Dr. Jim's WebLog

The Expectation of Gratitude

Luke 17:11, NIV.
Now on his way to Jerusalem, Jesus traveled along the border between Samaria and Galilee. 12As he was going into a village, ten men who had leprosy[a]met him. They stood at a distance 13and called out in a loud voice, "Jesus, Master, have pity on us!"
14When he saw them, he said, "Go, show yourselves to the priests." And as they went, they were cleansed.
15One of them, when he saw he was healed, came back, praising God in a loud voice. 16He threw himself at Jesus' feet and thanked him—and he was a Samaritan.
17Jesus asked, "Were not all ten cleansed? Where are the other nine? 18Was no one found to return and give praise to God except this foreigner?" 19Then he said to him, "Rise and go; your faith has made you well."

A 49 year old woman came in for biopsy of an ovarian cyst. The gynecologist sent me a portion for frozen section. I overcalled it as a malignancy, and she had a hysterectomy. The next day I realized my mistake and called the doc, who said that he would go tell the patient the good news. “She will be thrilled—she doesn’t have cancer!”

The way she showed me how thrilled she was, was to file suit for excessive surgery due to my error.


Most of us came to medicine to help others. We work long hours, gave much of our youth to studies rather than parties, sacrifice time with our own families. Of course we mostly do get paid well, but on the other hand we are on call and get called at all hours.

Is it too much to expect gratitude in return? Can’t we expect that people will understand how hard we work, how hard we try, how much we sacrifice, how much we worry over their conditions? Isn’t it wrong and unjust of people to not at least thank us?

And what do we often get? Complaints about bills. Complaints about waiting too long in the office. Complaints that recovery is taking too long. And of course complaints filed in court.

As I’ve matured, the realization has dawned that it is unwise to rely on expectations of undying gratitude and thanks from our patients. While gratitude and generosity are the absolute requirements for a happy and joyful life, for some reason many people choose ingratitude, thoughtlessness, or greed. Their choice is beyond my control, and should not dictate my satisfaction with my chosen calling as a pathologist. The scripture for the day reminds me that gratitude is a gift, not an obligation.

Luke 17 is a great story for young doctors and medical students. It teaches that even Jesus himself, performing miraculous cures that nobody else could have done, received only 10% gratitude. In fact, as I look back, I’ll bet my record is better than 10%. Our reward is doing a good job, taking the best care of people who have trusted their lives and health to our care and skills. The few times they come back to thank us are not their obligation, but a grand, generous, and unexpected gift from them to us, to be savored, enjoyed, and appreciated.

Lord, you of all of us most understand ingratitude from those you love. Your people constantly turn from your open arms and defy your loving instruction. We know you want to make us like you, like your Son. Teach us to serve without expectation, to excel in our work with your sons and daughters, to help them in their sufferings, and to rest content whether they think to thank us or not. Amen.

Badges? We don't need no stinking badges!

This Long Island boy got all the Merit Badges. Incredible.

I got an award for service to the College of American Pathologists. What a great ceremony. Here is a link to the press release.

Might as well link the other press release, too, on the Missions Ministries clinic we do each February.

Well, after several training rides, lifting weights, buying clothing, I did it. I rode in the Stonewall Century Ride August 16, 2008.

Those who know me, know that I am shall we say a bit compulsive? I really prepared for this ride, my first Century. It's really all Chris' fault, you know, my new son in law. Last spring he announced that he was going to do the Chicago Marathon in the fall. One afternoon he came in after doing a 13 mile run. Sheesh. Well, the testosterone imperative kicked in. My feet and knees wouldn't tolerate that much running, unfortunately, but I thought I could do the bike equivalent, a Century (100 miles.) So that became my goal.

Another thing that won't suprise my friends and family, is that I bought a book. Bicycling Magazine's Century Training Program, 100 Days to 100 Miles, by Marla Streb. She had been a lab tech in a medical research lab before going pro on a mountain bike and I obviously appreciated her take on things. Pretty good book, lots of good tips.

