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#15 The Marathon des Sables & Retrieval Medicine

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Virti Team
June 20, 2020

Apple Podcasts

Summary

On today's episode Alex is joined by Dr Tom Judd who completed the six-day, 251 km ultramarathon the Marathon de Sable while training as an NHS anaesthetist. Along with his medical degree Tom also holds a certificate in medical education and has conducted research into the impact of technology on team performance in medical students. Alex and Tom discuss training and completing the toughest foot race on Earth together with retrieval medicine, the importance of communication in high performance teams and lots more.

Transcript

Alex (Host):

Welcome to the Human Performance podcast. Here, we talk about everything to do with human performance, and how leaders and organizations can get the best out of themselves and their people. I'm your host, Alex Young.

Alex (Host):

Hey, everyone. Welcome to season two of the podcast. On today's episode, we are joined by Dr. Thomas Judd, who ran the Marathon des Sables around his training as an NHS anesthetist. We discussed everything around human endurance, performance, through his journey of training and completing the ultra-marathon. Tom also has a fantastic background in retrieval medicine, and we touch on communication as well as his background in medical technology and its application on how to build high-performing teams in the clinical space and beyond. Hey, Tom. How are you doing?

Tom:

Yeah, good, thanks. How are you?

Alex (Host):

Perfect. Really good, thank you. Great to have you on the podcast today. I just want to kick things off for the listeners. If you could just sort of explain a little bit about yourself and your background.

Tom:

Yeah, sure. So, my name's Tom Judd. I'm the anesthetic registrar currently working in Musgrove Park Hospital down in Taunton. A bit of ground from my medical side is my ACCS training. It finished in 2017. Over the last three years, I've taken time out of training to kind of explore other interests in medicine and outside of medicine, and I will be heading back into training as an ST3 in [inaudible 00:01:32] down in Wessex [inaudible 00:01:33].

Tom:

So, in my three years out from training, first year I did a year as a clinical teaching fellow, so getting the postgraduate certificate in medical education, and did some research on using VR as an educational tool with medical students. I then spent four months traveling around South America before heading off to New Zealand to work for 12 months, where I did six months of anesthetics followed by six months of pediatric intensive care, with a bit of retrieval medicine with that. And since returning back to the UK at the beginning of this year, I took up a post-retrieval medicine, repatriating people back to the UK from around Europe and North Africa. Then from the beginning of April, I actually have gone back into the NHS to help out during the COVID-19 pandemic in intensive care and anesthetics.

Tom:

My main interests in medicine have been mainly education and the use of virtual reality, and kind of from an anesthetics side, it'd be trauma and pre-hospital medicine. Outside of medicine, a big interest for me is rowing. I learned to row at the University of Bristol and rowed for that med school, and have continued to row since graduation. I currently still row for Nonesuch Boat Club, which is the University of Bristol alumni. More recently, since graduation, I've taken up ultra-marathon running, which culminated in running the Marathon des Sables in 2017 while I was doing my anesthetic core training.

Alex (Host):

Awesome. Now, we obviously know each other very, very well indeed. We were at med school together, and we, weirdly, haven't actually had an opportunity, basically because we've been so busy doing different things, to talk about some of your interests outside of healthcare and medicine. Obviously, one of the big things that I'm interested in is human performance, and amazing kind of feats of performance, whether that's in the sporting world, whether it's in the business world, especially in the medical world.

Alex (Host):

One of the things I really want to kick things off with is talking about the ultra-marathon, the Marathon des Sables, that you did. So, this is something that I find insane. I've run two marathons. I did New York and I did Tokyo in Japan. But an ultra-marathon is the next level up. So, could you explain a little bit about why you did that?

Tom:

Yeah. It's a bit odd that we never really spoke about it. The decision to run it, it's something I think, way back in early 2000, James Cracknell, who's obviously a GB rower and Olympic gold medalist, started doing these kind of endurance thing. I think the first thing he did was the Marathon des Sables, and then went on to row the Atlantic and I remember watching the documentary and him doing it, and thinking that was amazing, and something that I was really interested in. I think that was the spark that kind of imagined me as running it.

Tom:

I always then looked into it. It was always quite expensive. I didn't really run. You know, at university, I didn't do running. I purely did rowing. Then 2016, I think, an evening in with Leonie, we were sitting at the flat- [crosstalk 00:05:07]

Alex (Host):

That's your wife, for anyone who might not know.

Tom:

So, my girlfriend at the time, who's now my wife. I don't really know how we got onto the conversation about it, but we were having a bottle of wine talking about it. She mentioned as well, I didn't know it at the time, that she always thought about doing it as well. Half a bottle of wine each, we were like, "Oh, let's just have a look and see." You went onto the website and you could just register an interest to go onto the waiting list. The race was full, but they were like, "Oh, if you pay a £500 deposit each, you can go on the waiting list, and if you don't hear anything, then you get your money back."

