Postscript – Number two and not through?

So this is my final blog post for the Boston Marathon 2017 and as a member of Team BMC 2017

The evening before the marathon I did my final carbohydrate loading, hydration. Eileen and I watched the documentary on Running the Sahara, a 200+ mile run through the desert of Morocco. https://www.youtube.com/watch?v=k6WdYfZ96DI

One must among other things guarantee the cost of one’s body evacuation in case you die. Eileen said- if you do that, I WILL DIVORCE you! When I had shared prior emails that I had received of other job offers: a 6 month stint in Antarctica? (“Send me a picture of the penguins”) or locum in Hawaii” (“send me a postcard”) it was clear that this event would be off the bucket list (not that it ever actually was on the list or that there is a list). Team Feldman also recommended/decided that if I was going to wear a singlet because of the predicted heat, I would need a body makeover. Eileen Naired and clipped my hair so that I would be ready for all photo ops and to “shave” minutes off my time.

I took my asthma meds, hot shower, stretched and with a box of Kleenex went to bed early.

Summary of the race:

It was a long hot run. I had a bit of a cold as mentioned before and with that some mild breathing problems with my asthma. I started taking prednisone and using inhalers the day before and morning of the run. I had some concerns with using a long acting beta agonist (Symbicort) as I have had in the past some acceleration of my heart rate and was uncertain about the interplay with running the marathon vs heart rate accommodation, decided that breathing took precedence aka A,B,C mantra of emergency medical care. Although I was not 100%, I felt that I could survive the run.

Precisely on schedule Bruce Kraft, my designated driver, arrived wearing his Run BMC T shirt. He dropped me off at the South Street bus pick up in Hopkinton.

As in 2015 the BMC Development staff did an excellent support job at Santander Bank near the starting line with supplies, food, drinks, sun block, vaseline and foot care materials.

These are some of the views arriving at the Athletes Village, walking down the road to the Bank and starting line- best sign “Run Efficiently”:

 

Gathering at the Bank with Travis and Mike Perkins, Lauren Holmes checking in the runners.

 

Team BMC Team photo at Hopkinton:

Team BMC at Hopkinton

It was already pretty warm in the sun. I blocked up, stretched and prepared to run. Following the singing of the national anthem, 2 fighter jets flew overhead.

This is a picture of the qualifier runners starting, then the starting line

Qualifiers start

Finally the start shortly before 11:15 the charity runners enter the designated Corrals, line up and prepare to head out. People also donate extra clothing that is collected at the start.

 

I planned on running with more discipline, not weaving and with the heat aiming for 30 seconds below pace (John Furey instructions). With the steep downhill start and crowd excitement, this still was hard to do. I ran the first mile at 9:30. With the sun, crowd and lack of wind, it felt like a blast furnace. I could feel the heat through my track sneakers and knew this would be a long hot day.

The crowds were even larger than 2015 with the warm weather and great conditions to watch, they made a very festive cheering squad. Among the many interesting running outfits were a couple wearing “newlyweds- honeymoon Boston Marathon,” (she had a white tutu outfit) many dedications, tributes, causes and many countries (Iceland, South Korea, Mexico). I saw a few runners who were barefoot! and in toe sneakers. I passed several of the impaired mobility runners including a veteran carrying a flag running on a blade prosthesis, another on 2 blades, a man who was written up in the Globe using crutches and a boot to complete the run with a new ankle fracture. To each as I went by I offered my comment- “awe inspiring.” I believe Katherine Switzer cruised past me at one point. I would also learn from Larry DiCara that it was his friend and college roommate who was honored for 50 consecutive Boston Marathons starting freshman year at Harvard and completed this year in just over 5 hours.

I ran for a bit with a group from Tufts. One of their group wisely instructed those with him to slow down, save energy for the last 6 miles, when the sun was more powerful and the wind died he told the group to drop the pace.

I knew after the first 6 miles that this would be a long hot run and I decided that survival was the goal and time not a realistic objective. My quads melted in the heat and as mentioned in prior blogs, I know quite well the energy required to run in from the Ashland-Framingham border at La Cantina. It was clear this would be a hard day. I decided to stop at every water stop to drink and douse my head and body, follow my nutrition plan and keep my promise to Dr. Lori Harrington and the medical staff (and my family) that they would not see me in the medical tent. One of the challenges of training in the cold all winter is that the heat can be very problematic and one cannot acclimatize on one or a few warm day runs or running indoors on a treadmill.

My first 10 K was at 10 min/miles, but from then on I slowed quite a bit.

Some images along the way:

 

I also ran through each of the cooling stations along the course with hydrants with sprinkler attachments.

As promised, Sue Fish greeted me at the top of Heartbreak Hill and shouted encouragement. Although there were many people walking, I plodded along up the hills.

On Heartbeak 2017.jpg

There were several people who dropped from the heat along the route, including one of the runners from BMC JP’s team. I did not stop as there were emergency people around her and those helping her yelled to people to keep on running. Later I would learn from Boston EMS, Carol Shih, one of our residents in the Bravo tent with Ricky Kue and the news reports that the medical tents were very busy with many heat related injuries including several with exertional heat stroke and temperatures of 108 degrees or higher who required ice bath immersion treatment.

I saw many friends and relatives along the way including Irwin and Joni Rich in Natick, Jeff Schneider and his family along Comm Ave, the BMC Development Cheerleaders at mile 17, John Furey at mile 20 before Heartbreak- “how are you doing Jimmy?” he called out. “It was pretty hot out there” I replied, later to learn that it was 78 degrees at Heartbreak Hill. I also realize that there were many others who called out or cheered but given my focus on left/right left and keep going, am not certain that I saw everyone along the way. Bruce Kraft sent a photo from the marathon party at his daughter Amy’s party on Beacon Street.

Having pretty early on conceded trying to better my prior time and with the water stops, cooling stops and a couple of pit stops, I focused on completing the run. I continued through mile 26 and saw my mother, Josh and Stephanie in their Run BMC T shirts cheering and encouraging me on shortly before the downhill at the end of Comm Ave that goes under Mass Ave. I went down the decline to Hereford Street and decided to walk up this street to have some energy to run down Boylston Street (the famous right on Hereford, Left on Boylston) to the finish. I had written on my hand 4JR, thought long and hard about walking even this short distance but decided that sometimes sanity has to guide one’s decision making. Also the knowledge that I had ED shifts Wed, Thursday and Saturday this week to complete.

This is my finish photo – it captures the fact that for me, this was a long hot hard run and I was really happy to have seen the finish line mentally and crossed it physically.

Crossing the finsh line

I saw Kevin Shea, Bobby Morley and Jimmy Hooley from Boston EMS who congratulated me on my run. Kevin took a photo of me receiving my medal and I asked him to tell Lori and the others in the medical tent that I was sorry I could not stop by, was feeling pretty beat up. Misbah came to congratulate me and then Greta Morris (marathon runner, garage stair training) walked with me to Santander on Arlington so I could pick up my clothes and get on the T to Riverside where Eileen would meet me. I scrapped any plans of trying to meet my mother, Josh and Steph.There were also many people being pushed around in wheelchairs who were unable to walk.

