I write this
post in a minivan while driving from Boulder to Grand Junction after my first
attempt to complete an Ironman 70.3 race.
It includes my internal
dialogue during the race, flashbacks, wisdom
from the thumping music in the transition area, and announcements
from the P.A. system. I hope to convey insights about collaborative care
without being too explicit or corny.
1. Swim—samba snare
"Athletes please move to the beach, the race will start
in 20 minutes”. Pushed along by a veritable arctic seal mating ritual of
athletes in black wetsuits and color-coded swim caps, I descend to Boulder
"O’er the land of the free and the home of the brave!”
Wow, a flock of doves, a very
nice touch. The crowd claps
furiously as the pros plunge into the 1.2 mile swim.
"What doesn’t kill you makes you stronger, live a little
longer!” Eight waves to go until I start, plenty of time to perseverate. Other than 1980’s Speedo-guy, why am I the only person revealing my
knees? Does the ankle-length material provide
extra buoyancy and efficiency? If so,
why are people evenly split between the wrist-length and the Farmer John
arms? This swim is long—even the pros
seem to be plodding through the course.
"Cause I told you once, Now I told you twice, We gon’
light it up, Like it’s dynamite.” "In wave
6, we welcome a number of military heroes, including (name) who lost 2 limbs
fighting in Afghanistan and now leads a military program to train other veteran
amputees to compete in triathlons”.
waiting in water for the countdown for my wave, "On
my mark, 3, 2, 1, have a great race!”
OK, hold back a little, let the faster
swimmers go first. This is a long race, no need to try and win it all in the
first minute of the swim. OK, start with
freestyle and attempt to maintain it for at least 10 minutes. You can do this.
I get kicked
in the head and my goggles get lodged under my nose. Uh oh, this feels all too familiar. A flashed
mental image of my first open water triathlon: impenetrably murky lake, aspirated
water, tightness in chest from a wetsuit I borrowed from a guy who weighs 140
lbs. Ten minutes of dread, panic, and
OK, you can do this. Tread water, empty goggles, get them back on,
and you’re off. I can barely see a
thing. Even the buoys seem miles apart. Check watch, how can it only be 1 minute so
far? Crap, my high-dollar goggles are already fogging. Need to get back on track. OK, breaststroke: easier breathing, get a glimpse with every
stroke. Now back to freestyle, now
breast stroke, now freestyle. Only 3
minutes? Tread water, spit in goggles,
rub out the fog. Treading is exhausting.
I’m not going to make it. I need to flag down 1 of the wave runners to
take me back to shore. No, just swim
until the first turn. The first leg is
always the hardest of the 3.
OK, I made it to the turn. I get swum over by a person in a pink
cap. What? How can I already
be getting lapped by someone in a wave that started 5 minutes after mine? I’ve only been swimming 15 minutes. I am a miserably slow swimmer. Where is that wave runner?
Just focus on your breathing:
right-left-right-breath, left-right-left-breath, right-left-right-breath. Hey I know this rhythm, I practiced it
yesterday. Quick image of the first-ever Colorado Brazilian Festival
that was celebrated in Boulder the day before.
I’m in the drumming workshop, practicing the snare drum’s every-third-beat
accents: RIGHT-left-right, LEFT-right-left, RIGHT-left-right.
OK, just practice the snare. Swim
mindfully, BREATHE-left-right, BREATHE-right-left, BREATHE-left-right.
I still can’t see a thing in these
goggles, I’m only halfway done and exhausted.
This must be how Matt feels each time we train together. I see
myself at the Colorado Mesa University pool, my first time training with my
friend, "Matt”. I provide a few
pointers, dive-in, swim across and back, and see he is still standing in the
chest deep water. He informs me that
he’s never been a swimmer. I coach a
little more and he performs a halting, thrashy, 25-yard swim with his head
never going under water. I encourage him
a little more, suggest a 10-minute regimen, and take off on my own. I swim 500 yards while noticing that he
hasn’t swum at all and eventually disappears from the water. I walk to the locker room where I find him
setting on the bench looking despondent.
We talk for a few minutes, then walk back to the pool together and I
swim by his side for the rest of the work-out.
Flash forward 2 months to Matt’s first sprint triathlon, in which he was
the slowest swimmer (and the only person to mix-in the back stroke), but he
OK, 2 legs down, 1 leg of the swim
to go. Just get through it and you’ll be
fine. Hey, this snare drum breathing is also like the samba steps I learned
Left foot back, right foot forward, left foot forward.
Right foot back, left foot forward, right foot forward.
Left foot back, right foot forward, left foot forward.
LEFT, right, left. RIGHT, left,
right. LEFT, right, left. How did those crafty Brazilians figure out
that the feet and drums should move together?
