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I went on a Mindfulness Run and I ended up running 10 miles.

As you can imagine, physically training for a marathon is stressful. Despite all good intentions, life happens. For me, it’s family and work (fortunately, it’s really just those 2). The day really is very much one full-time job to another full-time job. The running is a side hustle in between the 2 full-time jobs.

This week’s challenge is Maya’s school Induction – 2 hours in the afternoon, all 5 days. This meant I had to cut out of clinic early, run down to nursery by 1230 and got Maya dressed into her school uniform in the boot of the car, drive her down to her school by 1300. Go back home, get some more work done, back to pick her up in 2 hours, back home, then pick up Xave at nursery. That was me on Monday and Tuesday as David was on long days. Maya’s new nanny, Carolina, picked her up on Wednesday. David on Thursday. Me again on Friday as David is on Nights.

These periods are marathons by their own right, where you somehow just stop thinking and just go on and do it. I am fortunate that I work in a job that is super supportive. I managed to review all my dictations and approved my letters, do the jobs from clinic, and see some inpatients.

One very important event this week was that I got to say goodbye to a patient I admitted a couple of weeks ago, who was dying. I saw her on Monday, trying to get her to hospice but we had missed the boat by the time a bed was available. On Wednesday, I stopped by her room before leaving to pick Maya up. She still recognised my voice but she was already becoming more drowsy. Her breathing was slightly laboured but calm, her movements were slow. She died peacefully that day with her friends around her.

That evening, I went for a run. I call it a Mindfulness Run. At the beginning of my run, I decided to just turn off everything and really just be present whilst running. I sometimes forget that running was meant to be my escape. It is so easy to get caught up with keeping up with a desired pace, looking at my watch, head filled with all the other things – To Do Lists, logistics, blogging, fundraising, school/nursery runs, etc. Distracting me from the pleasure of the run itself. So this run was different. It was very calm, the temperature was a lot cooler, the sea was also very calm matching the mood. Except that I was listening to a Mixtape I made a very long time ago called To Dance With. I just kept going… no water breaks, no gels. I ended up running 10 miles and it felt great. I need to go on more Mindfulness Runs.

I would have kept going but it was the kids’ bedtime. Sure enough, they were still wide awake when I got back, waiting for me. Straight back into the chaos.

It is sooo hot these days. Even with the best intentions of running some distance, the heat has stopped me dead on my feet. Even at 8am, it is already 20C!

Last weekend’s run was meant to be a 20-miler. THE 20 MILE RUN before the big race. Sadly, I managed 8 as I went out an hour later than I should have. I ran through the shady part of the streets but eventually the sun caught up. At some point, I found myself inside a corner shop looking for some Gatorade, I dont think I would have made it back home. I don’t know if I would have another opportunity to run 20 miles before the race. This evening I managed to escape when the kids were winding down in the evening and ran 8 miles. Not quite 20 and not quite the 14 miles I was meant to run as it was getting late.

This past Thursday, we had the Royal College of Radiologists (RCR) Clinical Oncology Induction. (Sidenote: when choosing Clin Onc, I’ve also become a Radiologist – that didn’t really sink in until I paid my Membership fees). Inductions are always exciting, always like starting school. Well, I’ve entered a new world really and it is very different from what I knew and what I was getting really comfortable with. Part of the training is also an MSc in Oncology from the Institute of Cancer Research, which starts this October. Hooray for structured learning! Additionally, there will be 3 exams throughout this training. But the one thing that really stuck with me this week was that I have to extract myself from many of the daily activities that the job entails and actually learn how to plan and deliver radiotherapy. Colleagues have already said that…

“You can walk through your training years and really get good at the ward/hospital stuff but actually not get to do the Radiotherapy side of things – which is what you are here to do.”

Point taken.

Tomorrow, my Maya starts her first day of school (though not quite a full day yet). She has a week of Induction (2 hour sessions) then Full-time (8:45-14:55) starts next Monday. As I did not grow up here, this is my stepping stone on learning how the UK education system works. I think I am more excited than her. She was mostly excited about her Unicorn lunch box.

With 23 days to go til the Berlin Marathon, I’m hoping I have enough strength and miles in my legs to complete the race without getting injured. With all the good intentions in the world and the self-promises, sticking to the training plan is always almost impossible. I always think well I’m hardcore and I can do it, yea but I’m not really that hardcore I can’t really do all of it. I’ve ditched the training plan a while back especially when coming back from the holidays, my Runkeeper App just kept scolding me telling me I’ve fallen behind.

