Your Gift

On Sunday, August 14, 2011, I awoke feeling a bit of tightness between my spine and right shoulder blade, not unlike I have 2-3x/yr for the last decade.  I’ll just put some heat on it, take it easy for a few days, apply some Tiger Balm, and it will go away just like every other time this has occurred.  It was 6 days until the Timberman Sprint Triathlon race, a mere “warm-up” before my first attempt at my first Half Ironman (The Pumpkinman), so I was about to taper down my workouts this week anyway.  After a very restless night, I awoke with the pain being worse, but also an intense ache in my triceps area.  I had a surgical case to be ready for at about 9am.  By the time I arrived at the hospital I could hardly move my neck and the elbow had joined the achiness party.  No matter what I did, there simply was not a comfortable position.  I pulled aside one of the anesthesiologists and begged him for a trigger point injection where the pain seemed to be originating.  We ran up to the pain clinic and he injected me with 15mLs of Marcaine (a long-acting local anesthetic).  By the time I made it back down to the operating room I was already feeling much better.  Three hours later, when the case was over, the agony had not only returned, but now my forearm was aching and my upper arm began feeling “heavy”.  A second sleepless night, despite taking some old Valium that I had found from a previous episode a year ago, and it was back to work on Tuesday.  We had two back to back surgeries that lasted a total of about 5 hours.  By the time we left the recovery room after the second case, Dr. Harrell (the surgeon that I work with) had seen enough.  He walked me down to the ER where I was immediately escorted to a room.  My entire neck and right arm was engulfed with this sadistic aching.  The only part spared were my fingers. In one arm I was given a shot of steroids.  In the other, a shot of a non-narcotic pain medicine (because I had to drive home).  I left with scripts for Valium (a potent muscle relaxant), Oxycodone (a narcotic pain reliever), oral steroids (for the next 12 days), and Nuerontin (we’ll just call it a “nerve-dulling” medicine), as well as an appointment for a cervical MRI the next day.  Despite these meds, it was still so bad that my sleep was regularly interrupted for the next several days.  It wasn’t until I got a few days of high-dose steroids into me that I began to notice a hint of a difference; however, I specifically recall that it wasn’t until day #8 that I enjoyed (term used loosely) my first night of sleep.  But by Thursday the 18^th I felt fortunate that Dr. Harrell was able to pull a few strings at a PT office that had helped him last year, and I got in to see someone who performed some traction which was immediately helpful, although short-lived. By the time I was half way home all of my symptoms were coming back.  They did give me a traction device so I could do it at home a couple of times per day.  I’m now relinquishing any doubt -- I’ve got a disc issue.  Dr. Harrell (Rob), is already making plans for me to be out for 2 weeks after my surgery, yet I hadn’t even placed a call to the spine surgeon, Dr. Dirksmeier.

Actual cervical traction device that I used

Despite the urgings of all of the wonderful people that I work with to “go home” (almost daily), I adamantly refuse.  “I haven’t missed a day of work in my life. I’m not starting today.”

One of the surgical residents I was on a team with during my training over 10 years ago once told me, “Man, if you’re going to go into surgery, you must remember one rule: Don’t call in sick.  Only call in dead.”

At last check, I had a pulse.

Depiction of an MRI machine

The most uncomfortable position to be in for anyone with a “disc” issue in their neck is an MRI machine.  You’ve got to slightly extend your neck (this is bad), keep both arms at your side (that is worse), and lie still for 25 minutes (pretty much impossible).

My MRI was at 7am.  By 8am, I am back at my office, begging for mercy, in about as much pain as I can ever recall being in, but we have a full morning of patients to see in the office for which I had already prepped for the day before, then our weekly “Chest Clinic” meeting up at the hospital, then a few more patients in the afternoon.

Thanks to digital technology, by 8:15 I go into one of our exam rooms and upload the images of my MRI. I’ve never read a cervical MRI in my life, and have probably only seen a couple, but based on my symptoms and medical education, I know right where to look. 

