Feet Don’t Fail Me Now

On Friday, once again, I cancelled my elective bilateral foot surgery, cheilectomies to ameliorate the effects of decades of running miles a day on hard pavement and wearing high heeled shoes to work. Like many other physicians faced with the dilemma of elective surgery, the “what-if’s” got the better of me—what if I get an infection, what if I have a poor result and am worse off than before, what if—god forbid—I end up with an amputation?  In the end, I opted out.  Six weeks after retiring from my job running a satellite radiation therapy facility for our local university practice, I am having far too much fun traveling, writing, gardening and culling the accumulated belongings of sixteen years in one house to undergo a forced “lay-up” for the summer.  The pain I know is preferable to that which my imagination can manufacture.  In short, I am a chicken.

Prior to becoming a chicken, I had always been an athlete.  At age seven, a swimming instructor announced to my mother, “She’s got talent!” and the next thing I knew I was trying out for the old Shamrock Hilton swim team in Houston, Texas.  To this day, the audition remains crystal clear in my mind—the coach asked me to swim the length of the fifty meter outdoor pool.  I had never seen a pool so enormous, but I resolved to try.  After all, what was the worst that could happen?  I jumped into the deep end reasoning that if I didn’t make the whole distance, at least by the time I tired, I would be able to stand up.  I reached the shallow end and touched the flagstone, gasping for air.  I stood up.  The coach said, “Okay, great, now SWIM BACK!”  I looked at my mother and began to cry.  She commanded, “DO IT!”  And so I did, despite the fact that the deep end loomed like a dark lagoon ahead.  I made the team.  Ultimately, my small stature and dogged nature suited me best for distance events—the 400 meter individual medley, the 1500 freestyle. The fact that I had once been daunted by swimming 100 meters seemed ludicrous a year later.

I graduated from high school one year before the passage of Title IX, the law that ultimately mandated athletic scholarships for women at every public university that offered the same for men.  With no incentive to continue a grueling five hour a day routine which produced green hair, bloodshot eyes and oversized shoulders, I turned to running for exercise.  And run, I did, for the next thirty five years—on the road, on the treadmill, in hot humid Houston and freezing snowy Boston—I ran away my fatigue, my stress, my disappointments and my sleep deprivation.  At age thirty one, after two residencies, I looked to be about eighteen years old, and so I wore heels, to make myself taller, more imposing, more apt to be taken seriously by patients and peers. Oddly enough, that strategy seemed to pay off, when my introduction of myself as “Doctor” no longer resulted in the question, “Really?”

The year before we left Boston in 1992, I watched the “Marathon Man” Johnny Kelley run his last full Boston Marathon at age 84.  Many years later, with these feet broken down from walking on tip toe when not running on asphalt, I am no Johnny Kelley. My running days are over for good, and even my walking days are fewer and farther between.  But as I contemplate the various ways in which our bodies fail us as we age—cancer, heart disease, stroke and dementia—I am thinking that arthritis and bone spurs aren’t all that bad.  I can always go back to the pool.  Or maybe get that little buckskin Quarter Horse I’ve always wanted.  There is no landscape, emotional or physical, that isn’t improved by the view from the back of a good horse.  I’ll get around to fixing those feet one of these days, sooner or later.  Probably later.

A Culture of Tenacity

It occurred to me yesterday evening as I walked off my flight from San Diego into Terminal C at Boston’s Logan Airport that I have done this before—landed at an East Coast hub two weeks after a major terrorist attack.  On September 20, 2001, my daughter and I, not without some hesitation, boarded a flight to Boston to look at colleges.  That was a long time ago but the mood there at Logan was strangely similar.  I ducked into Hudson’s Books for a late night snack, since I was waiting for her flight from Houston, and a woman in line next to me said, “Do you have any of those Boston Strong buttons?”  I had been thinking the same thing, just as she said it.

