Surviving the Marathon

James Gerson, MD

Fourteen miles into a recent 50-mile trail ultramarathon, I found myself running next to Gregory.* We began to chat and go through the usual—where are you from, what do you do—but when I told him that I was a fellow in hematology and oncology, he stopped me.

“Eighteen months ago,” he said, as we crested a hill and caught a glimpse of a lush valley erupting with golden flowers, “I had a feeding tube and weighed 85 pounds.”

He went on to tell me about his recent battle with human papillomavirus-positive tonsillar cancer—how he lost 75 pounds just 2 weeks into his treatment that consisted of radiation therapy with high-dose cisplatin. He couldn’t eat and, despite a strong aversion to it, acquiesced to placement of a feeding tube. A lifelong runner who had completed countless marathons and ultramarathons, he was forced to stop running for the first time in his life due to intractable fatigue and weakness. He felt lost and struggled to find meaning. He even considered giving up and stopping the treatments altogether.

But then, he told me, he realized that the only way through was to approach therapy just like he did the countless running races he had already finished. The daily radiation treatments became mile markers. Each cycle of cisplatin was a steep climb to the top of a 10,000-foot mountain. If he saw food, it was like an aid station—eat or drink even if you don’t feel like it. Soon he found himself at his last treatment. That finish was more joyous than completing any running race he had ever done.

Just a few weeks after his therapy ended, he went for his first run. It was 1 mile at a snail’s pace. Every step was agony, but he kept going. At 6 weeks, he ran a 5K sponsored by the Head and Neck Cancer Alliance, which was raising money for cancer research. Three months after that, in celebration of the negative posttreatment positron emission tomography/computed tomography scan, he signed up for his first marathon as a cancer survivor. And now, just 18 months later, we were running 50 miles together in the mountains, with the glowing sun rising behind us over San Francisco.

Our patients come from all over the world and all walks of life. Some are parents, some are police officers or teachers, and some are plumbers and veterans. They have hobbies just like my co-fellows and me, be it music or running, playing chase with their dogs, or staying up late watching bad TV. But the common thread of a cancer diagnosis ties them together as the disease shakes the foundations of their lives, threatening to pluck the things they love from their grasp. It defines a struggle that we as providers cannot truly know.

Each day in clinic, I find myself inspired by their stories. Our patients defy cancer by persevering through unimaginable toxicity, sometimes even completing marathons during treatment. 1 They astound us by remaining positive and warmhearted even when all seems lost. Those who transition to end-of-life care awe us with their grace and composure through the journey. With every visit, I am reminded of the reason I pursued oncology in the first place: to care for these astonishing individuals during what will likely be the most difficult time in their life and help give them back the life that cancer tried to take away.

Gregory and I chatted for a few more miles, and then he bade me farewell and sped up, finishing the race almost an hour before me. When I finally arrived at the finish line, he was waiting there for me.

“Doc,” he said, “I want to thank you for doing what you do.” My mind instinctively went to the pile of paperwork I had left behind in my office, the unfinished clinic notes from last week, a few unanswered phone calls, and an upcoming presentation I’d been too busy to finish. And yet I smiled. I couldn’t wait to meet my first patient on Monday morning. “No,” I said, shaking his hand, “thank you.”

*Name changed to protect privacy

Bernhörster M, Rosenhagen A, Vogt L, Thiel C, Jäger E, Banzer W. Marathon run under chemotherapy: is it possible? Onkologie. 2011;34(5):259-261. doi: 10.1159/000327804.