04 March 2017

Landing a Residency - Part I

Hope the first couple months of 2017 are off to a good start for everyone.  Been awhile here at Andrew Langfield Struggles, so thought I'd do a short series of posts concerning the residency match process.  Likely many of you reading are painfully familiar with The Match already, either from personal experience or from hearing me talk and talk and talk about it over the fall and winter.  But to those of you triathlon peeps to whom this is all quite foreign, thought it might be fun to shed a little light on the transition from med school to residency in the crazy world of American medicine.  I’ve been putting together a fun, photo-heavy entry with highlights from the interview trail, but first a brief intro.

The 4th year of med school is hilarious.  Sure, you have to do some tough rotations, keep making the grades and passing tests.  But for the most part, you really only have one job: match into a residency program.  “The Match” is actually an extended process, and it takes most of the year.  Start pulling your application together in late summer, get things submitted exactly on time on a very arbitrary day in mid-September (and if you don’t, you’re late), travel to interviews all winter, agonize over your rank list for a month or two, then sit around and wait for another month to find out if you actually landed a position.  And in some final, archaic ceremony, steeped in rich symbolism and pageantry, every graduating student across the nation actually opens an envelope and reads a form letter – that had to be physically printed, stuffed and sealed into said envelope by a human being – that tells you where you are moving to start the next chapter of your medical training.  And this happens at the same moment.  Noon eastern, to be exact, which is 9 am here in P-town.  Nobody knows why it’s done this way.  I think tradition, mostly.  The only redeeming feature: this year, Match Day falls on St. Patrick’s Day.  So that should be fun.

Don’t get me wrong, I think the match algorithm itself is genius.  Nobel prize worthy, even (and that isn’t just my opinion).  Plus, by going through this process, you do gain some fascinating perspective on how physicians are currently being trained and health care is being delivered in this country.  But for the most part, it seems like a system that ran off the rails a long time ago, forcing applicants and programs to spend exorbitant amounts of money to pair up.  Depending on the specialty, most applicants will apply to 30-100+ programs in the hope of getting 10-15 interviews to ultimately match at a single program.  And if you’re entering the Match as a couple – as Elena and I are – you basically just double everything.  It’s not easy for programs either, as they now have to sort through thousands of applications and interview hundreds of qualified med students to fill the same number of spots.  As one program director put it: “We still have the same number of spots in our program.  But since we have to interview 4 times as many applicants now, it just means each person we interview is only ¼ as likely to come here.”

All that said, if you can keep the right attitude about it, the interview trail is actually pretty fun.  When else do you have an excuse to travel to Burlington, VT and Albuquerque, NM in the same year?  I’ve been to places this winter I never thought I’d make it to.  And even more fun is imagining what life would actually be like in these new towns, and if you can see yourself living there.  Internal (and family) medicine residencies are typically only 3 years long, and I hear that time goes by pretty damn quickly.  It brings some levity to the process.

So there’s a little insight for ya, probably more than you’re used to getting here at Andrew Langfield Struggles.  Hope you aren’t feeling confused, angry or otherwise deceived.  Next up: adventures from the interview trail.  Then Match Day madness.  Stay tuned.


23 November 2016

Canadian (mis)Adventures

2016 Season Wrap-Up

Well would you look at that?  No blog post in 5 months.  Pretty typical, I’d say.  I’ve come to expect very little from the people at “Andrew Langfield Struggles.”  They work hard, sure, but if you’re looking for timely race reporting, you should really look elsewhere.

But how about 2016?  Almost in the books, damn.  On the tri scene, it was a super fun year of racing for me.  I felt like I really put that “year off” of med school to good use, and was fortunate to get to 6 big events up and down the west coast.  I revisited a few favorites, and made it to a few new ones.  This post is meant to briefly recap the second half of the season, and provide a general round-up for the year as a whole.

