Next Generation is a BWH Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. This month, we bring you a column from our archives written by Claire Twark, MD, who was a third-year resident in the BWH Department of Psychiatry in 2016 when she wrote this column. Twark is now an addiction psychiatry fellow, where she continues to train within the Partners HealthCare system and is currently rotating on the BWH addiction consult service. She will begin as an attending with a focus on sports psychiatry, addiction psychiatry and general adult psychiatry at BWH and BWFH in September of 2018.

Ultimately, nothing could have fully prepared me for the extreme weather conditions that I faced during the Ironman Texas triathlon on May 14th in The Woodlands, Texas.

The 2.4-mile swim in Lake Woodlands was chaotic since there are a couple thousand swimmers in the water at the same time. Due to recent flooding that washed away some of the original roads, the bike course was rerouted and shortened from 112 to 95 miles. The revised route had a turn at almost every mile and was technically challenging.

The 26.2-mile run was an ultimate test of my body against the elements. It was incredibly hot—in the high 80s with humidity—and there was very little shade along the course. Volunteers offered to help hold all of the cups of ice and fluids that I was getting at aid stations. Then rain and hail came at mile 21 of the run, with thunder and lightning that felt like it was right on top of me. In some places, I was running through about six inches of water. Race officials stopped the race and directed the athletes to emergency shelters before eventually allowing us to resume the race. I remember thinking: I did not train all winter and then fly all of the way down to Texas to not finish this race! I was determined to honor all of the hard work that I had done to get to this point.

My name is Claire Twark and—in addition to being a triathlete—I am a psychiatry resident at BWH interested in general adult psychiatry, sports psychiatry and addiction psychiatry. I have recently started collaborating with the BWH Sports Medicine Department by seeing athletes referred for psychiatric issues such as depression, anxiety, disordered eating, substance use disorders and stress related to injuries. I really enjoy working with patient-athletes, and my own experiences as an athlete help guide my approach to their care. Coordinating with BWH Orthopaedics, Sports Medicine, Nutrition and other departments allows clinicians to provide the multidisciplinary approach to care that is critical with complex cases.

When meeting with general adult psychiatry patients at Brigham Psychiatric Specialties, located at 221 Longwood Ave. in Boston, I frequently use motivational interviewing to discuss wellness topics including healthy eating and exercise. Many patients have improvement goals in these areas, and I see it as my role to support them. I often help patients set SMART (specific, measurable, attainable, realistic and timely) goals, such as going to the gym for 30 minutes twice in the next week or increasing their daily pedometer step count from 5,000 to 8,000 steps. Patients have been quite open to these discussions so far, and it gives them a sense of accomplishment to achieve the goals that they set.

Wellness has been a priority for me since childhood. My parents encouraged me to be active and eat healthy when I was growing up, and I started participating in shorter triathlons when I was 11. I remember setting the goal to compete at the Ironman World Championship in Kailua-Kona, Hawaii, like my idol Paula Newby-Fraser, who has won the race eight times. I eventually finished my first Ironman triathlon in 2009 in Nice, France. Just after my intern year in 2014, I completed my second at Ironman Coeur d’Alene in Idaho, where I qualified for the 2014 Ironman World Championship in Kona. Finishing that race and finally achieving my childhood goal was absolutely one of the best moments of my life. Based on my Ironman triathlon results in 2014, I was ranked 18th in the U.S. and 38th in the world (top 1 percent) in my age group. The highlight in 2015 was competing at the Ironman 70.3 (half Ironman) World Championship in Austria, where I placed 30th in my age group. I am thankful to have supportive parents, who travel to many of my races with me and are fantastic spectators.

For several months prior to Ironman Texas, I had trained primarily indoors for 10 to 12 hours per week. As the race neared, I stretched in a sauna several times in an effort to acclimate my body to high temperatures. People often ask me how I make time for exercise and wellness during residency. Questions about my motivation and drive are also common. I generally exercise in the evening, and I frequently bring my exercise gear with me to work to facilitate this process. I am a member of the Boston Triathlon Team (BTT) and also work with a coach. Between my teammates and the workouts that my coach plans for me, I have plenty of inspiring people around me and workouts to keep me accountable. My favorite workouts during the winter are the Sunday group runs that BTT does as a team followed by breakfast together.

As I faced the final few miles of the run at Ironman Texas, images of my family members and teammates tracking me from home via my timing chip propelled me forward. Crossing the finish line brought a rush of relief, happiness, exhaustion and gratitude. Volunteers greeted me with water, a warming blanket and a finisher medal that lives up to the reputation of everything being bigger in Texas. I greeted my parents who had also endured the extreme elements as spectators. I thought to myself: “That felt like a combination between a natural disaster and an adventure race, and this is an experience that I will never forget!”


Claire Twark; photo by Erin Valenti, MD

Nutrition tips from Claire Twark

Nutrition is also a priority, and I frequently bring a mid-morning snack, lunch and afternoon snack with me to work. Staples in my diet include yogurt, fruits, vegetables, hummus, quinoa, nuts and nut butters. I frequently practice mindfulness during my workouts (for example, staying in the present moment non-judgmentally can be very helpful as you approach the next challenging portion of a workout). To me, wellness is a lifestyle. It includes healthy eating and exercise as well as mindfulness and wellness within relationships.

I recommend proactively thinking about your own wellness and setting improvement goals for yourself. Here are five tips:

  1. We are all busy, so use the wellness opportunities that are all around you. Walk to work, take the stairs and choose healthy food options in the cafeteria.
  2. Contribute to a healthy eating culture. Take time to pack healthy snacks and meals for yourself. Take the extra step and choose healthy foods when you bring or are in charge of selecting food for BWH events.
  3. Find wellness partners. Encourage your co-workers to join you and/or join a club that has frequent events in a fitness area that you’d like to try.
  4. Keep yourself accountable! Try a pedometer, sign up for a race, take a group class and start logging your workouts with an app (such as It’s amazing how many steps you’ll add if you take the stairs up the Brigham towers or the Shapiro building.
  5. Mindfully think of each moment as an opportunity. Your choices yesterday, last week or last year don’t predetermine your decision in this moment.

Claire Twark, MD can be followed on Twitter: @ClaireTwarkMD