Some years ago, I was a post-call intern at UC Davis Medical Center. I had been up for about 30 hours in a row, but was hoping to get out for a quick bike ride on the American River bike trail in downtown Sacramento, near where I lived. I called up a fellow intern, and headed out for a quick training ride on a lovely bike trail by the river.
I was proud of myself for getting out, getting some exercise, connecting with a friend, even though I was post-call. In those heady days, I often followed the bike racing events like the Tour de France. My friend and I were learning to “paceline” or draft off each other as we rode through the early afternoon glades.
On our way back, there was a large lawn in between two bike paths, one that goes up to the bridge toward home, and one that continues underneath the bridge, heading towards downtown Sacramento. Due to a miscommunication, I nearly tangled with my riding partner, and swerving slightly to miss him, ended up splitting the difference of both paths and riding into the smooth green lawn.
No, problem, you say?
The trash can
I immediately spotted a trash can about 30 yards away, sitting by itself, no obstructions around it on this nice green lawn. I was headed straight for it, at about 20 miles per hour, a good clip.
My post-call brain went into emergency mode. My eyes locked on the obstruction as it grew rapidly larger, my hands locked onto the brakes, and I began to skid across the grass.
It became clear that I was slowing down, but not enough to miss the trash can. Now, keep in mind that the trash can was about 3 feet wide, in a large grassy lawn that is about 1/2 acre in size, and no other hazards nearby. I was making a beeline for the can.
The next thing I notice is that the trash can is starting to elevate into the air. Up … up … up; I puzzled over this for some moments until I realized that I was GOING OVER THE HANDLEBARS. This resulted in a flipping movement, my bike tumbling gently to one side, unscratched, and I
… did a complete flip, landed on my back, knocked the wind out of myself, and my cycling-shoe’d feet CLANGED violently against the empty green monster.
I lay there, chagrined. Maybe post-call and hence cognitively-impaired, high speed pace-lining wasn’t the best idea.
Furthermore, my friend comes over, holds me on the ground to stabilize my neck (he had just learned about cervical spine precautions in his ER rotation that month) and says: “Don’t move! I’ll call 911!” In a fit of inconsiderate and impaired judgement, I swiveled my neck, looked up at him and said, “Nah, I feel fine.” He yells: “I can’t believe you just cleared your own C-spine!” After some recriminations and an apology on my part, we rode home.
Don’t look at the obstacle
This is just a long winded way of saying that our brains work in mysterious ways. You will very likely hit what you’re looking at. SO DON’T LOOK AT YOUR OBSTACLES. LOOK AT THE CLEAR PATH AHEAD. On subsequent bike rides, some across very technical terrain strewn with boulders and sand traps, this really worked.
In my years of practice, this is one of my favorite personal stories I use as a cautionary tale to my patients. Don’t think about how bad smoking is, think of how you’re going to feel great when you haven’t smoked for a week. Don’t think about your weight, think about how good exercise feels when you get home. Don’t think about the difficult conversation you just had; think about the ideas to craft a win-win outcome from your next discussion. My patients always get a chuckle out of my personal failures.
CMIO’s take? A lesson from cycling: I can still see that trash can. Sure, acknowledge your obstacles, but don’t stare at them. There’s a path. Stare at that. Your body and mind will help you steer you through.