Necrotizing Fasciitis!! or maybe just Cellulitis…

“Nec Fasc” is one of those diagnoses in medicine that makes surgeons sweat bullets, ER docs pump antibiotics like firehoses, and sends interns screaming into phones to set up emergency surgery STAT.  We had a patient where this was a concern, he’d let it go due to the fact he was sooo close to finishing Hellweek as part of his SEAL training- and he made it!  But like most guys I’ve seen from this training, they are so cut up, beat down, and pushed so far past their limits you just have to sit back in awe at what they’ve done to their bodies.  Stress fracture?  That’s nothing!  Pneumonia?  Who cares!  Keep going!

Anyway, I got a few key pointers about telling the difference between nec fasc and cellulitis.  These are just things someone educated me about, I didn’t pull this from the 7th edition of a textbook or a randomized controlled double blinded study,  so take it for what it is.  Cellulitis is MUCH less concerning, though also usually requires hospital admission with antibiotics and can also be devastating in the long run.  So here were a couple physical exam pointers that can either raise your blood pressure or calm those 4 AM frayed nerves:

1.)  Erythema:  Present with both, but in nec fasc the infection in the fascial plane spreads faster than the erythema above it.  Therefore, patients often complain of pain beyond the erythematous border.  In cellulitis, pain is typically only present over the affected skin.

2.) Palpation: If there’s crepitus, think nec fasc.  I’ve felt crepitus before (from a botched chest tube placement) and it seriously feels like there’s crinkled cellophane just below the surface of the skin.  Others have described it as rice krispies, which is also close.  It actually feels like popping and snapping when you press down!  Lack of crepitus doesn’t rule out nec fasc though- it can still be an emergency situation if all you feel is the classic hot, swollen, painful skin.  Remember it depends on the organism causing the infection…

3.) Vital signs: Tachycardia may be the only change.  Especially in young, healthy patients (like in the military population) their body can compensate for infection for quite a while.. until a sudden crash that was unanticipated lands them in the ICU.  On exam, patients can appear to be doing well, but don’t let that fool you!  All that “badness” growing at exponential rates will hit a threshold the body can’t handle… and then you’re dealing with full blown Shock.  No thanks.  Watch your vitals carefully!

4.) Labs: Obviously infection will make your white count go up.  However, in the experience of most residents I’ve spoken with, ned fasc will raise it dramatically and usually above 35.  Of course, it depends on the time of presentation and immune status of the patient but if the lab starts calling you with critical values, that might be a sign that something critical is happening.

With the SEAL I saw, when I evaluated him in the emergency room, I drew a line at where the erythematous border was though he was already receiving antibiotics.  Being on ortho, I was there to rule out compartment syndrome (due to pain out of proportion to exam) but I quickly ruled that out since the skin was pretty soft.  Surgery decided to take him to the OR, where I saw him 1.5 hours later and was astounded at how far past my markings the erythema had progressed!  He had alredy received about 5 different IV antibiotics and still the infection was advancing.  In some places, it was almost an inch.  Holy smoke Batman!!!

The surgeon made an elliptical incision over where some new petechiae had shown up on the skin, often being a clue as to where the worst underlying infection may be.  I heard him teaching the resident that (only read on if you’re a surgeon or have a strong stomach) …. if it’s nec fasc, expect “dishwater discharge” when making the incision.  When palpating the fascia, run your finger up and down the incised areas and if it’s intact, that’s good.  If it breaks apart as you push, that’s bad.  That’s when you being the unzipping process and debride, debride, debride.  Then drink a couple RedBulls and Rockstars because you’re not going to get any sleep on the frequent post-op checks.

My patient did not have nec fasc, in case you’re wondering.  They just did the 2 elliptical incisions, packed and left them open, and kept pumping him full of antibiotics and fluids.  Phew

 

On call- Fractures! Compartment syndrome!

The fun thing about being on call is when you realize you don’t care that this patient has kept you from getting sleep, it’s the coolest case ever!

We had a patient come in just as my resident and I had tidyed everything up, seen and written notes on 3 broken arms, done our post-op checks, and had already said “goodnight, hope we get some sleep..”  Just as we were exiting the elevator, the emergency room number pops up     But when I saw the X-ray, that frowny face turned into a smiley face!!  (Did I mention I love trauma?)

It was a fracture known as “comminuted” because there were a bunch of fracture lines creating multiple pieces of bone . Because the limb was turned at an obviously weird angle, we gave a mix of fentanyl and propofol for pain control, brought in the fluoro machine ( live x ray vision!) and had our plaster splint on standby.  Then we pulled on it to straighten it out, which is known as reducing the bone.  Given the past reductions I’d seen, I expected to have to really tug hard to get the pieces back together. Instead, it moved almost too well!  I guess when you have bones in that many pieces you don’t have to force it.

