My Year Running Through Cancer

My Year Running Through Cancer

Long May You Run 

Like perhaps you do, I have a favorite trail. A trail I love so much it’s almost like a friend. You know it well and you can trust it not to tell your secrets. I have run this trail so many times that I know every nuance. The trail is actually meant for horses, but the running community seems to utilize it more than equestrians. It is packed dirt, the perfect running surface, the perfect length, three miles out, three miles back. I know this trail as well as I know the map of veins on the back of my hands. It is mainly a flat and featureless trail, but I know where each of the subtle dips and rises are located. I know where the best views of the Rocky River are; where you are most likely to spot a stately heron stalking for fish or a snowy white egret with a bright yellow beak. I also know where the rocks underfoot are and where it is likely to be soft and muddy.

I love the trail; I love the soft surface, the earthy smell of the shale, the high ancient cliffs that rise above it. I love how the river changes, sometimes subtly, sometimes severely, as though it were a living thing. I find a certain thrill when I run next to the river when it is high and rushing like a torrent, but I also enjoy it when the water level is low and the river moves sluggishly too. I even enjoy running under the two bridges that span it. The bridges are a study in contrasts. One bridge is old, white, stately. The other is a modern highway bridge, a pale blue-green, functional, but not beautiful. I always sprint under the bridges, the sound of traffic far overhead urging me not to dally too long.

I even love running through the mud, the smell of the earth, the water and grime streaked on my legs. I like the looks I get, you know the look, crazy runner, the feeling of being hardcore. I occasionally will jump in a mud puddle, just to feel the water and muck splash up onto my legs.

I’ve had good, glorious days on this trail. I’ve also had terrible days that I would as soon forget. You see, this is where I not only run, this is where I find solace, where I go when I need to escape.

At the end of January into the beginning of 2007, I was desperately in need of place to escape.

My tale of cancer diagnosis is a cautionary one for runners who think just because they are runners, they are automatically immune and immortal to illness and to disease. My problems began in November 2005, right after I received my bar exam results. (I like to joke that passing the bar and officially joining the legal profession made me sick!) The first warning sign was I noticed I was struggling on my runs. Nothing specific, but I’d get out of breath a little easier. Then I developed a very slight cough, so trivial I thought it must be acid reflux or allergies. Soon thereafter, I started having periodic flu-like bouts. They would last a few days and I’d sometimes run a very mild fever, have some mild night sweats (never drenching), feel malaise, and have aches in my jaws and back. The symptoms would start like clock work at 4:00 PM, worsen at night, last a few days, then depart as mysteriously and rapidly as they appeared.

Lacking much in the way of health insurance, I chose to ignore the symptoms. I figured my wisdom teeth were the insidious culprits as I knew there were impacted. Perhaps they were trying to come in, perhaps they were a little inflamed or infected.

Then Lumpy appeared.

Yes, I named it.

In February 2006, I woke up and discovered the left side of my abdomen from under my ribs down to my hip bone was rock hard. It didn’t stick out, the region was just hard. Since it was such a large area, and my stomach didn’t hurt or anything, I was baffled. A hernia? Could it be my abdominal muscles? I have scoliosis in my back, and I figured it was quite possible the abdominal muscles were developing more on that side more than the other. I figured it would probably just go away.

The flu-like bouts continued and I started to have annoying itching on my chest and right side. I continued running mega-mileage, and I continued thinking I was fine, even if my heart rate seemed really high for a long distance runner. All of the symptoms and signs were subtle. I always figured if you had a disease like cancer, it would be strikingly and ridiculously obvious. The entire time, I never felt much worse than I did during a cold — in fact, I’d say a cold made me feel more ill than cancer.

Finally, in November 2006, I developed a severe and intense pain in my right elbow and shoulder. The pain did not get better; in fact, it slowly got worse. In January 2007, I saw my primary care doctor about the elbow pain. Almost as an aside, I mentioned Lumpy.