Tom:

We were like, "Oh, okay. Well, let's just do it, see what happens. Probably won't get the space." And then at the beginning of January 2016, we both got a confirmation email saying that we'd actually both got a place and we were running in just over 12 months' time. [crosstalk 00:06:07]

Alex (Host):

Amazing, amazing. So, tell me about that conversation you had with Leonie when you both realized that you'd been selected, even though you may have been thinking this wasn't something that was on lock at that stage.

Tom:

So, it was a lot of panic, because I initially got the email and Leonie didn't have one, so it was this 24 hour period when I was running on my own. Leonie's done running at school. I think she ran at the national level at schools. So, she is a runner, and she's always done a lot of running, and I'd never done any. And so the person that wasn't really the runner out of the two of us ended up having the space, so there was a lot of panic and fear, and we hadn't really looked too much into it apart from just applying.

Tom:

Really, when we both found out, we were looking at what we'd actually signed up for, I think the reality kind of sunk in that although you could just enter it as a race, this was something that we really needed to take quite seriously, otherwise we weren't going to finish it. Like, it wasn't going to be a possibility at all.

Alex (Host):

And I think just to emphasize, this is an ultra-marathon in a desert in very, very humid condition. So, what's the actual distance, and what's the kind of average temperature? Can you remember off the top of your head?

Tom:

Yeah. So, you're in the Sahara in Morocco. It's a six-day race. Each day's a marathon, and then day four and day five are combined. So, it's a double marathon back-to-back, so it's about 56 miles, or 52 miles, all in one go, which you have up to 36 hours to complete. Average temperatures go up to, I think, 40 degrees. You carry all your own equipment. The only thing they give you is water, which is rationed. So you're carrying your food for the week, your sleeping bag, any change of clothes, all the safety equipment that they make you take. Yeah, and they only thing they give you at specific checkpoints is the water, so you have to manage your water.

Tom:

Bear in mind, so, when we signed up to this, the furthest I'd ever run was a 10k. I hadn't done a half-marathon. I hadn't done a marathon. So, you know, training started quite early. With regards to kits and things, that kind of came a bit later. The first thing for us, for me particularly, was actually just getting out and actually starting running.

Alex (Host):

Because obviously, your wife at the time, then girlfriend, was a dentist. You were training in anesthetics. So, busy careers where you're doing night shifts, you're working weekends. How do you plan not only a training schedule for a marathon, but for basically six marathons? How do you sort of factor that in to your day-to-day job?

Tom:

Yeah. So, I mean, the training program to start, the first thing, was we couldn't even start an ultra-marathon training program, because we didn't have the fitness to go into that. So when we found out we got the place in January 2016, the race was April 2017. So we had a reasonable amount of running time towards it. So, the first thing we did was we just downloaded off the internet a half-marathon training program, and then took the overall half-marathon, which was about two months' time, and did that.

Tom:

Then the next thing was, we did our first ultra-marathon in the August of that year, which was 100k. So that was the first time we were then looking at having to build up that kind of distance. Fitting it in... I mean, when you look at the training programs, the main thing is, there's actually quite a lot of short speed work, hill sprints, running up to 10k. So as long as you do four runs during the week, which we'd fit around work, or we would do them in the evening if it was an easy, low-tempo run. We live in Taunton, which is where I was working, again, at the time. So you would just get up that bit earlier and run to work in the morning as your training session, to kind of tick it off.

Tom:

The weekends, they were a bit more challenging, really. The weekends are where you build up more of your miles, and so you're building up to running for four, five hours on a Saturday, and then follow it up with a two hour, three hour run on a Sunday to kind of build up the endurance and recovery in your legs. Fitting that in around a social life or being on call was then quite difficult. It meant, for Leone, she didn't do any on call, so she could always do those ones on the weekends. I would then have to end up shifting, so if I was off on a Friday before being on for the weekend, I'd do the long runs then. So you kind of had to just be a bit more flexible, not really worry about missing a session.

Tom:

It wasn't like we were going out to perform and get a top 10 finish. Our goal was to complete it, and so missing one session because work's getting [inaudible 00:11:53], or you're getting quite tired... It was important not to get too stressed about that kind of thing, otherwise [crosstalk 00:12:00] become fun.

Alex (Host):

How helpful was it having a training partner when you're doing this? Because I would imagine that going from minimal running experience to having to put in regular running hours, especially in the UK. And although the southwest is a lovely area to live, it's not particularly sunny all year round. I think that's fair to say. Did you have any days where you were just like, "I just don't to get out, and I don't want to put in these miles?"

Tom:

Yeah, all the time. It was funny, we both had days like that, and not infrequently. I think the difference was, when you've got someone else that's doing it with you, I don't think we ever had a day where we both said, "No, I really don't want to go." I think if that had happened, then we wouldn't have done training. It just so happened that when Leone felt quite like she doesn't want to go for a run, I was like, "No, no, we need to go." We'd then go out and do it, and vice versa.

