Training Time

The season has begun — triathlon season in Saipan. I hope you are looking forward to more stories from Tagaman, XTERRA and the Festival of Runs soon because.. you’re going to get them. There was a point last fall when they weren’t sure any of those events would happen after the devastation of the typhoon and visitor authority funding, etc but I’m happy to report they are all on.

So, the training has begun. Much to my reluctance, a bike was lent to me so I had no excuse not to do the Tagaman race — this is an olympic (or you can choose half-ironman) distance traithlon on the road (i.e. no mountain biking required). I have started doing what are called ‘brick’ workouts on the weekends plus putzing around on my bike. This morning, I did a 3 km (well, that’s what they say — some say it is a shorter distance than this) ocean swim at PIC. It was a beautiful morning and here are some pictures.

This makes for an extremely hungry me but feeling good to be exercising and being outdoors!

As usual, it’s just a fun community to be a part of — the kids who swim smoked the adults on the race (seriously, 3 km in 34 minutes — that’s 1 km in 11 minutes, some people cannot even run that fast!) Here is one of our island’s super start swimmers accepting first place.


IMG_8759Oh yeah, PS they used a huge inflatable ducky as the marker for the shore.. pretty darn cute.


The wind was strong today so made for good windsurfing afterwards (let me clarify, windsurfing watching on my part).

And some recent sunset/long stretch of beach pictures thrown in for good measure.



Speaking of being outside and not sitting and watching TV..  superbowl Sunday and Chinese New Years are coming up! I didn’t plan well and am scheduled to be working in the clinic on Monday morning (yes, superbowl Sunday actually = Monday morning breakfast/brunch for us) so wont’ be partaking in superbowl watching this year. This usually happens at random restaurants and many people watch illegally on their computers if the internet connection is okay.  I guess I’ll just have to watch all the highlights later and all the ads on Youtube!

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Transport Number Who-Knows-How-Many-I’ve-Done-Now

So, another transport in the books for me. I write this on the long multi-part plane ride back to Saipan because I always find myself reflecting on this or reflecting in general. I must not be the only one that uses the loud white noise of airplanes, the romantic-ness of floating over beautiful colored clouds, and the anonymity of sitting in rows and rows of strangers to reflect.

Some Hawaiian islands pictured from the air en route back to Saipan

Some Hawaiian islands pictured from the air en route back to Saipan

This transport was unique for me because I was taking care of two patients. This, as you can imagine, rarely happens. It just so happened that two critically ill patients needed to be transported off the island for a higher level of care at the same time. It was exceedingly stressful. I was temporarily in charge of two sick patients, one of which was intubated (recall most of my transports involve patients like this – i.e. ones with breathing tubes that we need to artificially inflate their lungs with) and the other of which was potentially moments away from needing this type of life-saving intervention. Plus the help of two nurses and a respiratory therapist who awaited my assessments and plans for any issue that came up.. plus two family members who were making this trans-Pacific flight — one of which had never heard of California in his life.

Some of my thoughts:

I try to remember to put myself in the patients’ shoes as much as possible and this comes with the growth of empathy but also heart breaking truths about the world. Recently, many of the patients who have been ill have been people who are not originally from Saipan. I guess I mean their parents are not originally from Saipan. The child/patient was born here but their families came from other places. Some of these cases are patients whose parents came from other Micronesian islands (in general, ones that have a much higher percentage below the poverty line), some that have come as contract workers from other densely populated but lower/different socioeconomic status nations (Philippines, China, Bangladesh), etc. First of all, the process of getting off Saipan for these people is not easy. It is complex and multifaceted. It usually involves pleading letters from me that do virtually nothing to support the rapidity of obtaining passports, daily calls to USCIS (United States Customs and Immigration Services) and paperwork up the wazoo. In addition, there is the hurdle of working with the CNMI government-run medical referral system — an essential system in place that everyone needs to be funneled through to get care not available in the CNMI. It is a complicated, expensive, and frustratingly slow system. And then, one you get off island, it’s quite a different story.

