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france

paris marathon: a musical in three parts

There are things you just don’t do. You don’t put metal in a microwave. Never drink a Coke and eat Pop Rocks. Forget about feeding Gremlins after midnight. And absolutely don’t arrive 36 hours before a marathon in another country.

For those of playing along, that’s called foreshadowing.

J’arrive

I arrived in Paris around noon on Friday. Paris in the Spring is, well, Paris in the Spring. There’s a reason there are songs, movies and expressions about the Parisian springtime (granted, they are mostly in French, but trust me).

Everything is a lovely shade of pale greens and pinks and white blossoms. The willows by the Seine shed the chaff of their buds in a blizzard of light wisps. Couples canoodle, dogs trot a little lighter in their steps and rosé wine appears on outdoor tables.

I dropped my stuff at my hotel. After a stroll around les Jardin des Tuileries I turned my aim back towards the 6eme. Saint-Germain-des-Prés is my adopted home in Paris. I know its winding streets and juxtaposed upscale-meets-bohemian character as well as I know my neighborhood in Richmond. Saint Germain is also home to what I consider to be the best Irish bar outside Dublin. I had bite and a pint or three and called it an early night.

legumes

Saturday

The race expo was huge; think Atlanta airport, but full of runners. And that’s no surprise. 50,000 lean, mean, quick stepping machines signed up to run the 42.25km course. Part of the process involved handing over a signed medical form from your doctor. There was some nuances lost in the translation of the form, and indeed the process itself. American physicians, short of approving kids for school sports, aren’t accustomed to filling these things out. My trepidation about my form’s validity were assuaged when a young volunteer traded my form for a race bib.

I wonder why there’s a foam rubber sponge in the race bag? Welp, won’t be needing that…

expo

I picked up a few souvenirs and headed back towards the heart of town. The expo was held at one of the city’s large convention centers, a few metro trains and a bit of a walk from my hotel. Paris is known for being a walking city, which is great when you are working off that baguette and patê; not so great when you are attempting to save every joule of energy in your legs.

That evening, I went to the restaurant on the first floor of the building I once called home. Aux Charpentiers is a venerated, traditional restaurant in the 6eme. The waiter and chef were obliging to my request for a vegan meal, although I’m fairly sure the laughing I heard in the kitchen was at my expense. Would monsieur care for a glass of wine? Why yes, monsieur certainly would! One glass won’t hurt my run, right? And hey, this is Paris!

On the stroll back to my hotel, I popped into a bakery and acquired a baguette for the morning’s breakfast. I may have also stopped in for another pint of Guinness. Can’t hurt, right?

pint.

Part 1 - The Champs

Get to bed early, you’re advised. Get a good night’s rest they tell you. Don’t stress about the race, they say. I don’t know who they are, but at 3:00 am, as I lay in bed wide awake, on the morning of Sunday April 6th, I could have strangled them with the shoelaces of my running shoes.

The Marathon de Paris embarks from the famed Champs-Élysées, or as my friend Jarrett calls it, the chomps. I was signed up to run with the 4:00 hour pace group, the largest subdivision of the 50,000 runners expected that morning. I arrived three hours early because, well, I was up.

As it turns out, arriving early was wise. The French extend their liberal views on all things bodily to race-day facilities. In our coral of approximately 15,000 runners, there were two portajohns. Two. 1 + 1 = 2. That was it, for facilities with a closed door. But, for the gents, there was a bank of plastic, portable urinals. Imagine, if you dare, a knee-high plastic trough, facing the hoard of people…well, at this point you should probably stop imagining.

So, there we were. 50,000 new friends, forged in excitement and anticipation of heavy legs, swollen feet and soon-to-be heaving lungs, standing in the morning sun’s shadow of the Arc de Triomphe.

pre-race

The race organizers were apparently smitten enough with a French cover of Mackelmore’s Ceiling Can’t Hold Us to put it on repeat for the morning. For two hours, we listened to Guillaume Lorentz’s version of the jam. The announcers crackled to life. It was time for the pre-race warm up. Like a well heeled squadron of the North Korean army, we pumped our arms into the air, in sync to the beat.

As 9:30 rolled around, our group of 4:00 runners marched towards the start. With the decided lack of ceremony with which every marathon commences, we toed the startling line and were off towards the Place de la Concorde.

Running with The Boss

My plan for the first leg of the race was to queue up an audiobook. Spoken word should keep me slow and out of my own head. I settled in to Peter Carlin’s bio of Bruce Springsteen and started counting steps per minute.

My goal was to start off around 9:30, maybe 9:00 mins / mile. Our hoard snaked past the Concorde monolith and towards rue Rivoli.

