Running With a Six-to-Seven-Minute Mile Pace: My Simple Approach

(Note:  the following is *not* health or fitness advice.  It is simply my personal account of how I achieved a greater level of fitness.  You should consult your physician before starting any fitness program.)

I accidentally discovered that I can run a mile in less than seven minutes and maintain that pace for the duration of the run. I’m not a competitive runner; I run for health, fitness, and “speed hiking.”  I also have a talocalcaneal coalition in my left foot that was set off by an ankle sprain in junior high and that prevents any serious aspirations about running.

I don’t keep track of distance, only of time and relative speed, so I don’t keep track of how quickly I run a mile. However, inclement weather forced me to run indoors recently, on a treadmill, and I realized I can easily run a mile, on level ground, in well under seven minutes (something like 6:30 to 6:45).  More importantly, I maintained this pace for more than twenty minutes (the gym closed at that time) without fatigue.  At thirty-five years of age, that’s not bad.

For most of my life, I wasn’t nearly this fit at all.  Residency’s long hours made it difficult to work out, so I constantly had a middling level of fitness during that era.

After residency, I started running more seriously, but still didn’t attain a high level of fitness.  Finally, I decided to take my father’s advice (he’s been a very successful competitive runner for decades) and adopted the following, simple approach:  run once a week for distance, run another day for speed, and run a third day at an average pace for only a half hour.

This approach revolutionized my cardiovascular fitness.  Within a couple weeks, I felt fitter, running became easier, and then I accidentally discovered, many months down the line, that my mile pace is less than seven minutes.

In summary, I run three days a week, each separated by at least a day of rest (I do upper-body strength training on “rest” days, taking one day completely off):

1. I run once a week for distance, at an average pace, increasing the prior week’s maximum running time by no more than 10%.

2. I run once a week for speed.  This run usually lasts about thirty minutes.  I warm up and then run at an average pace.  At the 18-20 minute point (this point starts earlier as I gradually become fitter), I start interval training:  I run as fast as I can for one minute, then slow down to an average pace the next minute, and repeat this cycle until I reach thirty minutes.  (Note:  when starting a practice of interval training, one should not run as fast as possible during the speed intervals.  One should run just slightly faster than one’s average pace.  Over subsequent interval training sessions, one can slowly increase this “faster” speed until one is eventually running as fast as possible.  If one advances too quickly, one will get injured, won’t be able to run for a long time, and will lose any achieved fitness.)

3. I run once a week at an average pace for thirty minutes.  Because of my weekly interval training sessions, my average pace becomes faster and faster.  (Otherwise, it would stay the same and I wouldn’t become fitter.)


A Brief Report of Tragic Irony

I saw a patient today, a sweet elderly Hispanic woman of very limited means, and possessing of very limited education, who is lost in the maze of the convoluted Medicare system and cannot obtain her rheumatoid arthritis medications. She doesn’t qualify for Medicaid. Can’t afford other supplemental insurance. She signed up for Medicare parts A and B, but didn’t know she had to sign up for part D, and now she can’t obtain her TNF-inhibitor (for more than half a year now). What’s worse, she was recently told by her pharmacy that she won’t be able to get her methotrexate, prednisone, or quite frankly any of her medications. She’s been in a flare for many months, her disease gnawing away at her joints with irreversible damage.

This is tragic. What’s ironic is that the very system that should help people of her demographic (elderly, of limited means, etc.) has her lost instead in a complicated, confusing maze of complexity.

We tried to help her out as well as we could.  My attending spoke with a drug procurement specialist about her situation. I referred her to a case manager.

But it shouldn’t have even come to this. The system in place to help her demographic should make it easy for people like her to obtain the treatment they need. Sadly, ironically, tragically, many seniors find the system confusing.

A Witnessed Death


“You live like this, sheltered, in a delicate world, and you believe you are living…And then some shock treatment takes place, a person, a book, a song and it awakens [you] and saves [you] from death.” – Anais Nin

On June 12, 2013, my driver and I were on our way to Sierpe, Costa Rica from Manuel Antonio when the road entered a palm tree plantation.  About 50 meters in front of us, a blue hatchback circled into view along a bend in the road, then lost control, veered off into the plantation, and hit a palm tree head-on, its front bumper popping out along a dramatic arc back onto the highway.

We were the only people who witnessed the accident, and we couldn’t believe our eyes.  My driver pulled to the side, rushed out, opened the trunk, and pulled out a fire extinguisher.  Flames licked the front of the wreck.  I was afraid the burning vehicle would explode.

He doused the fire, but then a little fire started up again near the front left tire.  His fire extinguisher was empty now, though, so he pulled out his cell phone and called an emergency number.

There was no way to pull the driver out of the car for CPR.  The young man was unconscious (likely died on impact, if not before), clamped tightly by the compressed right front seat.  His head lay to the right, out the passenger-side window.  An arm stuck out the window, too, and his face was bloody, with blood on the ground.

I checked his pulse through a blade of grass to avoid contact with his blood; his carotid and wrist pulses were absent.