Lumpy struck my primary care doctor as abnormal so he sent me for a CT scan. I eventually had CT scans of my abdomen, pelvis, chest, and brain. They showed massive lymphadenopathy in the abdomen, chest, and around the collar bones. When I got my hands on the actual CT reports, I knew I was in trouble. “Supraclavicular Lymphadenopathy.” I Googled the strange term. All the medical journals I read stated that these were the sentinel nodes and 95% of the time if they are enlarged, you’re in deep trouble.

I saw a surgeon at the Cleveland Clinic. He thought I had Fibrolamellar Hepatocellular Carcinoma, rare liver cancer. He sent me for a biopsy to confirm.

I Googled Fibrolamellar Hepatocellular Carcinoma. The pertinent information could be distilled down to, maybe a year, at most eighteen months. Given how advanced my disease was, I would not even have that long. For a very long seven days, I thought I was going to die.

Of course, any of us can leave this earth at any moment, but, well, this was different. This was a mathematical certainty, this was a sentence. I didn’t want to say anything until I knew for sure — but I did all the things you would think you would do if you found out your time was severely limited. I planned all these things I was going to try and do before I got really sick.

Every time the phone rang, my heart stopped and I think I probably died a little bit. On the morning of February 14th, Valentine’s Day, at around 11:30 AM the liver surgeon called and told me I did not have liver cancer. Instead, I had Hodgkin’s Disease. He said I no longer needed his services — Hodgkin’s Disease is not treated surgically — and politely wished me well.

Hodgkin’s Disease? You guessed it — back to Google. My eyes seized upon the words often curable. In a short conversation I went from a year to, well, maybe I have fifty left. Of course that chance for 50 years came with the catch that to get the chance, I had to do 8 months of pretty nasty chemotherapy.

My father called his oncologist (my father had Non-Hodgkin’s lymphoma two years prior to my diagnosis with Hodgkin’s Disease) and the doctor agreed to see me the next afternoon.

I don’t remember much more about February 14, 2007, that day everything in my whole changed, what and how I exactly felt, but I do remember going out running, out on my trail that was covered with a thick and heavy white blanket of two feet of snow. I did not get very far (snow is very difficult to run through), but I can remember standing about a mile out, my breath appearing as thick clouds of white steam in the bitter air, and saying out loud, “Why me?!?” When it snows, the world becomes very silent and still. And so I guess I shouldn’t have been surprised when there was no answer, no answer at all. Not even a bird chirp disturbed the silence.

My string of good luck — can you imagine having a rare cancer like Hodgkin’s Disease and considering yourself as having good luck? — continued. I hit the jackpot with my oncologist. Dr. Spiro is a short, wiry man who always dresses impeccably. He has the build of a runner, with thick black hair and years of expertise in the field of causing tumors to self-destruct. From the start, he exuded calm confidence and dignity. He has an Australian accent and a slightly dry sense of humor. He proved over and over to be smart, dedicated, a good sport, and generous with his time. But the reason I really liked him from the very beginning was that he too was a runner, and a good runner at that. Cool, I thought, someone who at least can understand my lifestyle and if nothing else at least we have running in common.

In the intervening twenty-four hours between the time my father called and my appointment, Dr. S had come up with a treatment plan for me and had even scheduled all the necessary staging tests. It took me a little aback because I was still struggling mightily to come to terms with the diagnosis. Uh, this is real, this is happening to me. Not to someone else. This is my reality now. I think that’s the first time reality started replacing denial. I needed some time to digest all this. By profession I’m a lawyer, and lawyers are not exactly the types who like to leap before we fully investigate every little possibility about where we might land. Twenty-four hours was not enough time to go from you are going to die in six months to a year to you are going to spend the next eight months doing chemotherapy.

The problem was, which I now realize fully looking back, was that time was not something I had a lot of. My blood had been depleted of hemoglobin — that little iron-based protein that carries oxygen around your body. I was ridiculously anemic and I had the beginnings of SVC syndrome — a swollen right arm and face because the masses in my chest were literally crushing the vein that drained the blood from my head. I may not have had inoperable liver cancer, but I was still in hot water.

