent is pretty much closed when you get in. So I only touched a record breaking one pair of feet today! Great success! Lasagna and garlic bread never tasted so good. Thank goodness for the cooking cowboys. There was a lot of witty but slightly delirious banter doled out in the medical tent among the docs before bedtime. I was so thankful to get to crawl into my sleeping bag. 2 more days left. I can make it. I think.                      

Stage 5-

It feels like we are on the home stretch here.  We had a nice little checkpoint today with trees and actual grass.  This place was going to seem like the Hilton to our weary runners.  It was another hot day but blessedly cool in the shade.  With a little TLC, all runners continued on past our checkpoint.  It seemed like the day just flew by.  Before I knew it, I was donning my pack and headed down the dirt road to camp.  It was a short (and flat!) section to sweep tonight and we came into camp as the sun was setting.  All that’s left is a mere 7.7 mile trek in the morning.  Then on to town where luxuries such as cold beverages, showers, flush toilets, and alcohol exist.  It is always so satisfying to be wrapping up another race.

   

 

Stage 6 – the finish!

Yay!  Another race on the books!  I had the pleasure of hiking to the finish with Jennifer Starling. 

  
 Jen is an ER physician based in Denver who has previously completed a wilderness medicine fellowship.  She is great company and I can’t believe my good fortune of having her as my co-medic in Cambodia later this fall.  We had a blast cracking jokes and taking pictures as we made our way to the Grand Staircase.  The hike was challenging but ridiculously scenic.  We never caught up to any runners since we were after the last (ergo fastest) wave of racers so it was pretty cool having the whole place to ourselves.  We were met with cold pizza and an empty cooler at the finish but that’s okay.  Soon we would be able to eat or drink whatever our grubby little hearts desired in Kanab.  I caught a ride to town with Andy and a few other volunteers.                

   
    
 Finally!  Back at the Best Western!  It was kind of a rush to pick up bags and shower and try to get somewhat organized before our big grand finale banquet.  But we got it all done and soon a group of unrecognizably cleaned up docs were jumping on the short bus to Best Friends Animal Sanctuary.  The dinner venue was super nice!  We all gorged on the awesome buffet and then danced it off to some bluegrass music.  Not a bad way to end a race.  After only a few days back at my apartment in Syracuse, it’s off to another adventure.  Stay tuned!               

Our awesome medical crew:              

   

  

 From left to right: Josh Mularella (previous Upstate fellow, medical team leader for G2G, has a great website to check out: expeditiondocs.com), Jennifer Starling (see above), me (duh!), Jenn Kruse (previous military doc, recently graduated from Upstate’s Emergency Medicine program, all-around awesome gal), A-a-ron Reilly (also previous military experience, completed the wilderness fellowship in NM, was always looking out for our medical team), and Lindsey Pryor (current (and best!) ER resident at Upstate, an absolute blast to be around at all times)                                                                                                              

Grand to Grand

Pre-Stage 1 – September 19, 2015

Well here I am at another race. I am lying on an army cot in a big tent with a whole crew of medical personnel. Grand to Grand is a multi-stage ultra that starts at the North Rim of the Grand Canyon and ends at the Grand Staircase. It’s a bigger race than I have previously worked at, with 126 participants from all over the world. It also seems to be the race that treats their volunteers/medical staff the best. We get the entire week catered for us, including sack lunches each day. We also get our large medical tent set up for us each day and there is even a generator which provides us with power and lights until 9pm each evening. Pretty amazing. Even more amazing is our medical team. There are 6 of us, and we are all Emergency Medicine trained. Half of us have completed wilderness medicine fellowships, and every single person here has done at least one major race previously. This is heaven! I am not responsible for every single thing, and I won’t have to see every single foot that needs blisters popped or taped. The town we started in was Kanab, Utah. It’s a sleepy little town that used to have a lot of Western movies filmed there. There are monuments all over town with movie stars of days past etched onto them. There are souvenir shops and dark little saloons. Very cool. The first camp is literally on the North Rim of the Grand Canyon. The views were unbelievable. I think that this course is going to be gorgeous. It should be a good week with good people.

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Stage 1 – Off we go.

The first stage started off with a dance. It was exciting to see the runners bunch up behind the start line in anticipation of the countdown. Tess, one of the race directors, had the music playing and was doing a boogy in the start corral. A good portion of the running field started off strong at a run. Then we had the folks in back who were planning on spending more time out on the course at a walking pace. I jumped in a truck with the finish line crew and we headed out to camp 2. The finish line was set up quickly and I also was set to work quickly when one of our volunteers struck himself in the face while setting a post. I hate to hear “doctor!” yelled out and I hate even more to see people running. But that’s exactly what happened. I rushed over to see a gentleman pouring blood out of his forehead. I quickly applied pressure and we got him over to the medical tent that had literally just been erected. This is when I realized that our medical supplies were seriously lacking (to put it politely). We had a ton of laceration kits but no sutures. So after scrambling around and fumbling through an entire box of supplies, I barely had what I needed to close up someone’s forehead. Luckily, the direct pressure had stopped the bleeding so I just had to get our volunteer sewn back together. One of the other volunteers was kind enough to give me his personal supply of stitches and I was finally able to repair the huge crescent shaped wound. I’m all about the “Macgyver” medicine, but at the same time, I prefer sewing with sutures not dental floss. But anyway, crisis averted.