As a few of you may recall, I started the season a bit earlier than usual, and with more racing.  Kicked things off down at Oceanside way back in early April.  A month later Elena and I took a 10-day road trip, with racing over back-to-back weekends: first at Wildflower with med school friends, then a bucket-list event over at St. George.  After making the long drive back to Portland, I was eager to absorb the early season race fitness and settle in for another solid block of training before the “main” part of my season.  And by “main,” I basically mean Canadian.

June, July, and August saw me racing one event/month, all of them up in beautiful British Columbia.  Started things off with my fourth and final 70.3 of the season, at Victoria with good friend Sean Haffey.  6 weeks later it was time for IM Whistler, the unofficial “A” race of the year, if you want to call it that.  Then finished things off with a relaxed trip to the Okanagan with best bud Sean Moran and a fun new race course at Penticton.  What did all of these events have in common (besides being hosted by our friendly neighbors to the north)?  They all ended with an absolute death march/drive-through-the-night/kill-or-be-killed/battle-of-wills down the I-5 corridor at 2 am, as Elena and I struggled to make it back to Portland to start our rotations on Monday morning.  But were they all totally worth it?  Of course.

Victoria 70.3
I will remember Victoria as “the race where I actually rode my bike.”  The swim course was truncated due to an overgrowth of some aquatic plant life (great news for me!)  But in addition, I also had arguably my best swim of the year, and came out of the water in 17th position, within 60-90 seconds of most of the field.

Quick tea party with Yu in T1

In T1 I joined up with friend Yu Hsiao, and the two of us set out on the bike course ready to do some work.  While we are more or less equivalent swimmers, Yu is a much stronger cyclist, and usually puts up a few minutes on me during the bike leg.  I was feeling adventurous, and didn’t really have much to lose, so I decided to go with him as long as it felt like I wouldn’t explode.  At first things felt pretty doable, but he slowly ratcheted up the intensity until I eventually couldn’t hang.  Fortunately that breaking point didn’t happen until about 2 hours in, after we had covered most of the race course and passed about 5 dudes.  Instead of the usual 10-12ish minutes, I surrendered only 6-7 to the top cyclists in the field, and only 45” to Yu.  I came off the bike in 12th position, full of hope for the ensuing run.  It was my most promising ride of the year.  Maybe I’m not doomed to be a softman forever… booyah.

Happy, heading into T2

I proceeded to $h!t the bed on the run, though, and not in the good way.  I was able to keep the effort up, having eaten and hydrated well on the bike.  But there was a pretty obvious disconnect between my heart rate and actual pace.  The leg speed just wasn’t there, as I struggled my way to a very underwhelming 1:22.  Coach Bagg and I never really figured it out, and ultimately chalked it up to riding a bit too hard.  If I could have put together a run-of-the-mill 1:18 or something, I would have moved up 7 places.  In the end I came 14th, but in a pretty marked break from my usual style of racing.

Confused, heading into the finish

By the way, Haffey crushed it.  Broke the 5-hour barrier in his fastest half ever, and looked good doing it.

IM Canada
What I didn’t want to admit leading in to Victoria (and in the weeks following) was that there was something seriously wrong with my knee.  Some strategic vitamin I in T2 (great for the kidneys!) helped me get around the course in Victoria without too much trouble, but I wasn’t really able to run at all afterwards.  A full 12 days after the event, I stepped gingerly out in to the streets to test things.  4 minutes later – after shuffling around at 8:00 pace for a half mile – I pulled the plug and walked back home, extremely disheartened.  Contending with injury is just so frustrating, especially when you don’t know what the root cause is.

I paid a few visits to Chris Ramsey, physical therapist extraordinaire and endurance injury guru at PACE here in Portland.  Miraculously, he was able to get me diagnosed and back on my running legs over the course of a couple weeks, just in time to put in some volume for my ironman build.  It definitely wasn’t ideal, as my longest run leading in was only 90 minutes.  But Coach Bagg sorted me out with a few double-run days, and we generally tried to make the most of it.

