Medic Not Needed in Tuscany

Scene between Bonconvento and the farm

                                                                     
Two years ago, my wife Charlotte suffered a significant medical problem. She recovered, but required treatment with Coumadin, a potent blood thinner, necessitating close monitoring. She had previously made arrangements for her yearly Italian landscape painting course. The course, held on a farm in Tuscany, was scheduled within 6 weeks of her hospital discharge, and she was insistent on attending. I was very nervous about her making the trip. I had been to Italy enough to know the medical system is less than ideal. Not that many years ago a friend of mine, while in Rome, developed mononucleosis and was treated with enemas twice a day for 2 weeks. Three years ago my niece twisted an ankle in Venice and the hospital's xray machine was non functional

Since she was going on the trip despite the risks, I decided  to go, in case someone yelled "medic". She had a roommate and they had both paid accordingly. There was no additional room on the farm for a last minute extra person. I found a place in Boncovento 3 km away. Since I would have been by myself for the most part, I invited our other (sort of) daughter Jennifer to come along. I baby sat Jennifer when I was in college. She attended college here in Macon and we had informally adopted her over the years. Though now living in Baltimore, Jennifer remained close to the family, and we see her regularly. She had taken up cycling in recent years, but had never been on a cycling trip. When we extended the invitation, she immediately accepted, assuring me that she was up for the hilly rides.

Charlotte flew to Rome. Jennifer and I flew to Milan. We did not take our own bikes, a first for me, because we needed to be flexible, in case of an emergency. We rented bikes from DF Bikes, a store in Siena. This turned out to be fantastic. The bikes were fairly new, carbon frames with Campagnola components. The store delivered and retrieved at our hotel. The cost was less than it would have been, had we carried them on the plane as over sized luggage. We first stayed in Lake Cuomo with Camiel, my Dutch riding friend, who will be featured in a future blog. We then drove to Bonconvento and the bikes were there and ready.

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Most of the towns are on hill tops. In medieval times this was ideal for defense, now nonpareil in visual drama, when approaching the town on the bike. In the center of each town the roads were often so steep that it was difficult for us to maintain the balance necessary to negotiate our way through the pedestrian traffic. I think it was OK though, as many of the locals greeted us with the phrase " va fungul" which we concluded means "Welcome to our Town".

The painting group, Etruscan Places, was residing at an Agritourism. These are generally ancient farms with many stone/brick out buildings. In medieval times, the land owner lived in the main house and workers lived in these quaint structures.This provides some insight into European culture. The barns and other animal dwellings were all wood, some old and rotting, others new, but built to eventually rot. I would conjecture  the original owners were uncertain as to whether or not they would indefinitely use cows for milk and meat. Perhaps some new animal would be invented 100 years into the future. But the relationship of the owner to the worker would never change. So it was prudent to use materials that would last for centuries. There currently are few itinerant workers in Italy. Tractors have replaced them, but the out buildings still stand. The current owners, likely direct descendants of the medieval masters, given European social mobility, commonly rent the farm to large groups who occupy these recently modernized structures.

I picked up this Chianti Classico kit (riding outfit) at a wine store in Siena. I bought the red suede leather shoes in Pienza where this photo was taken. An unbelievable end of the year sale or possibly no one else wanted them

We took this photo on the way to Montepulciano. It is such a  characteristic scene, we could have taken 500 equally as stunning, between any two small hilltop towns. My over developed left sided brain (actually, more likely, my under developed right sided brain) found Tuscany to be so astoundingly beautiful, that despite being right in front of me, I first sensed these scenes were fake! Perhaps someone had painted them and  mysteriously moved the canvases along the roads to fool the tourists. I eventually was able to believe them, however. This, I concluded, was civilization. Despite all the baggage through the centuries, the feudal system to the class system, wars, the ridiculous heavy handedness of the Church, and the mulitple bubonic plagues, every generation, for over a millennium, made everyone of these places incrementally more attractive. Jennifer and I just cruised along, intoxicated by all the natural beauty, juxtaposed to the Tuscan's collective hard scape efforts. This experience was exponentially more entertaining on a bike, with our 360 degree panoramic view, than squinting through a car windshield at 3 times the speed. If I didn't ride to keep from going insane, I could ride 51 weeks a year to be in good enough shape to ride here one week a year.

