Post-Acute COVID-19 Syndrome

I don’t look sick. To the contrary, I look like I could run a marathon, or so I’m told. In fact, though, the last time I tried to run I couldn’t get out of bed the next day. This isn’t a figure of speech—I could not get out of bed the next day. And it wasn’t a marathon that put me on my back. It was a single, 10-minute jog on a treadmill.

The doctors call it post-exertional malaise, and it’s common among folks with chronic fatigue syndrome, as well as for those like me who suffer from post-acute COVID-19 syndrome. So, how is it that a person who can’t jog for 10 minutes without incapacitating himself for 36 hours still manages to maintain the appearance of being fit enough to run a marathon? The answer to this question is worth sharing, I believe, because it delivers a useful general lesson about effective weight management.

Let me start by saying that vanity always ranked low on my list of reasons for training before I was forced to stop several months ago. My wife and I agree that I look best with a little more meat on my bones, and what meat I once had was stripped away when I became a hardcore endorphin junkie in the late 1990s. I trained hard because I enjoyed it and it made me feel good and it taught me a lot about myself and I grew as a person through the process and I derived tremendous satisfaction from chasing improvement and competing, and I didn’t particularly care how training make me look so long as it checked all of those other boxes.

Still, I am human, and all humans are vain to some degree. Hence, when I was forced to stop training and lost its many benefits, I rediscovered the reality that I actually did sort of care about my appearance. In particular, I began to worry about gaining weight. This might sound laughable to those who’ve only ever known me as a beanpole endurance athlete who can wrap the index finger and thumb of his right hand around his left wrist with an inch of overlap between the two digits. But there was a time in my life when I struggled with my weight and lacked the wherewithal to do much about it.

I hit my lifetime peak weight of 206 lbs during my sophomore year in college. All the excess poundage glommed around my middle. Even then I could have worn a woman’s wristwatch, but I carried a sloppy old beer gut bookended by stretchmark-festooned love handles, the sight of which disgusted me. I remember arriving at the Haverford College dining center one morning determined to break the dietary habits—salad avoidance, second helpings, keg party attendance—that had added 68 pounds to my former runner’s body in the span of 18 months. But upon entering the cafeteria I discovered it was omelet day, game over. The cheese-heavy three-egger I requested tasted quite scrumptious, but I didn’t enjoy it, burdened as I was by the realization that I lacked the willpower to do what was necessary to lose weight and that I would always be fat.

This pessimistic outlook on my body’s future was based in part on the assumption that I would never run again. When I did get back into running a few years later, the weight came off very easily. What’s more, my desire to improve as an athlete motivated me to make better food choices in a way that my desire to look good naked hadn’t, and I cleaned up my diet quite a bit. Still, the large volume of exercise I did routinely allowed (and in fact required) me to eat a lot, and I worried about what would happen if a major injury or other setback forced me out of training for an extended period of time. I believed that, even if I continued to choose healthy foods, I wouldn’t be able to muster the restraint necessary to reduce my intake sufficiently to avoid gaining weight.

I should have known better, and in fact I did. Both scientific and real-world evidence indicate that weight management is easier overall at lower volumes of exercise. Sure enough, when I stopped running, my appetite decreased significantly, making reduced food intake almost as easy as listening to my body. Currently I weigh 148 pounds, or 2 pounds less than I did when I stopped running.

Eating less isn’t the only reason I haven’t put on a spare tire, though. In fearing weight gain, I underestimated the power of high diet quality in managing a stable body weight. In my beer-belly days I was living on bagels and pizza (and beer), but my current diet, which features a balance of unprocessed foods, fills me up with far fewer calories. What’s more, the practice in dietary self-discipline I got from bumping up my diet quality has proven to be more transferable to regulating overall food intake than I expected. Whereas when I was still running I truly ate as much as I wanted, I now put up with a little more unsatisfied craving than before (and all the more so since I was placed on a medication that increases appetite as a side effect), and it’s not a problem.

