In Practice: Reflections from NPs and PAs

Charity Maniates, MSPA, MPH, PA-C practices geriatric medicine in Maine.

 

The morning air has a chill, but pockets of early sun stream through the trees, melting on my skin, giving me goosebumps. I shiver and jog slowly to warm up, watching the relaxed runners chatting, pinning on race numbers, and the serious runners alone, earbuds intact, stretching on the grass. “Fifteen minutes to race time!” the announcer voice bellows across the school parking lot. In response, my sympathetic nervous system churns my gut and my heart pounds. Without fail, this sensation overcomes me before every race I’ve run — from the mile to the marathon. Today, I’m running a 5-mile road race with the simple goal of enjoying myself and not focusing on my split times or personal record.

The announcer calls the mass of runners, ranging in age from fourteen to ninety-one, to the starting line. The air feels suddenly stuffy and a strong waft of body odor circles; the heat from cramped bodies feels like a 95-degree day. “On your mark!” The throng of runners pushes to the starting line. The gun pierces the air and bodies spring forward, releasing invisible energy into the atmosphere. Scanning the crowd, I see my two-year-old perched in his father’s arms with his shark slippers peeping out and pacifier bobbing, pointing at me as I run by. Crushed that I did not stop to see him, he cries.

The first mile feels effortless as the runners move and breathe like a school of fish, merging in one direction. By the end of mile two, my pace settles, following the rhythm of my breath, and I resist the urge to follow the few people who pass me. Yet, my racing instinct calculates a strategy to slowly pick off runners who are waning or slowly wear them down by hovering on their heels. My body reminds me that simply holding my pace will be a challenge, as my “training” entailed fumbling out of bed at 4:30 AM to run 3 to 4 miles for the last month. Prior to motherhood, I was much more ambitious — integrating speed workouts or hill repeats, interval training, and long runs on the weekends. For now, the simple process of just running without a strategy is cathartic and satisfying.

In the middle of mile 3, I glimpse a spry older man in his 60s, moving at a good clip just ahead. As a runner, I appreciate his smooth stride, and as a physician assistant, I’m impressed by his strength and fitness in stark contrast to patients his age recovering in rehab, unable to ambulate more than 200 feet daily. I assume that the runner I’m following is healthy because he doesn’t fit the picture of the patients I see. I think about the typical underlying reasons for my patients’ failing health — lifelong tobacco abuse, drug addiction, obesity, and alcoholism, taxing aging bodies that no longer can fight. For others, these factors are not central to their health histories, but diseases root themselves no matter how healthy one appears. One particular patient stands out in my mind — a frail man with advanced Parkinson’s disease and severe dyskinesia leaving him wheelchair-bound. Just 10 years prior to his illness, he had been an avid marathoner and, sadly, was not able to stave off the insidious course of dementia. It strikes me that the fit, older runner I’m trailing could have been a mirror image of my patient during his running days.

I keep my eyes fastened on the nameless older runner as we run the hills and he stays strong, reeling me in with his own steady pace. His gait slows at the last hill and I pass him, and for a moment, in between my labored breath and burning quadriceps, I feel as though I’ve wronged a good friend. Grateful the hills are behind me, I feel the surge of energy propelling my unsteady legs down the backside of the hill with 1 mile to go. This is when my flimsy training regimen falls short, as evidenced by my poor recovery and lack of accelerations. I’m 1/2 mile from the finish and I attempt a push, only to sputter pathetically when I approach an incline and desperately rely on my mental toughness and determination to across the finish line. A cold water is thrust into my hand. I spot the phantom runner walking to his car, looking refreshed, as though he had never run the race.

After cooling down, I scan the final posting times and am struck by the intergenerational aspect of road racing, which is unlike most sports. I have come in 6th for the 40–49 age group, which is a pleasant surprise for me. What is more impressive is the final finisher — a 91-year-old man who frequents the local road-racing circuit, defying the typical path of the aged, committed to moving and breathing until he can no longer.

This year, I entered a new age bracket in both life and road racing, shifting my fitness goals to enhance my future health and simply revel in placing one bunion-clad foot in front of the other on the road, up a mountain, or in the woods. If all goes well in the next 30 years, maybe I’ll be the one to provide inspiration to that tired mother on the race course who just wants to keep moving.