 

Bostonians have a long history of resilience and tenacity.  When I was a horse loving kid I read a story about Paul Revere’s horse, told from the point of view of the horse (of course!)  Apparently Paul did not spare the spur in his midnight ride on Brown Beauty, a mare borrowed from Samuel Larkin—nothing would deter him from his mission, and the good people of Boston, their roots steeped in hardship and persecution and war and famine, have followed suit for centuries.   The blood shed on the cobblestones of Boylston Street two weeks ago was not the first, nor will it likely be the last.

 

What I loved about my training in Boston thirty years ago was that same unflinching and uncompromising commitment to patient care demonstrated by the forefathers in their commitment to freedom.  Yes, the hospitals where I trained had some of the best teachers and most dedicated researchers in the business.  They wore their old school bow ties like badges of honor, and they still do.  Doctors wore white coats, and medical students did not inquire if it was okay to wear shorts to clinic, as they sometimes will in Southern California.   There was a certain formality, which translated into respect—for their peers, for their students, and for their patients.  Especially for their patients.  We laughed about them, we cried about them, we read and lived “The House of God”, and in the end we gave our all for them. I have missed that these last twenty years.

 

It’s good to be back.

Memories of Boston

“Today the road all runners come,

Shoulder high we bring you home

And set you at your threshold down

Townsman of a stiller town.”

A.E Housman

As this afternoon’s events unfolded, I sat glued to my computer screen between patients.  My life has really been a tale of three cities—Houston, Boston and San Diego.  Boston was where I did my residency training, met my husband, had my three children and my first “real” jobs.  I wrote to my best friend, a physician and lifelong resident of Brockton and Boston—I was worried, since her two kids, now in their late 20’s are active, athletic and in a waking nightmare, I pictured them at the scene.  I received this reply from her: “Fortunately, we are all safe.  Boston is quite crazy right now.  The hospitals are in lock down, and there are amputations going on in every OR.  Thank goodness we have so many fine institutions in the area.  Everyone is stunned.  So very, very sad.”

Every year since we met, in 1982, until the time I left Boston in 1993, she and I would watch the Boston Marathon together.  But we didn’t go downtown—we always went exactly to the halfway mark, thirteen miles in, where the route goes directly in front of Wellesley College.  My friend had gone to Wellesley, and in fact had married one of her professors and they lived close by on the appropriately named Lovewell Road, a block from the marathon course.  I have happy photos from the time—I did not have children yet, but she had a beautiful little girl, blonde and blue eyed, who would sit perched on her Daddy’s shoulders to get a good vantage point.  Tuppence, their stubby little rescued pound pup was in attendance also, and all together we would cheer as the runners went by, and the Wellesley girls, dressed like Greek goddesses in their togas would flash their beautiful smiles, and occasionally their beautiful breasts at the runners.  The guys always picked up their pace a little when they made their way through Wellesley.  Thoughts of terrorism had never entered our minds.

That all changed on September 11, 2001, when our nation and people collectively lost their last thread of insular optimism and belief in the goodness of mankind.  But what happened in the world of medicine—specifically in the world of hospital based emergency medicine—in the wake of 9-11 has doubtless saved many lives in Boston today.  The ER and surgery residents and attendings of Massachusetts General Hospital, The Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Boston Children’s Hospital, Boston University Hospital and Tufts New England Medical Center earned their keep today and are still earning it as I write tonight.  They are treating shock, and abrasions, and contusions, and head trauma, and learning to triage under real disaster conditions.  And sadly, many of them are learning to perform amputations for the first time.  On video footage I watched physicians wearing yellow coats who thought they were there for the fun of it– to administer fluids to dehydrated runners and wrap them in thermal blankets and congratulate them—jump the barriers with EMTs and National Guardsmen to staunch bleeding and administer CPR.  I know that the survivors are in the best of all possible hands tonight.

Boston, like New York City, will overcome this tragedy.  But I don’t think anyone will watch the Marathon with the same innocent enthusiasm that we had so many years ago ever again.