Sunday, 19 September 2010

No Regrets

Last week, in a fug of self pity because I have a haematoma the size of a fist on my left hip meaning I can't sleep, and because I've been cycling around with a suspected broken wrist, I read an email from my friend Dean Johnson. I was overwhelmed not only with the news but the lesson therein, so I asked him to write it up for the blog. J 

My affliction seemed as well timed as it could be.  I would go out on top.  One week before the onset of symptoms, I had my best finish ever (third fastest) in a six hour adventure race where we competed in 37 deg. C heat.  The day after symptom onset, I was in full denial mode and won my team classification in a six hour orienteering race.  At almost 52, finishing uninjured by the cut off time is a realistic goal.  Finishing near the top or winning is out of the question.

On my nightstand, the latest New Yorker magazine contained an article detailing the lack of benefit from massive intervention to advanced stage cancer.  Many medical professionals agreed that hospice care resulted in no diminishment in life remaining and certainly a far more comfortable decline.  This finding corroborated my belief that my time left, to the extent I could control it, would be marked by vibrancy and not a drug addled struggle to prolong breathing.

Admittedly, no one thought that I was going to die.  I had a disk between C4 and C5 in my cervical spine that was severely bulging into my spinal cord.  In several places, my spinal cord was compressed into ribbon.  

I am not the first person in the world with this condition, but the consulting neurosurgeon stunned me within the first 15 seconds of his entering the exam room.  He had been fully briefed by his resident and Fellow who had each evaluated my current symptoms (numbness in hands, arms, torso and back and gradual loss of fine motor skills) and closely consulted my MRI.  In the manner of a man accustomed to dealing with gruesome spinal conditions on a daily basis, he matter-of-factly stated that I was one strong  sneeze, bad cough, minor auto accident or fall away from serious spinal cord injury.  The kind of spinal cord injury that could lead to quadriplegia...

You could have pushed me over with a feather.

He reckoned that normally I would want to research procedures, doctors and medical centers, but in my place, he would not wait an instant.  He consulted his next day’s surgery schedule and offered to cancel the morning operation and substitute my case.  His canceling another neurosurgery operation forced reality on a previously surreal situation.  Medical consumerism would never outweigh the potential harm from spinal cord injury.  

Scarily enough, the precise condition that was so concerning to the neurosurgeon had already been acute for a month.  It took that long to weave my way though the US insurance-driven necessity of a GP visit, physical therapy, another GP visit, an MRI and another GP appointment.   On top of that, I had to enlist the help of a neurosurgeon friend to get a neurosurgery consultation in less than two months.  During this time, I had sneezed, coughed, driven, had kids hanging around my neck and orienteered.  Ignorance had been bliss (with a healthy chance of paralysis).

I took him up on this offer for next day surgery.  The procedure involves making an incision in the neck, moving the esophagus and trachea to the side and getting to the cervical vertebrae from the front.   The surgeon remove the bulging disk, replaces it with cadaverous bone and screws a bracket to the surrounding vertebrae to secure them while bone forms and the vertebrae fuse.  In my case, they removed two disks and bracketed three vertebrae.  One loses the flexibility of the joints, but there is still much movement available elsewhere in the cervical spine.

The physical recovery has been pain and trouble free.  The "flirting with death" part has been the larger matter.  My current work/family/leisure balance results in my physical vitality being the key to all other happiness. I crave serious exercise and have taken up endurance bike rides as my next physical challenge. 

Not only was all that extraordinary activity in danger from my impaired condition, but also I was slowly losing my fine motor skills -- like buttoning shirts, tying shoes and typing.  When the activities of daily living become a challenge, this condition risks becoming the defining event in one’s life.  The traumatic realization that I had a “near miss” with life defining quadriplegia was pretty terrifying and is only starting to fade.

I am now three weeks post surgery.  My numbness has gradually declined and fine motor skills are coming back.  While I am making progress, it has been at a slow enough rate to appreciate the unfortunate alternative.  I do not want to over dramatize, yet this is precisely the physical condition I mean when I, lightheartedly, had hypothetically balanced my quality of life versus euthanasia.

