Recovery Day 17-ish: Recovery, Envy, and Mortality

I continue to work my way back from the heart attack I suffered during a trail race about 17 days ago. Okay, I confess, I've been trying to write this damn post for almost 3 days, and keep getting side-tracked!

I could whine about this whole rehab and recovery thing being no fun - which is true - but I choose instead to look forward instead of backward, to focus on improving and enjoying every breath instead of feeling sorry for myself or wallowing in frustration. After all, I have much to live for, such as my three wonderful sons

and of course my fabulous wife

So I'm planning on sticking around for awhile, and in fact not just being there but also on being vital and active during the time that I am around. One step at a time, one day at a time, but with the road clearly mapped - thanks in large part to many dedicated doctors and nurses. IMHO, it's always good to have a plan.

I am now alternating my daily "workouts" between (a) visits to the cardiac rehab facility or (b) working up a mild sweat on my own.

At the cardiac rehab facility I experience something that is at once both humbling and surreal. The facility at Park Nicollet Methodist Hospital is really very nice, and the staff have been terrifically friendly and helpful. But for me it's really odd to be attending sessions where I exercise alongside folks who are clearly decades older than I am and who have more than likely lived very different sorts of lives. I overhear discussions about diabetes, smoking cessation, dietary changes, and other very important topics for people who have not really taken care of themselves for decades (probably). I don't mean that be insulting or judgmental, and anyone who knows me also knows that I believe in the "to each his own" (or to each her own, I'm not sexist) approach to life: as long as what you are doing doesn't harm another person, then by all means feel free to continue. What's so weird for me is that I am surrounded by people who've experienced a serious cardiac issue just like me, but who are so significantly NOT LIKE me that it's as if I'm in the wrong place! At some level I know that's stupid and possibly narcissistic, because in truth all of us there are more alike than we are different, and everybody is trying to get better. We are a sort of club, or cohort. In fact, when one of us is finished with the rehab, the nurses jokingly refer to it as "graduation day". So we all strive together, and look forward to that symbolic diploma.

The facility is sort of like a mix between a semi-posh health club and mission control.

Actually, it's not either of those things exactly, but instead it's a series of concentric rings: in the center are the cardiac nurses who are manning banks of computers that monitor all of us via portable EKG devices; the next ring is made up of nurses and physical therapists who work directly with us, helping, measuring, encouraging; the next ring is an array of workout equipment ranging from fairly standard treadmills and stationary bikes to modified equipment that is very low impact and more appropriate for those who are less fit or possibly in fragile physical condition; finally the outer ring is a sort of track that encircles the entire encampment, used by patients to take monitored walks and to be tested on a timed six-minute walk (either as a pre-test or as a final measurement of improvement at graduation day). It all works like a well-oiled machine, and I'm there with my crew thumping away on the treadmill at 3.8 mph for all of 15 paltry minutes - wishing I could go faster and longer. Patience, patience, patience - not my strength I guess.

Conversely, when I'm exercising on my own, I've been focusing on cycling - gently - which enables me to open up my lungs, re-train my heart muscles, and to be OUTSIDE again. You never realize how much you miss the fresh air until you have it pulled away from you. Just feeling the wind on my face (and the occasional bug in my mouth) is bringing me such basic joy!

Of course, I'm only toodling along, and I'm being passed by EVERYONE: commuters with bulging messenger bags, mothers pulling kids in bike trailers, old ladies on their therapeutic tricycles, etc. Well, maybe I'm exaggerating just a bit there, but I do admit that I'm sitting in my seat, spinning a low gear, barely maintaining 14 mph and there are definitely people passing me left and right who would not have done so just three weeks ago (even on my easiest day). Well, I suppose the right attitude for me to take is "good for you, go for it". But I'm human, and mostly I just feel envy and frustration. Darn.

That time on the bike, going easy, sometimes zoning out, has given me some time to confront my mixed up feelings about this whole messy chapter in my life. Aside from dealing with anger/annoyance/frustration, feeling impatient, feeling somewhat emasculated, and whining about it all (those are the minor irritants, when you boil it down), what does bring me to my proverbial knees emotionally is confronting the reality of my own mortality.

