Wednesday, February 15, 2017

Surviving a Scare

It's been awhile since I've posted anything, but I've had irons in the fire.  Work and travel demands caused me to take almost two months off of the bike after Race Across Oregon in July, and when I emerged in mid-October, my fitness was in Nowheresville.  But, for the first time in nearly a decade, I  renovated the Pain Cave both physically and virtually.

On the physical front, I picked up a Tacx Neo smart trainer to replace my 2006-era Computrainer, and I've been using the heck out of it.  In my mind, the direct-drive setup is categorically superior to the older wheel-on technology, and the Neo is a beautiful beast.

On the virtual front, I signed on with Trainer Road and Zwift, following a structured training plan for the first time in recent memory.  I've gotten to be reasonably proficient at prescribing workouts for myself over the years, but there hasn't been much periodization to it, and overall things had just gotten a bit stale.  Between October and late January, I was able to ride 6 days a week with consistency, recording about 700 training stress/week, which is about 50% more than in years past.  And the result showed: my power/weight ratio jumped from ~3.8 to ~4.4, which was the highest it's ever been -- an auspicious place to be in January -- and I was getting stronger by the week.

All told, although nothing is ever guaranteed, I was confident that I could put in a serious showing at Sebring.  I'd initially planned to ride the 12-hour, but I was feeling so strong that I'd mentally committed to switching to the 24 and taking a shot at that magical 500-mile day.  I started my taper late, putting in a hard weekend only a week out with the idea that I'd take it easy for a few days and then give it a go.  The Sunday before the race was my last long ride, a 5-hour trainer session that I entered tired but knocked out with no problem.  Then it was off to a Super Bowl party to enjoy the fruits of months of discipline.

The following day (Monday), though, I found myself feeling like I had a bit of a cold.  I do get the occasional head cold, and it's common to feel a little under the weather during a taper, so I didn't think much of it.  The hard work was done, and a scratchy throat was nothing to be concerned about.

Tuesday brought no improvement -- I was definitely fighting something.  What had been a mild, generalized sore throat had become more focused in an area in the back corner of my throat, and it was acutely raw when I swallowed.  Still, I figured, no big deal.  I even knocked out a 3x15' sweet spot session on the trainer as planned, and did so without drama.  I reasoned that the workout might even help clear out my head and throat.  The workout wasn't easy, but I *was* in taper mode with the fatigue it entails, and nothing about the experience suggested anything more than a cold.

By Wednesday, I'd put myself into the category of sick, as much as I hated to draw that conclusion.  I'd busted my butt for months to put myself in a position to try to win Sebring outright a few days later, and the idea of being sick for the first time in years was unbearable.  I was blowing my body weight in snot on an hourly basis, and when I swallowed, it felt like there was a spiked golf ball in the back of my throat.  It turns out that we swallow a considerable volume of saliva and mucus each day, and when swallowing is to be avoided, you become pretty disgusting, because it has to go somewhere.  I bought some cough drops and made the best of it, even dropping my bike and supplies with a friend for transport to Sebring.  That evening, though, I had a fever for the first time, felt achy, and the rest of it.  (Crap.)  Still, my philosophy was that all I needed was a solid night's sleep and I'd be on the mend.

Unfortunately, Wednesday night brought almost no sleep.  I felt like I was drowning -- imagine the worst cold in the world where you can't swallow without an explosion in your throat.  Amy slept on the couch that night, but I didn't even notice until the next morning.  Pretty much sums up how out-of-it I was.

By Thursday morning, it was becoming increasingly clear that Sebring was a stretch.  (Many people would doubtless say "of course" at this, but I think endurance athletes are used to just working through challenges in a way that alters how you view things.)  Amy and my parents thought I might have strep throat; I was undeniably miserable.  Awkwardly, I had to go to work on Thursday because I had a hearing in court that afternoon that I felt I needed to attend.  By this time, I couldn't really talk without coughing spasmodically, and swallowing was almost entirely out of the question.  I managed to communicate to the judge that I was sick, and that was pretty much all that was required of me that day, but I went straight from court to a primary care doc to see what the heck was going on.