Tom:

It was quite nice. A lot of the runs for ultra-marathon running, they're not hard runs. It's just distance, and the pace that you're running at, you should be able to talk at anyway. So it was actually just quite nice that you go for a long run and we'll just chat, and just talk about things, which has meant that we've then carried on running and doing that since, because it was quite a lot of time that we then spent together and caught up on things. I think when you're both working long hours, busy jobs, you then come home and relax and sit in front of the TV or watch something. You don't actually really talk that much, and I think we found that we, doing this kind of thing with our training, we actually ended up talking a lot more, which is really nice.

Alex (Host):

And the other thing about this particular ultra-marathon is that it is in the desert, so how did you think about acclimatizing to the heat and temperature for when you actually did it?

Tom:

Yeah, so kind of didn't really have to worry about temperature so much until a month or two before. Because you're running on sand, again, you don't want to run too early on sand. You're potentially more likely to get an injury. And the other thing is running with weight. So, the minimum pack weight is six and a half kilos. Our pack weight, I think we got down to eight and a half, and that's because we weren't willing to spend. You get closer to the lightweight equipment, just costs so much more. So I think for every 100 grams we would save on weight, you had to spend an extra £100 on the lighter kit. So we just accepted that eight and a half was probably going to be, as, you know, we didn't want to spend all buying top-of-the-range equipment.

Tom:

So I think the first thing you do is mainly just elevation. There's quite a lot of elevation in the sand dunes and what they call jebel, which are basically just massive hills, rocky hills. So it wasn't unusual, on the course, to have a climb over 1000 meters, over the range of the day. So, you know, it's a huge amount of up and down, especially with the dunes. You don't feel like you're going particularly high, but you're constantly going up and down, and up and down. So, we just planned in a lot of elevation from that side of things.

Tom:

Regards to heat training, as the weather kind of got warmer and we trained through the winter, you then keep wearing layers when you go out for a run. So even though the weather gets warmer, you keep wearing the same number of layers so that you're kind of getting used to being overheated when you're running.

Tom:

The other thing we did was, we went to Gloucester University environmental chamber for three acclimatization sessions, which was really interesting. So, we literally we went and had a chat with them. They were quite expensive sessions to do, so we only did three one-hour sessions. One each week in the month before the race. And even doing that was a huge, huge difference, and we got an awful lot of information back from doing it. So I think the first session we went in, the guy was like, "Look, just walk." So, there was a treadmill and a bike, so Leonie was on the bike and I was on the treadmill, and then we swapped over at halfway. So for the first 10, 15 minutes, he was like, "Just walk on a treadmill." And Leonie was just doing quite lightly on the bike. And they would come in periodically and check out our core temperatures.

Tom:

I think within 15 minutes, my temperature had gone up to, like, 39 degrees from 36, which is the point where he almost has to take me out, within 15 minutes. I'd been slow jogging and a bit of walking. So, he's like, "Just go sit in the corner." So, I was like, "This is quite worrying. I've done all this running training, and I can't even actually run in the heat without overheating." But then, by the third session, I spent half an hour running at the pace I had been, and half an hour on the bike, and keeping my core temperature down to 37, 38 degrees. So even those three one-hour sessions made a huge difference.

Tom:

The other load of information that we got from that was how much we sweat, and how much water we were going to lose over the course of the race. The interesting thing that we learned from that was, I needed to keep my heart rate below 150. So, as my heart rate went above 150 when we were running, I started to sweat too much, which then meant the amount of water we knew we were going to get from the race wasn't going to be enough if I pushed myself any harder than that. So, then when we went out and we were racing, I had a wristwatch on, and we just made sure that my heart rate wasn't above 150, and if it did, then we would kind of slow for a walking recovery.

Tom:

Again, there was no point kind of pushing beyond that and risking not finishing, or getting heatstroke or dehydration, because finishing was the aim as opposed to getting a faster time.

Alex (Host):

I mean, again, what a great example of using technology to view new insights and new data that you wouldn't normally be able to pick up, or even think about, if you were to just kind of rock up. That's absolutely amazing. So, similar to you, I'm not a long-distance runner. I did things, basically, for a challenge. But I remember even when I was training for the marathons I did, you occasionally overtrain, you pick up injuries, or you have to have time off. Did you have any particular setbacks during your training?

Tom:

Quite early on, I did, particularly. We ran the half-marathon kind of a year before the race, and were building up to run a marathon just on a standard marathon training program, and I got a knee injury, and so ended up not being able to run, and needing to getting a lot of physio. And that was just down to, I hadn't done the miles before, and my body just wasn't used to it. I wasn't stretching enough.

Tom:

So that meant I did end up not running a marathon, because I was injured. So the first marathon I ended up running was the ultra-marathon a couple of months afterwards in August before the Marathon des Sables the following April. Which, again, I hadn't done a huge amount of training for. The reason we decided to do it anyway was kind of a big psychological factor. We knew that the longest stage we were going to have to run in one go in the Marathon des Sables was going to be about 90 kilometers, and this race was 100. So the idea was that as long as we finished it, we then knew that we had, even though I'd been injured, and a background of not having a huge amount of training, we have actually run that distance, the furthest distance that we're going to have to.