Not a bad venue

Race day in Whistler could not have been more ideal.  Clear skies and low winds meant the challenging course would likely run about as fast as could be hoped, but with more than 6,000 feet of climbing on the bike we were in for a long day all the same.  I executed on my pre-race routine, gave Elena a big kiss (second to last thing on the list), and waded into the lake feeling pretty damn lucky.  Given certain realities – like recent injury, returning to my last year of school, and really just being a mediocre person in general – I felt so fortunate to have made it to the starting line.  I had taped a simple reminder on my bike stem to remind me to stay grateful, especially on the back half of the ride when the suffering was bound to get real.

View from the cockpit

There isn’t too much to say about the actual race.  I exited the two-lap swim course ahead of schedule, which was awesome.  Near the top of the first climb I saw Andy Potts whiz by in the opposite direction, and was impressed by his sizeable lead over a legit chase pack with guys like Pedro Gomez, Trevor Wurtele, and Callum Milward.  I chased Elmar Hegar around on my bike for awhile, and by mile 70 was riding completely alone.  One of my biggest joys was the PB&J in my special needs bag, which was pretty mashed up and soggy but oh so delicious.  That fueling strategy is definitely a repeat.  I took a little while in T2 and emptied the bladder, then went about trying to find my run legs.

The first 14 miles of the run were the race highlight: spectacular scenery, clipping along pretty well, and feeling better than I should have.  I had the HR right where I expected it, but was surprised to see that equate to faster-than-expected running.  I was holding 6:45 pace and pretty much feeling like a Kenyan (well, maybe a Kenyan after a huge bender the night before, having literally the worst day of his/her life).  But of course things started to unravel where I thought they might, right around 90 minutes, which was essentially the limit of my run training.

Would have been easy to stop running and dive in 

I hung in there for the remainder, but we’ll just say I didn’t even-split that marathon.  In the end I was super pleased with what I got out of myself on race day, and was able to crack the top-10.  Lots of room for improvement, but not bad for a guy with only one lung.

Kidding.  I have both of my lungs.  But I’m doing a rotation in thoracic surgery at the hospital these days and spending a lot of time imagining what it would be like to only have one lung.

Challenge Penticton
The aftermath of IM Whistler wasn’t pretty.  Got home around 2 am and had to show up in the hospital for my sub-internship at 7 the next morning.  Several weeks of long hours and minimal sleep isn’t exactly an ideal way to absorb ironman fitness, but I was having fun and pretending to be an intern, so it was all good.  Plus, I had Challenge Penticton to look forward to at the end of the month, with best bud Sean Moran.

In preparation for the ITU long distance world championships next year, the folks at Challenge Pen had put together a unique 3km/120km/30km racing format that amounts to somewhere between a half and a full ironman.  I was somewhere between half and full fitness, so I thought maybe I was preordained to win the race.  (kidding, obviously, Jeff, if you’re reading)

Well, to put it politely, Sean and I went up there and straight-up slayed that course.  We were done racing and halfway back to Portland by the time our nearest competitors finished.  We went so fast they specifically told us we couldn’t come back for the world champ’s next year, because it wouldn’t be fun for the other participants.  Ha!

In all seriousness, both he and I struggled a bit due to somewhat limited training, but we had such a ball.  We raced with little to no pressure, purely for fun, enjoying the trip, the company and the location.  My fitness left a little something to be desired, especially on the bike where I’m pretty sure I saw people pointing and laughing at me.  The non-wetsuit swim didn’t do me any favors either.  But I put together a decent run on my way to 8th place and enjoyed the unique format.

Sean Moran's face on my blog always gets me a lot of likes

And so ended the 2016 tri season, way back in late August.  I had hoped to get to a race or two this fall, but the realities of returning to med school set in.  Since my sub-internship, I’ve been fairly preoccupied with the primary/only job of the 4th year student: specifically, get a residency position somewhere.  It’s an exorbitantly expensive and hugely ridiculous process, albeit a very exciting one.  I’ve been in 6 states over the past 8 days.  But that is the subject of a future blog post, I think.