Many years ago I created a set of integrated training and diet plans for endurance athletes seeking to improve their body composition. These short (four- to eight-week) programs were designed to help people shed a bit of excess body fat relatively quickly outside the context of race-focused training cycles, when fitness and performance are the priority and any improvement in body composition that occurs during the process is incidental. The specific methodology that made up the substance of these plans was based on a combination of mainstream science and real-world best practices. I never actually followed one of them myself for the simple reason that my weight never varied much, but ironically the formula for holding steady on the bathroom scale that I’ve defaulted to in response to my current health situation looks a lot like my old Racing Weight programs.

For example, these programs were heavy on strength training, which facilitates body composition improvement by increasing basal metabolism. Lucky for me, even in my present decrepitude I am able to tolerate a decent amount of strength training, perhaps because, unlike aerobic experience, it is discontinuous in nature. I lift weights for about 20 minutes every day, and doing so has contributed considerably to my successful weigh management. Seeing this effect has also confirmed for me that I was not doling out bad advice to my fellow athletes through my Racing Weight plans.

Inspired by this experience, I’ve created a new set of online Racing Weight plans for runners and triathletes. Six weeks in length, these plans come in four levels for each sport. You can learn more about the training component here and the dietary component here, and you can preview them here. To be clear, these are not “beach body” programs. They are practical, scientifically informed programs for performance weight management intended for use by athletes who care more about how they feel and function than about how they look. God forbid you should ever have to rely on one to merely look like you could run a marathon when in fact you can barely climb a flight of stairs!

Recently I received an unexpected phone call from Travis Macy. If the name is familiar, it’s because you know Travis as an inveterate ultrarunner and adventure racer and author of The Ultra Mindset: An Endurance Champion’s 8 Core Principles for Success in Business, Sports, and Life. I know Travis only slightly beyond this thumbnail bio. We started corresponding by email in 2013, when he first got the idea for his book. We now share a literary agent, and earlier this year I appeared on Travis’s podcast with my wife, Nataki.

The purpose of Travis’s call was to check in on my mental health. He didn’t put it quite so bluntly, but it was clear he was doing just that. Not a random check-in but a targeted one instigated by a red flag he’d identified in my response to an email check-in the previous week. I’ll go ahead and share with you what I shared with Travis in that message:

Alas, I’m still struggling. I feel like Paul Newman’s character in the prison-yard fight scene in Cool Hand Luke (my favorite film).The other day Nataki said to me, “Don’t give up, baby!” I told her, “I’m not, Kittycat. This is what not giving up looks like when you’re losing!”

You know those movies where things keep going from bad to worse for the main character? (The Martian comes to mind as one example.) Just when you think the hero has finally hit rock bottom, a trap door opens underneath him and he falls even further. And then it happens again. And again.

That’s what my life has felt like for the past eight months. I was seven months into the living death that is post-acute COVID-19 syndrome when I hit what I naively thought at the time was absolute bottom. I was laid out on a sofa at home, nearly paralyzed by a fatigue so intense that it was a kind of agony. Imagine burning alive, then replace “burning” with “exhaustion.” I’m not exaggerating. Yet at the same time I was maddeningly bored, because it was ten o’clock on a Tuesday morning and sleep was not an option and working was completely out of the question and I lacked the mental wherewithal even to focus on some dumb Netflix time-killer. The only thing that offered any sort of relief was listening to Yanni. That pretty much sums up my predicament right there: I needed Yanni.

It was then I decided to stop waiting my proper turn to get my first coronavirus vaccination and roll the dice, having heard reports of some long-haulers gaining a measure of relief from their jabs for reasons that baffle scientists and doctors. An hour later, Nataki and I were queuing outside the Modesto Civic Center with other responsible citizens. The next day Nataki found me sprawled naked on the floor of the master bathroom, hyperventilating, unable to answer her panicked questions, having crawled out of the tub after discovering I was too weak to make a fist and feeling myself slipping under à la Whitney Houston.

