Junque Miles:
By Mark Roberts
My Own Medicine - An Ultramarathoner's Long Journey
By Mark Roberts
Author's note: This article was originally written for print and shopped around various running publications. One of them, Ultrarunning magazine, printed a shorter version... without obtaining copyright and without paying! For those who would like to read about it without supporting the copyright violation of Ultrarunning magazine, I present the original article here in its entirety:
Training for his first hundred miler with the intensity typical of ultra
runners, Dr. Geoffrey Kurland became aware of a persistent pain in his ribs
after a 50-mile race and went in for what he assumed would be a routine chest
x-ray. In medicine, as in races, things don't always go exactly as planned
and in the 90 seconds that it took for the x-ray film to pass through an
automatic processor, Doctor Kurland, runner and physician, was transformed
into Geoff Kurland, patient. His recently published memoir, My Own
Medicine: A Doctor's Life as a Patient (Times Books, 2002), is his
account of his battle with cancer and his determination throughout to
continue running and to complete the Western States Endurance Run.
Dr. Kurland, a pediatric pulmonologist at Pittsburgh Children's Hospital,
now runs between two and five days a week, depending on his work load.
"I am.marked as the physician who runs the year round, at night after
work, carrying his beeper, in any weather. I am an acknowledged nut."
Usually the run is to and from work - a distance of about five miles each way
- because his 7-days-a-week work schedule allows little other opportunity. He
brings in one pair of pants and five shirts to keep in his fantastically
disorganized office for a week's worth of quick changes (after a post-run
shower in the O.R.). A collection of ties on the back of the door allows him
to complete a reasonably professional-looking fashion ensemble in short order
so he can get down to a typically long day of treating children with Cystic
Fibrosis and other respiratory disorders. When a "lunchtime"
interview takes at place 2:00 p.m. it is his first break since
7:00 that morning. He recalls how running has been a vital part of his life
since 10th grade, when he made the cross-country team "only because the
total number trying out for the team was less than the capacity of the school
bus." In his first ever cross country race, at age 14, he ran in
next-to-last place... until the last place runner quit. Now he credits the
strength and self-reliance he learned as a runner with helping him through
the years of surgery and chemotherapy necessitated by his illness.
He ran track and cross country for Amherst College in the late 60's, finding in running a continual thread that served to connect the various stages of his life. He ran the Boston Marathon and finished 185th, but is quick to remind me that this was back in the days when there were only 375 runners in the entire race! He got a taste of ultra running when a friend asked him to be his pacer for the last 14 miles of the American River 50-Mile. It was there that he first had the experience of running on trails "out in the middle of nowhere" without another runner in sight. He was hooked. On his second 50-miler, he finished within the qualifying time for the Western States Endurance Run. From there his training went smoothly until the day of his appointment in the radiology department, when all his plans - for his life as well as his running - went out the window.
The initial x-ray revealed a fist-sized mass in his chest, no less terrifying to a physician than to any other patient. The staff expert in his own hospital thought it was "probably" benign, a none-too-comforting diagnosis, and Dr. Kurland resigned himself to what was expected to be a relatively routine operation. He made an appointment at the Mayo Clinic, in his hometown of Rochester, Minnesota. But a follow-up CT scan requested by the clinic's chest specialist revealed an enlarged spleen, and hopes for a simple diagnosis and quick treatment vanished.
The next step, a bone marrow biopsy, brought more bad news: The cause of the enlarged spleen was hairy cell leukemia, a rare form of the disease named for the hair-like projections on the walls of the cells. At that time there was no effective treatment for hairy cell leukemia, so he faced an uncertain outlook even after the surgery that lay ahead. Complicating his situation (as if any more complication were necessary) was the fact that his blood counts were so low that trying to remove the mass in his chest could prove fatal - the slightest complication could result in his bleeding to death because there weren't enough platelets in his blood to insure proper clotting. He would first have to have his enlarged spleen removed, in the hope that his blood counts would then improve enough for him to survive the second, and much more serious, operation.
The day after surgery to remove his spleen, Geoff Kurland lay in his hospital bed, in a fog of pain and pain medication, and contemplated his fate. Even if the second operation went well, the prognosis for his rare leukemia was uncertain: The 5-year survival rate was around 40%. "Less than the odds on the toss of a coin," as he puts it. Then his father walked into his room holding the latest issue of the New England Journal of Medicine - hot off the press - with an article on a promising new treatment for hairy cell leukemia.
Anyone who's ever had to come back from a long layoff due to an injury will find Geoff Kurland's return to running familiar but humbling: His first run, which took place about a week after the operation (he couldn't wait any longer - sound familiar?) consisted of 200 yards of alternating walking and slow jogging.
