San Francisco: The Pacific and Death & Taxes

         
           SAN FRANCISCO – I ran to the Pacific Ocean this morning.

I ran under a canopy of stars, from the east end of the Golden Gate Park to the west, along Martin Luther King Drive for four miles, under giant pine trees, under a majestic dead pine with 20 crows in its crown silhouetted against a blue-black sky, past ponds of families of silent ducks and geese, past a fat-ass windmill, over the empty Great Highway, and onto the gray sand of Ocean Beach.

It felt good to stand still and to feel a slight breeze on my forehead. I thought about jumping in. I thought about running back after jumping in. I thought about time. I thought about distance. I stopped thinking and turned back. The Pacific would wait.

Running in the dark is a combination of peace and dread. Peace because of the comfort of being in the dark with no one around, no distractions, miles passing by with no markers. Dread because I could trip over a root or stumble in a pothole, and dread too because one of those running-free dogs that appeared every mile or so might run after me. I ran with my head down until I saw a running dog.

Eight straight days of running is this. I am in full push-back mode, trying to recapture my strength, my endurance, my waist of old. I don’t know how many days I will run consecutively, but it will be more than eight. I’m winded far too easily, I’m slower, I’m too fat.

Three days of San Francisco, a work trip, a getaway in the mornings when I run. Walking is almost as much fun. I stayed in a hotel east of the park, across from the famous Kezar Stadium, next to the Kezar Pub, which has big-screen TVs, basketball on all night, two vegetarian dishes, 12 beers on tap, two local, one dark porter Death & Taxes, which is damn good and damn good it didn’t keep me from running to the Pacific Ocean.

Lima: Running and being still

LIMA, Peru – One early morning in Lima I was running around a part of the San Isidro neighborhood (which has more policemen on bicycles per capita than anywhere I’ve ever been) when I came upon an old man standing on a street corner. As I passed him, he raised his knees up and down and moved his arms back and forth, mimicking my motion as a runner. He wasn’t moving. He was still.

I laughed, he saluted me, and it got me thinking about how being still was really important – even connected to a run.

This may sound odd, but when I think of running I break it down to many components. There is the start with some aches and the immediate adjustment to the weather outside, hot or cold. There’s finding my pace. There’s thinking about the day or people or something that just happened. And then there’s stillness – no thoughts -- in my mind as I run. I don’t know why and it’s not like being in a trance. But there is an absence of thought at times, and I enjoy it.

That’s not all for running and stillness. There are two other ways this happens to me.

One is quite literal: I am still when I stop due to traffic (I always welcome the break) or by choice when I see something so interesting I stop to check it out (this is rare).

But I did stop in a San Isidro park after I passed the old guy running in place. On the edge of the grass, the city has set up several small informational plaques about the birds in the neighborhood. I studied the photos of the Amazonian hummingbird, the Saffron finch, the Blue-black Grassquit, among a few dozen illustrations. And then I listened to the loud calls and the overwhelming number of doves or pigeons cooing to each other.

I saw some Blue-black Grassquits as I made my way around and even was lucky later to even to see a Saffron finch (an all-yellow bird with a slight orange tinge near the head of a male). Unfortunately, the hummingbirds stay out of sight.

I also stopped during my runs around Lima to take in small acts of beauty. People in the capital, from the poor neighborhoods to the more upscale ones, love to plant small gardens in front of their homes. Often they plant roses. The city even puts flower boxes on the exterior walls of some parking garages. Roses and cars: I never imagined the two together. (See the photo at the top of the post).  

The second experience of stillness happens at the end of almost all my runs. I do some stretching exercises that I learned from an acu-therapist in Miami some 20 years ago that I still use for my lower back and muscles around my neck and shoulders, and then I lie down and assume the corpse pose used in yoga.

I focus on my breathing and that cuts out all the noises around me. I am still. I experience a moment of peace; I collect myself. I generally feel ready for the day.

I am so still that passers by sometimes gasp. Some even shout out, “Are you OK?” They think I have passed out, or worse. On these occasions, I raise my head (sometimes startling them even more) and I assure them that I am well. I tell them, I am just being still.

Running in Lima: Loving baby Jesus

      
            LIMA, Peru – Here, when I run, I cross myself.