Bruce’s first band, Steel Mill, had a huge following in Richmond, Va. Who knew? Apparently it was the only place they got gigs outside of the Jersey shore…

1…2…3. I check my pace, I’m doing a steady 8:30/mile. Too fast, but I feel fine. Hey, what’s the worst that can happen?

Is that a marching band all dressed like Mario and Luigi from Mario Brothers? Yep, apparently it is!

1…2…3

Oh wow! We’re running along side the entire Louvre museum!

At mile 4, we narrow to squeeze past the crowd and into the expansive Place do la Bastille. I’ve heard people say to be careful about running the chicanes in a marathon. Take too many curves too wide and you add up to a quarter mile to your race. In the Bastille’s 500-foot wide roundabout, it’s easy to see how that could happen.

Part 2 - rock out

Paris is flanked on the East and West by two large public parks. At mile 6 we enter the Bois de Vincennes. I’ve had about as much of Bruce’s history as I can take, I’m ready to rock out. When I pull my phone out of my pocket, I see a text from my friend and fitness coach:

Andrew1

I hit shuffle on my Paris Marathon play list.

Top 40 pop helps me turn my feet over faster and faster. Throughout the park, every half mile, there are more preposterously strange musical ensembles. We pass a group dressed like they are ready for a medieval hunting expedition, and they are all playing the french horn. I imagine them, along with the Japanese drum circle, playing along to my mix.

We leave the park around mile 10 and head back towards the city. The course follows the Promenade Plantée, a collection of beautiful shops tucked into the old roman viaducts.

Since Parisian streets can be quite wide, the race directors paint a blue line down the absolute center of the course. It is there, primarily for the elite runners, so they run the shortest, most direct route; a true 42.2km.

I pick up the blue line at mile 10. For a mile, I try and make each step land on the line. Keep on the blue line I tell myself.

I check in on my legs. Feeling ok. But something’s not quite right. I push the idea out of my head.

If you wake up and don’t want to smile…if it takes just a little while…open your eyes and look at the day…you’ll see things in a different way

To take my mind off whatever is creeping in, I decide to focus on the crowd. For everyone with whom I make eye contact, I try and think of something nice about them. Oh how nice, they brought their young kids out to see the runners… For others, it was something like, that’s wonderful, a whole family holding a sign for their dad.

I’m counting on a karmic bonus, and thinking good thoughts has to help, right? Still, you’d be surprised how quickly you run out of nice things and dip into the observations about appearance, those sunglasses look great on her.

At the 20km mark, the Europeans celebrate the race’s halfway point. Now, I’m no mathematician, but 20 is not half of 42.2. I refuse to celebrate their false victory.

A smaller, less ceremonial marker notes the passing of mile 13.1.

Shake-shake-shake-ah-shake it! Shake-shake-shake-ah-shake it! Shake like a Polaroid picture.

Heeeyyy-yaaa! Was that out loud? I think I just sung along out loud!…oh look, there’s the blue line!

Mile 14 has a water stop. The French, ever the ones for elegance and ceremony, don’t hand out cups of water. No, instead they hand out full bottles of French mineral water. With the caps still on. For nutrition, they offer orange slices, banana segments and marshmallows.

Now, at this point, if you are thinking: hey, a full bottle of water and healthy snacks, what’s not to love about that? I offer the following:

water stop

That, dear reader, is what happens when 50,000 water bottles are opened, and orange rinds, banana peels, and marshmallows are cast underfoot over the stretch of a quarter mile of cobblestones. It is, in short, an orthopedic surgeon’s dream come true.

It’s alright if you love me…It’s alright if you don’t….I’m not afraid of you running around, I get the feeling you won’t…

Back around the Bastille. The water is doing it’s job. Bruce’s guitar is slamming and I get a second wind.

I prove it all night…

We’re running along the river again. I’ve lost track of what mile or kilometer we’re passing. I’ve run out of nice things to think about people in the crowd. How much further? Damn-it! It’s too early to think that thought!

En mass, we dip off the main road and down to the footpath along the river. Suddenly the crowd is high above us, looking down from the flood walls and bridges. French race supporters, as I’m learning, are an austere lot. Most don’t smile, or cheer. While there is a non-stop wall of people, only a scant few hold signs, or ring bells.

For the first time, I have a straight shot view of the masses of runners in front of me. This is my tribe, these are my people

When I arrived, in my own set of clothes….I was half a world away….Do not fear what you don’t really know…

We enter one of Paris’s underground tunnels. This one happens to be the longest, almost a mile. After a few seconds, things get pretty dark. I take my headphones out so I can hear the cacophony of feet and moving bodies.

Is that…? Naaaahhh. But wait….I think I do hear something….and there seems to be lights….laser lights in fact… and a disco ball…and….fog?

