Pain, death, and limits.

Barbara Warren, the 65 year old athlete I saw prone on the Santa Barbara long course being attended to by volunteers, died Tuesday night after having her ventilator turned off. She was an epic athlete, a world champion, and someone who clearly attacked life with zeal. After the accident she was paralyzed and kept alive by a ventilator, and able to communicate her wish to be allowed to die. Do you know your limits? Do you know at what point it’s time to stop? Do any of us really have the presence of mind to know when to back off before something horrible happens?

Warren’s death coincided with a 63 year old dentist that died on the swim leg of the Escape from Alcatraz race. In his case he had a fatal heart attack before reaching shore. This is at least the second heart attack I’ve read about this year that happened on the swim leg of a triathlon, and I can understand it to some degree. An ocean swim in cold water stresses the body, and an athlete may not know how far they are taxing themselves in the frenzy of the moment. Warren’s death has stayed with me, perhaps because I passed by the scene, useless (she was being attended to by volunteers, ambulances were on their way, it was under control), and I am particularly susceptible to death anxiety. When she was asked in numerous ways and contexts if she wished to be taken off life support, she confirmed over and over to be allowed to die. I am haunted by her decision because it seems to contradict the ideas about endurance sports that I have cultivated now for several years.

Last night I had my first migraine in almost 9 months, a reminder that I still have an illness beyond my control. It began suddenly, as they often do, with a strobing effect on one side of my vision. One moment I was getting out of the car in a grocery store parking lot, and the next I could not see my wife standing to my left. I could not focus, I could not read words, and parsing information became difficult. I stood at the front of the store with the anxiety of not knowing if the migraine precursor would manifest into a full-blown headache, or if it would pass. In the dozens of times I’ve gotten strobing precursors, once it did not materialize into a full-blown headache. Hope springs eternal.

We used the self-service checkout, a system that is both slower than a human checker and offers no discount for offsetting the labor onto the customer. The strobing had taken over my left vision, but I was getting by. Why didn’t I let my wife do the transaction? Why did I insist I was going to be OK rather than admit I was going downhill? On the way to the car she asked, “are you OK to drive?” And I said yes. Once away from the lights my vision was a little better. The strobing had become mild tunnel vision – no pain yet – but clearly I was slipping. We got home in a few minutes, unloaded the car, and as I took out my contacts the pain began to creep along behind my right eye. I popped two migraine pills, grabbed the dogs, and took them for a hurried walk. Why didn’t I let my wife take out the dogs? Even as I was taking the meds to deal with the crushing pain I knew was on its way, I still felt responsible about my duties. Why didn’t I let her drive us home? Because she had a cocktail at dinner, and in my mind I weighed my impaired vision against her impaired motor skills. (Having forgotten in my compromised state that my motor skills were probably just as compromised.) In hindsight, what the hell was I thinking denying that I was in a severe neurological downhill slide and still trying to act like I could do everything normally? 

When we talk about endurance sports we cannot isolate them as existing in a vacuum. It is a distinct personality type that gravitates towards these activities. I’ve said it before – triathletes are some of the smartest, most driven, determined, focused people I have ever met. My roommate in Santa Barbara said to me, “yeah, and the women have severe OCD.” I sort of dismissed it at the time, but I think that if you took the gender out of the statement, I’d bet that the sport attracts a lot of people with intense control and organizational impulses.

First, the sport requires clean, linear thinking, and imposing order to achieve personal goals. No one podiums through chaos training and living. Champions in this sport are efficient above all else, which requires a strict adherence to planning, order, ritual, and attention to detail. Second, there is amongst almost all triathletes I’ve met and read, a feeling of always being deficient in one particular area. Train hard for some places, beat yourself up for slacking in the others. Triathlon has three distinct sports, but transition and nutrition are also major factors that have to be trained. It is hard to avoid negative conditioning to motivate training, that is to say, “I’m great on the bike, but I suck at the swim” is to abuse yourself to motivate further training. The truth is that any triathlete that has completed even a sprint distance can swim. Yes, training will make improvements in speed and endurance. But why do so many of us have to insult our existing achievements to get out and train more?

As I sit here typing it is relatively easy to make decisions about life support options, resuscitation orders, and medical directives when I am a healthy, young, fit athlete entering the prime of his physical life. Barbara Warren made her choice with a tube down her throat, unable to move her body, kept alive by machinery. I fully respect her decision, and my heart breaks for her family’s grief.

And yet, if I imagine myself in her position I cannot envision myself making her choice. I finish races because I do not know when to quit. I push through a migraine, denying the inevitable crushing pain that’s coming because I will not admit being defeated by my body. I took the meds, I dealt with the pain, and with the help of my wife I got to bed. I have to believe that if I were paralyzed that I would recover from my injuries and begin a new life as a quadriplegic.

There it is: I value my brain more than my body. My death terror is from the cessation of self-awareness. The idea of being dead, of losing the sense of self and my place in the universe is the destruction of ego, my core self. I can handle the destruction of my body, as long as my mind is intact. I cannot empathize with Warren’s choice because I cannot willingly self-destruct. I can destroy my body because I know that my mind will go on. How shortsighted is that? My brain is part of my body! I am a single, unified system. Destruction of body IS destruction of mind! Training creates neural pathways to muscles, training the nervous system – the extension of the brain into the entire body – to become an efficient harmonious system. Perhaps there is Warren’s ultimate rationale – her mind disconnected from her body was antithetical to her life, and that is what allowed her to make that choice.

I do not believe in a soul. I do not believe in any metaphysical or unquantifiable spirituality. A soul is not testable, measurable, identifiable, or objectively analyzed. But a philosophy is a legacy passed on to others by behavior. Barbara Warren has given me something by her decision, a seed of a new understanding. I hope that I, or my loved ones, never have to make those excruciating decisions. But if we do, I want it to be the result of having lived a life I love, doing what I love, having reconciled as much of my internal conflicts as possible. Is that what we mean by resting in peace?

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2 responses to “Pain, death, and limits.

  1. Bingo. Here’s your diploma. Sometime in the mid 70s, I had a co-worker Jim (James Quackenbush) Frost. He had been a Assoc. Creative Director at Doner when I got there… and came over to RM&D as a peer after I was there. He was about 20 years older than me… which meant he was pushing 50 when I was about 30. So he was looking at Disability Insurance. He eventually blew it off. We asked why and he said “I asked them if they could insure my ability to continue to get new ideas. When they said no, I said no.”

  2. There are a number of articles written about the correlation between swimming and heart attacks.

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