Other posts talk about the training I did. Started at about 14 miles, gradually built up and did a 75 miler in July. My brother, Dave, and I drove down to La Veta to scope out the course which looked, well, remarkably steep and high but beautiful. I came to realize that my seventeen year old Trek bike was not going to cut the mustard after I tried riding up Deer Creek Canyon, a well known training hill west of Denver.

One night I was in bed reading Bicycling Magazine. Performance "frequent biker" club membership includes a year subscription ("A $10 value!") I turned to Denise and said, "Look at this, a carbon fiber road bike for $10,500. Amazing." She looked at me with a fish-eye and replied, "Are you reading that bicycle porn again?" Well, yes, actually, I was.

Then I talked with Gordon at work, a fellow pathologist and former bike racer. He waxed eloquent about the virtues of his new Trek Madone 5.something and about getting it properly fitted. That sounded good but the price tag seemed a bit steep. There are other Madone's, however.

So I bought a new Trek Madone 4.1. What a great machine. Full carbon fiber frame, Ultegra shifters, weighs almost nothing. Kyle at the Campus Bike Shop fitted me out and told me I could go test ride for a while, so I pushed off and rode east to Franklin Street to go over to Washington Park. I tell you, it took me about eight seconds to decide I liked the bike but I did a couple of loops around the park anyway, just because I could. There was a hard-core guy who looked about sixty riding a fixed gear single speed around that I got to talking with. People who ride fixed gears are almost always hard core. I showed him the bike, and he remarked that it would be a huge mistake to buy a bike with a triple front chainring. "Get a compact double. It will make you a much stronger climber. Really, you will thank me for this later. Triples just aren't any good."

Back at the shop, I asked Kyle what he thought. "A compact double will save you a few grams of weight, but it does not have the lowest gears. Some days you want the lowest gears. As you may have noticed, Colorado has some mountains." So I bought the triple and I tell you I have had no regrets.

Fast forward. The week before the Century, of course I haunted the weather reports on the Internet. There was this tropical storm that had pushed north and was raining all over Southern Colorado. On Tuesday, the report was perfect for Saturday, low in high 40's, high in mid 70's, partly cloudy. On Thursday, the reports was...light rain and scattered thunderstorms.

Andrew at work is a former bike racer, so of course I pumped him for information. "Well, make sure you wear layers. You'll get warm going up the hill, but going down at 10,000 feet will be cold, cold, cold. You'll want a vest and arm and leg warmers." So I went to the bike shop and bought what he suggested.

Denise and I started for Walsenburg after work Friday. Man, it rained all the way down there. Sheets of rain. Thunder and lightning flashed and boomed. We pulled into the Best Western, checked in and fell asleep. "Light rain on Saturday possible."

At 5 the next morning we awoke and I nuked some Muesli with yogurt and blueberries, drank lots of water, and we loaded up the Tahoe and turned west to La Veta. Light rain. Yeah, right. How about drenching downpour, lit up at random intervals by bluish white light followed by thunder. Denise looked at me and had this typical female look, like what on earth are you thinking, but what the heck? I'm here!

My gear: head, skullcap, ear band, helmet, wraparound ugly plastic brown dark glasses. Upper body, a polypropylene tank top, a polypro long sleeve T shirt, a short sleeve bike jersey (for the triple pockets in back mainly), a nylon vest, and a bright yellow vinyl waterproof bike jacket with some vents. Arm warmers in the back pockets. Lower body, a full length lycra stretch long pants with suspenders, a pair of standard bike shorts over that, leg warmers in the back pocket. Light wool socks. Regular bike shoes. There was also some other stuff that I decided against.

Four cliff bars, two bottles of Gatorade, and a 50 oz Camelback in a backpack with some stretch bungie cord in a diamond shape on the back finished my styling ensemble. Man I was ugly.