In conclusion, 2016 was a great year.  I’m definitely satisfied, but definitely will be back for more.  This is a great time of year to reflect on a fun season, and dream big about the next one.  I have a few things I’m eager to accomplish this off season (like learning how to ride my bike).  But my next post is actually going to dive into the crazy world of the residency match.  Stay tuned, if you’re into that kind of thing.

Happy Thanksgiving!


18 June 2016

A Tale of Two Races

Wow, so many things to catch up on here.  Last month I was lucky to take a huuuge road trip, covering 3,120 miles, 5 state parks, 4 breweries, 17 whale-sightings, and an embarrassing number of TRS Triathlon podcasts over the course of 12 days.  The trip was a smashing success, as I was able to tow the line at back-to-back races, but also get in some epic camping, eating, sleeping, cooking, sight-seeing, and all-around good clean living on the road.  Since that time it has been crazy here in Portland.  A couple weekend trips and some kick-ass elective time at a hospital here in town - on top of a pretty substantial training block leading up to 70.3 Victoria - kept the nose to the grindstone.  I actually started this post a few weeks back, when I had a "quiet" Saturday in town.  I was brewing beer, and trying to get some thoughts down between the mash in and batch sparge, but ultimately had to give up when things got real in the kitchen.

So thanks everyone for being patient.  Finally getting these race reports up.  Since it was a two-for-one sort of trip, you’re gonna get the same deal here.

Race #1 - Wildflower Long Course
I suppose Wildflower doesn’t really need an introduction on this blog.  It was my first pro race back in 2012, and I have been lucky to get there 4 of the last 5 years.  It is hands-down my favorite race in all the land.  But what made it beyond special this year was the company: 9 of my med school classmates make it down for the event.  For many of them it was their first half-iron distance race, which blows my mind.  True to form, Tri California hooked us up with their awesome hospitality and a great group campsite.

Would you believe all these fools are soon-to-be doctors?
The race itself went pretty well.  I had my usual “I’ve already been dropped, maybe I should just quit” moment about 300 meters into the swim.  But there was a group of maybe 4-6 dudes about 10 meters ahead of me.  I put in 20 hard strokes to try and make contact.  I looked up again and they were still 9 meters out.  So I put in another move and sighted again.  Still 10ish meters.  Damn.  I regrouped for a few strokes, then made another move.  Then another.  Then another.  I basically swam my little heart out, moving exactly the same speed as the second pack, which remained just out of my reach.  When we hit the first turn buoy - roughly half way through the swim - I had to reconcile that I wasn’t going to catch them, and back off to a more sustainable pace.  It was particularly disappointing, because I knew if I could just catch them I'd be able to back off considerably and maintain the same speed.  Need to be more attentive in the first few hundred meters.  So it goes.

Men's swim start.  I'm the tall gangly one in the center.
Photo props to Kaori Photo
I went hard on the 2 mile run over to the bikes.  Clipping on my helmet, I heard the announcer calling out Chris Bagg and Matt Lieto as they headed out on to the bike course, and was happy to be less than a minute down on those guys, who typically swim pretty well.

It was a particularly windy day in the saddle, but I was holding my own, and made up a few places before we hit the nasty grade climb.  I ended up converging with friend and fellow up-and-comer Yu Hsiao midway up the climb, and the two of us reeled in another guy up the road.  We were joined by Andrew Drobeck near the summit, and the four of us started the descent in close succession.  I was in second position behind Yu - who is a more fearless descender than I - and he began to pull away as we navigated the curling S-bends and cracked pavement.  The wind was still howling, and I was doing my best not to die.  I was relieved when the road bottomed out, but to my great surprise, a moto carrying one of the race officials slowly came abreast of me, signaling I needed to pull over…

Failure to stagger!?  Are you f***ing kidding me?  On that descent?  With those road and wind conditions?  I could not believe it.  I unclipped and stood there like a big idiot on the side of the road, watching in despair while the 3 guys I’d climbed with rode away from me.  My first penalty as a pro triathlete.  2 minutes of my life I’ll never get back.

