Movement Is Medicine: How an Ironman Faces Stage Four Cancer
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For Jonathan Pascual, movement has always been medicine. As a kid, it was hiking mountains with his father to prove he wasn't the scrawny, asthmatic kid his classmates saw. As an ICU nurse and lung transplant nurse practitioner at UCSF, it became something more disciplined: 16 Ironman triathlons, 22 half-Ironmans, marathons and 100-mile ultramarathons, over more than two decades as an endurance athlete. And in March 2022 — diagnosed himself with stage four mediastinal paraganglioma, a cancer so rare that patients who have it call themselves "zebras" — that discipline became something closer to survival.
Jonathan was told he had about five years to live. Eighteen months later, racing on Legacy Athlete status, he crossed the finish line at the Ironman World Championship in Kona — mid-chemotherapy, mid-diagnosis, still racing. He describes himself as caught in a Sisyphean loop: push the rock up the hill, watch it roll back down, and push it back up again. Not because he's in denial about where this ends but because, as he puts it, movement itself is medicine. Movement itself is defiance.
This conversation moves through Jonathan's diagnosis and the eerie clarity of reading his own scans before any doctor spoke a word, into the "six pillars" of what he calls his cancership, the stoic philosophy that reshaped how he thinks about control and impermanence, and the community he's built — from a 3.3-mile fundraising ultra in a California wilderness park to strangers who find him on Instagram. And it lands on something Jonathan calls the Art of Dying: the discipline of living so deliberately now that when the end comes, the people he loves already know exactly how he wants to meet it.
Join Cody for a conversation about clinical detachment and radical honesty, toughness and rest, and what it means to keep choosing to get up — and keep moving — even when the rock keeps rolling back down.
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Izzy Adams, My Way Home
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