The Finish Line

 

Years after his Olympic appearances, Frank Shorter, a gold and silver medalist marathoner, ran a race in Seattle. He finished out of the top 20 runners. As he was preparing to leave, another runner approached him. “Hey, aren’t you Frank Shorter?”

To which Frank replied, “No … but I used to be.”

Frank’s “glory days” are over, he will never cross an Olympic finish line again. Instead Frank is successfully crossing a new finish line – Race4Kids’ Health. Frank uses his experiences as a runner and as a victim of child abuse to connect children with the power of health. He explains, “What I’m trying to do through my work with Healthy Learning Paths, is to show kids how to use healthy habits like good diet and exercise to better their social and emotional health and their resiliency—to run toward a solution and not just away from a problem.”

We – like Frank - will grow old and slow and our finish lines will change. But there is one finish line everyone must cross. Loved ones will die and, in our own time and in our own way, we, too, will cross life’s finish line. How will we choose to experience it?

Runner Dr. George Sheehan was diagnosed with metastatic prostate cancer in 1986. In January 1993 he learned that his hormone treatment was no longer working, the cancer had gone into “fast forward”. George then needed radiation just to control the pain. At that time he was still ambulatory but could no longer run. He said, “My mission now is to deal with cancer, its therapy, and all the implications, and tell others what it is like.”

Success for George shifted from running to becoming the best George he could be. He chose to continue his search for meaning and truth, asking – “After I die, what?” which led to “Before I die, what?” He continued writing and reading extensively while he explored Quakerism, philosophy, and discovered anthropology. Two months before he died, George registered for a college-level anthropology course.

His running days were over but he made the best of his situation through reading, exploring new ideas and writing about his experience. George’s attitude towards his situation embodied the words of Holocaust survivor, Dr. Viktor Frankl, “Any man can, even under such circumstances, decide what shall become of him – mentally and spiritually.”

On November 1, 1993 George successfully crossed his finish line.

“In giving me cancer, fortune had smiled on me. Pain was key to opening up to a new and larger life. The interests of my past are still present, but now finally seen in perspective.”- Dr. George Sheehan

 

Perhaps more difficult than facing our own death, is dealing with the death of a loved one. Often we have to make decisions for someone who is unable to decide for themselves how and when they will cross their finish line. 

In 2003, my father was not feeling well and was admitted to the hospital. During phone calls with my mother, she insisted he was “fine.” Fortunately, my older sister called me to tell me Dad was not “fine” – he was dying.

I flew from Virginia to Illinois and went with my mother to the hospital. Dad was not responsive, he would occasionally open his eyes but only stared at the ceiling. I don’t know if he even knew I was there. No matter how much my mother wanted him to be “fine,” or how often the nurses checked him or gave him medication through his IV, Dad was not going to “get better.”

Mom and I sat in the room with him, talking as if he was “fine.” Then, as I drove her home at the end of the day, I told her I wanted to call my siblings to let them know they should come and see Dad because I thought he was nearing the finish line. “No!” she shouted, “He’s going to be fine!”

The next day we were sitting with Dad when his doctor asked us to meet with him in a consultation room. “We need to know if you want a do-not-resuscitate order,” he said.

Mom immediately said, “No!” Then she began sobbing. “I don’t want to fail him, we have to keep him alive.”

Patiently, and with precise details, his doctor explained exactly what would happen if the nurses attempted to resuscitate Dad.

I asked, “If you successfully resuscitate Dad, what then? Will his health be restored?”

“No.” the doctor answered, “We will just be prolonging the dying process.” He then explained Dad’s deteriorating physical condition. They had done all they could.

“Do not resuscitate,” I said. I looked at Mom and, through her tears, she nodded her agreement. Then I began calling my siblings.

Dad crossed his finish line on March 19, 2003 with several of his children at his bedside, holding his hands.

We did “the best” we could for Dad. The decision not-to-resuscitate due to his physical condition was informed and made in consultation with his doctor. Then we surrounded Dad with as much love as possible as he crossed his finish line. “The best” we could do for ourselves was to choose to be in control of our attitude towards our father’s death.