Nevertheless, after telling me my course would be eight cycles of ABVD chemotherapy and listening to the long litany of terrible possible side effects, I extracted the absolutely essential information from my oncologist — to wit, that he did not care if I wanted to try and run while undergoing chemotherapy — and I literally left his office and went running.

(I am still not sure Dr. S knows quite what to make of me and I’m sure the fact that I’m by education a lawyer doesn’t help much.)

I was overwhelmed, frightened, angry, and confused. As usual, a run helped clear my head. Since college, I had been using long runs to figure out things. I have written numerous papers and legal documents in my head while out on the trail. So of course, I tried to figure out how to deal with this whole cancer ordeal on the trail too.

Running has taught me many things: how to struggle, how to dedicate myself to a single purpose and task. Running has taught me resolve, and dedication. On many a hard run, I found myself needing to push through, and I had to dig down deep to find the energy and the spirit to keep going. Running made my lungs strong and my heart powerful. I didn’t know it yet, but running had given me the tools necessary to survive cancer. But I was going to test those tools to the maximum in the coming months struggle. Cancer would not only be a test of the physical body, but of the soul and of my will and character. Fortunately, running had given me both a strong body and a strong soul.

One thing was certain. I knew if I was going to survive, I’d have to keep running. I knew it instinctively. It was as though running was as essential as breathing. Life is nothing without passion; I have two real, true passions, Civil War history and running. Those two things make life worth living. And so I decided no matter what I was going to try and run even through chemo. The day before my first chemo, a surgeon was placing a port — a central line device used to spare your veins from being burned by the noxious chemicals and poisons — in my chest. My chest masses were so immense that the surgeon didn’t think he could manage to squeeze the port in amongst the enlarged lymph nodes. We should put it in your leg, he said. This would mean no running for the duration. I was staring at the daunting prospect of eight months of chemo. Eight months with no running? I said no way. I’d rather be burned inside out than not be able to run. The surgeon, a tri-athlete himself who I think understood why I needed to at least maintain the illusion that I was going to run my way through this mess, found a way to fit the little metal disk into my chest.

The running obsession was a bit, well, absurd. But it became how I coped. My life had quickly taken on the quality of a Salvador Dali painting — running was just one more little absurdity. (The absurdity of the whole darn year was driven home by the Indians home opener — which was snowed out after the grounds crew tried to clear the field of snow with leaf blowers.)

At first, I found running almost impossible. Chemo further depleted my blood of hemoglobin. My counts had already been ravaged by cancer. The first week after chemo, I was dizzy and my heart raced. I could hear it when I tried to sleep at night, thudding in my ears. Still, I would go out and jog around the block a few times. Going out after chemo to run was very hard, particularly because it was very cold and the streets were covered in snow and ice. I stuck to my neighborhood. I was too dizzy to drive to my trail and far too weak to even think of attempting the large hills I’d have to run up and down to get there from my house.

I went to Gettysburg over St. Patrick’s Day weekend and I started to then notice a real improvement. I was breathing better. My spirits started to rise as I toured the battlefield — then covered in a heavy cloak of thick white snow from a rare late winter March snowstorm. Watching the sun go down behind Seminary Ridge, having flirted with death, I felt I finally understood what Chamberlain had meant when he said that visiting the battlefield was “a transcendental experience, a radiant fellowship of the fallen.”

(2007 seemed to be the year of snowstorms on holidays, first Valentine’s Day, then St. Patrick’s Day, and finally Easter in April.)

Eventually the snow melted. And so, amazingly, did my masses. It was really astonishing to watch Lumpy shrink and to feel my abdomen become softer. And my blood counts actually started to improve too as the disease was knocked into submission. I went back to the trail. I watched it slowly come alive and turn green. I marveled at the little, delicate flowers that peppered the ground with white, pink, purple. I was blessed a few times to see a doe with a brand new, spindly legged fawn, still covered in spots. The birds returned.