Instead, I’ve changed strategies and just keep running longer and longer. I also find myself planning… okay if I run 100 miles the whole month leading to the marathon, I will be fine. So far I have run 42.5 out of 100 miles. And surprisingly, I managed to run 80.2 miles in August. Running almost only 3 times a week but much longer runs.

Also… I’ve booked tickets to Chicago!

Howeverrr… I have also missed the deadline for the Tokyo Marathon 2024 lottery with similar reasons when I missed the deadline for deferring my 2023 to 2024 – missed deadlines due to timezone difference. Oh well… that boat has sailed.

Speaking of boats… there’s a boat beached on Southsea beach. I run by it a lot, initially thinking it’s an art installation. Reading more about it, it is actually someone’s boat AND home, which became unmoored and drifted to shore. Sadly, thieves have also raided it and vandalised it.

Well I am clearly behind with writing. The honeymoon period of blogging is over. About 3 months since my last post and a month to go until Berlin.

As a Mum and the fam… the big events are going to Greece for holiday and for the first time without buggies! Maya and I went to the Philippines… 2 long haul flights via Dubai, went to a wedding, went to the beach, and back on 2 long haul flights via Dubai again.

As a Doctor, well after completing Internal Medical Training, I worked as a Medical Oncology Specialty Registrar covering lung clinics and skin clinic. And at the beginning of August, I officially started Clin Onc training, starting with Breast.

As an amateur runner preparing for back to back marathons, well I’m pretty much behind. With 31 days to go, 12 miles is the farthest I’ve ran so far. With the new role and the holidays, training has not been the best.

As with every last minute training, I always then just set a goal to run at least 100 miles before race day! So here we go…

New challenges ahead – Career progression.

I applied to only Wessex jobs (10 posts total). Earlier this week, I was unexpectedly offered a Wessex Clinical Oncology post. When I got the Medical Oncology offer, I almost accepted it straightaway but I managed to restrain myself and put the offer on hold instead. It felt selfish and presumptuous of me; I wanted to see if I was good enough. Sure enough, the Clin Onc offer came through. And after 48 hours of deliberation, swaying back and forth… I made my decision.

To myself, I’ve always said Clin Onc though I felt that I am Med Onc in nature. I was more into Chemistry than Physics, and honestly, I don’t know how I will do with the Physics. I like writing more than exams and there are not one, not two, but THREE exams throughout training! Then Clin Onc takes 5 years vs Med Onc takes 4 years! So whyyy?!

During a Taster Week a long while back, a Clin Onc Reg told me something that has stuck with me…

If you’re going to read a book, you might as well read the whole thing.

At crunch time, I chose Clin Onc because I want to learn ALL of it, I want to learn the Physics, learn a new language if you will (as if starting Oncology is not learning a new language in itself). It is 100% out of my comfort zone and I wanna push myself further. I know the exams are going to be difficult and I may fail them (given my track record) but I will get through them. Short-term sacrifices for long-term gains.

My other epiphany is… “Well if managed to get through all that (and actually smashed it), then I can get through this.” Having gone through all the challenges in the last few weeks, months, and even years, I think I am ready to face the challenges that lie ahead.

More challenges – More Marathons.

In the autumn time, I have not only one but TWO races to run, 2 weeks apart. Berlin and Chicago. Hopefully, my second and third star. Both deferred from 2022.

London was my 5th marathon, that already is a feat in itself. And I have finished them all under 5 hours. However, despite setting pre-race goals, I somehow revert back to “Just as long as I finish.” For these next 2 races, I’m going push myself a little harder.

I’ve not really tried hard enough yet to see how well I can really do in a marathon. My fastest was in Richmond (4 hrs 37 mins). And surely, I am slightly faster now than 2 years ago. I can hold a pace of under 10 mins/mile for probably 8-9 miles. But then beyond that, I start-stop. And once I do that, the cycle is VERY hard to break. I know I have gotten used to this and the reason why the my next races were around the 4 hrs 50ish min mark. So I want to improve that.

First, the one thing that has to go is start-stopping. I have to mentally prepare myself before each run and anticipate what I would if the urges to stop come around. I will have to work on this and break the cycle.

Second, training 5 days a week rather than 4. Currently, I am working at 80% (working 4 days/week) and I have yet to decide whether to remain at 80% once I start Clin Onc training. I worked Full-Time in IMT. Anyway, right now, I have some extra time to add in another run.