Man, I’m self-talking constantly.
It’s like I’m doing self- therapy in the lake. I wonder if this is what it’s like for one of
my patients with panic disorder to go to Walmart on a Saturday? I must be a jerk in the exam room. I can’t imagine enduring this trauma each day
of my life. Does it really ever get
easier? Nietzche and Kimberly Clarkson
were wrong. If I swam open water every
day, it would make me stronger, but it’d definitely also kill me. Fade to a counseling session from 10 years
earlier with a patient with OCD. He
explains his metaphor for OCD therapy.
"It’s like living in a house full of cockroaches. You know they’re there, but will only see
them if you sneak into the kitchen in the dark of night and turn on the
light. You need to continually expose
yourself to your worst fears to overcome them.”
further back to swimming lessons in Dallas as a kid. Each summer morning the surface of the pool
was covered in floating "June bugs” that would cling to my hair and back and
occasionally get swallowed during a breath. Exposure therapy is not for sissies. That’s the last thing I need to be thinking
about right now: cockroaches floating in the reservoir. BREATHE-left-right, BREATHE-right-left. Hey, this would make an interesting blog
Hit the beach running. "You’re on
the right track, baby. You were born this way!”
leisurely 10 minutes in the transition area (don’t ruin the physical endeavors with a haphazard
transition!) and I’m on
the bike. "Our lead rider just finished the first of the
two 28 mile laps.” I merge onto the county road just in time to
be blown by a hard charging phalanx of super-fit pros. I’m
never going to see them again, but I’ll take dry hot air over murky cold water
I’ve been spinning for 10 minutes and
averaging 14 miles per hour.
Extrapolated over a 56 mile ride, that’s exactly 4 hours. That is way too long for my goal of less than
8 hours total. It’s not looking
good. But, now downhill: 18 mph, 20 mph,
25, 31, 37. Thank you Jesus!
OK! The first aid station. I
approach a line of volunteers, each holding out a food item and calling out:
"Gatorade!” "Water!” "Gu!” "Bonk Breakers!” "bananas!” "Chomps!” I call back "Gatorade!” and a volunteer steps
out to the road with a full Gatorade squirt bottle (cap already opened). I lean
in, grab it without slowing down, and slide it into the water bottle
holder. I yell out "Chomps”, receive a
bag of energy gummies, tear them open drop all of the contents in my mouth and
drop the bag in the garbage heap at the far end of the aid station. What a slick operation that was.
Like an idealized collaborative clinic.
I’m the primary care doc surrounded by teammates of other disciplines
eager to help me out without slowing me down.
I see a man holding
a box roadside about 200 yards ahead. Look at that dude’s dread-locked
beard. It’s as thick and ropey as
DaVinci’s iconic Moses statue. What is dude doing? Cool, he’s handing out whole
organic peaches. Boulder definitely
comes as billed.
Hey, I’m 30 minutes into my ride and
haven’t yet used my clipped-in up-pedal. I need to get into that groove. Help me samba: UP, left, right. UP, right, left. UP, left, right. Was that a twinge in my
hamstring? Be careful brother. Don’t
even think that, you might increase the risk of cramping or pulling something.
Don’t picture a pink giraffe. Don’t
picture a pink giraffe.
Look at that guy’s bike: all carbon,
super-light tires, self-adjusting derailleur, aggressive profile. And, I just blew right by him. Based on his
calf number he’s only 24. I love passing younger people on super expensive
Lots of Obama bumper stickers,
haven’t yet seen a Romney. Boulder
definitely comes as billed.
the last aid station of the 1st bike lap. This one is sponsored by
the Boulder Triathlon Club. The
volunteers are all-decked out as disco superheroes. So, if this is the BTC, who is staffing the aid station. Maybe it’s the WAGs. What’s the male equivalent of a WAG…a BAH?
"Ain’t no mountain high enough! Ain’t no valley low enough!” Sing it Diana! OK, passing through transition area
after first lap. I averaged 18 mph for
1:35. That’s a better time than I’d
expected. I need to pace myself on the 2nd
lap so I have legs for the half marathon.
The second lap seems easier than the
first. That’s a good definition of
self-efficacy—re-tracing a familiar path.
Up-Right-Left, Up-Left-Right…Hey, what was that twinge in my hamstring? OK, stop the up-stroke.
I look to my left where there is a
female rider with "You’re stronger than you think” written on her arm in
marker. That’s a good narrative. I wonder where that came from: a therapist,
an athlete self-help book?
Facebook? Is she competing for
sport or for therapeutic reasons?