I joke with my 8 year younger wife and 42 year younger kids that they will not need to pick out a nursing home for me because I will have topped myself before moving in.  I have an agreement with a friend that if I am on a respirator, he will pull the plug when the nurse is not looking.  I promised to do the same for him.

Perhaps my life has been so worry free that I am excessively self absorbed with this close call.  Maybe.  However, my principal learning from counseling has been that my problems do not amount to a hill of beans in this world, but my problems are my problems.

As the old people say, “If you have your health, you have everything.”  More germane to vibrant souls like ours is not to waste a day, an hour, or a minute.  Shorten your time horizon.  Take that day off, do that bike ride, do an extra push up because you can and for heaven’s sake, take nothing, not a walk, a jump, a ride, a lift, even shoe tying, for granted.  God forbid the "time coming," but at least you will have no regrets.


Wednesday, 8 September 2010

a blow upon a bruise

The drive down was nice, as was breakfast. I listened to John Lee Anderson's biography of Che Guevara, and I thought about many things. In the afternoon sun, and with the roof down, I found my way to the hotel in Dunster, a couple of miles from Minehead, where the Tour Ride started. There I bumped into Matt and Ned and John unloading the gear from their car. Ned, who had produced some utterly implausible excuse for being unable to ride his own, crap bike, happened to have borrowed a brand-new Pinarello from an importer ... unridden and worth six or seven grand. It was a thing of great beauty. Who'd have thunk that the notorious scrounger would have somehow found himself riding a carbon-fibre jet?

I nonchalantly threw the wheels on my bianchi, checked the shifting, and we cycled into Minehead. There we met the crew, Team Real Peloton, and recorded material for a podcast which should go out sometime this week (ignore my undistinguished comments on why Contador should have waited for Schleck). There were some good people there and we drank some. Minehead was full of wired eyes, expectant, tremulous hands holding the saddles of yellow bikes.

I slept appallingly and woke to rain. I hate it when it rains on a Sunday morning. It reminds me of almost drowning in Istanbul and of those mornings when I can't get out of bed because I know my jacket is only water-resistant, not waterproof. I oiled my chain, checked the brakes, loaded my pockets with flapjacks, my water bottles with electrolyte, and put my brand new jacket in my back pocket. Ned, Matt and John were in the breakfast room, wearing the Real Peloton team shirts (above) that Matt had had brought over from Columbia, and of which we were duly proud. At seven, ready for the unknown we mounted our bikes in the pouring rain and headed out.

It wasn't going to go well. Over wet tarmac we hammered our way to the start, where we were going to meet the team. Ready for mountains, I forgot that it was the start of the day and hugged someone's wheel close. For some unseen reason up front brakes were applied, my wheel caught, and I went bouncing over the tarmac.

After sitting by the side of the road and a few exclamations of 'F**k', 'f**k', 'f**k' - I suppose I could have called out that bit about waking on the burning lake, poetry never seems to work in these circumstances - I climbed back on the bike. But my left brake head was almost broken off, I couldn't do anything with my right hand, and there was blood running down both legs and blood on the handlebar tape. I couldn't see my chin, though Ned pointed out that my rain jacket was torn across the front. It looked like a bullethole. 'Was there anywhere you didn't land on?' he asked.

I started with the team, rode the first couple of miles, and then headed straight into the hotel where I showered (they still had about 105 miles to go at that point). But not before I'd been displayed to Ned's motorbike camera crew: the event will feature in the ITV4 coverage of Stage 4 of the Tour of Britain on September 14. As I watched the blood run down the plughole I decided I had done the right thing.

And that was my ride. I drove to the finish, in Teignmouth, and saw a paramedic, who patched me off and showed the worst of the bruising to his assistant, thinking she might find it instructive. I had bruising and cuts on the front and back of my right knee, grazing on my right shoulder, a big graze on my chin, a knock on my forehead where my helmet had protected me, bruising on both wrists, an inoperable right thumb, a big cut and swelling on my left ankle,grazes on the inside and outside of my left knee, a swelling the size of a golfball on my left elbow, grazes and a swelling the size of half a cricket ball on my right shoulder, and something indescribable on my right hip.

