PHILADELPHIA — The routine was the same as always — the exact way I have grown accustomed to dealing with the hours before a big race. But on that November morning last year, everything else was different.
I had awakened before the sun and come downstairs to all of my running gear, laid out perfectly the night before, exactly as planned. There it all was: bottled water, my fanny pack, gels to eat along the way, my precious iPod with its playlist calibrated just for me. Exactly as planned.
I had even pinned my number to my shirt in advance. Alone, in silence, I ate a banana and a granola bar and half a bagel. Exactly as planned.
I thought to myself: I need this routine. I need to be a robot today.
Nearly five years before this day, before I started running, I had been diagnosed with melanoma skin cancer in my left shin. Then, much later, came the thyroid cancer; they found that one looking for more melanoma. I was 51 and I had two forms of cancer. Now here I was in the middle of chemotherapy — weakened, scared, with more chemo scheduled for the following day. And I was heading out to run a half-marathon on the streets of Philadelphia.
What was I thinking?
I arrived at the starting gate and joined the pack of runners. The sun was coming up. Nearby, I could see the city's art museum, where Rocky climbed the steps in triumph so many years ago.
I never heard the starting gun, but the people ahead of me began to move.
I clicked my iPod. My song came on — "Gonna Fly Now," Rocky's inspiration. Appropriate for Philadelphia, for this race and for me. The tears started coming, as they often do when I begin a run. I brushed them away because I didn't want to irritate my contacts.
And then I ran. Exactly as planned.
I was running for my life, in a sense, though I knew that competition was really unfolding inside my body, far beyond my control. I was running in affirmation, in defiance. I was running to prove that I could, to show that I was not defined by the clusters of renegade cells that were growing within me.
To deal with something in my life that has not, in any conceivable way, gone exactly as planned.
I haven't always been a runner. Cancer made me into one.
Two cancers, actually. They're unrelated, which is good. There are two of them, which isn't.
The National Cancer Institute estimates that among the 10.1 million cancer survivors that were alive as of January 1, 2002, about 8 percent had more than one form of cancer diagnosed between 1975 and 2001. Three cancers is "almost unheard of," one doctor told me. I guess I should be thankful for that.
This year, 62,480 cases of melanoma, the most serious form of skin cancer, are expected in the United States and 37,340 cases of thyroid cancer. While my melanoma was a recurrence, I still saw it as unfair: Fewer than 100,000 people in this country got one of those cancers; I, a regular tennis player and nonsmoker, got both.
The melanoma begat two surgeries — one to take it out and one to make sure it hadn't spread. What's more, I was informed that I could develop lymphedema, a sometimes painful swelling of the leg due after surgery that happens because the lymphatic system has been compromised.
"Unless you want a fat leg, stay on the couch with your leg up. No running and very limited exercise," one oncologist, considered among the best melanoma doctors in the world, told me.
Then, I was not a runner. I'd been intrigued by it and thought I might try it someday — whatever someday might mean. But to be told, at 46, never to run, made me realize that I was too young to be sentenced to a lifetime on the couch.
So I took up running. I started slow and short, built up, pushed myself, gained endurance. I won't say it was easy, but I won't whine, either. I ran my first 5K a year later, then a 10K, then two half-marathons.
My decision to take up running produced varied reactions from my doctors. Most were supportive. Some were concerned. One shook his head and told me not to do it. My brother Bruce, a crack marathon runner, said what many others echoed: Go for it. If you can't do it, your body will tell you so.
His words reassured, but only to a point. Because somewhere along the way, I had stopped trusting my body.
When it came to running, at least, my body didn't betray me. So I ran. And then I ran some more.
As I did, I felt thankful that the drugs and surgery hadn't stopped me. And as I ran my physical and metaphoric races, I began to realize that my chosen sport and unchosen condition shared many of the same traits.
Runners, for example, seem to have their own language — PR/PB (personal record, personal best), chip time (finishing time recorded by a small electronic chip), and distances of races like 5K, 10K and of course the 26.2-mile marathon. Cancer, too, has its own language, and terms like PETscan vs CT scans (imaging tools that help doctors pinpoint the location of cancer), stages of cancer, clinical trials and recurrence have become daily conversation points for me.
Runners cheer each other on. The fast ones who finish first populate the sidelines, cheering for those of us still running. Cancer patients do the same thing. During long and frightening days in the cancer center, you see people holding hands and clinging to each other.
Me, I usually huddle in the corner with my work e-mail, trying diligently to forget where I am. When I do talk to my fellow patients, I always hear good news — like the guy with lung cancer who was there alone because his wife couldn't handle it. He wasn't complaining; he was focused on his next vacation and on a recent Eagles game he'd seen.
His goal was not to worry his wife. Mine was more finite. I wanted to race and, like any runner, to win. And I did.
