Thursday, April 2, 2015

525,600

I looked down and chuckled. Wow, my legs are pasty white. April 2, 2015, the year's first run without tights (or my favored manpri 3/4 length), a hat, or gloves. The sun was out, the sky, which a couple hours before had been a milky gray, was now blue, and I was easily running home, the long way.  Spring was springing before my eyes, but, for the moment, my attention was fixated on the glaringly bright tan line highlighted by my shorty shorts.  I wonder if I can see my scars?

Right then the absolute beauty of the moment struck me - everything, from the melting snow tracing water across the sidewalk, to the honest-to-goodness chirping song of birds, to the mounds of blackened snow clinging to life at road's edge, and especially the pasty whiteness of my legs, flooded me with a near overwhelming sense of gratitude.  Here I was, on this absolutely perfect spring day, running home.  In a few minutes time I would be running on the dirt (and snow) of the Fells. But for this moment, on a vacant sidewalk in Assembly Row, pocked with months-old snow and ice, I was struck by beauty.

Exactly one year ago I underwent a "simple" knee surgery to remove a plica from my knee.  Regardless of competing, I merely wanted to regain the freedom and ability to run without worry.  There was nothing structurally wrong with the joint, just this extra bit of tissue causing pain whenever I ran. The recovery proved to be extended, pushing me deep into the pain cave, consuming my fitness and, honestly, a great sense of my identity. Today, as I ran on the melting snow in the Fells, listening to my breathing, hearing my foot steps, feeling the ground change between patches of dirt, snow, and rock, I forgot.  I forgot that just a few months ago I wondered if I'd be able to run again. I forgot the trips to the ER, the blood tests, the doctor visits, the injections, the pain.  I was simply running home.  On the trails.  In my shorty shorts. With my pasty white legs.

I didn't bother to check my scars.
---

One thing these past 525,600 minutes have taught me?  Feelings and experiences pass.  Our bodies and lives, despite our hopes, despite our desires, will always change.  They will be no better, no worse, just different.  Just as the pain and suffering of the many months post-op gradually gave way to a slow return to health and joy, today's bliss will eventually fade.  But, as I finished my run, I asked, Does it have to?  It is easy to accept these moments of joy, of pleasure, of connection to ourselves, to the trail, to the people around us, when things are going "our way." When things are not, it is much harder to accept our circumstances.  My hope is that this past year will have left me not with nearly-invisible surgical scars, but with a greater appreciation for the ever changing nature of life, so that, one day, when the euphoria from today's run has faded, I will be open a new joy, a different joy, a different pain, a new experience, an acceptance, be it on the trail, or elsewhere.

526,600 minutes ago all I wanted was to be able to run without thought of injury, without pain.  Today, I had that, in spades.  For that I am grateful.

Thursday, September 25, 2014

Perspective


Hitting the tarmac of a paved road never felt so good.  It was because I usually don't feel like such an utter and complete amateur when it comes to sports, especially "endurance" sports.  We're talking 100% out of my element, uncomfortable with every slight move my body made, absolutely zero fluidity of motion, and not an ounce of mental calm.  On this day, the sense of complete incompetence was nearly overwhelming.  My mind had been hyper-focused, but not in the clarity-producing, time-slowing "flow" kind of way, rather the "HOLY SHIT, IF YOU FUCK THIS UP YOU ARE REALLY GOING TO BE HURT SO DON'T MESS THIS UP BECAUSE YOUR BODY HAS NO DESIRE TO BLEED OR BREAK AND CRAP THERE'S A ROCK AND REMEMBER DON'T HURT YOURSELF AND SERIOUSLY THERE'S ANOTHER ROOT AND THIS IS REALLY KIND OF SCARY AND THERE'S A ROCK AND A ROOT SIDE BY SIDE AND WHAT THE HELL AM I DOING AND THERE'S NO WAY YOU CAN GET BETWEEN THOSE TWO ROCKS" sort of way.  This was the anti-flow state: five or ten minutes felt like an hour, maybe four.  Hitting the tarmac of a paved road really never felt so good.

The funny thing is, I have run those trails countless times, the very trails that were producing the "anti-flow,"  and reached a flow-state on multiple occasions. Those days the running was easy, fluid, natural; body, mind, and environment worked in such complete harmony that literally hours would pass in an instant.  Why, to paraphrase Jewish tradition, was today different from other days?

It all comes down to perspective.  Simple, simple, perspective.  You see, those days that achieved flow were when I traveled the trails powered only by my feet, my legs, and my desire to explore.  When I ran.  Years of practice had brought my skill and confidence to the point where I could run nearly any terrain, nearly any distance, with some level of fluidity, some level of competence.  This was not hubris, but awareness, an absolute absorption, and sense of self-control.  From the perspective of running I was enjoying every moment, and didn't have to consciously think about a single movement - I could "read" the terrain intuitively and react instinctually.  This day of "anti-flow" was different from all others because my perspective was not that of a runner.  It was that of a very, very, very inexperienced cyclocross rider.  

It has been just over nine months since I've been able to run at a competitive level.  In that time I had roughly four weeks of "training" in July and August before being sidelined by yet another injury.  While unable to run, I've turned to my eight-year old road bike and been able to log some decent mileage.  Still, biking has never filled me with the same passion that running does, but I've found I can capture a bit of the adventure I enjoy by simply leaving my house with no destination in mind, getting myself lost, and then getting myself home, all just by "feel." I've been doing it enough that biking has begun to feel easier.  I am starting to feel "in shape." Still, the necessary maintenance, the cleaning, the greasing, the rain, the potential for road rash, makes it just enough of a hassle that it's not as enjoyable for me as it could be.  But, as I would ride by trails I used to run, or trails, much further from home, that I wished to explore, I decided it was time.  It was time to buy a new bike, one that could get me onto the trails.  Maybe it's my midlife crisis (at 34 and 3/4 I really hope not!), but I bought a cyclocross bike, hoping to recapture some of the flow I've felt running the trails in the past.  Funny how quickly perspective can alter your perception.

