by Peter Sagal
The ride to the hospital—strapped into the stretcher, head immobilized—the triage at the emergency room, and trips to the X-ray and CT scan rooms all happened in a blur of changing ceilings. I felt fine, in no pain whatsoever, as long as I remained flat on my back. If I tried to sit up or twist or roll to the slightest degree, the angry dwarf stabbed me again, so I stayed flat, and enjoyed the Dilaudid, until I got my diagnosis.
“There’s nothing wrong with you. Nothing [is] broken,” said the trauma doctor.
“Then why does it hurt so much when I try to move?”
“Deep bruising,” he said, and shrugged.
I believed him because he was a doctor and I was a guy in spandex bike shorts who whimpered like a puppy every time I tried to sit up. They checked me into the hospital and started me on a morphine drip, thinking—I supposed—that I was just a little bit delicate and needed some meds to stop my whining. The next three days passed in a morphine haze, punctuated by meals I didn’t particularly want, visits from my wife and children I don’t remember, and a dose of Valium that made me even less interested in doing anything other than watching the ceiling stay still for a change. It was during that Valium-induced nap that the call came—a call I was too drugged to answer, and thus spent a good six hours trying futilely to return—explaining to me that hey, now: they had found something on the CT scans after all.
“The good news is, we don’t have to operate, it’ll just heal,” said the cheerful neurosurgeon who stopped by to see me the next day, after I had woken up. “The bad news is it’s going to hurt a lot, for a couple of weeks, then hurt a bit for six weeks, and then you’ll be fine.”
Picture a vertebra. There is the main structure, round and hollow like a napkin ring, down the middle of which runs the spinal column. Jutting off it to the sides are bony extensions called “transverse processes,” which provide an anchor point for a whole bunch of interesting muscles running through your side and back. I had managed to snap off two transverse processes on my left side, low down. Which, as it turns out, was why trying to move kept making me scream.
Four days after the accident they wheeled me out of the hospital and my wife helped me, gingerly, into our car, and took me directly to the supermarket to drop off my prescription of painkillers and then wait for it to be filled. I didn’t want to sit in the car by myself, so instead I wobbled painfully into the store, where the only place to sit was on one of those electric scooters elderly people use to shop. There was no key, and there was no rule against it, so I celebrated my release by cruising around the supermarket in an electric scooter, trying to cultivate the look of someone used to greater speeds.
• • •
The problem with being immobile is you can’t move. During the first week of my recuperation, my family took a planned beach vacation in Wisconsin, and I kept trying to do insane extreme sports, like standing up from chairs, rolling over in bed, and even walking. I found that if I held my back in a certain way—as if I was cocking my hip provocatively at some imaginary sailors—it could keep the painful spasms at bay, but doing so began to strain the rest of my back. My lowest moment came at the end of a half-mile shuffle on the beach, during which I kept having to bend doubled over to relieve the ache in my back, and I eventually had to send my poor wife hurrying back to the house to fetch the car, while my daughters held my hand and cooed comfort.
“I run marathons,” I muttered under my breath. “This isn’t me.”
But it was. This was a different category than my pulls and strains, even the time I tore my calf tendon. Those were training injuries, proof that I was hard-core, and a few weeks or even months of changing my workout routine was a small price to pay for such a badge of badassery. But now I felt utterly useless, and cut off entirely from any kind of training, which for years had been my refuge, my pride, and my natural antidepressant. I was sliding down into a spiral of gloom, and I spent the rest of the vacation sitting in a chair on the beach, looking out at the water, like the paralyzed hero in The Diving Bell and the Butterfly, waiting for someone to wheel me back in.
The next week, though, I was feeling well enough to visit the doctor, and I got the okay to begin—lightly, gently, carefully—exercising again. I went to the gym, lowered myself into a recumbent stationary bike, and moved my legs without pain for the first time in weeks, desperately lapping up the faint fumes of endorphins like an alcoholic licking a bottle. I managed twenty minutes before my back started to bark at me, and I felt torn . . . on the one hand, I was thrilled to have actually broken a sweat because of something other than terror or anxiety, but on the other, I felt pathetic and small. Perhaps next time I’d use the handbike, after making myself feel better about my weakness and fragility by bumping the senior citizen currently using it to the floor.
