In It for the Long Haul – 80/20 Endurance
Echocardiogram

In It for the Long Haul

In December 2011, Manhattan-based psychologist Bob Bergeron put the finishing touches on a book titled The Right Side of Forty: The Complete Guide to Happiness for Gay Men at Midlife and Beyond. To mark the occasion, he posted the following cheerful announcement on his website: “I’ve got a concise picture of what being over forty is about and it’s a great perspective filled with happiness, feeling sexy, possessing comfort relating to other men and taking good care of ourselves.” Three weeks later, Bob Bergeron took his own life.

The tragic irony of this story is glaringly obvious, but for folks like me, Bob’s startling final act is also a stark reminder of how difficult it can be to practice what one preaches in the domain of self-help. Having learned about Bob from a terrific posthumous profile that appeared in The New York Times in April 2012, I’ve been thinking about him often lately in the leadup to the release of my new book The Comeback Quotient: A Get-Real Guide to Building Mental Fitness in Sport in Life. In it, I preach the importance of making the best of the challenges we face as athletes—and as humans—by facing reality fully. It’s a message that I genuinely believe in and try to practice in my own life, but doing so has never been more testing for me than it is in the context of my present situation.

It started with a single bad workout—a set of 600-meter intervals that I was forced to abandon because I just didn’t have it that day. But it didn’t stop there—not by a long shot. Within a couple of weeks I had completely eliminated fast runs of all varieties as well as long runs from my training schedule, leaving only “easy” runs that felt anything but easy, even at a pace that was 90 seconds per mile slower than normal. By then I was feeling lousy not only during runs but also at rest. The first thing I noticed was a persistent run-down feeling. This symptom was followed in short order by a host of others, including erratic pulse, shortness of breath, tremulousness, excessive thirst, headache, lightheadedness, numbness, sleep changes, brain fog, memory loss, and affective symptoms such as anhedonia, anxiety, and withdrawal.

Nearly two months have passed since that single bad workout, and I remain wholly unable to train in any meaningful sense of the word. Treadmill walking accounts for the majority of my exercise. I risk running outside only when I can’t bear another hour on the old hamster wheel. The last time I did so my heart rate climbed to 173 BPM at 8:40 per mile. My maximum heart rate is 181 BPM, and the last time I pegged it prior to unraveling was at the end of a 4:55 mile. I never know what I’m going to get on a given day. Last week I did exactly the same treadmill walk-run session on consecutive days. My heart rate was 40 beats per minute lower in the second session, yet I felt equally short of breath in both. It’s as if my autonomic nervous system has forgotten how to communicate with my cardiorespiratory system. In fact, I believe that’s precisely what’s happened—a phenomenon called dysautonomia.

Far from just sitting back and hoping the problem goes away, I’ve been pursuing a proper diagnosis as aggressively as though my livelihood depended on my ability to run, which it sort of does. My hunch is that I have post-acute COVID-19 syndrome, triggered somehow by exposure to wildfire smoke (which would explain the condition’s unusually belated onset in my case). The symptoms certainly match those reported by known PACS sufferers, and I was down with a very COVID-like illness for a full month after returning from the Atlanta Marathon in early March. Trouble is, I wasn’t able to get tested then, and by the time I got an antibody test in July the negative result meant little. Bloodwork shows nothing amiss, my lungs look good, and my heart checks out, and I now stand only one specialist away (neurologist) from perhaps being told—like all too many PACS patients—that there’s nothing wrong with me. It won’t be the end of the world if this does happen, however, because there’s little that doctors can do to treat the syndrome.

So, here I am, mired in the worst health situation I’ve ever confronted at just the moment I’m coming out with a book in which I tell other people how to deal with bad situations. As I said before, I earnestly believe that facing reality is the only way to make the best of any bad situation. That’s reason enough to practice what I preach in attempting to come back from this thing. But The Comeback Quotient gives me a compelling second reason, which is not being a lousy hypocrite!

In the book I explain that facing reality is a three-step process. Here’s what the process looks like for me as I work to practice privately what I preach publicly.

Step 1: Accept Reality

It’s difficult to express how important running is to me. I’ve been doing it for more than 30 years, having started at age 11 under my father’s influence—a wonderful bonding point in my relationship with him. My two brothers run as well, and I could probably write an entire book (I promise I won’t) about all the ways the sport has brought us together over the years. I make my living by coaching runners and by writing about running, and remaining an active competitive runner myself has been a crucial source of the both experience and the sense of credibility I bring to these roles. Running is also my place of worship, the center of my spiritual experience, my prayer closet, where I feel closest to the divine. It is my greatest source of inner strength and self-discovery, without which I would literally be dead, as I’ve disclosed previously. All of this has been taken away from me.