As I biked down the trail, in between the images of my wrecked, broken body lying under the fancy new frame, I was continually amazed by one thing: how each and every root and each and every rock, no matter how small, would put the fear of God in me.  Each of these features, some literally no bigger than my six year old's fist, was a nearly impassable obstacle for me.  Beyond knowing how to simply pedal a bike, I was way out of my element.  I was awed at the thought that others could cruise these same trails on bikes at speeds that for me would be suicidal (or at least self-maiming), or simply navigate between (or over) obstacles that I had to dismount for.  I could run these trails nearly twice as fast, but now, these malicious rocks and roots,  the same that, while on my own feet and not wheels, were non-issues, were threatening to spill me every time I passed one.  By putting me on two wheels, these evil, evil features were like little devils.  Each posed real risk, and I realized one thing: this feeling of utter ineptness, of utter amateurishness, was, perhaps, even better than flow, even better than that sense of total competence and ability.  

Perhaps, when I really think about it, really think about why this day, this ride, was different than all others, it was not simply because my perspective was from a bike and not my feet (which really was a big part of it!), but because my perspective was that of a complete novice.  While getting back to the relative safety and familiarity of the pavement was a welcome relief to my white-knuckled fists, when I got home, it was that perspective of being a total newbie that enthralled me.  I had a entirely new appreciation for folks just getting into trail running.  I knew what it was to willingly put oneself into a situation where one struggles immensely - not just with the terrain, but with that most difficult of challenges, one's own mind.  It is different than a hard hill or speed session - those I knew, at least on some level, I could gut out.  My feeling on the 'cross bike is one of total inability.  It is at once scary and thrilling: scary because, frankly, I'm so horrible at it (and I just invested in a new bike!), and I really don't want to get hurt (again), but thrilling because how often do I actually and honestly put myself into a situation like this - a situation where the potential for incredible personal learning and improvement exists in such a concrete way?  A situation where I was forced to master all those mental traps and doubts I was setting for myself simply to get off the trail?  The answer is very rarely.  That, in and of itself, is exciting.  And, one day, when I'm able to run these trails fluidly and effortlessly again, I will try to remember these days of "anti-flow," these days when each pedal stroke was a struggle and a danger.  And those memories will make each step that much sweeter.

Wednesday, August 27, 2014

Thwarted

For the first time in eight months I had that feeling.  It was just the faintest sense, a mere glimmer. It was fitness. I knew it was there because I felt compelled to do something I hadn’t even dreamt about all year: I checked my weekly mileage (a whopping 49.7 miles, not quite half of what I typically will hit in training).  I knew my fitness had caught the slightest of flames because, on Friday night, I set aside my running gear, Body Glide, and, yes, even a water bottle and some calories for Saturday. After five weeks of consistent running I planned to “go long.” I felt that mix of nerves and anticipation that typically comes before a race.

The run was to be bookended by my responsibilities as a father: my older son, Cooper, had a makeup soccer camp session from 9:00 – noon, so I would drop him off, leave from the field, head to the vast trail network of the Western Greenway and return three hours later, shining in long-distance glory (and, I suppose, sweat).  I wanted to hit twenty miles and the early miles were fine, so good in fact, that I ran without even thinking about my left knee, the one that had been injured in December, operated on in April, and seemed to not want to get better until the middle of July.  It was a beautiful day.  About two miles from my planned turnaround it was still a beautiful day.  I, however, was no longer feeling so beautiful.

It happened first on the little downhills.  There was no distinct moment of reckoning, no misstep or epic fall.  Instead, what felt like the top of the right side of my butt just started hurting.  It felt fine on the flats and ups, but running down I had to sort of limp.  It felt like a muscle and came only when my weight transferred to my right side and then pushed off.  I shook it off, at one point smiling thinking about how this literal pain in my ass was nothing compared to the figurative pains in my ass and the literal pain I’d had the first two or three months post-op.  Still, the bravado didn’t last too long, and, as I made the decision to turn around, I started worrying about my ability to get back to Cooper in time.  And then I started worrying about that steep hill I’d have to run down, on a sidewalk.  That was really going to hurt.

By the time I reached this hill of destruction (Mill St, in Belmont, for those in the area), even the flats hurt.  My teeth were gritted against the absolute pain, but I still chuckled (on the inside at least), thinking about how much sweeter this pain was than the pain post-op.  I began to think I would try to get down the hill as fast as I could, almost sprinting.  Upon attempting said strategy, my leg basically buckled, I clenched my jaw and grimaced. I was relegated to a walk that, in a different setting, a person could have mistaken for swagger.  Suffice it to say, I got no swag’. 

During the last two or three miles of the run a sentence played on infinite repeat in my mind.  It was Araceli Segarra, from the IMAX film Everest, in her Catalan accent describing the last push to the apex of the world: “It was the longest hundred meters of my life!” I may not have been scaling the world’s highest peak, but those last couple of miles put a hurt on my body and mind like few others have.  I grimaced.  I laughed at the absurdity of situation - just weeks after returning to running, I was clearly hurt.  Again.  I worried what would happen if I couldn’t make it back to the field in time to pick up Cooper.  I struggled, both physically and mentally, knowing my “comeback” to running was being further thwarted with each step.

Practice was just finishing when I got back to the park.  I smiled to myself for the dual pleasure of having made it back on time, despite what was now something very much wrong with my body, and for being able to sit down on the rail at the end of the field.  I was not smiling when I attempted to stand and nearly fell over for the pain and the fact that those muscles in your lower back/upper butt have a lot to do with your ability to move your legs.  I smiled again when I made it to the minivan and sat down in the driver’s seat, almost instantly extinguishing the pain.  I did not smile when we got home and I tried to walk into the house, each step onto my right leg causing the pain to return in earnest to my right butt/lower back.  I didn’t smile much for the rest of the day.

