by Lynne Cox
The tests Dr. Drinkwater, Dr. McCafferty, and Dr. Horvath ran on me confirmed that I was in tune with my body, that I was training it to not only survive but to be stronger and excel in the cold water. I needed that confirmation. The coach I had before I entered university convinced me that I needed to swim six hours a day in a single workout in the ocean to break the world record for swimming the Catalina Channel. After those workouts, I was exhausted, too tired to sleep, and I had no appetite.
I attempted the Catalina crossing, but when I was more than halfway across the channel, and two hours ahead of the world record, I did not care. I decided I wanted to get out. I stopped swimming. For more than an hour I treaded water and argued with my crew. I told them I was burnt out. The crew concluded that there was nothing wrong with me. They convinced me to continue swimming because they thought I would regret quitting. I struggled but worked through my negativity and became the fastest person to swim the Catalina Channel.
A few days later, I decided I was done channel swimming. I was so tired of it, I couldn’t look at the ocean. I told my parents I had decided to quit swimming. They said I could do whatever I wanted to do, so I visited friends, read books, and went to see movies.
A few months later, I heard the call of the ocean in the sea breeze rustling the palm trees in front of my home. I smelled the sharp notes of salt, felt the cool moist air awaken my body, and felt the pull of the tide that grew stronger as the moon grew fuller. I missed diving into clear cool blue water, the feeling of the waves lifting and embracing me. I missed the joy and strength that swimming gave me. I knew I had to return to the water, but I needed to do something different.
There were only a few people attempting long-distance open-water swims, and fewer swimming in cold water, and there weren’t any coaches who specialized in open-water swimming. I realized that I knew how my body responded to stress better than a coach. While I was in college, I decided to coach myself, but I knew I needed to do something more to become faster, and stronger, and swim in colder waters. To accomplish this, I studied and spoke with world-class athletes, learned how they trained, and figured out how to translate elements of their training to open-water swimming, to my training. Their help was invaluable, but I realized I needed to do more to excel in sports and in life.
I looked at the pace clock. It was ridiculous. I could swim across frigid oceans, but I was fighting to keep my hand in a bucket of ice water. For some reason I told myself the pain would disappear in nine minutes. My hand would be used to the water and I would be okay. I don’t know why I told myself that.
I watched the black minute hand move. Nine minutes passed. I looked at my hand. It was snow white and full of pain so I glanced at kind and caring Mattie. His curly brown hair and large dark-rimmed glasses made his face look pale. There were black circles under his eyes. He looked exhausted.
One researcher asked me to lift my hand out of the water and straighten my fingers. He ran an infrared wand over my hand to measure heat flow into and out of my hand, then he asked me to put my hand back into the bucket. I wondered how long I could do it. I never knew that the more intense pain became, the more energy it took to fight it. I was trying to figure out if there was a way around the pain or a way to let go and not fight it.
Dr. Keatinge said everything was going according to plan. He left to check on some things in his office.
I looked at Mattie.
“Do you need to stop?” he asked, and grabbed a towel.
2
MIND SHIFT
I was tempted.
After a long swim, nothing feels as good as being wrapped in a warm towel. It is the reward for swimming hours in cold water and overcoming challenges. But I hadn’t earned a warm towel. I hadn’t completed the test. I had to endure, but I was scared.
My hand felt hard, like frozen meat, and I wondered if the ice water surrounding my hand was crystalizing my blood. My mind could override my body’s response to pain to a certain point. But this was a different kind of pain than I had ever experienced.
I was searching for a mind shift—a new way of thinking that would help me escape the intense pain.
A mind shift was something that Dr. Roger Bannister, the British runner and neurologist, achieved when he broke the world record by running a mile in less than four minutes.
Before his attempt, most people believed that it was impossible for people to break the four-minute barrier. But shortly after Bannister’s success, other runners ran the mile in less than four minutes. Bannister’s achievement created a mind shift. It changed the way people thought and inspired them.
My hand had been immersed for fourteen minutes and ten seconds. Each second was a tiny victory. I reminded myself that small victories lead to large ones, but my resolve was teetering. I could not concentrate. I started counting. That worked when I was tired on a long swim. But it wasn’t working now. A shrill alarm was sounding in my head.
“It might distract you if I talk with you,” Mattie said, and smiled reassuringly. He said he was going on holiday in a couple of weeks to anywhere he could find sunshine. The winter in England had been long, gray, rainy, and depressing. He had spent most of the year working in the hospital and cold laboratory. He was craving warmth and was considering traveling to Spain, Portugal, the South of France, Madeira, the Azores, or Italy.
It would be wonderful to visit any of those countries, I said, and for a moment I daydreamed about traveling. I told him that I loved Italy, walking the narrow, winding streets, seeing beautiful and varied architecture, watching the sunlight move across the piazzas, making the terra-cotta, cream, yellow, pink, and orange buildings glow and the rushing fountains of water sparkle. I loved the smells that came from restaurant and apartment kitchens, the delicious aromas of garlic, tomato sauce, cheese, and bread, and I loved feeling the warm sunshine on my back. Mattie said he would think about traveling to Italy.
