My Theory of What the Fuck Happened – Guest Blog by Ari

Well, that happened. This is still pretty fucking surreal. I’m still bouncing in Wave 1 Corral 5 with Tom Stark a few feet away in a sea of runners. But it’s three days later. And I’m alive. Somehow.

At about 5:00 on Monday afternoon I woke up in a hospital room. Apparently the first thing I said was “what’s my time?” (3:03:05). But I don’t remember that. Or anything in the previous four hours. The first thing I remember the ICU staff (yup, two days in the ICU) asking was a series of orientation questions. What’s your name? (Nailed it.) Who is the president? (Got that one too.) and What day is it? “It’s Marathon Monday! It’s April 18.”
That, apparently, stayed in my head. Not much else did.
I’ve been reading up on heat stroke and I still can’t be exactly sure of what led to this. I didn’t get enough sleep, jetting cross-country back from officiating a wedding (oh, yeah, if you need a wedding officiant, let me know) just in time to grab a bib number and go to sleep before the race (the flight attendant had run six Bostons, knew all about NP, and kept throwing water at me, I drank five or six bottles). Still going to bed after midnight Pacific Time probably wasn’t good. I’d run seven miles out there in similar-but-warmer conditions—75 and dry and sunny—and felt great. Dumb? Certainly. But I’ve done stupider things and survived (Seven Sisters the day after NFECS relay), so why not this? Monday I was up before my alarm (my body was a little confused) and ready to run. Off to the bag drop, on to the buses and out to Hopkinton.
I was plenty hydrated, too, (this might be TMI, but then again this is NP, so whatever) peeing with a line of runners against a fence (right in front of a cop who didn’t seem to care) and then twice more before the start. Lots of #GrassrootsGear out there (but still, lots of untagged shirts, so plenty of #worldtakeover to go). I started out fast—I’ve been working on running downhills on Summit—and was bobbing and weaving past runners down the first big hill in to Ashland. It didn’t seem that warm, 60s, sure, but dry and a bit breezy, and I was churning out 6:30s like it was my job. With a goal to go sub-3—I missed out by 7 seconds in last year’s rain and windstorm—I was banking plenty of time. I chatted up some NPers, felt good up the firehouse hill thanks to the Newton firemen having a run-through shower at the turn (my advice to BAA: have these every mile) and came through Mile 18 with a bunch of FUCK YEAHs for the crew there. Heartbreak was a bit harder, but I was still holding low-7s, and I got a big cheer from my sister at the Gatorade table at Mile 21.
Oh, drinking. I drank a lot. Not a ton, but a lot. I didn’t want to overhydrate, but I know what dehydration feels like for me in cooler weather—cramps—and I wasn’t cramping so I figured I was fine. It was also cool enough that I though that I was not overheating. I would splash water on myself every mile or so and cool down (this may have been a bad thing per My Theory of What The Fuck Happened—MTWTFH—which I’ll discuss later) and felt okay going in to Brookline. Now, my legs hurt. But I was at mile 22 of a marathon. My feet hurt. But I was at mile 22 of a marathon. My hands were warm holding the gels. But I was at mile 22 of a marathon. I tossed the half-eaten gel I had in my hand and grabbed some more Gatorade on Beacon Street, remember running through Coolidge Corner, and then things get fuzzy. Here’s what I remember:
  • Calculating that I needed to maintain about 7:15 miles to break 3:00 (I went way to hard: 3 minutes slower than last year and 1000 places higher, which would be great if I hadn’t almost fucking died)
  • Trying to push hard, but my legs yelling back
  • Saving a bit for the push over the Turnpike and back from under Mass Ave
  • Very vaguely being on Boylston and seeing the finish
  • Something about someone grabbing me from under the armpit
And then four hours later I woke up in the hospital.
Here’s what happened:
I had decided to run without a shirt. I’m not sure why, but it seemed warm enough, and I figured why deal with extra chafing when you can just run in a pair of short shorts with NO3EMB3R PROJ3CT on the back? I had a ton of sunblock on, so I wasn’t really worried about sunburn (although, still, kind of dumb) and was fine for most of the race.
I also decided to go pretty hard, because I was hydrated, not hungover (I was the self-appointed DD on Saturday night) and it seemed relatively mild: all the literature says that the most dangerous conditions for heat illness involve humidity and while it was around 70˚ the dewpoint was 30˚ which is really dry, so it felt pretty cool. Plus the easterly fetch of the wind meant that it got a bit cooler as we got towards the city (this may have also played a factor in the MTWTFH). We always hear about football players collapsing in 100 degree heat with high humidity. But it was mild and dry. So I wasn’t concerned about the heat. At least not enough. These were all minor decisions, but they all cascaded in a “Swiss Cheese Model” of system failure: a unique set of minor mistakes led to an almost-catastrophic outcome. This is often something discussed in plane crashes and medical care and in my case, a bunch of innocent-enough decisions and circumstances led to a bunch of holes aligned, and, well, catastrophic system failure.
Here’s what I think went wrong with my overheating (the aforementioned MTWTFH, which is completely not grounded in any medical or scientific training), in addition to all the pre-existing factors: At most feeds, I would drink some gatorade, and then throw some water on my body. (At several points, spectators were passing out water bottles and, in the spirit of #BostonStrong runners were passing them amongst each other on the course. Just fucking awesome.) Without a shirt, I was cooling my body quickly, but for very short periods of time. A shirt would have retained moisture, and let me maintain a more constant temperature. Bare-chested, I actually felt cold for short periods of time because with the temperature of the water and the evaporation. It takes a lot of energy to convert water in to water vapor, and this happens quickly when there’s a large difference between the temperature and the dewpoint. (Evaporative cooling is how many houses are kept cool in desert areas, because science, and during exercise, the body can lose as much as 85% of its heat through evaporative cooling.) And on Monday, it was dry, desert-like air.