In his seminal book The Denial of Death author Ernest Becker lays out a fascinating treatise that builds on the works of Soren Kierkegaard, Sigmund Freud, and Otto Rank. Becker's basic premise is the we humans embark on a sort of "immortality project", wherein we can overcome the dilemma of knowing we will die by a pursuit of becoming part of something that feels eternal. Yeah, I know, it's not simple or obvious, and frankly you'll need to read the book because I am admittedly no expert here. My totally amateur interpretation is that we need to create meaning and a sense of permanence, or else we'd all be in a psychological state of paralysis brought on by thinking something like this: "I'm going to die and disappear anyway, so why bother?" From that perspective, all that we strive for, find joy in, love/desire/lose, and all other personal experiences are enabled only because we can deny our own impermanence.

Thus, when that shield of denial is pierced by, oh say perhaps having a totally unexpected heart attack, it creates a great deal of inner emotional turmoil and chaos.

Perhaps the true measure of a person is how they then cope with that disruption.

I'm also no expert on Freud, but in reading ALL of his books (yes, I went to grad school), I think I was able to glean at least a surface understanding. If anything, Freud was recommending that all of us open our eyes to ourselves, confront our defenses, admit that life is rife with conflicts and disappointments, but then just get on with it anyway! His work showed that denial and other defenses could be -when taken too far - maladjustments to life, leading to all kinds of dysfunctional mental, emotional, and even physical states.

Interesting, right? But am I just intellectualizing here? And, really, this is a blog post, so enough already! All I'm really trying to say is that it's hard, at times, just readjusting to what amounts to a sort of new life. I'm getting my feet back on the ground, moving forward, but I'm not fully recovered yet - and that means not just my injured heart but also my tumultuous psyche. I remain confident that I'll emerge from this eventually, and I wish it would be NOW, but time is an essential part of the healing process, isn't it?

If you are healing from any difficulties in your life, know that you aren't alone and that we all have to face our own demons now and then. Let's all try to be patient - but let's also admit that our task is not simply waiting for time to pass. Instead, we have to work actively at getting better, and not just physically.

In closing this all-too-long post, I just want to re-thank everyone who has been on my side and wishing me well. Every single thought matters and helps. Thank you!

A Very Bad Day - or - Lucky to be Alive?

Last weekend started off like a lot of weekends for me: an early alarm, a quick bite and cup of coffee, then a drive to a nearby trail race. In this case, I'd be running the Sour Grapes Trail Half-marathon for the third year in a row. The race was part of the 2014 UMTR Trail Race Grand Prix Series, a competition that I did well in last year but for which I had a lot of catching up to do this year.

I arrived in plenty of time, found a decent parking spot, picked up my number, and went about a typical warm up: a bit of walking, a mile or so of easy running, a few basic stretches, and heading for the start. Nothing out of the ordinary, in fact I was feeling pretty good.

The organizers got us lined up and sent us off. As usual, the faster-younger-more talented types rocketed off the line, leaving me and the rest of the pack to follow. I was probably sitting in about 15th place, more or less, about where I'd expect to be. With 13.1 miles to go, no need to push the pace early.

We rounded a couple of corners, and hit the first tiny little hill. We weren't even half a mile into the race at this point, but "something" happened to me right there. I felt a kind of flutter in my heart, and started breathing a bit heavier than I'd expect to be. Hmm. No pain. So I slowed down, thinking maybe I'd overdone the caffeine that morning, just needed to get my breathing under control and I'd be fine.

About a mile later I felt some tightness across my chest muscles. What the hell? Could I be having a heart attack? No way, I'm still running, only a few people have passed me, this is just a bad day. Maybe I was tense on the steering wheel during the drive, so I shook out my arms, slowed a bit more, tried to control my breathing.

Boy, did it feel like a bad day. For the next 3 or 4 miles I was forced to slow down to about 8:25 pace, well off what I thought I'd be able to do. But I was able to keep running, so I ignored my sensations and plugged on.

In fact, I plugged on all the way to the finish, which was a disappointing 20th place in about 1:47:00. Results. Compare that to last year's second place in 1:32, and you can see it was a bad day.

It was about to get so much worse.

I really felt crappy after the race. Super-tired, nauseated. and a bit woozy. Maybe I was bonking? I grabbed a banana, had some electrolyte replacement drink, toweled off, changed into dry clothes, and hit the road home. Still felt awful.

About 20 minutes into the drive, I finally admitted to myself that something was really not right. Stubborn fool. I pulled off the road, called my wife. She said, "Get to a hospital". She was right. I asked Siri to find me the nearest one, she obliged and I pulled into the parking lot of St. Gabriel's Hospital in Little Falls, MN.

I strolled in, sweating profusely and feeling light-headed. I told the receptionist that I might be having a hard attack. Within a couple of minutes I was on a bed and chewing children's aspirin, as the staff ran preliminary tests. It wasn't long before the doctor told me that I was indeed having a heart attack.