This wasn’t a matter of the usual side effects. My first Pfizer shot had simply worsened a chronic illness already bad enough to cause me to reach for the music of Yanni as a lifeline. A new bottom. Still, I held out hope for my second shot, having heard reports that other long-haulers had, like me, gotten worse after the first shot but then felt better following the second.

Two nights after my second jab, I was awake in bed, desperately fatigued from prior sleep deprivation and knowing with 100 percent certainty that I would not sleep a wink that night. Inoculation number two had further intensified several of my symptoms, including insomnia, tingling in the lower legs, fatigue, brain fog, and chest pains. The 10 out of 10 pins-and-needles pain in my legs alone would have kept me up, but an even greater issue was the hyperadrenalized jittery sensation in my chest. It felt as if I had drunk five cups of strong coffee and then narrowly missed being crushed by a falling piano after hopping off a rollercoaster.

Next night, same. Last night, same. I don’t remember what it feels like to have a clear head. The other day I tried to fill a water bottle by holding it against a light switch. I swear I’m not making this up.

It’s impossible to suffer this much for this long and retain perfect mental health. The toughest part for me has been not so much “depression, “anxiety,” or any other such diagnosis but rather the general strain and enervation of having to fight nonstop for my happiness and sanity all day every day. I’ve largely succeed in holding it together, but I am doing so at a tremendous cost that continues to grow every single day with no end in sight.

Very early on in this process I made a conscious decision to share what I’m going through with friends, work associates, and the public. I did so for three reasons: 1) I share (some would say overshares) everything, good and bad. It’s how I’m wired. 2) I don’t think there’s anything to be ashamed of in experiencing mental health challenges. And 3) I’d done it before and discovered that it’s extremely helpful.

On this last point, my 2018 memoir Life Is a Marathon tells the story of the long and painful battle Nataki and I have fought with her bipolar disorder. I held back nothing in those pages—not even my own 2007 suicide attempt. When the book was released, Nataki was justifiably terrified about how the reading public would perceive her, but the response she got couldn’t have been more different from her fears. Praised for her strength, courage, resilience, and spirit, Nataki now has a little fan club of her own known. Indeed, that’s partly why Travis Macy wanted her on his podcast.

So that’s one benefit of sharing your mental health challenges: People (enough of them, anyway), respond with love. Another is that the connections you create go two ways. Everyone is either going through, or has gone through, something, and when you open up, the person you open up to often follows suit, and you end up helping each other.

By now we’re all familiar with the public-service message, “It’s okay to not be okay.” Individuals who are currently struggling with mental health challenges are the main targets of message, I assume, but the greater numbers of folks who might know someone who’s not okay need to hear it and take it in too. Travis is clearly a kindhearted person, but I can’t help but wonder if he would have reached out to someone he knows as glancingly as he knows me if the okay-to-not-be-okay meme hadn’t begun to permeated the zeitgeist.

I will say this: That first step can be awkward on both sides. I think that people like me who are currently struggling bear some responsibility to make it less uncomfortable for the listening ears. That’s why I begin Zoom work meetings sometimes by matter-of-factly informing my colleagues how my cognitive and emotional difficulties are currently impacting my productivity. It’s why I’ve candidly informed the hosts of podcasts, before they press Record, that I’ve been dealing with social anxiety and mental confusion and may require rescue at some point. It’s why, when neighbors ask me how I’m doing, I tell them exactly how I’m doing. The fact that we need help doesn’t mean we’re helpless. In being upfront, unembarrassed, and unapologetic about my immediate state of mind, I’m training others to feel less awkward when their next turn comes to be a listening ear. You can do the same.

If you’re going through something and, after reading this, you’re still not ready to let others know you’re not okay, try journaling or art therapy. Expressing your feelings is half of expressing your feelings to others. I’ve written a lot of poetry since my life became a waking nightmare, and it’s been cathartic. I leave you with a poem that addresses my own occasional ambivalence about opening up. As you read it, do your thoughts drift toward someone in your life who might also be the feeling this way? Reach out. Is that person you? Reach out.