It is at this point where I start to question things. I cannot see daylight in front or behind me. And yet, the sounds of Abba are growing louder the closer I get to what appears to be a discotheque. And there, in the middle of Paris’s longest traffic tunnel, the one where Princess Diana perished in a horrific car wreck, is a mid-race disco.

What sort of Dali-esque nightmare is this? That is the actual thought crossing my mind. But instead of picturing the real Salvador Dali, I keep seeing Adrian Brody pop into my head.

Dali

At last, up ahead, daylight breaks. We’re out of the tunnel and back on the streets. The Eiffel Tower is in front of us. And that’s when it all comes together.

Tower

Monsieur Lapin!

In french, pacers are called rabbits, or more correctly, les lapins. Rounding a slight curve, I see the 4:00 rabbit. That’s my rabbit! Survivor’s Eye of the Tiger starts playing.

I’m chasing Monsieur Lapin. My pace recovers.

9:25….9:15….9:00…8:50… I’m shoulder to shoulder with Monsieur Lapin.

Rising up…back on the street….did my time, took my chances… I’m air-guitaring for all I’m worth.

Together, we tick off two miles, me and Monsieur Lapin. Mile 17 turns into 18 and 18 into 19. I might just run this race today….

Pas aujourd’hui, Pax aujourd’hui

At mile 21 we enter Paris’s western most park, Bois de Boulogne. Bois de Boulogne is home to Roland Garros Stadium, where the French Open is played. It is also known for its large gathering of transgendered sex workers. And now, it can additionally be known as the site where I hit the wall…hard!

It is a hurting thing…you don’t want to talk about it….pain in your heart, well it’s taking your breath away…

Really, I’m conscious enough to ponder, that’s the song that comes on my iPhone at this moment? Thanks for nothing John Hiatt!

Did I mention my no-fast forward policy? Yeah, I’m regretting some of these song choices now.

We pass a German oom pah band, all in lederhosen, many with a horn in one hand and a glass of Riesling in the other. I kid you not when I say a good number were also holding sausages.

I could be hallucinating.

Mile 22. I’ve slowed to a crawl. I’m trying to put one foot in front of the other. It’s not happening. Not today. pas aujourd’hui.

and I don’t think its weird….that the one thing you fear…is losing the one thing….

I make a pact, a d’accord as the local say. Next water stop, I’m walking. Seriously, not that psych-myself-out-keep-running-BS from the Richmond marathon. This. guy. is. walking!

Why are there still so many people?

1…2…3

Where is that water? Why don’t they drink more water? Why don’t they… and that’s when it hits me. Why don’t they drink electrolytes? There has’t been any Gatorade, no Poweraid, and not a salt-covered pretzel in sight. Where was that oom pah band? Surely they have pretzels. They held out on me!

That’s when I notice runners dipping sponges into buckets of ice water along the course. Where the hell did they get spon…..oh damn it! That’s what the foam rubber sponge was for!

1…2…3

I need water badly. At mile 24 there’s a station. I slow. I stop. I grab two bottles and ask the volunteer to take the caps off. I’m done.

It’s going down…I’m yelling timber….you better move….

I move into a walk-run cycle. I make myself little deals.

If I can get to that lamp post, I’ll walk 100 feet

Andrew2

I couldn’t will my thumbs to reply even if I wanted to. Though, I’m nonetheless grateful for the encouragement.

I start to think about what isn’t working. I keep giving myself permission to fail. Pas aujourd’hui, I tell myself, not today.

Oh where do we begin, the rubble….or our sins….and the walls kept tumbling down….

I start to list off the poor decisions I made. I started too fast. That glass of wine last night, what was I thinking? I regret racing (and setting a PR) in the 10k less than a week before. Absolutely don’t arrive 36 hours before a marathon in another country you bloody idiot!

As we leave the park, Paris is laid out before us. I’m still shoulder to shoulder with 50,000 of my new best friends. Slowing or walking requires darting to the shoulder or grass to avoid being run over. And there’s something different about the crowd. Is that actual cheering?

It is cheering! And its coming from the transgendered community who call the Bois de Boulogne home. They are standing on 8" platform shoes, decked out in Elton John-style sunglasses and they are screaming their heads off.

The blue line! The Blue line is back! I pick my head up and see the Arc de Triomphe in the distance.

through the mud and beer…the blood and the cheers…so if you’ve got the guts mister…if you’ve got the balls….if you think it’s the time, to step to the line….then bring on your wrecking ball!

Pax aujourd’hui

I’m going to run Paris today. I’m going to finish this race. It’s the first time it feels real. I choke up.

I speed up.

1…2…3…

The crowd narrows. More Parisians join in and are cheering. I’m running non-stop. It’s not my ideal pace, but I’m moving forward.

42 km.

I sprint towards the finish with borrowed energy.