“If there is a problem, it’ll be . . . right . . . oh shit!”

My face collapses into my palms, and I needn’t say what happens next.  I kick the door closed.  I need a moment . . . or two.  Thankfully, I’m able to get about 5 minutes, none of which I particularly recall.  After collecting myself I head out into the hall and see Dr. Harrell coming towards me.  He’s smiling like he knows something, like he has already seen my MRI, which would be just about impossible, “Alright Chief, when is your surgery?”

I pull a U-turn and we head into the room to look at the MRI together.  “Whoa, Dude!  Now THAT is not subtle.”

I don’t have much of a reply.

He continues, “Alright, when do you see Dirksmeier?  Do I need to place a call to get you in sooner. . . um . . . like today?  I’m no spine surgeon, but that has got to come out.  I’ve been there, man.  I had two discs that he took out – plus a cervical fusion, and the disc of this MRI that I’m looking at right now looks much worse than mine.”

I tell him that I’m seeing him one week from today.

“No you’re not.”

In 30 seconds he is on the phone and my appointment in changed to the following afternoon.

Yup, that's my MRI

Since my ER visit several days prior, I was only taking the narcotics (Oxycodone) and benzos (Valium) right before bed, and just suffering through the pain all day long so I could work, and drive, and be conscious for my kids in the evening.  Well, today was about to change that.  Kathy, our office manager, knocks on my office door.  I tell her to come in.  My office is pitch black and I’m laying in the corner on the floor, my neck is in the traction device, my right arm is propped up on two pillows, and I’m writhing.

“Kathy, I can’t do it any more.  I need some medicine (and I don’t mean Tylenol). I left all of the good stuff at home because I know I can't take it at work.”

My arm feels like I’m holding a 50-pound weight after going through a meat grinder (without the bleeding you’d expect). 

“Shawn, get out of here. The rest of the day is clear.  I’ll let Dr. Harrell know.  Just go, please!” she demands.

It’s the longest 32 minute drive of my life.  I averaged 15mph over the posted speed limit.  In my eyes, every yellow light was green.  Every stop sign was a yield.  Every time I had to touch the brakes I dropped an F-bomb.  After making it home and medicating, the next 12 hours are a haze.  I have a new appreciation for anyone with debilitating pain.  Apparently I fell asleep in a seated position on the couch, wearing my homemade soft color, and my wife, using physical force, was able to “awaken” me.  I stared at her blankly with my upper body kind of shaking awkwardly as I fought with the faucet of drool showering my chin and neck.  While sitting upright I announce, “My legs are frigin huge.  Look at ‘em.  My legs.  Look.  They’re huge, and swollen.  Look.  Do you see ‘em?”  I had been on high-dose steroids for numerous days now and my body was showing the effects.

Karen demands, “Let’s get you to bed.  C’mon. Shawn? SHAWN!? C’mon!” Karen sees me fading.  I have no fight left.  My brawl with the drool wore me out.

About the next thing I recall is turning off my alarm with no ill effects, no “hangover”, actually feeling quite refreshed, and aside from some neck stiffness, my arm feels the best it has felt since this all started.  My normal morning routine is performed nearly flawlessly.

After a fairly uneventful and mostly tolerable morning, I’m off to see Dr. Dirksmeier, the spine surgeon.  This is the man I trust. He did a similar (more extensive) surgery on my mentor, Dr. Harrell, a cardiothoracic surgeon.  Both he and my mentor are triathletes.  I reckon that before he even meets me, he “gets" me. He knows all of the things that I am going to say.  He knows all of the questions that I am going to ask.  Silently we tick by the same watch.  We have an understanding, but when it comes right down to it, after the taking of the history, and the physical exam, and the anatomy lesson while viewing the MRI, he finally has to cut to the chase, “You must have more races in your season?”

     “I have been training 8 months for my first Half Ironman, the Pumpkinman,” I tell him.  “I know you do that race too, so I don’t need to tell you that it is only 3 weeks away.  You tell me what I need to do in order to be able to do that race and I will do it.”