I Am Suffering

I was going to say something to
you but I decided against it.

It seemed unseemly to speak for no
reason other than to elicit sympathy.

But wait: Am I trying to have it
both ways, saying it by not saying it?

That idea doesn’t sit well with me.
Neither, though, does the idea
of saying nothing.

Perhaps I need only speak it—
not to you but to God, or a bird,
or a stone. Maybe that’s enough.

Forgive me, I’m thinking out loud.

But no, having thought about it,
I can say for certain it is not
enough. I need you to know.

Can you do that for me? Can you
let me say it, let me let you know,
and promise not to feel sorry for

me?

Dear Dr. Young,

The good news is I have heart disease . . .

These are the actual first words of an email message I sent to my primary care physician a couple of weeks ago. I had just undergone an angiogram to determine the source of an abnormality seen in my EKG reading during a prior exercise stress test and learned that my calcium score was 363, which, according to the University of Maryland Medical Center website, means, “You have heart disease and plaque may be blocking an artery.” Now, it so happens that I have no blockages. That’s likely because the same thing that caused the plaque buildups in my coronary arteries—decades of punishing my body with hardcore endurance training and racing—also blessed me with arteries the size of sewer pipes that can (at least for now) accommodate all that calcium. This silver lining is one reason I was in a mood to joke about my diagnosis.

But there’s a second reason, which is that I believe in the importance of joking about everything, including one’s own potential death by heart attack. If you know your Bible, you may be familiar a proverb that begins, “A merry heart does good like a medicine.” The phrase “merry heart” is sometimes also translated from the Hebrew as “laughter,” and it’s scientifically accurate. A study published in Psychosomatic Medicine in 2016 reported that, within a population of 53,556 elderly people tracked over a 15-year period, women who recorded high scores for the cognitive component of sense of humor in a standardized questionnaire were significantly less likely to die from cardiovascular disease or infections, while men with similar scores were also less likely to die from infection.

Laughter has an instantaneous healthful effect on mood and physiological stress levels. But mirth is more than just a salutary state. As a psychological trait, a sense of humor is an effective way of coping with challenges. The 18^th century German poet Novalis wrote, “After losing a war, one should write only comedies.” My response to this advice is, “Why wait until the war is lost?” Laughing amidst a losing battle will take some of the sting out of defeat and may even improve your chances of turning things around and winning.

In my latest book, The Comeback Quotient, I describe how humor helped me cope with serving a drafting penalty during Ironman Santa Rosa 2019 after having dealt poorly with the same situation at Ironman Wisconsin 17 years earlier:

In 2002, while serving my penalty, I argued with the referee who had flagged me for drafting until she threatened to disqualify me if I didn’t shut up. This time I cracked jokes with the two officials stationed at the penalty tent (“Dang, these are longer than church minutes!”), not only because I didn’t want to be disqualified but also because I knew they had an unpleasant job (thanks to athletes like the one I was 17 years ago), and I wanted to be a bright spot in what was surely otherwise a largely trying day for them. And also because I knew I would feel better and probably even finish the ride stronger if I kept my sense of humor. Before my five minutes were up, I peed myself, unaware that doing so was a violation of the rules punishable with a DQ. I got off with a warning, however, and I can’t help but think the officials’ leniency was a karmic reward for my having treated them like human beings.

See how that works? The lightheartedness that I carried into this triathlon, signaled by my quip in the penalty tent, enhanced my enjoyment of the overall race experience and very likely also aided my performance. And there are a million other situations where having a sense of humor can benefit an athlete in similar ways. Just recently an athlete I coach, we’ll call her Cindy, found herself struggling to perform hill sprints in tough winter conditions while wearing ice shoes. In the past, Cindy might have allowed her frustration to get the best of her, ruining the workout, but this time she didn’t.

