All Runs End
The author, originally from Detroit, Michigan, is a graduate of the University of Michigan (1965) and of the University of Michigan Medical School (1967), with honors, where he was elected to the Alpha Omega Alpha Honor Medical Society (1966). He trained in internal medicine at Duke and in Rheumatology at Harvard (Robert Breck and Peter Bent Brigham Hospitals). He served as Professor and Chief of Rheumatology at the University of Florida, Chairman of the Department of Medicine at Saint Barnabas Medical Center, Livingston, NJ, and Professor of Medicine at the University of Medicine and Dentistry of New Jersey and Mount Sinai Medical Schools, and is currently Emeritus Professor of Medicine at the Keck School of Medicine of the University of Southern California. He has received numerous academic awards, recognitions, and distinctions, and has over 700 scientific publications.
During most of his lifetime he has been a recreational athlete, basketball player, long-distance cyclist, and marathon runner of no distinction, experiencing virtually every possible injury. He was among the first to study running and arthritis and published numerous authoritative scientific articles about running and exercise (featured in Time magazine) and arthritis and rheumatic diseases, contributes the chapter about this in the leading arthritis/rheumatology textbook, and has served on the medical/science advisory board of Runner’s World.
“To Run. To go faster than a walk; continued rapid movement. To accomplish or perform; to direct business activities; to manage or conduct.” (Merriam-Webster Dictionary)
“I just wanted to get all this down somehow, to capture it all in one place. I wanted to have something like this so one day when I’m old and creaking around with a cane I could pick this up and remember what it was like to be young and strong and fast again. I wanted to be able to remember what it was like when I was once a runner.” (Parker, Jr, JL: Again To Carthage. Scribner, NY, 2007. P 360)
We passed the first mile comfortably.
I automatically glanced at my wrist. My old Apple watch was asking me if I was working out. I smiled, as I had stopped wearing heart-rate monitors or chronographs some years ago and now wore this device for potential emergencies, not to record my runs anymore. Monty, now 12, and Toby, seven, my faithful and intrepid running companions, were on my left, as usual, trotting along easily. We were enjoying a sunny California afternoon with the temperature in the 60s. We slowed for a moment to appreciate the spectacular vista from the Pacific to the inland mountains. And for the dogs to sniff at their surroundings.
I let my thoughts wander. I had just started my 50th year running log. Though I had always done sports and been active, keeping a record marked a transition to a different relationship with running.
I was a mediocre athlete but always active in sports. My closest to notable achievement was summer basketball at camp during adolescence, with a friend; we were pretty evenly matched in our daily one-on-one competition and I was proud of him — and for myself, by extension — when he made the NYU freshman team with two future NBA stars (Barry Kramer and Happy Hairston, the number 6 and 33 selections in the draft, respectively). Like John Grisham, “…I was determined to become a star… around the age of sixteen, I realized that… my prodigious ability to dream was no match for glaring lack of talent.”
I remained a recreational athlete, and then a runner, of commitment and dedication, but no particular distinction. It was an easy way to stay fit, and I came to love it. I was lean, relished the solitude and opportunity to be alone with my thoughts — or without thoughts — and was refreshed by the efforts.
I’ve run more than 50 marathons as well as an ultramarathon, triathlons, and duathlons. I’ve run in Gainesville’s 100 degrees heat and 100% humidity, in Vermont’s minus 20 wind chill with icicles on my beard, at 2:30 a.m. before travelling and at midnight after returning home, 7 and 1/2 miles each way to and from my office at dawn and dusk sometimes losing track of which was which and perhaps bumping into myself going the other way, between the bolts of lightning and afternoon north Florida rain drops, with my running partner over a car in our way, up and down the San Francisco and Monte Carlo hills and on the long sloped Florida beaches, in the hills of the Galilee and by the Dead Sea, on the equator in Malaysia in August, on the busy streets of Hong Kong (barely avoiding death to traffic going the wrong way), on the beaches of Tahiti, on the University of Florida (UF) track competing in the Florida Relays’ master’s mile and on the streets of Gainesville, with my son David (who ran on an NCAA championship cross-country team at Williams) and his friends (once we got past “dad, I’m not a recreational runner; I’m an athlete and, besides, I can’t run that slow.”), with my children at the Tel Aviv half-marathon, with my friend from basketball summers through Jerusalem, barefoot and with every imaginable orthotic and in max cushioned shoes, with a broken arm and with a broken toe, at an international consensus conference about physical activity, fitness, and health with other experts in this field, with Tony Fauci (when he was our visiting professor at UF), with friends at professional meetings, on the Olympic marathon course and into the stadium at a meeting in Barcelona, in the rice paddies (where I got lost) while a visiting professor in Japan, and with my grandson in Central Park and around the reservoir.