My only real rule when training is that as much as possible, don’t run when the kids are at home. And if they are, 30 min run max. Them at home is our time with them. It’s bad enough that we have careers that keep us in the hospital for very long hours. So I absolutely need to reserve Home time for the kids.

Further challenge – Fundraising.

Lastly, fundraising. For the last marathon, I got my place through the ballot, not a charity place. But I ended up trying to raise money for 2 charities. I had already signed up to raise money for Cancer Research UK before finding out about Home-Start. This proved to be a not so great decision. Anyway, for the rest of this journey, I will only raise funds for Home-Start Portsmouth. Also, I found it difficult reaching people. I have been off social media for 2 years now, and back then, this has worked well for fundraising. So I might have think about re-joining or think about better fundraising strategies.

Sidenote:

During the best week of my life, this was simultaneously happening…

Have you ever heard of Food Protein Induced Enterocolitis Syndrome or FPIES? Well let me tell you, in a nut shell it is a non-IgE reaction from food protein that causes gastrointestinal symptoms in a person. In this case it is some protein in banana causing projectile vomiting and diarrhoea in Xavier.

When Xavier was a baby, he periodically would projectile vomit, with no rhyme and reason. It took a while for us to pick it up but we started noticing that it would happen on days when he would have banana. Eventually we caught on. NO MORE BANANAS FOR YOU XAVE. Banana is his listed allergy at the nursery. What a weird and sad allergy to have.

Periodically, being the brave and daring Mummy that I am, I dare to give him a small piece of banana. “Maybe you’ve gotten over it, you are almost 3.” A few hours later – at least 3 episodes of projectile vomit!

The Sunday before the Marathon, David was at work. Xavier wanted a banana and I was in my daring, yea you’re over it mode. So Maya had an apple and Xavier and I split a banana. A few hours later, I noticed that Xavier’s stool started becoming lose (No Vomiting…yet). Then he went again and again. Then Maya’s stool started becoming loose. Then she went again and again.

When David got home, Maya immediately said, “Xavie had banana Daddy!” “Mon….” Well, nothing yet. After dinner, we all were watching TV in the living room, I was cuddling Maya and Xave on David’s lap. They’ve both just had a bit of oat milk when…. BOOM! Projectile vomit all over David…

“MONNN WHY DID YOU GIVE HIM BANANA?!!!

A major clean-up operation ensued. Showers for father and son. Me scrubbing the floor, Maya crying because she does not want to get sick.

The rest of week was chaos…

Monday – had to leave in the middle of clinic as both now have diarrhoea and Maya upset that she didn’t get to the toilet quick enough.

Tuesday (PACES Results Day) – When I got home from the Fareham clinic, my stomach started to cramp – around the same time when I was about to find out about my results. After finding out I passed, I spent the whole day in foetal position.

Wednesday – kids were still home as needed 48-hours. I couldn’t go in to work so I had to do clinic from home. I had also changed my address to our toilet. I sat there for so long, so scared that I might not be able to run on the Marathon on Sunday.

Thursday – The kids managed to get back to nursery. I thought I would have been over it. Wrong. This was so bad – I NEVER get any gut issues, never had diarrhoea. But David and I managed to get some food, we went out for burgers for lunch. This was out of my system by dinner time. I managed a 2-mile run.

Friday – Kids okay. I finally was okay. Managed to go back to work and no had no movement. I had also called my Mom and asked if she could fly in from NY so she can be with me at the Finish Line.As I was meant to be carb-loading by now and had to catch up by miles, I made pasta dinner – Chicken Pesto. A few hours later, David started feeling nauseated and his tum started to grumble.

Saturday – Kids woke up ay 545am. I went downstairs – David had spent almost all night in the toilet, had zero sleep. I was planning to leave by 930 for the Marathon Running Show to pick up my bib. And we had also planned for kids to meet friend and go to baby cinema and watch Luca (now cancelled). Now here I was, in a panic coz I couldn’t leave David (who by now is half dead) to look after the kids. I had very limited people to call. The only solution I could come up with was that Mom should come here straight from the airport rather than be with me at the race. Her plane has landed but she was not answering her phone. At this point, I was frantic around the house because the kids also chose to throw at least 5 tantrums each, they were fighting, and demanding all sorts. The latest I could leave to get to the ExCel Centre on time was 1300. I managed to get a hold of Mom in the most convoluted way possible and told her the plan. I made the kids some pasta for lunch and they had ice creams for dessert (I gave up fighting them at this point). I took them upstairs to David with an iPad set up (David still dying). Then I really had to leave. My heart completely shattered.