 

There were many remarkable things from this run. Our EM RA Marc Reid ran among the top 1000 finishers in the world, Emmy Liscord Speigel past grad and qualifier had a strong run. Travis, Mike and many others- they rocked it! Jeff Rixe who in the past has had tremendous runs in Boston, new baby, limited training and longest run 16 miles finished with an excellent time, took a nap and went to work in the ED!

Probably from the heat, dehydration and long run, my cold and asthma really worsened. Fortunately I was home, able to do work from home and call in to a scheduled meeting at 6pm.

As in the past I would like to offer some metrics about this event, thoughts, thanks and future plans.

Marathon official time BAA and my Garmin (note if 30,000 started the heat took a toll):

Final BAA results email

Marathon 2017

My brother Richard is a devotee to heart rate training and targets. I have never done this before. The new Garmin captures these data. I was not sure I wanted to know these results as seeing that I maintain a sustained heart rate of 160 was not what it feels like when I run.

Marathon Heart Rate

Weight at start: 197 lbs

Weight p finish, rehydration and eating: 196 lbs

Fundraising: (please note that one can still donate to this site p event) https://www.crowdrise.com/bostonmedicalcenterboston2017/fundraiser/jamesfeldman

fund raising total 2017.jpg

Perhaps the Development Office will still hold an auction for a stay at the Mountain Club at Loon to push me over $11,000.

Today I worked in the ED. My co-workers, ED staff, residents, runners, trauma surgery all congratulated me on completing Boston 2017.

Thank You’s 2017

Once again I have the opportunity to thank all of those who have shared in this experience and as in the prior version, any omissions are unintentional, order not meant to be prioritized and will shift around as I have time later to edit this- this section is a work in progress as I have to finish early to prepare for another 7am ED shift tomorrow and will continue to revise and edit. Also, I will go back to some of my earlier blogs posts for more revisions. Among these will be a picture of Richard as my mother has located his year book and his Cross Country team photo from SHS.

Thanks

click on link to sound track, roll credits: (I believe this is a free download cover)

  1. Of course, Eileen- this could not and would not happen without her support for this entire endeavor. Also, she has promised to take over future fund raising activities- more to follow on this.
  2. Steph and Hope- always there with ready to run encouragement, fashion consultations (tights, singlet) and of course Steph for tuning up with the BAA 10k on a hot summer day and Hope for her marathon training and insight, encouraging me to train in Switzerland and of course, staffing the in-flight medical emergency
  3.  Team Feldman and now extended Team Feldman, Feldmans Seattle, Ipswich, the Nana, Flickers, Nancy Allen and Bob Dicker, Marcia and Barry, Radacks. cousins…..who are part of the social support network that I am blessed to be a part of.
  4. Bruce Kraft- owe you lots Brucie and of course, for getting me there on time!
  5. All of the BAA volunteers and staff- what an incredible devotion to a cause- from the Expo, Registration, bus drivers, course support.
  6. John Furey and the staff at Joint Ventures- the road map to Boston lies here- his final email:

Final note John Furey.jpg

7.Dr. Habershaw- BMC Podiatry, no foot pain!

8. A very large circle of friends, especially Team Eileen’s who have been there to support us through what this year has been for us, various health issues and life- it happens

9. Marathon Sports – you are the Marathon Doctors

10. All of my co-workers- ED staff, RNs, EMS, residents, faculty, trauma surgery, IRB and the very large world that is part of our special place

11. BMC Development of course since Lauren, Cristen et all make it an honor to be part of the larger mission that this is all about

12. My co-Team BMC team members seen here at the fundraising orientation and Laugh at the Pasta Dinner

 

13. Harvard friends (Rob and Brenda, Jim, Phil) who were a part of my youth and the caring network for John and all of us over the last 2 years of his illness and to Gloria for her kindness to all of us.

14. Friends from Medomak Camp, SHS, med school who sent me words of encouragement, donated to our cause and cheered me on.

15. The many who flew their Run BMC colors with great pride, exemplified by Dr. Sharon Falk-Bord, Bob and Evan, Bruce and Karen, Steph Josh and my mother, Kenny Lewis….(I sold and shipped a lot of shirts and thanks again to all- it was great fun although I felt at times like a web based T shirt company!

Sharon Falk-Bord Team BMC

16. Taylor Herring, Donna Medaglis for spinning and cross training classes in 2017- and for your predecessors including Ashley Minogue and the many other spin instructors Monday (and occasional rare Wed or Saturdays) who have helped me get into marathon shape

17. Misbah Mohammed Team BMC Captain 2015, marathoner, web wizard- always a smile, positive word, incredible Google form for my T shirt campaign that people commented “looks professionally done.”

18 SHS Coach Charles Kimball- I sometimes wonder what would have happened that spring track tryout when he asked me whether I wanted to stay with the other weight group (discus, shot) perhaps evaluating my “size and speed” and that I was on the SHS football team (second stringer) and I said I wanted to go out with the distance runners- he said “OK.”

19. Everyone who has contributed to my fundraising effort this year, Team BMC and towards the NEW EMERGENCY DEPARTMENT!!!!!

20. All of the spectators that make the Boston marathon the greatest marathon in the world. The Wellesley Scream tunnel appropriately world renowned for irrational exuberance, exceptional sign creativity (“Kiss me i’m a physicist,” “Kiss me you did more work today than the President ever did!,” “Kiss me I’m Asexual,” “Kiss me if you’re over 65!”…). And every person whose chanting, clapping, cheering, children collecting high fives make every single runner feel like she or he is indeed a hero and part of an event much larger than life. And thanks for the snacks, orange slices, banana slices, pretzels, licorice and this year ice cubes (I grabbed many, ran with these, rubbed my neck, arms and face,  put down my shirt in an effort to cool down- it really helped.” And the cheering- “Go Jim!” “Looking GREAT Jim” “You’ve Got this Jim” and “BMC! BMC!BMC! Yeah BMC!.” I tried to wave and acknowledge every single cheer. Thank you.

21. Grand dog Dexter- yes, training runs in the fall on the trails and hills in Callahan and being the smartest dog in the world and Hope for letting him visit with us for a while during her clinical rotations.

and more to come….

Final thoughts Boston 2017

I can certainly now answer the question- one and done? No. Two and through? Probably not.

As one can tell from the story that my blog captures, this is an experience that I find profoundly worthwhile- every aspect of this process. Fundamentally, it is about raising funds to support an institution that has been the focus of my professional life, setting goals and going hard after them. I have raised almost $30,000 to support the future of Boston Medical Center.

Every part of the training for and then running the Boston Marathon, discipline, dedication to the goal is worthwhile. It also does impose a significant physical, emotional and time burden, especially for one who is not designed to run long distances. Beyond the many accommodations one must make- diet, work/life fit, prioritizing training, stretching, light weigh lifting there is also an emotional strain of trying not to get injured, modifying other activities to avoid an injury so as not to disappoint  people who have donated to support one’s run. This long campaign that for me must begin in October does really take a toll on many others, especially Eileen. When one is running 10 minute + training miles, it really does add to the time sink when the runs are 10-20 miles fitting in family, work and life.

I will certainly look forward to an occasional run in from Riverside on my own and Eileen has asked me to drive the course with her. These kinds of activities will certainly keep the spirit alive and hopefully in the future rekindle the fire.

It also is  problematic to annually solicit family, friends and colleagues to donate to this cause. Donor fatigue is something I would prefer to avoid and there are certainly many important and worthwhile causes out there.

