Crashing out at Ironman Louisville

As many of you know, I crashed out of Ironman Louisville last month. As my body continues to heal, I am now able to comfortably type with two hands so I decided to write a short recap of my experience. The whole thing was quite an ordeal both physically and emotionally. So now, just in time for Thanksgiving, I want to recap my experience.

I am going to spare you all the details leading up to the race. Suffice it to say, I was very well trained, nicely tapered, and ready to execute my race plan. My coach and I discussed target power as well as run paces and I was confident that all my green boxes would add up to a great day.

On race morning, I had a small issue that required some tape. Melissa ran back to the hotel and got me some gorilla tape so I could deal with the minor issue. This slight delay put me near the back of the very long line of people waiting their turn to jump in the Ohio river to start the race. I had hoped to see some of my friends on the course but by being in the back of the line, I would only see them if I caught them.

Getting ready to jump in. Thanks to Lilo for the picture

Overall, I had a pretty decent swim. It was really not too crowded as the river was wide and the time trial start really opened things up. For some reason, during the whole swim, I kept having visions of my brother on his death bed. At the time, I did not know it was his death bed. I knew he was very weak though. I have written about this in the past but it is worth repeating since the images were so vivid in my mind during the swim. John was too weak to even sip water out of a straw. He would call out to me and say, "Jim. Water." Then I would dip the straw into the cup of water and drip water into his mouth. It was difficult for him to swallow even those small drops of water. But afterwards he would always say, "Thank you. " I would say, "You're welcome brother. I love you." And then he would say, "I love you too." Thinking about it now makes me so sad. Hours later, he would be gone. These thoughts and visions of John in the hospital stayed with me for the entire swim.

Finishing an Ironman swim is always quite exciting. To go from quiet contemplation in the water to the throngs of cheering crowds on land is quite a transition. After the strippers removed my wetsuit and I started running down the chute towards transition, I heard my name from some spectators. I glanced over my shoulder and saw the smiling faces of my former coach who taught me how to swim back in 2010. It definitely gave me a boost.

After making my way into the changing tent and weaving my way through lots of naked men, I found a spot on the ground to change into my riding gear. And then it was off to get my bike and head out on the bike course. The first part of the bike course seemed very fast. I felt so great. I was locked into my target wattage yet I was passing so many people. This was not typically the way my races have gone in the past. Usually I am the one being passed. I stuck to my plan and kept on trucking, careful not to burn any matches. At one point, I passed my friend Meredith. I recognized her Pro K kit and yelled Pro K as I passed. She yelled, "Is that Jim." I yelled back to her, "Yep."

Shortly after seeing Meredith on the course, I hit the turn around. And it was shortly after that when I hit the pavement. The freshly paved road was smooth but there was a 3 or 4 inch drop off the side of the road. My front wheel veered too close to the edge and suddenly I was on the pavement. I had what mountain bikers call a "front side washout." And it happened at 22 mph.

It is amazing how quickly thoughts move through the brain. My first thoughts were of another Pro K athlete, Lynn. She had crashed at her last Ironman but rallied to finish the bike and the run bandaged up like a mummy. I thought, "Can I rally like Lynn?" That thought was quickly replaced with, "I need an ambulance." I was in such terrible pain. My entire chest was throbbing and I was grunting with each breath.

While crashing does not seem like a lucky thing, I was lucky in many respects. I had hit my head but my helmet did it's job and I did not have a headache at all. Also, many of the competitors stopped to help me. Two EMTs, an OR nurse, and a doctor stopped to help me. They were kind enough to pause their races to tend to me. Nurses, doctors, and EMTs are always on call really. If there is trouble, they jump in and help.

The nurse held my head to prevent damage to my spine. She was very concerned that I might have a spinal injury. She was able to calm me down and looked into my eyes and smiled. I remember her race number which was on her helmet. They removed my helmet and rolled me onto my back very carefully. Despite their professionalism and expertise, I moaned in pain when they moved me. They cut off my jersey and removed my heart rate monitor which did provide some slight relief in my chest. I was in horrible pain. And I was scared too.

