Flip i317537

After flying 4 connecting flights I landed in Santa Cruz, Bolivia a little tired and ready to take a shower. The flight down to South America wasn’t too bad actually, we flew over some gigantic river that was probably the Amazon plus got to see Lake Titicaca with nearby La Paz and surrounding mountains all in the morning sunlight. From the perspective of a plane, La Paz can be described as “brown.” while Santa Cruz is “green!”

So here I am in Santa Cruz in a house full of medical people.. residents, med students, a nurse, people working on research projects, etc. Everyone here seems to be extensively traveled so it’s been fun talking and getting to know them. Yesterday we all took a trip out to the grocery store to shop for a Thanksgiving dinner today and then went to an open air market (“feria”) which sold knock-off clothes and mystery meat cooking in large vats of oil. Then we went to dinner at Casa de Camba, which I Highly recommend! We orderd a bunch of Chilean and Argentinian wines (Bolivian wine.. I’ve had better but I’ve also had worse) and they served us yucca with spicy sauce. The meat only dishes come over hot coals and pretty much all the food is great. There’s no walls to the restaurant and they had this awesome open courtyard with live music. So even though I was exhausted from no sleep on the plane, it was a fun night.

Today a few of us ran 2 miles to the Plaza 24 de Septiembre. Although my marathon was just one week ago and I really shouldn’t run with my IT band needing to heal…. I couldn’t resist!! The girls I ran with had a bit slower pace and I was a little winded from the higher altitude, so it wasn’t too bad. The weather was also perfect, about mid-70’s (cool for this time of year) overcast and a little rainy. My knee didn’t bother me until maybe mile 1.5 and hasn’t hurt much for the rest of the day- although I did pre-medicate with some ibuprofen.

The plaza is gorgeous and full of spanish tourists. A political rally of about 50 people stood on the cathedral steps chanting for autonomy. The tensions are getting a bit high just recently here in Bolivia as the northern group wishes to set up their own nation. Although I’m still unclear about the details, apparently a new constitution was approved under some shady circumstances and OK’s the current president to be re-elected repeatedly.

The people back at the house were cooking all day for this Thanksgiving lunch which was absolutely delicious, complete with stuffing and cranberries and apple cobbler. Afterwards we went to a futbol match and cheered on the local Santa Cruz team of Blooming… though they lost. Fireworks went off- IN the stands and onto the field- whenever a goal went in.

But that was nothing compared to the crowd after they realized they lost when they began throwing things and rattling the barbed wire fence behind the opposing team. On the stadium itself “Autonimia Si…” is posted, in reference to the brewing-maybe-starting-civil war. As we exited, police in full riot gear were outside and fights were breaking out so we got away fast. People randomly raced past when some loud banging was heard, but it was probably just a scare tactic to keep a mob from forming. So far, we’re not concerned the political situation is serious enough to be dangerous- there’s no talk of blockades or closing down the airport. Basically we’re keeping an open eye and ear to what’s going on.

I’ll have photos posted as soon as I can dig my camera cord out of my luggage and load them up. I’m soo excited to be here in Bolivia and start this rotation! Yay Santa Cruz!

When I finally, finally crossed the finish line of the Tulsa Route 66 marathon, the volunteer who gave me a reflective blanket asked me:
“So how do you feel?”

I thought for a moment, and all I came up with was: “Hurt.” But I smiled as I said it.

Overall I’m tremendously happy about finishing my first marathon- but it didn’t come easy! Many times I have talked to marathoners about their first experience and have been told multiple times about how grueling it is, how you wonder why you ever put yourself through this. Now that I know firsthand what a marathon feels like, I have to say I have a different perspective.

It was grueling. No doubt. My calf, strained for the 4th (or more) time gave me problems for the first half. But it was pretty easygoing up until mile 8. Then my IT band started flaring up…and flaring…and flaring… although I adjusted my stride to avoid straining my calf, the compensation is what seems to have triggered the IT irritation to begin with. And now, after surviving a cortisone shot and 11 miles of running, the outer aspect of my left knee was searing in pain on every step.

Albert, who I have no words to thank, was there every step of the way. He made me stretch out my calf more than I would have on my own (almost as many times as he took pee breaks which I think is what eventually made my calf settle down after mile 12. But one of the most painful miles of the marathon was between 11.5 to 12.5. It felt like I had been hit by a metal baseball bat and the pain was searing deeper and deeper into my knee. So after mile 13 we switched to a run-walk strategy that eventually got me to the finish line.

Many times I had to concentrate on the perfect balance between placing pressure on my IT band/muscle strain. For a while, each fought for my attention with IT band winning the battle where I limped along duck footed (easing pressure on IT) versus pigeon toed (sparing the cramped muscle) At first, we stopped at some medical tents and asked for Ibuprofen. They didn’t have any, and just said “listen to your body, don’t overextend youself.” Gee, thanks. Eventually we got some Bio-Freeze but by then it wasn’t able to touch the pain.