In sum, in this week, my role and Mum, Medic, and Marathon Runner had perfectly and chaotically intertwined. Whilst I was having the most perfect week in my career as a doctor, in the background my whole family suffered a violent bout of the runs. Almost risking me not running the London Marathon. I blame this really for not achieving the time I wanted. I had lost so much water and electrolytes and didn’t gain a lot of it back in time.

All because of… “Here Xave, you are almost 3, maybe you can now eat Bananas…”

Train journeys seem to be the perfect time to reflect. I am now on my way to London to pick up my kit at the ExCel Centre. And if no hiccups, I will run the London Marathon tomorrow. Today, the reflection really is about how wild this past week had been! As in my previous posts, I was anticipating several life-changing outcomes this week.

• Maya’s school allocation
• PACES results
• ARCP outcome (based on PACES results)
• Oncology Specialty Registrar job offer
• London Marathon (result tomorrow)

Monday – Like any morning, I was up at 6am, getting ready for the day. Of course the first email was about Maya’s school allocation. She got allocated to our first choice – Devonshire Infant School! She was asleep but David and I were silent-screaming next to her and cuddling her! It’s not the catchment school but we really liked it during a visit. We’ve been told that the low birth year would be in our favour. We were really looking forward to this. As parents, you always want what’s best for your children. To us, for now, this is the best for her and we hope it will really give her a good start. And this was a good start to the week.

Monday afternoon – I found out that I didnt get an Oncology job offer. First, came the Clin Onc email and then the Med Onc. This didn’t surprise me as I didn’t rank highly. I might have half expected to not get an offer. Bummed but recovered quite quickly because I had mentally prepared for it. I would have just continue locuming and do a PgCert and apply again next time. But also, there are more rounds to go.

Tuesday – this was the most dreaded day of the week. PACES results. I had just finished clinic when one of my colleagues messaged that results are out. I had a 30 min drive home ahead of me and thought, I should drive home first. I had also already mentally-simulated this – for when and how to click on my results. I needed to have seen all my patients, not in the middle of a work day, not before driving home (especially driving home with kids). I had to be at home, in the living room, with David. I drove home envisioning my result and tried to see how I would react. What I did know was that I had no more energy left if I failed again. So got home, found David and Maya in the living room, Xavier asleep on the sofa. I told David results are out… I sat myself on the floor and logged in. There’s no room for any more build up – already had a 3 agonising weeks of that. Andddd… I PASSED!!! And I passed well – 159/172! One mark higher than David (had to say that). Too bad it took 3 attempts to get that (also had to say that). But OMG. That was it. That whole saga is finally over. I am now a Member of the Royal College of Physicians.

Subsequently, I emailed the ARCP panel about the result and I was granted an Outcome 1 – Achieving progress and competencies at the expected rate. I completed Internal Medical Training!

Wednesday. In the background. Bouts of violent diarrhoea had taken over our household. More on that on the next post. Seriously thought I wouldn’t be able to run on Sunday.

Thursday. Whilst we were on our way to pick the kids up from nursery, David driving, stuck in traffic, I randomly checked my email. And there is was, out of nowhere, not expecting it at all… an offer for a Medical Oncology job! In Wessex! I had only ranked the Wessex jobs, a total of 10 places. And I finally managed to snatch one. I could have accepted the offer there and then but I decided to take a breath first. I’ve held the offer, wait this coming week if a Clin Onc job comes around. But OMG! I’ve got an Oncology Specialty Registrar post!

I’m not gonna lie, I have been dreading this week – 95% because of PACES results. I have already thought out my worst case scenario and started processing that outcome. I envisioned the moment before clicking to find out my results. This became a mental exercise of what success would mean and what failure would mean. What I would do next, I really had to mentally prepare myself for the worse outcome, which was fail PACES, not quite completing IMT, not get a job. Well, I would have to get over some heartbreak but I would then need to keep on truckin’.

Throughout this week, I’ve been talking to one of my mentors, my previous Intensive Care Medicine Clinical Supervisor in Cheltenham, and he said…

It’s all about training and luck on the day. More training, the luck gets less.

I always believe that I just got lucky getting to where I am today. I can’t help the Impostor Syndrome kicking in periodically. I have learn to pause and acknowledge all the hard work I’ve put in throughout the last few years and of course, appreciate and enjoy the journey itself.