It’s not the danger of getting more blood clots in my legs (although that will worry me for quite some time). It’s not the fear of getting hit by a car. It’s not the pollution. Rather, it’s the number of Jesus statues and Nativity scenes everywhere.

Fifteen days after Christmas, Christmas is going strong in Lima.

The Christmas lights are still strung all over this vast city, up and down palm trees, on light poles, on hotel fronts, on city signs, and, of course, around all the manger scenes – the thousands of manger scenes, most of them with flashing colored lights forming an unnatural border.

The truth is, there is no greater love here than the love for baby Jesus, and I saw that firsthand over the weekend at the National Children’s Hospital, where outside the children’s tuberculosis ward over the weekend the staff held their traditional (and sad) ceremony to take down the manger.

They called out for everyone on the ward to witness the scene. Children with TB who could walk came out. The staff and their children filed around. Doctors, nurses, and family members all gathered around. 

Two things happened. One was that everyone was invited to take out one of the 300 figures in the manger scene (from tiny lambs to large cows to the very heavy statues of Mary and Joseph) and then to put a coin in a collection box.

The second was that the baby Jesus could not just be simply packed away.

No, baby Jesus would linger outside the cardboard box that held all the other figures. He was passed from nurse to nurse, child to child, doctor to doctor. The nurses, though, didn’t want to let him go. They cradled him in their arms like he was the baby Jesus, kissing him on the forehead, whispering words of prayer, squeezing him to their bosoms, some shedding tears, and ever so reluctantly and carefully passing the baby to another’s arms, and the whole loving baby Jesus started over again. I stood in awe.

            I know this is a running blog. And I’ll write about the running in Lima in the next post. For now, the reverence for the meaning of the season, the birth of Jesus, is more than enough for me. I don’t think I’ll look at a manger scene the same ever again.

Rangeley, Maine: ‘All my pores are open’

For the last several Christmas breaks, we’ve traveled to Peaks Island, Maine, off Portland, for a pre-Christmas stop with my parents and then driven with them to the northern Maine town of Rangeley. Rangeley is home not only to Saddleback ski area, but it also has many other small-town charms, including a great ice skating pond in the middle of town and a great sledding hill in the middle of a golf course.

I haven’t been running much since I had an episode of deep-vein thrombosis after a long flight to Manila in mid-November, but, now cleared by doctors to exercise on all sports that don’t include the risk of head injury (there goes downhill skiing), I’ve been slowly building back.

This morning, I checked the local Rangeley map and found a route along the Harold Ross Road, named after the legendary New Yorker editor who had the good sense to hire E.B. White. I admit to running slowly before reaching Harold Ross Road; to get there I had to run a good three-quarters of a mile along the Saddleback access road, and it was steep, befitting the beginnings of a good mountain road.

But once I reached the turnoff, I relaxed and fell into a steady rhythm. It had snowed an inch or two overnight and that made for the best type of winter running. I had soft landings. My footfalls were almost silent, save for a slightly squeaky land and push-off. The north wind pushed me south.

I registered only a few things along the way: some street signs – my favorite was Stub and Luraine’s Lane -- and also animal tracks. The deeper I ran down Harold Ross, the greater the number of tracks. I was running on a deserted road as well as an animal highway.

The most common track was moose. I stopped and put my running shoe next to a hoof print, and the hoof was significantly longer than my shoe, probably a size 12 man’s. I paced off the distance between prints, and one stretched five feet. I started out again and ran along the ridge, up and down, over streams, and pass pine wood, looking for but not finding moose.

Fifty-five minutes after my start, I returned back to our rented house on Rangeley Lake, called Windy Cross, perhaps because of the wind and also all the crosses in the house. I found my father, Mike. I had tried to persuade him the night before to go into the hot tub next to the house, and he had demurred, saying “let’s wait until morning.”

He was carrying bags to his car, getting ready to return home with my mother, Mary.

“Want to go in the hot tub, Dad?”

“Sure!” he said.

Five minutes later, we opened the hot tub and stripped down to our shorts. Barefoot, we made the short walk across snow and ice before submerging in the warm water. It was wonderful. (Check out the video.) Afterward, I asked my father how he felt and he said, “All my pores are open.”

