Eleven Days Out.
In less than two weeks I will line up for my half-Ironman. I’ll be dipping in to the saltwater canals around the old Bader Field airport in Atlantic City, New Jersey. I’m ready. Well, I’m as ready as I’m going to get. I’ve done about 90% of the work my coach assigned, and I did all the long runs and rides. I’ve done 60 miles on a bike, and 14 miles on my feet. I swam a long swim of 1.5 miles. I did a two-hour ride followed by a one-hour run.
Yesterday I spent 40 minutes on strength at the gym, followed by an hour ride and a ten minute “shakeout” run. I’m still having trouble with my front derailleur. It’s driving me crazy and I recommend no one buy anything made by SRAM or Specialized. I’m so frustrated with their inability to build reliable equipment. I will likely be replacing my road bike when this is all over.
I have my final call with my coach Monday. I’m excited, scared, and eager to get going. I know it’s going to hurt. It’s going to hurt a lot and for a while. But I think I can do it.
That is, if we get to race. Hurricane Irma currently looks poised to hit Florida or Georgia, possibly the Carolinas after shaving her way up the coast from Miami. this could easily result in tropical storm-force winds and rain soaking New Jersey by the end of next week. My race getting canceled is among the least important things that can result from a hurricane, so I’m not going to ask for any pity. But I do hope I get to race.
The Next Steps.
I’ve been reached out to by an academic hospital, not MECMC. I sent them my resumé in response to an advertised position for a new Quality Director. They reached out with some additional questions. They’re narrowing down an interview list. I’m hoping to be on it.
I’ve been thinking about what my next steps are. What do I want? My dream of being the director of advanced engineering at MECMC is feeling more and more remote. My boss is a good boss. But she doesn’t seem enthusiastic about advancing my career. At least, not according to the visions that I have.
So I ask myself. What’s next? Do I want more administrative responsibility? Do I want to be an executive? Where are my best options for growth and impact? What mark do I want to leave on healthcare? Is it arrogant to think I can even have one?
I feel like I have a reasonably impressive resumé at this point. But it’s full of heavily academic accomplishments. I have been consciously trying to expand my experience along the management track. I’ve taken short courses in management. I’ve published papers in management journals.
But am I a director? That starts to get into serious responsibility. Accountability for hospital-wide initiatives. Accreditation. Liasing with governments and hospital membership organizations. Administrative bureaucracy on a logarithmic scale.
I’m a lazy person. I barely work 20 hours a week most weeks. If that. Being a director would require many more hours, and it would mean mostly abandoning the subject matter expertise that has been the hallmark of my competence for the past 20 years.
But it would also mean having a much larger footprint on an organization. A much larger ability to influence how care is provided. To design and implement programs designed to make lives better. Patients’ lives. Employees’ lives.
It would likely also mean a much larger paycheck. Though it’s hard to know for sure. MECMC is an enormous, wealthy institution and the hospital I applied to is neither, to my knowledge. I am satisfied with my compensation at my current job, but like most people, I’d take more if I could get it
So I have a lot of thinking to do.
Sixteen into the Wind.
Yesterday was my long ride. The longest before my race. Sixty miles of road bike monotony. Just me, the bike, and the road. I put down about 600 calories and 60 oz of liquids during the ride, which included a spectacular cloudburst at mile 18 that meant I was riding wet for 42 miles. I averaged 15.9 mph for the whole thing. And I hit 56 miles, the length of my race, at 3:28:15 or so, which is exactly where I want to be. 16 miles per hour.
The whole ride out was into the wind, and marking time was a challenge but good. A little uphill, along the banks of the river. A little into the wind. Out at the turnaround I nearly got a little lost as I ran out of trail and rode on streets. But I figured it out and maintained a good speed regardless. As time wore on, it became more difficult to keep pace, as my legs burned. But I did it.