Eleven days have passed since that last run.  In many ways it was good I was hurt, as the family went to northern Vermont and New Hampshire, and, being unable to run, I spent more time with my nephews and niece than I ever have before.  Nine days after the first flair I ran a total of about 100 yards during a coaches vs. kids scrimmage at Cooper’s practice.  The effort was near crippling, nad “graciously” I offered to play goalie for the coaches where I could at least pretend to play whilst looking like one of those blow-up tube-dudes you see outside carwashes and wireless stores.  Last night I rode my bike.  The leg felt great.  Until I got off.  Today I was able to hit the stair-climber at the Y and made it to the top of the Burj Khalifa tower.  I was able to walk afterward, albeit with more of a limp than the swagger I had a couple weeks ago. 


If these last eight months have taught me anything though, it’s to be patient.  I believed I was being patient in my return to running – keeping the effort and mileage in check – which has caused  this newest set back to weigh more heavily on my mind than any of the difficulties I faced earlier this year.  It has taken me much longer to accept this injury and the limitations it has currently placed on me – limitations that were made abundantly clear when my family spent this last weekend in New Hampshire’s White Mountains and two of our three days featured bluebird skies on the high peaks.  Limitations that have prevented me from playing soccer or tennis with my kids.  Patience.  Tomorrow I see Tom Karis, the witch doctor (aka, orthopedic massage therapist), as a first step in seeing what’s wrong (update: he thinks it is the sacrum that got out of line.  This update comes on September 25th.  I still ain't really running).  And, on the bright side, at least my knee feels pretty good!  Running will always be there.  I’ve gone through this before.  In fact, this is how I've spent all of 2014.  Here’s to getting better.

Wednesday, July 16, 2014

Success

I have run the past two days, totaling more mileage (just shy of 5 miles) than I have accrued since the day after plica surgery on April 2 (I ran 5K the morning of the surgery - perhaps the antecedent to the complications?).  This piece was just written for an intensive teacher-class I just took - 9+ hours in the classroom each weekday, tons of reading, and, gasp, homework.  Reckoned I'd throw it up here for a more permanent record, and as a reflection of things beyond running.


“I learned this, at least, by my experiment; that if one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with a success unexpected in common hours. . . . As he simplifies his life, the laws of the universe will appear less complex, and solitude will not be solitude, nor poverty poverty, nor weakness weakness."

- Henry David Thoreau, Walden


I was six or seven.  It was summer.  A clear day, blue sky, the woody smell of Vermont’s Green Mountains deepened by the heat.  I was sitting on the third step leading up to the porch where we stacked our wood for the winter and had the swinging bench for summer days and nights.  The stairs faced the giant tree, the one I was always too nervous to climb.  The one with the “pull bark” that I would pick and flick like little knives.  I was crying. The tears came from a realization. A realization that one day, any day, I could die.  For some reason, unknown to me, on this day I confronted the only promise of human life, the promise that we will all end.  It was not an anxious moment, a depressed moment, it was just a great epiphany.  Still, it scared the shit out of me. 

. . .

There was a growing sense of foreboding.  We’ve all had it - that twisting pit of anxiety that builds in the bottom of your stomach and gradually builds to consume your mind, training your thoughts on all the negative possibilities.  The freezing cold water, engulfing me to my naval, did little to inspire confidence.  The cold caused my breath to grow shallow. Despite being surrounded by all this fresh water, my mouth began to go dry.  This was going to end badly.  Very badly.  Why was I doing this to Liz? 

“Dad, we’re swimming across,” Cooper proclaimed, the general soft, “kid” quality of his six-year-old voice masking a brash confidence I had lacked in youth, and adulthood.  My four-year-old, Jacoby, mirrored this confidence, but had the sense to say he’d be swimming on my back.  Between us and the far edge of Walden Pond lay a stretch of water that, despite being crystal clear looked like a black-hole, it’s impressive depth swallowing all the light before it could return to the surface.  Every instinct I had as a parent cringed at the thought of letting my two sons, whom I love deeper than my own life, risk theirs to swim across this water. There was no reason to do it, other than to fulfill a natural sense of wonder and exploration, the same drive that propelled the earliest humans to step into the unknown and explore the world.  I thought of Liz, who, during the summer months works longer hours while I watch the boys.  How could I tell her what was sure to happen to one, or both, of our children?  Heart racing, every muscle tensed, every ounce of parental instinct screaming, “NO!” we pushed off and began the swim.   This was going to end badly. Very badly.

. . .

Years before, my Grandpa Barney struggled to enjoy the last bit of his failing strength and vigor.  He and I strolled the beach outside his Florida home, an activity once done for hours without rest.  Today, we stopped at every beach chair we could find, Grandpa clearly struggling to walk the fifty yards between each.  Despite his troubles, we shared the deepest conversation we had ever had.  The details are fuzzy, bleated out by the bright sun and my realization that this would be the last time I could share a walk with him.  But looking at the man who, through his work and economic acumen had brought financial fortune to my family, I confessed the fear that I would never make much money.  My grandfather, who had started humbly, peddling fruit in Brooklyn to feed his family, then laid bricks, and eventually became a successful builder during the heyday of Detroit, told me, “Josh, there are many forms of success.” We sat silently for a moment. “Money is only one measure.  It’s probably the least important.” The conversation ended as we reached the next beach chair, Grandpa winded, eyes closed as he struggled to catch his breath, those “other” forms of success left a mystery to my freshly minted, college-graduate mind. A mystery that remains to be discovered through living. 