I now have experienced the “alternate year” approach to running the Boston Marathon. This is something that seems to work for me. I will hope to make it to Boston 2019 and once again join Team BMC. One of course can never know what lies ahead for any of us. But it is nice to dream, isn’t it?

This will be my final blog for the Boston Marathon 2017. If the stars align, I will see you again in the fall of 2018.

Thanks for sharing in my experience and happy running to all.

jim

Final Blog stats 2017

 

Time to go to bed. Long day tomorrow in the ED.

 

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On Gratitude and “There is no I in QUIT”

Oliver Sacks

 

The final pre-race blog.

 

This blog I will change the standard formula to write first a bit about the bigger picture and my answer to the question “why do they run?” as well as the elements that by now have become expected components to those who follow this blog- fundraising update, news about marathon running and Team BMC and some final reflections before Monday.

The Runner’s Passport suggests that runners write a thank you after the race to people who got you there. I will again look forward to doing this after the marathon.

About the title and subtitle

As blog readers know, the major theme for my run this year has been gratitude.

Here I get to say thank you to my family and relatives, friends, colleagues, co-workers, neighbors, camp friends, SHS, college, med school and so many others for their encouragement and support for my entire personal journey.

A photo collage and in the interests of space it would not be possible (and have little meaning) to include photos for all so  just a few symbolic photos and please realize that omissions or inclusions are for space-note I will update this later

Of course, Eileen Team Leader

 

Family

 

 

 

Friends

 

Colleagues, co-workers

 

Medomak campers

 

Spinning classes 2017 – Taylor Herring, Donna Medaglis

Taylor spin.jpg

 

As I have collected a few photos for my blog this year, I have placed these in a folder that cycle through on the screen of my computer. These images effectively capture the journey that goes well beyond this marathon and this year.

And about the subtitle-

Stephanie and Hope would tell you this is another example of my inscrutable “sayings.” What this means is that when people ask me if I am ready or what I think about Monday, the answer is that I will already have achieved a great deal that has been meaningful to me. All aspects of preparing for the Boston Marathon, or as Eileen would observe, becoming obsessed with the Boston Marathon (note from twitter feed all other marathons are just qualifiers) are components of an inner journey. Fundraising for BMC, the early morning training runs every Saturday that mean getting up by 5:20 am to either work in the ED for a 7 am shift or train with John Furey and Joint Ventures and late night hill runs up Carter Drive in Framingham with my headlight and flashers. The many travels out and back along a course I know now so well. These are all achievements in their own right.

Whatever the outcome on Monday my story will be woven into the fabric of thousands of so many others and the history of the Boston Marathon. When I went to one of Team BMC members Steffi Acierno’s (BMC social worker and fund raiser extraordinaire)  office to get some T shirts, I noticed the inspirational sayings she had displayed taped to her wall and a photograph taped on the side. She said that she is running in memory of her cousin who died last year. Her voice and tears captured the powerful emotions that this marathon evokes for every single individual who will gather in Hopkinton. Please take the time to read her personal statement about her pathway to Team BMC 2017 https://www.crowdrise.com/bostonmedicalcenterboston2017/fundraiser/StefanieAcierno

So it is for the 30,000 stories that will unfold on Monday. Personal questions or dedications to a cause, person goals or collective achievements. These stories will be evident on the shirts worn, cheering friends and signs and in the individual struggle for every runner.

One also learns to appreciate that the outcome of Monday is unpredictable. Other than the certainty that I will cross the finish line, everything else is to be determined. A wrong step, or temperatures that will be a bit warmer (any temperature > 40 degrees is warm for us) can change the outcome quite quickly. In 2015 Bob Segal, one of the charity runners who is my vintage and a very experienced and dedicated runner, tore a lateral part of his quad soon into the run. Although he was able to finish, he did so many hours after his anticipated time and told me he was unable to run again for 4 months. I learned last evening that my colleague Ron Medzon’s wife Karen Miller Medzon, a very accomplished marathon runner running for Team BMC this year, suffered a serious stress fracture and major ankle injury on the last long run a few weeks ago ending her run this year.

I returned from the BMC Pasta dinner with a bit of a prodrome, mild sore throat and runny nose. Not too surprising in spite of careful hand washing given the number of patients I saw in Urgent Care on Wednesday with viral infections and confirmed influenza. Fortunately I have today to recover and given the fact that I was able to complete a 20 mile run after an overnight flight from Zurich, will be confident that once started, I will be on my way.

Although I have tried to avoid anything related to the 2013 events, watching the HBO special on the marathon is a reminder to all of us about the challenges that so many have had to overcome. Watching the wounded veterans and marathon survivors at Walter Reed has to inspire one to put discomfort aside.

I spent this weekend looking at various marathon related things- the twitter feed (saw this story about Katherine Swtizer running again at age 70, 50 years after she shattered gender mythology and helped to launch equity in marathon running and in sports) http://www.runnersworld.com/boston-marathon/50-years-after-sparking-a-revolution-an-icon-runs-boston-again?utm_source=facebook.com&utm_medium=social&utm_campaign=sharebutton, marathon quotes and some running movies, running movies on iTunes

Last night Eileen and I watched “Run Fatboy Run” and other than the foot blister scene and Eileen’s expressed hope that I would not replicate this run on Monday, it is a funny take on marathon running. McFarland, USA  is always a great choice – “that’s not Danny Diaz?” http://www.imdb.com/title/tt2097298/

Marathon inspirational quotes:

https://getmotigo.com/26-quotes-to-inspire-you-to-run-a-marathon/

some favs

The thirst you feel in your throat and lungs will be gone minutes after the race is over. The pain in your legs within days, but the glory of your finish will last forever. ~ Unknown
“When you run the marathon, you run against the distance, not against the other runners and not against the time.” ~ Haile Gebrselassie
“There are times when you run a marathon and you wonder, Why am I doing this? But you take a drink of water, and around the next bend, you get your wind back, remember the finish line, and keep going.” ~ Steve Jobs

And for those who have shared in the joy of marathon running exemplified by Team BMC 2015 Captain Misbah Mohammed and her runs in Boston, New York and Chicago (reproduced with permission):

MIsbah marathons.jpg

 

Final marathon preparations

Thursday was Team BMC Day at Boston Medical Center. Although it was hard to compete with the Puppy Van as everyone loves puppies, it was a lot of fun chatting with people as they passed by wishing all of the runners good luck.

 

On Friday morning I donned my Philadelphia Marathon shirt (blog readers know the back story about this) as it was cool 40 degrees at 6:30 am with some wind to do my last 3.7 mile run before the race followed by 30 minutes of spinning. This completed my taper of  the final week- runs of 5.6 and 7 miles at 9:30 minute miles Monday and Wednesday interspersed between working in the ED.

For those who are out early in the morning, it is awe inspiring to see the elite runners from Africa jogging at what I would estimate at 5 minute miles. One can tell these are teams as they all wear special sponsor’s suits. And once again none of the major sponsors contacted me to offer to support me this year. My Phili 26.2 shirt and 9:35 minute miles did not seem to attract much notice and as they glided effortlessly by, I did not sense much fear in their eyes recognizing that that I had once again returned to run for Team BMC.