The runners started arriving at the finish around 1pm. Most of the more elite runners don’t require much medical care. But then once the bulk of the field started arriving, our little medical tent started getting pretty busy. It started to feel like every single person who crossed the finish line came straight into the medical tent. I probably saw around 50 runners personally before we finally closed up shop. It was a lot of blisters, and muscle cramping, hot spots, and nausea. The usual racer complaints, just a whole lot more of them. It seemed like a lot of people really struggled to get through this first day. We had a total of 6 folks drop out of the race.

Lindsey, one of the current residents at Upstate Medical, came in around 9pm as the last sweep. She looked adorable with her backwards trucker cap and was lit up with pink polka dot flags from the course. Our cowboy cooks had made us a meal of stew and coleslaw. It is a luxury to have all of our meals taken care of. It’s also a luxury to sleep in these big tents with the cots. By the end of this race, I will have spent almost an entire month outdoors. Awesome.

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Stage 2 – Another 5:45am wake up call. We stumbled over to the food tent after cramming sleeping bags and other goods back into our duffel bags. Pancakes and bacon! I was at checkpoint 1 today so we left around 7am to beat the runners. Checkpoint set up went smoothly. Since this is a self-supported race, there is basically just a tent, chairs, and water at the checkpoint. The runners came to CP1 in droves.  There was an hour and 15 minute cut-off and one woman came in 5 minutes past the time and had to get pulled out. I felt bad for her but she seemed to take it pretty well.

After all runners were in, Mary (one of the volunteers, from Alberta, very sweet) and I started sweeping to CP2. This was supposedly the hardest section of the course – a steepish uphill stretch for 1.4 miles. It was a piece of cake. Apparently sheep hunting and climbing mountains in British Columbia is the perfect preparation for ultra racing…. One of the runners was really struggling about 1/2 way up the incline -we found him lying under a tree in the shade. He felt dizzy and nauseous but I think he was really having a hard time mentally as well.  I can’t imagine the difficulty of convincing yourself to keep going forward when you know you’ve got 150+ km to go. We trailed him the rest of the 5 miles to the next checkpoint. As we went, we pulled down all the course markings. We were unable to raise anyone on the radios and therefore could not let anyone else on the team know that we were going to be coming in way after the cut-off time. Our runner ended up stumbling in about an hour and a half late. Because of our tardiness, we were met with one of the local search and rescue volunteers. He was not amused whatsoever that he had driven all of the way out to the checkpoint when everyone ended up being okay.  Oh well, all’s well that ends well.

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We got a bunch of awesome products from Rock Tape prior to the race.  It’s the only tape that I’ve used in all different environments and it always stays on for days.  I even used it myself on our long hiking treks in B.C.  So we took tons of advertising type shots for them.  Plus we all just looooooove feet.

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When I got back to camp, the medical tent was bustling with activity. There were runners on all of the cots waiting for help with their….. wait for it…. blisters!  Dinner was great again. And we saw patients right until we closed at 9pm. It is so nice to get to hang out with the other docs while we are all in the medical tent.  It makes me realize how much fun it used to be working with your fellow residents back in training.  Don’t get me wrong, there wasn’t much fun about residency but at least at 3am in the trauma bay, you had someone to goof off with. Here’s a good example:

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I had a hard time falling asleep which doesn’t bode well for our 30 hour day tomorrow.  (Stay tuned for the continuation of my narration of the Grand to Grand race.  The long stage is next…)

British Columbia – Off the grid

So as promised, I wanted to share a recent trip that Nick and I took.  We went to the wilds of British Columbia, and it was absolutely incredible.  I have never been in such a remote area in my life.  It was so far out there that it took us an 8 hour horseback ride, and 2 float plane rides to get out of there.  We spent about 2 weeks in this gorgeous area.  We climbed peak after peak, and each time that we came to a summit, there was no signs of man as far as you could see.  Or in other words, this was paradise for a girl like me.  We landed on bodies of water that looked too small to call a pond, let alone land a SuperCub on.  We rode in a pack trail of horses during the day and cooked dinner over the fire at night.  One night when I got out of my tent, I was startled to look up and see the earth trying to stream up into the heavens.  An eerie blue light encased me, and in wonder I realized that I was seeing the Northern Lights for the first time in my life.  I will carry the memories from this adventure with me forever.  Instead of trying to capture this trip in words, I figured that I would let some photos speak for me.  They are surely more eloquent than any words that I could string together.

     
    
    
   

   

Sorry!

I am so sorry dear blog followers!  I know that I have been a total slacker and have not written any updates in quite some time.  Well never fear – you are about to become inundated with blog posts!  But let’s start with what I have been up to.  It hasn’t been all wilderness medicine fun and games.  It was mainly a lot of working shifts in the Emergency Department and editing papers that had already been submitted (the decidedly less fun and grown-up part of the fellowship….).  I did just get back from an incredible backcountry experience but I am keep you in suspense until an upcoming dedicated post about the adventure.  

