I forgot to mention in yesterday’s entry that when I wrote the date on the first patient’s chart (no EMR) 6-Dec-23 (Honduran way) I realized that it was my late father’s birthday. It was always easy to remember as it was the day before Pearl Harbor day (and my mom’s the day before Valentine’s Day). 

Charities Info: Nuestros Pequenos Hermanos: NPHUS.org  OneWorldSurgery.org

Surprisingly I took no photos before getting to the hospital on Thursday morning but here is a video from my walk to work a few days earlier.

I was scheduled to work in OR 2 again, and as the first scheduled case was a forearm tendon transfer I came in early so I could get all set up and still get to do the infraclavicular block. However, the schedule had changed and my first case was instead just a knee arthroscopy (no block necessary). Dr. Merlin was a little late so it was more like America where I routinely rush to get ready on time just to wait.

The knee scope was on someone who had a total knee replacement at OWS earlier in the year but had persistent pain. There was a small loose piece of tissue that they removed. The next case was the repair of a tibia fracture. The patient was an agricultural laborer who was knocked over by a cow, he was taken to the city hospital but had no way to pay the $800 they wanted for the needed “hardware”. Earning only $50 per week all his money went to feeding, clothing, and housing; nothing left for savings or medical care. I was told by someone else that a housekeeper or nanny in Honduras only earned $2/day. It was obvious that Honduras was poor but only when I researched the numbers was it clear HOW poor. The poorest nation in Central America … and only above Cuba in all of Western Hemisphere.

Luckily for the Tibia patient, his injury was only 10 days old so it would be a “normal” repair as opposed to if it had healed improperly and gotten attention only months or years later.

Dr. Merlin had to leave early as the official graduation of the Orthopedic Surgery Fellows was that night at his home so Dr. Michael Forseth supervised the tendon transfer case for a patient with an old untreated laceration that left their hand crippled. Dr. Forseth had flown down from Minneapolis on Wednesday with Dr. and Mrs. Daly, the couple who had founded One World Surgery. Dr. Forseth is with Summit Orthopedics, where Dr. Daly worked before retiring and concentrating on the charity. Below he shows how multitalented he is by cooking our dinner (Italian!) with Lulu Daly and then working in the OR with Juan Carlos.

Earlier in the trip during our tour, it was mentioned that Dr. Daly and his wife would be coming down during the week but it wasn’t mentioned why to us. Obviously, the surgeons who had been here before were aware of the graduation. Maybe that is why Dr. Sigman came this week even though he had no cases scheduled.

Dr. Forseth had a special “mission music” list on his phone and I enjoyed it when Warren Zevon’s “Lawyers, guns and money” came on. I didn’t realize that it had the Honduras line in it, a few verses after the Havana one; “I was gambling in Havana, I took a little risk, …). If anything Honduras is probably less safe now than 45 years ago when he wrote the song.

Here is a nice video of some of the volunteers visiting with the orphans.

I only saw the outside of it but there was a medical clinic just for the orphans (300 total, 80 with special needs). Some of the mission volunteers were there each day helping out it was not nearly as modern or well-maintained as the surgery center/medical clinic. It had a staff of one MD and two RNs every day and one stayed there overnight in case a child had a medical emergency. They also had specialists from the city come in regularly to see the kids rather than having to transport the kids to the city.

The last case on Thursday went quite late (in theory all cases were supposed to be done by 3:30 or 4:00). It also seemed poor planning to have the deaf patient for the last case (but I just give anesthesia). When his family came into phase 2 recovery and helped him change clothes I asked “Tiene hielo en su casa?” Luckily the answer was yes as the surgeons had given orders that the arm should be kept iced and elevated above the heart as much as possible to decrease swelling.

It was 6:30pm by the time he was wheeled out to his family’s car and I hurried home as dinner was at 6:30 usually. I decided to take the main dirt road instead of the narrow path through the forest as it seemed like it would be less creepy.

It was PITCH black. There was no moon and finally, the sky was clear (it had been a little overcast every evening, Jupiter was always visible but few or no stars) so I was happy I would get a good star photo with the iPhone 10-second night mode exposure.

I had a penlight in my backpack but it was pretty dim, the iPhone flashlight was much better. I was walking along and looking at the stars when I looked down and saw this beauty. 

She had her head lifted pretty high and kept an eye on me. She was about 6 feet long and quite thick. After I shared the photo on WhatsApp several people asked what I “did” when I saw the snake. Obviously, the most important thing was to get a good photo! Then I backed away a little and walked on, looking back once or twice to make sure she wasn’t following.

I was excited to see the snake actually as I hadn’t seen a reptile or amphibians on the trip. In Costa Rica, they had such a variety of lizards, frogs, etc. I asked one of the staff and they said that in the wet season, they have a lot more wildlife including big iguanas. I guess in the dry season they head down to lower coastal areas that are rainforests year round.

I’m not sure what we had for dinner that night but luckily it was Xia’s (PACU RN) birthday so we got CAKE.

The graduation ceremony at Dr. Merlin’s home was attended by some of the surgeons.

As a consolation prize, they had a bonfire after dinner for the rest of us. I had realized the day before leaving home that I would be in Honduras for the first 2 nights of Hanukah. I still light the candles even though an atheist so I slipped a few into my luggage.

The marshmallows were REALLY good. Perhaps they were freshly made. Someone else got this good video of leaf-cutter ants working at night.

Today is Sat. Dec. 16th, I worked yesterday for the first time since returning home from Boca Raton on Wednesday. I had thought I was completely over the mild cold I returned from Honduras with, but it still lingered slightly as I felt fatigued all day at work. Luckily it was a fairly stress-free day of 2 total knee replacements and 3 D+C/ablations. I had hoped to do this entry on Thursday but ….. argh…… again the WordPress “autosave” somehow locked up and the site was frozen for the last 30 minutes I was writing. This had happened once before on my iPad and I thought that now writing on my MacBook this would not happen again but ….. I looked into how to disable “autosave” and it was so complicated I eventually gave up. I Will look into it again when I have finished up my Honduras “series”. I pulled up my Peacock account on the computer and will watch Chelsea-Sheffield while I write. Sheffield is in last place so hopefully, Chelsea will not embarrass themselves. The announcer said that it is a chance for Chelsea to “stop the rot” of their disappointing season. I just heard a sigh behind me and saw that Fifa had snuggled onto my office couch to “watch” the match with me.

In case someone is reading today’s blog and missed the earlier ones here are the names of the charities. NuestrosPequenosHermanos: NPHUS.org  and OneWorldSurgery.org

I had another nice night’s sleep and noticed it was wet in the courtyard when I went for my morning coffee and Clif bar. The sky was dramatic but it would clear and be sunny as every day of the mission would be. The interior highlands of Honduras’ wet season is from May to October.