When I registered for my number at the Marathon Expo, I indicated to the volunteer that there must have been an error as I was anticipating wearing #1 this year. He laughed!?!? Hope said that, “You would have to lose 50 lbs, cut > 30 years from your age and run just over a 4 minute mile. Science has not advanced that far yet.” (and knew this would appear in my blog. She then sent me her “You’re still Number 1 to us” emoji).

Saturday was spent grocery shopping, stretching and then going to the Team BMC Pasta Party at the Westin Seaport hotel Laugh. The Improv group did a wonderful job taking prompts- an interview with Kate Walsh (BMC CEO )about her life, things people like in April in Boston (Eileen’s prompt was the Swan Boats), and a wonderful set with a 4th grader and her mom who had to supply a word when tapped to complete a sentence. It was also a reminder that things to tend to return to a normalized state of being as there was no honorary celebrity captain or 2013 survivor. I think that this is a sign of healing that is positive and represents moving on.

Some photos from the event at Laugh Westin Seaport

 

Fundraising part of the blog

I have crossed $10,000 and beyond! Thank you to everyone who has donated to Team BMC, bought shirts, sent me notes of encouragement. I am closing in on a 2 run total of $30,000.

Fundraising April 16

 

And a brief Emergency Medicine note

It does appear that the journey will continue. One of our residents asked me about the meaning about my prior blog note about future plans.

After Sept 1 I will reduce my clinical time to 1 shift in the ED per week while continuing with my other academic roles – research, Chair of one of the IRBs, teaching and writing. Like the start of Heartbreak, when I contemplated my return to Team BMC I seriously considered hanging up the cleats after this summer. In part this was a reflection of the reality that has become emergency medicine and has been described as an international phenomenon- routinely caring for older, sicker more complicated patients and even with very strong residents, caring routinely for more than 20 patients including many in hallway beds, boarding sick patients, dealing with the electronic health records and the many hours “off work” that become consumed by charting as uncredited but expected certainly have had an impact on me. Often when I have responded to people who have donated to this year’s run, I have indicated that this really is in support of the new ED that is desperately needed. And I certainly want BMC to survive and thrive for its history, mission and that this is my hospital as well.

I am also hopeful that the recognition that has finally come to what is happening to the practice of medicine and its effects on those who work in health care may lead to some substantive changes in how providers are recognized, compensated and resourced. There is a pending National Academy report on Burnout that includes many stake holders as well as CMS (Centers for Medicare and Medicaid).

Although the Faculty Practice Plan has offered meetings about retirement and I know several colleagues who have successfully retired – Peter Moyer has demonstrated that in retirement one can devote time to great causes (his the threat of nuclear war and health effects of climate change, youth mentorship), I found it quite challenging to frame a mental image of leaving entirely that special privilege that one has as a physician caring for patients and in being in a position of working with students and residents who share in the joy of learning and discovery. In running the marathon there is a mental image of approaching Heartbreak Hill and then the down side recovery that carries you up and over. I could not get there. Also, Eileen told me that having me follow her around the house all day was not a welcome vision.

So after September 1 (many maternity leaves in the Department this summer), I will be cutting back but not heading out.

Will see where that road will go.

Some final words- an excerpt from Coach John Furey’s final email to the charity runners:

  • Stay calm and relaxed at beginning
  • Do not start too quickly, even if pace feels real comfortable
  • Prepare to dig down deep for tremendous physical and mental challenge
  • Be ready mentally to handle “bad sections” of race. Do not let these rattles you.
  • Let the crowd and fellow runners energize you!
  • Think about how hard you have trained. Battling through injury, weather, difficult runs.
  • Think about why you are doing this and the people you are running for.
  • I will be just past the mile 20 marker on left side of road(center street) if you are facing Boston. I’ll be there until everyone goes by.
  • Please email me today or tomorrow if you have any questions.
  • Enjoy this day. There is nothing like the Boston Marathon.

See you at mile 20.
John

Tomorrow I will get up at 6 am, take a hot shower, stretch, eat the standard breakfast of cereal with banana and honey. Bruce Kraft will be by around 7 am to take me to the South Street bus stop in Hopkinton. It is a short walk from the Athlete’s Village to the Santander Bank that is the home base for Team BMC. I will FaceTime Eileen from the start as this year the logistics of her coming in to watch were problematic and in many ways, technology will allow me to share this event with her that are even better than being tthere. Some time after 11:15 am I will cross the starting line, saying BMC 3 times – I really do take great pride in who were are and what we do-  and see you at the finish line.

In Memory of:

 

john-and-me-at-md-anderson

 

I also wanted in this blog to return to John Romero to whom this run is dedicated. This photo was taken shortly before I left John where he was staying at MD Anderson. He was well aware of his road ahead and yet his love, friendship, positivism and courage are self-evident. Shortly before he died, John called each one of us – Rob, Jim, Phil and me to thank us for our friendship and being part of his life. I will be thinking about John as I step out from Hopkinton, the blessing that was his life and about things that really do matter.

 

jim

 

 

Spring fever

This will be my next to last pre-race blog. In part this is a celebration of FINALLY the arrival of spring, my hitting the milestone of $10,000 for fundraising and the last training run with John Furey and the charity runners.

With the goal of under promising and over delivering, I will hope to go beyond $10,000 with the Team BMC Day at Boston Medical Center on Thursday. My final pre-race blog will be written next Sunday after the Team BMC Pasta Party when I will share some final reflections on Boston 2017. Now of course, everything is relative in terms of achievements. One of the charity runners will run Boston next Monday, fly on Thursday to London and run the London marathon. Rock on!

First things first. Fundraising progress report. (Note to blog readers: if you know of anyone who would consider contributing, Matching Mondays will continue for the next several weeks so any donation will DOUBLE). This was one lesson I learned in 2015 to use the multiplier effect of Matching Mondays and one can make real progress towards a fundraising goal.

Fundraising 10k

Running part of the blog

Yes, it really does appear that spring is finally here. Some of the indicators included return of Red Sox baseball and home game 2 with Brucie, one of the tennis boys of summer and marathon day designated driver.

Bruce and me Red sox 2017

and a brisk eve at Fenway with an impressive pitching and defensive dual

Red Sox panorama

I finally shed all of my winter running gear. Fashion note- this year I learned that no shorts, no tights as Team Feldman advised that running in one’s underwear (running tights) as a male was prohibited. There is a funny story that triggered this fashion review after a woman running behind me on Comm Ave said “nice tights” and I assumed she was referring to the color of my Nike tights. As they say in emergency medicine, no one died!

Getting rid of winter stuff

Friday my feet paid another visit to Dr. Habershaw at BMC Podiatry for another (and hopefully final) steroid injection of my left calcaneal bursa. I asked Dr. Habershaw whether I would pass the drug test at the finish line. “Only if you don’t come in first place.” “Is that a possibility?” I told him that for reasons that remain completely unfathomable, the African elite runners don’t seem to be too intimidated knowing that I will be running again this year.

Feet to Podiatry

Today was the final charity run from Joint Ventures, a leisurely 8 miles. A large crowd gathered for the final light run to BC stadium and back.

Although there was a bit of a headwind heading out, the run was perfect and far different from the December slog on ice and slush.

Basin last run

Final training run:

Last Team run 8 miles

This is also a time to reflect back on training, the long campaign that began in October on the hills of Framingham and continued through weather, some injuries, work and life.