“It was comical trying to pick up speed,” she reported to me afterward. “I think I worked harder for those six sprints than any I’ve done before. As difficult as it was, I know I got the intended benefit and oddly really enjoyed the challenge of doing something almost impossible. I laughed out loud during every recovery.”

In addition to supplying a terrific example of how maintaining a sense of humor can benefit an endurance athlete, Cindy is also living proof that a risible mindset can be cultivated over time. You don’t have to be Rodney Dangerfield to laugh at your own losing battles.

But wait: If discovering I have severe plaque buildup in my coronary arteries was the good news that I reported to my PCP, what was the bad news? It was, simply, that the new diagnosis offered no explanation for my chronic fatigue, brain fog, orthostatic intolerance, and other symptoms (of post-acute COVID-19 syndrome, I’m about certain) that caused me to seek medical care in the first place. So, in a sense, I went to the doctor with one ailment and came away with two. Which, now that I think about it, is itself kind of funny.

In 2013, Maria Kang became an overnight sensation when a photograph that showed her posing underneath the caption “What’s your excuse?” clad in shorts and a sports bra, her chiseled abs bared, and her three young children surrounding her, went viral. The reaction was mostly negative, critics accusing Maria, an attractive 32-year-old with a well-toned body, of fat-shaming and placing unhealthy pressure on busy moms.

I got to know Maria three years later when she reached out to me for guidance while training for her first marathon. Despite her quasi-villainous reputation, I found her to be an intelligent and thoughtful person, so I wasn’t at all surprised when, in 2019, she apologized publicly for her “What’s your excuse?” poster, writing on Instagram, “I’m sorry for my presence—for unconsciously normalizing an unnatural body standard, not expressing my challenges with body image and not being strong enough to [fix] this years ago.”

I applaud Maria for her better-late-than-never show of contrition. At the same time, though, I think there’s a piece of her original message that’s worth preserving. I see nothing wrong with wanting to be an example to other people, as Maria did. Nor do I think there’s anything wrong with using shame to motivate others to follow your example. But you need to go about it the right way. If your desire to help others is genuine—if you want to actually succeed in motivating others to make positive changes—then you must not be overt or in your example-setting. In other words, don’t tell folks what to do; instead, just show them what they could also do if they so chose. In Maria’s specific case, I believe she could have avoided the backlash she provoked and succeeded in getting more of her fellow busy moms to improve their fitness if she had simply presented herself as an example of a fit mother of three and left it at that.

What I’m saying is, if you want to use shame to motivate others to make positive changes, refrain from saying, “What’s your excuse?” Instead, keep your mouth shut and let them ask themselves, “What’s my excuse?” Demonstrate what is possible for people like them so that they are no longer able to use “can’t” as a valid reason for not doing what you’ve done.

As an athlete, I have benefitted greatly from what I like to call benign shaming. When I encounter an example of an athlete who has demonstrated exceptional courage, grace, resilience, discipline, intelligence, or some other admirable quality in overcoming an extraordinary challenge, I ask myself, “What’s my excuse?” The way I see it, all it takes is one case in which an athlete holds himself or herself to the highest possible standard of character in a tough spot to deprive me of any excuse for not doing the same. Mind you, I’m not talking about qualities like physical strength that cannot be emulated but about character qualities like courage that can be.

Lately I’ve been thinking a lot about Gabe Grunewald, an American professional runner who fought a long and ultimately losing battle against cancer, passing away in June 2019 just shy of her 33^rd birthday. Gabe displayed tremendous generosity of spirit in her final years, striving to make her illness bigger than herself and to make something positive come out of it. She also showed awe-inspiring tenacity in the fight she put up against her disease, running her final race during a two-week break between chemotherapy treatments. Whenever I’m tempted to give in to the poor me’s in my struggle against a far less serious condition—post-acute COVID-19 syndrome—the thought of Gabe and others like her shames me into staying positive.