I cross the sensor pad and crash into a wall of other finishers. Many, like me, are dripping with tears and sweat. We push and shove. And there’s more effing cobble stones and banana peels. Oh Paris, I love you!

Finisher

Doctors 2.0 & You - Patient Designed Care Recap

If there is a universal language, its words are human feelings and its sentences are shared experiences. Healthcare, the state of being a patient or caring for someone who is a patient, is surely part of that universal language. At some point, each of us will have someone else put their hands on us with helpful, healing intent. Some are lucky enough to have skilled hands they can use deliver care to someone in need. This happens everywhere. It transcends language. So, it was not a surprise when Liza Bernstein told me, during a break at Doctors 2.0 & You, she had immediately felt a bond with other patients from around the world, at the conference.

Doctors 2.0 & You is a conference, anchored in Paris, focuses on future-facing healthcare trends such as mHealth, HCSM and participatory medicine. The conference is an interesting juxtaposition of the setting’s medieval-styled center of Paris’s CIUP and modern healthcare innovations. Perhaps that describes all of Europe.

Untitled

On the first day of the conference, I had the fortune of participating in a panel discussion titled patient designed care. The wording was carefully chosen. We wanted to imply that the next logical step in the evolution of patient-centered care is one which patients will participate in developing.

The Panel

Traditionally, throughout the Western world it seems, healthcare has been delivered paternalistically —a top-down, assumptive approach. We’ve only recently begun using the term patient-centered care to refer to care planning, environments and processes where the patient is at the center. Our panel wanted to share some of the avant-garde trends each of us is seeing and what they portend for patient-designed care.

Meet the panelists

  • Liza Bernstein — Liza is South African by birth, American by residence and French through her education. Liza has a background in design, which she applies critically while thinking about her experience as a three time breast cancer survivor.
  • Kathy Apostilidis — Kathy is from Greece where she participates in many European healthcare policy endeavors. Kathy is also a cancer survivor and a passionate advocate for participatory medicine.
  • Nick Dawson — I live in Richmond, Virginia, USA. My background and education center around hospital administration, specifically finance and strategy.
  • Michael Seres Moderator — Michael, from just north of London, is the 11th person in the UK to receive a bowl transplant. Starting with his blog, he has developed a strong social media presence including connections with his doctors and clinical care team.

What is patient designed care and how is each person advancing it?

Liza

 

Liza spoke about going from being overwhelmed by the healthcare system, "gobbled up by the machine," in her words. As a patient, she had the medical problem, but not a lot of insight into how the medical process would unfold. That led her to think about how she might hack the system to her advantage. 

Liza applied design-thinking to her patient experience. Her goal was to find ways to take back power and choice in places where she felt she had lost both.

After Isolation, Liza says she moved to global engagement: "Twitter and Hashtags became my Gateway Drugs; I found my people, my purpose".

Kathy

 

Kathy spoke about her experiences as a patient in Greece. When she discovered her physicians were not using electronic medical records, she began to take her own notes.

I made my own medical record, which I stored on my computer.

Kathy went on to discuss her passion for policies which help move away from a paternalistic system to a participatory one.

Nick

 

I began by sharing that I don’t identify as an ePatient myself. But my career has been profoundly shaped and influenced by active, engaged patients.

Early HCSM experiences, like fielding patient complaints on twitter, exposed me to ePatients. Those experiences helped move me from a place of designing healthcare services and offerings by assumption to a place of designing though participation.

Michael

 

Michael shared his own experiences while directing the panel as its moderator. For Michael, access to his care team via social media and texting allows him to participate in care planning from anywhere.

What is your vision for the future

Liza

Liza spoke about the need to move away from an approach which pays lip service to patient experience, without providing meaningful impact. To Liza, including patients in the design process would help uncover those areas for deeper impact.

Kathy

Kathy addressed her vision for a more patient-centered European care system. For Kathy, an ideal system would not only exchange data effortlessly, it would allow patients to see and contribute to their own records. We need policies which support this too.

Nick

I’ve been a broken record lately. 2013 is the year of the ePatient. That’s my line. We’re starting to see ePatients involved in the design of care services, care plans and healthcare delivery.

Once someone gets exposed to the idea of including expert patients in the design of healthcare processes and services, its very hard to imagine how it could be any other way.

Conferences like Doctors 2.0 & You and Stanford’s Medicine X are leading the pack with their patients included strategy.

Elsewhere advisory firms, like the one I work for, include ePatients in the design and delivery of work we do for healthcare clients.

From a policy perspective, regulatory and advisory boards like PCORI are promoting and funding patient-identified research efforts.

NOTE: a more personal, objective view of my thoughts on patient-designed care can be found in this companion post.

Michael

Michael helped close the panel by reiterating that his success with his transplant team can serve as a model, anywhere.

And what a fantastic model it is!