Years later, I walked this same stretch of beach.  It was late at night, mid-February, the temperature a welcome, but unnoticed relief from the wicked cold I had left in Boston a mere twelve hours before.  My mind remained in my grandparent’s home, where, just minutes before, I had held Grandpa Barney’s head, gently running my hand through his beautifully silver hair, hearing the “death rattle” in his throat, speaking to a spirit I hoped remained in the wasted, unconscious body.  As he lay dying we shared a moment of physical intimacy we had never shared before.  I said goodbye and, alone, left the light of the building, left the pain of my parents and grandmother, who would keep vigil that night, to walk to the hotel where my wife and two boys were waiting, asleep.  With not another soul in sight along the entire ten-mile beach, I stopped.  At first I heard the waves, their melodic rhythm unending, infinite.  I pitied my loss, my grandfather’s pain.  I turned to the heavens, to the great expanse of sky above the water and was awed by the sheer scope of the universe, the stars, eternal beacons to worlds beyond our reach, and to the great human sense of exploration.  Looking at that night sky, I realized I was looking at the same stars, which were forming the same patterns, which had been looked to in moments of joy and sorrow and contemplation for thousands of years. As my grandfather’s last bit of life was leaving his body, I thought of how every moment, in all of creation, had led to this one.  In this moment, wrapped in the personal suffering of loss, I thought of all the people who were, at that moment, comforting their loved ones in death, or were welcoming their child to the world, or were meeting the love of their life for the first time.  I thought of all the people who, despite the infinite vastness and opportunity that spread above me, were thinking of my grandfather.  From his earliest days, pushing his wooden fruit cart on the streets of Brooklyn, to his days as a grandfather and a great-grandfather, and all his days in between, his eternal stars were his relationships with others. His honesty. His integrity. His love.

There are many forms of success.

. . .

It had been a long three months for me.  Just weeks from the 100-Mile Trail Running National Championships, where I was confident in a top finish, my knee flared up.  I knew exactly what the pain was, having suffered from this three times before, and did all I could to rehab.  My fitness, both the physical and the mental, that is needed to run 100 miles was at an all-time high, having been built over the previous year through long miles and wake-ups that match last call at many bars, and an almost maniacal focus. As the weeks progressed and the recovery did not, this was lost.  I dropped from the championships, mourning the lose of a reality I had pictured, but that had never existed. Fourteen weeks from the initial flare of injury, after nearly two months of consideration and counsel, I stood on the eve of a “simple” surgery, which promised to fix my knee, fix the problem, forever.  In about fifteen hours a surgeon would put his tools into my knee, but first there was this ridiculous coaches meeting I had to attend.

It was Tuesday, April 1, 2014.  I had missed bedtime with the boys to sit among close to two hundred coaches for the Town of Arlington, mostly dads, many of whom joked around and caught up, my natural introvert squirming as I sat awkwardly at a middle-school cafeteria table, just waiting for the meeting to end. In lieu of my usually intense, and time-consuming training, I had signed up to coach my son’s U-8 soccer team, this meeting marking the start of the spring season and my formal commitment to three days a week of practice and games.  I was dismayed when Mike Singleton, the director of the Massachusetts Youth Soccer, was introduced as the guest speaker.  Honestly? A guest speaker?  I was coaching a group of seven and eight year olds!  I just wanted my gear so I could go – I had a surgery the next day.  Being polite, I feigned interest as Mike spoke about youth soccer and his many experiences coaching – from the awkwardly large ten year old who was six inches taller than him to the college level player who got hurt and lost his scholarship. My mind half present, a word floated through the air that caught my attention: pedagogy.  This was starting to feel like a really bad PD.

Yet, as Mr. Singleton spoke of pedagogy, comparing soccer to education, to school and planning, he addressed something that had been stewing in my mind for years, something I had been unable to articulate and something not enough people in education are willing to look at.  Now, with my rapt attention he continued, “Of the hundreds, possibly thousands of kids who play soccer here in town,” his demeanor intense with its honesty and passion, “Only a few, maybe ten, will go on to play Division I soccer.  Maybe one will go on to play professionally,” he iterated, placing a clear emphasis on the maybe. “But this, I promise you,” his voice now almost a whisper, “These kids will become adults.  Many of them will become parents. What we need to teach them is not how to be the best soccer player, but how to be the best people they can be.” Coaching, suddenly, was not just a “filler” for my lack of running.  It was a sacred act.

There are many forms of success.

                                                - - -

Thirty yards from the far shore, Cooper started to tire.  I started to panic. I offered words of encouragement, focusing to keep my tone calm and collected.  This was the moment I had gravely feared.  My mind’s eye showed my son sinking below me, me struggling to save him.  I became acutely aware of every little movement Jacoby made on my back, sure that he, too, would fall and sink like a rock.  Cooper grabbed my arm and clung on, his little legs losing their strength below the surface.  I pushed toward shore, my heart pounding from fear, carrying both boys, desperate to get out of this situation, until he said, “NO! I just need a little break.” Jacoby added, “This is fun.” The fear and grim fate I imagined did not exist for them.  We tread water for the longest thirty seconds of my life, and then, my two boys finished their swim across Walden Pond.

As a child, I never had the chutzpah to do something like this, to confidently advance in the direction of my dreams.  My successes were visible in athletic trophies and rankings, academic grades, gainful employment.  But always was that sense of, “Can I really do this?” sounding in the deepest recesses of my subconscious.  Perhaps it was that day on the steps, when I understood my mortality, but I was never willing to push myself to the absolute edge of potential.  It wasn’t until my senior year of college that I rode a roller coaster, until my 34th year of life that I went cliff jumping.  Even today, as a teacher and athlete, I continually question if I’m “doing it right” or “doing enough.”