Tom:

We didn't complete the ultra-marathon. We got to 90k before we got timed out and got pulled off the course. But I think that was a huge, actually, psychological boost, that this was going to be an achievable goal. I think at that point it had always seemed something that was so big and unobtainable that even though we hadn't finished it, at least going 90 kilometers, which was roughly as far as we would go the longest distance without a break in the Marathon des Sables, meant on the background of not a huge amount of training at that point because of injury, it was something that was then achievable, and we really then pushed on from there.

Tom:

We were quickly lucky. Once I kind of got over that injury and after that race, I didn't have any further injuries. Leonie picked up a very small one when we started running with weight. She ended up getting quite a lot of neck strain, neck spasm, from where the backpack was kind of sitting, so we ended up changing her bag that we were going to go out running with. [crosstalk 00:22:13] And that was quite close to the race, but that seemed to be okay.

Alex (Host):

Then let's fast forward. So, you've been through your training. You've got to a position where the race is approaching rapidly, and you're out in Morocco. What's going through your head the night before, and the days kind of leading up to the actual event itself?

Tom:

Yes, I mean, it's an interesting kind of lead into a race. Obviously, all of it's arranged for you, so the race really starts when you arrive at the airport. It's a chartered plane, so everyone getting on that plane is doing the race. So you all meet at Gatwick, and you fly out to Morocco together. So, the night before, you're kind of packing, triple-checking your bag. You've gone through all your equipment, the exact amount of weight that you're going to have. You make sure that you're wearing your race trainers, because you don't want to put them in the hold, because if they go missing, the race is even you've started. Your hand luggage is your race pack, because again, you don't want to let that out of your sight.

Tom:

So, you're kind of panicking about getting all of your kit through, and making sure that you get through the airport and the other side, and then land in Morocco actually with everything that you can and then start the race. So they then book you onto the plane. You fly over to Morocco, and then as you come out, you'll get greeted by the staff for the race, onto buses, and then drive you into the desert. So as soon as you arrive, you get straight onto a bus that drives you into the desert.

Tom:

You then get sent round this clipboard, and everyone's got to write their name on the clipboard, and that's how you arrange what tent you're going to be in. So, they do put up a shelter, like a bivouac type thing, a small tent, that shelters you from the sun, but it's kind of open on each end. Eight people sleep in one of those through the whole race, and you get your number, and you stay together for the whole week. So the guy that we'd been sitting next to on the plane ended up being in a tent with us, and then it was basically people that were sitting around us. So, it's completely random. [crosstalk 00:24:42]

Alex (Host):

That's crazy. And I guess you're hoping you don't get anyone who's very annoying, or who snores, right?

Tom:

Yeah. I felt a bit sorry for Leonie. She was the only girl in our tent. It was seven other guys. Massive range of one, talent and ability, and kind of background. So there were two younger guys, must have been early 20s, one that had taken a sabbatical from a job in the city. One had just, I think, left university. There was a guy who worked in a restaurant as a manager, and then there was a older gentleman who's done a lot of Ironman running, Ironman races, and then was doing the Marathon des Sables. And then there was a chap, probably in his mid-50s, who'd done the race 20 years earlier. Basically, I think he'd just turned 50, and wanted to see whether he could still do it. Everyone's speeds were all quite different, so Angus, who worked at the restaurant. I think he came in the top 100 in the end.

Alex (Host):

Wow. And I guess as well, because this is technically a solo race, but obviously when you're training, unless you're training with a group of people who are all going over, it's very much a kind of solo experience, and your friends and relatives back home might think, "You're crazy. Why are you doing this?" But actually, probably when you get on the plane, and certainly when you get paired up, I'm sure there's a lot of camaraderie and a lot of teamwork that's going to help everyone get through. Is that something that you kind of found? And I guess when you were seeing the other types of people doing it, were you a bit like, "Okay, this is looking more achievable?" Or were you kind of intimidated by some of the people?

Tom:

I don't think we were ever intimidated. I think you made some really good friends. So, [Jamie 00:26:41], one of the guys that met, came to our wedding. We met him, he stayed in our tent when we were doing the race. What surprised me was just such the wide range. So, [Shaun 00:26:57], who was the chap who just turned 50, he was really unprepared and had propagators, even though he's done it before. You know, partially missed some of the equipment. But he walked the whole thing. His feet, you know, were absolutely shredded by the end of it. Walked the whole thing. Some people had iPods for music when they miss it. He'd brought a book, so he would walk with his book and read that to keep him entertained!

Tom:

The first couple of days, we were all like, "How are you going to finish this? This is absolutely insane." And I remember after the long stage, he got in. Probably, he was out there for 33 hours, out in the...

Alex (Host):

Wow.

Tom:

Trying to complete the long stage.

Alex (Host):

What book was he reading?

Tom:

I don't know. [crosstalk 00:27:53] A good book.

Alex (Host):

Like, War and Peace, or the Game of Thrones series. Amazing.