How does that feel?

“I am feeling generous and benign,” he said.

We laughed, and he and I understood exactly what he meant. All is good.

Estonia: Running in the deep dark

During winter, I often run on weekdays in the dark. For the past few days in Estonia, in the far Baltic north, I’ve been running not in the dark but the deep dark. Night here in mid-December stretches for close to 17 hours; the sun sinks by 3:30 p.m.

Maybe it’s all in my head, but when I set off at 6:45, as I have in the last few days, it feels like late in the night, not early in the morning. The sun won’t rise until after 9 a.m. So when I set off, there’s no dawn peeking around the corner.

I’m in the university town of Tartu, and it feels very European. Fanciful truffles are in the windows of shops. Women wear thigh-length wool coats and knee-high black boots, brightly colored scarves knotted around their necks. Men, hair stringy, rush by in suits, scarves, cigarettes between their fingers.  They all watch their steps along the narrow cobblestone streets of Old Town or along the bridges that are for pedestrians not cars. Christmas lights are everywhere, strung up on lamp posts and bridge posts and high in the air above Town Square.

The Christmas lights don’t only raise holiday spirits, but they also raise spirits, period, it seems. They provide light. This morning, I ran underneath a string of holiday lights along the Mother River and up and over an impressive pedestrian bridge, passed by a few bikers wearing winter coats and scarves that flew behind them, flapping in the breeze. Then I headed along the river again on a long stretch of blackness.

When it’s dark, I often feel a lightness of being. I’m concentrating on not falling and I watch the ground for holes or humps. I’m not thinking. That is freeing mentally and sometimes, when my pace is just right, I can run for a mile or two and not realize it. Night makes you feel invisible. Night also makes others invisible, of course, which can be a problem. But when you see an occasional person, and when it's exceptionally cold (as it is in Tartu), and when wind is cutting across your stride, it is possible to relax into a rhythm and lose yourself.

On the run this morning, I retreated into this zombie-state and only snapped out of it when I looked up the sky and saw light. It was limited to a large circle in a bank of low-lying clouds. I couldn’t figure it out at first. But then it dawned on me that the lights from the street, Christmas decorations, and a nearby mall had reflected upon the clouds. It reminded me of one of those spaceship movies in which the scene is all black until shafts of light reach to the ground. Only in Tartu, the direction of the light is up, not down.

I don’t know why, but the scene almost made me laugh. It was entirely a man-made phenomenon, and it seemed a rare one. I thought to myself it’s not often on a run when you think of nothing in the dark and then you look up and think of spaceships.

First run

I missed running. I didn’t know how much until now. I’m just back from a run, my first in 24 days. On my last run, I had to stop after three minutes. I could barely breathe. Days later, I learned that I had blood clots in my legs and my chest. I stayed in a hospital for three days and left with a pile of blood thinner medication and the words of a doctor not to exercise for a while.

So that stopped me. It stopped me not only from physically exerting myself but it also stopped me from thinking about running. I put it all out of my mind. I focused on my legs, my heart, my breathing, making sure I did a kind of internal body check-up several times a day. Everything was stripped back to the basics of being able to live.

My run today, then, is a step back to reclaiming something lost, or maybe even it is reclaiming my life. I didn’t have a euphoric moment. I ran for 25 minutes. I ran slower than normal, half the distance of my short daily run, consciously checking on my breathing. Was I breathing too hard? Was my chest contracting? Was that slight pain in my leg a sore muscle?

But when I finished, I felt a trickle of sweat twist and turn from under my running jacket and flow down my right thumb. I opened the door of our house and called for our dog, Juluka, and she knew what that meant; she shook her nine-year-old legs and bounded out the door. I ran around the block with her, tossing a tennis ball ahead of us so that on first bounce she could leap and snare it, and she did, again and again.

We stopped in an open area under pine trees. I stretched. I felt the aches of calves, of my lower back, of my shoulders. My hair was damp at the edges. Then I walked back into our house, took off my running jacket (which was wet on the sleeves), fed the dog, boiled water for black tea, and thought for a moment about how the pieces of a carefully constructed life are coming back. I really missed running.

I live, she dies: Access to quality health care

(A version of this blog appeared in Global Post)          

I am thankful this season for good health care, and yet I am sad that many don’t have it. Here’s why.