       

The steepest grades were usually 1 to 2 kilometers and in between the towns. The rise into the the towns could be as long as 20 kilometers but were fortunately less steep




























The best place to ride was out of town and past the dirt road to the farm. This was the back way to Siena, mostly uphill going, and a fast net downhill when returning and drained. The above shots were taken at a functional abbey on this route. They had a small restaurant and we had our best meal of the week here. Check out the Missoni water bottle. I ordered grilled mushrooms and (real) truffle pasta. If you go to Tuscany, do not pass up truffle pasta when on the menu. I unabashibly sniffed it for 10 minutes before eating, somewhat to Jennifer's visible embarrassment.  I on the other hand couldn't have cared less, confidant I would know no one, an oft repeated bonus of overseas travel.

One day we drove this way to visit Siena and entered the town at a confusing place. We mistakingly drove further in than necessary, parked illegally, and walked to the center. We hung out at the Piazza del Campo, had great coffee, snacked, purchased the riding kit, and attempted to drive out at dark. When we decided to leave our actions became a scene from Chevy Chase's European Vacation movie. The roads were the windiest we had ever seen and our Garmen kept assuming we were making U turns, as we weaved along each of these roads. We heard "recalculating" more than 100 times. After driving for more than an hour we hilariously noted the exact place we had originally parked. If you go, enter on the main road and take a long hike to the town center. Otherwise you  might want to bring a sleeping bag

Jenny conquers another hill town

Infinity pool at the farm. Like I said , they had modernized

 Charlotte fortunately had no problems the entire trip and no medic was needed  We were able to eat with her at the farm every night. On the way to back to Milan we took a detour to a City on the west coast which had a precariously leaning building. The engineers were on strike so the city leaders were looking for volunteers to take turns holding up the building. We were proud to do our fair share before leaving the country.

My Weekend with the High School Girls

For the last 5 years or so my wife Charlotte and I have spent a planned weekend with her best friends from high school. They were all graduates of Leon County High in Tallahassee, Florida, well, not that long ago. There are  8 or 9 principles and most are able to make it. All but 2 are married and the husbands dutifully follow. They change the location each year, choosing an interesting place such  Buford SC, Grove Park Inn , (Asheville), Atlanta and 2 years ago they came to Another Green World (our home)

Last weekend we met at large beautiful house on Lake  Keowee, north of Greeneville SC. The house belonged to the son of one of the women. (Finally, someone with a prosperous offspring.) My only condition for attending each year, is that I can bring my bike and ride it all I want. With less than 4 weeks to prepare for Ride Through the Free World, no way to miss a weekend of training.

This was great location for me. The lake is on the edge of the mountains and mountain miles, once you are there, are always efficient training. I knew nothing of the area so I Googled "Map my Ride", a site that illustrates a number of rides, distances, topography etc at any location you enter. I easily found one heading up to the mountains on highway 130, through the top of South Carolina and into North Carolina. The road had a nice surface and there was very little traffic. No rider likes traffic, but this road was so sparsely traveled, I was a little nervous about getting help if a problem occurred.  I headed straight North and pretty much straight up. It was a little over 30 miles to Lake Toxaway, NC and it took 3 hours to get there, which sounds pitiful. It  was nonethless, a confidence booster to cross a state line, considering I will need to cross about ten on the big trip.When I arrived at Lake Toxaway I was wasted. I had to take a long break and I consumed  more than a few recently baked  chocolate chip cookies I purchased at an attractive country store. Most of the customers were white water enthusiasts and anxious to exchange stories with me and their like minded  fellow shoppers. The ride back was a lot faster of course, though I did not go all out since I was alone and did not know the descents. I felt much better at the end of the ride than at geographical middle.

My bike at waterfall along the way (when it is just us, the bike and I always argue who will take picture of whom at photo opts. It usually turns out this way)

I was a bit concerned that my solitary training would annoy my wife or some of the group, but by now, this is expected. Over the years there has been some stress in the marriage related to this issue. The next day for instance, I repeated most of the first day's ride, leaving the house before anyone was up, returning just as everyone was loading up to leave. This is what I call barely acceptable behavior. My advice to riders is to find the line you can not cross, then live on that edge.