I got an early start on my 1/2 mile walk to work since again I wanted to be able to set up my room, see my patient, and do a nerve block in time to get into the room by 7am. I was scheduled to do anesthesia for some arm and shoulder surgeries today. Marcia and Theresa were each supervising one CRNA a piece in the other 2 rooms. Marcia wanted to learn more nerve blocks from Theresa and I was happy to let them do them all except that I wanted to have Theresa teach me to do infraclavicular blocks if one of my patients needed one.

My first patient was having shoulder surgery so they did a modified supraclavicular/interscalene block (as a true interscalene causes 100% of diaphragm paralysis but supraclavicular only 30%). In my practice, I do interscalenes for all shoulders (unless they have severe COPD), who receive general anesthesia for the surgery, as we don’t use Exparel (that lasts 2-3 days) and if we do get a patient who is bothered by the diaphragm issue it will resolve in at most 12 hours with the block.

Despite being given 2mg of versed (midazolam) as sedation for the block the patient was VERY uncomfortable and kept moving. Eventually, the block was completed and I took the patient into the operating room. After the usual placement of monitors and pre-oxygenation with a mask I injected Propofol to induce general anesthesia but after a minute or 2, the patient was still awake, despite also receiving inhaled sevoflurane. Looking at the site of the IV that had been placed by the pre-op nurses we saw that it was infiltrated. And, of course, being a shoulder case we had only one arm to work with. I asked the OR nurse to find one of the free anesthesiologists and she came and started an IV while I masked the patient. I was planning to place an LMA but as we worked on getting an IV in the patient a woman walked into the room and asked if “the patient will be having general anesthesia for the procedure”, I told her that yes the patient was “asleep” and as soon as we had an iv I would place an LMA. She then said the patient would need to be “paralyzed” and I asked if she was requesting the patient be intubated, she said yes if that was needed for the patient to be “paralyzed”. I had no idea who this person was. The surgery was scheduled for Dr. Anand Murthi and I guessed that maybe she was an ortho resident or PA he had brought with him on the mission (again…. we never received a list of the people on the mission, their roles, etc. ). After she and Anand had gone outside to scrub I asked the surgical tech who she was and he said she was “another surgeon” but he hadn’t worked with her. Once again I was confused as this meant that there were 3 arm surgeons here but there were only cases scheduled for Dr. Anand and Dr. Moddaber (Los Angeles).

The mission seemed hugely overstaffed with 2 leg surgeons, 3 arm surgeons as well as the local Dr. Merlin and his orthopedic surgery fellow, and the local eye surgeon with just 3 operating rooms. There was also ANOTHER surgeon there the first few days who I never met but apparently “helped” in some cases. I had initially been scheduled to work with Anand on Tuesday and Monday afternoon I had made an effort and found him seeing patients in the clinic to introduce myself and ask about his first case for the next day.

Anand was from Baltimore (so of course the first question to a doctor is … “at Hopkins?”, the answer was no) and he worked at Memorial Hospital. It is located right next to the Johns Hopkins University undergrad campus (on the calm northern edge of the city, not the deadly downtown area where the medical school is). I told him I had returned there a year ago for my 35th reunion and Charles Village was looking much more upscale than in the 1980s. I didn’t mention the guy in my fraternity who used to climb over the fence at Memorial Hospital to collect Nitrous Oxide canisters for parties… 😉

Anand had brought a teenage boy with him on the trip and they were also always with a woman and I assumed it was his family. After a few days, I learned that the boy was his nephew but it was not until after the OR on Wednesday that it became clear that the woman was another surgeon, Caroline, from Florida who was a colleague of Anand’s. I never learned if she used to practice with him or had trained with him, etc.

I talked to his nephew a few days later, he had his 16th birthday on the trip and we got cake. Both of his parents (and most of his other relatives) were doctors in Maryland.

After the “misunderstanding” about “paralysis” I asked Theresa to talk to Caroline and make clear that as all the patients were getting excellent nerve blocks their limbs were “paralyzed” and we could use LMAs to administer general anesthesia without giving muscle relaxants and intubating. After that, everything was fine in the room for the rest of the day, except that Anand played Country Music…. really? There are many people who dislike Country music and raunchy Hip-hop so I don’t approve when surgeons play these. Everyone can tolerate classic rock, pop, jazz, classical…..

As I mentioned earlier, I was interested in having Theresa teach me to do ultrasound-guided infraclavicular blocks. I had done infraclavicular blocks very rarely years ago but that was before ultrasound guidance and they always seemed too close to the lungs for my comfort. For hand and arm surgery I always use supraclavicular blocks, but because of the 30% chance of phrenic nerve blockage (to the diaphragm) and as Theresa uses Exparel with a very long duration the infraclavicular is safer, especially for patients with compromised respiratory function.

All of the upper extremity surgeries could have been done under just sedation but as there was the language barrier and no propofol infusion tubing it was easier to just do a light general anesthetic with LMAs (laryngeal mask airway, a breathing device that sits in the back of the mouth with the patient breathing on their own, versus an endotracheal tube). Speaking of language barriers, it was nice finally on Wednesday to work in an operating room with US surgeons speaking English. On Tuesday for the 8-hour case the surgeon, fellow, and our scrub tech (Cesar) all spoke Spanish so myself and Carrie (the circulating RN) had no idea what they were discussing the entire time. I did ask questions occasionally and Merlin was always happy to answer but it felt weird to not be privy to all the discussions about that very complex case.

Because I had been the late doctor the day before I got out early after everyone had lunch, another delicious meal of course in the clinic cafeteria. Yvonne (RN from L.A. who had been to NPH in Honduras before a few times) had mentioned that there was a nicer place to swim than “La Posa”, the smallish, stagnet-looking pond we had visited on our tour. We had been told that there were 4 dammed reservoirs on the property and I saw on Google Maps a very big one north of the hill to “La Roka” we had earlier climbed.

I copied the location from my photo at the top of the hike (the star) and saw that it would just be a little further hike. I contacted one of the local staff to ask if this was the place that Yvonne had mentioned (and where people jumped from cliffs into the water). She said that I could swim there but the place Yvonne was talking about was much closer and just past the farm. I checked Google Maps again and found the correct one and confirmed with her.

I labeled it “cliff pond”, not only was it much closer (only 1 mile from the Moscati) but a mostly flat path versus hiking up the hill to La Roka and then down to the bigger reservoir. I did not have a bathing suit since had not been told about any swimming potential but I did have my running compression shorts that I put on under my regular shorts. I also had no goggles but wasn’t sure it would be swimmable anyway. I headed out with just my water bottle and run belt for my phone but I did also bring my selfie stick/tripod. Again it was 80 and humid so I slathered myself with sunscreen and DEET. I planned to run a few miles, jump in the water to cool off, and then run a few more miles. It was very easy to find the way as Lucia had said to take the path just across the dirt road from the Cocina building.