There seem to be a lot of similar
gear. I wonder what of it is
empirically-supported and what of it is unproven fold tradition, or
worse—shameless marketing? Pressure socks, that funky body tape from the London
Olympics, the disk wheels from the Los Angeles Olympics, triathlon handle bars,
the lycra bike short/tank-top combo that everybody (except for me) is wearing. I like the triathlon handle bars with water
bottle and straw that pokes up inches from the rider’s mouth, but worry I’d get
a chipped tooth or black eye.
"Boom, Boom, Boom, Even brighter than the Moon, Moon,
Moon.” Katy Perry signals the end
of the ride. 3:10, exactly the same pace
as the 1st lap. Feeling good. "Welcome
back our first female pro, Liz Blatchford of Australia who finishes in 4:07:48!”
3. Run—Broken down, but not beaten
Call my W(AG)
in the port-o-John. Re-apply Boudreaux’s
in strategic places to prevent chaffing. Apply nipple bandages. After another 10 minute transition I’m off on
the run. Just before leaving the area I
stop at a station of speedy volunteers with medical gloves slathered in
sunscreen who wipe down my face and arms. This race has 2 categories: triathlon pro and triathlon amateur. Apparently, I’m in my own category: triathlon
The first mile of the run is always
the hardest. The transition from bike legs to run legs is brutal. I just need
to do two 6.5 mile laps. You’ve done dozens of half marathons before…just never
after swimming and biking.
Well, that wasn’t that bad, the
first mile only took 8:50, which would equal…under 2 hours for the full run. Legs and lungs are feeling strong. The calf number on the walking man in
front is a 75. Holy cow, I’m
just now passing old dude in the run? "Fantastic job!”
Good, the first running aid
station. I’m saggin’. "Gatorade!” "Chomps!” A volunteer holds
out a sponge. I grab it, drench my head in the ice
cold water, and drop the sponge in the pile.
I feel a
twinge in my lower right knee. Uh-oh, that’s the IT band. Not a good sign with 9 miles to go. Flashback
to 6 weeks of pain and abandoned runs after an IT band inflammation 2 years
mile 5 aid station in view the IT Band flares horribly simultaneously with
cramps in the calves and lower quads of both legs. No!! OK, just gimp into the aid station and see how you
feel afterward. "Gatorade!” "Bonk Breaker!” I quickly down both. Still
hobbled, I grimace past the sponge volunteer, who pipes-in with "You look like
you could use a sponge, sir.” I’m not a family doctor, I’m a
freakin’ surgeon! I just scowl and someone hands me a sponge. OK, let’s try running a little….Ouch, no, too
soon. Let’s walk to that next bridge and
see how it feels.
OK, a little better. I run for 3 minutes before giving-in to the returning cramp and IT band
pain. I follow this same pattern through the end of the first lap of the half
"We are the champions, my friends." I love that song, but not…right…now.
I’m feeling more like "you got blood on you face, you big disgrace, kicking
your can all over the place.” Or is it "And another one’s gone, another one’s
gone, another one bites the dust”?
OK, Reitz, pull it together. Find a way to finish this race in 1 piece. Six miles to go, what would I tell my chronic
pain patients? Manage the pain; strive for optimal performance without pushing
so hard that I break down.
the trail I see a young runner wearing what appears to be a diabetic pump. I strain to catch up with him. "Is that a pump?”
have a whole team of diabetics running today.
Are you diabetic?
We chat for
about 5 more minutes, until he tells me that his legs are failing him and needs
to pull-up. I run ahead another minute
and pull-up myself. Over the next 5
miles we repeat this pattern: I pull-up,
he catches up to me, we run together a little then he pulls up. I run a little further, then pull-up.
One mile to go, the pain is unbearable,
I can’t go more than 200 yards without walking.
I…will…not…finish this race walking.
What would I tell my patients?
Breath into the pain, breath into the pain. Breath into the pain…
Well, that was a crock of new age
I walk until
my diabetic friend catches up to me. We walk together until we can hear the
music thumping and then run the last 300 yards to the finish line together
"Get up, get down, put your hands up to the sound. Get
up, get down, put your hands up to the sound.
Everyday I’m shufflin”
Drop plastics in the plastic bin,
organics in the compost bin, and garbage in the trash bin. Boulder comes as billed.
Thank you Boulder,
Thank you Jesus,
Thank you samba,
Thank you snare,
Thank you grimacing surgeons,
Thank you inspirational marker
Thank you evidence-based practices,
Thank you folk traditions,
Thank you rich young athletes who are
slower than me,
Thank you older athletes who are
faster than me,
Thank you diabetic kid who finished
Reitz , PhD, LMFT is the Director of Social Media of CFHA and the Director of Behavioral
Science at St Mary’s
Family Medicine Residency in Grand Junction, CO. When younger, he liked to trail run. Now older, his body appreciates cross-training. He posts his ideas at CFHA's Collaboblog and tweets at @reitzrandall.|