A lot of stuff goes through your head on a 60 mile ride. I don’t ride with music or anything, so it’s just me and the road. One thing is, WHY THE FUCK WON’T MY GODDAMN FRONT DERAILLEUR WORK LIKE IT’S SUPPOSED TO. That lasted about 14 miles. I’m taking it in to put it into race condition and I have confidence in my local bike shop.
But mostly, long-distance cycling is contemplative. I am mostly on flat ground, so I’m not pushing myself from a cardiovascular perspective really hard. It’s mostly about the slow burn of about 60 calories a mile. I’m feeling capable. Ready. Strong. I’m still a little heavy, but that’s just what it is. Now I have two weeks until the race. Hopefully Hurricane Irma stays away from the East Coast, and I can get it in.
Losing.
My father is awake and talking. He seems to have returned to the state he was in immediately prior to the sepsis. It’s a sort of childlike state of basic needs and frustrations, inattention and confusion. But he’s still in there. He’s still my father. And based on the current state of this episode there’s no reason to believe he won’t live a few more years. But it’s hard to tell, obviously. He still has advance diabetes and heart failure. He still can’t take care of himself. Part of me wonders if it might not have been better for him to pass now, and not suffer more.
I’m 43 years old and I’ve never lost anyone truly close to me. Grandparents. But no siblings or parents. The closest thing to permanent loss I’ve experienced is a divorce, I guess. It was sad, but it was also a relief. It’s hard to know what death is going to feel like. I spent the week girding myself for it and then it didn’t happen. I’m not sure what to do next. Things proceed as they were.
I am moving forward. My big race is in two and a half weeks. I am, at the moment, fit. I have two more really long days this week: a 60 mile bike ride and a 12 mile run. I’m looking forward to it. Long distances are good, the weather is good. I’m fit and I’m capable for these. I’m excited, but I’m also feeling somber. And those are difficult emotions to reconcile. Such is life.
An Eventful Weekend.
I spent Friday and Saturday waiting for my father to die, which he has persisted in not doing. He has improved physically, and he has “improved” mentally, in the sense that he is no longer comatose but occasionally opens his eyes and grunts and squeezes in response to voices and commands. I do not know what the prognosis or next steps are, but imminent death does not appear to be one of them.
In the midst of this, I summoned the energy to continue my training. I’m less than three weeks from my half-Ironman, and I am going to complete it unless it kills me first. So I did a 33.5 mile ride in two hours, followed by a 5.7 mile run in one hour. Emotionally it was hard to work myself up for them, especially because I was trying to do so on about two hours of sleep. But physically, they felt really good.
I don’t expect to get a lot of sleep the night before the race either. So this was very good training. I got my hydration right. I got my fueling right. I got my paces right. This was a three hour race-pace brick that if I can duplicate on race day will have me finishing with plenty of time to spare. I’m pleased with the effort, and I’m proud of myself for finding a way to do it in a difficult emotional place.
Sunday BB (who paced me during the run and literally carried my water on a bike) and I competed in the Philly 10K, which is a great and fun little race through the historical districts of South Philadelphia. We didn’t try to go fast, and we averaged about 10:09. It’s a runner’s race, which means that I finished down near the bottom of men, and men my age. I don’t care. It was a good shakeout run after the long work the day before.
I’m feeling confident about my ability to finish this race. I’m less excited than determined. My new next door neighbor called it a “bucket list race”. Something that an average man like me might only do once in a lifetime, just to prove to myself I can do it. I think that might be right. This has been so hard. So much work. So much time. But I’m nearing the finish line and I am going to cross it.
It’s a difficult time, emotionally and physically. But I am going to do well enough.
A Sudden Lurch.
Well, my father is in a very bad way. He was finally discharged on Monday to a nursing home. A nice one he was at least willing to go to. After three days there, he became agitated and combative in the middle of the night. They calmed him and got him back to sleep. He hasn’t awoken.
He was taken to the hospital with sepsis, and in what the ED doctor described as a “coma”. I spoke to his nurse, who said it didn’t look good for him initially but that he’s improving. His lactate is 2.7, down from 3. Those numbers are high, but not, apparently, extremely high.