I mean, I can still run a bit, but not in the way that matters. For me, running’s true richest are revealed only through the testing of physical and mental limits, pursuing mastery. When I have a big race in front of me that I’m focused on and progressing toward, everything else in my life lines up in a way that’s impossible to explain, and when that polestar is lacking for whatever reason, I feel adrift. Dave Scott said it better: “When I’m on, and when I feel good about my exercise and I’ve been on a good wave, I feel invincible. I can handle any kind of hurdle and I can meet any kind of challenge head-on. And when I don’t have it, when I don’t have that morphine-like endorphin feeling that resonates throughout my body, it affects everything. It affects my personality, it affects my confidence, it affects my ability to interact with other people.” Amen.

Recently I had a phone call with Jordan Metzl, an eminent sports medicine specialist I’ve known casually for some years, who I reached out to after I saw a piece he wrote for The New York Times about returning to athletic training after coronavirus. He told me that, although I needn’t worry that exercise in general is exacerbating my condition, as I have feared at times, under no circumstances should I attempt to actively progress in my exercise regimen until I’m feeling better. This advice would be easier to accept if I perceived I was on any sort of trajectory toward feeling better.

Running aside, I feel crappy to some degree all day every day. In my best moments, I barely notice my condition—unless I stand up, or walk, or climb a flight of stairs, when shortness of breath hits me with a gentle reminder, “Still here!” Other times it’s bad enough that I just have to stop whatever it is I’m trying to do and lie down. Evenings are the worst. When I sit in the living room with my wife, Nataki, sipping Sleepy Time tea and winding down, it sometimes seems as if an invisible giant has placed a thumb on the crown of my hard and begun to slowly squash me into the floor. At night I sleep so hard that when I wake up in the wee hours needing to use the bathroom I can barely peel myself off the mattress.

The docs seem most concerned about the numbness I’m experiencing. They’ve ordered an MRI of my cervical spine, suspecting, I suppose, that there’s a tumor or something lurking in there. I myself am less concerned about this particular symptom, which appears to be common in those with PACS, except when it’s at its most severe, like when I woke up in bed a few nights ago to discover that my entire left leg “gone to sleep” with that tingling, pins-and-needles sensation, frighteningly intense.

Before the headaches and brain fog hit, I used to tell Nataki, “Well, I might not be able to run, but at least I can still work.” Ah, those were the days! Reported almost universally by PACS sufferers, the brain-fog symptom is almost impossible to describe in a way that anyone who hasn’t experienced it can appreciate. Sometimes I come to with a start having heard Nataki say something to me and discover we’re in the care together or out walking. It’s like returning to reality from a trip to another dimension. How the heck did I even get here?

The other day Nataki accompanied me on another visit to the hospital, where I got an echocardiogram, after which we decided to pop into Costco to pick up a few things. When I pulled into the Walmart parking lot, Nataki gently asked what I was doing. We haven’t shopped at Walmart in years, making a special point of avoiding the store. Such cognitive glitches have struck a devastating blow to my confidence. Lately I’ve been entertaining fantasies of retiring. They’re only fantasies, but if I could afford to take some time off I would. I can’t, though, so instead I’ve scaled back my work activities where possible, saying no to stuff I would have said yes to before. I dread Zoom calls and regular business-related phone calls and, frankly, any contact with people other than my family and closest friends.

On November 22nd, 60 Minutes aired a segment about a special research and clinical-care division for so-called “long-haulers” that has been created at Mount Sinai Hospital in New York City. Thousands of patients have sought treatment there already. At the end of the segment, interviewer Anderson Cooper asked Dayna McCarthy, one of the division’s staff doctors, who herself has PACS, how many of those thousands had made a fully recovery so far. The answer was zero.

All of this is enough to make a stronger man than I am feel a little sorry for himself. But I refuse to go down this path, because ultrarealists—the masters of facing reality I describe in my book—don’t. Among these ultrarealists is Jamie Whitmore, a former world champion off-road triathlete who came back from a horrific cancer ordeal to win a gold medal in cycling at the 2016 Paralympics. When I sat down to interview Jamie last summer, she said to me regarding the darkest days of her ordeal, “I would allow myself to feel sorry for my situation or be angry at it for 15 minutes a day. After that, it doesn’t get you anywhere.”