You spend weeks or at least days preparing for a trip that you know very little about and that us doctors can only hint at. Then, you board a commercial airline where you see your child surrounded by these virtual strangers in scrubs who sit next to your child and negotiate with airline ticket agents, customs officials, and carry about their weights’ worth in medicines, equipment, and who knows what else. (I know what else — excessive just-in-case things because I am a cautious person who doesn’t like being caught without something important and also food — no food on long domestic flights (Guam to Honolulu = 6-7 hours, Honolulu to the West Coast = 5ish hours) that the doctor needs to stay awake for = need for a large amount of food, usually of the junk food variety!)

My meal on the way back -- CPK Cobb salad, Starbucks Iced Green Tea Latte. When in .. anywhere other than Saipan .. you purchase these things!

My meal on the way back — CPK Cobb salad, Starbucks Iced Green Tea Latte. When in .. anywhere other than Saipan .. you purchase these things!

Then, after navigating customs in Hawaii, being dragged to airline lounges or places where you can get reliable power sources for their medical equipment, being dehydrated, having a partially numb buttock, and excessively worn out (as everyone is after a flight), you show up in a hospital built for children. This means you enter a place with colorful walls, shiny million dollar equipment and computers everywhere, the hustle of medical professionals who are learning how to be doctors and seasoned pros with what seem like all the knowledge in the world and the doctor/people from your small island drop your child off and turn around and disappear! In one case I brought, in less than the 24 hours it took to get to the hospital, your child has already been taken to the intensive care unit, had multiple radiology images done and been operated on — not to mention you find out news on what your child has that your doctor has been waiting for and conjecturing with you about for the past two weeks.

Waikiki and Diamond Head (I think) from the air

Waikiki and Diamond Head (I think) from the air

There’s only so much you can do to prepare your patient and their family for arrival to a place like this but I’m sure grateful that I can do it. I know what it’s like when you arrive so I do my best to instruct them on how it is going to be. The new children’s hospital world that they will be temporarily swirled up in is alien to most — even if you didn’t have to travel 24 hours to get there. I’m so thankful that there is a way for me to get my patients from Saipan to better medical care — that they have access to it and they can benefit from it. So while I have written lots about the craziness that is transports, I wanted to be sure to share why I do it still. While it is scary and crazy for these patients and I wish that we didn’t have to take them so far away from everything they know to get these things, sometimes we get to see the fruits of the labor of these transports. It reminds me of how much more there is to be done in places that are worse off than Saipan and how much more improvement there can be to care. I’m grateful be able to step back and see the bigger picture about the disparities in needs/services in medicine around the world and participate in closing that gap for just a handful of patients.


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Plane caught on the ground – only in Saipan

Okay, so this didn’t exactly take place in Saipan but it’s one of those things that you just think cannot happen anywhere else.

I just returned from a patient transport to California and was on the last leg of my flight. I have discussed the finicky nature of flights from Saipan to Guam in the past but — this is the only way to return. The rest of the flight connections had been surprisingly on time and without problems but I was exhausted and ready to be at my home. We boarded the plane in a relatively timely manner and then.. we waited. I was at a window seat and noticed there were people milling about the outside of the plane – not promising for having the plane take off. We waited, another 30 minutes, and then another. We should have landed in Saipan by now. The pilot exited the plane and came back and stood in the aisle.

“We’re going to need everyone from here back,” he gestured, “to get off the plane.” …

So, I dutifully removed myself from the plane. Turns out, a panel on the bottom of the plane that had been opened was stuck.

Reassuring, right?

IMG_8643 (You can barely see the stuck panel on the picture to the left. On the picture from the window you can see how the tarmac is not one smooth piece of concrete but really more like a sidewalk. )IMG_8644

So, the panel was opened and got stuck in the CRACK in the tarmac. Their genius thought after an hour was to get some people off the plane so that they could possibly slightly lift the plane so that the panel could get unstuck.

Well, it took taking everyone off the plane and the luggage off for this to work. And, two hours later, we were off to Saipan.

Oh, only in Saipan.


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Official Race Pictures

So, I ended up purchasing the data package of the official race pictures. For those unfamiliar with official races – there are always hired photographers around the course (think like in a roller coaster ride, they always pick the spots when you’ll be the most tired, the finish line, start line, most excited, etc). This does not happen (or at least I don’t think so) with Saipan just because it’s not a big enough race but having been in bigger official races before, I knew to expect this.

I received the pictures recently and printed out a few nice ones for safe keeping and also to send to friends who ran the marathon with me.

