Marathon

Anthony wasn’t supposed to have a heart attack. After seeing his father clutch his chest and fall to the ground while mowing the lawn when Anthony was only 12 years old, he vowed to control every factor he could to avoid the same fate. Sure, he had strayed from his commitment a little bit – binge drinking with his fraternity brothers at Syracuse, cocaine-fueled nights of partying during his MBA years in Boston, greasy take out during his first few years on the trading floor – but concerns about an STD got him in the door of a primary care clinic. The doctor was a new graduate who enthusiastically conducted a full history and physical exam. Upon hearing of his family history of sudden cardiac death, the doctor ordered baseline cholesterol labs, and the results of these labs were enough to scare Anthony into abstinence from alcohol and a nearly vegetarian diet.

The first time he went to the gym, he met his future wife who was walking out of a spinning class as he was walking into the weight room. While they were dating, she introduced him to running and he was immediately hooked. He had always thought of running as a punishment for poor performance in another sport, but without the glares and whistles of angry coaches and commiserate glowering of teammates, he loved it. Convinced he had reversed both his genetic curse and the effects of those wild years in his 20s, Anthony was a perfect specimen of middle-aged male fitness. Completing his first marathon in under three and a half hours was going to prove his transformation was complete. Unfortunately, the plaque that ruptured in Anthony’s left anterior descending coronary artery at mile 18.3 of the Tunnel Glow marathon didn’t care what he thought about his health and fitness.

Lucienne was supposed to run fast enough to qualify for the Boston marathon without letting anything distract her – not thinking about the stress of her upcoming away rotations, not thinking about her ex-boyfriend and the nurse he was now dating, and not doubting that she could run the marathon ten minutes faster than she had run the previous four. She was starting her fourth year of medical school, and had meticulously followed an eighteen-week training schedule over the summer, missing only one of the six-times-per week workouts. She had run mile repeats on the treadmill in the undergraduate gym at 5am, and had done long runs post-call on two hours of sleep during which she listened to board review podcasts. She was in excellent shape and determined.

As long as the residency match worked out, she was going to be a urologist specializing in bladder and kidney cancer. April of her fourth year of medical school would be the last time for many years that she had enough control over her schedule to plan a trip across the country to fulfill her lifelong dream of running the Boston marathon, and Lucienne had never been someone who failed at achieving her goals. Unfortunately, the plaque that ruptured in Anthony’s left anterior descending coronary artery when she was at mile 18.2 of the Tunnel Glow marathon didn’t care about Lucienne’s fitness either.

Lucienne is still rolling her split from the eighteen-mile marker around in her mind: a 7:35 mile. She knows she is on pace to go under 3:30, but her brain is fuzzy with exhaustion and mild dehydration, and she is having trouble figuring out how much of a time buffer she has accumulated. Ahead of her, a middle-aged man in expensive clothes who she had been leapfrogging for the last few miles suddenly takes a lurching step to the side and falls forward, his face slamming into the packed gravel.

It doesn’t consciously register to her, but part of why she senses something is seriously wrong is that he hadn’t even tried to break his fall. Tripping over your own feet while they dragged with fatigue is common in long runs, almost expected to a certain degree, but you at least put your arms out to stop the fall. To her credit, she also does not think “I’m not supposed to have to do medicine right now” nor does she think of her thin margin for a Boston qualifying time slipping away. She sees someone who needs help and runs to him.

Within a few seconds she is crouched next to Anthony, shaking his sweaty shoulder.

“Are you okay?” she turns him over onto his back and brushes the adherent gravel off of his face.

There is no response. She looks around but doesn’t see anyone else along the trail. The marathon course is known for being downhill and fast. It is also beautiful, following a rail trail with clear cuts to stunning views of the surrounding mountains. The trade off for the scenery is that the race logistics are a little difficult, and therefore there are fewer aid stations than there would be at other races. For a few miles at a time, the runners are on their own.

Without hesitating, she shoves her fingers in his mouth, feeling for an airway obstruction but just encountering a parched tongue. She then cocks her ear over his mouth to listen for breathing, trying to ignore her own ragged panting. There doesn’t seem to be any air moving from his mouth. Is she supposed to give rescue breaths? The basic life support algorithm changed recently and she doesn’t remember if they were still part of it or if it’s now chest compressions only. Before she finishes deciding about the breaths, she is feeling for a pulse. His skin is sticky, and her heart is pounding, but the flesh under her fingers is still. She sweeps her fingers along the side of his neck, making sure she’s in the correct location, but feels nothing.

After one more quick glance around, she starts chest compressions to the cadence of the classic disco song “Stayin’ Alive”. One hundred beats per minute. It’s tiring, and she’s already exhausted. After a minute, she stops to check for a pulse again and sees another runner coming up on them from behind. Finger to Anthony’s neck, she yells “Call for help!”

The runner, a shirtless man in his early twenties, looks stunned, but takes out his cell phone. “I don’t think I have service,” he says, scowling at the screen.

She doesn’t feel a pulse, and starts compressions again. “Run to the next aid station then!” she gulps out between compressions, and the runner nods and takes off at a sprint. Her hamstrings cramp and she kneels, trying not to break the rhythmic pounding. The sharp little rocks dig into her kneecaps but she continues, one hundred beats per minute. She hadn’t thought it was possible to be sweatier than she was when she was running, but somehow she is, beads dripping from her forehead onto Anthony’s already saturated chest.

Pausing again for a pulse check, she doesn’t expect to find one, but is elated to feel a gentle throbbing of the carotid artery under her index finger. Had it been there all along? She sits back on her butt, knees burning from the gravel. Anthony moans and his chest begins to rise and fall, encouraging signs of life. She puts her fingers to his wrist, and feels a thready beat of the radial artery. That’s an even better sign, because as they learned in physiology, a high blood pressure is needed for a palpable radial pulse than a carotid pulse. Reassured that his blood is circulating again, there is nothing she can do but wait for help, which arrives two minutes later in the form of a mountain bikes with a modified stretcher trailer attached to one of them.

As she gives report to the paramedics – no she doesn’t know him or anything about his medical history, he went down in front of her, achieved return of circulation after two minutes of CPR – they place an oxygen mask on his face, cut his shirt off to stick defibrillator pads to his chest, and hoist him onto the stretcher, securing him with Velcro straps.

“We’ll get him to the ambulance two miles down and then send someone back for you,” the paramedic says as they mount the bicycles.

Without thinking, Lucienne calls after him, “No it’s ok, I’ll keep running”.

It will take Lucienne eight more years to qualify for the Boston marathon for the first time. As she weaves through the line in the Convention Center to pick up her race number, she sees a sign mounted on an easel that says “The best chance a runner has of surviving a cardiac event on the course is the prompt initiation of hands only CPR by a fellow runner” and thinks of the most recent Christmas card she received from Anthony, smiling with his arms around his seven year old twins.