Spring eventually softened into summer. The air became warmer and thicker, the days much longer. And my trail became something like a tunnel cut through a jungle canopy, a ribbon of dirt through a heavy curtain of bright jades and greens.

Having Hodgkin’s Disease was still oddly interesting and I found it exciting to pore over research. Chemo too was still something of a novelty. I was surprised that life basically went on — I practiced law part-time, I wedged in many good runs around treatment. Then the ultimate good news. Remission. It came at the end of May, three cycles into chemotherapy. My masses were still there, but they didn’t light up anymore, which suggested they were just dead tissue. Things were going well. That’s perhaps why it caught me so off guard when things suddenly and drastically changed.

Cancer is a terrible disease. It rarely slays it’s victims quickly and mercifully, but cancer rather slowly and insidiously drains them of their life. As a student of Civil War history, I think cancer is akin to the 1864 Overland Campaign. Grant versus Lee. No matter how many times Lee would side step him and even win a battle, Grant would simply keep pushing on until he finally cornered Lee and bled and starved him to death through the siege at Petersburg. Cancer is a foe like Grant — relentless, unavoidable, unforgiving. (Those of you well versed in history are no doubt noting the irony that Grant himself died of inoperable throat cancer.)

Although my cancer was considered beatable, even my conservative oncologist dared say the goal was cure, the treatment seemed almost worse than the disease. And even if my body was not dying, it felt like my life was disappearing under a ruthless assault of chemotherapy.

As I have alluded to, I have Hodgkin’s Disease. Hodgkin’s Disease is considered a curable cancer. This leads some people to conclude that it is a “good cancer.” Let me tell you, there is nothing “good” about Hodgkin’s Disease. While it may not take victims in the same numbers that other cancers do, it remains a prodigious killer. Untreated or unsuccessfully treated, Hodgkin’s Disease carries the same grim and dismal prognosis of any other cancer. Further, treatment for Hodgkin’s Disease is far from easy or “good“ — whatever that means. My treatment course of eight months worth of chemotherapy would leave my right lung scarred, upped my risk for a secondary cancer significantly, left my heart at risk for problems, and ravaged the nerves in my hands.

Chemotherapy is hard. The terrible thing about chemo is the drugs don’t just target the bad cells. No. Unfortunately, chemo is not a smart weapon, it does not know enough to make just a targeted attack on the bad cells that are dividing out of control. Chemo is a poison and it kills indiscriminately, targeting good cells and bad ones alike. Chemo therefore causes lots of collateral damage: to your hair, to the lining of your stomach, to your skin. It can cause so much other damage — even occasionally other cancers, a future leukemia is a possibility for Hodgkin’s survivors, for example — that you may end up with the equivalent of a Pyrrhic victory.

(Chemo is especially hard, I think, for an athlete. We take pride in the strength of our bodies, we are extra careful what we put into them. To be poisoned systematically is especially hard for us.)

As I said, at first this whole cancer thing was novel — in a hideous and twisted sort of way. It was kind of strangely fascinating to have a rare cancer like Hodgkin’s Disease and so everything was new and different and intriguing. By the midway point through chemotherapy, the novelty had all worn off. Eight months no longer seemed like just a long time, it now seemed impossible and interminable. And thus midway through chemo and without warning, one by one, like the last leaves of autumn falling off the trees, I suddenly found myself losing pieces of my identity to that sinister beast, cancer.

As a runner, you have probably reached a point on a long run or perhaps in a marathon where suddenly the tide turns against you. The adrenaline has worn off, and you realize you have come a long way and you are starting to get tired, but there is still a very, very long way to go. That is how I suddenly started to feel. I woke up one day and just felt exhausted.

The most frustrating and difficult part was the constant two-week infusions. My chemotherapy regimen consisted of a 28 day cycle with infusions on day one and fifteen. It began with a drug infusion that blended seamlessly into a few days of sickness. I would be so sick for a few days following chemotherapy that I could barely stumble out of bed. I would then slowly improve so that by the time the two weeks were up and we were back at day fifteen, I felt almost well and healthy and that made me dread the return to chemotherapy all the more. In a way, it was nice not to be sick the whole time. But at the same time, it was also dreadfully cruel to feel as though I was returning to health just to get thrown back again.