On the upside, I sang a lot on the run! Albert may not think it was an upside, but it helped put a smile on my face and kept me going My “RUN!-Hypd Up” list definitely helped up to mile 25. The spectators and the volunteers were also amazingly wonderful, each of them smiling and waving and being as helpful as they could. I couldn’t help but muster a smile and laugh along with other runners or to cheer along those ahead of me doubled back along the same route. At mile 13.1, I finally caved in and realized I wasn’t able to run the whole thing, but I distinctly remember turning to Albert and saying “I’m finishing this thing. I don’t care. I’ll go until my knee tears off.”

The last mile is one I will never forget. Pain. Up until mile 25 we tried to keep up a fast walk (I limped) but I told Albert that we were going to run it in, and I was determined to finish strong. Cherry Street in downtown Tulsa is burned into my brain as an area where I hurt. A lot. But I kept up a jog, both up and down some inclines. I could say excruciating, but I wasn’t exactly rolling around the floor screaming in agony…ut if I have to rate my pain I’d say it was 9/10. Albert’s words along the way, saying “The pain is only temporary” definitely helped when it felt as if my knee could explode apart. Just as we were coming up on the mile 26 sign I felt like my knee was about to lock up. Although I didn’t want to walk at all, I realized I had to. For only a few yards, I walked and checked that this fucking knee would carry me to the finish. It would. I began to run again.

Around the corner and now I can see the fencing by the finish line. Miraculously my knee pain abates, and I feel just a little bit stronger. Now I see Katie smiling and waving at us and I know we’re almost there. The finish line photographer is there and I’m hoping the champion chip timer mats would come just a bit closer to me with each step. Somehow I made it across and… wait, I can stop now? I’m done?

Even as I type this, it’s surreal. I finished a marathon? Was that me, or was it someone else? I did that?

I have a cool medal to tell me I finished, plus a huge finisher’s shirt that says “I Kicked it on Route 66.” After the race, we went back to the hotel and showered up. Driving around to find a good place to eat, Albert and I recalled a few places we’d seen on Cherry Street. Revisiting that street only 2 hours later, a visceral wave of remembrance, of how I felt as I last saw these storefronts, came back… but I just have to laugh at that now! Yes, it hurt. But I did it!! And then I had a yellowjacket beer of Guinness plus Boulevard Wheat and it was delicious. And so was dessert.

Albert had some nice things to say about how I did, how I never gave up, how I kept up a positive attitude. Which is exactly how I wanted my run to be. Now that it’s done, I can say that I had fun. It was not hell. I never questioned “Why am I doing this?” I knew why I was doing this. I love to run, and I stick to my goals. I wanted to see if I could do it. Another more complicated reason is the excerpt posted just before this… I realize now that this is most likely the foundation of why I wanted to finish, to pay respect in a way. To explain why is a lengthy one so I’ll just leave you to read it… and then hopefully the book ( an extremely powerful 109 pages.)

Now one day after the race, I feel okay. Still having problems going down stairs, but unlike just after the run yesterday I can now climb up stairs! Only my quads are pretty tight and I’m taking Ibuprofen to help both the inflammation and soreness. My time was 5:34:28, overall about a 12:45 minute mile. My goal was to finish and I did, no matter what time. So although it is wayyy slower than I could have gotten if uninjured, I’m just glad I did it and it’s over. Yay!!! I ran a marathon yesterday! Thanks Albert and Katie!

p.s. I match in 35 days… or so! I’ll find out online where I’m going to be next year for my internship. There’s only 3 Navy hospital choices (San Diego, Bethesda, or Portsmouth) and I hope to get a transitional year spot at one of them. Or internal medicine, that’d be ok too. And I’m thinking of flight surgery or a General Medical Officer tour before I apply for an emergency residency. So now it’s just sit and wait and check email!

running towards the finish

crossing 26.2 miles

cooling down

we kicked it on route 66!

limping along the next day

In my copy of “Night” I have kept a photo taken April 17, 1996.  On the left side of the frame, I am a 15 year old girl wearing short hair and glasses, the black straps of my backpack are seen over a white shirt.  A girl to my left is holding out a pamphlet.  On the right side of the photo is the author of “Night,” Eliezer Wiesel signing my book in blue pen.

In the years since this photo was taken, the impact of this book and his memoir of the Holocaust have never left me.  This excerpt in particular has always haunted me and now, reflecting on my own marathon and will to push on, I am including it here to share some back story on what it really means to persevere and the courage that it took.

An icy wind blew in violent gusts. But we marched without faltering.

The SS made us increase our pace. “Faster you swine, you filthy sons of bitches!” Why not? The movement warmed us up a little. The blood flowed more easily in our veins. One felt oneself reviving…

“Faster, you filthy sons of bitches!” We were no longer marching; we were running. Like automatons. The SS were running too, their weapons in their hands. We looked as though we were fleeing before them.