And now for something completely different.  I worked a shift at the New York State Fair at the end of August. That was quite the experience.  There is a ridiculously nice infirmary on the fair grounds and I spent an interesting 12 hours there.  The morning started off slow with a trickle of fair workers (is Carnie politically correct?!?) who were getting basic primary care medical needs met.  Then the day was off and running with a rash of folks feeling light-headed.  I guess fried dough and wine slushies are bound to eventually get the best of any of us.  I was able to take a little time to roam the fairgrounds, hence the cow selfie that you see below.  But the highlights of the day had to be the rollercoaster crash and the stabbings.  Unfortunately I can’t comment any further on either of these (as I had to tell the news reporter as well), but let’s just say that working the fair definitely met all of my expectations.

   
   
In other news, I was able to get another article published!  It was a quick blurb to the editor of the Wilderness and Environmental Medicine Journal regarding treatment of a runner at the Bhutan race.  One of the proven treatments for altitude sickness is a medicine that is a diuretic (it affects your kidneys and how your body maintains its water homeostasis).  It is tricky to balance the benefits of helping someone who feels sick at altitude with the risks of possibly pushing them to become dehydrated.  It’s a topic that could definitely use further and more detailed review in the future which I will have to tackle some day in the future when I can actually go more than 2 days without an airline flight.  But I was just super excited to get another publication.  I’ve still got 2 more articles in the review stage at other journals so continue to cross your fingers please!

One more update: Nick and I are training for a marathon.  This will be my second and his first full marathon.  It is in November in Las Vegas (of all places).  I hope to eventually complete an ultra so hopefully this commences longer distance training for me.  Here is our training schedule, it is geared towards the beginner runner:

  
So that about sums up my last 2 months.  I had also been working in the ER like crazy, trying to build up my hours given all of the travel that I do.  I know that this post was pretty brief and disjointed but stay tuned…. As I have said before, things are about to get exciting again.

Mom, Amy & Plane selfie:

  
I’ve got to give her a shout out – she is by far my most dedicated reader 🙂 And also recently discovered the awesomeness of the selfie
   

   

I did it!

So way back in March, I had posted about submitting my first paper to a peer reviewed journal.  Well ladies and gentleman, 4 months and several edits later…. my paper has been accepted!!!  After an initial rejection from the Journal of Ethnopharmacology (boo), the manuscript was eventually accepted by the Wilderness and Environmental Journal.  I’m super pumped!

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As an aside, here a few photos from a recent trip down to Hershey, PA.  It was a perfect mini summer getaway.

There was a huge difference in visibility on the flight down versus the flight home.  The flight down involved being “in the soup” where you can barely see the wing tip.  But we were rewarded with gorgeous sunset views on the way home.

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We rode every single roller coaster at Hershey park.  Some day I’ll make jolly rancher….

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Breck

I just got finished with the Wilderness Medicine Society (WMS) summer conference.  It was paid for by my program (sweet!) and took place in the mountain town of Breckenridge, Colorado.  Which is both a blessing and a curse – the more fun the conference location, the harder it is to make yourself sit through the hours of daily lectures.  But sit through the lectures I did, and I was happy that I was able to force myself to keep my behind indoors.  There was an assembly of lecturers from all over the country, many of which were experts in their field, who talked about topics from the earthquake that shook Mount Everest to Ebola.  I felt like I learned a lot, and also had a good bit of fun as well.  This was also my first time giving a presentation at a national conference.  Although it was only a very brief overview of the research I’ve been performing at some of the recent ultra racing events, it was still pride-incuding.  Here’s me in action:

  
As alluded to previously, I also got out and enjoyed the fresh mountain air.  There are a ton of beautiful trails in this area, and one of them started right out of the back door of the hotel.  Although I don’t tend to get altitude sickness (the altitude at our hotel was 9,600 feet), I did find myself breathing especially hard when climbing very slowly up the Burro Trail.  But I was rewarded with lush groves carpeted with wildflowers and a blazingly fast run back down.  

   
 
The last day in Breckenridge was particuarly awesome.  One of the lectures was about building a medical kit, and I learned an incredible amount of tips and tricks.  As my regular readers know, I am always obsessing over gear – both general outdoor gear and medical.  The speaker was also very helpful when I approached him after the talk regarding finding malpractie insurance, etc. once my company gets going (fingers crossed!).  The afternoon found me on the tippy top of the ski resort.  After a gondola ride and a high-speed quad chairlift, I was at 12,998 feet.  I had a nice, easy jog all the way down to the base area.  The views from the top were truly stunning, and I thoroughly enjoyed each step of the way down.  I wish my little red man would have been bounding down in front of me, but he was there in spirit.

View from the top:

   
  This is Jacks and I after taking his first gondola ride in Aspen.  Circa 2004. 
One of the highlights of the past few days was getting to meet Rich Levitan.  For those of you not involved in the medical world, you will not get me getting star-struck in a dorky way about this man.  He is a world expert on managing the airway in ER patients, and I am convinced will change the way we manage patients.  He is also a heckuva nice guy.  Turns out we also have a lot in common – he now lives about an hour north of where I used to live in New Hampshire, and we both have a love for the tiny remote Emergency Department where there is no help or back-up.  Talking with him made me realize how much I miss working in a rural ED.  My job before this fellowship involved 48 hours a month working in the 8-bed ER in the town that I grew up in.  I miss my nurses (who I am convinced could probably take care of some patients better than I could).  I miss my incredibly grateful and personable patients.  I miss having people see my name written on the white board in their room and having them start a conversation with: “Does your Dad go to Holy Hill church?” or “Did your family used to live in Erin Meadows?”.  Working alone for 24 hours at a time in an ER that saw it’s fair share of sick patients taught me to grow up real fast.  Or as I like to say – it taught me how to put my big girl pants on before going to work.  Don’t get me wrong, I love the adrenaline rush of a gunshot wound to the neck in the middle of the night at one of the big trauma centers.  But there is something about taking care of someone who knew you when you were in kingegarten that it satisfying and career-affirming.  Or having a family thank you for saving their son’s life at a Christmas pageant.  That is why I wanted to practice medicine.  Not for the glory or the appreciation, but for the tangible sense that I am actually helping people.  It is nice to realize that the 14 years I spent getting to this point wasn’t a waste. So it was cool to meet Rich, but even cooler to remember that even on the worst day, my job matters.  

RATS 2015

Desert RATS is my first US multi-stage race and it is already winding down. You might think that Colorado and Utah would be less spectacular than some of my more exotic sounding travels, but this is not the case at all. The scenery of the Southwest is so varied but consistently vast, and majestic, and grand. Sprawling, green cattle ranches abut steep, red sandstone cliffs which sharply transition into rolling alpine. The heat permeates the air in waves and the breeze doesn’t cool down until well after sunset. This is the desert, and it is awesome.
  
Stage 1
The staging of the race occurs at the Gonzo Inn in Moab, Utah. This is a funky motel in the heart of this funky town. Race check-in goes smoothly. I am used to the routine by now: check runner’s pre-race medical clearance forms, race and medical briefings with runners, staff meeting, try to get to bed early to bank some sleep before the long race week.
I sleep really well in the plush hotel bed, and it’s a blur of activity in the morning as racers and gear are loaded up and driven far into the desert. The field is small at this race – only 16 runners. After rushing to the start, we then rush off to our respective checkpoints. It’s ungodly hot at the random corner of nowhere where the checkpoint is set. A surprising amount of work goes into setting up. There is a large tent to try and erect, and then stake down. There is a table to open up and find a place in the shade for. There are numerous plastic jugs of water to slide out of the tailgate of the car. Then for the grand finale there are at least two tupperwares of food, sunscreen, bug spray, hand sanitizer, and cutting boards to organize out on the table.  And finally the camp chairs to also find a place for in the shade.  Anyway, we had an hour or so to sit in our desert palace before the first runner breezed in. The leader seemed to make the heat and distance inconsequential. We started getting radio calls that folks were lost out on the trail. So resources were mobilized to try and find them. Except for the lead runner, most everyone else was hot and miserable. Participants trickled in throughout the day, and finally our sweep (volunteer who folllows the last runner on the course) on his fat tire bike rolled into our checkpoint. All runners had been herded through at this point, and it was time to start breaking apart this monstrosity of a coddle-station, oops I meant aid-station.

  
 Our first camp was just a square of desert in a sandy parking lot. But lots of effort had been placed into making it feel like a home away from home – large shade tents had been erected with camp chairs strewn about, there was a camp kitchen set up, and hot food was waiting. I set up my brand new tent for the first time. And after a brief comedy of errors, I had a quaint little shelter. I had settled on the Sierra Designs Flash 2 after obsessive gear hunting, and have been thrilled with it. My peaceful sleep was interrupted with the patter of drops on my rain fly. The natural lullaby soon turned into a torrential downpour complete with wind gusts and flashes of lightning. The thunder got more intense until I was nearly startled out of my sleeping bag when the the sound reverberated through the canyon almost simultaneously with a blinding crack of light. Eventually the storm subsided and I was left with both wonder and a little fear. And I was also left questioning why the hell I didn’t get out of my tent and into my car. I figured it would be a pretty big faux pas (and incredibly ironic) if the wilderness medicine fellow died of a lightning strike while on a wilderness medicine trip. Interestingly enough, I read part of the text book chapter on lightning the next day at the checkpoint, and I found out that I am a believer of a good portion of the myths that exist regarding this interesting natural phenomenon. Apparently lightning is not actually attracted by metal objects. And you are safe in the car not because of the “grounding” effect from the tires but actually because of the Faraday cage created by the car’s metal external structure. It was an eye opening chapter. And also humbling to realize that I was in the majority in terms of people that have absolutely no true understanding of lightning or the injuries that it could potentially cause.  

Stage 2
So day 2 started bright and early. We rode out in tandem to another aid station out in the middle of nowhere. We had absolutely no radio contact or cell phone service all day – communication black-out. Which is really goooooooood for races where you need to know how racers are doing medically and in the case of possible evacuation. Some racer decided not to go on and slumped down under a tree, so we had to drive out in the desert to get her.  Thankfully this runner ended up being totally fine medically.  Everyone was once again pretty hot and miserable when they came through the checkpoint but there was a lot of determination to finish. Not a single racer dropped out at my station.  After we were down to one racer still out on the course, I went for a walk with Reid, the race director. It was nice to at least stretch my legs and see a part of the course. What the runners have been experiencing is certainly beautiful but also hotter than Hades. It was finally time to get back to camp and set up my little tent. By the way, my rental Chevy Impala ended up being an off-road beast! But seriously, it could get anywhere that those little subaru station wagons could….  You can see it looking strong in the picture below of our aid station.