I always thought as a Civil War buff that what was astonishing about the soldiers who charged into the face of certain death with such dash and with such valiance wasn’t that they just did it once without exactly knowing what would happen. No, what struck me was that they would heroically throw themselves into the smoking cauldron again and again, knowing exactly what could happen to them, knowing they could be killed or horribly maimed. That was the quality I most admired in them. I now understood why the ability to go back into Hell seemed so awe-inspiring. I think anyone could do one chemotherapy session. But to keep going back over and over again, that was a completely different kind of trial of the body and the spirit.

The two-week cycles began to take their toll. Chemo tends to rip away your identity and leave you in tatters and pieces — I quickly reached the point where I knew I could not practice law for much longer because I was just too tired mentally. I was losing weight. Nothing tasted good and I just simply had no desire to eat. I had a headache, I was nauseated, I would suddenly break out in fits of painful hiccups. My sweat smelled like chemicals (though fortunately only I and the biting bugs seemed to notice). I had a tan from being outside so much, but my face was as white as a sheet. And swollen. My face was constantly puffy, as though I had just gone a few rounds in a fight. And my hair. It was thinning. I was lucky. It never all fell out as Dr. S promised (I think it may have tenaciously hung on just to spite him), but I lost it in little bits, a few strands at a time. I was afraid to run a brush through it or even to wash it because the hairs seemed so fragile. Psychologically, I was a mess — I was by turns depressed and then very angry.

And then cancer dared to attack the one thing that had up to this point allowed me to remain a part of the world. Cancer started to assail my running. I would push myself out the door through the hazy tiredness, but I found myself getting breathless very fast when I tried to run. It was a chilling omen.

Educated as an attorney, I was once paid to make fervent appeals and ardent arguments for my clients. So maybe that’s why in my mind I mustered up my best arguments and advocated passionately against this unreasonable, heartless, callous opponent. Please do not take running. I’m a reasonable person, sir, I will gladly bargain with you so we can negotiate a reasonable settlement that is amenable to both parties. You can take my hair, you can have my job, you can even have my hope for the future. I will concede them all. But, you hideous beast, you can not have running. Please not running. I draw the line there, sir, I will not concede that to you.

The insidious culprit in my decrease in exercise tolerance was Bleomycin. Bleomycin is a drug used in Hodgkin’s Disease that is notorious for causing pulmonary problems. Soon after I started noticing it was harder to run I developed severe right-sided chest pain and shortness of breath.

And with frightening alacrity, a once proud runner who posted mileage that would make a long distance truck driver envious found herself unable to run three miles continuously without stopping to gasp and walk.

For the first time since the beginning of treatment, I considered stopping. Just stopping. Like that. Just not going back for any more treatment. I was at a fork in the road, and it was time to choose — go quietly into the night, or make a stand. For the time being, I kept going, but with each passing treatment, things were not getting better, they were progressively getting worse.

What was I going to do? X-rays showed my right lung filled up with blood and pus from Bleomycin damage, and even after discontinuing the drug (which is very commonly done to prevent further problems), I struggled for a long time to even walk up the steep stairs in my old Colonial house without wheezing.

I’m not sure why I kept running. Or rather I should say kept trying to run because by this point I was no longer really running. I suppose I desperately wanted to cling to an essential piece of my identity. I had no business running, but I just couldn’t let go of it. It was the one activity I had that made me feel normal and alive and like I was still a part of the world.

(When you have cancer, you see, it seems like the entire world seems to keep going at it’s normal pace, while you are left behind. You cannot really live while undergoing chemo, you just try and exist. You try to make it from treatment to treatment. You try not to think too far ahead. It is like when you try 20 miles for the first time. Think about how far 20 miles is, and you will fail because the distance seems so intimidating. It is the same with cancer.)