            Three weeks ago, I flew to Manila, stayed a week, and then flew back to Washington, D.C. My calves felt extraordinarily tight during the whole trip, and when I went running one day in Manila I had to stop every three or four minutes. I have run marathons, but I couldn’t breathe after three blocks. (And that's where I left things in my last blog post. See below.)

            Back in Washington, I walked up three flights of stairs and again had to stop to catch my breath. I knew something was wrong so I opened my computer and typed in Google: “calf pain + shortness of breath + long flights.” Google told me what I feared: deep vein thrombosis, or dangerous blood clots that could migrate to my lungs and possibly kill me.

I drove myself to an emergency room, where 15 minutes later a technician using ultrasound found two clots in my leg; a doctor told me the clots were also almost surely in my chest. A nurse injected me with blood thinner, and after a few days in the hospital, I am now out of danger. I left for home and now recuperating.

            I am fortunate. I know this from years of experience of reporting about people who have poor or no access to quality health care, from rural areas of West Virginia to Afghanistan to Zambia. But today I feel this deeply, in large part because of an email that I just received from Rudi Thetard, the country director for Management Sciences for Health (MSH), a Cambridge-based non-profit that works globally to improve health care.

This summer, I met Rudi in Malawi and he had introduced me to Lucy Sakala (see Dominic Chavez's photo above), an HIV counselor at Salima District Hospital in Malawi, about a two hour drive from Lilongwe, the capital of the southeastern African country.

            Lucy was battling cancer and I wrote about her difficulties in getting treatment. Here’s what she told me in July about how she tells people that they are infected with HIV:

            “I tell people who just learn their diagnosis that they should live positively,” Sakala said. “I tell them that there are several conditions more serious than HIV, including some cancers. And I tell them I have cancer, and it’s difficult, but that I live positively. Then I say it’s so important for them to take their medications properly so they won’t have opportunistic infections, and that they shouldn’t fear much. They should listen to their health provider.”

            Those patients, Sakala said, sometimes “feel sorry for me, and their problem becomes a little lighter. But I tell them not to feel sorry. I tell them to live as positively as I am.”

            The story documented how Lucy couldn’t afford the cost for chemotherapy. MSH staff around the world donated $2,000 for her treatment.

            In the end, it was not enough. Rudi’s email was Lucy’s death notice. She died a week ago from her cancer, which had spread from her uterus to her brain, esophagus, and lungs.

            Here’s what he wrote:

            “Lucy has for the last year battled her own cancer whilst continuing to counsel persons who have tested positive for HIV.  Her death has been felt strongly by MSH staff in Malawi as we had all hoped that she would recover.

            “Her story echoes the story of many other cancer sufferers in Malawi.  Following the diagnosis of cancer she was able to start with a program of chemotherapy which had to be supplemented by radiotherapy.  It is at that point that that the doctor advised a course of radiotherapy which was only available in Zambia.  MSH staff (in Malawi and globally) contributed generously to the expenses she incurred in travelling to Zambia and she was able to complete a course of radiotherapy.  She returned to Malawi a few weeks ago and had to face a reality of a shortage of essential chemotherapy – these drugs have been out of stock since September in Malawi.  She died this morning and was only 28 years old, leaving a daughter and husband.”

            I told this story to Dr. Kevin De Cock, a pioneering global health researcher who is now director of the Center for Global Health at the Centers for Disease Control and Prevention in Atlanta.

            “This story of the 28-year-old woman is regrettably a common one,” he said. “But at the same time we need to step back with non-communicable diseases and say where we are: The world is just starting to recognize the global problem. Not a large amount of resources are being made available to for specific non-communicable diseases, such as cancer, hypertension, and diabetes. … Still, a great deal can be done through appropriate public health policies. This does not solve the problem of the sad story of this woman, but there is an awful lot we can do now.”

That is almost surely true. The reality today is that someone like me who was born in a middle-class family in a rich country has the means to access health care that can add years – maybe decades – to my life. Lucy Sakala, by virtue of being born in a poor country with poor health care, didn’t have that. Basic chemotherapy treatment was not available to her. And because of these facts, I live and she dies in November of 2011. It’s not right.