  
Stage 3
Today was a good day for the runners. It was a much shorter distance and everyone seemed to be in good spirits. It is amazing how quickly people start to acclimate to the excessive heat. I noticed the same thing at races both in Cambodia and in Sri Lanka. Day 3 always seems to be when people start to actually race rather than just try and get through the suffer-fest. It was joyful to witness the runners cross the finish line with big, goofy grins.  Once people are past the finish line, I think it is really important as a race physician to kind of always be watching from a distance. This may sound like I’m bordering on creepy stalker territory but it truly is an important tool to truly assess how folks are doing. If no one knows that you’re watching, they tend to exude the actual degree of their suffering – not the degree that they want everyone to believe (or pity them for). I have seen so many individuals really suffering, but then put on a brave face when I put a hand on their shoulder and check in with how they are feeling. On the flip side, I also see racers wandering around, doing quite well handling their own business, who just crumple when I enquire about their well-being. It’s just like the ER though – sometimes you have to watch someone while hidden in the doorway before you really get a handle about what’s going on.  
Our camp was really neat after this stage! We were right on the Colorado river, and were able to take an icy cold dip after everyone was safely into camp. The water was so cold that I literally had a hard time getting a full breath in after fully submerging myself. A few staff members along with one of the racer’s husband a racer went for a hike up along one of the many ridge lines. We were rewarded with amazing views as well as a renewed empathy for the heat that the runners were experiencing each day. 

   
 
Stage 4

“Expedition stage” aka ultra day. It ended up being a 19 hour day in total, with about 14 hours spent at the aid station. One of the first things that we noticed as we were getting the aid station set up was the fact that there were cows all over the place. They must have been free range the majority of their lives as they were extremely startled to see us. I guess it was a little extra company though throughout the day. Due to the lengthy nature of the day, I ended up taking several walks. Most of the time it was just wandering 15 minutes down one of the dirt roads, and then meandering back. I tried to go for a little run as well. Partly to offset at least a portion of John Graham’s amazing camp cooking, but also because I had to get the ants out of my pants. As mentioned previously, one of the runner’s has her husband, Peter, here with her. Peter was an awesome support crew – it is really wonderful to see that level of support for your spouse. Plus, he is just a ton of fun and incredibly generous. When he would show up at our aid station, we would be treated to good music, cold cokes, and hilarious stories.  
  
It was an incredibly long day for the runners. I was worried about how people would fare in the heat. With the serious race medical issue, hyponatremia, sometimes you have to worry about the slower runners. These individuals are out on the course much longer than other participants meaning that their water consumption is likely going to be much greater. However, it is thought that with their overall slower pace, these runners may be consuming too much water for their level of exertion. I also worried that the heat in general would prove to be a major obstacle to those trying to conquer this long stage. I was pleasantly surprised with not only the degree of health of most of those passing through, but even more so by the racers’ spirits. Everyone was determined to finish and somehow also happy to be out on the course. What amazing mental fortitude is possessed by distance runners….

We drove back into camp well after dark, but there was hot cocoa and grilled cheeses waiting for us! One of the runners, Gene, offered out a little tutelage regarding some of the constellations, and I learned a lot about the universe in general. The milky way was visible this far out in the desert! I am not a touchy-feely kind of gal, but it was really emotional to watch almost all of the runners stay up to cheer everyone in. You would see this tiny head lamp from far away, and the cheering and cow-belling would start. What a wonderful accomplishment! I actually got goosebumps when a group of 3 women skipped across the finish line after a trying day together. 

View from camp:

  
Stage 5 (Rest!)
Today was a designated rest day for the runners. We were supposed to have a late start but unfortunately it was way too hot to sleep in. My tent felt like a sauna when I finally stretched and opened my ways. A lazy morning ended in an insanely awesome camp brunch. Bacon and breakfast quesadillas and salsa-poached eggs, oh my! I went on a happy little hike with my fellow race doc, Kai,  and one of the racers to a set of tiny waterfalls. I can’t even describe how cold the water was. Maybe this picture will do it some justice:
  
Most of the Desert RATS entourage spent the afternoon at the river. There was a tent set up where racers could get massages and we also had a mini food and beverage tent. It was pretty relaxing (and awesome) to just wade around in the river. We were shuttled back to camp where we had our last camp dinner.  There was a slideshow put together by the racer director’s brother after dark. There was a lot of laughter and joking while the pictures flashed up before us. It was good to see there finally be some camaraderie between this group. I am so excited to go to bed. Last night out in the desert! Tomorrow we return to civilization in all of our smelly glory!!!
Stage 6 (Finally)
Last day – whoop whoop. We had absolutely incredible views from our checkpoint this morning. What do you think – not a bad view from my office….
  
I was really touched today by one of the racer’s determination. This is a woman who has been extremely fit and gifted in racing her whole life. As she has gotten older, you can feel her frustration at not being able to compete at the level that she used to. On this particular day, she not only took a fall out on the course but also got lost as well. She was nearing the cut-off time for this stage, but refused to give up. She passed the cut-off time for this stage, but refused to give up. I went out on the course to check on her, and she was all blazing will and tears of frustration but still with a steady gait. I let her finish her own race, and made sure to meet her at the (already torn down) finish line. I hope that 30 years more now, I have half of that level of fitness or determination.