Running requires a lot of breathing, of course, and since I couldn’t do that essential activity very well, it became a massive struggle. I spent a lot of time stopped on the side of the road or on the trail, bent over, grabbing my knees, wondering if my heart was going to leap out of my throat onto the ground in front of me. I found the mental image of my heart lying next to me darkly humorous.

Dark humor or not, I looked — and felt — like a poser. I was just pretending to be a runner. I was once a runner. I wasn’t one now. I seriously wondered if I would ever be able to run again. All I could do now was jog at a ridiculously slow pace for a few minutes, then stand breathless by the side of the trail. When another runner passed me walking or crawling along the ground pathetically, I wanted to scream “I WAS A RUNNER ONCE, TOO!”

For whatever reason, one morning during this dark phase I decided I’d run for forty minutes — previously an easy amount. Twenty out, twenty back. Four miles out on my trail. Give or take. Easy. No pressure. Done it a million times. It was a warm, overcast day, and the air was thick. Two minutes into the run, I was in trouble. My chest hurt, I was breathing heavily. So I slowed down. It felt like someone had put a very large stone on my chest. I slowed down some more. The entire right side of my chest burned and stung. It felt like I was sucking in volcanic air. No, this time I’m not stopping, I told myself. Work through it, run through it, stay tough, you have to be willing to suffer some. Runners suffer for their sport, you can do this, be tough. No amount of self talk would change matters. I stumbled to a stop. I knelt on one knee, the other planted in the dirt. I coughed and drops of crimson congealed into a black puddle in the dirt of my trail next to my left knee. The coughing released the pressure in my chest; I felt better.

A runner passed me and I saw the sympathy on his face. I think he thought I was probably throwing up from exertion or from the heat, and I could tell he didn’t know whether he should stop and try to help me somehow, but I waved him on. Sure I’m ok, I thought. Just a little blood. No big deal. Except it was actually quite a bit of blood.

Cancer had brought me literally to my knees.

I stood up and my hands were shaking. I had to kneel down again. The pain in my chest became intense again, and I started thinking, I’m a mile from my car or more, how am I going to get back? I consider myself fairly strong, but the pain in my chest and the frustration made tears well up in my eyes and I had to keep brushing them away. Then they started to stream down my face and I could taste the salt. I wished I had my dark sunglasses on so I could hide from the curious looks from an occasional passerby. There was some blood on my shirt and my mouth tasted metallic and terrible.

I had to literally crawl part of the way back to my car and it was a good half an hour sitting in it with the air conditioning blasting before I was able to go home. Driving over the bridge that spanned the valley near the hospital, I found myself seriously considering pulling over, getting out of the car, and simply jumping off the bridge. It seemed so easy, and I was that deeply depressed and despondent. But I thought of all the people pulling for me — my running friends, Civil War friends, my family, my doctor, my nurses, and then I felt ashamed for even allowing that blackest fleeting thought to pass through my mind.

That didn’t mean I was totally rational, though. Terrified my doctor might finally put an end to this running game I was playing, that he might implicate running as the culprit, I didn’t go to the emergency room and I never mentioned that I coughed up a very large amount of blood on the trail.

I now had to make a decision. I would not take the Roman way out, would not end this battle directly myself, but what about continuing treatment? Treatment was clearly working; I was in remission. But never before in my life had I felt like giving up more. Several times I dialed the cancer center number, prepared to ask for Dr. S to tell him I was done, to thank him for helping me, but that I just wasn’t tough enough to continue. I even rehearsed what I would say in my head. Each time something stopped me, but the terrible questions kept running through my head: What was the point of recovering from Hodgkin’s Disease if I couldn’t run anymore? If I was going to always get winded walking up my stairs? Is it worth being alive if your chest is going to constantly hurt and you are going to be left gasping for air like a fish out of water? Did I even care anymore? It was 2 A.M. and the Titanic was going down very, very fast. Only one time in this whole horrible journey had I felt like giving up this much, and that was the day after the first treatment when I was so sick to my stomach I could not even crawl out of my bed. That time, I had placed my faith in my doctors and they made sure it never happened again. I decided that I would put my faith in them again, that I would take them at their word that this would probably improve. I was going to make a stand, I was not going off quietly into the night. Dr. Hodgkin’s, your disease picked on the wrong person.