After a half mile down this dirt path there was a gate with just a lanyard securing it and once through it was just not much further to where I could see water off to the left and found the dam.

It was the dry season and hadn’t rained recently so there was just a trickle over the dam falling about 40 feet down. I saw some cliffs across the river but there was NO WAY to safely walk across the dam. I later learned that people would swim across and then there was a path to climb to find a cliff to jump from but not something one could manage without a local guide. I didn’t see a “beachy” spot on the banks but I felt the long grass there and it was soft (not sharp) so it seemed a possible entry point. I had only run a little over a mile though so I went back to the path and continued my run. The path was very rocky and got steep so my pace was fairly slow in the hot sun.

I didn’t want to go too far though so I turned back and got to the dam area again after 2.6 miles of running. There was another nice “cove” in the river I passed that had a sandbar.

The water here seemed much clearer than at the small pond and the surface was clean as it was slowly flowing over the damn. I did a test of the footing and after the muddy/grassy bank, it went right down to a few feet deep and had a smooth solid bottom. The water was still a little muddy but that is typical of jungle rivers (like the one Alex and I had tubed down in the Ecuadoran jungle).

After the most important step… setting up the iPhone, I swam in comfortable at least 80-degree water. I swam to the rock and back twice and then across the river once for a total of just 10 minutes and 300 yards. If I had not been alone I would have loved to have kept swimming north to the cool sandbar I had run by earlier.

Here is my official Tarzan swim Movie! I edited out the part of me wrestling the Crocodile.

and a screenshot from the video, it was super quiet, really no birds or insects making noise. If you turn up the sound you can still hear my strokes all the way across.

After my swim, I realized it would have been smart to have brought at least a hand towel with me as I ended up having to use my shirt to wipe the mud/gravel off my feet before putting my socks and shoes back on. I had stopped my Garmin after the run to switch to swim mode and now put it back on run mode but I ran straight back to the Moscati center and saved that track to share with the rest of the people. It was exactly one mile. I also drew on the Ranch map and shared it with the group on WhatsApp along with my swim photo. I said that I would be working late on Thursday as had been out early on Wednesday but that I would love to swim again on Friday and would be happy to be a tour guide or lifeguard for anyone interested in going. A group of people did go there on Friday but they never shared the plan on WhatsApp or told me so I just ran on Friday.

After tracking the route back to Moscati I did another 1.5 miles of running to get an even 5 miles total done. On the path down to the hospital I saw my favorite horse with his head reaching through the barbed wire to get to some longer grass. I tore off some beyond his reach and fed it to him. I usually try to get a trail ride in on vacations but this was good enough.

Having gotten out of work so early I still had time to shower and rest in a hammock for an hour before dinner. I listened to John Prine and eventually actually dozed off to sleep.

There was a WhatsApp message that food servers were needed but as quickly as I was able to leap out of my hammock and get across the courtyard I was too late. I got to clean dishes and serving platters several times but never got to serve food. After my long run and swim, I was VERY happy they subbed in a piece of chicken for me (others got pork) because just rice and zucchini would have been a disappointment.

As soon as we lined up for dinner there was a huge amount of noise from the ceiling and we looked out at the courtyard to see a tropical downpour. But it only lasted 20 minutes and it was dry by the time I headed to bed.

Dr. Merlin gave a great talk about the health system (or lack thereof) in Honduras. There is a “national health insurance” but only 20% of the population is covered by it through their employers. Everyone else has to pay cash for everything, medications, clinic visits, and if one needs surgery must pay in advance for the cost of bandages, and implants, arrange for friends and relatives to donate blood, etc. Many rural people suffer and then die of completely treatable illnesses or injuries.

During Dr. Merlin’s 7-year orthopedic residency, 3 years were devoted to orthopedic trauma, he said 85% of it was from motorcycle accidents. Because of the huge amount of motorcycle and car accidents, shootings, drug abuse, and tropical diseases taking up almost all of Honduras’ limited medical resources very little is left over for “other stuff”. So treatment for things that would be considered urgent in the U.S. such as cancer, heart disease, or new diabetes ends up being delayed. Only one hospital in the country provides major oncology care. There is a 300-day wait to start treatment for breast cancer so it is all very advanced and likely fatal before treatment is started.

I slept very well having taken a Sonata (Zaleplon) and wearing sleep comfy headphones. Sonata is a very short-acting sleeping pill that keeps me from waking up a lot during the night but has no sedation after 6 hours. I had first used it for my 11-hour flight to Fiji as I knew that I would have to work on the day of arrival and wanted to guarantee some good sleep on the plane. At breakfast, some first-time mission people said they slept poorly as so nervous about the first day of work. I wasn’t very concerned as I knew that even though my first patient was a 6-year-old (and I haven’t done a pediatric case in several years) a 6-year-old’s anesthesia is not that different from an adult’s. For a 6-month-old I would have switched rooms even though I was working with a CRNA for the case. And other than supervising the CRNA in the eye surgery room (with the rest of the schedule being just adults for cataract extractions) I was only supposed to give breaks to and do nerve blocks for the ACL reconstructions for the anesthesiologist, Marcia, who was in the room with 2 knee arthroscopies and 2 ACLs.

Every morning after a quick shower I went to the outdoor kitchen area and had coffee and a Clif bar for breakfast. It worked out great that my two roommates were surgical techs because we all needed to be at the hospital by 6:15am so we always all woke up around 5:30. Some women mentioned the daily inconvenience of some of the roommates being surgical team members (getting up early and using blow dryers, etc.) while the others were primary care team that didn’t need to get to the clinic until 8am to start seeing patients.

The 15-minute walk to work along the path through the woods was very peaceful. Listening to the birds and the babbling water over rocks in the streams provided the short period of mindfulness that is supposed to be so good for starting the day but is so rarely possible in our hectic lives.

Right after entering the building I saw the first patient and his mom in the post-op area where they were giving him his own space to get ready rather than with the other patients in the busy pre-op area. He and his mom spoke no English so I introduced myself and tried to connect with him a little but he looked very scared. He had his other eye surgery 6 weeks ago, which went well, but maybe he didn’t enjoy the experience much. As soon as I changed clothes I checked that Allia (CRNA) had all she needed in the room and then went in search of some liquid Tylenol to put 0.75mg/kg of versed in to pre-sedate the boy. In about 20 minutes he went from scared/shy to smiling/giggling. Allia carried him to the OR and the RN helped us get his monitors on and then we did a mask induction (a little slower than in the US since we had no nitrous oxide) with Sevoflurane. All patients also got 100% oxygen since we had no medical Air supply. Once he was well anesthetized (limbs floppy) I placed an IV and Allia placed an LMA and then the surgery started.