After a few minutes, I could hear Meredith's voice. She knelt down beside me and held my hand. I am not sure if she remembers doing this but it was very comforting to have someone I know there with me. I also remember that before the EMTs started tending to me that one person on the scene put his hand on my shoulder and I screamed, "Don't touch me." I remember Meredith scolding him. He meant well but he happened to touch me right on my broken collar bone. Meredith could see the swelling on my shoulder which was immediate. It made the injury look worse than it actually was. It was bad but the bone was not sticking out although it looked like it might have been.

After a while, a policeman came and took over the duty of holding my head in position. I asked that the racers continue. There was nothing they could really do for me. I figured the ambulance would be there shortly. But I was wrong. This particular part of the course was probably the absolute worst place to crash. It was a two lane out and back with no shoulder and thousands of bikes on both sides of the road. An official EMT did finally arrive. He arrived on the back of the neutral wheel support motorcycle. He did an initial evaluation and put a bandage around my shoulder. He said it was to keep the bone from puncturing my lung which apparently is something that can happen.

The EMT eventually disappeared and I was left lying on the pavement with the policeman holding my head. I laid there in terrible pain for quite some time. Practically naked, I was shivering on the pavement. I had a broken collar bone, several broken ribs, and two punctured lungs. Of course, I did not know that at the time.

All I could do was stare up at the sky. I told the policeman that help needed to get here soon. I was starting to feel really bad. I felt an overwhelming sense of doom. And I thought of my poor brother John. He had suffered horribly in the hospital for more than a week. He was in terrible pain and no one could seem to do anything about it. As I lied there staring up at the blue sky, I pictured those final hours when the nurse put a tube down his nose into his stomach. He instantly started throwing up dark purple liquid. As I lied there, I pictured his face as he looked into my eyes. He was frightened, and bewildered I think. The look on his face said, "no, I am not doing this. I give up." He crashed and an emergency team was scrambled into his room to try to stabilize him. I started to weep. But then the doctors came in and were asking the nurses questions. The nurses did not seem very forthcoming with the answers the doctor needed to try to stabilize John. I stepped up and answered the questions. I had been with him all night and knew how much IV fluids he had had and was able to answer other questions. In a few minutes, they had stabilized him. But he looked bad. John was a fighter. He had been through so many surgeries and had always come through. But now, he looked defeated. They rushed him down to the OR for emergency exploratory surgery to see what was wrong. The anesthesiologist looked pretty worried about putting him under. My brothers and mother told him that they were going to fix him up and we would see him soon. He looked defeated and I don't think he believed us.

I relived all of these memories while I was lying there in great pain. Poor John. It was not fair. His care was terrible, the doctors and nurses nearly incompetent. They did not seem compassionate. They were distant and had no answers. All of this was on my mind as I waited and waited, shivering on the pavement. My eyes welled up with tears as I remembered all of this. The tears were partly from my grief and partly from my pain.

Finally, an ATV arrived and they put me in a neck brace and put me on a back board. Each time they moved me I shouted in pain. At some point on the ride, I suddenly had an emotional shift. I no longer felt the doom. Something had clicked and I decided that it was time to model John's behavior. John was a fighter. John did not complain. John was always polite to everyone. John was my role model.

After the bumpy ATV ride, they transferred me to an ambulance. Again, I moaned when they moved me. The ambulance finally took off with sirens blasting. The EMT put in an IV line and asked me lots of questions. At some point after I told him how much my chest hurt, he did an EEG. I told him I was not having a heart attack but he had to check I suppose. It seemed like a very long ride in the ambulance. But I tried to lighten the mood. I told the EMT that whatever they were paying him, it was not enough. That seemed like a joke John would appreciate. I said thank you and please. They could not give me anything for the pain at this point so I had to suck it up. No pain, no gain Rosen. John used to say that all the time. John was with me in the water earlier that day and he was with me on the pavement and ambulance. His strength, his stoicism, his attitude guided my behavior for the next 48 hours.

