My chest is heaving. The air I rapidly suck into my lungs does not seem to be adequate as I immediately gasp for another breath. My heart is pounding, trying to escape the confines of the sternum that lies over it. The waves of nausea are somewhat overshadowed by a brewing headache. To put it bluntly, I feel like crap. My eyes gaze towards the clock on the wall and to my dismay it’s only 5:40 AM. Twenty more minutes of hell stand between me and relief. And I can’t help question for a moment why am I here again?

Several weeks ago, after a month of relative inactivity from some back strain, I accompanied my daughter to her physical therapy appointment. The session happened to be inside a gym or “sports performance” center where I watched several high school athletes get put through the ringer doing sprints, lifting weights, core work etc. A fleeting question at the front desk led to meeting Dan; aka “Meat”. Five minutes later I found myself booked for a 5 AM trial “session”.

So here I am, with daylight still an hour away. I have just pushed a “sled” with some unimpressive amount of weight stacked on it, about 30 yards or so on some astro turf like substance. I am now trying to simultaneously keep my heart in my chest, yesterdays dinner in my stomach, and my head from exploding, while doing push ups with my toes on a bosu ball and my hands balanced on top of two circular ten lb. weights. There is nothing I want more than to just lay down on the ground and just breath, vomit, and let my heart rate slow. At that moment, I feel more uncomfortable than I have in any Ironman I have raced (including the one where I did a marathon with the majority of skin on my left shoulder gone). But for many reasons I do not stop.

I have described in previous posts the challenge of managing pain in the ICU.  There are a range of patients I see from adults with chest pain from a heart attack to abdominal pain from a ruptured appendix or an inflamed gallbladder. Maybe its a cancer that has invaded their bones or lungs or brain making just “existing” a painful experience. That is what true pain is.  Not only is there the “physical” component but there is also the “psychological” part. “Where is it coming from?”  “How can I make it go away?”  “Will it ever stop?” It is hard as a physician to see this. In general, doctors receive little if any formal training on how to treat pain and even less on how to cope with the internal emotional distress it can cause. I am often in a position where I am unable to quickly treat someone’s pain and at times, unable to significantly help at all. As the doctor I have an easy out by writing an order for some morphine or dilaudid. Then I walk away to the next room, leaving the nurse and family to tend to the patient at the bedside and wait hopefully, sometimes desperately, for some relief.

What I am experiencing now is not that kind of pain. I am suffering, but this is completely voluntary. I am uncomfortable, but I can stop at anytime (my ego and pride aside). I know when it will end and I know where it is coming from. What is fueling me now? A desire to be in better shape? Strengthen my core and prevent injury? Faster time on the bike? My vanity, my desire to have a 20 something year old’s abs?  Probably a little of all of the above.  But that is what gets me to the gym at 5 AM. The truth though, is at the moment when I want to stop, I’m not thinking of my patients or my abs but just getting through the rest of the workout without calling it quits.

I have now suffered through a half dozen of  “Meat’s” workouts. And it is afterwards, when not in oxygen debt, that I have the ability to gain some perspective. During my often prolonged post-workout showers (made so by my inability to raise my arms above my waist), I am able to answer the question why I do not stop. It is in the last 20 minutes or the last “circuit” I do, that I find my limit and then try to push beyond. It is similar to the challenge I look forward to on the run portion of my triathlons. After ten or eleven hours, my quads and hamstrings are toast, and the blisters on my toes and the cartilage in my knees are screaming, reminding me with each step, that I have a choice to keep running and carry this “pain” with me, or slow down and walk, and part ways. It is not physical but mental at that point. Can I continue to make the decision to run when walking would hurt so much less, knowing that I actually have complete control over what I choose to do. And it is through my attempts to push myself that I have gained an even more acute awareness of the pain my patients often endure and the complete lack of control they have over it.

Tomorrow morning at 4:20 AM my  alarm will go off and I will head to another session with Meat. And during that hour I will again have another opportunity to push myself forward despite my brain and body telling me to stop. Afterwards, I will head to the ICU. And hopefully I won’t be so quick to move on to the “next” patient, while trying to help the one in front of me who is truly suffering.

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