Tom:

I remember when he arrived back, he could barely stand. He'd been pulled by the medics and given a emergency IV drip. In the race rules, it's a penalty, especially if you're one of the top guys. You get a big time penalty for it. For him, it was of no consequence. But if it happens for a second time, that's it. They pull you. If you need one a second time, they pull you from the race. They won't let you continue. And he could barely stand, couldn't open his food, so the whole tent, getting his shoes off, getting his bed out, and cooking his dinner for him. You know, just to help him and make sure, try and get him hydrated and recovered for the final day to see if he could actually finish it.

Alex (Host):

Wow.

Tom:

Which he did. And I think that kind of summed it up, that as soon as he got back, everyone instantly helped. [crosstalk 00:28:53]

Alex (Host):

Did you feel kind of obliged, I guess as one of the only medics, obviously in that tent, but also in the race. Would you have to pull out any medical skills, or was the provision of medical help so rife that you could just kind of chill out and concentrate on your running?

Tom:

I mean, I didn't really have to at all. The race is so well-supported. The point I kind of realized that was, we were running, racing. You get to a checkpoint. Every time you get to a checkpoint, they [inaudible 00:29:27], and they stamp your card, make sure that you've then gone through. That's when you get allocated your water until you get to the next checkpoint.

Tom:

As we were going through, there was a guy obviously who was coming just behind us, and the woman's radio, someone radioed through saying, "Check number 371," or something, which was this chap that was coming in behind. And they were like, "Are you okay?" And he was like, "Yeah, yeah, yeah, I'm fine, I'm fine, I'm fine." Just trying to motivate you, get through the checkpoint and get going again. And she was like, "No, no." She's like, "Just want to check you're okay." She goes, "Just stand still for a second."

Tom:

He goes to stand still, and he instantly just starts leaning over to the left and starts to fall over, [crosstalk 00:30:16] at which point they just grab him and put him into a tent, get him some shade, make him drink some water. But it was all about facilitating people completing it, as well. It wasn't like that was going to be the end of his race.

Tom:

They had to, one of the guys in our tent as well. The end of the race, he was in a complete mess. I think Angus had systolics in the 70s or 80s when he finished, crossed the finish line on one of the stages. He didn't want an IV drip, because obviously, doing quite well in the standing. So they just make him drink his allocated amount of water, rehydrate himself, rechecked blood pressure and it was okay, so then he was released from the medical tent. So, they were really, really good and kept a close eye on people.

Tom:

There was one chap, I think, who ended up being medevaced out on a helicopter. I didn't personally see that happen, but he ended up in hospital. But they came back the next day and said that he was doing well, and he was fine. I think he probably had a heart attack or something, but he was doing all right.

Alex (Host):

My goodness. And for you, obviously you were running it with Leonie, and you guys run it pretty much side-by-side. What was some of the highs and lows of the actual six-day course for you, personally?

Tom:

One of the big highs is the start. So, you arrive into the desert. Then the following day, you kind of get up. There's a food tent. They give you all your food and stuff before you start the race. You'll need to be self-sufficient at the end of the race, and the day before is like all the pre-check. You register, you get your number. And then the next day's, like, that's it. It's the race. To everyone kind of getting ready, standing on the front line, and the countdown to start. They play the Highway to Hell. It's like the anthem of the race, which they play every morning as the race starts, and you're running out into the middle of the desert. And I think that was probably one of the most exciting bits, you know. Really, really enjoying it.

Tom:

That happens every morning. It's a great atmosphere. Everyone's really excited [inaudible 00:32:41] to go. They even, on the last day, everyone's absolutely knackered. But still, you know, everyone's excited, and the atmosphere was just great at the start of the race.

Alex (Host):

And you, [crosstalk 00:32:54] obviously completed it, and you got a very good time. When you actually, the finish line was in sight, and then subsequently when you crossed it. What was kind of going through your mind at that stage?

Tom:

So, I really struggled on the last day. We'd done the long stage. We completed that about 18 hours, which meant the following day, we had a full day to recover. Leonie really struggled on the long stage. She was getting a lot of shoulder pain still, and there was one point, she just kept complaining, so I turned round and said, "Well, the options are, just push the emergency SOS button on your GPS and quit, or shut up and carry one." Which, I think in hindsight was probably a very brave move. It could have gone either way. But she then stopped complaining and kept moving forward and we finished that, so it was great.

Tom:

But I then really was struggling on the last day, and I ended up getting my own bit of tough love to keep going. Then as we were running in, we were quite high up, and you could see the finish line, but it just seemed to be relatively close. But then it was just a flat expanse, so you kept running, and it just never seemed to be getting any closer. Then, you know, you finally start hearing the music that was being played at the finish line. You know, "Okay, we're actually getting quite close now," and crossing the line.

Tom:

The race director is there, you know, they're all handing out medals. Yeah, it was just the best feeling, finally finishing and getting your medal at the finish line. Yeah, nothing like it.

Alex (Host):

Yeah, I mean, it's such a fantastic achievement, and I think it's just amazing. I remember when us sent me and some of our other friends a picture of you just literally on a sun lounger by the pool. Which must have felt absolutely amazing after you'd done that, and you'd got through it.