The doctors asked us what his wishes are and we’re all in agreement that dad wants a DNR. He’s not there yet – he’s not immediately dying. But it’s a real possibility, in the immediate future.
I didn’t sleep much last night. A few hours. I’m not 100% sure how to wander around today. Luckily, I have some mindless work to carry on with.
Four Weeks to the Half-Ironman.
My training has stepped into a different gear, and I am feeling more confident. The big thing I did last week was a 50 mile bike ride. It was long, and difficult, and actually a lot of fun – at least in retrospect. Sure it hurt at the time, and it was a lot of work. But I rode 50 miles! By myself! At almost 16 mph average!
It was a warm, but not hot, day. But it was almost 100% humidity. So my sweating didn’t cool me off at all and didn’t evaporate. So by mile 20 my shoes were puddles and I was sloshing through. It had rained heavily earlier in the day, and each way there’s a 2 mile section of the path which is hard-packed dirt and sand. I was coated in filth. It was awesome.
Last week I also did a 1.5 mile swim, which is 25% further than I’ll need to go on race day. I hit my race-distance split (1.2 miles) in 54 minutes. And I think I swim a little faster in the open water. So I’m feeling prepped for that. I have a 60 mile ride upcoming too. This week is a “cutback” week, which means I’m doing silly amounts of work but not ludicrous.
This weekend I had a 25 mile bike ride on BB’s heavy mountain bike, and an 11 mile run. My legs felt heavy, but I got it in in exactly 2 hours. Not bad considering the path we took finishes on a 5 mile uphill. I’m beginning to feel like I can complete this race. Which is all I want to do. Finish.
I am just hopeful that the weather cooperates, and we get to swim. Think kind thoughts of the mid-Atlantic in September, people. Think cool and dry. Think still. Think calm. Think peaceful. Radiate that out into the weather. I’m pretty sure that works.
The Public Health Catastrophe of White Supremacy.
White supremacy comes in many forms in the United States. We recently saw an emesis of it in Charlottesville, ending in a terror attack that killed one and injured 19 others. Other associated acts of terror injured many more, as self-proclaimed Nazis rampaged against peaceful protesters, and police largely looked on and let it happen. It was horrifying, appalling, and deeply disappointing.
But it was not shocking. White Christianist terror has been part of the United States’ story for centuries. As some forms of it became socially unacceptable – like the KKK – it was driven underground, only to resurface in forms like Timothy McVeigh, George McGovern, and the NRA. The mass incarceration of black non-violent offenders – a new slavery quietly persisting today.
Our president, Donald Trump, has now openly embraced the rising violent tide of white supremacists, saying many of them are “very fine people”. While he did specifically condemn the driver of the car, he embrace the reason that these neo-Nazis were assembled, and defended their motives and character. He equilibrated the violent white supremacists and the peaceful protesters there to confront them.
There is a terrifying and rising tide of white Christianist terrorism in the United States, but that is only the tip of the iceberg when looking at how white supremacy harms us all. White supremacy has more insidious tendrils which infiltrate systems and laws and culture in ways that cause terrible economic and health damage to all of us. Primarily and egregiously to the minorities that are oppressed, but with negative effects on the privileged as well.
It starts with historical injustice and inherited wealth. Few non-white families in America have much of that. And it doesn’t take much. It doesn’t even have to be wealth in terms of dollars inherited when relatives pass away. Inherited wealth includes parents being able to help pay for college, or school supplies. For health insurance to the age of 26. Whites have much more access to these kinds of wealth. Which result, at the level of public health, in an ability to participate in the economy in greater proportions.
Lack of inherited wealth results in ghettoization of minorities into areas with substandard housing, schools, and services. This results in poorer education, less access to health coverage and care. We see exactly how serious it is in cases like Flint, Michigan, now years without lead-free water. And that isn’t isolated to Flint. Dozens, perhaps hundreds, of poorer communities have lead-contaminated water. Flint is famous because it was a cover-up.