Please visit this link to read the story from the beginning of my short trip to Japan.

Anyway, they threw in a few extra shots of the race since it was such a beautiful day in the area so I wanted to share them with you. The majority of the pictures are of me (they track you based on your race number which is supposed to be displayed prominently on your front side) but I am not including them here. I was glad they took some pictures of the race course separately since really there was no way I was going to get those pictures. I did take quite a few on the course but they aren’t nearly as nice as these.

Good memories!


This is a view of the bridge that we cross over a portion of Lake Kawaguchiko. The path has us run a bit in the town before crossing so by the time we are crossing this bridge, it’s about 10 km.


This is a view of Mt. Fuji from that day from Lake Saiko I believe.


They must have taken this the morning of the race — seriously, we woke up to this — perfectly clear views! I’m so glad they got these night pictures/dawn pictures because I never seem to be able to get these types of pictures to come out and I love the lighting and love that this is captured.


20151129-071531_25084620-1-1_157-2645558_ALLDATAx1.jpgAnother view of the bridge perhaps the day before since there are still cars on the bridge – it was obviously closed when the race was going on (as were all the roads – this is super nice.. never fun to run a race or run in general with cars on the road)


Seriously, a beautiful lake — this is Lake Saiko I think.


The foliage, morning dew on the lake and Mt. Fuji combination is picturesque – this is from Lake Saiko.

20151129-081743_25084620-1-1_155-2772209_ALLDATAx1.jpgOne of the ?2 or three tunnels we ran thru.




This is the view from the bridge looking back at Mt. Fuji. (see blog post for more – this is where I found my fellow runners after losing them!)





More posts and pictures to come, a bit busy now at the hospital with some short staffing and another transport coming up later this week.

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Other islands


The Commonwealth of the Northern Mariana Islands (CNMI) is not just Saipan — and the every now and then mentioned Tinian on this blog. It consists of 13 islands I believe, not all of which are populated. This has been the topic of land use by the US military which I understand right now is a question that has fortunately been put on hold.


This morning, I saw a post that a friend of mine saw Anatahan, the island neighboring us to the north. I have never seen this island as it takes perfect conditions to see it.

Screen Shot 2016-01-13 at 6.35.27 PM

Here’s a reminder of where the CNMI sits in the grand scheme of things. The way it is outlined here helps you see the are north-south that it spreads — it’s actually quite a distance! While I’d love to visit the Northern Islands some day I doubt it will be in my cards since at this point it takes a chartered boat (where I would inevitably throw up the whole time) to get there.

This is Anatahan..


“Anatahan aerial” by U.S. Geological Survey – Licensed under Public Domain via Commons –

Today, the weather was perfectly clear and at sunset, I went up to my roof and was able to see it in the distance. Yes, I know this picture is horrible because it is so far away.


As I stared off into the horizon and saw the speck of land in the distance I couldn’t help but wonder what people before the days of wikipedia, heck the days of planes and trains and anything but what you made with your hands and the things on the ground around you thought. Apparently this island erupted in 2003 and sent a plume of ash into the sky. Can you imagine what it was like when you didn’t know about volcanos and things and you just saw a plume of ash come out of a neighboring island? It’s the same feeling that you have here when you get to see all the stars in the sky. People made stories about constellations just like people that live in island communities have stories about how islands were born. Someone many years ago also looked into that sky and discovered planets and the way the world revolved around the sun. I appreciate here being able to wonder at the things that are free to all of us.



photos from my deck as the sun has been setting the last two days :)

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License plate mishap – only in Saipan

I should create a category on my blog for ‘only in Saipan’ things. This, as I believe I have mentioned before, is a common phrase uttered amongst us Saipan-folk.

Today, I had one of those experiences.

Vehicle registration (or doing anything officially here) always seems to have one or two extra steps. I knew this and had some time to kill this morning (aka, I had work to do but wanted to procrastinate and do something mind numbing and that did not involve much thinking).

So, I needed to renew my car registration (actually, I was overdue and something about the new year made me feel like being an upstanding citizen). First step – visit the Bureau of Motor Vehicle’s here. This is the same as the United States except a lot smaller and there is no ‘take your number’ — you just sit in line along the wall. There’s the same windows where the customer service representatives slowly do one thing at a time. God help those people – they have a hard job!