To accept a bad situation is to resist actively wishing that things were otherwise. The more time and energy you give to wishing for a different reality, the less time and energy you are able to devote to changing that reality. Jamie Whitmore understood this, and I figure if she could limit her indulgence in self-pity to 15 minutes a day in a situation far worse than mine, then I certainly have no excuse for playing the pointless “Why me?” game.

In fact, I’m going a step further and resisting even hoping I get better. That might sound crazy to you, but think about it this way: When you’re 23 miles into a marathon and suffering like a dog, how much good does it do to hope the last 3 miles are easy? Less than none. You’re much better off accepting that it’s only going to get worse going forward and finding a way to cope with your suffering. Likewise, although I certainly do want to get better, there’s no telling how much longer I will continue to feel crappy, so instead of actively hoping I wake up one morning and don’t immediately feel short of breath on standing, I’m trying to be as okay as possible in my present state.

Step 2: Embrace Reality

Embracing the reality of a bad situation means committing to making the best of it. What stops a lot of athletes from embracing realities they have at least managed to accept is an all-or-nothing attitude toward their goals and wants. If their original goal falls out of reach, they struggle to muster the adaptability needed to come up with a fallback goal.

Ultrarealists can. Jamie Whitmore told me that her most satisfying athletic achievements were those she achieved after cancer because they required more of her. For ultrarealists, the true goal is always to make the best of the situation; hence, surviving in a bad situation can be every bit as satisfying as winning in a favorable situation.

I am embracing my current situation by looking at it as an opportunity to raise my level of mastery of endurance training. How much fitness and enjoyment of the process can I preserve despite my severe limitations? Doing my very best to stay as fit as possible and to enjoy exercise as much as possible for as long as I remain the way I am will demand degrees of creativity and resourcefulness that were never demanded of me in better times. In this effort I again draw inspiration from Jamie Whitmore, who in an interview she gave in the midst of her own travails said, “If someone tells me it’s impossible, I refuse to believe there is not another way to do things. . . Maybe I will not be able to get from point A to point B in a straight line anymore. But I will still get from point A to Point B.”

One of the ways I’ve found to get to Point B is indoor walk-run sessions. By walking 4 minutes for every 1 minute I jog, I get the emotional boost of knowing I haven’t abandoned running entirely in a way that doesn’t set me back. And by doing it on the treadmill, I can read as I go, and if there’s one thing I enjoy more than running, it’s reading.

Perhaps this seems rather pathetic, but what’s the alternative? I have faith that there is real satisfaction to be had in watching myself grow in other ways even as I regress physically.

Step 3: Address Reality

The well-known expression, “When life gives you lemons, make lemonade,” is all about the three-step process of facing reality. To admit that life has given you lemons is to accept reality. To commit to making lemonade from those lemons is to embrace the reality. And to complete the process by actually producing lemonade from those lemons is to address reality.

Two things are needed above all to succeed in this final step: effort and judgment. In sports and elsewhere there tends to be too much focus on the role of raw effort and not enough on the equally important role of sound decision making in overcoming challenges and setbacks, and in my book I take pains to correct this imbalance. Nevertheless, if in the present context I could share only one element of the approach I’m taking to addressing my ongoing health woes, it would be the motivational element that fuels the effort I’m putting into it.

Every athlete, every human, is capable of great efforts. All it takes is the right motivation. The more it matters, the harder you’ll try. In the depths of my battle with coronavirus in the spring, I couldn’t wait to get back to training and racing. I wanted it for myself, and I was motivated enough to go from my first tentative test run to a 2:54 virtual marathon in just six-and-a-half weeks. (Here’s where the troll-minded decide I brought this thing on myself by coming back too quickly, to which I say, not so.) But this time is different. This time my will to overcome is fueled by a heartfelt desire to help others. At least 10 percent of people who get COVID-19 and survive will be left with long-term effects, and a certain percentage of this percentage will be fellow athletes. In coming back from PACS, I want to create a road map for others to do the same.

What I’m going through right now has caused me to reassess a lot of things on a deep level. In various past writings and interviews I’ve been candid in admitting that I’ve been driven by a desire to impress people for as long as I can remember. Earlier in my career, I much preferred being told that something I’d written was good than that something I’d written had done somebody some good. Lately, though, I feel myself letting go of this compulsion—or perhaps, better said, I feel it letting go of me. I do hope—in principle, not actively—that I get my health back, but at the same time I hope that I don’t go back to being the same person I was before. Whether I achieve the first hope is largely outside of my control. The second, however, is up to me, and I am determined not to let myself, or you, down.