It was late August. I wrote off the Chicago Triathlon at the end of the month as too great a risk of death by drowning. However, I had registered for the Chicago Marathon six weeks later, on October 10, 2010 (10/10/10), and I was determined to be there on the starting line. This struck those who didn’t know me well as crazy, and those who did know me well as crazier than usual. I had been hit by a car, hard enough to leave large, me-shaped dents in the sheet metal, and I was talking about running twenty-six miles not two months later. I realized they were right, so I stopped talking about it.
For my first run after the accident, I went out alone. I didn’t know what would happen, or what would break, and didn’t think any of the options might be pretty. I stepped softly and slowly, as if I were learning to walk, and managed three miles before my back started to stiffen. I felt both excited and depressed: I was running again, but running as if I had never run before.
And so it was for the month of September. My running was slow, painful, and it seemed that in the four weeks of complete and near immobility after the accident I had lost four months’ worth of fitness and gained four years in age. I felt fragile and vulnerable and ceded my usual place near the front of my running group, following along from the back, shrieking out warnings whenever a car approached anywhere near an intersection.
The day of the 2010 Chicago Marathon approached. The idea of walking away from another race seemed like one defeat too many, so I decided to do it. I stumbled painfully through some longer runs, ending up bent over and gasping each time. Six days before the marathon, I did a short run with the editor of Runner’s World, David Willey, and afterward he looked me up and down, and he said, “You’ll do fine. Everybody who gets laid up with an injury does great at races after they recover, because they had enforced rest.” This seemed insane to me. I had lost so much time, and so much speed, and so much fitness, that I still had no idea if I could even finish the race.
At 7:25 AM, on the tenth of October, in Grant Park in Chicago, I stood in a seeded corral that had been earned, it seemed to me, in another lifetime. My right knee felt creaky and gritty, like somebody had forgotten to oil it. I was tired and dulled and still a bit hungover from a successful series of performances (and after-parties) with my radio show the prior week in New York City. Then the crowd around me started to shuffle forward with a cheer, and I started to move my legs forward, and swing my arms, and I committed myself to the road.
My plan was to help pace a friend to his 3:30 Boston qualifier, keep it up as long as I could, and give him a cheerful wave and a pat on the back when I flagged, which I anticipated would be around the ten-mile mark. But by the five-mile marker I had left him behind. Keeping to a 7:50 pace seemed surprisingly easy. I expected nothing except to fail, so I kept going until I did, and when I didn’t, I kept going. The familiar landmarks slipped by . . . downtown, Lincoln Park, Boystown, downtown again, Little Italy. I kept waiting for the inevitable, and it never happened. My back felt fine. My legs felt fine. I kept running.
The heat rose and I flagged a bit in the last four miles, stopping to douse my head and slurp down fluids, but still, no disasters, no breakdowns, and no pain. I climbed the course’s one hill at Roos
evelt Road and turned and went down the gauntlet of the finishing chute, not sprinting, not giving up, just waiting, again, for something to stop me. The simplest pleasure is to move, so I just moved.
My watch read 3:27, my third fastest marathon ever, a Boston qualifier, and without question, my easiest and most pleasurable 26.2. Even as the inevitable cramps and soreness started postrace, as the blood rushed to the strained muscles in my legs, I still felt elated. I thought of an old story about a samurai who went into a duel with a perfect resignation, prepared to die, and his opponent, frightened by his calm, withdrew from the duel. I had entered the race expecting the worst, and the worst had never come. In fact, one could argue, it was my best race ever.
