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Same shift, different day : High-intensity interval medicine… : Emergency medicine news

well-being, burnout:

Dr. Harmon and his friend Atlas’ dog on the Pismo Dunes.


About 10 years ago, my wife and I followed our daughters’ high school football team to the Pismo Dunes. They were going to run in the sand to condition themselves. Afterwards, we decided we could go there periodically to run a few dunes to change the pace and add variety to our workouts. We’ve been doing it ever since.

Running away can be approached in several ways. We usually hike the quarter mile access trail in the sand. It’s like a moonscape – rolling sand hills for miles. Some of the dunes are small bumps; others are 40 or 50 feet high. We rarely see anyone there. Unlike the coastal side of the dunes, there is no ATV or RV traffic. It’s beautiful and threatening at the same time.

The workout is what you might call high-intensity interval training. It’s just a euphemism for torture. Set the timer. Run up the dune, then back down as fast as you can. You earn your rest. If the timer is set to 45 seconds and you go up and down in 10s, you have 35 seconds of rest. Once the clock catches up to you, you’re done.

What’s crazy is that it’s different every time. So many variables come into play. Aside from the usual things like your rest or your motivation, conditions are constantly changing. If it’s hot and the sand is really dry, it’s like running on a moving escalator. If the wind has been blowing all night, then the 30ft you last ran is now a 40ft or maybe even gone. If it’s raining and the sand is compacted, it’s more like running stairs. It’s easier, but you’re going to be there a lot longer before time runs out.

I talk to myself a lot while running in the dunes. The first thing I usually say is, “I love it. What a beautiful day. Look at these surroundings. It doesn’t take long, however, until I ask, “Why am I doing this again?” The quads are starting to burn and it doesn’t seem like there’s enough air even in those big spaces. Invariably, I start counting a 1-2-3-4 cadence in my head. It brings me four steps closer and distracts my mind for a second or two.

I usually keep my head down, staring at the sand. I sometimes looked up at the crest of the dunes. He’s usually disheartening and never seems to come any closer. Looking down and counting and trying not to notice that my wife is in front of me is all I can do. I can also make a line in the sand at the bottom each time.

The Dunes of ED

It’s ironic: these dunes hurt me but give me something I can’t get from any other workout. I love it, especially when it’s done. I think you see the parallel with ED.

We love it even if it hurts us. It is high intensity interval medicine, which can sometimes result in torture. There is no specialty like that. It’s beautiful and disturbing. I don’t know about you, but I talk to myself a lot during a busy shift. I try to keep my head up for what’s going on in the department, but it’s head down when it comes to work. Looking at the waiting room or listening to the count of the ambulances gives the impression of looking at the top of the dune: discouraging. We definitely deserve our rest.

The dunes are incredibly popular and people come from all over to camp and have fun. It’s the only beach accessible by car in California and a unique place. They also bring a huge amount of tourist dollars to the local economy. They are not without controversy, however. Some want to close them for environmental reasons and to preserve natural habitats. Others believe that all vehicle activity leads to airborne silica and is a health hazard.

What’s doubly ironic to me is that we also evacuate a good portion of our trauma patients from the dunes. What makes training unpredictable applies to the “nuts” who like to drink and fly on their mountain bikes. Conditions are constantly changing, and the 10ft dune they flew over yesterday is now 20ft. My run is usually lonely, but the state park side can accommodate 25,000 campers at a time. You can see my love-hate relationship with the dunes once again.

I will be going back there in a few days. I will wonder why. It will be a challenge to keep moving. I’m gonna keep my head down and talk to myself to keep going. I will adapt to all conditions. I will earn my rest once more. And when I get home, I can even go back to the dunes.

Dr. Harmonis an emergency physician at Marian Region Medical Center in Santa Maria, California. Read his past columns on