It was confusing at first because until the morning of surgery, I didn’t realize the eye surgeon (and a fellow) were Hondurans who usually worked in the city but came to the clinic to do charity cases. As we had not gotten a list of people on the mission and their roles. They also had a nurse with them who dealt with all the eye equipment. And since they spoke Spanish to each other during the surgery (although the surgeon was fluent in English), the anesthesia team, scrub tech, and circulating nurse had no idea how the surgery was going. While I was with the patient before surgery, I introduced myself to the fellow (thinking he was the attending surgeon) and then the actual surgeon when they arrived. I was interested in the case since juvenile cataracts are rare in the US and I tried to get some information from the surgeon about how severe the blindness was, for how long, and what had caused it but he just gave a vague “who knows?” and wandered off. I noticed later when reviewing the adult cataract patients’ charts that many were here for their second eyes and had their previous surgeries done with a local CRNA providing anesthesia under ?supervision? of the eye surgeon. That was fine since it is arguable that an anesthetist even needs to be present at all for modern cataract surgery using topical anesthesia drops (in much of the world an RN just gives a bit of sedation or none at all). I wondered though, why we were staffing a surgical tech, circulating nurse, and anesthesia for the cases when they had their experienced techs and nurses who usually did the cataract cases and there was a Honduran CRNA there acting as a translator in the clinic. Wednesday there would also be a full schedule of cataract cases in one of the three ORs.

During the case, I went and saw the next cataract patient in the pre-op area. There was always a translator available in the pre-op area to help with interviews by surgeons and anesthesia and consent. I could usually do 75% of the interview and exam on my own but always had the translator help with any details I couldn’t manage and ask at the end if the patient had any more questions. The patient woke up smoothly (again a little slowly as no nitrous oxide) and we took him to the recovery room. While Allia gave a report to the nurse I went back to pre-op to see the 3rd patient since I assumed the adult cases would move more quickly. While I was talking to the patient the OR coordinator JC came in and asked if I was doing anesthesia for the next eye case. I said yes but wasn’t clear on why he wanted me to come to the room as the CRNA was going to be in there for the case. It turned out that the eye surgeon or his fellow had brought the patient back to the operating room himself without our circulator RN or the CRNA meeting the patient or checking the paperwork. I scrambled to connect the patient to the monitors before they started. I guess this is the usual practice when they do cataracts (with local Spanish speaking staff) but it was not acceptable for us. It just further made me wonder why we were involved in these cataract cases. I spoke to JC and he spoke to the surgeon and they waited for our circulator and CRNA to see and bring the patients to the OR thereafter.

I didn’t think the remaining 8 adult cataract cases would take that long but the surgeon was teaching the fellow and they did retrobulbar blocks on several cases that they thought would be more difficult. The whole eye OR team also took a break between cases for both breakfast and lunch.

There was a big full breakfast every day for us (served by our general volunteers). I always just took a small bowl of fruit and coffee as I usually don’t eat anything more than a Clif bar before lunch.

With the eye room moving along well I did the pre-operative evaluation and consented the first ACL patient for an adductor canal nerve block which I had been told was what the surgeon in room 3 liked for his patients. Marcia who was the anesthesiologist in room 3 had told me on Sunday that she “needed to be” in that room because she came to give anesthesia for Dr. “Sig”‘s patients. This confused me as the surgeon assigned to room 3 was Dr. Redler but I was fine with it and happy to do the blocks to speed room turnovers. She had said she preferred to be in a room by herself as there hadn’t been CRNAs on any of her previous missions. I was surprised that we had 2 CRNAs and 3 MD Anesthesiologists for just 3 Operating Rooms. I could understand 4 in case someone got sick or injured but 5 seemed excessive. We ended up with having one MD in a room by themselves (Marcia day one and then me the other 4 days) and 2 MDs each supervising just one CRNA. Theresa (the other MD anesthesiologist) had brought a CRNA with her from CT so they worked together each day.

All good until …. Theresa whispered to me in PACU where I was getting the ACL patient set for their block that…. “it’s nothing personal…but Dr. Redler would prefer if I did the blocks on his patients since we work together back home”. Of course, I took it personally as I am sensitive that way.

But mostly I was just confused as Marcia was in room 3 to “work with her home surgeon” but Dr. Redler was the scheduled surgeon in room 3 and now Theresa was saying she was his home anesthesiologist. It would take me another day or 2 to figure out that there was another surgeon (Scott Sigman) on the mission who had no OR cases scheduled but just participated in other docs cases, he was from Lowell mass and had brought a large group of people from there. It was only his second One World Surgery mission but he was friends with Dr. Redler.

Room 2 had some arm cases and once the last case was in the room Theresa took over supervising the last cataract case and I was told I could go. I was a little mopey as I trudged back to the Moscati Center. I just wondered why I had traveled from Buffalo, taken a week off work, paid for my flight and the $1000 donation just to supervise a single CRNA. I didn’t feel like I was needed. I knew that a run would perk me up so I got changed and headed out the gate and up the dirt road (after slathering myself with sunscreen and DEET, it was sunny and 80 and humid). Only a few hundred yards ahead I noticed was Stephen who I had run with on Sunday. I sprinted for a few minutes and then snuck up to him and grabbed his shoulder and yelled “roar!”. He was very surprised but he was the kind of person who appreciated it. We ran together but I listened to my book on tape and he to music except for some brief comments.

When we were done I found Panther lying outside the gate (he wasn’t allowed in the Moscati center, moocher) and sat next to him and got some serotonin therapy by petting him. Unlike Fifa, he didn’t want to lick off my run sweat. I felt better mentally and physically.

My “no carne” meal was a little bland so I was very happy it was someone’s birthday and we got dessert!

Theresa had changed the OR assignments as Marcia now wanted to not be in an OR but wanted to be out so that Theresa could teach her some nerve blocks she didn’t know. Theresa did a ton of nerve blocks in Stamford and taught courses on them. I told them I was happy to be in a room by myself but would like when possible to do my nerve blocks.

I was excited to work with Dr. Antunez who had grown up as an orphan at NPH and was now medical director of the hospital and an orthopedic surgeon.

Saturday I had a flight from Miami International to Honduras (XPL, Palmerola International Airport, in Comayagua, serving Tegucigalpa, the capital and largest city; all the different names made it confusing when looking for flight info at the airport). My flight on American Airlines was at 11:20am. For our medical mission, we were told we had to arrive in Honduras between 10am and 2pm as all 45 of us would be bused together to the location.