Dealing with death shifts the terms of success. “The best” often is not what we may want, nor wish for, and it can be extremely painful. In the worst situations our attitude may be the only thing we can control while in better situations we have more options from which to choose.

Many challenges will confront us as we move closer to our finish line. We will not always be healthy, we will grow old, we will experience the death of loved ones and, ultimately, our own turn to cross life’s finish line.  Regardless of the situation, we choose our attitude towards our experience. We are always free to “decide what shall become of us – mentally and spiritually.” 

 

A Good Day for Cancer?!

That spring day in 2007, when I first heard the word “carcinoma,”was memorable. Not just because of the diagnosis, but because of what happened after my appointment at Johns Hopkins. As I drove through Baltimore on my way home to Leesburg, Virginia, I came upon a horrible car accident. As the police directed me around the crash, paramedics were placing a sheet over the driver’s side of a mangled car. Someone was not going home.

“Holy crap!” I thought, “That could me. At least with cancer I still have a chance.”

Then I remembered reading something that my running guru, Dr. George Sheehan, wrote about his cancer diagnosis. He was diagnosed with inoperable prostate cancer. His son, an endocrinologist, tried to reassure him, “People with prostate cancer usually die of something else.”

What his son said makes sense. Older people have other risks – heart disease from smoking, weakened blood vessels from untreated high blood pressure, diabetes from obesity. Many people die from heart attacks, strokes, and complications from diabetes.

But George decided right then and there: “I might die of prostate cancer, but I was certainly not going to die of anything else.” *

Likewise, I told myself, “I might die of breast cancer, but I certainly wasn’t going to die of anything else. What I can control, I will control.”

I chose the Sheehan approach. I kept running, had surgery, and worked with my medical team to help my body maintain an optimal state of health. Cancer was going to have to look elsewhere for help. I went about making myself the best body possible.

Was this a cure? No way. The idea of a cure leads many people to assume they are immortal, that they will live forever. Most people assume this. That’s why they smoke, don’t wear seat belts, skip a helmet while riding a bike, or drive after drinking a couple jumbo margaritas. Everyone thinks they are an exception, “It won’t happen to me. Death is a fact of life, but not in my life.”

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Twelve years after my surgery … I had an MRI which indicated one of my lymph nodes was “suspicious.” It could have been caused by anything, a cold, seasonal allergies or … “carcinoma.” My doctor suggested waiting a couple months and then repeating the MRI to see if there was any change. I agreed.

Then COVID came into our lives. On a spring day in 2020, my doctor called to cancel my repeat MRI. Mayo Clinic was canceling all procedures except for the most urgent and dire cases due to the COVID pandemic. “To be honest,” she said, “Your risk of death from COVID is much greater than from cancer. We will reschedule once we get a handle on this virus and can control its spread.”

“How can I control my risk?” I asked her.

She answered, “Wear a mask, avoid groups of people – especially indoors, wash your hands, and continue exercising outdoors!”

Once again, I reminded myself, “What I can control, I will control.”

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The word “carcinoma” is not a word anyone wants to hear. Many people describe the day of their cancer diagnosis as the worst day of their life. No one would choose to have cancer, nor to have their life put at risk. But if cancer or COVID or any other possibly life-threatening disease enters your life, remind yourself that you do have control of your response to the disease:

• Will you accept the possibility that you might die or will you avoid thinking about that possibility and deny it exists?

• Will you embrace your risk with a determination to exercise control over what you can control or will you downplay the importance of your life choices and decide to “just let what’s going to happen, happen?”

• Will you actively engage with your doctors or will you ignore their advice because you think you “know better?”

Eventually I received both a mammogram and an MRI. The results were better than I expected, BI-RADS 1, meaning the image was “normal” and there is no evidence of a lesion or mass. This was good news as there is no obvious sign of cancer at the present time. So maybe I don’t need to have any more imaging studies? Oh, heck, no! I am in control of my appointments and my response is to continue with the scheduled MRIs as my doctor has advised me. Who knows what the results of my future MRIs or mammograms will be? No one. My best hope thirteen years ago was, and still is today, early detection. There is no vaccine to prevent hospitalization or death from breast cancer. The risk will always be present. It’s always there, sitting just outside the door. 