The researcher asked me to remove my hand from the bucket. He needed to take another reading, so I lifted it and made sure not to knock the wires. I wondered if my hand would be okay after the experiment.
“You’re doing quite well,” he said.
I nodded. I was trying my best.
The other researcher looked at the monitor and said he hadn’t gotten a good reading. His colleague repeated the test.
I wondered what would happen if he couldn’t get an accurate reading. I wondered if I would have to repeat the test.
The red hand on the pace clock ticked off five seconds. I wondered if there was a limit to the time my hand could be out of the water.
“Got it this time,” he said.
I submerged my hand. I couldn’t believe that I was so exhausted. This experience gave me a new understanding of pain, how debilitating it was, and how difficult it was for people who had to endure it.
I tried to put my body on autopilot and disconnect my body from my mind. I did this on long swims, but I couldn’t do it now.
Dr. Keatinge opened the door and jogged into the lab. He spoke to the researchers, they updated him, and he said, “You’ve only got ten minutes remaining.”
I gritted my teeth.
He instructed, “When you reach thirty minutes, Mattie will remove the wires, but you’ll need to keep the probe in. We want to take a few more temperature measurements to see if the cold blood in your hand circulates and lowers your core temperature.”
I nodded. I could not speak without my voice wavering.
“The rewarming phase may be rather uncomfortable,” he said.
Could it be more uncomfortable than this? I wondered.
“Okay, well done, thirty minutes. You can take your hand out,” Dr. Keatinge said with relief. He checked the monitor and said, “She has minute blood flow into her hand. Less than anything we’ve seen.” He sounded thrilled.
I stood up and felt a little dizzy.
“If you walk over to the sink, I’ll run some cool water over your hand. It will make it feel better. You don’t wa
nt to run warm water over it; that will hurt more,” Dr. Keatinge said.
When Dr. Keatinge ran water over my hand I wanted to scream. It felt like I had stuck my hand into a hive full of stinging wasps. I pulled my hand out and put it in my armpit. I thought that this would allow it to warm up gradually, but my armpit was much warmer than the water. It hurt more. I wished I could cut my hand off and reattach it when it was warm. I shook it fast and hard. It didn’t help.
“You okay?” Dr. Keatinge asked.
“Not yet. Why does it hurt so much?” I was ready to cry.
“You almost completely restricted the blood flow into your hand and it’s starved for oxygen and warmth. You responded to cold dramatically differently from anyone we’ve ever studied. The other subjects slightly reduced blood flow into their hands and their temperatures dropped. You only allowed a minute amount of blood flow into and out of your hand and your core temperature remained normal. It’s astonishing,” he said.
“I thought I had a high pain tolerance, but I feel like a wimp,” I said.
“You aren’t at all. People who get frostbite in their hands completely shut down their blood flow and their tissues freeze. Their pain during the rewarming phase is often so intense they need morphine. We don’t have narcotics in the lab, but I can give you a Tylenol.”
“Will the pain diminish without meds?” I asked.
“Yes, it will,” he reassured me.
“I don’t need to take drugs. Is it okay if I walk in the hallway?” I thought that if I could walk I would create heat through exercise and that would warm my hand from the inside.
He said I could go wherever I wanted.
I bolted out of the lab and ran the length of the hallway. It made me feel better to move, and I hoped that would oxygenate and warm the blood more quickly, so my hand would rewarm faster. For five minutes, I jogged in the hallway. Dr. Keatinge joined me and offered medications again, but I told him I was doing better. He asked to look at my hand and said that it was turning pink. The blood flow was returning. It would feel normal soon.
He needed to return to his office and asked Mattie to walk with me.
Mattie said the initial results of the test were extraordinary. The immediate results changed the way they thought about human physiology, and I hoped they would be even more valuable in the future. He said it could take months or years to fully understand the data.
That made me feel good. I took a deep breath. I was relieved the test was over, and I never wanted to do anything like it again.
Dr. Keatinge asked if he could take a look at my hand. It was hot pink and was feeling warmer. He suggested trying the tap water again—start with cold water and slowly add warm water according to my tolerance.
We returned to the lab. I placed my hand under the tap and watched the water cascade over it and splash in the sink. In five or ten minutes my hand felt almost normal.
Dr. Keatinge said it was lunchtime. He wanted to know if I was hungry and wanted to have lunch with the research team.
I was hungry and eager to talk to the team about their work, and to learn more about them. It seemed strange to do something so intense and not even know the people I was working with other than Dr. Keatinge.
We were at Queen Mary University of London located in the East End. It was a diverse area. I had heard that there was a nearby Pakistani neighborhood. I love Indian food and had heard that Pakistani food was similar. I thought the heat and spices from the food would warm me up on the inside.