The only thing is, I recently saw a patient who had a lot of muscle taken out of his leg after a fracture that led to “compartment syndrome.”  When this happens, the swelling gets so bad that you cut off blood supply to a bundle of muscles within that compartment.  The fascia and skin create an almost tourniquet-like effect and the muscle can die within 24 hours.  Because this new case was so severe and had so much swelling, I was really, really worried that this fracture might progress also.  On admission I placed orders for neurovascular checks every 2 hours to make sure there were still pulses and sensation beyond the fracture site but still went to sleep biting my nails…

So, I learned a little bit and was able to expand my knowledge on the classic compartment syndrome’s “pain, pallor, pulselessness, parasthesia, and pain out of proportion”  Though the compartments were really tense from all the swelling, it wasn’t compartment syndrome.  I hear it’s pretty obvious when you find compartment syndrome on physical exam (the leg/arm will feel like a block of wood.  Really!) But it’s scary nonetheless when you see such a severe fracture with so much swelling!  I’m glad I had someone there to tell me NOT to do a fasciotomy, if I was in the middle of Afghanistan on my own and this happened to one of my marines….I still would have waited but I’m just glad everything turned out ok today

… 1 week later…. After I left post-call, I heard that they did end up taking this patient to do a fasciotomy, but no muscle tissue seems to have been compromised.  Compartment syndrome is a clinical diagnosis, though you can use a Stryker compartment pressure machine to get actual numbers.  This is used more in exercise-induced compartment syndrome because patients will occasionally consent to having long needles inserted into their muscles for this kind of evaluation.

 

Snow, salt, potholes… and flat tires :(

A few days ago I was running a short errand as it began to snow… hard.  I crawled along with wipers at full swing, barely able to see past the flurry in front of my headlights.  But it was just a quick errand not too far from home and so I pushed on.

With the road appearing as one planar sheet of snow, I wasn’t able to distinguish the foot-deep pothole directly before me until I was right on top of it- but as a seasoned midwest driver, you know do not brake and don’t steer away too hard!  So I sucked in a deep breath of anticipation and bounced right into it… and my car immediately began pulling to the left.  However, optimist Leslie was hoping that it was just the ruts of ice forcing me that way.  Pretty quickly I sensed something was just wrong with my car and pulled over into a residential area.

My tire was shredding all over the snow and smelled of burnt rubber.  Great, just what I need!  It’s dark, cold (10 degrees before accouting for wind chill) and snowing!!  Oh well, I figure I can handle this.  So I pull out my tire repair kit and quickly realize that with this odd swinging mechanism to jack up the car I’ll be here all night.   I call my friend Eileen to help and figure she can give me a lift to Sears where I’ll get another jack.  But when she arrives she brings out a similar jack, a bit more rusted but easier to crank.

As we’re struggling with the jack, a car stops and two guys come out to help.  Thank you Lord for the kindness of Chicagoans!!  Their jack was wayyyyy better and we had the tire changed in no time.  The next day I drove straight over to the Sears Auto Shop and the guys there were amazing about getting my car fixed, even offering to fix my broken headlight.  It might have helped that he noticed my “United States Navy” sticker on my car and we ended up talking about his friends in the Navy, deployment, etc.

Basically I realized that I hated being unprepared for my flat tire.  I know how to change a flat, but hadn’t used my own materials!  So here is what is on my shopping list:

1.)  An easy to crank jack, preferably with an up and down mechanism versus a swinging in a circle mechanism

2.)  A reliable headlamp:  The flashlight worked OK, but it was best when someone else held it and it kept flickering on and off

3.)   Extra gloves with dexterity

4.)  A piece of cardboard to lay down next to the tire so you don’t get soaking wet by the end of it

5.)  A socket wrench with a big long arm

Items 1 and 2 are the most essential, but the rest are helpful! But really the most helpful thing was the people who stopped to see if I needed assistance.  I wished them the greatest karma as I shook their hands and said THANK YOU! … and I hope it comes to them

 

A runner lifting weights!

I detest lifting weights. My idea of a good workout is to build up a sweat while getting my heart rate up and enjoying a lot of good scenery… or at least watching some CNN at the gym if it’s a treadmill run. The last time I lifted weights was 3 years ago when my only work colleague was a body builder type who convinced me to try it. Sure, I was sore. But I hated going there… repetitions, sets, the unspoken gym Etiquette, and of course, being the only girl in a room full of mirror-watching boys.

