Lessons Learned from 10 Years of Boston Marathon Medical Volunteering

Believe it or not, April 17th, 2023 will be my 10th year volunteering as a medical staff member at the finish line of the Boston Marathon. It also happens to be the 10-year anniversary of the 2013 Boston Marathon bombings. I’ve learned a lot of lessons in those 10 years and I’m here to share a handful of them.

#1:  Hill management.

Heartbreak Hill, near mile 20, gets a lot of coverage as the toughest part of the course. This half mile steep uphill climb comes late in the course when cardiovascular and muscular fatigue are high. However, part of the challenge of this climb actually comes from the hills before it. Around miles 16, 18, and 19, there are three other shorter, challenging hills to climb, so by the time you begin the Heartbreak Hill ascent, your quads, calves, and glutes are already burning.

Nearing the top of Heartbreak Hill. Courtesy of: Mark Connor

All good and bad things must come to an end, and so does Heartbreak Hill. Or so it seems. Because beginning at the very top of the hill, the next 3 miles are almost entirely downhill. So on the one hand, you can catch your breath and allow your cardiovascular system to recover. But on the other, your quads must still work exceptionally hard to get you safely down the hill. Keep in mind that eccentric muscular contractions (contracting and lengthening, i.e. running downhill) are more physically taxing on muscles than concentric contractions (contracting and shortening, i.e. running uphill). To help you climb hills more efficiently, focus on taking shorter, choppier steps. This will increase your cadence and reduce the muscular demand on the legs with each step. Let’s hope all your hill training and strength work will pay off!

#2: Prioritizing safety.

At the 2021 Boston Marathon, I was assigned to the medical ICU (intensive care unit) at one of the finish line medical tents. This was an exceptionally interesting year of volunteering; the runners sent to the ICU were often in rough shape, with several being sent from the ICU via ambulance to the hospital.

I treated one man I’ll never forget. Let’s call him Tim. Tim was a 45-year-old male with a wife and two young kids at home. He crossed the finish line with a personal best of 2:46:00, an exceptionally fast marathon. He was extremely proud of himself (and deservedly so). Tim was directed to the ICU because he had developed moderately severe chest pain at mile six. Yes, you read that right. Despite having CHEST PAIN, which is often cardiac related, he finished the race. He ran for another two hours and 20 miles…

After the team thoroughly assessed him and got several EKGs, he was diagnosed with a previously undiagnosed cardiac arrythmia. He got lucky; his arrythmia (atrial fibrillation) didn’t cause any lasting damage or immediate cardiac arrest, but it very easily could have. I got to speak with him extensively and we discussed whether running through 2 hours of intense chest pain was worth it. His answer changed initially from a clear “Hell yeah! I just got a new PR!” to “Wow, I nearly left my wife and kids behind. That was pretty stupid.”

It turns out that Tim had had some chest discomfort warning signs on his longer training runs leading up to the race, especially when running at a faster pace, but it apparently wasn’t “bad enough” to warrant a trip to his cardiologist. He got lucky. He may not get lucky again, and neither might you. The lesson here: if something doesn’t feel right, get it checked out.

#3: Believing in community.

You may or may not know that I was about 50 yards from the first bombing at the finish line of the 2013 Boston Marathon. I spent my afternoon that day providing wound care and tying makeshift tourniquets to freshly amputated limbs. It was a day that changed my life.

One of the side effects of 2013’s terrorist attack was the enormous sense of community that permeated throughout both the city and the country. Even Yankees players spoke of being Boston Strong! Locals supported each other in a way that initially felt a bit out-of-place for New England’s rugged character.

Running is near and dear to my heart today, largely because of the Boston Marathon. Whether you run, play soccer, dance, or participate in any other sort of physical activity, there is sure to be a local community to support you. If and when you need a hand, the community is there to help. Don’t be afraid to ask for help. Life is short! Here’s to another 10 years of volunteering!