Tom:

Yeah, so then, the cruel thing about it. You finish the race. The following day is a charity fun run.

Alex (Host):

What?

Tom:

So you finish this thing, and you stay in the desert. They give you two beers at the finish. Once the last person's come across the finish line, you then get given those two beers, and then you do the ceremony for the people that have come in the top three. But you stay in the desert that night, because it's quite late by the time that people finish, and they do this fun run, so people's families and things can sign up to do the Marathon des Sables fun run. It's 10k, so it's not short, and everyone has to wear these charity the-shirts, and you run the charity stage. And you have to run it. If you don't run it, you get disqualified, so then you technically don't finish.

Tom:

So, you run this fun run. Then you get on a bus at the end, and that then takes you back to the hotels where you're staying, and the bus, it's full of 40 people that have all run through the desert for six days, and all they had is, like, one wet wipe a day to clean themselves. So the bus is bit smelly. They put the air con on, and the smell is just horrendous.

Tom:

Then we turn up to this hotel. For some reason, they put the Brits in the five-star one. I think we pay slightly more for the entrance fee. So you turn up to this five-star restaurant wearing this charity t-shirt, you've just run 10k, and you stink. You check into the room, and it was amazing. There's a pool, spa, bar. Yeah. That was probably the best feeling. Sleeping in a bed again, as well, having slept on the desert floor for seven nights or so was-

Alex (Host):

No, I'm sure. I'm sure. I mean it's, again, such a fantastic achievement. You know, with me having done a little bit of long-distance running, I think it's phenomenal, and I think anyone who is coming from a background of not having done something, like where you hadn't really done a huge a mount of long-distance running, it's an event greater achievement.

Alex (Host):

Was there anything, I guess, from the process, whether it was the training or the race, that you took back into your daily working life, and in something like anesthetics, which obviously medicine in itself can be very, very stressful. It's a bit of an endurance sport in many respects itself, in doing long hours and having challenging scenarios. Did you feel that it kind of, I guess, changed you as a person from the experience?

Tom:

Yeah. I think so. I mean, I never really had set out something like such a big goal, long-term goal, that you had to specifically work for and train for, especially something that not only did you have to train so that you improve your running performance, but the logistics side of sorting out all the kit that you need, weighing it all, repackaging all of the nutrition and food that you're going to take with you, and kind of looking at other variables such as the weather, heat-specific training and things. I'd never done anything like that, and I kind of, I guess, retrospectively thinking about it, I probably have now taken that kind of approach into how I approach medicine.

Tom:

University, the goal was to graduate. I never really had a specific target or goal or whatever I was going to do after that. I was quite lucky. I stumbled into anesthetics. I ended up with an intensive care job in my foundation job that I really enjoyed, and decided that anesthetics was something I was interested in, and then just applied for a job straight from F2, and was lucky enough to get one in Taunton. And even then, then this is [inaudible 00:39:44] job. So, the first 12 months, I didn't do any anesthetics, so I didn't know if I liked it or not. I just quite lucky that since starting the training, I was like, "Actually, this is something that I really enjoyed."

Tom:

I think since coming back, having done the Marathon des Sables, I'm a lot more focused on thinking about what I want to achieve, and longer-term goals, and how you go about achieving those kind of things. I think that's what led, mainly, to the three years out that I've had. That kind of time period was a known. I'd always decided that that was then what I was going to do, and what I wanted to do with it. So I think I've become more targeted in picking an approach, and it's all to do with longer-term goals. What type of doctor do I want to be at the end of my training? How do I gain the skills and improve my performance to achieve those things? How do I get other experience that will then improve my chances of getting the job and career that I want, towards the end of it?

Tom:

I think I learned quite a lot about that during the teaching fellow year as well, is that I think in medicine, when you're training, you do a lot of training to kind of improve your performance. That's the aim. That's why we do the training. But the reason that we then put ourselves into situations, we're trying to learn and improve from them. You're trying to improve your response to stressful situations. You're trying to improve your teamwork and improve the environment that you work in.

Tom:

In medicine, it's always about improving performance, whether that's yours, individually, a team performance, or even the hospital, looking at quality improvement projects and all those. Everything is looking at improving performance, and I hadn't really thought about it like that until having done something like the Marathon des Sables, and I think that's probably what I've taken back into my medical career. It's become a lot more structured and focused.

Alex (Host):

And one of the things I wanted to talk to you about is, as you mentioned, the time you took to do what was an education teaching post for a year, where you actually got to focus on teaching and training, and how you could utilize technology again to improve the performance of the workforce. Could you speak a little bit more about that? About what you did and why you did it?

Tom:

Yeah. So, I took 360-degree videos of performing of, like, a CPR, cardiac arrest scenario, and using a virtual reality [inaudible 00:42:41] platform, created some teaching scenarios. The idea behind it was, CPR is something which medical students, some will get exposed to in real life, and the majority won't. I specifically didn't get taught that. It's quite a stressful situation. I think the first time that you're in that situation, it's very unfamiliar. People were very surprised by it. Most people won't have come across someone that's actively dying in front of them.