At La Veta, some drowned rats of local folks manned the registration table. Someone has done a short YouTube video of the rain! Didn't seem like people were exactly rushing the table to sign in; they handed me my arm bracelet, Stonewall T shirt, various maps, samples of HEED by Hammer (one of the sponsors) and said, go out that road, turn left, and your next stop will be Segundo (the half way point.)

So Denise stifled a smirk, she really is wonderful, and she took a picture of me. I was off through the rain!

The beginning went very well. Determined to warm up and not fry myself early, I spun along easy for several miles admiring a couple of drenched Mule Deer and noting the sign announcing this year's event to warn the drivers. The Stonewall Century actually starts at the La Veta Town Center at about 7500 feet and heads southerly up to the high point at Cuchara Pass, just shy of 10,000 feet. This is about 20 miles or so. Then there is a very long downhill to Segundo, the half way point. All you have to do then is turn around and come back, and you're done. Apparently last year some dude did it averaging 20 mph.

I was motoring along and then the road began to ascend with more vigor. Somewhere along here people started passing me, an experience that would unfortunately repeat itself often. One nice guy slowed down for a few minutes and chatted as I cranked in, you guessed it, the small Granny gear of my now adored triple front chainring.

"Yes, it is my first Century," I panted. "Lot of rain, but maybe it will clear off. A guy in a pickup truck told me that Cuchara Pass was clear and it was nice all the way to Segundo."

"Your first century? That's great. Uh, why did you pick THIS one?" he said. Hm. Wonder what that means? as he spun out of sight.

The first rest station came up just past the town of Cuchara. This is a town with six houses and a bar/grill. Sue who sets this thing up has the entire valley involved and the people were fantastic. I coasted in and they had hot drinks, cookies, cakes, peanuts, HEED by Hammer (one of the sponsors), so I ate and drank, refilled water bottles, took advantage of the Porta Potty they had set up, and took off again. "Took off" does imply a rush of speed, doesn't it? Maybe "pushed off and downshifted into granny gear" is more accurate if less picturesque.

I actually liked the HEED. It was slightly sweet with a bit of salt; turns out it has maltodextrin which is a good carb for athletes. I drank a lot of it that day. One gal at a rest stop told me most people had not liked it. They must be sugar addicts used to Gatorade or something,

At the top of Cuchara, things changed suddenly. Instead of grinding up hill and sweating, the road plummeted downward into cold fog. My speedometer showed 42 mph rather quickly. My legs would have had to spin at about 200 rpm in highest gear to keep up with that, so I just coasted, wiped the fog off my dark glasses, and my legs got cold! Amazing. Since I have a bit of a spare tire (yes, I know that is hard to believe) the mass was really pulling me down on the hills and I actually briefly passed someone. Soon the next rest stop appeared out of the mist by one of the mountain lakes, and I pulled in this time for some hot chocolate and a refill of the HEED.

My legs had actually stiffened a bit from the breeze. Thanking Andrew with enthusiasm, I pulled on the arm and leg warmers and took off for Segundo. And this time, "Took off" was accurate. Man I was flying. 25-40 MPH.

Flash. Blue-white light filled the sky. "One thousand, two thousand, three thousand, four thousand, five thousand, six thousand..." BOOM. OK, well, over a mile away at 1100 feet per second, and besides, I'm down in a fairly sharp valley between two high ridges. Should be OK. Of course, my legs felt strong and mighty at this point, a combination of training, downhill road, and of course adrenaline.

The Stonewall rest station appeared on my left. Flash, Boom. No, actually, I don't think I am tired at all and I have plenty of fluids. Off to Segundo.

That ride went fairly fast, but along the way the storm really kicked in. Sheets of rain came down, small pea sized hail briefly (but I think I missed the main hail storm because I saw little piles of dirty hail along the road in the shadows.) Wiped the glasses with my new full-finger gloves (bought those the day before thank goodness). Rode through puddles, fresh mudslides, and did not crash. Amazing.