One of the more effective training recommendations came from one of the ED RNs (Greta Morris) who uses the stairs in the garage to train for marathon runs as well as events like the Prudential stair climb. I park on the 8th floor- cue theme from Rocky, and run the stairs (photos looking out, looking down stairwell)

My son-in-law Joshua AD also joined the “Be with Team BMC” campaign. Although the Boston Hospitals are not quite in the league of Yankees and Red Sox, I will have to make sure this photo if discovered (especially by BI Deac) is immediately classified as fake news.

Joshua AD Team BMC

And finally, John Furey sent a detailed note about race day preparations and strategy. The weather forecast at least as of today looks favorable but as one knows in New England, perhaps it will snow on April 17th.

Race day plan

So tune in for the last and final pre-race blog for Boston 2017 on April 16th. It has been a great adventure.

“If you will train and run the half, I will run the full”

As befitting the unexpected storm (aka April Fools again!) that led to the cancellation of the last long Saturday run (12 miles) with the charity runners, cancelled I suspect out of concern that slippery conditions this close to race day could lead to an injury, I have decided to write a bit about the pathways that while seemingly disconnected in life all have a reason. I did drive in to Boston for the Saturday spinning class with Donna at the Harvard Club and to make a final stop at Marathon sports to get new running sneakers (still time to break in before the 17th), replace my Garmin that finally passed its time. I will plan on doing my final tune up on the marathon course out and back to Walnut Street tomorrow. Clearly, I was not the only one who paid a visit to Dr. Marathon Sports today.

 

As is always part of my blog since this is running for a cause, the update on my fundraising. When I selected a photo for the Crowdrise website, I chose a photo that Sue Fish had taken in 2015 at the top of Heartbreak Hill. This image serves as an ever present metaphor for this entire experience- the training, fund raising and ultimately running the Boston Marathon. When one begins, $10,000 looks like a very challenging goal on the distant horizon. Yet with the wonderful support from so many family, friends, relatives, colleagues, the T shirts that I have sold and mailed I am rapidly approaching this milestone.  So here we are and with less than a month to go Team BMC and my individual progress:

 

Marathon running and the Causal Pies of life

Dr. Kenneth Rothman is one of the foremost epidemiologists in the world. I knew Ken when I was in middle school and high school as he was as I recall at Colgate University and at the time married to the daughter of a close friend of my parents, Dianne Feinberg.

“Kenny” as my parents would call him taught me a bit about chess and it was quite evident that he was exceptionally bright. He went to dental school and then completed an MPH and DrPH from the Harvard School of Public Health. At least as told by my father, his interest in epidemiology (Epi 101 = distribution of diseases in human populations) started with a project that Ken did that looked at whether there was any relationship between the foramen (opening at the base of the skull) and the nerve that exits with the disease called trigeminal neuralgia. My father had completed both an MD and DMD degree and was at the time the Chief of Radiation Medicine at Boston University. Googling Rothman and trigeminal neuralgia there are several publications by Rothman in 1973 and 1974 about the epidemiology of trigeminal neuralgia and survival in trigeminal neuralgia that suggest that my father’s stories about how Ken decided to pursue a career in epidemiology and public health were based in reality.

In 1976 Ken wrote a seminal paper that changed how disease was conceptualized (citation with image). He developed a theory that could explain why some non-smokers could develop lung cancer while some life time smokers would not, or why some exposed to an infectious disease would develop illness while others would not. This theory was called the “Causal pie” model of disease that suggested that there could be some component causes that could be necessary but not sufficient unless all of the factors were present. These could be genetic, environmental and combinations of these. Thus there could be several pathways that could lead to the same illness.

Rothman's Causal Pies

For more on this, see

http://sphweb.bumc.bu.edu/otlt/mph-modules/ep/ep713_causality/ep713_causality4.html

Rothman KJ. Causes. Am. J. Epidemiol. 1976;104:587–592.  [PubMed]

Now please don’t panic blog readers, it will soon become evident how this is linked to marathon running and my decision to run in Boston.

Dr. Rothman used to (not sure if still does) give a talk to all of the Boston University School of Public Health students in one of the epidemiology courses about the origins of disease. As I recall, he gave this 90 minute talk without lecture notes or slides. I considered this at the time I was a student at the SPH as one of the more intellectually exciting presentations that I had heard in quite some time. I recalled Dr. George Wald, Nobel Prize winner at Harvard whose talks “The Origins of Life” and “The Origins of Death” were always given to standing room audiences as non-bio majors would come to hear these legendary presentations about the biological inevitability of life and death from the formation of the universe to the single cell.  Ken’s lecture was that extraordinary as well.

One example that Ken cited to illustrate the false dichotomy that is often framed that disease must be genetic or environmental was a bird disease (believe it was called Yellow Chicken Disease (obviously in chickens)). The illness as I recall was genetically transmitted yet completely prevented by dietary changes. There are similar examples in humans that can be derived from his “causal pie” model.

The point of this was that Dr. Rothman said that when one carefully considers even what may seem to be the most random of events, say a golfer being struck by lightning, there must be some explanatory factors- why one would play golf (genetic? Environmental?), why play on that day with risk of lightning (genetic, environmental)?

I have thought about this as I ponder why the marathon and why the Boston marathon?

The title for this installment comes from our daughter Hope and her suggestion that for her senior year in college she would run the Philadelphia marathon if I would run 1/2 with her and pace her.

Now some background about this as there was a lot more underpinning this idea. First, as one would note from my earlier blog in 2014-5, running was clearly a part of my family (mother, father, both brothers) although I was not the caliber of runner as my older brother Mitch or younger brother Rich. It also had been quite a while since I had run any road races and even when I was running (Falmouth, Heartbreak Hill) 10-15 K was about my range. So for me, running a 1/2 marathon seemed a bit of a reach.

For Hope, this seemed even less of a reasonable objective. Hope had become ill running in the Tufts 10k that she ran with Stephanie. This was a road race that my mother and Aunt Louise had run for many years. Originally the Bonnie Bell 10k, this was a race that celebrated women and running. It seemed that running exacerbated Hope’s chronic illness and the thought of attempting a marathon seemed pretty remote.

Nevertheless and despite some serious misgivings, I agreed.

That fall I trained up as best I could with some longer runs in Framingham. Guided by the suggestion that if one can do 10 miles, one could complete a 1/2 marathon, I slowly increased my running.

Race day was one of the events that I will always consider one of the most treasured events as Stephanie came to help Eileen to a place near the University of Pennsylvania where they would be able to see us and on a cold November morning when it was still dark outside, Hope and I headed to the start of the Phili marathon at the base of the Rocky steps and the Philadelphia Art Museum. One of Hope’s roommates who also was running that day went into the city with us.

Hope gave me specific instructions – “10 minute/mile pace dad” and was not too embarrassed by my pit stops at the start of the run.

I had never run in a “named event” like the run in Philadelphia. This was such an amazing celebration of the city. We held hands at the start and headed out into the cold morning with at least one of us wondering how this would end.

Hope chided me when she thought I was too pumped up with adrenaline as we ran through the great crowds, especially the students around Drexel and UPenn who were out en masse cheering, playing instruments and over the top with enthusiasm.