     “Well, that’ll be how long since your pain started?”

     The math has already been done, “Exactly 28 days.”

     He lists, “You have to be pain-free for 2 weeks.  You can’t have any numbness or weakness in your arm.  You have to have absolutely no expectations except to finish, so if you had a time goal, wipe it out.  It doesn’t exist. You can’t do another workout until the day of the race, except an upright stationary bike, but not until you are symptom-free.”

     To clarify, “So, if I meet all of that criteria, I can do the race?”

     “Yes, but the likelihood that it will set back your recovery and possibly cause a reaggrevation of your injury and symptoms are probably greater than 50%.  So, if you’re willing to mortgage your entire off-season training plan for this race in 3 weeks, which then endangers your 2012 season, you can do it.” I knew the direction he was leaning, but after that reiteration, I’m thoroughly confused.  Well, except about one thing.  At least as of right now, he is >90% sure I can avoid surgery AND have a symptom-free 2012 season.  (But it’s 3 weeks away, and I’ve trained for 8 months!)

The Pumpkinman

An hour later when I give Rob (Dr. Harrell) the news, he gets the “deer in the headlights” look.  He essentially already had me booked for surgery.  He’s looking at the calendar, moving patients around, looking at the call schedule, etc.  He was convinced.  And he’s been there, so I was just about as shocked as he, but elated still.  I think?  “Okay”, he says, “I guess I accept that I’m no spine doctor.  He didn’t steer me wrong.  He did my surgery and 2 months later I was training again with no recurrence of my symptoms and it’s been over a year and a half now.”

But most of you know where my head is at, right?  I’ve got 3 weeks.  Three weeks to do what I’m told.  I’ve got 1 week to get myself symptom-free, and 2 weeks before the race.  You know, that one I just dedicated 8 months of my heart to.  I can do this.  I WILL do this.

Hammering a hill at The Mass State Olympic Triathlon (July 2011)

A couple of hours later, while preparing dinner, and with my head still trying to get mentally prepared to race in three weeks (because I know that I am), I’m asked by Karen, “So, how’d it go (with the surgeon)?”

I cringe and the hair stands up on the back of my neck.  The crystal ball that was blocking my view on my dashboard during the ride home already prophesized this conversation.  I had memorized Dr. Dirksmeier’s exact parameters, word for word, and so, in my most confident and calm and convincing tone, verbatim, I begin to recite. I can’t look her in the eye.  If I do, I’ll crack.  When my brief dissertation is complete, I’m ready for the comeback dropkick in the chops.

     “You’re actually thinking about doing this? Seriously, Shawn?  Why? Do you think that is wise?  I don’t get why this is so important to you. You’re actually considering doing it, aren’t you?  Do you even have disability insurance?” (answer:  Yes – but it’s shitty) “Are you thinking about us (her and the kids)? What if this makes it worse? If it does, you may need surgery, right? What if you can’t work? You just got done telling me it takes 6-12 weeks to heel, yet this race is 3 weeks away.”

     “You’re right.  You’re right.  I won’t do it.  I won’t do it.  You’re absolutely right.”  My highly emotional, stubborn, impatient self, was taking over.  I had clearly not thought this through.  I had no bullet points to bring out of my back pocket to support my argument.  This conversation was promptly over, and as well it should be.  The better, more reasonable, and smarter half had easily won.  It was a one-sided debate.  I had no business even stepping to the podium.  Frankly, I am grateful.  I am very grateful for her.  As of the moment that I publish this posting, I have not met any of the criteria outlined by Dr. Dirksmeier.  I’m not even close, although I am clearly improving.  I’m still having episodic debilitating pain from my neck to my hand. I’m now able to sleep through the night most of the time having just taken Motrin.  However, the weakness is still quite impressive.  It is so bad it has affected even my penmanship.  I would need help putting on The Iron Roosta trisuit, never mind taking off a wetsuit after a 1.2 mile swim.  I can no longer do a single push-up, so leaning on aerobars is out of the question for one mile, never mind 56.  The slight impact of jogging even causes pain, so you can forget about a half marathon.