The Segundo Volunteer Fire Department supplied the Segundo Rest Station and Lunch Stop. What a great bunch they were. Wheat bread, cold cuts, cheese, fruit, hot and cold drinks, and there were lots of chairs for me to fill with the wet clothing I stripped off to dry. To dry, in the cool humid air. One couple was there talking, and the man decided to bag it; he was shivering. Another guy rolled in wearing only bike shorts and a long sleeve jersey. The fireman wrapped him in a nice dry white wool blanket. There was an elderly man there with tiny calves, but the people there told me he rides every year and his kids are trying to talk him out of riding century rides every month. My thought was, why? He obviously loves this. And he was, uh, ahead of me.

After a while, I decided it was time to roll. I texted Denise, told her I was at the half way point (maybe, what, 11:00?) and rolled out the door. (It turns out the cell service really sucks in that valley and she did not get the text until about 4 PM. That must have gotten her attention--half way point at 4 PM?) The weather had improved in that water was not pouring out of the heavens. I actually got a brief view of the sun. But the road, which for thirty wonderful miles had gone mostly downhill, had perversely decided to go up for thirty miles on the return trip. Again I complimented my good sense in buying a triple front chainring.

At one point coming up to the Stonewall station, my front wheel got caught in a little ridge by the side of the road and it spit me out at a bad angle. For half a second I was certain I was going down on the wet pavement, but somehow my inner ears came through and I managed to regain control. That certainly got my attention, and I paid closer attention to the road.

A couple miles before the station, a woman drove by in a white van. She leaned out the passenger door (well, duh, someone else was driving) and asked me if I was OK. The fact that I was basically the last rider, and probably looked a bit bushed, might have contributed. I raised thumbs up and yelled, "Yes, I am the mighty Tortoise!" She smiled, closed the door, and rolled up the hill.

At the Stonewall station, four people ran out to catch me, take my bike, handed me food, and that same woman yelled "Hey! It's the tortoise!" I just can't say enough about the people who staffed the stations in the miserable cold wet weather we endured. Warm, nice, helpful, generous. Small town America at its best.

So then, back up the hill! Pushing low gears, often below 5 mph, grind, grind, grind. The chain was starting to squeak and shifting was getting less crisp; in retrospect, a bit of WD40 or something like it would have been a great idea. Calves both cramped; stretched them on the bike, pedaled a bit differently, they let up on my sort of. Then I bonked.

Within about three pedal strokes the strength just went out of me. It was very weird. What happened, I think, is that I had gotten lazy about drinking enough on the downhill part of the ride. Going back uphill, in better weather, I got too hot and dry. I stopped, sucked down fluids, and removed the impermeable coat, the arm and leg warmers, and the vest. They all got stuffed under the bungie cords on the Camelback. I unzipped what I could. Strength came back gratifyingly quickly with enough fluids, and I did not repeat that mistake.

Somewhere around seventy miles, my right inner thigh cramped up but good. Sucked big time, I can tell you. That was probably the point that I was most tempted to bag it, but I had listened to Dave Ramsey describe how he trained for a marathon. He said that marathoners have what they call "Hitting the wall" when you really want to quit, usually at twenty miles or so. He said to be prepared for it so it won't surprise you. I stopped, massaged my leg, sucked down a bunch more HEED, and tortoised my way up the hill.

At the last rest stop, the clouds had returned. They were really ready to close up. I refilled everything and rode on.

Then at around 82 miles, I saw a bright FLASH, counted to six before the BOOM. Ok, over a mile. Crank, crank, crank. At 83 miles, just five miserable miles short of the pass, there was another FLASH. One thousand, two thousand, three thous...BOOM. Half a mile, not good, approaching a big open park with no trees at the pass. So I called it, waved down a SAG truck and rode in to town. Just in case I was rethinking this obviously wise decision, just as I got in the truck there was one of those FlashBOOM's that mean the storm is right on top of you.