My serious running began in Gainesville (Florida) in the 1970s and ’80s. The UF (where I began my career and became chief of rheumatology) and the Florida Track Club created a unique environment for running. Frank Shorter (1972 Olympic marathon gold medalist) stayed at the home of one of my faculty (while on a sabbatical) to train. We shared clinic space with nephrology and watched Bob Cade develop Gatorade and sponsor Olympic hopefuls.
It was quite ordinary to see champions (like Brian Maxwell, Canadian marathon champion and inventor of the Power Bar) and Olympians (medical student Dave Roberts, pole vault bronze medalist, 1976, and 3-mile world record-holder and Olympian Marty Liquori) in clinic, at the track, or on the streets around town. They recognized me and my great friend and running partner, C. Richard (Dick) Conti, our chief of cardiology and future president of the American College of Cardiology (recently deceased, whom I miss keenly), and would greet us knowingly with “Hi, docs!”. We even ran once with Marty (when he was injured). One of my patients, at our clinic at the adjacent VA hospital, was Paul DeBruyn, the 1932 Boston Marathon champion. He would bring his scrapbooks and regale us with stories of his training, trips to the 1932 (Los Angeles) and 1936 (Berlin) Olympics, and photos of his legendary friends like Jesse Owens and Paavo Nuurmi.
Dick and I ran together 9–10 miles daily and 20+ miles Sundays for most of 15–16 years, occasionally reaching 100-mile weeks. It was only later that I appreciated how unique was our relationship — we enjoyed each others’ company (telling jokes, talking about ourselves, families, our work), never fought, were comfortable running at the same pace and distance, and pretty much trained the same. We solved personal, professional, and the world’s problems while we ran. We raced together, locally, around the state, the New York City and Boston Marathons, a 50k, and duathlons (swimming and running), usually but not always finishing together (see Figures 1 and 2a).
We had shin splints, side stitches, lost toenails, sprained ankles, sore knees and tendons, and even chest pains (we ran through them ’til they stopped). We took beta blockers, in their early days, as part of someone’s experiment, and ran 10 miles with heart rates of 72 bpm. We outran loose dogs and watched for Florida’s poisonous snakes when stopping to pee or take a dump in the bushes on a long run; Dick swore one Sunday morning that he narrowly missed being bitten by a coral snake (he did once have an alligator in his pool, which is why his wife wore a holstered gun when walking their dog).
We ate anything and everything and never gained weight. We did long bike rides, abandoning those when neither of us could fix a flat (or anything else) and our wives refused to come for us. Our only near-argument was who got the bath and shower first after a cold, rainy 1976 Boston Marathon. Dick sweated a lot, particularly on hot humid long Sunday summer runs. The first time he got dehydrated and lightheaded, and I rolled him out of the car into his house, where he lay on his living room floor for several hours rehydrating, his wife was very concerned. The next week, when it happened again, she was mostly disgusted. We continued our long, hot Sunday runs anyway. I’m not sure if we ever experienced “runner’s high,” but in the middle of long summer runs we stopped at convenience stores for chips and beer, or ran by one of our homes to jump in the pool to cool off (Figure 2b).
One year I entered the spring Florida Relays masters’ mile. Never having competed in something like this, it was exciting to hear my name called on the loudspeaker (“…and in lane… Rich Panush!”). There were eight of us on the track, a couple older than I, and Barry Brown, reigning masters’ mile champion and American distance record holder, whom we saw regularly gliding on the streets around Gainesville with elegant fluidity and form. My goal was to not finish last. I didn’t, but Barry lapped me en route to his victory.
John L Parker, Jr’s, “Once a Runner” was published in 1978. He ran for UF and placed his novel, generally considered the best about running, in Gainesville, with recognizable settings and characters. My youngest (David) began high school running then, which stimulated me to write John. He kindly responded and inscribed copies of his book for us both. I regret never meeting him.
After a number of years of running, racing, and completing marathons, I contemplated the obvious question “What was running going to do to my joints (particularly hips, knees, ankles, and feet) in later years?” Back then, we mostly conceived of joints like materials, or metals, that would deteriorate with “wear and tear,” i.e. use. But there was some evidence to the contrary, that not all activities or occupations necessarily “wore out” joints, and that joints, as living tissue, behaved quite differently than inert materials.