We flagged down an eighteen-wheeler and other vehicles for assistance.  One of the drivers brought out a fire extinguisher but squeezed its lever with no effect, so he went back and produced a large container, previously for what seemed to be motor oil, and splashed what was probably water onto the remaining fire, dousing it.

More people had accumulated by this point.   Among other things, they looked at him and repeatedly checked for a pulse.  Then they put their hands on their heads and said “muerte,” one of the few Spanish words I understood.

If we could have pulled him out, if we could have cut away the car, we would have performed CPR.  I could have directed it.  But CPR was impossible.  Eventually, my driver and I got back into the car and drove to Sierpe.


He dropped me off at a waterfront bar/cafe, “Las Vegas,” where I waited for a water taxi to the jungle town, Drake Bay.  The accident I witnessed earlier was on the Costa Rican national news.


Sudden deaths are spooky.  Day in and day out, the most unusual thing about working in a hospital, relative to working elsewhere in a developed country, is that there are no illusions between you and the brutality of nature, which manifests most terribly as mortality. This is the most disturbing thing. Debility, deterioration, and death constantly force themselves into your view, such that there can be no illusions about what will happen to each of us, and indeed to all animals, everywhere (except, perhaps, the hydra).

I no longer spend a large amount of time in a hospital or acute-care setting.  Outpatient medicine is somewhat buffered from the three D’s above.  When I’m not dealing with the three D’s regularly, though, my wishful thinking begins to reconstruct itself: warm illusions of safety, stability, and longevity begin to envelop my perspective again.

The lesson in all of these experiences, for me, is to not take anyone in my life for granted.  It’s important to be fully present with yourself and others, to refrain from pettiness, to interact with others fully aware that you have no idea how long they’ll be around.

This essay was republished by on 1/28/15.

Tune Your Guitar After It Adjusts To Your Body Temperature

Until recently, I always checked the tuning of my guitar at the start of each daily practice and found it to be off.  I thought it just didn’t stay in tune.  I realized recently that I was wrong:  it actually stays in tune quite well!

Here’s a tip I haven’t seen in any guitar-related book or website:  check your guitar’s tuning after it has had time to adjust to your body temperature.

I accidentally discovered that if I play scales at the start of guitar practice sessions, and then check the tuning about five to ten minutes after the guitar and its strings have had time to warm up, then no adjustment to the tuning is necessary at all:  it’s perfectly in tune.

However, if a tuning check is the first thing I do upon picking up the instrument, then it’s almost always out of tune.

So, while many other factors can affect the tuning of your particular instrument, a subtle factor to keep in mind, that I haven’t encountered anywhere else, is that tuning should not be the first thing you do at the start of a practice or play session.  Instead, it should be something you do after the instrument has adjusted to your body temperature.

“Cormorants” and Other Challenging Pencil Drawings


Way back in January, 2011, I went on a whale-watching trip off the coast of Southern California with a friend–a Basque neurology resident–from Spain.  I had been drawing for only a few months, working through Drawing on the Right Side of the Brain, and wanted to challenge myself with something tricky, so I drew my hand drawing cormorants (I used a photo from the trip as a reference; the drawing was done with graphite on low-quality paper).  It was exciting to do something with a different visual perspective!

Since then, I’ve challenged myself in numerous other ways, all with the goal of gaining skill as rapidly as possible.

In November, 2011, I sketched this shell directly in five minutes…


I wasn’t happy with it, because it wasn’t sufficient practice, so I drew the shell again, this time by drawing the negative space around it.  It took about thirty minutes and was drawn from a slightly different sighting angle than in the below photograph:



My right hand drew itself drawing itself:


That wasn’t easy.  Sketched it while flying back from a fellowship interview in September, 2012.  (It’s hard to draw on a plane because of the jitter and the shakes!)  The plane trip took a while, so I also drew this:


Just as with any other skill, drawing requires deliberate practice for improvement.  Think of such challenges as “interval training” for your drawing ability.  (Interval training is one of the things runners do to gain speed and fitness.)

iPad Art: Rapid Sketch of a Soprano Ukulele in Paper by 53


I recently updated Paper by 53 on my iPad and was pleased to find that it’s been updated with key features that make it much more likely for me to use it in the future:

1. The zoom lens expands as you approach its border, making it easier to draw while zoomed-in on detail.

2. The watercolor brush maintains your current wash even if you lift your stylus briefly.  In the past, it would start a new wash if contact with the screen was broken.  It was quite a challenge, without a sufficiently receptive stylus (or your finger) to create large, uniform washes.  That’s no longer the case.

3. The watercolor brush changes to a smaller size when you’re zoomed-in, allowing finer detail (even if you’re not using a pressure-sensitive bluetooth-enabled stylus).  This, along with #2, is a critical feature that I really appreciate.  I couldn’t take the watercolor brush seriously until now.  (Real watercolor brushes are so much more nuanced in applying paint to paper.)

As for ukulele, I have two soprano ukes and am learning them on and off while learning classical guitar (which is my primary musical focus for now).