I was awake by 5am and got in an easy paced 4-mile run and then some Yoga while watching the sunrise. I had plenty of time to shower, have some food, and finish packing.

I had arranged for a car service to the airport for 8am. Even though it should be barely an hour from Boca on a Saturday morning I wanted a nice safety margin. South of Ft. Lauderdale all the lanes of the I-95 were at a standstill (I assume from an accident) and the driver’s map app had him exit the highway. We took surface streets for 20 minutes and then were back on a different highway and at the airport by a little after 9am (actually an hour and 30-minute drive as he had arrived early at my Mom’s apartment and we left at 7:30).

Bag check and security were fairly fast even though I was only flying Economy plus and had not gotten TSA precheck on my boarding pass (I think probably because AA had not listed my middle name on the reservation). Terminal D was enormous and totally modernized from the last time I was there.

I was at my gate by 9:30 with a large coffee to have later with my apple and Clif bar as lunch before boarding. I sent out a message on the Mission group’s WhatsApp chat group that I was at the gate and wearing a yellow shirt and hat (but not a big yellow hat as in the Curious George books 🙂 ).

Two women who had flown in from L.A. and Denver on red eyes and had been at the airport since 6 or 7am found me soon after and we got to know each other and discussed previous mission experiences. The nurse from L.A. had been on MANY missions over the years including three to our destination; Nuestros Pequenos Hermanos, with One World Surgery. It was the first medical mission trip for the medical assistant from Denver and my second (Fiji 6 months ago). While there were a few people on their first medical missions, I think about half of the 45 people had been to NPH before, and most of the others on at least one other mission. There were also a few teenagers and spouses who came as “general” volunteers. They would work on the farm and in the kitchen preparing and serving meals but also were used in the medical clinics as scribes and got to help out in the operating rooms if interested.

There was also a response on WhatsApp saying “the Boston crew is eating breakfast and will be there soon”. But none of them let us know when they got to the gate or looked for us so it was not until we were about to board that we saw a group of over a dozen people (some in One World Surgery shirts) in the boarding line. We briefly said hi before boarding. It would be a few days before it became clear to me that the majority of the surgical teams had come from two orthopedic practices in Lowell, MA, and Stamford, CT.

I, and several others, were surprised that prior to (or even on arrival) we never got a list of the names, roles, and hometowns of the 45 people on the mission. During the trip, I emailed the charity’s trip coordinator with the suggestion and she seemed very excited to start doing it in the future. If a mission is only a dozen people as my Fiji one then it is easy to learn everyone’s names and roles in a day or two but our group was huge and the primary care people and surgery people were at separate places during the day. A Google doc with everyone’s names, roles, hometowns, and photos would have helped me a lot.

We did have a Zoom meeting a few weeks before departure but it only gave information about what to pack, how to do online immigration and customs forms, etc. There was not any type of “meet and greet” during the Zoom. After the main WhatsApp chat was set up I set up a second one just for the five anesthesia providers as I assumed we would need to be in contact without wasting others’ time by messaging via the big group. There was one anesthesiologist from Lowell and one from Stamford, one of them brought a CRNA with her and then there was myself and a CRNA from Williamsport, PA (who also brought her husband and 18-year-old daughter). He was also a CHELSEA fan.

I was very glad to have scheduled my one-day stay in Boca between flights when we got this message in the WhatsApp group….

He ended up getting lucky as his flight arrived only a few gates down from ours, if it had been in a different terminal he might not have made it, although our flight was delayed a little as well. We boarded almost on time but then the pilot announced that there would be a delay as someone’s bag was on our plane but they had never boarded so it had to be removed for safety reasons.

The United flight from Houston that some other people were on was also delayed a little, it got in about an hour after ours to Honduras. The seat next to me was empty but there was a Tortuga Marina (like my earring) on the floor there. The woman in the aisle seat was an administrator of the Lowell practice who had been talked into the trip by her boss. She brought the toy as it was her son’s and he wanted it to go on the trip to keep her company.

The plane headed south from Miami along the coast and then turned west below the Everglades and over the Florida Keys, I wondered if we would avoid Cuba but we went right over it. It was only two hours of flying time. I read my Kindle (Demon Copperhead) and listened to some Jimmy Buffett as it WAS the Caribbean.

Honduras was beautiful, green, and hilly with small villages and fields on the flatter areas.

It looks like such a tropical paradise from above. So sad that it’s people live in such extreme poverty and violence.

Alex actually brought this book home with them for Thanksgiving break as reading it for a class. It is about Nicaragua, El Salvador, and Honduras :((( I decided to not read until AFTER returning from my trip.

The Palmerola airport is only a few years old. It was built to replace the old, smaller airport that the city of Tegucigalpa had grown around making it a tricky place to land and take off from as taller buildings were built so close by. It is weird though that it is almost an hour’s drive to the city from the new airport and it is literally in the middle of nowhere and nothing. Just open grasslands around the airport and for many miles around.

After walking down the beautiful glass jetway we just followed the crowds. There was a 20-minute line for immigration. I spoke Spanish with the officer until I couldn’t understand one question and we switched to English (I had been practicing on the DuoLingo app for 10 or 20 minutes a day for the last 2 months in anticipation of the trip. I would have liked to have also used my Pimsleur learning system but it is all on CDs and neither of my cars has a player and I was too lazy to convert them to computer files, maybe I’ll do some before I head to Puerto Rico in March). The officer thanked me very earnestly when I told him why I was visiting the country. My suitcase was already ready when I got to the baggage area (like in Costa Rica several workers were unloading the bags and neatly lining them up). As we exited there were staff from the ranch who told us it would be an hour until the other peoples’ flights arrived and that we could wander but not to leave the building. Most of us hung around the coffee shop. I ordered in Spanish.

We were told via the WhatsApp chat that there would be Pizza and water on the buses and once all the flights had arrived they took attendance. It would have been nice if the three surgeons standing with the NPH staffer had given their names but they often seemed to assume that everyone knew who they were. The large, pristine parking lot was mostly empty and the exterior of the building was very nice looking, I loved the Dunkin’ Donuts sign. And of course, the pizza was … Dominos, the traditional Honduran meal. I was given a salad as I had specified no beef or pork and they made way too much effort to accommodate me. I can easily pick a pepperoni off a pizza, or not take bacon from a breakfast buffet 🙂

It was only an 80-mile drive but although the roads were all paved (and part of the highway was even 2 lanes each way) it took around 2 hours.