So I, with colleagues in rheumatology and radiology collected what data were then available to us. Our observations suggested that running need not lead to osteo- (degenerative-) arthritis, and that putting a normal joint through a normal range of motion was not necessarily harmful. Coincidentally, colleagues, Jim Fries, Nancy Lane, and collaborators, at Stanford, reached identical conclusions and both our papers were published together. This was subsequently featured in the media, including Time magazine and Runner’s World. Follow-up and many other independent studies since have confirmed the validity of the original observations and conclusions. I still write a chapter in the definitive textbook of rheumatology which addresses recreational activities and arthritis, and presents all of this in detail, with the same conclusions.
We passed the second mile marker, still comfortable. As I now do, we paused again. Not for me, you understand, but for the dogs to smell their surroundings and relieve themselves.
I recalled that in 1989 we reluctantly departed Gainesville as I became Chair, Department of Medicine, Saint Barnabas Medical Center, Livingston, NJ, with academic appointments at Mount Sinai Medical School and the University of Medicine and Dentistry of New Jersey-New Jersey Medical School (UMDNJ-NJMS). I ran with new friends but the arrangements, conversations, and pace for four (or more) wasn’t as simple as before. I often ran from home, before work, with my two (rescue) dogs (see Figures 3 and 4).
I ran with other friends too at the American College of Rheumatology and other meetings, time, schedules, and health/injuries permitting — Nancy Lane, Mike Schiff, John Sergent, Bob Lahita, Joe McCune, Bob Wortman, and others. This was a delightful way to strengthen and sustain those friendships.
George Sheehan, running’s renowned philosopher and spokesman, lived just south on the Jersey shore. I invited him to visit, meet, talk, and present “grand rounds.” It was great fun and an honor to meet him and to introduce him to my son, the high school runner. He contributed a piece to Balliere’s Clinical Rheumatology on Exercise and Rheumatic Disease that Nancy Lane and I co-guest-edited; I’m pleased and proud to have collaborated with George.
It was there that I met Ron Karnaugh, the 200 IM world record holder who should have won the event’s gold medal at the Barcelona Olympics in 1992, had his dad not died suddenly just before his finals, not surprisingly perturbing Ron’s preparation and performance. He was then in medical school and would occasionally benevolently invite me to “cross-train” with him on his running days, but I couldn’t begin to provide him a decent workout.
My work on running and arthritis led to invitations to conferences where I met notables in the world of running and science like Tim Noakes and Paul Thompson, and maintained relationships with both.
I continued running marathons, but slower, and local road races. There was a “hounds and harriers” 3-miler nearby each fall that I, my daughter, and my son, David, would do with our dogs; David and his chocolate lab held the course record. I could still place in my age group for the 5k race in our town. I had reached a time in my life where I was the fastest (running) old man (then in my 60s) in Florham Park (those who finished ahead of me in the age group came from neighboring towns).
We passed another mile marker. We stopped again. I resumed my musings.
I have been blessed with mostly good health and a fulfilling personal and professional life. It was extraordinarily good fortune to have not been born in the shtetls of my parents (where I would have perished in the Holocaust). It is an amazing privilege to be a physician in the United States, in a world with billions destitute, starving, homeless, or virtually homeless. Few have our education, stature, and income with the opportunities to serve and care for others. We are not (usually) the ones at the other end of the stethoscope, without means, shelter, or health insurance.
I have been married 59 years and love my wife. We have three successful children, a daughter-in-law and son-in-law, and four grandchildren we cherish. I have exceeded what ambitions I may have had, with opportunities to be program chair, division chief, department chair, and professor at excellent academic medical centers; to do and contribute meaningfully to scientific progress; to edit important journals; to serve in leadership roles, including presidencies, of my professional organizations; and to be recognized with awards for distinguished pedagogy, research, leadership, service, patient care, and humanism. It has been a special honor to participate in the lives of others and to try to make our world better.
In 2010 my wife and I moved to Los Angeles (LA). After nearly forty years as a director, chief, and/or chair, it was time to be near our (then) only married child and grandchildren, then seven and four, great ages, while we were still in pretty good health. I looked forward to a new role at the University of Southern California, emphasizing mentoring, advising, consulting, supervising, and teaching, and never going to another meeting.