There will be no Pumpkinman 70.3 in 2011 for me.  All of that training for one race seems for not.  They say it is not the destination that makes toeing the line worth the sacrifice, but rather, the journey to get there.  But then the starting line was taken away from me.  And that’s not all that was taken from me.  Things I took for granted have dissolved.  My ability to hyperfocus on my nutrition has disintegrated.  I have put on 10 pounds since August 14^th.  My circadian rhythm which took me weeks and weeks of careful planning to reset has been retuned and is now dissonant with the triathletic lifestyle.  I miss methodically packing each of my training bags the night before my next day’s training session, then rechecking then two more times before I fall asleep on the couch by 9pm.  I miss making my nutrition plan for the day, the work week, and the weekend.  I miss hitting the grocery store three times per week for fresh produce.  I miss that 3:45am alarm that was so damn easy to awaken to.  I miss being halfway into my runs when the sun crests over the trees.  I miss listening to all of my motivational music on the way to the pool.  I miss taking that last sip of coffee as they unlock the door to the gym at 5:00am.  I miss counting laps.  I miss the kick drills (No, I don’t.  I still FN hate those :).    I miss topping off my tires with air and resetting my odometer.  I miss designing new routes on mapmyrun.com.  I miss counting calories.  I miss filling my water bottles.  I miss the stench of my sweaty workout clothes.  I miss needing to do a load of laundry consisting of all of my week’s training clothes on a Sunday night.  I miss logging all of my workouts in Training Peaks.  I miss talking about my workouts on Facebook.  And now I will be missing my most anticipated race of the year.

You see, all of these things are gifts.  They really are. I took them all for granted, but I awoke one morning a month ago and all of these gifts were taken away from me and I have no idea when I will get any of them back.  They will never be taken for granted again.  It has been nothing short of pure agony.  I have been depressed, displaced, and distraught.  I hope it is something you never have to go through (although I know some of you already have).  Unless you have, I guess it is incredibly difficult to comprehend.   The outpouring of constant support has been mindboggling.   This triathlon community has literally been checking on me hourly.  It is what has helped me get through each day.

So, today all I want each of you to know is that your next workout is a gift.  Be thankful that you have it.  At any second it can be taken away.  If and when that moment comes, you will beg for it back.  You will beg to be able to organize and pack each of your training bags each day, beg to awaken at 3:45am, beg to watch the sun shine over the trees during mile 7 of your 10 mile run, beg to do kick drills at the pool at 5am ‘til you can’t propel yourself forward another meter, beg to top off your tires and your water bottles and then ride until the skin on your crotch wears off, beg to run hill repeats ‘til you puke, beg to wash your stinky clothes, and beg to do laundry late on Sunday night so you’re ready for the next week of gifts. 

I will be at The 2011 Pumpkinman 70.3 this Sunday in South Berwick, Maine.  I will be beside each of one of you as you swim, bike, and run . . .  but only in spirit.  I would, however, like to particularly thank race director, Kat Donatello, for another gift.  Because of her generosity, I will be racing the 2012 Pumpkinman 70.3.  She has allowed my entry to be deferred due to injury. As irony would have it, the week before my injury I had already signed up for my first race of 2012, The Rev3 Quassy Half Ironman in Middlebury, CT, on June 3.  This race now becomes my first attempt at this distance.  I wanted it to be “in my backyard”, so to speak, but it was just not meant to be. 

My next attempt at 70.3 happens here

I will return with restored focus, enhanced determination, a flawless plan, and possibly in better physical shape than I have ever been.  I must allow myself to heal 100% and follow the plan of my physical therapists and surgeon.  My body will be rejuvenated, my mind will be unwavering, my heart will be tranquil, and as they all coalesce, I will again be prepared to conquer.

I’m still awaiting my next gift. When is yours?