The effects of white supremacy do not stop there though. Biased behavior – which everyone exhibits – conspires to diminish opportunity and outcome both for minorities once again. Minor scrapes with the law – common for persons of all races – result in warnings and small fines at much higher rates for whites than for other races. Black men especially are incarcerated for minor offenses at extremely high rates. Wealth again is a factor – the ability to hire one’s own lawyer is a major factor in the severity of punishment for minor crimes.
Once a person has been incarcerated, it becomes incredibly difficult for them to find housing, employment, or access to social services. And poverty claims another generation when those people can’t provide good educations and health care and housing for their families. The cycle continues.
Even those minorities who escape all that face greater obstacles in terms of biased hiring and promotion. Stereotypes of racial labor create barriers to entry in many types of industry. Hiring managers often worry that a candidate may be the “beneficiary of affirmative action” and thus unqualified. When in fact, affirmative action helps prevent the hiring of unqualified whites over qualified minorities.
These biases – which are often small and clandestine – are difficult to prove in any individual case, but have profound effects to the public at large. Lower wages, fewer leadership positions. Resultingly, the problem of inherited wealth perpetuates. Less access to high quality educations, more debt, less health coverage.
Each step is relatively small by itself. They combine to create a system which promotes whites and represses minorities. Minorities have worse health outcomes in nearly every measurable category. Because they have less coverage, less ability to attend preventive care, and because doctors are less likely to provide them with high quality care – there’s bias in the doctor’s office too. Worse treatment, and worse access to treatment.
The pernicious effects of this system result in shorter lives and worse quality of life. Not for any intrinsic reason. It is a function of wealth, access, and bias.
And it harms everyone. It is easy for white people to ignore these problems – our privilege lets us. But we do so not only at great cost to our own moral condition, but also at great harm to our own lives. Systematically oppressing some 39% of the population (the 2016 estimate from the US Census Bureau is that 61.3% of the population is non-Hispanic white) has profound consequences on many things.
We sacrifice equal participation of almost 40% of our innovators. Of our inventors. Of our professors. Our leaders. Our artists. Talent, drive, intellect, ambition – these things are not based on a person’s “race”. What we call “race” is not supported by genetics in any meaningful way. It is a way of looking at people that pigeonholes them into various boxes far more closely associated with economics than with genetics.
The United States is much like a large swimming pool, one we all wade in. We have selected a large group of people based on their skin color, fired all their swimming teachers, and pushed them into the deep end. And then we blame them for drowning.
Five Weeks.
Well, I have five weeks until the biggest race of my life. Certainly up until now. Possibly from now until forever. I would be lying if I said I felt ready. But I had a good training week this week. The only major problem is that it’s been at least a month since I had a good long swim. My last several swims have been cut short due to cold, and rage. The pool has been so overcrowded and annoying that I haven’t been able to get in good workouts.
Luckily, the swim is the part I’m least worried about. A 1.2 mile swim is a long way, but it’s not the huge daunting distance for me I know it is for some. Tonight I’m supposed to swim 2400 meters. I’ll do my best to get it in and have it mean something. That’s after a 1 hour tempo run, which will just be a 1 hour run. In the heat, for me, “tempo” just means “whatever pace allows you to keep going the whole time.”
But my past week was a good week for training. The weather has been agreeable, and my fitness is at least nominal. I had a good 10 mile run, a hard 30 mile bike ride on a mountain bike on a wet dirt/gravel trail. I did a 12.5 mile ride/5 mile run brick. And I did a good hard 10 km run. I also threw in a couple days of strength training.
My X-wing has been out getting repaired. Now it’s back and I have a 50 mile ride tomorrow. The longest since I was about 13. I’m excited to do it. There’s something amazing about riding a bicycle 50 miles. It’ll take me more than three hours and leave me exhausted and sore. And I’ll be thrilled to have succeeded at it.