Okay, let me just pause here for one second. I was having a heart attack, one which had started almost 2 hours before, in fact I just ran something like 12.5 miles on trails WHILE HAVING A HEART ATTACK. Clearly, my capacity for denial is pathological, and my pig-headedness about finishing races had now put my life in danger.

I was so scared, it's hard to describe. Alone, and informed that I'd now have a wild ride in an ambulance for about 30 miles to get to St. Cloud Hospital, where they had specialists in cardiac catheterization waiting to help me ... I put my life in the hands of the professionals. I guess the fact that I'm writing this proves that it was the right thing to do.

The next few hours were a surreal and painful and frightening blur. I recall moments, like banging through the hospital corridors on a gurney, having my pants pulled off fast, receiving anesthesia, feeling almost out of my body, being told that I'd had a significant heart attack, and that I'd had an angioplasty and a stent implanted in my right coronary artery.

Then, I was in a recovery room. My typical, beloved type of trail race weekend had begun so normally, and now here I was.

My heart, shocked by this whole thing, couldn't seem to find a rhythm. After a couple of hours of my EKG bouncing all around, they sent me back to the Cath Lab so that they could insert a temporary pace maker for the night. I spent the wee hours in and out of a restless sleep, my heart pounding out a faster-than-normal and heavy-feeling beat, while intense thunderstorms pounded outside of my window. Like something out of a bad movie.

Eventually, I began to bounce back a little. On Sunday morning they turned off the pace maker, and my heart hung in there (mostly, still some funny beats now and then, they told me that was to be expected). I finally got a bite to eat. They came to my room Sunday evening to remove the catheters from my femoral artery (painful, very painful). By Monday morning I was able to take a few tentative steps out of bed, and by Monday evening I was able to be moved to a step down unit called Telemetry, which I always thought had something to do with launching satellites into orbit but apparently is basically a way to monitor things from a distance.

By Tuesday afternoon I could head home. Still scared, and now with a body filled with new and probably-long term chemicals (medicines) to help keep me alive: blood thinners, beta blockers, ACE inhibitors, and statins.

I had almost zero of the risk factors, and had just had my annual physical about 5 weeks ago - passing with flying colors. I do have a father who's had bypass surgery, but he smoked for years, didn't really exercise, and loved his eggs and bacon. Still, those darn genetics are just enough to get you. A heart attack? Me? Never!

Well, wrong!

I've now got a long road ahead, to work on recovery. The cardiologists said that my overall heath and fitness will not only help me make a "complete recovery" (well I hope so), but that in fact without it I would have suffered this episode earlier in my life and might not have survived it. So there's that.

I start cardiac rehab next, and if all goes well I'll be back running in several weeks. Not sure about any of this right now, of course, because I'm still wobbling around in a mixed up emotional and physical fog caused by fear, dread, anger, indignation, embarrassment, and drug-induced side effects. I know I've got to give it some time and work through everything. Of course I wish it had never happened in the first place.

I want to thank my loving wife for being strong and taking care of so many things through this crisis. And for someone who hates driving on the highways, she managed to come see me every day even through blinding rain storms and terrible traffic. Of course I'm also very grateful to the nurses, doctors, and everyone else at St. Gabriel's and the St. Cloud Hospital. The latter really was a top-notch experience.

As the weeks unfold now, I'll try to be more diligent about sharing here what I experience and what happens to me on this next leg of my life journey. I've got to get back up off the ground, dust myself off, and move forward again. I'm a pretty determined fellow, so I am confident that this hurdle can be overcome. But I'm damn glad to have help along the way, and I'm lucky to be alive.

Take care of yourselves, our time is so short and so precious.

Hope to see you out on the trails in a few weeks time, fate willing.

On Being Injured

If you are a runner, you are going to deal with being injured. I hope that you are very durable, or at least a fast healer, so that your need to cope with running-related injuries is minor. But, trust me, if you are in this for the long term you are going to get hurt. Like I am right now.

Left hip, back side, probably gluteus medius. It’s inflamed, and in spasm. Therefore it irritates my sciatic nerve, so I get the occasional shooting pain down my left hamstring and ITB. Running more than a couple of steps is painful. Sigh.

As an endurance sport, running is essentially a long series of physical stresses followed by periods of recovery. In order to be a runner, you will be testing your body’s capacity to adapt to your workouts and races. That repetitive process, whether played out over minutes, hours, days, weeks, or years, will eventually lead to a break down, or two, or three or more. It is inevitable.