OK, it wasn't winning in the traditional sense. I didn't come in first that day last November; in fact, I crossed the finish line that day way in the back. But for me, it was a more towering personal victory than I could ever have imagined.
My close friend awaited me at the finish. Around the country, my parents, sister and brother were tracking me on the race's Web site. When it crashed, my sister tracked down my friend to find out how I was, how I looked and if I had finished. My brother the doctor, my brother the marathoner, told me later that he was "sweating bullets."
Early this year, two months after I finished the race, I finished chemotherapy. My first post-chemo scan was in April. I would have done just about anything for positive news. And I thought I had done everything right.
On April 15, exactly one year from the first recurrence, the scan showed "uptake" — one of the words that cancer patients don't want to hear.
It means doctors are seeing "something" — maybe scar tissue, maybe a reaction to the shots, perhaps more cancer. In my case, the uptake was in both the thyroid and melanoma sites. That meant it could be a simultaneous recurrence of both cancers. Every doctor I spoke to said that would be all but unbelievable. And yet suddenly possible.
The news came back a few days later. The good: I did not have both cancers again. And the bad: The melanoma was back.
A day later, I ran. It had become what I do, how I fight back, how I shake my fist and press forward despite feeling like an unseen enemy is always following, always chasing.
It was a local race, only five miles, and I finished. I knew, however, that my metaphoric run — the one against an unseen enemy that just wouldn't go away — was only gearing up.
During the Chicago Marathon last year, which was held in brutal heat, a young man dropped to his knees a half mile before the finish line. Another runner ran by him, stopped, took a few steps back and said something to him.
The first man struggled to his feet. Together, they ran to the finish line.
I still wonder what the runner said to the man who was down that inspired him to get back up. I could use some of that.
I began this story with a run, and I end it with one. But first I must tell you about what happened in between.
It is not a happy ending. But neither is it entirely bleak, and in that I find hope.
For me, the summer of 2008 was not a good one. From May to August, I did not run at all. Radiation therapy kneecapped me and a debilitating round of chemo made sure I stayed down. For the first time, I lost a significant amount of weight — 15 pounds.
I now feel as if I know what it's like to be in a coma. I called in sick for four days — something I never do — and slept for 15 hours each day. Nothing I ate stayed down.
I was enveloped by my illness. It was controlling me. The fatigue was so intense, the sleep so deep that it was as if a chunk of my life was sucked away. I rose only to take a shower. One afternoon I tried to make tea and slept through the kettle's whistle. I awoke to the kettle burned dry to the stove and belching smoke. I had few conversations; that took too much energy. A trip to the grocery store was overwhelming.
One night around 5 p.m., as I was getting back in bed and closing the shades, I saw neighbors firing up their grills for a summer dinner. I felt as if I was slipping away from the world I knew. I would ask myself: Is this what it's like to die?
One recent day, I met with my doctors. They told me I looked frail. I felt frail. But I responded in a way that, by now, will probably not surprise you:
The morning I did, in August, was exactly three months after surgery and 19 days after my treatment ended.
What, I wondered, would happen? I felt slow and stiff. I felt thankfulness and I felt hope — hope that I could do the run after all, hope that the drugs had worked and the cancer was gone.
I powered up my iPod. The same song came on as I had heard during that run last year — a day that now feels as if it happened a lifetime ago. I listened to the lyrics, and they penetrated my brain:
"Won't be long now. Getting strong now. Gonna fly now."
My goal was to run a half-mile without stopping — a small goal in the running world but a big one in the universe I now occupied. The one that mattered most.
I ran two miles. Yes, it took more than a half hour. Yes, it was difficult. But I expected it to be harder. And I didn't expect it to be quite so ... exhilarating. I was not shuffling around, not in a hospital bed or sick from drugs or closing the blinds at 5 p.m. and leaving the world behind. I was outside, and I was running.
I wish I could tell you that the surgery and the drugs worked. But I don't know yet if that's the case. I am setting smaller goals these days, in both my running and my life. My aspirations are more compact than they once were, but they still loom large. My reach, I hope, still exceeds my grasp.
I'd be lying if I told you my future wasn't cloudy. But aren't all futures? My two races are, today, being run in parallel fashion. I am racing against cancer and against my own clock. Under the most adverse of conditions, I am becoming a decent runner.
Few things unfold exactly as planned, it turns out. And now, though I am weakened, I am stronger, too. I can handle more, appreciate more, understand more about the world around me. I can cope with the unknown, too; I'm not happy about it, but I am capable.
And I fight. It's an old metaphor, but it's all I have. I'm fighting to become a runner and a healthy person, and giving up either fight is not an option. I may be in the back of the line for the moment, but I am running two races. I am a dedicated runner now, and I plan on finishing both.
Exactly as planned.