When my sons, who, by any reasonable account were much too young for the risks and, all too real, consequences this swim across Walden Pond entailed, first told me they were going to do it, I balked.  Yet, perhaps for the spirit of Thoreau that pervades this place, we swam.  By embracing their goals and dismissing my fears, their challenges, their dreams were made my own.  They accomplished something that, for them, was truly epic.  Reaching the far side my heart swelled with pride.  Not at their accomplishment, but at the sheer audacity of action and willingness to push the limits of what they, and I, deemed possible.  It was this summer day, a clear day, blue sky, the woody smell of Walden Pond deepened by the heat, that my sons gained a true education. It’s an education that in most ways can only be known to ourselves, an education that, when gained, produces an inner strength of character that allows one to advance toward dreams with a confidence “unexpected in common hours.” I wish for them to continue seeking, and I strive (and struggle) to replicate this education, this success, inside the confines of my classroom.  Years after that lonely night walking down the beach in Florida, as Cooper and Jacoby lay panting on the far shore of Walden Pond, veritably glowing with pride and accomplishment, I felt what Grandpa Barney’s words meant.

There are many forms of success. Grandpa Barney realized that the ones that really matter are the ones that people may never know you’ve achieved.


The life which men praise and regard as successful is but one kind.  Why should we exaggerate any one kind at the expense of the others?


- Henry David Thoreau, Walden

Monday, April 21, 2014

Losing The Zen, Finding Relief

The doctor had just called and you could hear the concern in his voice.  Nearly three weeks post-op and the fact that I had developed chills with a low-grade fever and no other symptoms did not bode well.  The knee was hot to the touch and the swelling, despite being wrapped with ice and compression nearly 24/7 the past two weeks, had not changed at all.

I put the phone down, sitting on the edge of the Ottoman, about to lift myself with the two crutches that have become the key to my mobility the last three weeks.  Liz had refused to go to bed until we knew what was going to happen.  As I braced myself for the throbbing pain that I now expect when raising myself from a seated position, I stopped.  I didn't want to hurt.  I didn't want to suffer.  My fingers went to my eyes, which were beginning to burn with warm saline.  My nose got stuffy, and I sobbed.  I shook my head, thumb and pointer finger holding the inside corner of each eye, tears flowing, angry that I had "elected" to have this surgery. "There's no use thinking about that now," Liz counseled.  The TV showed highlights from the day's game at Fenway, at that moment focusing on the pre-game with the survivors from the marathon bombing in 2013.  I was too self-obsessed, too far into the realm of self-pity, anger, and frustration, that I couldn't feel compassion.  My suffering was all that mattered.  What if I did not come back from this trip to the ER?  What if I had a raging infection in my leg, and the only solution was amputation?  What had I done? I sat there, Liz consoling me, hand on my shoulder. In our seventeen years together I have broken down like this maybe three times.  "I'm sorry," I sobbed, my thoughts now turning to what she and the boys would have to go through without me.  The memories that would never be made, the missed joy and experiences simply overwhelmed my psyche, which swirled with negativity and hopelessness.  I was engulfed in an imagined future that was horrible.  There was no other way to say it: I was scared.

Nearly everything about this post-surgical recovery has gone so horribly wrong.  With another trip to the ER in front of me, I expected this time to be no different.  With Liz's encouraging words, I gained some composure and loaded myself into the car.  The only positive thought I had?  Maybe I'll get to see that damned mountain lion that is hanging out around here.  It was 11:17 PM, Sunday night, two-weeks and one day, almost to the minute, since my last visit to the ER for complications from this knee surgery.  A surgery, which should have been "simple," but has proven to be anything but.

One benefit of of becoming a "frequent flier" at the ER is that I know how to make my stay a bit easier.  I brought a backpack filled with my meds, and other "essential" items, that I could throw my jacket into.  I went knowing there was a real chance I would be spending a huge amount of time there.  I went armed with knowledge about what tests to ask for and what I wanted to avoid.  Despite these mental and physical preparations, I was not ready to hear the doctor telling me, given how the knee looked and felt, there was a good chance that another surgery to "clean out" a (very likely) infection was probably in the cards.  The last thing I wanted was to have these wounds opened up again, and someone else poke around my knee.  I just wanted my ability to walk back. I was tired of suffering.  It was 1:30 in the morning - I was also just flat out tired.  "If this is infected, and we don't treat it, you will probably never run again because it will do some serious damage to your knee." I try not to swear much in public, but, in this moment, "Shit," was all my vernacular could muster.

Growing up in Vermont, I remember "tapping" a sugar maple tree on our property and then my mom boiling down the clear sap to a dark, amber, deliciousness.  Lying in the ER bed at Winchester Hospital at 4:17 AM on Marathon Monday, this was most definitely not the image in my mind's eye as the doctor took the largest needle I'd ever seen and prepared to "tap" my knee to pull as much fluid as he could out of it.  This fluid would determine the course of my immediate future - if it tested positive for nasty bugs, I didn't want to think what would happen.  If it didn't, well, I'd likely have some relief from the pain/pressure I'd been feeling near constantly for the past two weeks.  Finger's crossed as the needle broke the skin.

My late Grandpa Barney would have said, "That's a crap-house load of fluid." The doctor said, "Well, it's not a record, but that's certainly a lot of fluid." After pulling many, many ounces of what looked like blood (and not puss), I caught a small glimmer of optimism.  "The tests will take a couple of hours, and the real result will be the culture, which will take a couple of days, but we'll start you on some IV antibiotics, and I'll let you know as soon as I get any word." With that, the doctor left the room, and I settled into a fitful couple of hours, with one thing abundantly clear: draining all that blood had relieved a lot of pressure and discomfort.  I could flex my foot without the knee feeling like it was going to explode or pop.  Still, since I've been taking anti-coagulants for blood clots (the first post-op complication), the concern was more bleeding in the joint and blood simply refilling it.  As my father (a family doctor up in Vermont) has told me through this process, "Blood where it is not supposed to be, especially in/around a joint, can be extremely uncomfortable." I had experienced that the last two weeks.  It was 4:31 AM.