He attributes the strength to cope with these crises, and the perseverance that carried him through his treatment, to his running. "Early on I learned the power of persistence.when I was out running in a race.no one could help me but myself. Success or failure came down to me alone."
By the time he worked his way back up to four miles a day he was strong enough to undergo his second surgery, which put him right back to square one. For the second time in as many months he was reduced to beginning with an eighth of a mile jog/walk, but continued undeterred. In his book he recalls thinking, "I am strong enough to walk, and I know that walking foretells running, itself one of the keys to my future."
In My Own Medicine, running is the axis around which the story of Geoff Kurland's illness revolves, the way it permeates their lives of all those for whom it is a passion, sometimes to the bewilderment and concern of those who don't share the obsession. Comments from some of Dr. Kurland's friends, relatives and even physicians will be familiar to anyone who has ever faced non-runners' doubts about the healthfulness of running. Kurland's father was on the phone to his hematologist asking if running could have caused his leukemia within an hour of hearing the diagnosis! But the one person who never had any doubt was Geoff Kurland himself. He never for a moment considered giving up the passion that is such a crucial part of his definition of self: "Running was.one of the definers of my self, a veritable limner of my soul."
When he was too sick to run the Western States Endurance Run, he volunteered to work as a physician at one of the aid stations (as he continues to do every year). The sight of runners struggling in after 62 miles of running through desert valleys and over mountain peaks, with 38 miles still to go, only strengthened his resolve to someday complete the race himself. "All I can think about is the look in the eyes of the runners, the strange mix of pain and exhilaration."
He began his chemotherapy with the same determination that carried him through his surgeries. All seemed to be going well until the middle of his first round of treatment when he collapsed at work, his chemotherapy-weakened immune system falling prey to an infection that his doctors couldn't treat or even identify. (Eventually diagnosed as an antibiotic-resistant form of atypical tuberculosis, this infection came closer to killing him than the cancer.) Weeks of hospitalization and a third surgery followed, this time to biopsy lymph nodes in his chest. By the time he recovered, no one was certain at first whether he could even take more chemotherapy. Well, no one except Geoff Kurland himself.
The second stage of chemotherapy, with an experimental drug, left him stricken with debilitating bouts of nausea. He timed his chemo injections to come just before he left the hospital at the end of the day, allowing himself barely enough time to drive home and take his anti-nausea medication before the worst of it hit. He recalls telling his cancer cells, "I'm still here and you're the ones who're going to die... This is me talking. The long distance runner. I'm here to stay." Nonetheless, he believes that it's modern medical technology that saved his life and is realistic about the role running played in his recovery: "I'm a big believer in real medicine. Illness takes control of your life away. There are a few things we can do to maintain control and identity. Running at least gives you the illusion of control during treatment." That said, he still takes pride in one of his surgeons telling him how easy he was to operate on because of his having "remarkably little subcutaneous fat!"
In a memorable passage in My Own Medicine, he recalls stopping in at his health club to change for a run and being suddenly confronted with the sight of himself in the mirror; shockingly thinner and older looking than just a few weeks prior. But then he took a second look: "My legs are still strong, though pale, my shoulders squared, though my arms are thin" and concluded "I am still alive, and, by God, I am going to run."
The final irony came with the diagnosis of the mass in his chest that started
his ordeal: It was a completely benign cyst. Moreover, it was totally
unrelated to his leukemia. A coincidence. But a coincidence that got him into
treatment weeks or even months sooner than would have otherwise been the case.
In fact, had he delayed longer, his blood counts would have deteriorated
further and he could have succumbed to a sudden, massive infection without
ever learning of his leukemia. The threatening shadow on that first chest
x-ray may have actually saved his life. To this day he is unsure of the role
running played in his original diagnosis. Perhaps someone who didn't subject
himself to the stress of long distance ultramarathon training wouldn't have
noticed anything wrong until much later in the progression of the disease -
perhaps too late. Of course, it's also possible that someone with a lower
tolerance for pain might have sought diagnosis sooner rather than later. Geoff
Kurland doesn't spend much time on speculation like this. He's been
cancer-free for 12 years now and has his eyes on the future, and possibly
another run at the Western States 100.
My Own Medicine ends with Dr. Kurland 30 miles into the Western States Endurance Run, less than a third of the way through the race, overlooking mile-wide valleys under the deep blue sky of the California desert. He pauses to reflect and give thanks, and then resumes the run, following a trail that leads toward a distant horizon.
Perhaps the message of My Own Medicine is that running is like life: Having a finish line that's a long, long way off is not necessarily a bad thing.