I drove my dusty rental car back into Moab, and checked back into the Gonzo Inn. The shower and subsequent air conditioning felt incredible. I don’t think you can truly appreciate how good a shower feels until you have spent 6 days sweating in the dust and heat with numerous applications of sunscreen and bug spray. The obligatory racers’ “banquet” was soon followed by drinks at a “dive bar” (funny, where I’m from, most dive bars don’t have a cover charge…), but then it was finally the moment I had been waiting for – Bed Time! Another race trip completed. More sunburns sustained and more friends made. Stay tuned for my next adventure!
  

Get ready, get set, go!

Here’s the final installment on the Bhutan race series.  Enjoy!
It’s race time. I’m trying to keep my eyes open long enough to at least record a few thoughts and memories I would like to keep from the last two days. It is already the night after stage 2. Stage 1 went really well. I had a lovely checkpoint that I shared with Laura in a little open air shack by a large suspension bridge. Prayer flags fluttered in the breeze while white water rafters hooted and hollered down the river. A handful of people were struggling with the altitude which was odd since we were well under 2000 meters. I think people are starting to think themselves sick with thoughts of altitude sickness. Our camp after stage 1 was at a monastery. It was so sweet – a few of the monks would come and talk to me. Mainly to practice their English but maybe also as a small window to the rest of the world. We were invited to take part in one of their sacred Buddhist ceremonies. It was so cool! And I was so thankful to get that opportunity. In a small, elaborately decorated room rows and rows of monks rocked and chanted. There were statues of Buddha – past, present, and future. The incense and the chanting made for a very unique experience. I won’t forget it anytime soon.

 
The medical crew  

  
Today was physically very challenging. I think that the ADK winter school was actually a little more difficult but this was no walk in the park. It was 29 km with an elevation change of roughly 2000 meters. I starting walking with my medical kit about an hour before the runner’s start time. There was no vehicle access on Stage 2, so once I started walking, there was no way else to go except up… and to the finish. The dogs from the monastery walked with us, and ended up following the first runner all the way to our camp. We walked through step cultivated fields, and thick jungle, and mud, and tiny villages. But most importantly – we walked up. Roughly 14 km straight up a mountainside. I fell twice because the rocks and mud were so slippy. I was exhausted the first bit of the climb but finally fell into a rhythm. Just like with the winter school, once I started getting enough fluids and food into me, my legs finally had a little get up and go. There were leaches everywhere! Apparently they sit on rocks and in trees, and fall on unsuspecting travelers. Really… heat seeking flying leaches!?! I had a giant one on my wrist. I am embarrassed to admit this, but I squealed just a little bit like a girl. Oh well, not my finest hour. We got stuck behind a bunch of cows on the trail, and even got charged by the bull of the group. I felt like the climb would never stop, but it did. And then came the 10 km of straight downhill. It went well though. I felt happy while walking despite the physical struggle. I feel proud of this body that propelled me up and down a mountain. I also feel humbled by the course.   

  
Stage 3 was another tough climb. The course ends at a very sacred monastery that stands at 3,600 meters. There is no car access to this holy space, so everything has to be carried up and hauled by mules. We walked from the last point accessible on the road and it was a roughly 4 km climb. The path was steep and rocky. This day was the auspicious day that the Buddha was both born and died, so the trail up was covered with pious Buddhist pilgrims headed to the monastery. There was a celebratory atmosphere with family groups stopping often for tea with traditional music blasting from tinny portable speakers. We were offered refreshments more than once but we had to make it to the top before the runners started streaming past. I figured if elderly women in long skirts and plastic sandals could make the climb, I really should try to tone down my huffing and puffing. The view from the top was gorgeous! And the monks were much friendlier than expected. I spent the entire day at the finish line as Erin could not make the climb up. There were no major issues thankfully. I had treated a few cases of altitude sickness the night before to prevent problems at our high sleeping altitude. The runners played a soccer match against the monks which seemed to be the highlight of everyone’s evening. We lost. The monks took the match quite seriously and you could tell that they had been practicing. Guess what was for dinner again???? Rice and vegetables. Just like every other night. I have never had to eat the exact same thing over and over again before and it is a bit of a struggle. I hate to complain because the staff is so great, and it’s wonderful that we have food catered for us. But….. I have been forcing myself to eat at every meal because I know that I need the calories but it’s getting tougher and tougher. Good thing that I never travel anywhere without massive quantities of snacks. The buffalo pretzels, goldfish, beef sticks, and fruit snacks have been irreplaceable. After dinner, it was an unbelievable view when the moon came out. There was a pale, full moon peaking in and out of the clouds perfectly framed by mountains. I tried to take a number of pictures but of course it did the incredible setting no justice. We slept in a small classroom on the floor. It was cold but I was happy to finally take my sleeping bag out of the compression sack. I slept like a rock!