Much to my surprise, I felt quite good as we approached the split where near the finish line the 1/2 marathon runners and marathon runners divided. I said to Hope, “I am feeling pretty good. I think I could go all the way.”

Now of course there is a complete quantum leap between a 1/2 and full marathon and as runners know, a physiologic chasm between 20 miles and 26.2 miles that becomes despite the new nutrition supplements and modern training an exercise in anaerobic metabolism and lactic acidosis. This is why Heartbreak Hill is considered so strategically placed in the Boston marathon.

Hope said, “No dad, this is my day and my run.” Also, she had arranged for one of her classmates (Constance) to meet her for the last 5 miles of the run.

Needless to say seeing Hope and Constance cross the line, recognizing what this achievement meant in terms of resilience and dedication, that will always be a moment to treasure.

Yet certainly it was here that the seed was planted that perhaps “going the full” could still be in the cards.

To use the Rothman model, in hindsight it clearly was not a random event that brought me here. Some part must be genetic- running and my family. The experience of Philadelphia and thinking that this distance was something that I could consider. Finally in 2015 there were the non-random factors of crossing 60 years of age, running out the demons from 2013 -I suspect one could spend more time contemplating why emergency medicine, why I had been in the ED in 2013 when the bombing happened- and the opportunity to raise funds and give back to the Emergency Department at Boston Medical Center.

I also have to wonder a bit about the fact that we live in Framingham and that the marathon course is so proximate to where we live- I routinely will have to drive on at least part of this route, will often see runners in training throughout the year and where 5 minutes from my house the siren calls to head out to Boston.

So this was my causal pie that set me on this pathway in 2015 and now again in 2017.

My next blog I will circle back to where I have started the blog this year- to John Romero and the enduring gift of friendship, to the joys of life that I have been blessed with and some final thoughts pre-race day. I will also have some photos from Team BMC Day at Boston Medical Center and perhaps the Team BMC Pasta Party on April 15th. Also, hopefully one last steroid injection of my left calcaneal bursa scheduled with Dr. Habeshaw on April 7th that will carry me through to the finish line.

We run because!

Some running Feldman images.  Will add and update

 

 

My older brother Mitch running in high school:

 

 

My younger brother Rich SHS Cross country track added

Rich runs track

 

I have added my father’s track notices from the New Hampshire newspaper, no photos

Dad UNH

 

 

Steph ran the BAA 2016 10k with me. This year I used the BAA 10K and BAA 1/2 marathon to prepare for April

Steph and BAA 10k.jpg

 

 

It’s the final countdown!

” I have thought about running New York City, but not really any other marathons. Boston is the funnest, the celebration, running into Kenmore and Fenway. It’s the best.” Liz Burke, ED RN, 5 time Boston Marathon runner (Team BMC 2014)

Fundraising:

Thank you to all who have contributed to my run and Team BMC! I have crossed $7,000 and with a few matching Mondays will hope to cross the next hill. I will volunteer on April 11th for Team BMC day at Boston Medical Center and make the final push towards $10,000. Fund raising March 26, 2017.jpg

Running progress report:

After a week of cross-training skiing on the slopes of Grindelwald for a long planned father-daughter vacation while trying to maintain the marathon training program, I returned to the scheduled mock marathon 20 mile run. Our road trip to Switzerland was noteworthy for may reasons: the medical emergency on Swiss Air when a 62 year old woman from Greece had a syncopal event that required some creativity negotiating the differences in medical equipment and technical challenges providing care in the aisle and then in the galley area (thanks to my first assistant Hope as we placed an IV and gave volume and medication), the extraordinary beauty of the alps, the fact that I now qualify for a senior ski pass and a couple of memorable runs along the river in the valley of the village and in the shadows of the Eiger (as well as the steep hills down and up from the valley). Sadly, the Swiss air crew indicated that physicians usually do not respond to calls for in-flight medical emergencies because of liability concerns.

I stayed awake on the return home from Zurich in order to minimize the jet lag. March 26th was the scheduled 20 mile run for the charity runners and the big tune up before Marathon Monday. Given the time shift, the fact that I did not have the ritual pre-long run carbo loading meal (unless chocolate counts) and the weather conditions that were quite similar to 2015 – cold (42 degrees, mild headwind, intermittent rain), the run went reasonably well.

I had missed this event in 2015 as discussed in the prior blog. Many of the charity runners were bussed from Kenmore Square and Joint Ventures to St. Tarcisius Church in Framingham. John Furey said that while part of the use of buses was related to transport logistics, the bus ride also simulates the race experience because “The bus ride out to Hopkinton can be a little intimidating.” Fortunately, I can forgo this experience as my friend Bruce Kraft will drop me and Mike Perkins, Elissa’s husband who is also running for Team BMC and will leave with us from Framingham) at the EMC park in Hopkinton on race day.

Once again I set out from La Cantina for the run in (20 miles). There were several running clubs on the course that were running the entire marathon course! There were many aspects of the run that also did effectively simulate race day- many groups with support stations, cheering teams (including TeamBMC), the famous gorilla at Heartbreak Hill and many impressive runners cruising in high gear. The roads from Newton in to Boston were blocked off with police officers controlling traffic. I tried to thank each person – the police and people at the stations for their presence. There is a lot of positive energy in this experience, runners encouraging you with “good job” and “have a great Patriot’s day” as well as the many well wishers along the course. I am not quite sure where the various photos (Saucony Run Support tent?) can be found as there were several photographers along the route. See as example http://wellesley.wickedlocal.com/photogallery/WL/20170325/NEWS/325009997/PH/1?start=2

Most of the run went reasonably well until the cold set in and my legs and quads became a bit tight. Although I ran with my Team BMC short shirt, shorts and a marathon wind breaker, I felt quite cold by the end of this run. I ended my journey at Joint Ventures where they had physical therapists, pizza and chocolate milk to resuscitate those who needed some help with recovery. I am thankful that I still have a few more weeks to prep for Patriot’s Day. Tomorrow I will hope to spin a bit and possibly take part in a Yoga for Runners class after my ED shift and then resume training runs on Tuesday.

Marathon tune up March 25, 2017

Emergency Medicine part of the Blog- awards, sometimes they do matter

On March 30th at the Suffolk District of the Massachusetts Medical Society Annual Meeting I will look forward to presenting the Community Clinician of the Year to Dr. Sondra Crosby in recognition of her career dedicated to caring for the most vulnerable population of patients in Boston and around the world- refugees, victims of torture and violence. see http://physiciansforhumanrights.org/about/experts/sondra-crosby.html . This will be the second time that I will have had the privilege of nominating a colleague for this award that has included among its past recipients Dr. Kenneth Edelin who demonstrated extraordinary courage throughout his career in his advocacy for women’s rights. Suffolk, the largest district (group) of the Massachusetts Medical Society and a region that includes all of the Boston academic medical centers previously gave this award to my colleague Dr. Judy Linden in recognition of her career advancing emergency medical care and the health care of survivors of sexual assault.

I consider the formal awards that I have received more a reflection of a larger team that I have been part of than my own individual achievements. Among these I would include the Pinnacle Award from MACEP that represented the culmination of the efforts of so many who led the successful campaign to become the first and only state in the country to BAN ambulance diversion, the Grant V. Rodkey award from the Medical Society supported by the medical students at Boston University as well as the recognition that I have received from emergency medicine residents, Boston EMS and my Department Chairs.