The word “carcinoma” may once again enter my life even though it appears I am “in the clear” – for now. I am aware of life’s fragility in a way I wasn’t before that memorable, “carcinoma” day. I control what I can by striving to take care of myself - my one, precious body and encourage others to do the same. Each morning I wake up excited, eager for what the day will bring. Every day is a “good” day when I simply reflect on the fact that I am still here.

* Sheehan, A. (2013). The essential Sheehan: a life time of running wisdom from the legendary Dr. George Sheehan. Rodale Books.

A Good Doctor ... or a GREAT Doctor?

   “A good doctor treats the disease; 

the great doctor treats the patient who has the disease.” – William Osler

"What the …?” After a 17 mile training run, I was taking my house key out of my pocket when I noticed my hands. They were white and cold. What is this?
I immediately called my primary care doctor, I felt fine but my hands were freaking me out. By the time I arrived in her office, some color had returned. She held my hands and examined them. “This looks like Raynaud syndrome. What have you been doing?” she asked.
I told her about my training run. She stared at me …

What would be treated, the “disease” or me? 

Three Important Questions:

1. Does your doctor have experience treating runners?

Even if your doctor seems to be an excellent doctor based on her credentials and training, it is important to have a doctor who enjoys working with runners; has experience treating running injuries; and understands the physiological and biochemical differences between running and non-running patients. 

• My doctor responded, “Listen. I don’t have experience treating runners. Every day I beg my patients to exercise. But I suspect the medication, which I prescribe routinely to many patients, has caused this. I know a cardiologist who is a runner and specializes in treating athletes. Let’s get you an appointment with him.”

2. Does your doctor run?

If my friends and family can’t understand why I am running, how will a total stranger like a doctor understand me better? If your doctor doesn’t run, you can’t expect her to understand your passion for running. 

• The first thing the cardiologist said to me was, “So you’re training for a marathon, which one?” I knew I was in good hands. After chatting about our favorite races, we were able to work out an effective treatment plan. I ran my marathon and I have never experienced Raynaud syndrome again. He was great.

According to a survey of 4,950 doctors in the U.S. conducted by AMA Insurance, running is popular among doctors. Approximately 50% of the doctors surveyed who were under the age of 40 said they ran. Among those ages 40 to 59, 36% run and those age 60 and up, 23% run.

And while doctors who are runners may be more prevalent in practices related to sports medicine (cardiology, orthopedics, podiatry, etc.), they are out there - even my breast doctor is a runner!  

• At my last appointment, we shared our pandemic running experiences. She encouraged me to keep running and emphasized the positive impact running has on my health and wellness. We discussed an array of medications to reduce my breast cancer risk and then which one would be best for me - a runner. She is great.

3. Does your doctor say, "Stop running"?

“Stop running,” is the easiest thing for a doctor to say. This is understandable from a doctor’s point of view. If you have a specific running injury, your doctor wants to treat the “disease.” A good doctor wants you to heal. A great doctor wants you to heal, too. Plus a great doctor will work with you to create a customized plan to get you back to running.

 After a running injury, doctors will often ask you to switch from running to riding a bike, swimming or working out on an elliptical. These exercises can decrease high impact stresses, especially in the feet and ankles. This type of lower impact exercising can help running injuries heal.  

However, many doctors will attempt to talk you into permanently switching from running to a “different kind of exercise.” That advice is appropriate for people who are exercising to lose weight or maintain a certain fitness level but not for you if running is your passion, your lifestyle.

 If you are experiencing other health issues, you could hire a good doctor to provide expert advice and guidance on your specific “disease”.  But you want to hire a great doctor.  A great doctor has the medical “know-how” and is willing to work with you to develop strategies which specifically treat you.   

It is crucial that you explain to your doctor that, for you, running is not entertainment, it’s not a way for you to lose weight, and it’s not simply “exercise.” Make it clear to your doctor that running is an essential part of your life - physically, mentally, and spiritually. If, after sharing this, your doctor treats your running as a “disease,” go find a great doctor who will treat YOU!