The Longest Mile

When I was in high school I ran cross country. Poorly. To make things even worse, I was one of those cross country runners that the other runners hated, namely the person who was running only to train for another sport that they were much more interested in. In my case, I was a 6'5" basketball player whose only purpose for running was to show dedication to his coach's advice to run in an effort to make varsity as an underclassman. I had little to no stamina, only a moderate amount of sheer determination, and exercise-induced asthma. On the other hand, as I was a veritable behemoth when it came to the prototypical running physique, at least I had a long stride. Needless to say, when it came down to it I was the epitome of average.

Cross country was probably one of the most physically and mentally exhausting things I've ever done. I wanted to quit during the first mile of every race I ever ran, and imagined a myriad of scenarios in which I used my asthma as a crutch to get out of finishing the race. My lungs would be burning, my legs were lead weights, and I would be struggling along with the pack while the more skilled runners whizzed past us, all while my mind worked fervently to betray my efforts. With each race I was convinced that this would be the one when I would finally succumb to these deep desires to just give up on this cross country insanity.

One race stands out in my mind as the turning point when I realized that I would never be able to just give in. Each season teams from around the region in our conference would travel from town to town, usually running on golf courses or courses running through large parks. It was considered an honor for your town to have a course with which to host a race. The small town of 4,000 at which I was a freshman was one such town, and boasted one of the most challenging courses in the conference, filled with large hills, abrupt changes in direction, and was ran as a continuous circuit, with no repeated laps. This made it even more difficult, as it was impossible to scout the course out during the first lap and make any moves on "easier" parts of the course during subsequent laps.

Our team had been instructed to work even harder heading into this race, as we wanted to put on a good show for our fans at home, which in cross country mostly consisted of close friends, family, and significant others. I complied with this coaching stratagem, as I was certainly not going to go out of my way to look like a slacker in front of my friends. However, about a week before the race I became ill with what, at the time, was my semiannual respiratory infection. These infections seemed to come on each winter and spring and lasted almost a month each time, worsened by my asthma. I was always able to continue competing in sports, however my stamina was usually diminished somewhat and I coughed like a maniac, often forcing referees to ask me during the game whether I was okay to continue playing.

So naturally, I was extremely excited to be running our heinous home course in front of my close friends, feeling like crap and in a sport for which I had no actual affinity. I barely remember the thoughts racing through my head during the actual race. I do remember feeling somewhat delirious during much of it, and wondering if I was simply going to collapse. Oddly enough, the thought of actually quitting the race of my own volition never passed my mind. It wasn't so much that I was determined to finish, rather my mental state was such that I'm not sure my brain actually registered that it was a possibility. I had been reduced to primitive reflexes. Evidently one of those reflexes has something to do with running like a dying chicken (which, I've been told, summarizes my running style). In the end, I crossed the finish line glassy-eyed and diaphoretic with a finishing time slightly off my average for a 3 mile race and as my friend who worked as our team assistant ran over to congratulate me, I doubled over and threw up. Looking back, I think that day marks the first day I actually felt proud of running cross country, because it was the first time in the sport I overcame an obstacle that months before I would have said was impossible.

I'm now exactly one week away from finishing my 3rd year of medical school, which is the first year spent entirely in the clinical setting. Over the last year I've worked with infants suffering from terminal brain damage in palliative care, incredibly warm military veterans with newly diagnosed cancer, psychiatric patients who will likely never receive the care that they need simply due to the American health care system, and an incredible number of patients with a nebulous distrust of health care professionals and a nearly infectious negative attitude. I've worked long hours shoulder to shoulder with some of the most caring physicians a patient could hope to work with, and also with some of the most jaded, cynical, and nearly inhuman health care professionals treating patient and junior colleague alike with nothing but distrust and disdain. I've found my personality and attitudes morphing into the dominant culture of every branch of medicine in which I've rotated and in the end I've said and done things that I'm not proud of and wonder just how firm my self-identity really is. As I approach residency, one year away at this point, with the stresses placed on a new physician and the hours necessary for our training, I wonder if I will even be able to keep tabs on who I am and will have any control over who I will become. Will I be just another one of those overworked physicians whose patients are convinced don't listen to or care about them?

I guess my cross country story entered my mind today because I type this as an exhausted medical student. Not someone looking for assurance, sympathy, or misplaced compliments. Rather as someone who often feels delirious as he tries to understand not only the medical concepts that he is inundated with on a daily basis, but also the ethical and interpersonal ramifications of the health care system in which he struggles. As I limp away from my third year of medical school I find myself utterly confused as to just who I am to become in this profession. I can only hope that much like the aforementioned race my mind can slip into a primal autopilot and emerge on the other side of this training proud of the results.