I have an old and fading 12 lead electrocardiogram framed in my office that is a special kind of “award.” This tracing captures the achievement of integrating prehospital recognition of a major heart attack (STEMI) with a system response. Well before this practice became widely accepted, Boston was one of the first cities in the entire country that implemented this procedure.

My note from 2002 reads “Door to cath 13′ (minutes) as this patient was taken directly to the cardiac cath lab bypassing the ED for treatment.

 

 

I had developed an interest in the linkage between prehospital disease identification from my earliest association in 1983 with Boston EMS when it became quite clear that trained and experienced paramedics could reliably identify patients who were experiencing STEMI. Indeed, I have files from 1984 (earlier examples lost in various office moves) that captured this fact with certainty. Here I include examples from 1984 and 1995 – well ahead of the curve:

1984 prehospital notes, EKG at receiving facility:

Edited 1984 EKG

1995 (pt treated with clot dissolving drug based on prehospital EKG)

1995 STEMI

1996 STEMI 3

It is important for blog readers to realize that this was at time when cardiologists doubted that emergency physicians could reliably make this determination and routinely required that a cardiology fellow or when FAX was later available cardiologist (attending, fellow)  confirm  by review of a transmitted electrocardiogram before treatment (thrombolytic= clot dissolving drug) could be administered. It was an exceptional collaboration between cardiologists (Dr. Alice Jacob, then head of the Cardiac Cath Lab at BUMC, Dr. Sheilah Bernard, head of the CCU at Boston City Hospital) that Boston City Hospital/University Hospital became one of the first hospitals in the country that moved to a catheter based approach to STEMI and adopted a system that was based on the emergency medicine attending’s identification of the required ECG findings.

This is the letter implementing this STEMI catheterization activation system at Boston City Hospital and Boston University Hospital Medical Center in 1996- one of the first in the country. This procedure included several innovations. These included a single page to contact the cardiology interventionist (31-PTCA) and the fact that this was based on the emergency medicine attending activation of this pager:Cardiac cath letter

I will also always treasure the reviewers’ comments from an article we submitted in 2002 that described the rationale for the Boston AMI Triage and Treatment Plan. This paper was rejected by the two major emergency medicine journals (Academic Emergency Medicine, Annals of Emergency Medicine) that suggested in part that this system, now widely recognized as a major advance in emergency cardiovascular care

(see American Hearth Association Mission Lifeline https://www.heart.org/HEARTORG/Professional/MissionLifelineHomePage/Mission-Lifeline-Home-Page_UCM_305495_SubHomePage.jsp) was not “evidence based” and was not supported by data that demonstrated an improvement in patient outcomes. see Moyer, P., Feldman, J., Levine, J., Beshansky, J., Selker, H.P., Barnewolt, B., Brown, D.F., Cardoza Jr, J.P., Grossman, S.A., Jacobs, A. and Kerman, B.J., 2004. Implications of the mechanical (PCI) vs thrombolytic controversy for ST segment elevation myocardial infarction on the organization of emergency medical services: the Boston EMS experience. Critical pathways in cardiology3(2), pp.53-61.

This is an excerpt of the Reviewers’ letters that I indicated I would add and have included in the entirety for historical records:

“The authors need to separate out these two issues. A stand alone paper describing their STEMI diversion model would be very helpful for those who wish to create such a system. However, any opinions on the usefulness of such a system must be regarded as editorializing their views and should not be contained in such a paper. There are certain dangers in leaping to conclusions on the value of STEMI diversion protocols. The authors cite similar policies in Trauma Systems as justification for their program. However, on more scientific inspection is has now become clear that there may be no real population based value to the current Trauma System model. It would be dangerous to allow the same false assumptions to lead to a similar error in pre-hospital cardiac care.

Certainly time would confirm that our approach was correct. This achievement was the result of the leadership of many individuals including Drs Peter Moyer, Chris Cannon, Tom Ryan and many cardiologists, emergency physicians, prehospital providers and many others.

Many lives have been and will be saved because of this as this system of care was implemented around the world.

03-458-0.decision

And Winter said, “Not done yet!”

Winter home shot

It has always been a New England cliche that when all else fails, the weather gives you something to talk about. As kind as the winter conditions have been this year, things can change in a minute. And sometimes the Running Gods are with you, sometimes not. Both were reminders as another storm and harsh conditions returned to Boston. I have picked up yet another virus from Mars in the ED and slipped and re-injured my left knee going down some stairs. Knee brace back on, spinning, had to call out of an ED shift as my nose would not stop running despite a continuous nasal Afrin infusion. The usual “man cold” and recently we learned that the “man flu” is physiologic and yet another reason men don’t go through child birth. https://www.uottawa.ca/gazette/en/news/mice-and-man-flu

Fundraising: 

I have now passed $6,000 and with matching Mondays will hope to make quick progress towards $10,000 and beyond. I have sold and or shipped about 20 T shirts as part of my “Be with Team BMC” project and at times feel like the a small clothing concession tracking orders and mailing out shirts. Part of my standing in the race to fundraise:

Fundraising update March 15.jpg

 

Running update

I paid a quick visit to Marathon Sports on Boylston Street at a Team BMC event to buy this year’s marathon jacket. The countdown and other reminders say that soon it will be time.

Marthon sports countdown

In a very short time we went from the warmest temperatures on record to an alternative universe. A series of winter storms brought the return of snow, cold and harsh running conditions. I woke up last Saturday for the scheduled run, checked that this was not cancelled with predicted sub zero wind chills and drove into Boston to join the charity runners at Joint Ventures. These are some of the images from that morning : 11 degrees in Framingham with strong gusty winds when I left at 5:30 am and into Boston.

 

There was a mechanical problem with the elevator at Joint Ventures and rather than wait for this to be resolved, I went out on the run as I planned to nap before my 4 pm ED shift.

Heading out Beacon to Comm ave there was a strong headwind and blowing snow. It was cold enough that without goggles, one’s eyes teared and then froze. I made the running haute couture faux pas of running in this year’s jacket rather than a prior year’s because I had bought an XL size and could wear two light layers comfortably underneath this.

I feel that I can run large sections of this part of the course by topographic memory and this run put that skill to use on this day. The road conditions were slippery as well. How cold was it? At one of the rest stops the Gatorade in the plastic cups had frozen!

Although I had planned on only running the 10 miles to Walnut Street and back, the conditions were exhilarating and at this early time in the morning, there were fewer people out training and some sections that were far less populated than a usual Saturday.  I ran to the Newton Firehouse and back to Boston (16 miles, usual pit stop in Newton). With a 20 mile an hour tail wind it felt at times effortless to sail along up and down the hills section back in.

 

The Joys of EM Research:

Continuing along the theme of gratitude I wanted to provide a brief shout out to the many who have played on Team BMC Emergency Medicine Research. To pursue research one must be ever the optimist. Fundamentally this about not seeing the glass half full or empty, but rather what can be done to fill it up- make it (clinical care, science, public health…)  better. One has to see clinical care and health care systems’ limitations and imperfections as opportunities to improve the world. This really means embracing the mantra, “Each day I get up and try to figure out what I can do to make the world a better place.”