I have been reading Edward O Wilson lately. He is the social/evolutionary biologist at Harvard famous for his study on ants and his comparisons of ant and humans culture. For years, on long bike rides,  I have enjoyed defending my own theories on the evolution of successful cultures. These theories involve no scientific research, only wild speculation, based solely on my observations. Freud did this. Why can't I?  A typical  argument I enjoy defending, is that it is evolutionarily advantageous for women not to get along with their mothers. In primitive cultures, had they coexisted well, they would have hung around and exhausted the food sources and perhaps died out. If a different group had the trait of mother- daughter conflict at puberty, likely the young woman would hook up with someone unacceptable, leave, perhaps bringing along a few other like minded couples. With new and plentiful food sources for the hunter gatherers, she would then survive, procreate and  pass on the female conflict gene. This a group trait involving both the mother and the daughter. Wilson, perhaps being in the back of the pack on some of these bike rides and eavesdropping on the gripping conversation at the front of the pack, is now moving away from his claims on the importance of kin selection (individuals helping themselves or relatives to pass on their genes) to the advantages of traits beneficial to the group.

I truly admire an enjoy each of these women and also everyone of the husbands. Over the weekend they had their own stimulating agenda. They toured the BMW plant and  hiked into a long cave, blasted with dynamite by the railroad in the 19th century, in a futile attempt to get through a mountain. Back at the house there were boat rides, outstanding meals and some high school era musical hits on the stereo.There is something very satisfying in regularly seeing the survival of this Leon County High School group. It is a microcosm on the success of the group which just seems more right, at least more attractive, than the survival of the individual. I look forward to our gathering next year on the Gulf Coast, and yes, I will bring the bike.

The High School Girls (Barely Legal)

The Huffy

Perhaps I should have started the blog with this story. My cycling passion began at one definable moment in the spring of 1970 during the third of my five years at Georgia Tech.  I had just moved into an apartment on Juniper Street in Midtown within walking distance of Tech. My friends and I had decided to break out of the dorm scene which was DEPRESSING. Because none of us had a car, Midtown was the only residential area close enough to meet our limitations. Midtown's cultural scene at that time could not have been more different than Tech's, which was all male, all engineering, very intense, though occasionally fun on the weekends if injected with enough alcohol. Midtown was loose and served as the counterculture center for the entire Southeast; the epicenter being Piedmont Park. The park hosted frequent events so foreign to Georgia Tech's culture you might think you were on another planet instead of only 10 short blocks away.

We started hanging out there a bit and took up throwing the Frisbee on the small golf course still open at that time. The course was on the Tenth Street edge of the park and had so few golfers no one seemed to mind our infringement. After a nice session with the Frisbee one Sunday, my roommate Todd and I, seeing a large interior crowd, journeyed deeper into the park to investigate. There was some type of art show, and just as we arrived we ran into a friend from Tech, Tommy Sims, who rode up on a bright new purple Huffy Super Ten. Tommy was the most outrageous guy we knew at Tech. He had long hair and dressed in denim overalls with no shirt. Great look. I had never seen a 10 speed bicycle before, nor had I ridden a bike since the 8th grade, which was seven years prior. I was in decent shape from playing basketball and chasing the Frisbee, as our sessions with the plastic disc involved a considerable amount of running. I asked Tommy if I could ride it and he handed it over, giving me a quick tutorial on how to shift the gears

I took it around the park, which, like everywhere else in Atlanta, is quite hilly and required me to use all the gears. It shifted like butter. It was unbelievably fast on the downhills and painless on the uphills. I felt as if I were on a magic carpet. This ride was very different from the one speed I rode on flat roads in South Florida as an 8th grader. I instantly loved it. When I returned and handed it over, I announced that I intended on riding one of these every day for the rest of my life. Within days Todd and I purchased the same bikes. We rode them to class at Tech regularly and also to Emory, where we threw the Frisbee on the president's lawn. With the coeds, it was a much more attractive location than the Park.