I spent the next hour and a half falling in and out of sleep, trying not to move my knee, thinking, for some reason, that this would limit the bleeding, and relishing the lack of pain/discomfort in the joint, even when just lying there.  I tried to meditate, to find my Zen, but fatigue and the fervent hope that no "nasties" would be found in the blood, made it difficult to settle the mind and just embrace the moment and reality.

"I know it's been a long night, but I have good news.  The first tests are showing that this was just blood so you won't be needing surgery right now.  Your INR (a measure of the level of anticoagulant Warfarin in your blood) is also therapeutic now, so, if you follow up with your PCP this morning, you may be able to stop injecting yourself with the Lovenox (a "bridge" medication that prevents blood clots from getting worse.  You inject this medication into your belly, every twelve hours.  I really don't enjoy it, and have a whole new respect for those that have to do things like this their whole lives.  I had been looking forward to stopping this routine since my first trip to the ER, 15 days before).  We'll know for sure in a couple of days with the culture, but, for now, I'm going to give you some antibiotics, and send you home." It was 6:02 AM.

The fact that a second surgery would not be needed lightened my heart.  The fact that my knee had felt fine since being drained (and remaining propped up) made me excited to "test it" as I left the hospital.  I envisioned being crutch free, triumphantly walking into my house unaided and pain free, celebrating a massive victory in what has been the slow progression back to health.  I put my foot down on the floor and stood up, hope replacing the fatigue I felt.

I nearly fell back down.  I could feel the blood returning to the knee, and, as my dad said, "it felt a rather uncomfortable." It took me a couple of minutes to stand upright on my crutches.  My head swam in a hazy cloud of an all nighter and pain.  By the time I got to the car, I was winded, teeth barred against the discomfort.  It hurt.  It took me four minutes to get the ten feet from the car to the house because of the throbbing.  But then I sat down, propped the knee up and the pain went away.  I've spent the next 13 hours sitting on the couch, watching the incredible performances at the Boston Marathon, and, unlike every other day for the last fifteen days, my knee has not bothered me one bit while sitting.  I've been flexing my foot with a smile on my face because it feels "normal" to do so - not like a water ballon being squeezed by a tantrumming toddler.  Sure, it hurts like hell when I get up, but just thinking about the fact that I will likely get a comfortable night's rest, has been exhilarating.  Knowing I have (at least a temporary) reprieve from additional surgeries is huge.

We had a picnic dinner in the living room tonight so that I could keep my leg propped.  Cooper and Jacoby were willing to play games with me lying on the couch (before Liz took them to the Marathon, Jacoby and I were trying to play a game and I kept falling asleep as he asked me the questions - "Dad?  DAD!  It's your turn!" His sweet little voice kept waking me up when I would fall asleep ever thirty seconds or so).  I eventually gave in and mumbled that he could just play on the iPad.  Cooper (who when he first saw me in the ER following last-year's Vermont 100, told me, "You could have just walked it in."), kept telling me, "I can't wait until your surgery is better," or "At least the plica is gone and can never bother you again." I couldn't agree with him more.

I wasn't proud of myself for losing my Zen last night before heading to the ER.  But, just like "tapping" the knee led to some serious relief, by allowing myself to fully experience all those negative thoughts and emotions, even if it was just for a relatively brief time, I was able to find some sort of relief from this silly ordeal that has consumed my body and mind since April 2.  A good initial lab report didn't hurt any either!

Tuesday, April 8, 2014

Time Heals All Wounds: A Story In Two Parts

Part 1: Sometimes You Need a Really Sharp Knife

On Monday, March 31, 2014, Dr. Anthony Schena received a call from a patient (let’s call this patient, oh, I don’t know, Josh).  A message was left that went something like this: “Doc, I know my surgery to remove the plica is on Wednesday, but, I’m not kidding, just two days after we finalized the date for this, the knee started to feel better, and, well, I don’t know.  I’ve been able to run to and from school this past week, and am just wondering what your thoughts are about this, if the surgery is really necessary.”  What I (I mean “Josh”) couldn’t articulate in the message was the feeling that, like my recent procurement of a new winter running jacket, having surgery at this point, after fourteen weeks of discomfort that had seemingly, miraculously healed itself (literally, two days after finalizing the date), was, somehow a “luxury.”  The pain was (mostly) gone, so why did I even need this?  Afterall, I was running again.  Each day that past week, I had made it to school and most of the way home.  Why would I willingly let Dr. Schena cut into my knee and put me back on the DL for several more weeks?  I couldn’t help but shake that feeling of being the impatient American, a consumer, looking for the “quick” fix that would cure my personal woes.  Because there was no pain when running, I started to think of this as “cosmetic surgery.” I started to think about the miles lost during recovery.  If the operation had just been scheduled for two weeks before, before I had been given the gift of pain-free running again, there would have been no question what the right choice would have been - cut this plica out!  It’s amazing how quickly we can ignore history when our present situation fits our mental model of what we hope will happen.

On Tuesday, April 1, 2014, Dr. Anthony Schena left a message for his patient Josh.  It went something like this, “Josh, you can always postpone surgery.  However, I think, as you’ve experienced and know, this is something that has already come back three times.  You may feel fine for a day or a month or a year, but then, one day it will bug you and you’ll be out again.  You’ve been out for almost four months already.  If you want to postpone, just call my office.  Otherwise, I’ll see you tomorrow.”  This was the reality: the plica wasn’t going anywhere, and it would become irritated again.  At some point down the road, I knew I would be facing this same choice again.  