My last marathon was LA in 2010. I continued running, now mostly with my dogs, Sweedee and Speckles, and then (and now) with Monty and Toby, usually 5–10 miles at 4 a.m. before leaving for work. There was a haunting beauty, quiet, serenity, and solitude of running, alone, just us, contemplating everything and nothing, through the streets and along the beach of Venice and Santa Monica, while the world was sleeping. I sometimes think I even slept through at least parts of those runs. Those were times of deeply satisfying and refreshing reflection. Those were moments I felt running inextricably part of who I was. And it made me more alive. Those were experiences that enhanced, facilitated, and also complemented personal relationships, professional activities and responsibilities, and my spirituality.
I was now in my 70s and stuff began to happen which interfered with my running (and life). Meniscal injury. Posterior tibial tendonitis. Prostate cancer. Disc disease. Sciatica. Even polymyalgia rheumatica (I have written about some of this elsewhere. Panush RS: Reflections On Becoming A Patient. Being On The Other End Of The Stethoscope. The Pharos, In Press.) I never quite returned to my easy daily 10 miles and never was quite ready for that next marathon. I wasn’t my younger self anymore.
Then came an Achilles tendon tear (probably from resuming some basketball). The repair and recovery went smoothly; I never took so much as a Tylenol. But, the immobilization, followed by relative inactivity during rehabilitation, led to considerable loss of muscle strength, mass, balance, and coordination, despite diligent physical therapy. Could I run again, on my repaired tendon, with other nagging injuries and lost fitness? Would I?
We passed another marker. We paused. We continued. The run isn’t over yet.
Of course. My blood pressure is still 110/70 mm Hg, my resting heart rate in the 60s, my HDLs (usually) greater than my LDLs, at my high school weight, and BMI 18. I was a runner virtually all of my adult life, and still am. But different. I’m no longer my younger self. I’m slower, much slower, don’t run nearly as long, nor as often. And there are days and weeks, or longer, where I abide by the demands of my dysfunctional menisci or posterior tibial tendon, or something else. But I come back to it, to my running.
I see occasional stories of someone starting or continuing to run and even set records in their 70s, 80s, 90s, and 100s. These are inspiring. But exceptional. This is not normal. None of those I have run with over the years have been spared the consequences of aging (and some have died) (see Figure 6). Most no longer (can) run. There are data, particularly from Jim Fries, Nancy Lane, and colleagues, suggesting that running indeed has salutary effects on aging. The challenge here is to adapt, to moderate expectations, but to persevere, to remain as active and fit as possible, to find those running moments or their equivalents in our lives, to still do and be the best we can. Despite my problems and constraints, I still consider myself incredibly lucky.
As Roger Hart (whom I did not know but wish I did) wrote so eloquently in an essay about the running experiences of his group over the years — “We learned that we were alive, and it felt good. God, it felt so good.”
Life is different with running. More intense, more engaged, more aware, and yes, more alive. I can’t contemplate not continuing. I now time my runs with a calendar, or a sundial; for sure they’re slower and shorter, but my running partners (my dogs Monty and Toby) enjoy them with me, we’re all pleasantly tired and sore after, and we remain fully engaged with life, alive, into my 9th decade. Running enhanced and enriched my life, and still does.
We were approaching the last turn at the end of the run.
Not the end, yet; not the final turn, yet; but it was ahead. More thoughts.
I had tried to understand life, its meaning, and the universe, often on those otherwise solitary runs, and was unable to, returning to my own version of the comfort of the faith and traditions with which I grew up and have lived, accepting their inherent epistemological uncertainties. It is important to have faith if possible and certainly values, and to affirm them. A core — perhaps the most fundamental — value of my religion is that “it is not our responsibility to complete the work (doing good in/for the world) but neither are we absolved from trying” (Talmud Avot 2:16). It is important to continue to try and do good.
As I have attempted to do and teach humanistic medicine during my 50-plus year academic career, I have come to understand that “caritas,” a kind of biblical loving-kindness, is at the essence of clinical medicine, probably life, perhaps of fully “being alive.” It is important to “care,” truly, for our patients, for our profession, and for how we practice, teach, learn, lead, and live. And too, of course, for our families and those we love, and too others. It is part of aspiring to do good. And, I try to live in the present and savor the moment, mindful of the story of the rabbinic sage who, when asked about the most important thing he ever did, wisely replied that it was what he was doing now.
Running has helped me understand and live that.
Author’s Note
Some of the ideas for this reminiscence were derived from “Runners”, by Roger Hart, Runner’s World, April 2003, pp 74–8.