I have to think the tenacity learned on a hard run is what got me through. I think that must be what stopped me from quitting chemotherapy.

I know now it was probably a little dangerous what I did, elevating running to such a high point of status in my life. I had always been a runner, but never before had my life actually hinged upon my running. Running had become more than an activity. Running was now a symbol.

Part of my bargain with myself to keep going with chemo was to keep trying to run. If I couldn’t run continuously, fine. I would swallow my pride and run like a beginner. I refused to give up. The next day, stubborn as always, I was back out again on my trail, jogging a few yards, walking a few, jogging, walking, jogging. Although I had some pretty poor runs after that, I never coughed up blood again. Soon after that incident, my lungs started to heal from the Bleo assault, and I was able to start really running again. My pace gradually improved. The number of chemo treatments dwindled into the single digits. Then I could count them on one hand.

By late summer, my mileage had picked up. And my pride came back. Waiting to see my doctor, he spotted me from the hallway through the open door, and casually asked me how many miles I had ran that week. Fifty, I said with pride, and laughed when he nearly spat out his water. My signature sign off became, I ran so much, my oncologist did a spit take.

I finished chemo in September. Within a few weeks of chemo ending, I noticed that I was running fast and it felt easy. I also noticed that my trail started to change again. Now the days were getting noticeably shorter, the angle of the sun was changing, becoming lower in the sky. And soon my trail blossomed into a sea of splendid bright golds and fiery crimsons. It was so beautiful, that it would take your breath away to see it. No picture, no poet could do it proper justice.

I took another trip to Gettysburg. As my spring trip was ridiculously cold and snowy, this trip in mid-October was incredibly hot. It was 90 degrees plus the entire trip. But I couldn’t help but notice how easily I could scramble to the top of the ancient steel war department towers. And how I could trot up the steep hills without gasping for air.

Fall turned into winter. In Cleveland, November is the change over month. November may be the most gray month of the year. It seems like the sun never shines during November. Of course, that’s an exaggeration, but still. One starts to run out of ways to describe the color of the sky: battleship, steel, iron, sooty, silver, ashen, dismal, smoky, powdered, leaden .. all synonyms or adjectives to describe that extremely dull color: gray.

The trees turned late my year with cancer; some of the trees desperately hung onto their burnished golds and fiery scarlets well into November, but soon most of the leaves were on the ground. The decaying leaves gave the air a certain earthy fragrance. They made a soft carpet to run on, even adding cushioning to the hardest concrete sidewalks.

Fall then turned into winter, and now winter is ending.

I’m back running the volume I was running when I was diagnosed. I feel strong as I fly down my favorite trail. I no longer struggle to shuffle down the path, I no longer have to stop every few yards to gasp. I run with my head up, confident.

Sometimes I run and I forget that I am running and suddenly realize I’m a lot further along than I thought. Other days are a struggle, though I almost always feel better for having run. Still other days I seem hyper aware of my surroundings; I become extra aware of every tiny little detail: from the wildlife to the mottled green, gold, and red colors on the leaves under my feet. It’s not just sight either, but the smells — the wafting scent of breakfast or burning leaves or a fireplace. And sound — the crunch of gravel underfoot, the soft padding over the leaves, the squish and squeak of a well worn pair of running shoes, the sound of cars and the wind whistling past my ears.

For me, I think running fulfills some sort of strange psychological need to feel invincible. If I can run miles and miles, then I cannot be that sick. I desperately want to feel and be normal. Cancer has shaken up everything about my life. Think of the United States before the Civil War and then after. The gulf between 1861 and 1865 is absolutely immense. That’s the type of rift in your life cancer creates.