However, I realize that lifting is a necessary evil to truly be fit and prevent injury. Though I ran a marathon a few months ago and recently went hiking in Peru, I wouldn’t say I’m in the best shape of my life! I can’t even do a push up! So I hired a personal trainer to decrypt all those machines for me and help me get over my IT band syndrome.

The first meeting was great! We sat down and I went through my goals, which is primarily to get into a routine that will get me back into military shape. After officer training school 2 years ago I can say that was the best shape of my life- and I want to be able to repeat my personal best physical fitness test numbers (sit ups, push ups, 1.5 mile run).

Then he took me through numerous machines and wrote down how much weight to use, how many repetitions, how many sets. When my knee would begin to hurt, he’d find another machine that wouldn’t aggravate my IT band. After a few months of living with this injury, there is a notable difference in my quad strength!!

And now today after doing the same routine of legs, arms, abs, stretching, I found it much easier to do the sets. It hasn’t even been a week with this being my third time lifting and I’m already noticing that it’s easier to regain my balance while getting out of the car, I have more force when opening a door, or when bending over to the side of a chair my abs can handle it

Plus this is a better gym than the one I was at 3 years ago (Loyola’s gym is Amazing!!) and I have a lot of friends who work out there too. Which is different for a runner who’s used to working out solo… and it’s kind of nice. Not so boring. Maybe I can do this! Hopefully I can show off when we have our second meeting tomorrow.

“For the record: Strength training before, not after, cardio is better for your heart, reports a study in the Journal of Applied Physiology. Japanese researchers found that participants who lifted before running had more flexible arteries and improved blood flow after eight weeks, compared with a run-then-lift group (who experienced no such improvement). Why? Lifting can increase blood pressure, which stiffens arteries. Running afterward releases chemicals that cause the arteries to dilate and lower blood pressure, says Robert C. Scott III, M.D., Ph.D., senior staff cardiologist with Scott & White Hospital in Temple, Texas.” – Women’s Health Magazine March 2008, page 28

 

iBuenas Noticias!

The only times I ever wake up before my alarm clock goes off are the nights I am super stressed out. So when I woke up a full half hour early this Wednesday, I wasn’t surprised… it was possible I might find out where I would match!!

There are 2 air force med students here in Bolivia staying at the house who got an email Tuesday night announcing the list would be out at 5:30 AM CST. I didn’t get an email like this from the Navy, but had heard a rumor (through Facebook, no less) that we might find out at 9 or 10 AM. That morning, I sat at the kitchen table watching the other students nervously fidgeting and clicking “update” on their email every 4 seconds. Finally the list was up, they were on their feet scanning the pages, and “YESSSS!” they screamed in unison. But I had to wait until later…

As we had to work in a rural clinic that day, we drove out 2-3 hours into the Bolivian rainforest and saw patients who came in from the nearby pueblos. When clinic was over, a few of us drove an hour to the nearest internet cafe in Buena Vista, Bolivia. Just off the town square is this tiny, hot, steamy room filled with local boys playing video games. After getting a computer, opening my email, and initially missing the GME-1 email amidst the junk I received, the match list was slowly…slowly..slowly downloading. Then it aborted and an error message popped up in spanish.

With my heart pounding and hands shaking, I actually consider opening up Facebook to read the messages on my wall which may actually tell me where I’ll be next year. A little girl in the cafe tries to peer around at the screen as I’m unconsiously saying “Oh my gosh… oh my gosh…” as I’m wringing my hands with nervousness and sweat is dripping down my neck.

Deferring to Plan B, I log onto the Navy GME-1 site and enter the password. The page slowly begins to load…the circle at the right top hand of the screen swirling away… and just as someone behind me offers a suggestion, a list of names with locations pop up. I gasp and hear nothing else as I punch the down arrow quickly but scanning carefully so not to misread the “Crawford, Leslie….” that should scroll up any second. Before I have time to register that next to my name reads “… Transitional Year, San Diego” I am already out of my dirty red plastic chair, screaming and literally jumping up and down.

The other med students and doctors from the clinic high-five me, give me hugs, as I see the street vendors gaping at me through the open garage-type door. Later I was told that one of them asked our clinic coordinator

“What’s going on? I just about had a heart attack!”

“Good news from home.” she responded.

“Oh! Is she having a baby?”