   
     5:30am of Stage 4 had me getting ready to get out on the course. I walked down 11+ km to checkpoint 1 with one of the local guides. It was a gorgeous walk. I could not have been happier to be on the trail in the early morning. The first few km were still a climb and my legs were wailing their protests. But then the trail meandered through a meadow and then a steady downhill trek through virgin forest. I chatted with my guide, Kinzang, most of the way down. I learned a lot about both Buddhist and Bhutanese culture. A few of the runners passed us and were in good spirits. This walk has created a lot of happy memories. At checkpoint 1, there was a little fire by a stream. This is such an unspoiled and beautiful country. One of our runner’s was having a problem with mentally tackling the distance but decided to continue on for one more checkpoint. She ultimately dropped out but I’m glad that she showed herself that she was capable of going farther than she wanted to. The drive to our farm camp was horrendous. We were stopped for at least 30 minutes on the road while an endloader completed a construction project. Then the winding road coming off the mountain commenced. Stefan kept telling our driver that he was too slow which made for tire squealing turns around blind corners in the other lane. Gooooooood. Cows and people vied for space on the blacktop as well. After several white knuckle hours, we arrived at a dingy and fly-ridden farm house. A dimpled toddler showed off for his guests with his coke chugging antics. It was touching to see all of the runners wait to eat their dinner until our last racer made it in. We made a little tunnel for him to run through. I love the camaraderie at these events. Dinner was more of the same…bleh. I was exhausted after dinner and my little spot on the floor felt like a small semblance of home when I crawled onto my therma-rest. Two more stages with tomorrow being the long day. Almost there.

   
   Thankfully the long day went smoothly and was not quite as long as expected. The runners started their ultra in two separate groups. We all kind of dreaded yet expected a finish in the dark. I was at checkpoint 4 along with Laura. By far, the filthiest checkpoint of all of Global Limits races. We shared a small space of concrete with the flies, the garbage, two town drunks, and lots of dogs. The one bright moment of a very long and hot day was getting some local dumplings with extremely hot chili sauce. The runners came through quickly and in high spirits despite the intimidating distance of the day and the heat. Stage 5 ends at the ruins of a Bhutanese fortress. It was a tight cork-screwing pass that allowed one to gain entry to the finisher’s circle. There was not much to see at the ruins but it was a peaceful place to pass away a few hours. At least the fly population was slightly more moderated. After all runners were in, it was clinic time. Despite just a small distance to complete in the morning, there was a lot of requests for medical assistance this night. Strained ankles, abrasions, black toe nails, muscle soreness, chafing, gurgling stomachs, and the ever-present blister. I was happy to comply with requests as all of these racers were just one day from being finishers.

   
   4:30AM came early on the last day. It always does. Krista and I picked up Hellen, one of the racer’s girlfriends, so that she could see the grand finale. The luggage truck ride up the mountain was hair-rising to say the least. And it seemed that the more we squealed, the more the driver laughed and jammed his foot onto the gas. We made it to the parking area with some vertigo but otherwise unscathed. It’s about a 4 km walk up to Tiger’s Nest – an extremely holy monastery and religious site for the Buddhist religion. It was a hell of a climb… like usual. The views of the mist in the surrounding mountains was breathtaking. And the view of Tiger’s Nest, which looked to be about straight up, was intimidating. We got into a traffic jam on the way up as one of the most holy Buddhist Tibetan monks was visiting for the day. Unfortunately this individual is wheelchair bound therefore a team of younger monks shouldered him, literally, up the narrow and steep path. Throngs of pilgrims shuffled in their wake. We finally reached the finish area and began to get ready for the first runners. I still never manage to avoid feeling emotion as each person that I have cheered on all week crosses the finish line. Some runners are nonchalant about their accomplishment, others break down into hugs and cries. I am always thankful to be part of this little world. Congrats team!

   
 The day and a half after the race is over is truly to be savored. We are staying at a 5-star hotel outside of Paro. The imposing grey stone structure is covered in beautiful and colorful carvings. There is even a spa! Laura and I treat ourselves to a relaxation massage and I can’t remember feeling more relaxed in my life. There are no flies here, toilets to sit on, cold drinks to be had, and beds! Luxury! The ending ceremony is touching but seems like a stepping stone until everyone can head out downtown to truly celebrate. My comment – I can sleep when I’m dead, when I’m in Bhutan I karaoke. Manu commandeered us a party bus and the vehicle was totally full and blasting early 2000’s hip hop as it pulled away from our hotel. The karaoke bar unfortunately was having technical difficulties but we were able to find “Club Insomnia” where our crew took over not only the dance floor but behind the bar area as well. Another rowdy bus ride found us exhausted and back at the hotel. What a perfect way to end a difficult week!

   
     There is no rest for the weary…. I leave in just a few days for another multi-stage race. I don’t need my passport for this one as it is in the Western US. Check out Desert Rats to get a heads up on what I will be up to next. (I’m already here by the way, sorry, I have gotten behind on my blogging)
Thanks for reading! And thanks to all the runners for sharing a small piece of their impressive running lives with me. It is always a pleasure to take care of you.