Little did Andrew know, that just 30 minutes down the road,
a terrible penalty awaited him.
Kaori Photo, killing it again.
I rode with renewed energy for the 10 remaining miles into T2.  Could have been the sense of injustice, or the two minutes of unwanted recovery time, but I felt strong coming off the bike, having made up a couple more positions since the penalty.  I proceeded to unleash the best run of my career.  It all just came together, and it was an absolute blast.  The first 6 miles of the run are pretty beastly, but I regulated my effort and felt better and better as things progressed.  Miles 6-9 through the campground I felt like I was flying.  I was seeing a lot of 5:30-5:40 pace on my Garmin, and the effort felt very sustainable.  I started to run out of steam by mile 10, but then it was just a quick kick down the final hill and I hit the tape in 14th position.  Give me back those 2 minutes and I move up a few more places, knocking at the top 10 in arguably the strongest field I’ve seen at Wildflower during my tenure there.

With Coach Bagg after the race.  Don't know why I was hiding my face.
Kaori Photo, doing what they do.
The med school crew all killed it.  The feeling of accomplishment after finishing this race is something you carry with you for the rest of your life.  Special thanks to Elena, Steve, Nate, Brook, Maura, Mari, Heidi, Steph and Will for making this a great trip.

Race #2 - 70.3 St. George
St. George has been a bucket list race for a lot of years.  I remember it’s debut year - when it was a full distance Ironman - and the characteristically unpredictable spring weather in southern Utah had half the field dropping out.  I wanted in on that deal.  The treacherous weather, unsurpassed natural beauty, and notoriety of this race keep the fastest people in the world coming back.  This event has served as the North American Pro Champs for awhile now, and recent winners include Jan Frodeno and Tim Don (neither of whom are North American, ha!)  Trouble is, it has always coincided with the Wildflower weekend, which as previously discussed, is the best race in all the land.  So when I discovered that the two events were going to be on consecutive weekends this year, it was a no-brainer.  Plus, racing back-to-back… yeah, deal me in.  I want in.

As a quick aside, the week in between these two events was an absolute blast.  I won’t go into too much detail, but highlights included chasing whales around Santa Cruz harbor in a sailboat, camping in the Valley of Fire State Park, and hitting it big on the Strip in Vegas.  Included a few pictures below.

Just when we thought things couldn’t get any more beautiful, we rolled into St. George the morning before race day, and set up shop in one of the “primitive” campsites on the south shore of the swim venue.  

"Primitive" = no tap water, which seems like a small price to pay
Some hellacious wind the evening before gave everyone a scare during bike check-in, but things quieted down and there were high hopes for a clear race day.  I executed on my pre-race routine, feeling relaxed and reasonably recovered.  I was excited to race again, on this spectacular new course, against the best in the world.  Unfortunately, my tummy had other plans.  In the cold and blustery pre-dawn aura, I took my first gel 15 minutes before the swim start... and felt my stomach cringe.

This was a trip of “firsts” for me.  First time seeing a whale.  First time making it to the Firestone Walker Brewery.  First bike penalty at Wildflower.  Here’s another one - for the first time ever, the swim was actually the best part of the race for me.  I lined up far left, got off strong, found a great rhythm, and before long was swimming comfortably in a nice little pack.  As we approached the swim exit, I actually thought “Damn, I wish I could keep swimming for a bit.”  I braced myself for a chilly bike ride.  I was pretty happy to exit the water in a pack with Nicholas Chase, Dylan Gleeson, Jeff Manson and eventual winner Lionel Sanders (more on him later).