Over the past year (perhaps starting at the Vermont 100), I’ve begun listening to both my “gut” and other’s advice more careful, more thoughtfully, especially those most important to me.  And so it was that I found myself on the morning Wednesday, April 2, 2014, shaving my leg before heading to the hospital (I was looking forward to the shaving of the leg part, because, really, when else would I have such a great excuse to do that?).  It was certainly not an easy decision (the surgery, not the shaving).  Of course Googling “plica surgery recovery” did not help make up my mind, as I soon discovered that the Internet is full of horror stories of people that, years later, still have pain.  A doctor was about to stick some rather invasive tools into/through my knee!  But I am learning.  I tried to not heed the words of anonymous users like DJBlueSKY1179 on random Internet forums and instead focus on the voices of people that know me.  After a couple of weeks of counsel from friends and family, it was the words of my father (a family doctor in Vermont who had happily taken my MRI to all of his orthopedic and radiologist friends, who had all graciously looked over it for me) and my wife (who was the one who was going to have to deal with all the post-op kvetching on my part) that truly helped me make up my mind.  First, my father and the several experts he had shown my MRI to had all seen the plica.  They reported that everything else in the knee looked great and that (in the universe of the knee), the plica was not near anything “of consequence” to the structure of the joint.  Then there were Liz’s words.  She has been patient with me these months, and truly understands how much of my personal identity is wrapped up in my ability to run long distances (not necessarily compete, but to be able to move, under my own power, where I choose.  She also has the distinct pleasure of knowing me well before I was a runner!).  She reminded me that another two to three weeks of recovery would pale in comparison to how frustrated and angry I would be at myself if I postponed the surgery, when the plica became irritated again.  I would have to start the whole process over.  It had taken fourteen and half weeks this time.  She was absolutely right.  Ultimately, this decision was mine to make, and, heeding the inner-voice, I knew I’d be going under the knife.  Time does heel all wounds, but, I realized, sometimes those wounds need to be made by a really sharp knife in an operating room.  

Just over 72 hours post-op, the procedure seems to have gone quite well, with the doctor telling us that my knee, “Looked perfect, and now the plica is gone.”  Liz and I actually got to have a little “date” pre-op, where we simply chatted for about two hours, interrupted only occasionally for IV lines and status updates (I also took great pride in setting the alarms off on the pulse-monitors, because my heart rate was reading 39 BPM.  After having run only about ten miles a week (if that) over the past fourteen weeks, I was sure my resting heart rate would have been much higher.  If nothing else, this objective measure made me think, “I’ve still got it,” which was a great boost of optimism before knowing I would be very limited in activity for a good chunk of time post-op).  When I removed the surgical dressing forty-eight hours after getting home, there was much less swelling than I had imagined.  The stitches certainly tug, my calf is a bit tight, and I am being super conservative in putting weight on the knee, but I’ve even felt improvements today - a more “natural” stride with the crutches and more confidence in placing weight on the leg.  Patience has become the name of this new game, and it is a patience tinged with an optimism I did not feel much over the last fourteen weeks: if I am cautious now, the bloody thing that bothered me is no longer there, so I’ll be okay!

This has been my biggest lesson so-far: be optimistic.  The days leading up to the surgery, I still couldn’t help but Google “plica surgery recovery”  (I’m still learning not to trust the myriad opinions/voices on the Interwebs - I’m not totally there yet!).  A fascinating article about Joan Benoit Samuelson (from Runner’s World) appeared in the search results.  Turns out she had the same procedure I did back in 1984.  “A few days later, she tested it to the . . . tune of 17 miles.” 17-days post-op, she won the first ever women’s Olympic Marathon Trials.  She then went on to win the first-ever women’s Olympic Marathon!  Her story certainly has given me a reason to be optimistic (and wise about recovery.  The article also explains how, following her “test-run” she had caused such damage to her leg muscles that she needed 14-hours a day of “microcurrent stimulation.” Sorry, I’ll pass on that).  Although I feel “weak” (mentally and physically) because I succombed to the knife, I am determined to enjoy the recovery and subsequent return to form.   Right now, when I am overly-conscious of every movement my knee makes, this process feels glacial, but, by the time summer arrives here in New England, and I am running pain free, it will be but a distant memory.  And, for years to come, each time I come home from a long run, the kind when you’re out so early that you experience that subtle transition from dark night, to gray dawn, to bright day, the kind where you’re so thirsty and tired, and it’s so hot you wanted to stop miles before, I will smile and likely not even remember that time, one April, when I was laid up on the couch for a couple weeks.

Part 2: In Which I Am Grateful For Having Written Part 1 Three Hours Earlier

“Patience has become the name of this new game, and it is a patience tinged with an optimism I did not feel much over the last fourteen week: if I am cautious now, the bloody thing that bothered me is no longer there, so I’ll be okay!”

Somewhere, in the deepest folds of my brain’s gray matter, those words, which I had finished writing just hours earlier must have been playing on infinite repeat, because the only thing that was really freaking me out was the fact that the nurse had just casually mentioned that I would have to self-inject the medication before he casually left the room.  And now, about twenty minutes later the doctor and nurse were back explaining that I would be starting Lovenox immediately and the nurse would be “teaching” me how to inject it into my belly every twelve hours.  And now, just seconds after that conversation, the nurse was grabbing a fold of skin and fat around my belly, saying, “This is going to burn and itch for a bit” and stabbing a needle into my gut.  It was 2:30 in the morning.  What in the hell just happened to me?