But… they are slow. See this movie trailer for a good laugh.

(P.S. I initially saw this trailer before The Force Awakens.. the movie theater is open again!!! and with new seats! It opened in time for Star Wars and I saw it on the 4th day it was playing — and I was one of TWO people there. I guess everyone who wanted to see it desperately in Saipan already saw it!)

Okay, moving on…

I approached the desk when I was up and asked for my registration renewal. ‘Okay great, return after you pay at the court and get your car inspected.’ I expected this so duely went off to … pay my dues. I went to the court which fortunately is basically next door, went thru security and then went into the payment section where I waited in line to pay with my check. (FYI, do not use an off island check, no credit/debit cards accepted, and they do not give change if you only had cash… yes, only in Saipan. In the States, I bet they practically take anything including apple pay or something ridiculous where you pay off scanning a barcode tattooed on your body .. just kidding!). Of course, they needed my license plate number to type into the receipt so I provided that.

I then drove off to the nearest vehicle inspection place. As I pulled up and rolled down my window to tell them I was interested in a vehicle inspection, they said — your car is practically brand new! Just park there. So, I parked there, paid my fee and got my inspection paperwork stamped and drove away. Notice anything missing? haha, well I’m sure my car would have passed anyway but, only in Saipan.

I drove BACK to the Bureau of Motor Vehicles and fell back into the queue for my vehicle renewal. They took all my paperwork and began processing it. This is where it got fun.

‘Miss, do you own a second car?’ ‘No, I don’t’ ‘Are you sure you don’t have a car in Tinian’ (i.e. the next island over). ‘No, I don’t’ ‘Sure?’

Why were they asking this question?? Because apparently there is another car in Tinian with my SAME LICENSE PLATE NUMBER. Okay, first of all, how is that possible? Secondly, why would you ask me if I had another car on another island with the SAME LICENSE PLATE NUMBER.. even if I had another car on another island, wouldn’t it have a different license plate number? I could only smile.

So, they decided the best thing to do would be do give me new license plates. Remember above when I had to go to the court to give my payment? Well yeah, I had to go back to get the receipt from my payment changed to reflect my new license plate number. Also, I had to go to my car dealer to obtain their copy of the seller’s documents with the license plate number on it and they had to redo my ownership document for the car. At the car dealer, they nicely replaced my plates for me (because I did not have a screwdriver on me in the car! Who knew I needed one?!) and then I returned my old plates to the Bureau of Motor Vehicles.

Oh yeah, and then I drove to my insurance company to get them to print me a new car insurance card with my new license plate number on it.

Whew! Only in Saipan will you go thru all of this. Why did I have the same license plate number as someone else? No idea. That information is lost in the Marianas Trench somewhere and no one will ever know.

For now, I have a shiny new set of plates (and new plate covers courtesy of my car dealer). Now all I have to do is get my really dirty car washed and everything will look brand new!

Some recent pictures for your viewing pleasure…



(Sunset on December 30th from American Memorial Park Beach)

IMG_8389.JPGThe view from Suicide Cliff at sunset mid-hike this past weekend.

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Looking backwards before looking forwards

I think a lot of people do this inherently but maybe not explicitly… Looking backwards before looking forwards to the new year.

I recently read this post from…

It’s that time of year. You know, the time of year when you see people posting New Year’s goals, resolutions, and tips to bring your hopes to life. And nothing is wrong with that, but what I worry about is the temptation to thrust yourself into future without appreciating the past and enjoying the present.

So why not flip the script today? Can you make a list of everything you accomplished this year? Not only will it remind you how far you’ve come, it’ll prove how far you can go. And that’s the best way to start a new year.

I felt like that really resonated with me since I am lucky enough to be working and living in a place that helps me slow down and appreciate the now. I hope you do the same before you jump into resolutions for next year — appreciate what this year has been. I think as you get older you find yourself saying more and more ‘time is flying by’ and this is my way to slow down the clock a tiny bit. Take 5 minutes to sit somewhere where you can see something outdoors, give yourself 2 minutes of that time to stop thinking about anything and just focus on slowing down and relaxing .. then you have three whole long minutes to run thru your list of the things you are thankful for right then. Do not let yourself think about the to do list for the rest of the afternoon, do not let yourself think about the potential things that could happen to ruin that moment, etc.


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