Having cancer at any time is hard, but it is especially hard to have it when you’re young. You’re supposed to have your life ahead of you at 26. You’re supposed to be looking for a mate and starting your career. You’re not supposed to be sick. You’re not supposed to be known so well in the radiology department at the hospital that the tech at the desk casually says “Oh hi Jennifer” when you walk in the door. You’re not supposed to be worried about what if your life was meaningless ’cause you haven’t done half the stuff you thought you’d do. You’re not supposed to be contemplating death.

(Oh sure, people in their mid-20s die. But its usually a sudden, unexpected event. No one is REALLY thinking about dying when they are 26. That’s just not how it is supposed to be.)

Through all the turmoil, running has remained a constant. The mere activity of going out to pound out some miles has sometimes been the only sign of safe harbor in an otherwise stormy and uncontrolled sea. When the whole world seemed to come crashing down around my ears, at least I could hang on to running. Through this struggle, I’ve gone through a couple periods where running was darned near impossible, but I still felt like I had to try. Even if I could only jog a minute or two and then walk and repeat over and over again while crying because my chest hurt so much, I had to do it. It was necessary in a way I cannot describe and I do not think anyone can fully comprehend or totally understand.

(Oh and of course, I still especially enjoy splashing through the mud.)

There have been scares. My end of treatment scan wasn’t the best, and as my doctor notes, my case keeps him up at night. But I’m not unique, for every cancer survivor lives with this fear in the back of their mind. Relapse dangles over our heads like the Sword of Damocles. You try to drown it out with other activities and thoughts, but it is always there. But while that incessant whisper is part curse, it is also part blessing. I once took running for granted as something that would always be there. Now I know it can’t be taken for granted.It makes me love running all the more. I love it even when it hurts, even when it does not go well.

My lungs, especially the right one, are not the same as they were prior to chemo. The right one is filled with ground glass opacities, and although I have not had a pulmonary function test since mid-chemo, I am guessing I am still not where I was prior to beginning treatment.

But in war, there are casualties. So, I won’t ever be an elite runner. I probably never would have gotten close anyway. And I would rather run for fifty years than be an elite runner for a short period. I’m in this for the long haul.

People say having cancer changes things and how you look at life. It does. When I tell people this, many ask me to impart the wisdom gleaned from the experience of being diagnosed with cancer in my mid-20s and undergoing almost a year of chemotherapy. At a loss for what to tell people, I finally drafted this. This is how you should live your life, so when it ends, people can say this about you:

The flame within you, your spirit that spurred you to exist so ardently, will always burn bright. And although when you took your last breath you indeed vanished from this earth and shuffled off this mortal coil, that smoldering ember within you refused to be quenched. And so your spirit will blaze forever in the memories of those who knew you, for the strength and power of the human spirit is mightier than all the armies of the world.

And I think that is the way you should live your life, whether your time on this earth is set at only a few days or for seventy more years.

I sometimes think my body betrayed me. Yet, having cancer has taught me that in the end we are not judged by what are bodies do, but by the deeds of our souls — by our fortitude, by our resolve, by our struggles, by our patience. I will always be thankful that my experience as a runner has made both my body and soul strong.

I have said that I don’t think I would be alive if I wasn’t a runner. And I believe that. Running taught me innumerable coping skills, it taught me how to suffer, how to not quit when the going becomes tough.

(And personally, although we rarely get to choose the time, method, and place where we shuffle off, as Shakespeare so poetically put it, “this mortal coil” I kind of like to hope when my time comes to leave it will be at a ripe old age, at the end of a glorious trail run. To die at the end of the long run was the fate of Phidippides, the first marathoner. It does not seem like such a bad way to go.)

Every run is a gift, run long and run strong.

Please feel free to write me, and if you think this essay would benefit a runner or even someone just going through chemo, please pass it on. I especially like to hear from running cancer survivors. From this day to the ending of the world, But we in it shall be remembered; We few, we happy few, we band of brothers; For he today that sheds his blood with me, Shall be my brother.

You may also be interested in my blog: Draw the Sword