Research also requires an exceptional resilience as one must always face the reality of failure and rejection. There is also the possibility of finding that your hypothesis is incorrect or that many of 1,000 potential biases or design flaws will be considered fatal flaws by reviewers. Research also requires that one be truly committed to the “blind justice” principle that any outcome is possible- better, worse or no different. Research is not advocacy. Finally, one must be willing to pursue challenging and difficult areas of investigation with rigor. While it is often said that emergency medical care is the ultimate team sport, clinical research especially when conducted in as challenged an environment as a busy urban academic medical center cannot succeed without a great team.

Rather than write about all of the researchers I have been privileged to work with over my career and the many who have been on this team, I wanted to include a few pictures that capture a sense of the camaraderie and teamwork that has been an important part of my life at BMC

Hudson’s farewell gathering:

Research team photo

Who is the REAL Boss of EM research:

Big Boss

Example med student research project Matt Mendes:

Matt Mendes med student symposium

A Long and Winding Road

Fundraising:

I am making excellent progress towards my goal- $10,000 and beyond! If I reach this, I will have contributed almost $30,000 in support of Boston Medical Center and the new Emergency Department. Given the almost 35 years that I will have called this place home and the importance of the institution, that would be truly worthwhile.

fundraising-3-5-17

Although I remain in search of the elusive corporate sponsor desperate to add their logo to my Team BMC running shirt for the marathon run, the search continues.

I have indicated that anyone who donates any amount on a Monday in March will DOUBLE the amount that Team BMC receives. This is the result of “Matching Mondays available to runners who have crossed $5,000.

This was the announcement:

Here’s the scoop: starting Monday, March 13, any money you raise on a Monday—through CrowdRise only—will be matched dollar-for-dollar. What does that look like? Let’s say you’ve raised $5,000 so far, and on Monday, March 13, you receive $500 in donations. The donations from that day will be matched with an additional $500, meaning you actually raised a total of $1,000 that day!

Runners can become eligible at any point during this matching program, so if you’re not at $5,000 yet, but hit the mark by March 20, you’ll be eligible for Matching Monday then. This incentive will run until the matching pool runs out.

Lauren Holmes | Office of Development

So anyone who reads my blog and would consider donating – MONDAYS in March are really a great opportunity to donate to a worthy cause for 2017.

Crowdrise: https://www.crowdrise.com/bostonmedicalcenterboston2017/fundraiser/jamesfeldman

With the help of Misbah I have launched my “Be with Team BMC” T shirt project:

https://goo.gl/forms/ps8EAMQpBn2po8fp2

I am encouraging people to either send a selfie in the T shirt or a short video “Be with Team BMC” that I can post and share with the Development Office and Team BMC site. Everyone this year can wear a Team BMC shirt on Marathon Monday! I have already shipped T shirts to former BCH staff, past residents and friends.

We really do run because of the special place and mission that is Boston Medical Center:

we-run-because

Running part of the blog:

I have completed the 5th and final planned run from Riverside. Although I was on call, I carried a cell, Charlie card and let my colleagues know that it might take me some time to get to work if called in for emergency coverage Saturday. True to the teamwork that really is Team BMC – several colleagues offered to either cover the hours I would be running or be available if I was not able to get back quickly.

The morning started at 5:30 am waking up to see the temperature (12 degrees) in Framingham and hear the wind still blowing quite strongly. Given the predictions of possible below zero wind chill conditions, I checked my email to make sure that the run was still on and John Furey had not modified the day.

A smaller group gathered at Joint Ventures and boarded the T at Kenmore for our final trip out to Riverside. As is often the case with winter running, it can be very difficult not to overdress. John had said that once we were out running in the sun, it would get quite warm. He was quite correct in his prediction. I saw many runners shedding clothes to supporting cars or vans- this included some runners wearing the green of the Lowell Runners Club and our own group.

I wear wicking layers so only found my head uncomfortably warm with a light hat rather than a marathon baseball hat. Soon despite the 17 degree temperature, I was dripping sweat. As I have mentioned in prior blog, I really have found this run in one of my favorite parts of training. The perfect conditions, tail wind and that my legs had (mostly) recovered from my 20 mile run last weekend made this one of my more enjoyable training runs this year.

Data:

last-riverside-run-2017

Emergency Medicine part of the blog:

At the end of the day, it is about causes and a legacy that Boston City Hospital and Boston Medical Center represent.  I believe that there is a clear and direct linkage from generation to generation of those who have chosen to dedicate their careers to these special places and their missions. As I look at the old historic photos of House Officers and Thanksgiving in 1894, the Dispensary in the 1900s and the HOA leaders from the 1960s, I can see the faces of our present residents, the crowded Emergency Department and images of the Yellow Fever tents and the implementation of cutting edge programs that serve the needs of our patients and the community we serve. Some of the old and new-

 

I will look forward to a future blog installment and tour of the New Emergency Department.

I have indicated that I wanted to provide a brief note about mentors and mentorship as part of the continuing theme of gratitude. I will certainly not have the time nor the space to recognize the many mentors who have offered their guidance and support along my journey. Rather, this is meant as illustrating the point that we are all blessed with the opportunity to be a mentor. This is really just a snap shot and meant to be respectful of the interest of blog readers.

Sometimes, it was just a key insight that distilled years of wisdom as when Dr. Harry Gordon, an internationally recognized pediatrician and past Dean at AECOM who was one of the first Patient Advocates at Jacobi who told me, “Jim. you have to know the medicine first” – by which he meant that in order to play a role as an advocate one has to establsh  credibility as a clinician- that was very powerful. Somehow Dr. Gordon found the time to take a first year medical student under his wings. See http://www.nytimes.com/1988/07/22/obituaries/harry-h-gordon-81-a-pioneer-in-baby-care-child-development.html

I am including just a few snapshots about what mentorship can mean- Grant Rodkey, a very famous surgeon putting his arm around me as we walked down the corridor at a medical society meeting to talk to me about leadership, organized medicine and making a difference.

Dr. Rodkey age 96, speech this past fall Boston Medical Library

img_0185

Peter Moyer MD MPH (Past Chair Emergency Medicine) who served for so many years as a source of inspiration, leadership and friendship

peter-and-me

Sue Fish PharmD MPH (first Research Director in the Department of Emergency Medicine) at the first academic emergency medicine poster presentation I gave at a national meeting- model of expertise in clinical research, research ethics and academic writing and reviewing

my-poster-saem

Dr. Bill Bicknell – visionary leader in public and international health who was always had an open door or phone for any of my questions (shown injuries after he crashed his Segway and demonstrated living to the end on his terms rather than the dictates of lung cancer. see http://www.bu.edu/sph/2012/06/06/william-bicknell-iconoclastic-ih-professor-dies-at-75/

bill-peter-and-me

Finally, to recognize the many faculty and residents in emergency medicine and others (nurses, other faculty and residents, administrators, teachers…..) who have been among my greatest mentors (shown as example c 1988);

And as promised, the emergence of Eileen’s Amaryllis (now 10 years old) and a sign of spring around the corner:

 

amaryllis-2017-flowers

In one of the remaining blog posts (not that many as race day quickly approaches, several weekends working ahead before a road trip with Hope) I will write a bit about the joys of the marathon experience, the teamwork that I have been privileged to have been a part of in emergency medical care and in research and some final thoughts on Things That Matter.