Abstract
An internist describes preparing to run a marathon in memory of her mother and the injury that prevented her from completing the race. Her perspective on this setback was shaped by her own loss and memories of patients whose lives were interrupted by cancer, reminding us that a cancer diagnosis comes without preparation and without choosing. While more cancer patients are surviving, there are still those whose life journeys end much too soon.
For runners around the globe, the Boston Marathon is special. Even before the terrible events of April 15, 2013, many committed months to years training for an opportunity to run Boston! New to the sport, I ran the Boston Marathon in 2012, and despite the agonizingly hot temperature that day, I crossed the finish line. Having done that, I promised myself that I would run Boston again… for my 50th birthday! As 2019 approached, I was determined to achieve this goal. With no chance of qualifying by time, I decided to run for a charity. A few years earlier, I discovered a local organization that supports children and teens who lost a loved one—it connected with me on deeply personal level because my mother had died when I was 14 years old. I was then a Russian immigrant, living in Brooklyn, NY, in the mid‐1980s. There was little support offered within our family unit and no resources outside of it. My grieving was solitary, and healing has spanned decades. Those who know my line of work may suspect that she died of cancer, but that was not the case. I often thought that had she died of cancer, as a parent of my childhood friend did, I may have been prepared for her death, shared the last months and days with her, and strengthened our memories for years to come. Unfortunately, she died without warning. I felt that running the Boston Marathon, connecting with others who have also lost loved ones, and dedicating my fundraising to my mother could allow me to grow closer to her and promote my healing process.
During the 5 months of training, I often thought of my mother while running—she would be so proud (and surprised) that her daughter, a chubby, studious girl who did not participate in any sport or physical activity, was doing this. With just 3 weeks to go, I embarked on my 20‐mile training run, a rite of passage for any marathon, although in Boston, this day is more than just about running. Thousands come out, proudly donning clothing with logos of their charities. Residents and volunteers line the course for miles, offering water, snacks, and cheers. There is a real sense that you are running for a greater cause. On that day, I took part in the starting line festivities and then took off on my run with the crowd. I had expected joy while gliding through the initial downhill, but there was none. Almost immediately, my hip was not feeling right. I never thought of quitting, especially as I was passed by many friendly faces who offered words of encouragement. I tried to dig deep, thought of my mother, pretended I was hearing the Wellesley College girls along the course, and visualized crossing the iconic finish line. Nothing worked. I realized I was in physical pain that I had never experienced. By mile 12 I could no longer walk, and without any alternative option, I had to stop. I called my husband in tears and asked him to pick me up. As we rode back to our home, I kept asking, Did I give up? Did I quit too soon? Should I have pushed through?
For the next week, I limped around (in fact, attended an American Society of Clinical Oncology committee meeting) thinking my hip would recover on its own. However, when I could no longer walk or even sleep without pain, I did what doctors typically hate to do: I saw a doctor. Soon after completing my evaluation, I received her call and heard the words, “I am sorry, Larissa. You will not be running this marathon.” I was diagnosed with a femoral neck stress reaction, a diagnosis I had never heard of, but soon found out it was a precursor to a hip fracture. Just like that, my dream of running the Boston Marathon was over. As I sat on a bench across the street from the Sidney Farber and “Jimmy” statues, I was distraught. How did this happen? I trained, I rested, I did everything right. My family, friends, and colleagues supported me with donations and good cheer. In the days that followed, I heard all sorts of words of encouragement—“it could have been worse,” “just do it next year,” or “run another marathon in the fall”—although there were those who took this occasion to let me know that running a marathon is “crazy” and “not meant for the human body.”
Feeling sorry for myself did not last long. Since my mother's death, there have been few disappointments in my life that affected me to the core. No breakup, school rejection, or job challenge had risen to the point of shock, disbelief, and life‐altering experience that her passing did. But my perspective on this injury was also unmistakably shaped by two decades of clinical practice and vivid memories of patients whose lives had been abruptly interrupted by cancer. In them, I saw courage, spirit, and determination that willed them to get through the shock of the diagnosis, endure the toxic treatments, and carry on with their lives. I remembered others who suffered endlessly even after treatment ended and, undoubtedly, those who died much too young. In the words of my colleague, “some patients stay with you always.” Indeed, I remembered a young man in his 30s who saw me on a Friday afternoon with a swollen lymph node—upon examining him, I knew his diagnosis was going to be grim. I stayed in clinic until that evening, waiting impatiently for his blood count, and will never forget calling him with the shocking news. Unfortunately, after being diagnosed with acute leukemia and undergoing a bone marrow transplant, he died of a recurrence. I remembered a young woman who was a “success story” in pediatric oncology, having been cured of neuroblastoma. She went on to have a productive career and loving relationships, but had numerous symptoms related to her treatment and struggled to balance her life with the medical care that she needed. She was one of the first patients to teach me about the joys and perils of being a cancer survivor—she understood this too well, and, in the words of her mother, “used every second of every day to live her best life possible.” Unfortunately, at the age of 30, her health suddenly declined, and within months she died of complications that resulted from treatment that saved her life two decades earlier. Lastly, I remembered an elderly woman treated for pelvic cancer many years prior. Her persistent leg pain led to numerous visits to the emergency room, and after many tests and consultations, she was told, “there is nothing wrong.” I wish that I had the survivorship expertise then to know that she was suffering from radiation‐related effects. Though I realize that there was little we could have done to ease her pain, just validating her symptoms and letting her know that she was not “crazy” may have helped.
As physicians who diagnose, treat, and support cancer survivors, we have a unique perspective that can be a source of strength when we are faced with adversity. With that perspective, I had no doubt that my injury was a temporary, minor setback. Instead of focusing on the disappointment of not running the marathon, I needed to take stock in what I achieved in the process of training. I acknowledged my dedication and appreciated my almost 50‐year‐old body for enduring the miles. I was grateful for the donations I received and was proud to have made a significant charitable contribution to a cause that meant so much to me. Miles of running with my mother's memory helped me connect with her and left me feeling more at peace with her passing. I celebrated these accomplishments by proudly hobbling over to the expo on my crutches, picking up my bib, and posing for pictures at the finish line. On Marathon Monday, I sat along the infamous Newton Hills and cheered on my fellow teammates and other charity runners. Whether running to qualify for another Boston, achieve their personal record, or just to finish, these runners committed, prepared, and were pushing through to get to the finish line. Yet cancer comes without preparation and without choosing, and while more and more make it through, there are still those whose life journeys end much too soon. At that moment, I took comfort in knowing that there may be a future Boston Marathon for me to run or another challenge ahead.
Disclosures
The author indicated no financial relationships.