Sidenote: I asked my mom to fly in from New York to celebrate all the wonderful news with me, she was going to be at the Finish Line tomorrow. Instead, she had to go straight home from the airport, to take care of the kids as David had fallen victim of the tummy bug.

So here I am, Sunday morning – Marathon morning 4am, finishing my reflection. This week could not get any better (apart from the violent tummy bug). All these good news is filling me with fuel for running 26.2 miles in the streets of London!

If you have made it to this end, in the Spirit of the London Marathon, please check out my Fundraising Sites (which regretfully had taken a back seat in the last few months). I am raising funds not just during the London Marathon but until I complete all 6 World Marathon Majors! I will be much grateful for any amount.

Cancer Research UK – https://fundraise.cancerresearchuk.org/page/reachforthesixstars. I will be running with a Cancer Research jersey. A big chunk of the work I will now be doing are Results of this organisation.

Home-Start Portsmouth – https://www.justgiving.com/fundraising/MarathonMon – Home-Start is a fantastic charity in Portsmouth that helps get young families to a good start.

The train ride back from Liverpool was a well-deserved 5 hour break. I initially thought that I have to be preparing for my Clinical Oncology interview – but I just listened to music instead. But maybe also thought about the things I said and did not say during the exam.

Simulation Course – BRASH. – Throughout our medical training, we go through simulation courses periodically. And these are always fun and exciting. You go through scenario with a model that appropriately responds, manage the patient as you would in real life and debrief at the end and see how you could improve it the next time. Many people find these exercises anxiety-driven as we are observed by our peers but it is also a very good learning experience. This time I dealt with BRASH – Bradycardia, Renal Failure, AV nodal blockade, Shock, and Hyperkalemia. Like everything else, you only get good at what you do when you continue training.

Clinical Oncology interview. – A week ago, a Clin Onc Consultant (who used to be my Reg) had offered to practice with me. This proved to be very useful. The interview consisted of 2 clinical scenarios, ethics, and commitment to specialty/portfolio. I think I was more relaxed pre-interview compared to last week’s Med Onc interview. And once the interview starts, it goes by so quickly. I thought this interview went well so fingers-crossed.

The day after the interview was a free day. I was going to go on a 20-mile run but the wind was knocking me over and I was wet within 10 minutes. I called it off after 5 miles. I will try again in a few days when it is sunny out. I sat in front of the TV and watched and finished YOU on Netflix.

Last Acute Medicine weekend/last shifts as an Internal Medical Trainee. – I would say that this was a good weekend. Worked in the Acute Medicine ward, with a good weekend team. Saturday was better than Sunday. Baked brownies for fundraising on Saturday, pizza from the Consultants on Sunday, also got given a fancy pen by a Ward Clerk. A few good cases – hypopituitarism from a macroadenoma, persistent hypoglycaemia, Campylobacter gastroenteritis, MS, ?Bulbar MND. And the very last patient I saw with a Consultant had a finger infection that led to a deep tissue infection in the chest.

Birthday + 20-mile run. Today I turned 38 and I went on a 20-mile run. It was a beautiful day for going on a long run. I ran to the marshes and back. The water was calm and there was no wind. Coastal running.

ARCP (Part 2). It was also my ARCP, my second one in the last few weeks. The last time, the panel found a few things missing on my portfolio and had given me another 2 weeks to get them done. Whilst on my run, at 19.5 miles, I made the mistake of checking for my result. I had an email stating that one of my Procedure assessments (pleural aspiration) was not adequate as it did not say I was competent to do this independently. This is a procedure that is now done with an ultrasound for safety. IMTs are not ultrasound-trained. Anyway, there was another panic episode – especially during the last 0.5 mile of a 20 mile run. When I got home, thank God David was home. Talked it through and at this point, I was just glad to have finished 20 miles without dying and it was my birthday. So we went out for lunch and I’ll deal with this tomorrow.

Over the next 2 days – I got the pleural aspiration procedure done and signed off, then let the panel know – who had come back with a response and allowed me to continue with my new job. I was also meant to start my new job but the Consultant is on holiday so next week. I managed to get training for the drug-prescribing system.

These past few weeks have really been a test of my endurance, my mental stamina. All throughout, I had to focus on one day at a time (one mile at a time, one foot after the other). I am now on the other side but I can’t relax yet as it’s not quite over yet. I have now entered a waiting game – waiting for results. The saga continues.