Somehow our main riding activity evolved into something that now seems bizarre; not to mention dangerous. Every night after we finished studying, we went out for ride. Of course it was dark and we had no helmets, no lights and no reflectors. We traveled all through downtown Atlanta, mostly enjoying the big building streets south of North Avenue. The lights from the buildings provided ample illumination. With the limited visual perspective at night, you feel you are going three times as fast as is actually the case. Of all the riding I have done, and I have indeed ridden almost every day since that day in the park, as I absolutely knew I would, night riding in a crowded city dodging traffic may have been the most fun. I intend on getting back to it when I find out I have a terminal illness. How we survived those nights, I haven't a clue!

The bike lasted through college. Todd and I  even rode them from Tallahassee to Miami in the summer of 1971, over 500 miles in five days. Prior to that trip we had never ridden more than 15 miles in any one day. We knew no one else who rode other than our two other roommates who also purchased bikes with us. We were the only guys at Georgia Tech who commuted to school and I never again saw Tommy on his bike.

I loved my Huffy as much as Picasso loved any of his 5 wives. Much like El Maestro, sometimes you just move on. I bought my Atala (that sordid story later) just before graduating, but I kept the Huffy and brought it with me to Med School in Gainesville Florida. In contrast to Tech, Gainesville was odd, as many students had bikes. If you left a good bike parked outside your class it could, and frequently was, stolen, despite being locked up. I never rode my Atala to school and rarely took the Huffy for fear of its theft. I mostly commuted on my sister's old JC Higgins one speed baby blue girl's bike with thick white wall tires she had received on her ninth birthday. I turned the wide handle bars upside down, put a 2 foot seat post on it anchored by a racing saddle and was able to ride with a fairly good 10 speed type positioning. Gainesville has two hills in the whole town so the one speed was not a problem. Theft was not a concern. I never even had to lock it.

So my one true love was relegated to irrelevancy. Perhaps the bike sensed this and wanted  to go out in some spectacular way. For some reason one morning circa 1978, during my training in Neurology, I decided to ride it to work. I must have been in a hurry and needed more speed than JC Higgins could deliver. Rather than lumbering on the side streets with many turns as I usually  did, I rode on 13th street which is Gainesville's main North-South artery. It is a straight shot with not that many  traffic lights. The City did have a bike path which was pretty sorry, nothing more than the sidewalk with a little concrete pads at each intersection to ease you down and then back up. The obvious problem with this design was the cyclist was almost  invisible to a driver going in same direction, putting one at considerable risk every time a driver made a right turn into a driveway or parking lot.

Being in a hurry I was moving faster than the aforementioned pathetic bike path allowed. About halfway to the the hospital, a car to my left and heading the same direction, passed me and simultaneously turned directly into my path. Before I could do anything evasive I slammed into the passenger side of the vehicle and landed on top of the car's roof. Fortunately, I maintained a semblance of control and managed to roll down the back hood as the car continued to move forward. I  somewhat gently rolled off onto the parking lot, tumbling just enough to avoid the full body slam. While on the asphalt I took a quick inventory of body parts. All parts were accounted for, seemed to be functioning properly, and not too terribly in pain.

Very quickly the scene to develop into one unsympathetic to my plight.  The driver, a 30 or so year old woman, was entering an office parking lot as other employees were arriving to work at the same time. Several of the driver's coworkers ran over and rather than coming to my aid, they were assuring her they had seen the whole incident, and I was the one at fault. I pondered getting up swinging or arguing. The former, punching a woman, was unacceptable and the latter was definitely going be difficult to do in short order, as I was still in a hurry to get to work. I quickly decided to adopt Plan C, conceived on the spot. This lady and these people needed to be punished.

I decided to play dead. Real dead. I had been to the morgue a few times and I knew how real dead appeared: eyes wide open, all muscles relaxed, and no movement, including breathing. I could pull this off for one to two minutes and not put me too far off schedule. It was about that time the driver finally came to inspect the carnage. When she saw that I was "dead" she immediately went totally batshit, wailing like an Italian mama sending her son to war. To a lesser extent, but with some musical harmony, her comrades joined her. While this wailing symphony was still escalating, I needed to breath and equally importantly I needed to get to work. So I jumped up, gave everyone a quick glance of contempt, got on the Huffy, and rode off. I was moving fast with the adrenaline pumping but noted the ride was a little off. When I arrived and parked the bike I saw than the frame was broken.