I strolled out of the finishers’ chute with my friends, who, having pressed and tried to do their best, had either exhausted themselves or collapsed completely, and thought about where I had been two months before: lying on the ground, with broken bones in my back, gasping for breath and wondering if I would ever move again. I walked out of the park to Michigan Avenue and stopped at the crosswalk, and carefully looked at the drivers of the cars stopped at the light, and gave them a wave to make sure they noticed that I was moving.
I was so pleased with myself. I thought I had run through, truly, the valley of the shadow of death, and emerged unscathed on the other side. And I had! But not completely.
• • •
It was an October morning, three years after that race in 2010. I woke up at 7 AM in my Divorced Dad Town House, having missed my running group’s early morning start. Again. Dammit. I had expected that with no kids to look after, I would be able to devote even more time to running. But going running at six in the morning—or earlier—only makes sense if there’s an important reason to be back home at seven. Now that I was no longer responsible for waking my kids at that hour, or feeding them, or sending them off to school—lucky me—it was harder to justify going to bed early enough to wake up at five thirty to be out on the street by six, and since I wasn’t going to go to bed early anyway, I might as well mix myself another drink, and what’s that you say, Netflix? Another episode of Parks and Recreation will start in just fifteen seconds? Who am I to say no? I got nobody else but you, Netflix.
I picked a shirt from the basket that wasn’t that smelly, added shorts and shoes, and headed out the door. I made it exactly one mile before I ran into the grocery store.
Once inside, I didn’t need to ask directions; I had scouted this place out months before. And I certainly wasn’t going to waste time asking permission. Across the store diagonally—damn, why did it have to be all the way on the far side—through a big swinging door into the storage area, right turn, down some stairs, through the employee break room—look, motivational posters, how precious—and straight to the gray door. Anybody watching me traverse those last fifteen feet would have seen a man skewered between the need to hurry and the need not to jostle any systems, as if he were wearing a motion-sensitive bomb vest. And I was, sort of. At least, there was a risk of explosion.
Proximity to the target has a strange effect on the mind-body system, and with every step toward my destination my need to already be there became more acute. I might have leaped the last few feet. I may not have locked the door. And then . . .
The first thing we’re going to need is a euphemism. Something evocative but not gross, something original so it doesn’t bring up past unpleasantness. How about “egress,” a lovely antique word with the simple meaning “to exit.” Done. Egress.
As I said, when I was brought to the hospital after being hit by the Orange Nissan of Death, the helpful nurses put me on morphine to ease my considerable pain. Opioids have a lot of wonderful effects, but they often paralyze the digestive tract. Thus, I did not egress for four or five days, although I was too blissed out to care. (This is apparently a common side effect of opioids, judging from the ads for “opioid-induced constipation” medications I see on cable TV.)
Since then, though, and up until this very day, my running career has been punctuated by what some call “cramps,” although those can get confused with the muscular kind. Others call this phenomenon “the trots,” but technically, most runners trot every now and then, especially after a speed workout. And of course there’s “the runs,” but that’s a distressingly confusing homonym. But this is something very particular, and something very, very hard to ignore. It is nothing so much as a specific subassembly of the bodily machinery taking over from the brain and insisting on having its own way. You may not want to stop; you may be in the midst of a race or a large group run. You may not have any place to stop. But you will stop, or you will explode. The Egress will not be denied.
So in recent years I have found myself hunkered down in bushes and alleys, hoping I won’t be discovered, arrested, or shot. I have made my poor running buddies wait up to three times during a long run while I inspect the inside of some construction site’s porta-potty or a Starbucks restroom. I squandered the one real chance I’ve ever had to win a race—that 5K in Hamilton, New York, two days before the 2013 Boston Marathon—because I had to duck into the woods and find a secluded spot. While I egressed, two runners passed me. I came in third.