So I missed all the fun. I missed seeing Ned fly up the first mountain, and then have the freewheel on his brand new Pinarello bike freeze. It was an hour and a half before it was fixed. I missed Rob's rear derailleur snap (he also had to abandon). I missed crashes. I missed watching Matt pushing his bike up hills. I missed eight plus hours of cycling and several of standing around. Instead I limped to a bar and had a roast dinner and some wine and re-read a PhD thesis. It was all about how spirit is inseparable from matter, which seemed self-evident at that point. Then I went to the finish and saw individual members of team Real Peloton finish in better-than-respectable times. And finally I saw the Lanternes Rouge roll up -- Ned, Matt, team captain Steve Trice and Chris with the supportive girlfriend -- and finish side by side at the end of an honest days work slogging over the unforgiving hills and through the uncompromising winds of Somerset and Devon, navigating the incommunicable chemistry of camaraderie and isolation that is cycling.

We went out drinking in Torquay. This is how some of it looked the next day (don't look if you're faint at heart). As my friend Sarah said: so much for cycling being easier on the body. 


Friday, 3 September 2010

On the back seat of my convertible

Few people who do not own them know how practical a car a convertible is. The phrase "a practical, sensible car" probably evokes an image of an estate or a 7-seater family car. Not so. In the past I have placed six trees on the back seat of my Saab 9-3 convertible (with the roof down). And today my bianchi is sitting on the back seat. Though I did have to take the wheels off.

This is because I'm taking part in the Tour Ride this Sunday, 175k and 10,000 feet of climbing across Somerset and Devon. Having survived the London to Cambridge ride --

ok, a little more on that. It was pleasant. At least once my lost bike had been relocated at the start it was pleasant. I started off gently and admired the London morning. Then a group of racers flew past me. I couldn't bear it, so I hung onto the back. We churned through London and the southern parts of Essex at some pace. For a moment i thought: this is going to be fast. Then they pulled over for lunch. I kid you not. Half way through, they just pulled over to a pub. So I kept on going. And then I began to worry that they'd catch me up, so I pushed it all the way, over the hills of Essex.

I made it to the finish. The banner was so high that I failed to notice it, and I shot right past it into the drinks tent on Midsummer Common and almost crashed into a marshall. The whole experience took three hours, which is perfectly respectable for 59 miles. Then I went for a beer (belgian) at the Fort St George.

So, back to the present. I signed up to ride with the Real Peloton team in the Tour Ride, 175k and 10,000 feet of climbing, with my friends Ned Boulting and John Beech, with whom I've run marathons. In fact John was there in New York in November 2006, meaning that he's the other man who beat Lance Armstrong. Also Matt Rendell, who's written some interesting books on cycling. These are people who talk about cycling, and are sometimes paid for it. And then there are some other people signed up for the team who actually train and so on. We will be wearing matching shirts, but the bodies underneath will be very various.

Let's be clear: having learned to cycle I love it. It's less hard on the body, you go faster, get to see more, and can drink more the night before. But 10,000 feet is like going up Mont Ventoux one and a half times, and then cycling another seventy or so miles. And I'm not allowed to do it with my bike in the back of the car -- I have to take it out and ride it. Together with the new gears that I personally fixed on when I heard about the 20% gradient (thanks to Howard Zinn [Zinn & the Art of Road Bike Maintenance -- great book] I managed to do this with zero knowledge). The petty hills around Cambs and Suffolk are no preparation for the ravenous pit of suffering that awaits us.

And what's worse, I hear from Ned that the whole thing is going to be filmed for the Tour of Britain TV coverage, and that there'll be a motocam on him the entire way. You may be able to watch eight hours (?) of self-inflicted pain on TV when the proper Tour of Britain rides through a few days later. Perhaps if I get in front of him I can ride in the slipstream of the motorbike.