83 miles the Might Tortoise cranked out on his First Century. A new personal record for miles, beating the old 75 mile training ride on the flats. Many thousand feet of climbing. Wonderful people along the way, great support, a beautiful ride. And I feel quite proud for having braved the elements.

This experience hammered home the value of a goal. During the summer I found myself exercising instead of being a slug, knowing the Stonewall Century was coming. I'm so much stronger, happier, enjoying life because my son-in-law decided to do a Marathon and the "old man" decided he wasn't so old after all.

So what about next summer? Stonewall Century again, or Triple Bypass (the 120 miler with three 11,000 foot passes?) Who knows? But I'll be on my Trek Madone Bike for sure.

Here is video of Sarah and Chris' first dance.

Here is Chris and Irene's touching Mother-Son dance.

Here is Jim and Sarah's farewell Father-Daughter dance.

Yesterday my bro and I went for a drive to look over the course of the Stonewall century ride. It is a beautiful little valley just west of Walsenburg, CO. The two lane road winds through pine and aspen forests up from La Veta to Cuchara Pass, fairly steep looking actually. I think it averages around a 3.7% grade. I came back with a new intensity to my training!

So today I went for a ride. West from home to Platte River trail, South to 470, East (up and down and up and down hills) to Tower Road, north along Tower/Potomac to try to find the Cherry Creek Trail which is Caley and Jordan, the around the reservoir. There is a good potty stop at the Tower Loop, little one-seater that I have to remember. Then down trail to Downing and home. 57 miles! Woof woof. Half Century, under my belt. I think it might be the second longest ride I've ever done, averaged a bit over 12 mpg. Longest was Tecate-Ensenada back in the 80's which I think was around 75 miles.

Ate two Cliff Bars, 250 calories@, 11 g of protein, 6 g of fat. 37 carbs. Breakfast was usual Muesli and Yogurt with Mate Tea. Then after church a peanut butter and banana sammich on whole wheat, and 3 of those SportLegs supplements. Left on ride, probably 45 min later.

Century book: carb to protein, 4:1. She says 75 gm of carbs per 30 minutes of riding (!) or 1 bar/30 min (Clif bar has less than 75 gm of carbs, about half actually.) That would have been a lot more than I ate; ride was 4 hrs, that would have been 8 bars.

Also drank 2 28 oz bottles of my electrolyte drink that has 1/8 t KCl, 3/8 t NaCl, 1/2 c sugar per 2 liters. I ccould get some powdered whey to add a bit of protein to the drink too; 4:1 ratio, once again. Since it rained a couple of times, I may have lucked out since it was nice and cool. She says 1 bottle per hour. So, again, I was at about half of what I should be. Also it is time to play with the camelback thing; how much does it hold?

It's not her body. It's IN her body.

If I do what I need to do I'm happy. If I don't do what I need to do I'm unhappy.

If we don't know what each other are doing we can't support each other.

Sober views are more likely than romantic views, to lead to a romantic life.

From John Patrick, but a similar thought:
Moral thoughts are reliable, moral feelings are not.

I heard this referred to on a radio program. Didn't know what it meant. The link is here. They are:
1. God LOVES you and offers a wonderful PLAN for your life.
2. Man is SINFUL and SEPARATED from God. Therefore, he cannot know and experience God's love and plan for his life.
3. Jesus Christ is God's ONLY provision for man's sin. Through Him you can know and experience God's love and plan for your life.
4. We must individually RECEIVE Jesus Christ as Savior and Lord; then we can know and experience God's love and plan for our lives.

According to Prager, there are five questions God will ask a Jew at the gates to heaven:
1. Did you conduct your business honestly?
2. Did you partake in every permitted joy?
3. Did you set regular times for Bible study?
4. Did you look forward to redemption?
5. Did you reproduce?