Shortly after finishing Part 1 of this story (which was supposed to be the only part!), I went up to bed.  It was Saturday night, about 10:30 or 11:00.  My calf (below the operated on knee) had been really sore since Friday morning, when I first tried to take some “substantial” steps (I mentioned it as “being a little tight” in Part 1.  That was like an ultrarunner saying they feel “fine” at mile 80 or so.  It really means things are not well).  It felt like it does after a really steep/long run.  I figured it was the stress of surgery and the fact that I had been trying to not move the leg much post-op.  It remained sore for much of the day, but I thought little of it, trying to stretch a little, even massage it.  Nothing seemed to help, but I thought little of it.  Saturday morning dawned and, getting out of bed, the calf hurt.  It hurt enough that I got a little nauseous and thought, “This isn’t right.  It shouldn’t hurt this much after a night of rest.” I laid back down and focused on my breathing, trying to push the “what if” thoughts out of my head.  The calf continue to bother me throughout the day, especially after it had been lying on pillows.  That really didn’t seem to be right.  When I got in bed this night  (again, minutes after finishing Part 1), the calf hurt simply resting on a pillow.  This is definitely not right, I thought to myself.  I lay awake for most of an hour, thinking that something was terribly wrong and that Liz would discover the worse in the morning.  It was about 11:30 PM when I got up and called the surgeon.  On the other end of the phone I heard the exact advice that, since Friday morning, I had been desperately trying to deny in my mind, “Go to the ER and be prepared for a long night.” I woke Liz up and refused to let her drive me, simply telling her I would hopefully be home by the time she woke up.

And so there I was, lying in a hospital bed, having an ultrasound of my left leg.  Perhaps it was a combination of fatigue or having already accepted that this is what was going on, but I was not too shocked or surprised to hear the ultrasound tech say, multiple times, “There’s a clot.  There’s a clot.  Here’s one.  Let’s just check here too.” I had had a feeling that this is what was happening, and just stared at the monitor.  The tech brought me back to the room - I tried to be gracious to her for a doing such a thorough job -  and I closed my eyes, and started meditating, focusing on my breath, letting thoughts roll in and out of my mind.  It served me well by helping to avoid the fears and anxieties that were starting to surface, from the question of what this meant for my running, for my post-op recovery, and, more importantly, for my family - was my telling Liz I would be home by the time she woke up a simple act of denial? - and ultimately the question of my mortality - could this kill me?  The short answer to that last question was, yes, especially if I had simply been my typical stubborn self and thought myself invincible.  The good news was that as soon as the nurse stuck that first needle into my belly, I was on the way to protecting against this worst case scenario.

The official diagnosis is Deep Venous Thrombosis (DVT), which is a fancy way of saying that there are a bunch of blood clots in my leg that shouldn’t be there.  These are possibly complications from surgery, especially of the knee and hip, and, if left untreated, can ultimately lead to a pulmonary embolism (PE), when a clot “breaks loose,” travels through the heart and into the lungs.  A PE is not good: an estimated 100,000 Americans die of PEs every year.  Perhaps it was denial, perhaps it was that I had already accepted the reality of this situation, but this was not one of the two things that really freaked me out.  Those were, first, fact that I was going to have to start injecting myself with “blood thinners” (which are actually anticoagulants, which limit the blood’s ability to clot.  A very good thing if you have congestive heart failure or DVT or PE.  A not so great thing if you are, say, running on a trail and trip and get a really deep cut (which I have done more than once)).  And second, that I would be on some type of anticoagulation medication for three to six months.  These two facts of my newly shaped reality really freaked me out - like sick to my stomach, dry mouth freaked me out (beyond the fact that these steps which I fear will likely prevent me from developing PE, another positive is they have helped me realize I will never become an IV drug user.  I’ve been able to do the injections, but there is no way to get around it except to say they are absolutely horrible.  I have a whole new level of respect and empathy for what diabetics must go through on a daily basis).  

Since that first shot at 2:30 Sunday morning, there has been one moment where I felt nearly completely overwhelmed and simply thought to myself, “FUCK.” It was Sunday night, right before I went to bed.  I was checking on my boys, who sleep in a bunk bed.  I looked at them and thought, “What the hell was I thinking?” I questioned, again, if the surgery was even necessary and felt like a horribly selfish person for doing something simply to be able to return to running faster.  It was a sad moment for me, where I thought about all the “what ifs”; and especially what this could have meant for my family.  And then, as I hobbled over to kiss both of the boys, the crutches clanking so so much I feared I’d wake them, I thought of a lot of the lessons I’ve tried to teach to my students this year: about acceptance, perseverance, kindness and strength of character, and the negative thoughts were fought back.  The reality of the situation, of the present, returned, and I stopped thinking of a past that I wanted to reinvent (not have surgery), or a future that I feared (all those what-ifs), or the “perfect” future I craved (a speedy post-op recovery).

As I got in bed that night, I focused on my breath again and just let my thoughts flow freely, not judging them, but observing them.  In the end, this new reality has not changed the lesson I learned when I thought the recovery was going to be “quick.”  It is still about patience, still tinged with optimism, albeit a bit different than before.  This optimism is less about my own ability to return quickly to running great distances, and is about something much bigger to me: an optimism for the good of humanity.  While my physical recovery will be longer, my mental and spiritual recovery has begun in earnest.  I feel so much gratitude for all the people (especially my family and friends) that have been so supportive and caring, listening to my bellyaching (literally - it’s from those injections!).  A gratitude for the surgeon, ER staff, ultrasound tech, and other medical professionals (especially old Dr. Dad Katzman, who has provided several hours worth of consultation already), who have helped me make sense of this situation and get me on the path to recovery.  It has brought a deeper gratitude at hearing the tales of friends who are running trails and winning races - something that, at times, had brought jealousy, but now just creates a sense of awe at what the human spirit is capable of (and offers some incredible incentive to heal quickly!).  It has even brought a deeper gratitude for my students, who, when I returned to school (a couple of days later than originally planned) for the first time today, treated me with a kindness and care that is not often demonstrated by teenagers.  I was so impressed with their concern and compassion that I joked with my fellow teachers that I was considering faking more surgeries in the future and showing up on crutches more often.  As for actual surgeries . . . I’ll avoid those as long as I possibly can!