The nurse practitioner saw me quickly, noted that my tonsils were swollen, and performed a strep test that everyone expected would be positive.  But it wasn't -- negative as could be.  She consulted with some other folks in the office and recommended that I go to the ER based on the fact that something was clearly wrong, but there was no obvious answer as to the "what" of it.  By then, things were so bad that I dialed Amy's cell and asked the nurse to tell Amy what she'd just told me, because I couldn't speak more than a couple of words at a time.

Amy met me at home about an hour later; I took that time to stand in a hot shower and just try to stop shivering.  We drove to Sibley Hospital ER, where I was admitted about 8:00 p.m. on Thursday night.  I got a CT scan, which showed several large peritonsillar abscesses (essentially pus-filled pockets of infection) in the back of my throat, some of which were dangerously low in my neck and thus close to my vocal cords and chest.   Also, I had a 103-degree fever.  After hours of deliberation, the folks at Sibley determined that I needed surgery immediately but that they weren't equipped to do it -- given the scope and location of the problem, the ENT docs needed a full-fledged facility that could deal with collateral chest infections that might arise from the initial surgery.  Unfortunately, for whatever reason, it took hours for Sibley to find another hospital that could take me.

During this time, which stretched until about 1:00 a.m. on Friday morning, we'd decided it made sense for Amy to go home to try to get some sleep.  I promised I'd let her know where they took me for surgery and when it was scheduled to happen.  I didn't see the point in her destroying herself to sit in an E.R. indefinitely while nothing happened.

Ultimately, in the middle of the night, Sibley decided to send me by ambulance all the way to Johns Hopkins in Baltimore.  It was a pretty surreal scene staring out the back window of the ambulance as it bounced through deserted streets as I was tranquilized on morphine.  The only comparable instance was nearly 2 years ago -- coincidentally, in connection with another 24-hour bike race, in Texas, following a particularly nasty crash.  At least this time I was headed to a real hospital.  I let Amy know that I was in Baltimore with surgery scheduled for Friday morning.  Communicating that was about all I could manage between my misery and narcotic haze.

I don't remember much from that point until Saturday afternoon.  The surgery apparently revealed problems significantly more severe than the surgeon had anticipated.  Among the several infected abscesses was one that was about 4" long -- one of the largest the surgeon had ever seen -- and it was necrotic, meaning that the tissue was dying.  It also was in a particularly sensitive area.  They had to remove a tonsil just to get to it, and it was very close to the nerve that controls my vocal cords.  The doc was alarmed that such an extensive problem had developed so quickly, and feared that I may have contracted a flesh-eating bacteria.  The phrase "necrotic fasciitis" was thrown around.

I vaguely remember a conversation with the doc after the surgery in which he expressed concern that he might not have taken care of the entire problem.  Scans showed additional swelling further down my neck, and if the infection continued to spread, more surgery would be required.  My hazy recollection of that conversation involved my telling the doc to do what he needed to do -- if was another surgery, it was.  But my memory is pretty hazy, as I was on several different kinds of potent painkillers, had a breathing tube down my throat, and could barely even write on a board, much less talk.

Amy's experience was even more alarming.  Apparently the doc told her that the next surgery could require going into my neck from the outside, through the vocal cords, which meant that I'd never talk again, assuming I survived it in the first place.  He asked her the odd question: "Is Damon risk-averse?" and also whether being unable to talk would significantly impact my career.  As a lawyer who appears in court regularly, I think the answer to that is pretty damn clear.  I have no memory of this.

Meanwhile, the bacteria were being cultured to try to identify what had attacked me, and everyone was watching my white blood cell count to see whether it was moving in the right direction.  I was on four different kinds of high-powered IV antibiotics because no one was certain which one might prove effective.