In anticipation of a long, winding, bumpy bus ride I had taken a Meclizine (Dramamine 2) before the flight. I was glad I had as I ate my salad quickly. I was sitting next to Matt who was a physical therapist who was on his first mission, he worked for one of the orthopedic surgeons. It was great he came as he was able to give all the patients instructions in the recovery area and print out exercises for them (many were illiterate so a demonstration and pictures printed were so helpful, there were no physical therapy services available to any of the patients once they went home)

The first part of the drive was flat and rural grasslands, soon there started to be small shops along the highway but not any houses yet. Once about halfway to Tegucigalpa (it is a mouthful, even the locals call it Tegu) we started to climb up significant hills with very winding roads and then went down into a valley as we passed the city (but never got to see it) and then back up again.

I understood that we could not do any outings as the country is very much NOT safe but I wished we could have at least seen the Capital city on a quick bus tour. I read that it has nice Colonial architecture. Here are two photos I downloaded from Google.

There are also several significant archeological sites in Honduras of Mayan and other origins. 90% of the population has native American genes mixed in their ancestry. In fact, the audiobook I picked for the trip (I had searched for books that took place in Honduras) is about the discovery in 2015 of a previously unknown large site.

I enjoyed the book, written by a National Geographic writer who went on the expedition, but it was ALL over the place. It did provide some modern political history of Honduras and a lot of information about the pre-Columbian cultures there. I am glad I didn’t get to the part about tropical diseases until I returned to the USA (my ankle bites seem to be slowly healing).

Because the Houston flight was delayed it was already getting dark just as we reached the ranch. Anywhere by the equator, it gets dark REALLY fast. One minute it is very light out and then it is pitch dark. The sunset for us was at 5:30pm.

The bus turned off the highway onto a dirt road and then we went through a gate and into the 2000-acre Nuestros Pequenos Hermanos (NPH from here on) “ranch”, it included an orphanage (300 children), the surgery center/medical clinic and a ranch and farm growing all the meat and veggies and dairy they needed. We were supposed to get a tour on arrival but as we were late and it was dark that was pushed back to Sunday.

Until a few years ago the volunteers would stay in housing that was borrowed from staff or kids that relocated for the week. But as mission groups got larger and larger and more frequent (there were 30 weeks this year of medical missions) it got difficult to accommodate them all. Two years ago a HUGE hospitality/conference center was built with donations. It was designed by the brother of Merlin (the medical director) who had also grown up at the orphanage.

We had a brief orientation session with basic rules and the schedule for Sunday and got our room assignments. We were told to not worry about hearing gunshots in the morning as there was a military base a kilometer away.

We had some nice traditional Honduran food for dinner.

There were around 20 rooms each of which accommodated 4 people but most were not full. We had three in my room. David was a surgical tech from Lowell and Cesar was another tech from L.A. Cesar was born in L.A. but spoke fluent Spanish which helped in communicating with the local OR staff and patients. The accommodations were MUCH nicer than I expected. With a very high ceiling and lots of screened windows and fans it was a very comfortable temperature for sleeping. The shower had nice hot water and electrical outlets in Honduras are of U.S. type.

After unpacking my clothes and gear into the roomy closet and drawers, I was happy to get to sleep by 9pm after a long day.

I am in Boca Raton for one day today, December 1st, 2023. I am flying to Honduras tomorrow for a weeklong medical mission and didn’t want to risk winter weather or other airline issues. I am writing today on my new MacBook Pro that I bought on Black Friday.

It is the first laptop I have ever owned. I have always (and still do) had big desktop Macs in my home office (sadly they discontinued the 27-inch ones and now 24-inch is the largest). I love being able to have two full-size windows open when writing or doing photo editing. For travel (or the backyard) I have always relied on an iPad, but it failed to allow the latest OS upgrade (it was 7 years old) and when I saw how expensive a new iPad Pro was I decided to just go with a MacBook. I am very happy I did. I didn’t realize how well integrated into iCloud my home computer was until just logging into my iCloud account on the new MacBook produced my same desktop and access to all my files. I got a mini travel mouse also for when I have space. It will be staying safely at my Mom’s apartment as I won’t need it in Honduras and wifi down there is not great anyway.

My medical mission in Honduras is with One World Surgery. They work in both Honduras and the Dominican Republic. I’ll obviously write about the experience afterward but here are some links if you want to read about them, or watch a short video.

To learn about Honduras the Wiki info is really good.

https://en.wikipedia.org/wiki/Honduras

Honduras was the actual original “banana republic” a term coined by the American Author O. Henry in his first book (1904) based on his experiences there.

The two links below are to One World Surgery. If you don’t see them (argh, WordPress again being difficult, even on a brand new computer with strong Wifi, maybe in 2024 I’ll try to switch to a different writing platform, everyone else seems to be on substack, etc.), just go to Oneworldsurgery.org .

About us

Home

The movie link seems to be good…..

It is less than a 3-hour flight from Miami to Honduras and then a few hours on a bus to the ranch. Sadly Honduras is so plagued with crime that it is not safe for tourism and we will be restricted to the ranch for the whole week.

Since there will not be any sightseeing or recreation in Honduras I will be spending a few days of actual vacation in Boca after I get back from the mission. Today I got in a nice ocean swim. The water was warm but pretty choppy, I swam way out past the beach break and surfers but it was still pretty rough. I saw an amazing school of Tarpon, a few hundred of them, I stopped swimming and just floated amongst them as they swam along. I also saw (and touched but no stings…) some pretty Moon Jellyfish. I swam slowly, between the waves, no wetsuit and my safety buoy dragging behind me.

I’ll be removing Facebook from my phone and not reading any news for a week. I’ll take many pictures and notes and write a report after I return.

About a year ago my child called and said “can I ask you a question”? They wanted to know IF I would run the NYC Marathon with them. Obviously YES! I’ve run many Marathons and Triathlons with barely any reason, much less the honor of accompanying them! We had run one 5K together many years ago but Alex was never an enthusiastic runner even during the 10 years they played soccer. But this is Alex’s last year at NYU and they wanted to experience the Marathon.

The NYC Marathon has gotten much more difficult to get into since I won the lottery 20 years ago on my first try. It has increased from 40,000 to 51,000 people but Marathons in general (and especially the Abbott Series ones; NY, Chicago, Boston, London, Berlin, Tokyo) have gotten more popular. Despite the nation and world’s populations growing there is a limit to how many people can be accommodated even in the world’s biggest cities. And there are less lottery spots for NYC now as they allot some spots for people with “qualified times” as Boston does.

NYC was my third Marathon. My time seems so slow compared to how fast I run now, but back then I was working 60 hours a week and with Alex just a year old my training time was limited. All my marathons after NY were sub 4 hours (except the 4:30 ones as part of Ironmans). As I learned about speed training, Yassos, cut down to half-time work 10 years ago and now 1-2 days per week, better nutrition and, newer shoes; I had a PR (personal record) of 3:40 in London in 2021.