After work I rode home slowly like a dirge. Not a word was spoken. Kind thoughts between man and machine were exchanged, The Huffy was never again ridden.

Busted

It would take a lunatic to claim emergency Neurology call for a 700+ bed Level One Hospital is the least bit fun. Twenty five years ago when I was consulted on a difficult case, perhaps someone in a coma or with a stroke unpredictably occurring after being admitted to the hospital for a non critical problem, the encounter went fairly well.. I would do my assessment, explain to the patient's family what had transpired and the most likely future course.  Invariably I was thanked for my time and effort. Technically this is a new millennium which may be the explanation for the current  bedside scene. Now my efforts can be hostilely received and I am sometimes accused of conspiring to cover up the facts.

"How could this happen?" a family member might ask. " She is only 85 years old ".
I have heard this comment shouted more than once. As I said: It's a new paradigm.

But occasionally something funny does occur. In Neurology we now offer a clot buster, TPA, for acute stroke which is beneficial if given within a certain exact time frame. More often than not, the Emergency Room MD makes the call and I see the patient over the hour that the medication is being administered. Occasionally it is not clear whether the Emergency Room patient is having a stroke or there is an event on the regular hospital floor, outside of the Emergency Room domain.. It is then necessary for me to do a bedside examination within this narrow time frame. Obviously I need to get there quickly meaning I get to drive like a maniac. Given the potential seriousness of the situation, I had assumed I would escape consequence as long as I did not cause an accident. 

Once you are comfortable racing a bike at high speed, shoulder to shoulder, through narrow turns with total strangers on a machine weighing less than 20 pounds, on tires less the 1 inch wide with greater than 100 pounds of pressure, you feel that nothing could go wrong at any speed  in a one ton machine with 4 fat tires. I drive a 1999 Audi A4  that has Quatro computer assisted 4 wheel independent drive   This means anyone can corner like a race car driver without losing control  It is not legal to have Quatro in car racing, too easy to be good. I had my brakes repaired for the first time at 130,000 miles. The first rule of criterium bike racing is not to brake through the corners. Generally in the car I turn at full speed.

Several months ago I had a call from the fifth floor in the hospital concerning a patient with a probable acute stroke. There was some ambiguity necessitating my immediate presence. I had 30 minutes to get to the Medical Center, do the assessment, and make a recommendation 'yay or nay' on the clot buster. I drove a short distance to I 75, flew down the interstates at high speed, passing everyone, using all lanes including the emergency lane when blocked in the conventional lanes. I encountered  no resistance and elicited no sirens, Off the interstate I drove through the side streets, only slowing at red lights and stop signs. When I came down the hill approaching the hospital, I felt I might make it on time but I needed to run  two stop signs within thirty feet of each other. They were set at a 45 degree angle with such good visibility I could easily see at 100 meters the intersections were both clear. I sailed through  without slowing  and then parked on the street just past the signs. As I leaped from the car I noted the blue light approaching. I acted like I did not see it and trotted to the front entrance of the hospital. The car stopped and the driver, a stocky young guy, took off after me. I picked it up when I reached the lobby and headed for the stairwell.

I sensed he had pulled his weapon . Having a good lead I ran zig zag avoiding a potential volley of bullets, adding to the spectacle the bored people in the lobby were now enjoying. I had planned to sprint up the stairs knowing most bikers can drop anyone going up five flights of stairs. I suddenly realized there was no way to out run this. He could just wait for me at the car or worse have it impounded. So I stopped, appearing to just realize there was a problem, hoping he was clueless about the bullet avoiding run.

"What's wrong?" I inquired

"What was the hurry though those stop signs?" was his predicable response.

I quickly explained the situation and agreed to meet him after the consultation in the police station located on the first floor. I managed to make it to patient's room in time and made the appropriate decision, which at this point, I do not recollect. When I  got to the office the policeman was waiting and appeared somewhat angry. I assumed he would give me a lecture and let me go. I was then shocked to find out he had written two tickets and had no intention of any mercy. I got a little feisty myself and began to argue.