In her seminal 1969 book “On Death and Dying", Elisabeth Kubler-Ross first introduced the now-famous concept of the five distinct stages of grief. At first she intended to apply these stages to those with terminal illness, but she later postulated that the very same coping model applied to anyone suffering a loss that was felt deeply on a personal level. I can’t imagine a better definition of how we runners react to injury.

Stage One: Denial.
You think that the pains you feel couldn’t possibly indicate an injury; after all, this can’t be happening to you. You run, you recover, you do it over and over, so this just can’t be an injury, and it will just go away if you ignore it. You keep running.

Stage Two: Anger.
Of course, the pain intensifies, to the point where you can’t ignore it any longer. You think (and maybe even shout out loud, enraged), “Why me?” At this point your fellow runners and loved ones find it difficult to deal with you. You simmer and seethe; words of encouragement sound as if they are mocking you, and anyone who is running is subject to your resentment, envy, and displaced rage. Of course, you keep running, with gritted teeth and an edge to your attitude.

Stage Three: Bargaining.
Whether you are religious or not, you begin to negotiate your case with a higher power, muttering things like, “Please, just let me get through the next race, then I promise I’ll take some time off and I’ll start stretching regularly and eating right and everything else I should have been doing.” At this point you also start impulsively improving other habits, in the desperate hope that doing right by your body in other ways will magically heal the running-related injury. You make sure to brush twice a day, you eat better, you remember to take your vitamins, and you get to bed earlier. Eventually, you try taking one day off from running, as if you can trade just one workout for a clean bill of health. But, of course, you go right back and you keep running.

Stage Four: Depression.
The pain of the injury has now compromised your ability to run. You take one day off, then two, then suddenly a week has gone by and you haven’t logged a single mile. You stay in bed a little longer in the morning, thinking “That’s it, I’m finished, I’ll never run again.” You find yourself lingering in the ice cream section at the grocery store. Your running shoes are now tossed into the back of the closet; you can’t stand to see them. The latest issue of your favorite running magazine arrives, and you toss it into the recycling bin without even opening the cover. Nothing can cheer you up. You’ve stopped running and you think you don’t care.

Stage Five: Acceptance.
Finally, one day, you look at yourself in the mirror, and you admit, “It’s true, I’m injured.” You feel slightly ashamed at having taken all this time before admitting to the obvious … again! You also start to listen to your family and friends, who have known all along that you probably just needed some rest, or maybe a visit or two to your physician/chiropractor/acupuncturist. While you don’t quite see light at the end of the tunnel, at least you admit that you are in the tunnel. And you stop despairing, and start making the adjustments necessary to get back on your feet. After all, you haven’t lost your identity, you’re just injured. That’s right, JUST injured. You know you need to be patient, and you finally begin the healing process.

Ironically, I’ve been through this more times than I care to count, and yet I fall victim to the same pattern almost every time. You could take my running log, page back through it, and discern the stages as I plodded through them over and over again. Take this latest injury, for example. It was over eight weeks ago that I first wrote “left hip tight and sore”. Did I change anything? Nope. That’s stage one. Then you see the tone of the log entries change, and the stray comment appears such as “damn hip still sore, WTF?” Yep, stage two. Then there are some embarrassingly sincere comments like “need to stretch more” and “taking anti-inflammatories”, and (rolling my eyes as I type this), “just need to get through the 50k at Bear Mountain”. Right … stage three. Of course, I managed to get through the 50k race, despite limping along the entire way. Immediately thereafter I stopped running entirely. Sure, I got on my bike and did some half-hearted pedaling last week, but I also “overslept” a couple of times and missed the bike workout completely. My wife tried to be sympathetic, but I was moping around and detaching. Tsk, tsk, stage four. Then, at the end of last week, I finally faced the music and just admitted that I’m hurt. I also began to recall in more detail the time two years ago when I had a very similar injury in my right hip. I eventually overcame that one, and my right side is completely fine now. Given the right amount rest and easy stretching, I’ll get the left side back in shape someday too. Made it to stage five.

Kubler-Ross emphasized that not only is there nothing wrong with going through these phases, but in fact it is necessary, on a psychological level, to move through them as part of the normal process of coping with loss. She also pointed out that not everyone experiences all of the stages, and not everyone goes through them in the very same order, but to my estimation they remain an elegant and resonant way to describe a very common experience.

May you never be injured. But, if you should fall victim to the rigors of our running lifestyle, try not to beat yourself up too badly for being, well, human.