As the chances of both of us getting in via the lottery were very low we signed up through the NY Roadrunners Team for Kids Charity. It has a fundraising requirement but guarantees entry to race and one gets to train with the group, take a dedicated volunteer ferry and have special tents before and after the race. I told Alex that they should not start any fundraising until after completing the half. I planned to just do my own donation to cover my entry and then also cover any gap if Alex didn’t reach the required minimum.

Alex’s plan was to train for the Buffalo Half-Marathon in May as a warmup/test race. Alex and I had for many years volunteered at mile 2 of the Buffalo Marathon at the Buffalo Triathlon water stop. I’ve actually never done the Buffalo Marathon, maybe someday, but I know it is lonely out there as only a few thousand do the full distance, most do just the half.

This year I was out of the country on a medical mission on Memorial Day weekend but Alex had a college friend come home with them as a Sherpa/Fan for the race. Although they didn’t train perfectly for the race they did put in a lot of time and had no problem finishing the half in 2:55.

I made a big point of telling Alex after the half that although they did decently with less than perfect training they would need to do more for the full distance. I printed out a 16 week “first” marathon training plan from Runners World magazine and took them to a local running store to get a pair of the new high tech marathon shoes.

Alex told me that based on the half-marathon they would not want to run with me but just be together for the start and meet up afterwards.

After my half-Ironman triathlon in Cassadaga at the beginning of September I started a marathon training plan aimed at just doing a comfortable sub-4 hour time. I also thought it might be fun to run in a costume for a marathon (I had actually run a few Halloween races in a costume) as long as not going all out.

Here is my training plan. If going for a best time I would have done more midweek runs and less of the biking and swimming.

One of my favorite Marathon stories was from a friend in residency who said he had run one marathon in college but decided it was not his sport after he was passed by someone in a giant Gumby costume.

Alex had a Sharknado themed party in the summer and it got me thinking about a shark costume. This one was awesome and only $39!

I also got a few cool shark hats. Once it got close to the race date and I read the runners guide I learned that (I guess since the Boston Marathon bombing) only simple costumes (Superhero’s, skirts, etc) were allowed. Not allowed were any that projected beyond the body profile, so no Gumbys, Dinosaurs, etc. I ordered a fin to go with my hat, it was only $10 so I was willing to risk being asked to take it off.

The week before the race Alex asked if I would run at least the early part of the race with them and I said of course. I told them I would be happy to stay with them all the way until they finished as long as we got to the finish line by 6:30pm (to get our post race clothes bag before 7pm at the Charity tent).

Friday, November 3rd. RACE EXPO!

The Marathon Expo and number pickup was at the Javits Convention Center on the west side. It ran from Thursday to Saturday. Saturdays are always the most crowded day so we were glad we could get there on Friday morning. It was very well organized and after about 30 minutes in line we got inside and there was zero wait to collect our number bibs and race shirts.

The New Balance “store” that one had to pass through to get to the rest of the Expo was mobbed! We each got one shirt/sweatshirt. Alex was superstitious and avoided anything that said “finisher”. I had already ordered a few shirts on line as I had a 20% off coupon. I told Alex they could pick the ones they liked and I would keep the rejects.

After paying and escaping the New Balance section the rest of the Expo was full but not crowded. We snapped some cute photos and collected some free snacks and merchandise.

We found our names on the Wall. Alex counted and there were 14 Shapiros running! Alex let me know at the expo how little they had trained (less than for the half!). It made me nervous but Alex would soon show what can be accomplished with just youth and determination!

Saturday, November 4th: BAG DROP!

In the past the runners would have a labeled bag that we would drop off at a numbered truck as we headed to the start corrals. To improve safety? Or just logistics? And help environment? The current system required me to go to Central Park and hand in our post race clothes bag on Saturday. All it had was 2 sweatshirts and a phone charger. Nothing we would miss if it got lost somehow. The drop off was very well organized.

I snapped a few photos of the finish line on my way out of the park.

After my pre-race dinner I prepared all my race day gear ….

Sunday, November 5th. RACE DAY!

Until the week before I didn’t realize that the clocks turned back race weekend. An extra hour of sleep was probably a treat for most people but I would have preferred to keep the extra hour of light for the end of the day.

Alex and I were assigned to the 7:45 charity ferry and had been told to get there at least 30 minutes early. I left my hotel at 5:45 and walked the 15 minutes to their apartment. We spent 30 minutes going over final race plans, a meeting spot if we got separated (and phone service poor), stuffing our pre-race bag with water, gels, my costume , etc.

It was just a mile walk from Alex’s to the ferry dock. We walked past a large fenced in garden and park and I wondered what nice apartment building (right on the East River) it belonged to only to see that it was part of Bellevue Hospital. I peeked in the front glass doors and saw that it was a large atrium and the front of the original building was a hundred feet back and very impressive. It is the oldest hospital in America (1736).

https://www.nychealthandhospitals.org/bellevue/history/

NYU hospital was just north of it and then right at 34th street was NYU children’s hospital.

The earlier ferry was just starting to load and the line for ours was just a few dozen people. I told Alex to sit (and REST the legs) and gave them my jacket to sit on the ground.

A beautiful sun was rising over Brooklyn and the East River. It was in the upper 40s and not windy so really fairly comfortable. I wore some throwaway old gloves.

There was a quick security screening and then onto the ferry. I told Alex we needed to sit on the starboard side to get views of Manhattan and The Statue of Liberty. 🗽

The seats were very comfy and the boat very stable. It seemed like a great way to commute from the Upper East or West sides to lower Manhattan.

It was only a 30 minute trip to Staten Island and then a few blocks walk to the bus loading area. Last year apparently the bus loading was a disaster with mobs pushing to get on. This year it was perfectly organized with corrals directing people to the next available bus and volunteers counting as people boarded.

But it was a much longer bus ride than I expected, about 30 minutes. Who knew Staten Island was so big! 20 years ago I had taken a bus from midtown to the race start but it had to leave super early (before the Verrazano bridge was closed) and I had to spend 3 hours sitting on the ground in the Race Village.

This was only the second time in my life that my feet touched Staten Island…I was disappointed not to see Pete Davidson or Colin Jost 😉

Once off the buses we all got wand screened by security (our bags weren’t really checked at all). We had Team for Kids volunteers with signs held aloft lead us all the way through the huge athletes village in the park. The line for the porta potties on the main path were long but later into the village they were shorter and no lines at all in the Team for Kids area.