"Take it up with the judge" and he pointed to the hand written court date on the citation

Conceding for the moment though fully intending to show up in court with a team of lawyers, I asked why he was so inflexible, given the fact I was legitimately in a hurry.

"Because you almost ran someone over." He confidently spat in my direction

"Almost. Almost! " I countered.  Almost don't count in car wrecks !

The  Crime Scene (as visualized by "The Man", look carefully under far Stop sign)

The Speed bag

I have attempted to follow a comprehensive training regiment for The Ride Across the Free World. Five to six hours a day on the bike with only three rest days in seven weeks is likely to cause problems I have never encountered. Besides many hours riding, I felt I needed an additional daily upper body routine. I have dabbled with a few in the past and found most to be boring and difficult to maintain. The one exception has been the speed bag, which was always quite attractive as pure visual effect in the many boxing movies I enjoyed.

I first hit the bag  in 1985 when I went to a cycling camp in Cental Florida. In my first Medical Practice, I had a partner who died of melanoma in his early 40's. He had an adolescent son, Mike, who I got to know after his father's death.  We spent some time together and I wound up introducing him to cycling. In addition to training, we went considerable distances to many races. He would ride in the 17 and under Junior category and I would ride in the Masters 35 and older. Each spring we would have a self made local camp with the few other riders in our area who were racing at the time. In addition to conventional riding we would take our road bikes to my pecan orchard. Here we would practice crashing into each other until we could  do it without losing our balance. We initially fell many times, and developed a proficiency for landing without injury, the grass "floor" of my backyard being relatively forgiving compared to the hard road. We were also eventually able to develop the skill of colliding, pushing off the front wheel, and maintaining the upright position.

One year we read in the Velo News about a real winter cycling camp in Cental Florida run by a team from Michigan who had a number of coaches. They had produced many high caliber riders including Bobby Julich who went on to finish third in the 1998 Tour de France. The Michigan team  brought coaches, about 25 riders and allowed entrance of another 30 or so riders for an unbelievably small fee. It would cost us $130 apiece which included 7 days lodging in boy scout type bunk houses, 21 cafeteria style meals and the coaching expertise. After some discussion with his mom, Mike and I were signed up and off to the Orlando area of Central Florida

At the camp, we were able to ride many miles with experienced racers picking up a few nice tips. The program was comprehensive covering  predictable related training and recovery topics. The novel discipline was the introduction to the speed bag. First it takes several days to acquire the minimal proficiency needed to to get any benefit.. Once that is accomplished you can get a nice aerobic upper body work out, ideal for cool winter nights. There are several additional layers of benefit with the speed bag routine. When riding for many hours the upper body absorbs a good deal of near constant vibration. Your arms are essentially shock absorbers, adding  fatigue to the more obvious problems occurring  in the legs. The repetitive punching tones the appropriate muscles to better endure this. The high reps preclude muscle bulking you would have to carry up all the hills.We were also instructed not to look directly at the bag while hitting it, training the peripheral vision to be more acute, a necessary skill when riding a tight pace line. Here the center vision is directed ahead of the front rider(s) in order to anticipate changes in speed and direction. With the newly acquired precision peripheral vision, you can put your front wheel one inch from the back wheel of the rider in front of you and hold the narrow distance steady just like you can better hold a full glass of water while walking when you do not look at it. One inch greatly reduces the drag that would occur at 2 feet.

The last benefit was entirely serendipitous. Once home and able to hit the bag in my barn, I discovered this  to be a great way of taking out some aggression which helps melt away the relentless crashing waves of the daily stress monsters. Besides wailing away at the bag with the enthusiasm of a gladiator, given no one is in ear shot, I can yell out expletives, at great volumes which in conjunction with the punching, exponentially dissipates the demons. So far there have been few complaints from the neighbors and only a rare call from the crisis intervention center.

Mike went on to first become a better road racer than I and later developed a special interest in the velodrome (track racing). Despite commitment to his own family and some sort of highly responsible job, we still manage to go on bike trips together. More on that later.