Conventional wisdom suggests first to look at the other end of the system—what are you eating, and when are you eating it? But that seems to have nothing to do with it. It doesn’t matter what I eat the night before and it doesn’t matter when I eat it. (I never eat within an hour of going for a run, and I never eat at all before a morning run.) The other solution, obviously, is to get up a little early, move around, and then spend some time egressing in the warm privacy of my own house. I’ve tried it. It doesn’t work; whatever I do, within a few miles, the gremlin awakes. My body (or, a specific section of my body) apparently needs me to run a mile or two before it’s ready to work. I’ve even tried going for a mile jog and then returning home, to see if I can fool my system into thinking I’ve started my actual run—nothing. My body seems to know when I’m actually running and when I’m just pretending.
All this has led me to have a very strange relationship with my own digestive system—as if it’s another being who happens to be occupying the same body as the rest of me. We get along, in a mostly symbiotic relationship—like those birds who clean the teeth of crocodiles. But eventually we disagree. I have even had conversations with my gut—once, running along a familiar beach in Massachusetts, near my parents’ home, my large intestine let me know it would like to make a stop. I told it not to worry, there was a public restroom up ahead. When we arrived, the restroom was locked. I told my gut it would have to wait. My gut was having none of it. I spent the next two days worried that the Boston Globe would run a headline, “Public radio host found lurking in bushes, doing unspeakable things.”
Fed up with this constant interruption, I consulted an expert. Dr. Satish Rao is a (intake of breath) professor of medicine and the chief of section on gastroenterology and hepatology and director of the Digestive Health Center at Augusta University in Georgia and thus, as Gene Weingarten of the Washington Post put it, “the greatest living American expert in the field of how poop moves through the body.”
In his pursuit of colonic knowledge, and specifically of how exercise affects the “motility of material” within the colon, Dr. Rao once asked healthy test subjects to exercise at up to 90 percent of capacity with probes inserted into their behinds. I assumed these were tiny things, like suppositories or maybe one of those buglike things from The Matrix. “Oh, no,” said Dr. Rao, who, perhaps as a survival technique, has maintained his sense of humor about his subject. “The colon is about three feet long! We use a three-and-a-half-foot-long tube!”
So these men and women ran as best they could—what does a three-and-a-half-foot tube up your business do to your stride?—and Dr. Rao discovered a strange and unexpected thing: during intense exercise, the colon “goes quiet.” “In fact,” he told me, “the higher intensity of the exercise, the quieter the colon became.” His
hypothesis is that blood rushes away from the colon to support the other systems involved in exercise—muscles, heart, lungs—and the colon, starved of energy, hibernates.
At the same time, those porta-potties don’t line marathon routes for the comfort of the spectators. Dr. Rao doesn’t know for sure, as we “don’t have the technology yet” to figure it out—the mind boggles at the thought of even bigger probes—but his guess is that after a long while of being starved of oxygen, the colon might “complain” by cramping, in the same way that the sharp chest pains known as angina are caused by a lack of blood to the heart. And, he says, once exercise stops, the colon wakes up with a vengeance. Your colon cramps up, you stop because of the pain, and the machinery whirrs back to life, sending you to a porta-potty or behind the nearest bush.
But what about me? It’s no longer an occasional disaster; it’s a regular part of my runs, as much as tying my shoes or starting my watch. Dr. Rao believes that my situation was related to my accident, but not quite in the way I imagined. His theory is that my injury to my vertebrae might have affected the nerves running down to the business end of my GI tract. Which, in turn, might have affected the complex interactions that take place down there—the dance of the colon, as it were.
First, he suggested trying an over-the-counter probiotic. More and more research shows that the bacteria of the gut contributes to its well-ordered functioning, so why not go to Whole Foods and pay twenty bucks for a jar of the stuff? (Other doctors are experimenting with fecal transplants. To which I say: THANK YOU, BUT NO.) Perhaps a dose of store-bought bacteria would restore my intestinal flora to the lovely garden of germs they were before the accident. If that didn’t work, he suggested I try a prescription medication that would help reabsorb bile, if any extra was sloshing around where it shouldn’t be. I tried the probiotic, and there was no effect, which I guess is what you’d expect when you throw down a bunch of randomly selected bacteria into your gut in the hope that it will do some good.