Pitch darkness. Every now and then, an explosion in the night. They had orders to fire on any who could not keep up. Their fingers on the triggers, they did not deprive themselves of this pleasure. If one of us stopped for a second, a sharp shot finished off another filthy son of a bitch.

I was putting one foot in front of the other mechanically. I was dragging with me this skeletal body which weighed so much. If only I could have got rid of it! In spite of my efforts not to think about it, I could feel myself as two entities- my body and me. I hated it.

I repeated to myslef: “Don’t think. Don’t stop. Run.”

Near me, men were collapsing in the dirty snow. Shots.

…

The commandant announced that we had already covered forty-two miles since we left.  It was a long time since we had passed beyond the limits of fatigue.  Our legs were moving mechanically, in spite of us, without us.

…

I was thinking of this when I heard the sound of a violin.  The sound of a violin in this dark shed, where the dead were heaped on the living.  What madman could be playing the violin here, at the brink of his own grave?  Or was it really a hallucination?

It must have been Juliek.

He played a fragment from Beethoven’s concerto.  I had never heard sounds so pure.  In such a silence.

It was pitch dark.  I could hear only the violin, and it was as though Juliek’s soul were the bow.  He was playing his life.  The whole of his life was gliding on the strings-his lost hopes, his charred past, his extinguished future.  He played as he would never play again.

I shall never forget Juliek.  How could I forget that concert, given to an audience of dying and dead men!  To this day, whenever I hear Beethoven played my eyes close and out of the dark rises the sad, pale face of my Polish friend, as he said farewell on his violin to an audience of dying men.

I do not know how long he played.  I was overcome by sleep.  When I awoke, in the daylight, I could see Juliek, opposite me, slumped over, dead.  Near him lay his violin, smashed, trampled, a strange overwhelming little corpse.

- Elie Wiesel, Night

I went for a really, really nice hike yesterday.  It was beautiful.  Fall leaves turning red and orange, bright sunny day, crisp air with a blue sky…chatting with some friends and standing aside for mountain bikers as they zipped by…

I was breaking in my boots and new backpack for my January trip down to Peru to hike the Inca Trail and so I stuffed it full of clothes, my therma rest with sleeping bag, travel books, etc.  I added a few more hardcovers to try and up the weight to the limit of 40 lb (probably only got to 25-30, but anyway…)

Near the end of the hike I was walking up a slight incline and felt a small extra stretch in my left calf.  My left calf that 17 weeks ago became strained and made me fear of a worse tear.  Nine years have passed since the initial insult and here it returns.  Today I can’t walk normally.  My calf is so tight today that if I even straighten it quickly, I feel a sharp pain just below the back of my knee.

(Insert another explicitive.)  I’m scheduled to run the marathon ONE WEEK from today.  My IT band is still nagging, but that can be cured with a shot of cortisone.  What now, what about this (explicitive) muscle!!!!!

Will I make it to the 26.2 mile finish line… I don’t know if I can even walk a mile at this point.   Am I optimistic? No.

Will I try anyway? Yes.  With every broken muscle fiber in my body.

Last year on my family medicine rotation I worked with a sports medicine doc who totally understands the importance of helping people achieve their goals… even when it means a cortisone shot. This past weekend I ran the Malaika 5K and actually placed third in my age group (probably only 10 people in the group, but anyway…) and my knee started bothering me after mile 1. But it wasn’t painful until after I crossed the finish line and was walking along with a friend. Within 20 yards, my knee began to flare up and by 50 yards I was hardly able to walk!

So I spent all of Sunday worrying. Monday I was able to fit in an appointment with the sports doc and he recommended I get the shot next Tuesday. In the meanwhile, a physical therapist gave me some strengthening exercises to do so I can avoid getting IT band again. I feel totally stupid doing them and I was skeptical that they would help, but I do actually feel a burn while I do it! They said that my hip stabilizers are weak, as evidenced by my wobbling on a one-leg squat and by how short my one-leg long jump is (they had me stand on one leg and hop forward as far as I could. My injured leg only made it about half as far as the uninjured) which makes sense since my hips start to hurt after a long run.

So my 3 exercises are to do 3 sets of 25 each:

• Scissor kicks lying on my side, keeping sure my hips are perfectly straight and I’m keeping my toes facing forward
• Standing on a step and dropping, then raising the hip hanging off … this one looks the dorkiest!!
• One leg squats. These are tougher than I thought! I have to do them in front of a mirror or else I slouch and drop my other hip

Hopefully these will help on marathon day in 12 days… now I just have to keep up my cardio, which is hard! I hate swimming for longer than 20 minutes. Last night I could only stand 30 minutes. I hope tomorrow my knee will allow me to cycle at least. And I hope this shot works some kind of miracle and I survive my marathon!

Although I had a dream of maybe doing a marathon in every state, I’m contemplating resetting that goal to a half marathon in every state. I’ve already got Wisconsin and Virginia crossed off that list!