The underlying concept here is that of holding yourself to a high standard. There was a time when this concept had a high degree of cultural currency—when it was common for people to think and talk about the importance of setting an example with one’s conduct at work, in relationships, and as a member of the community. The Stoics of ancient Greece were big on this idea.

As the great Stoic philosopher Epictetus put it,

“Imagine for yourself a character, a model personality, whose example you determine to follow, in private as well as in public.”

In American society today, unfortunately, the concept of holding oneself to a high standard is largely ignored, and inasmuch as it is not ignored, it is laughed at and ridiculed, dismissed as naïve, corny, and weak, a form of self-handicapping, something that only a sucker would do. Just look at the way boorish behavior is glorified in reality television. The subjects of these programs have no shame, and are adored for precisely this quality. Collectively, such pop culture inputs effectively train our young people to regard themselves as perfect just as they are, and to pursue happiness by imposing their will on the world rather than through any kind of introspection and self-betterment. Good luck exploiting people’s natural, healthy capacity for shame to motivate positive changes in a culture that has neutered this very capacity!

This is why it is all too easy to throw the baby out with the bathwater in a case like Maria Kang’s. As she herself recognizes, saying “What’s your excuse?” was not a skillful way to inspire positive self-change in others. But in all honestly, I don’t think her message was rejected entirely for good reasons. I think it was rejected partly because people do not want to be reminded that they should hold themselves to a high standard. Everyone wants to feel better nowadays, but very few of us genuinely want to be better.

It’s hard to believe it was this year—January 21^st, 2020, to be exact—that my mom came to stay with my wife, Nataki, and me. She has Alzheimer’s disease (my mom, not my wife) and had deteriorated to the point where my dad was no longer able to care for her on his own. I couldn’t bear to see her placed in a facility just yet, so after consulting with Nataki, I offered to take her in.

Everybody we knew who had already been through what we were about to go through warned us that it would be even more challenging than we thought.

Their counsel reminded me of something my friend Bernie said to me before my first marathon:

“No matter how hard you think it’s going to be, it’s going to be harder than that.”

Bernie was right, and so too were the people who gave us a reality check concerning our reverse-parenting intentions. I recognized going in that much of the burden would fall on Nataki, who doesn’t work and who therefore has more time for such things as making sure elderly houseguests don’t accidentally set fire to the kitchen. But the reason Nataki doesn’t work is that she has bipolar disorder and can’t handle a lot of stress in her life, and the stress of looking after her mother-in-law quickly proved to be unacceptably harmful to her mental wellbeing. So, after just six weeks, we shipped mom back to Rhode Island.

By this time I was sick, having picked up a certain virus on a trip to Atlanta. The worst symptom was a relentless, racking dry cough. In the most hellish stretch of my monthlong illness I coughed for 30 minutes nonstop as soon as I got up in the morning and for 30 minutes again right before I went to bed at night, often disgorging blood, or bile, or both. One time I coughed so violently that I injured several ribs. Prior to that moment, the most excruciating pain I had ever felt was when I suffered a third-degree ACL tear playing soccer at age 14. My rib injury hurt just as much, and every single subsequent cough (20 coughs per minute times 30 minutes equals . . .) hurt that much again. To get a better sense of how it felt, stab yourself in the lung with a letter opener 600 times. Fun stuff.

A few weeks after I recovered (temporarily, as it turned out) from the virus, George Floyd was murdered. Having married into a Black family in 2001, I take racism a bit more personally than does the average white guy, and I took this latest atrocity very personally. But what really sent me over the bend was the ugly backlash against the social justice movement that came out of Floyd’s lynching. A poisonous mix of indignant fury and helpless dismay ate me alive as I watched American racism skulk out of the shadows and become “cool” again, unprovoked verbal and physical assaults on people of color who were just minding their own business becoming as commonplace as rain. Unable to think about anything else, I put more energy into angry tweeting than I gave to my work, which was already suffering as a consequence of the pandemic-induced recession. A big chunk of my income comes from selling online training plans to endurance athletes who are preparing for races such as the Boston Marathon, and, well . . .