I was only vaguely cognizant of this stuff.  I like to think I was at least partially lucid at the time, but I can't remember much of what happened.  At one point, I scrawled on a white board: I feel like post-Trump America.

For me, the most alarming part of things was that I'd gone to the doctor thinking I'd get just get some antibiotics.  From there, I'd learned I needed surgery, perhaps even a tonsillectomy, and the thought of spending a weekend in the hospital was nightmarish.  But now, no one could tell me much with certainty except that I'd be intubated for the foreseeable future and my hospital stay could last for weeks if things didn't play out in my favor.   A week-long stay was the best I could hope for.

Fortunately, things broke in my favor, and I recovered more swiftly than the doctors' most optimistic estimates.  I think my relative youth, good health, and strong immune system counted heavily in my favor.  The antibiotics succeeded in driving out the infection over the course of a few days.  I was intubated until Sunday, moved out of the ICU on Monday, and released on Tuesday -- 5 days after admission.

From here, it's going to be a bit of a road to recovery.  I'm on a liquid-only diet for several more days, and I'm exhausted and weak.  Given the blood I lost during the surgery and over the course of hourly tests, my hemoglobin levels are through the floor, and I wasn't able to sleep for more than half an hour at a stretch for 5 or 6 days.  ICUs are terrible -- loud, beeping machines, a tube down your throat, 800 wires and IVs connected to you, and nurses who poke you, draw blood, change drips, and ask you how you're doing literally every hour.  Several times I managed to fall asleep, only to be awoken by a nurse who just wanted to know if I was okay.

Ultimately, given the background terrible luck that put me in the hospital in the first place, I think I'm pretty fortunate.  The primary care nurse sent me to the ER rather than sending me home, which isn't an inevitable call to make for someone who presents with a sore throat and fever during flu season.  Had she done otherwise, I think my life could look significantly different going forward, because the infection was ballooning in a nightmarish area.  I also found myself at Johns Hopkins, which is about the safest place one could be; in many parts of the country, that wouldn't have been an option.  I had a tonsillectomy, but that's an afterthought in the grand scheme of things.

It's hard to know what conclusions to draw from this.  It's easy to say: "If you're sick, go to the doctor," but I'm almost never sick, and when I am, it tends to last about 12 hours.  Moreover, I think I have a high pain tolerance -- the sorts of athletic events I'm drawn to suggest as much -- and an allergy to drama.  Put it together and it translates into a philosophy of "there's nothing wrong with me that a little sleep won't fix."  I suspect many endurance athletes share some or all of these traits, so maybe this story will provide a cautionary tale to someone out there.

It'll take time to get my strength back, catch up on work, and get life back to normal.  Obviously there will be a lot of rebuilding needed on the bike, although hopefully it won't be a return to zero.  It's amazing how much strength you lose from being confined to a bed for only a few days.

On the whole, I'm a lucky guy.  Amy was an incredible trooper at a time when she really couldn't afford to be given her situation at work, and I had a steady stream of friends visiting me in the ICU from D.C. and Baltimore.  I had more messages and well-wishes than I could hope to respond to.

Perhaps this is best placed into the category of a near-miss.  Life is full of those, whether we know it or not.  Ten years ago, my brother Jaron -- for whom this blog is named -- presented at a primary care doctor with a headache.  His experience was the opposite of mine: he was prescribed pills and sent home, and then the same thing happened again when he went to the E.R. a day or two later.  No one even performed a CT scan.  By the time someone took him seriously, it was too late, and a treatable cyst in his brain had become fatal.  From what I'm told, my situation could have headed in that direction if my caregivers had been less concerned and diligent, and if my treatment had been delayed much longer.

We all rely on other people in life, whether we want to admit it or not, and regardless how recently we've read Ayn Rand.  Life is about making the most of the opportunities and gifts we have, but it's also about being lucky in countless ways -- from having a caring family and educational opportunities to people who look out for us when we desperately need it, even if we don't know it at the time.  I'm happy to say I've been deeply fortunate in all of the ways that matter.

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