Tom:

And so I was kind of intrigued about how you train someone to still perform, having been put into a very stressful and different environment, without having been in that situation. So, took a bunch of third-year medical students and gave them all their CPR training, and then gave half of them the virtual reality platform to kind of learn and train with, and then put them through a couple of scenarios. Once, initially, with some training, and then three weeks later, just to see what their response was, and how they managed the scenarios. What we found was that those that had been kind of immersed in it, in a virtual reality environment, performed better in a kind of surprise cardiac arrest situation, and felt less stressed by it. Which brought up that kind of interesting, actually, because they'd had more exposure into what felt like a more real-world scenario. Did that mean, because of their less stress, they're then more clear-minded and they were able to perform better in those situations?

Tom:

Like I said, the idea behind it came from about improving performance. In sport, they've been using technology. As new technology develops, it's instantly picked up by sports teams, and they've been using virtual reality and other things to improve performance all the time. Been quite slow, I think, in the pickup of that in the medical profession. But as I said, the goals are the same, and so it was trying to bring that in and show that it's a useful teaching tool.

Alex (Host):

Yeah, it's interesting. I mean, the overlaps between sport and training and other sectors are very, very apparent. Like we were talking about earlier with when you went up to Gloucester to have your own personal metrics tested and assessed and get some unique data on how you perform at a high temperature, is something that you wouldn't normally be able to access. So, that's where technology has brought something to your door, and then it's also given you kind of unique data insights on your own performance, and that's very similar to what you're describing with putting medical students, or doctors or nurses, into these difficult-to-access environments, and then collecting that unique data on them.

Alex (Host):

Interestingly, you've done a lot in team-based and kind of team performance analysis, and obviously your own career has taken you through anesthetics, which is very team-based, but also into retrieval medicine, which is a really, really interesting aspect that not many medics get exposed to. Could you speak a little bit about that as well?

Tom:

Yeah. So, the retrieval job that I was doing at the beginning of the year, about two-thirds of the work was flying out to Europe and North Africa and retrieving people back from the UK that had been admitted to hospital, some from intensive care or high-dependency units, and others from ward-level care. The other kind of third, it was taking patients from Jersey and Guernsey across to Southampton for emergency treatment. So, there's no cardiology service in Jersey and Guernsey for acute MIs, or a possible cardiac arrest, so those patients need transferring, time-critical transfers, back to mainland at Southampton.

Tom:

I think the one way I think I got more value of it, actually, was the transfers from around Europe and North Africa. From kind of a logistics point of view, it's got an awful lot of people involved in repatriating someone. You have the insurance company who want to bring the patient back. You've got the hospital that you're going out to where the patient currently is, finding a hospital that you're going to bring the patient back to. You've got the land crew in the foreign country and in the UK, transfer to and from the airport. You've got the airport here in the UK that you're leaving from, and the airport that you're going to land in in the UK, the one wherever you're flying to. You've got the ground crews when you arrive. You've got to get through security.

Tom:

So there's just a huge amount of logistics and hurdles and loads of different people that you're interacting with, which makes things very difficult. You need to be very flexible, and be aware that there are a lot of issues that can lead to error or miscommunication, and then you throw in the language barrier with that as well, and you become extremely complicated.

Tom:

So, it's just being very clear with kind of what you're trying to achieve, and kind of planning. You get a varying amount of information on the patient you're going to go and retrieve. Some of the times, they don't sound too sick, then you arrive and they're a lot sicker than you thought. Other times, they sound really, really sick and then you arrive and they're actually absolutely fine. All the information that you get is normally probably two or three days out of date. By the time it filters through all the different people and gets to you and then you fly out to get them, it's all kind of a bit different. Which I think made it quite interesting. I mean, it was a very different challenge. I think the medicine and the repatriation side of things weren't the difficult parts. It was more the logistics and how different teams interact, I think was a bigger learning point from doing that job.

Alex (Host):

Yeah, really interesting. I mean, I think emergency medicine, at the best of times, is unpredictable and it's quite stressful, but if you're then adding in unknowns like, for example, the weather and flight paths and people who speak different languages, it sounds very unpredictable, and it's probably something you've got to just deal with as best you can when things happen, and just be as best prepared as you can. I mean, do you have any particular stories that kind of come to mind which you just can't believe kind of happened?

Tom:

Yeah. So, the majority of the time, you would go and you'd pick up the patient. It's all fine, the hospital's expecting you. You don't really get the handover. So, you get handed a varying amount of paperwork from the nurse that's been looking after the patient, I think. Picking up a patient from Morocco, I ended up with an A4 side of paper. It's a patient that had spinal surgery and been intensive care in Morocco, been in hospital for over two weeks. I've got an A4 side of paper that a handwritten note, and then a sticky notepad that I think had five drugs written on it, and that was the information that you get given.