I am totally oblivious to this as I’m grinning and still jumping up and down and realize that I’m so happy I can cry… and I did tear up a bit! I am soooooo sooooo lucky!!! Barely catching my breath, I compose myself enough to sit down and see where my friends matched, write off a few quick emails before my computer time runs out, and then call my parents with my phone card.

The rest of the day I spent glowing and squealing with disbelief about how awesome this is and how lucky I am that I actually matched in my first choice!!! Then the other med students and I toasted with some Cuban rum and coke (a.k.a. Cuba Libre) and watched telenovelas. Though I wish I could have spent it in the USA so as to be able to call friends and family and celebrate properly, the knowledge alone that I will be moving to San Diego next year made it one of the happiest days I have ever had in med school.

 

26.2 miles, One Step at a Time

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

 

The Great Dismal Swamp

Now I’m across the country in Portsmouth, Virginia. The Great Dismal Swamp is one of the best things ever out here! It’s an old highway that was converted into a running/biking/horseback riding trail next to this huge swamp preserve. When I initially flew in last Monday, I figured out pretty fast that the hospital seems to be about all there is to see in Portsmouth. I also didn’t know where to run (at this point, I still haven’t explored Norfolk or Virginia Beach) but then I got some advice to run at this Dismal Swamp place. Though it’s kind of a drive, it’s worth it!

I have to admit that my running schedule suffers from a serious lack of consistency on my part. I’m being lazy!! Also, any time I run more than 10 miles my left calf starts to tighten up. I’m halfway between allowing it to rest and giving in to my procrastinatoriness. But I just signed up to run the Fleet Week 1/2 Marathon this weekend so I know I have to run that at least. Not fast, but it will be nice to run with refreshments along the way!! (the dismal swamp has noooo water fountains…the only downside)

At the hospital, I’m working in the emergency room which is awesome!! I’ve worked a few evening shifts so far and have seen some cool stuff, worked with awesome residents and attendings. I have to say, it is very different than working in a westside Chicago ER… no walk in gunshot wounds yet The pressure’s getting a little more heated with additional interviews and letters of recommendation and the selection process getting started. I’ll be matched in 2 months! TWO MONTHS AND I KNOW MY DESTINY! Well, 2 months and 3-5 days… I’m not nervous or anything…. of course not….!!!!

I had a few days off and drove up to Bethesda and saw some friends up there, which was wayyy cool. We had lunch at Fogo de Chao and then went to the Spy Museum. We had some drinks while watching the Yankees lose, and as everyone had to work the next day I just walked around downtown D.C. on my own until Nilsa got done with work and we went over to Georgetown for dinner. But I had to drive back for conferences and lectures today, plus I’m starting night shifts tomorrow. Gotta go stock up on Red Bull…

p.s. download the new radiohead album. it is awesome!!

 

Little nigglepoo

When I set out to run my 17 mile this week (which I pushed back for time constraints and also for having to skip some weekday runs) I had a tightness set in again in my left calf around mile 4. I was sooooooo mad!!! This run was out on Coronado, following the path up north that runs around the peninsula. I tried slowing down and stretching, which allowed me to run back to base and finish 9 miles. Then I ended up not running at all for 4 days because things got so busy as I was leaving San Diego. But today I ran an easy 3 mile and didn’t feel that nigglepoo whatsoever so I’m feeling optimistic about doing a long run tomorrow. My goal is to do 13 miles, then continue on if my calf is up to it.

Otherwise, I’m now in Chicago and missing San Diego!! Last night I was at a house party in Wrigleyville and with the Cubs winning something or other, fireworks were going off and everyone was blaring their horns. It definitely reminded me that I am now back here and conversations revolve around the Bears versus the Chargers, Cubs or White Sox versus Padres, getting to the Lake versus the beach. Also, I don’t know how I forgot how bad traffic in Chicago is, but I managed to and that made me love San Diego “rush hour” even more!! Plus, parking is just terrible here compared to San Diego… in suburbs, downtown, and Wrigleyville alike!

I’m flying out again to Virginia Beach on Monday for my emergency rotation at the the Navy hospital in Portsmouth. So, this weekend for me is just trying to fill out reimbursement paperwork, opening a month’s worth of mail, and walking around town while my car is in the shop. Fun fun fun

See, we can have fun in the hospital too! I had to wear that khaki uniform every day. And this is my resident, who graduated from Loyola too! That was a super fun rotation… Go Red Team!!

This is a few of us at an italian restaurant in the Gaslamp district. It was called Acqua 2 or something. It was yummy!  And sitting across from me is my girl Nilsa, who’s Puerto Rican and a kick ass salsa dancer

This was taken while driving over the Coronado bridge at dawn, looking out over to the 32nd street base. The USS Mercy is one of the ships to the back (although you can’t really see it with this lighting!)