It was exciting to walk with the research team through the streets of London, across cobblestone roads. This might have been where Charles Dickens once walked. The buildings were red brick, and there were people walking past carrying colorful umbrellas with interesting patterns. They wore dark clothes and bright scarves and walked quickly.
The day was foggy and gray. It was perfect—what I imagined London would be like in winter. We passed a few Pakistani restaurants and the team agreed on one.
When we walked in we smelled curries and fresh naan bread and felt warmth moving from the kitchen to the dining area. The walls were decorated with pictures of different foods and descriptions of the dishes written in curly Urdu script and English.
The restaurant owner recognized the team and escorted us to a table, handed out menus, and in a few minutes, we were eating steamy chicken, beef, and vegetable curries, platters of tender naan, and drinking sweet bright-orange-colored mango lassis from tall glasses.
The food was spicy and the steam from the dishes released their fragrance: cardamom, ginger, turmeric, and pepper. It smelled exotic and tasted delicious. We talked a little about the cold research they were conducting, but they said it took a while to understand the test results. Sometimes it took years for researchers and physicians to apply their information, but they enjoyed exploring the physiology of the human body. It was exciting.
I asked them about the tourist spots in London, and they told me the sights I needed to see.
When we were returning to the laboratory, Dr. Keatinge said he had decided to take the afternoon off so he could show me some of London. I was so excited. We saw Royal Albert Hall, the changing of the guard at Buckingham Palace, and the King’s Troop Royal Horse Artillery in Hyde Park. The horses were beautiful and the troops were regal. We stopped at the British Museum and could only see a fraction of the amazing collection.
Dr. Keatinge drove me to the outskirts of London so we could have dinner with Annette, his wife. It was like a magic carpet ride, winding through the city, past shops and historic landmarks. I was happy and relaxed, and was enjoying the chance to see the great city.
Dr. Keatinge told me that the initial results of the test were amazing. He spoke in understatements and was reserved, but for the first since we met, he couldn’t contain his excitement. He said he knew the test had been difficult, but he was thankful for my participation. He asked if I would consider repeating it in a couple of days. I could take some time to decide, and I didn’t have to say yes.
My results were unique, perhaps startling, and he was intrigued. To learn more he wanted to do further studies on blood flow into and out of my hand. He would need to have cannulas placed in my wrist.
A cannula is a long tube that is inserted into the body with a syringe. It is a precise pressure gauge that would measure the amount of blood flow into and out of my hand. He explained that most researchers believed that blood flow into the hand was regulated at the wrist, but their findings from the initial study led him to believe that blood flow in the hand might be regulated at the fingertips.
I don’t think he had any idea what he was asking me to do—how difficult it had been for me to endure the first test.
I asked him if the test was that important.
He said my responses were different from anything he had seen before, and he thought his group might discover something new and important by doing another, more in-depth study on me.
It was difficult to think about repeating the test. I felt like I’d been through a battle, and my hand was still a little numb.
Dr. Keatinge explained that the cold had affected the nerves in my hand. It might take a couple of weeks before they regenerated.
Maybe the numbness would make me feel the ice water less. Maybe because I’d experienced the test once, I would know what to expect and it would be easier. Maybe I could do it, but I didn’t like needles.
He would ask his friend and colleague, who was a cardiologist, to insert the cannulas. He was expert at it. Once they were in place, I wouldn’t feel them.
I asked why cardiologists are the experts with cannulas.
“They often measure blood flow in the heart,” he said.
“You don’t need to put a cannula in my heart, do you?” I asked.
He considered for a moment. “That would be interesting, but we only need to look at blood flow in the hand.”
“That’s good,” I said, relieved.
I agreed to repeat the test and conv
inced myself that it would be easier the second time because I knew what to expect. But I felt like there was another reason I agreed to it.
3
CANNULAS
Dr. Keatinge turned on the lights in a different room in the lab and offered a chair to me. It was 5:30 a.m. I was still jet-lagged, and tense.
Dr. Keatinge told me that the cardiologist was fitting us in between rounds. He explained the procedure the cardiologist would perform and left me in the lab as he went to get a consent form from his desk for the test.
I took slow deep breaths and cleared my mind.
Ten minutes later, Dr. Keatinge returned with the form and the cardiologist. He introduced us, but I didn’t hear the cardiologist’s name. He said he was originally from India and he spoke with a combination of British and Indian accents. He explained the procedure in detail, and I asked him a lot of questions. He made sure I understood. I asked him if he placed cannulas in people often and he said he did and told me how they were used in cardiac surgery.
I was fascinated but nervous. I signed the consent form and he went to work.
He sat down facing me and asked me to roll up the sleeve on my left arm.
He gently turned my arm so the palm faced up and palpated my wrist. He explained he was going to insert two cannulas, one into a vein and the second into an artery.
The room was frigid and my vein and artery responded to the cold by closing down. He couldn’t insert a cannula into either.
Dr. Keatinge had anticipated this would happen. He left the room and returned with a portable space heater, plugged it in, and positioned it under my left arm.