In August the wildfires hit. Where I live in California’s north Central Valley there’s little risk of losing my home, but this year the fires were close enough and extensive enough for the smoke to make outdoor exercise impossible for weeks at a stretch. I adapted as best I could by running and cycling indoors, even wearing a mask (luckily I had plenty of those lying around) for some workouts. On the (literal) darkest days, my eyes stung and my head throbbed and my esophagus burned regardless, effects that, unpleasant though they were, I accepted as a passing nuisance and that’s all—certainly nothing that might change the course of my life.

October 6^th is the date the course of my life changed. A single, random poor workout became a bad patch in my training, which became a downward spiral in my fitness and health, which became a chronic condition that shows no sign of abating almost three months later. Crushing fatigue, extreme exercise intolerance, shortness of breath, brain fog, tingling extremities, wild fluctuations in heart rate and blood pressure, phantom smells, and other symptoms indicate post-acute COVID-19 syndrome, which normally manifests immediately after acute COVID but appears to have existed as a latency in me for six months until activated by inhaled smoke particulates. Many long-haulers are being diagnosed with postural orthostatic tachycardia syndrome (POTS), an incurable autonomic nervous system disorder often brought on by viral infection. Key symptoms are crushing fatigue, extreme exercise intolerance, shortness of breath, brain fog, tingling extremities, wild fluctuations in heart rate and blood pressure . . .

As I sit here at my desk with a numb left foot on the morning of December 31^st, I find myself becoming a bit nostalgic already for this crazy year, and I’m certain this feeling will only intensify in the years to come. Ever since I was a wee pup I have craved intense experience. As painful as it is, I love endurance racing because it is freaking intense. I feel so damn alive when I’m immersed in that acid bath of purposeful suffering. And for me, 2020 was nothing if not intense. Sure, I suffered a good deal, but because much of the suffering I experienced was unfamiliar in nature, I found it interesting and challenging, a new place to explore and learn. A bad trip is still a trip, after all.

Novel challenges also present rich opportunities for self-discovery and growth. The moment that sticks out came in late March, during one of my nightly coughing spells, when I was shocked by the sudden realization that I felt a pinch of disappointment when this particular episode turned out to be not quite as unbearably awful as preceding ones. Am I a masochist? I wondered before concluding that, no, I’m just a person who has been through enough in life that I rely heavily on toughness to cope, and coughing violently for 30 minutes straight with injured ribs was, if nothing else, a terrific opportunity to test and hone my toughness. I’m not saying this is a good thing or a bad thing. It’s just something I learned about myself that I wouldn’t have learned had 2020 been smooth sailing.

I tried to find—and largely exceeded in finding—the opportunity in each of the challenges I faced this year. Although I hated to raise the proverbial white flag so soon after bringing my mother into my home, I will forever treasure those six weeks, during which I was able to express my love for her in ways I never had before. And although at times the surreal mainstreaming of white supremacy made me want to go live in a cave, it also gave me a chance to listen to and encourage a college-age cousin on Nataki’s side whose diapers I used to change and who is now active in the fight for social justice. And although it sucked to lose a month of running to my initial illness, I relished the subsequent comeback, learning valuable lessons about the possibilities and limitations of accelerated fitness building in the process of going from bedridden to a 2:54 virtual marathon in six-and-a-half weeks—lessons that I can pass on to the athletes I coach, even if my own marathoning days are over.

Having said all of this, I will also say that I hope next year is nothing like this year. But I would say the same thing if 2020 had been smooth sailing start to finish. I mean, who the hell wants to live the same year twice?

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.

It all started with a single bad workout…

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!

3-Step Process in facing reality

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 22^nd, 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.

I Am Suffering

It all started with a single bad workout…

3-Step Process in facing reality

Step 1: Accept Reality

Step 2: Embrace Reality

Step 3: Address Reality

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