Alex (Host):

You're laughing, that's actually a normal orthopedic spinal handover. [crosstalk 00:50:46]

Tom:

And then I remember turning up to a hospital, a patient wasn't there, and someone else in the hospital had arranged for another ambulance to take the patient from the hospital to meet us at the airport, whereas our company had arranged for an ambulance to take us to go their hospital to pick up the patient. So, the patient was missing for about half and hour, and then we found out they were in the airport. Then the ambulance crew was saying they were going to bring them back to the hospital. We were like, "No, no, we'll come and meet you there."

Tom:

The majority of the time, I think that I turned up to the UK and turned up to the hospital with a patient and they weren't expecting them. They knew nothing about them, didn't have a bed for them, and that wasn't uncommon. I think that's just, there's a huge amount of people involved in bed planning and organizing, and sometimes I'd turn up with a patient, they were like, "Oh, we were expecting this patient yesterday."

Tom:

But with the logistics and planning, like you said, with the weather and everything else, and where you've got crews and where planes are, it's not a case of, "We're flying out to pick this patient up today. We're definitely going to be back with them today." You're limited by the pilots are only allowed to fly for a certain number of hours, so depending on what time they arrive at the airport and the plane can actually take off, and we land in the country and how long we spend in country getting our patient means that sometimes, we'll there and we can't bring the patient back because the pilots don't have enough hours to fly back to the UK. So just all those kind of things led to quite an unpredictable thing, but I think the missing patient was probably the most- [crosstalk 00:52:35]

Alex (Host):

Yeah, missing patients at the best of time are not good things at all. But it's very interesting, because a lot of the stuff that you're talking about, it is all teamwork. It is all about communication and the soft skill side, which is where a lot of the mishaps can occur. So, I think we're almost out of time, but just to kind of wrap things up. I mean, one of the things that I like to kind of ask everyone on the podcast is, is there any specific, I guess, individual or example of human performance from either your own past or from anything external that you really kind of admire that has really inspired you to do anything that you're doing now? Any sort of really interesting examples that you can think of?

Tom:

So, the one that kind of springs to mind, and kind of gives me inspiration if there's anything I think is too difficult or unachievable. When I ran the Marathon des Sables in 2017, there was a gentleman called [Duncan Slater 00:53:42] who ended up being a bilateral amputee from being blown up by an ID in Afghanistan. He was also running the Marathon des Sables in 2017. He'd done it the year before, and unfortunately was unable to complete it. He then went away. I think he had quite a lot of issues with his prosthetics and things in the heat, but came back the following year, the year that we were running it, and completed it.

Tom:

I think, you know, I turn up on the start line and I'm worried about whether I'm going to be able to finish this or not, and then you've got a guy that's had both of his legs blown off and he's raising money for Walking With The Wounded. You know, I think that was just a big, big inspiration, and definitely something that, kind of, when I was feeling quite low when we were running the Marathon des Sables that you know, I was thinking, "Well, there's no reason why I can't do this. I've still got both my legs."

Alex (Host):

I mean, that's absolutely phenomenal. That's incredible. I mean, what a fantastic effort. I think even, you know, to fail at something the first time round and then to go back and pick yourself up and go back and do it, you know, speaks a lot to that story as well. So, that's incredible.

Alex (Host):

Obviously, you've got an amazing background. You've done some fantastic things. Do you have any kind of advice to anyone, not just in healthcare, but I guess in any sector, who might be looking at wanting to do something like the Marathon des Sables, or might want to be taking a chance and taking some time out of their job to go and do something super-exciting like a teaching technology year, or something like retrieval medicine or flying doctors? What would you say to those people who might be a little bit kind of on the fence? Or any kind of, I guess, words of wisdom from your own personal experience.

Tom:

I guess, it's a scary prospect. It's always quite intimidating, whether it was booking, deciding to do the Marathon des Sables, and even taking the time out from medicine, everyone's like, "Oh, what are you doing? Why aren't you going into training? Why haven't you applied?" I think the thing is, I don't think you're ever going to regret taking on a challenge or taking the time out, especially if it's something that you're passionate or interested about. Like I said, I looked at my long-term goal and what I was trying to achieve, what I've done in my time out has kind of helped towards that. It's all things that you're interested in.

Tom:

So I think if you have a goal that you truly want to achieve and it inspires you and drives you, if anything that you want to do, taking time out from your career or anything else that's going to help you achieve that, I think is worth doing, and you should just throw all of your effort and resources behind doing those kind of things.

Alex (Host):

Awesome, awesome. Well, Tom, it's been, as always, an absolute pleasure chatting to you. I definitely feel inspired to go and at least check out the Marathon des Sables website, if not sign up, and I mean it. Again, it's a phenomenal, phenomenal achievement. I guess, you know, for anyone who wanted to follow you or kind of reach out to you, what's your social contact details for people?

Tom:

So, I'm on Twitter. That's probably the best one to. That's @DrTomJudd.

Alex (Host):

Perfect, perfect. Well, listen, man, it's been great speaking to you, as always, and best of luck returning back to the NHS now that things with COVID are settling down. [crosstalk 00:57:41]

Tom:

Cheers.

Alex (Host):

I look forward to catching up very soon.

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