 

Still in love!

I love San Diego.

I love being in the Navy.

I love being a sub intern.

So yes, my life is totally awesome right now!!  It’s crazy to think that this might actually be my future.  After 3 years of being around people who I have to explain my career decisions to, I am now surrounded by people who not only understand it, but support it and can give me invaluable advice.  The people I’ve met here are awesome.  The stories I’ve heard are awesome.  How many people in your field have gotten to practice all over the world?  Fly with the Blue Angels? Treat Navy SEALS?  It’s sooo cool!!  Oh, and the SEALS are staying at my base on Coronado and just got done with Hell Week.  Apparently that movie G.I. Jane is the closest to accurate!

Plus I’ve been having fun with the other med students, getting around San Diego and Coronado and going to restaurants, clubs, beaches, chilling out on the patio with a beer, etc.  One downside is that I’m staying in a dorm-style room with just a microwave to cook with.  And having to wear my khaki uniform everyday.  Today I had to park far away from the hospital and had to return salutes all over the place.  It’s kind of an inner groan to see a uniform walk towards you, since you have to squint at their rank from a distance and figure out if you salute first or if they’re supposed to salute you.  Since I’m an officer, and a majority of the Navy is enlisted, most of them salute me.  But when I was walking along and a huge group of Marines was getting out of a van right as I walked past…that was interesting.

As for internship interviews, I’ve had 3 so far and they were awesome.  I had to wear the Navy summer whites, the uniform you’ve probably seen in Top Gun.  They’re still stressful in that you need to have a CV and personal statement ready and you’re looking to impress.  But I think they went well!!!  The only downside is that the selection process in the Navy is undergoing a big change and everything is in transition and although it used to be like the NFL draft, the new system is so complicated I’m just crossing my fingers and praying.

As for my marathon training, I’ve done the long runs of a 15 last week and an 11 this past Tuesday, which was actually harder than the 15!  During the week I really only have 1 or 2 days to do an additional day.  Plus I’m keeping my social life a bit more active than my running life at the moment   I’m heading up to Ridgeland this weekend and will probably do some hiking, and I’m scheduled for a 17 miler on Sunday.  Though I was nervous about the 15 and did fine, I’m still a little nervous about the 17!  Not sure why, I guess I’m just not as familiar with all the routes and am constantly worried about getting water along the way, which is what makes the Mission Bay trail a great place to run.  And I’m hoping I’m getting the mileage right, I’m just running the mileage x10 minutes and assume that’s the full distance.  I probably should get a GPS thing…I should look into that.

This is a photo I stole that shows the bay, the bridge is going over to Coronado Island where I’m staying (to the right) and San Diego is to the left, with all those ships being privately owned.  But I thought it was pretty

 

LOVE San Diego. L-O-V-E.

So I flew into San Diego last Monday just in time to spend a couple hours on Mission beach/Pacific beach amidst the bikini-clad tan body crowd of college students and get a little bit of time in the waves before starting my rotation at the Navy Medical Center Balboa.  I’m doing a medicine rotation, basically acting as a sub-intern and taking care of active duty Navy people and their families.  It’s sooo nice to finally be working in this hospital!!  I’ve been wanting to work here as I’d heard great things and want to do my internship here but hadn’t actually seen the place.  The days can get long but my team is super cool and the nurses are friendly.  Everyone here is so polite and helpful!!  The only weird thing is I have to wear my uniform and do the saluting thing when I’m outside.  Thankfully you don’t have to do that indoors.

I’ve had the chance to do a couple things in San Diego like visit Coronado island and go out with other medical students for dinner and such.  Last night I went to the Gaslamp district for sushi (excellent!) although parking was a nightmare (much like Chicago).  Then we went over to a jazz bar in Pacific Beach called Turquoise which was really cool.  We walked along the beach at night and ran into some bums so that was fun!

But I’m here to work and hopefully make a good impression.  My running has kept up pretty well, I’m running on the boardwalk alongside the beach, which is incredible.  Last night I watched the instant the sun dipped below the horizon over the ocean while on mile 5 and the people lined up to watch the sunset applauded all in that moment.  I’m on call today so can’t do my cross training, which I think will consist mainly of jumping in the waves or surfing if I get the chance.  Tomorrow is my long 15-miler which I plan to run around Mission Bay after watching the Bears game.  If I survive I’ll let you know!

And by the way, I LOVE SAN DIEGO.

here’s a photo from my half last weekend!