Doing a reasonable job in T1.
Even though it boasts 3300 ft of climbing, the bike course at St. George feels waaaay easier than Wildflower.  Much of that climbing comes in the form of short little rollers, most of which you can carry speed into and is very big-ringable.  The hardest climb, in my opinion, is a steep little effort that comes in the first few miles and takes about 5 minutes.  The one everyone talks about is a sustained, cat 3 climb through Snow Canyon State Park that averages 4% and gains about 800 feet over 4 miles.  Then it’s a bomber 10 miles and 1400 ft back down to T2, where you hardly need to pedal to carry 30 mph.

My legs actually felt surprisingly great.  The cooler temps weren’t a problem at first, and I was cruising along in my target zone, making up a few places here and there.  Sadly, my stomach wasn’t fully cooperating.  I knew I wasn’t getting the necessary calories in, and things were slowly progressing from “hmmm, I’m not really hungry” to “I couldn’t possibly eat that.”  I was less and less able to eat and drink, feeling like if I forced things down they’d just come right back up.  I told myself just to get to T2, then I could use the port-a-john and that would sort things out.

Suddenly it was raining.  Then it was a downpour.  Then the rain turned to sleet.  I have the courage to admit that I don't race well in the cold.  The first thing that seems to go is my vision; I get all cross-eyed and have trouble focusing.  So the second half of the bike became a bit of a blur.  I do remember looking sideways at one point, to stretch out my neck, and catching a break in the clouds and fog, through which I glimpsed one the most dramatic, towering red cliff bands I’d ever seen.  I just had to forget about the weather, and my tummy, and the daunting run course ahead, and laugh at the privilege of racing on this ridiculous day in this spectacular place.

Not a joke: this is actually where the bike course goes.
I made it up the Snow Canyon climb in pretty good shape.  I resolved to chug a bottle of fluids on the descent and get myself ready to run.  But what actually happened is I basically froze to death, and mentally quit on the race.  Sad.  I made a real mess of things in T2.  I had a lot of trouble getting my helmet off and socks on.  Never a good sign when you have to actually sit down.  This picture pretty much sums up how things were going for me.

I seem to be scolding my sock.
I did some quick mental massage: At least I was off my bike, and I hadn't actually frozen to death.  Plus, this was a new run venue for me, which are always fun to explore.  And at the very least, it would be a well-catered affair.  So I set out on the run course... half-heartedly.  Hanging in the back of my mind was the knowledge that I had only gotten about half my calories in on the bike, and it was only a matter of time until things went south.  I was being realistic about the whole thing.  I set a pace I thought would be sustainable.

Long story short: it wasn't.  The wheels came off around mile 7, at which point I straight up suffered my way to the finish.  It was good for me, though.  Good to have gained the experience, to have seen that run course, to have swallowed my pride when I got passed by the the first place female, to have earned every mile on the road to the finish.

Suffering in a beautiful place.
Last comment: Lionel Sanders is the real deal.  Was pretty humbling to come out of the water with him, get beaten by 20 seconds coming through T1, and then watch him ride away.  The guy out-biked me by a solid 20 minutes.  That's more than Lance Armstrong did when I raced him down in Florida.  And I'm a better cyclist now than I was then.  I saw him dominate the field at Oceanside as well.  He seems pretty much unbeatable this year, and I won't be surprised if he wins 70.3 Worlds.  Great story though, and his write-up on his win here at St. George is worth a read.

Next Steps
I’m currently riding a BC ferry from Vancouver to Victoria for tomorrow’s 70.3 (at least I was when I wrote most of this post).  I haven’t raced in 5 weeks and I’m eager to get back out there.  I'm working through a bit of a nagging knee issue though, so unclear how the run is going to play out.  But I'm going to give it a go and see how things hold up.  I've gained some great fitness this spring, and am building towards IM Whistler at the end end of July.  Hoping to peak for that race, then am going to need to take a few weeks off and focus on school for a bit.

Thanks for following along!