There was a large heated tent and we went inside to get some bagels and coffee and bars. As the weather was nice we found a nice grassy spot to relax for an hour in the sun and get ready at a leisurely pace. If it had been very cold or wet though it would have been a huge advantage to be in the comfy tent until our start time.

I had Alex take a photo of me once I put on my costume and had someone take a photo of us together. When I went to try to post it to Instagram though I saw that as predicted there was very limited cell service due to 15,000 all being in a normally tranquil park all at once and ALL trying to use phones!

Alex was a GREAT Sherpa for me and my friend Mark at 2021 Ironman AZ (when I had serious case of bronchitis, not Covid! on 4 tests) so I was completely happy to carry all of their gels, house keys, some phone charges, and a liter water bottle in addition to all my own gear. I had a front and rear fanny pack 🙂

About 20 minutes before we were supposed to walk to our corral a TFK volunteer led a brief warmup and stretch session and then we slowly packed like sardines into our assigned areas.

About 10 minutes before our start time the ropes between corrals were dropped and several thousand of us slow walked up the ramp and onto the end of the Verrazano bridge. The bridge is so wide that there was not the extreme crowding at start like for some other marathons. There was an announcer on loud speakers amping up the energy and playing music.

I checked my phone just before the start and saw I had already walked 9000 steps 🙂

Here is a one minute official video:

At exactly 10:55 they fired a Howitzer and we walked to the starting mat and were then off and running. Our bib color (pink) were on the lower deck of the bridge (20 years ago everyone was on top deck) which had the advantage of a less steep hill but less scenic. We still had views out the left side of Manhattan far in the distance. The top and bottom decks exit the bridge in different directions, at mile 3 all the groups merged again.

Once we emerged from the shaded lower deck the sun was bright and it actually felt quite warm as the temperature was close to 60 now that it was 11. After a few miles of brisk running Alex took a short walking break and I (dedicated Sherpa) handed them the water bottle I was carrying for them. I also checked my phone and now that in Brooklyn and spread out more my phone was working fine and my Instagram post went through.

Once we worked our way off the bridge’s highway ramps and onto the local Brooklyn streets (the first long stretch was north on 4th Avenue, a very wide road we took until making a right turn at mile 8), the crowds of spectators were amazing.

Running at a leisurely pace I got to spend so much time reading signs and high fiveing kids. Alex and I had written our names on our bibs and got lots of “go Alex”, “go Dave” screams. The shark hat and fin were VERY popular and I waved every time I heard “go Shark man”, “yeah baby Shark”.

There was someone in a giant Lobster costume cheering and I ran over to see him.

During the race a few runners asked if it was ok if they took my photo. I was ecstatic of course! One of them was wearing his Long Island Triathlon club’s shirt, “The Land Sharks”. I’ll definitely be wearing my Shark hat for any future runs (unless going for a PR) and it will be perfect for the run in Ironman Florida next November.

I also realized after collecting several Dunkin Donuts Marathon hats that my fin made a great storage space!

Alex did a great job running at their planned pace with just short walking breaks as we covered the long miles in Brooklyn.

Alex had 4 friends who were watching the race and they tried to contact them during walk breaks but we ended up only seeing 2 out of the 4. One was in Brooklyn and one at mile 25. As Alex’s official photographer as well as Sherpa I kept shooting video whenever we got close to where we anticipated seeing one of their friends.

After passing a tall beautiful bldg at Flatbush Avenue we briefly headed East into the huge crowds of fans in Clinton Hill.

Then we headed North through the Hasidic Jewish Williamsburg neighborhood.

After Greenpoint Brooklyn the route briefly cut through Queens in Long Island City.

We then reached the dreaded Queensboro Bridge with its steep hill at mile 15-16. Almost everyone was walking up it and many people stopping along it to get their photos taken with Manhattan behind them.

After midway on the bridge it was DOWNHILL and then into Manhattan. A short turn around and then we headed up 1st Avenue into the canyon of buildings and loud, supportive crowds.

Next was a 4 mile run North past the upper east side and Spanish Harlem until the Willis Avenue bridge took us into the Bronx!

The Bronx section was less than 2 miles and not residential but there were a good number of supporters out there even though it was getting late in the day. There was some good music and I got some treats. When running hard I never would have considered such a decadent snack, but at the easy pace it was all about having fun.

Once back in Manhattan at 5th Ave and 135th Street we only had 5 miles to go and knew we would have no problem finishing by 6pm. We ran 2 miles south thru Harlem and then were at the northern edge of Central Park at 110th street. I pointed out the Duke Ellington Piano statue to Alex.

It started to get dark out as we did the last parts of 5th Avenue but it was well lit. I put on my flashy rings, they weren’t necessary as no cars but FUN! I also had 2 small headlamps that I had brought in case we were still on the course very late but we didn’t need them.

At 86th street the course goes into Central Park and then comes back out by the Plaza Hotel before heading west on 59th street and back north into the park for the last quarter mile.

Alex got a shot of pickle juice from their friend at mile 25 and I took their hat and headphones and they sent me ahead as they wanted to finish on their own.

I sprinted the last half mile and then walked really slowly through the medal area, I was going to wait for Alex before the turn off to our TFK tent but they were fast and grabbed me from behind before I got there!

We collected our snack bags and got our AWESOME ponchos… fleece lined, inside hand pockets, quite nicer than the old basic aluminum wraps.

We knew that we would want to veer over to Central Park West at 72nd street to get to the charity tent area. Regular finishers had to trudge all the way up to 79th street before getting to exit the park (20 years ago I then had to walk ALL the way south past 59th street to get back to the east side hotel I had mistakenly picked).

A TFK volunteer actually escorted Alex and I out of the park and to the charity tent and then took photos for us while we had our official ones taken.

After a snack and some water at the tent we collected our post race bag and headed over to Columbus Avenue. We didn’t see any free taxis for a while and the Curb App failed to find one either so we got an Uber that showed up fairly quickly for the trip back to Alex’s place.

Very nice Medal!

Some of our official race photos!

The next morning I did a light workout in the gym and then had brunch with Alex before heading to the airport.

After 4 days of Blue Skies in NYC it was rainy when the plane landed in Buffalo. But Fifa was warm and dry!

The next day I got an email from Abbott about a lottery to get into the Tokyo marathon which is the only one of the 6 “majors” I have not done yet. I applied to run it in 2024 with a Marathon Travel company (their lottery is impossible) I could have applied to a charity but it seemed like a lot of effort with all the other stuff I have planned for 2024, Including Ironman Florida in November.

AND for some true inspiration, here is a video of the last 10 people to cross the finish line before they stop handing out medals at 8PM (assuming they were in the last wave they took 8.5 hours to finish), other people finish later but after then the roads are open to traffic and they must walk on sidewalk and no medal at end.