Pre-race musings… and jitters 

I am home from Bhutan and it was amazing!  I always try and keep a travel journal so that my thoughts regarding my trip maintain somewhat coherent.  Enjoy the next installment of my Bhutan series.  
So the race will start tomorrow morning. Snugged up in our tent with the soft rain falling, it feels like the last shred of peace before a week of worry and hard work. I love working these races but I feel like I am on edge until every last runner is safely stepping into the hotel lobby after the last stage. I just fixate on all of the serious medical problems that could pop up. And if and how I could handle them. But I guess I shouldn’t worry so much. I would get myself all worked up before my Hartford shifts but it seems like thinking of what could happen is much worse than dealing with what actually does happen. (For my readers’ reference: Hartford is the small town that I grew up in. Hartford has a hospital with an 8 bed ER where I would be the sole physician for 24 hours at a time. At night, every other doctor would be home in their beds, and so any scary badness of a medical emergency would become my responsibility…. I actually looooooved working there.)
We went to an amazing sight today on the way to the first camp, Punadkha Dzong. A dzong is a distinctive type of fortress architecture found in the Tibetan Buddhist kingdoms of the Himalayas. This particular dzong was surrounded by a small moat. Crossing the bridge gave a very nice transition to entering the grounds – it made me realize that now I was crossing over into something special. Fragrant blossoms rimmed my view of the ornate woodwork of the structure’s roof. We climbed steep stairs to enter into the fortress and were met with the patient determination of an elder monk who was chanting and spinning a prayer wheel. What struck me the most was entering the temple of the fortress complex. It was the hushed quiet one typically experiences in a soaring Catholic church with the addition of monks in crimson robes murmuring on the benches. There was a large Buddha sardonically grinning from high in the center of the shrine with many other golden statues flanking him. I made a clockwise circle around the perimeter of the temple and was struck by the intricate detail of the 100’s of religious statues. But up where the Buddha sat is where I was really overwhelmed with the space. There was a statue standing guard on Buddha’s left that seemed like he was looking right at me. Just seeing all of the jeweled religious artifacts made me overwhelmingly thankful.  I think that you have to step outside of your regular life and into the exotic sometimes to be truly mindful and grateful. Maybe there are people who are just better at that sort of thing on a regular basis in their comfortable old environments, but for me, this is where life really begins to unfurl.  

   
   

Travels to Bhutan: the Last Secret

On the Road…. again

The following is a little traveler’s log on my way to the next race, Bhutan: the Last Secret put on by Global Limits.

  

I’m once again on an incredibly long intercontinental flight. Feeling incredibly sluggish after waking up from a fitful sleep. I was working nights before this trip and I can’t tell if my upside down sleep-wake cycle is going to be of benefit on this trip or not. Right now it feels like not. I took the same 7am flight to Philadelphia as I took a few months ago when I traveled to Sri Lanka. And now I’m on the same flight to Doha on Qatar Airways. A traveler’s ground hog day if you will.

I do have a traveling companion this time, Erin. She is the EMS fellow at Upstate Medical. She has already been on a few races throughout her fellowship so it will be really nice to have an experienced medical team. I’m looking forward to this trip – I haven’t even been able to imagine what it will be like in Bhutan.

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Qatar to Bangkok was uneventful. It was another 6 hours in the air. I tried to watch a movie but ended up falling asleep. It was strange to be served breakfast after not sleeping much over the last two days. But it was a delicious “Arabic” breakfast, so not really breakfast-y at all. We landed in Bangkok around 7pm. Getting through immigration and customs was surprisingly easy. I wasn’t sure if I should declare the medical equipment so I asked one of the customs officers. I think I confused the poor girl so much that she just waved me through. The hotel was literally a 5 minute shuttle ride from the airport. Once again, my travel agenet, Steve Turner, did a phenomenal job. The hotel was much nicer than expected and had a restaurant in its lobby. I do feel like eating in hotels is slightly cliche, especially when visiting a new country, but after almost 24 hours of travel, it was about all I could muster. I had an excellent dish of Pad Thai and it was finally time for bed. The soft bed felt delicious but unfortunately I was wide awake at 3am with subsequent tossing and turning until it was time to head to the airport. Finally, the last leg. The approach into Paro, Bhutan was everything I thought it would be. At some points in the flight the mountains sloped away and above the aircraft. The plane made steep s-turns to stay in the valley until finally descending onto the short runway. The airport is a beautiful wooden building with colorful carvings along the roof-line. I’m excited to be here.

The ride to Thimphu from the airport was absolutely gorgeous. The mountains rise sharply from the road and are covered in velvet green and sharp Cypress trees. Every building is a picture of neatness with immaculate paint and ornate carvings. Dogs line the roads and small families picnic at picturesque viewpoints. The hotel is very nice with high ceilings and hard wood floors. Lunch felt like a Cambodia runner’s reunion with a buffet lunch that managed to be bland yet spicy. We were taken on a short sight-seeing tour that included several holy/prayer grounds, a giant Buddha on a hillside, and a zoo that featured the never heard of before (at least to me anyway) Takin. The Buddhist sites have numerous prayer wheels that bent elderly Bhutanese with betel stained teeth continuously spin on a clockwise rotation. Tents are set up where more fervent devotees sit and pray. We were able to walk into one temple where monks were frantically handing around boxes of chips and other snacks. According to our guide, the food are brought as offerings to the gods. After the foodstuffs are blessed, they are then passed out, and those who have been devoting their day to prayer now have lunch. Eerie chanting accompanied the spinning of the prayer wheels and burning of the cypress oil, leading to an overall very mystic experience. So different. So interesting.
  
One of the small structures that houses prayer wheels.

This one should be pretty self-explanatory.  He’s over 100 feet tall!

Laura and I at the Buddha statue.  I was lucky enough to work with Laura both in Cambodia and Sri Lanka.