I kept telling the people in triage that I had to talk to my wife. I kept thinking about how worried she would be. And that upset me. Again, I was fighting back the tears. Partly due to my pain, partly due to my emotions. I did not want her to worry. It struck me later that this was how John would have felt. He was always concerned about other people's well being. I remember when he was first admitted to the hospital on Good Friday. He was very concerned about his responsibilities as an usher on the upcoming Easter Sunday. Here he was in horrible pain in his head and he was thinking about others. He told my mom to make sure to call the head usher to let him know that John would not be there.

I finally did get to talk to Melissa. It was such a relief. She would be on her way to the hospital and would bring me some clothes, my phone, and other things. I think at this point the doctors had allowed the nurses to give me something for the pain. As I waited and waited and waited, the back of my head started to hurt where the neck brace was biting into my head. I raised my hand up and placed it under the back up my head to relieve the pain. It hit me hard that this is exactly what John did while he was in the hospital. He was constantly trying to relieve the pain in his head with various pillow configurations. Ultimately, his hand behind his head was the only thing that minimally helped. I again felt sad as I remembered my brother's last days in the hospital. Everything about where I was reminded me of his ordeal. Just like in John's case, I pushed the call button and no one came. I yelled out and no one came. Finally 45 minutes later, someone would come. It was very similar to John's experience. However, the nurses and staff at the University of Louisville hospital were nicer, more communicative. They seemed more compassionate.

The combination of the physical and emotional pain I was experiencing from the crash and the memories of my brother's death had really worn me out. Here is what that looked like.

Melissa arrived and snapped the picture above for me. Now that Melissa was there, I started to immediately feel a little better. The pain medicine had started to kick in and I was so relieved that Melissa had made it safely and was now there to be my advocate. For the record, if anyone you know is ever admitted to the hospital, they need an advocate. The hospitals cannot provide the level of care that we need. An advocate is a necessity.

I finally was taken to have my CT scan. Not long after that, the doctors determined I did not have a spinal injury and they were able to remove the neck brace. That was a relief and gets filed in the lucky column. The doctors started me on oxygen to help my body repair the holes in my lungs. I was going to have to stay overnight for observation and to make sure the holes did not get bigger. I am familiar with pneumothorax and really did not want to have to get another chest tube so I was relieved when the doctors told me that the holes would likely heal on their own.

Feeling a bit better but still in a lot of pain

I was finally admitted to a room about 4 in the morning. I was able to doze off a little in the quieter room. I was so hungry though. I had not been allowed to eat or drink anything because of the chance I would need surgery. Surgery was not necessary and I was finally allowed do eat something. It felt good to eat. It had been over 24 hours since I had eaten anything at all.

I kept improving and eventually they released me. Thankfully, my friends were still in town and they were able to help Melissa and I back to RVA. I could not drive and Melissa had not gotten any sleep at all as she sat in the chair next to my bed all night. Here is a picture of her trying to sleep.

So we joined the caravan of Pro K racers. Meredith drove my car and Melissa rode with the others. Honestly, we could not have done it without them.

There are some more details of this story that are worth telling but for now, this account will have to do. I am on the road to recovery now, doing PT, typing, driving, cooking, cleaning and even running. I did my first run this past Saturday. Now I am sore as if I had run 20 miles. I am still not riding my bike or swimming but that will all come sooner or later. For next year I am already signed up for 3 triathlons including Ironman Maryland in October of 2016. I still have a long way to go to get back into shape but I am going in the right directions. And I am lucky. Lucky to have people sacrifice their race goals to stop on the course and help me. Lucky to not have a spinal injury. Lucky to have friends help me make it home. Lucky to have a friend hook me up with an appointment to see the orthopedic surgeon.  Lucky to have a loving family and sense of belonging. Lucky to have my brother as a role model. And most of all lucky to have a loving wife who had to do everything for me for several weeks. I am grateful for everyone. I am thankful for all my many blessings. Happy Thanksgiving everyone!