This is the time I have to really buckle down and do the work. I am by nature a procrastinator. But you can’t procrastinate fitness. It takes time to develop it. It’s not like I can wait until the week before the race, do a hard swim, a hard ride, and a hard run and my body will just go, “Ah, yes. We need to be in good shape now. GO!” I have to build slowly.
I’ve been doing that. But I’ve also been eating too much and I find myself in decent fitness but significantly overweight. I want to try to lose some of the weight before the race so I’m not dragging extra around with me the whole distance. Losing weight while building fitness is really hard, because running and biking and swimming long distances all make you really hungry.
So I have to figure out a better way to eat and train at the same time. But if I have to pick one, the one to pick is training.
I really am nervous. It’s going to be a long, hard day. I’m going to be really challenged by this. I think I’ve got it inside me to do this. But if the day ends up defeating me, well, I’ll have given it what I’ve got. After a week like last week, I feel like there’s a chance that what I’ve got will be enough.
The Gifts of Warning.
The saga with my father continues to unfold. He remains in the hospital as of now, in a stepdown unit. He remains “difficult” and “agitated”. He asked my sister for “whiskey and a shotgun.” But he has also apparently been flirting with the nurses, and doing better from a withdrawal-detox perspective. He may be medically ready for discharge soon, which means he’ll need to go to a psych unit for evaluation. I think. Things are confusing.
The facility that we had gotten him approved to move into doesn’t take people who don’t want to be there. And dad won’t accept placement in any place except home. But home isn’t a safe environment for him, and his “wife” can’t take care of him anymore. So we’re having to look into other options. The social workers at the VA have been fabulous, but there’s only so much they can do. My sisters have been even more fabulous.
So I don’t know what’s going to happen. My father is not well, mentally or physically. I understand why so many people express relief when a long-term ill person dies. Not only for the person, that their suffering is over, but for themselves. I’m doing very little from a practical perspective. My role has been to offer a pressure valve for my sisters and cover some of the costs of travel and attorneys. But I’m emotionally exhausted by it all. I can’t imagine how the front-line lifters must feel.
The situation though, gives me gratitude. My father is an excellent example of what happens when alcoholism, diabetes, and depression go essentially untreated for a lifetime. Sure, he’s had doctors, and he’s abstained from alcohol from time to time, and he’s taken anti-depressants. But he’s never been invested in good health, physical or mental. He’s simply persisted. He’s found ways to get other people to take care of him, rather than making the decisions to take care of himself. Now, at the end of his life, he’s made it incredibly difficult for anyone to do so.
I have all the same genes and problems. I am alcoholic. I am insulin resistant trending eventually toward diabetes. I have been diagnosed with major depression. And I certainly suffer from serious anxiety, even though I don’t recall any healthcare professional ever officially diagnosing me with an anxiety disorder. I have tendencies toward isolationism, self-destruction, entitlement, and self-medication.
But my father shows me where that leads. A life of poverty, frustration, illness, dependence, and infirmity. Eventually, involuntary commitment and recalcitrant self-pity. He has shown me very little about how to be, but much about how not to. I thank him for that. I can learn what there is to learn, and let go of the rest. None of my father’s deficiencies are rooted in malevolence. Only illness and indolence.
I wonder sometimes, if my father’s failures as a father are born of insecurity. His own father was a vicious drunk. Violent, abusive, and dead at a young age. Surely my father feared being like his father. Surely he reacted against that. Drunk and lazy perhaps, but my father was never violent. Perhaps he never attempted to be a real father to me for fear of damaging me the way his father damaged him. I don’t know.
But I know that one of the reasons I don’t want to be a father is that I don’t want to pass on what my father passed to me.
Emotionally I have worked incredibly hard to overcome the pitfalls and lessons I was taught by both my parents. Neither was ever really fit to be a parent. Neither had parents fit to be parents, with the possible exception of my father’s mother. But I cannot overcome the diseases wound into my genes.
I have made the decision to end the line with myself. I am too broken to make and prepare a new generation of humans for a planet that will need resilient denizens to make the next way forward. I am grateful for the lessons I learned.
Infactorium 