Without a shirt, I would toss water on myself, and actually feel a little cold. What I think happened—and here is my wild speculation of why this happened to me, and not to anyone else, so #NotScience—is that rather than maintaining a steady temperature around 100 as my body would during a normal run, it actually dropped down a little when I would cool myself. Then my brain would say “oh, shit, cold” and warm the body up when the running would have done that anyway, so it was spiking the temperature up. It was only 65, and the dewpoint was 30, so it was probably right in thinking it was cold. And because we were running in to the wind, it was even more efficient at cooling my body—too efficient. So rather than fluctuating by a couple of tenths of degrees, it was probably fluctuating by a couple of degrees. A wet shirt would have cooled it more slowly and evenly, but I didn’t have a shirt on, so that didn’t happen. This was all well and good as long as I was manually wetting myself (uh, yeah, let’s go with that) every mile, because as the temperature would start spiking up I’d throw some water on myself again.
Until I didn’t. Not that I remember it, but I probably made a decision around mile 24 to say “fuck it” and just run to the finish, because there they’d have ice water and food and I could pee and all sorts of good things. Under normal conditions (more humid, wearing a shirt, etc) my temperature would have steadily increased to the finish, and maybe been at 104—on the verge of heat stroke, but nothing that couldn’t be solved by an ice water dumped over my head and a big swig of Gatorade. However, multiple factors—the temperatures which were high but not so high that I was worried, the low humidity, the (stupid) decision not to wear a shirt, the pushing myself too hard, the recent travel, the not-perfect sleep—compiled and the rate of temperature climb was much higher.
You wouldn’t expect a post from me without a chart, would you? I think I was dealing with something like the red line, while most racers were more in the blue territory. So while my average temperature was about the same, allowing me to run well, skipping one feed at the end spiked my temperature much more quickly, leading me to almost dying, rather than just being hot and thirsty: image
I have no idea if this is the case. I can’t really tell from my Strava and I didn’t wear a heart rate monitor (I probably should have; it would have shown my heart rate spiking with my temperature) so this is all wild speculation. But there’s got to be a reason that I was the only one with this kind of overheating—nearly as high as in 2012, when it was 85˚ and the highest admitted temperature was 110˚!—on a relatively benign day.
So where does that get us? Oh, yeah, 1:05 on Monday. This is all from video and hearsay—I was out for four hours. 200 feet—99.9% of the way to the finish!—I stumbled, but before I could put more than a hand on the pavement, two strangers grabbed my shoulders and keep me upright as the neurons in my brain get so scrambled my legs can’t keep me upright. They hustle me to the finish line—only a few seconds away—where the marathon med team grabs me and puts me in to a wheel chair. They take my temperature: 108.8. Heat stroke begins at 104. More than a few minutes over 108 is major organ failure if not certain death. In to the ice bath. The goal of the ice bath is not finesse; it is to cool the body as quickly as possible. And being a scrawny dude, I cooled pretty quickly. So when I came out I was down to 84˚. Hyperthermia to hypothermia in minutes. Two PRs I never, ever want to break. On the other hand, I’ve experienced two body temperature extremes in 20 minutes most people won’t in a lifetime.
At least it was in the best place to have this happen in the entire fucking world. Then it was in to an ambulance and off to Tufts Medical, less than a mile away, where they are prepared for marathon-related illnesses every April. Apparently I was in to the ER there very hypothermic: they were carefully warming me (unlike cooling, in warming accuracy is as important as speed since warming too fast can cause airway and especially cardiac issues) and I just barely avoided being intubated. When I came to, I was on to the ICU under a bunch of blankets, with my freaked out family (“Hi, this is the Boston Marathon, your son may be dead, how quickly can you get to the finish line BTW all the roads are closed.”) there and several doctors and I was wondering where I was and why I was there.
Oh, and at 1:07, Meb had Tweeted a picture of me. The Globe ran an article. I had gone viral. And I was damn near dead.
But then things got better. I recovered well. Being in the hospital sucks. Being in the ICU really sucks. Blood draws every two hours (I still don’t like needles, but I’m used to them). Automatic blood pressure tests every hour. Nine separate tubes and wires attached to your body. Scrapes and bruises from the ice bath. Achy legs because, you know, marathon. Swelling. Doctors telling you all sorts of things. I had rhabdomyolysis: my muscles broke down and the toxins were being carried through my blood and kidneys, hence the IV and catheter to flush my system (no organ damage, apparently—luck and medicine).
But there were two mitigating factors. One was that once I started recovering, I recovered really well. Modern medicine, and the people who practice it, are fucking amazing. Still, apparently sometimes people spend weeks in the hospital after something like this; I was out in less than three days. A few cheeky anecdotes from an otherwise not-that-fun couple of days:
  • The first night I asked a nurse if it was a problem that my heart rate was elevated—in the 80s at rest, where it’s usually in the 50s—and she laughed and said “oh don’t worry you have by far the lowest heart rate on the unit.” Well, shit, I was on a unit for very sick people.
  • The next night I was saying that the beds weren’t all that comfortable. Someone on staff said that no one else had complained about the beds. Why not? “You’re the only one here not sedated.” Well, shit, I was really on a unit for very sick people.
  • When I was moved to the regular unit, I asked one of the nurses how much IV saline I’d had. She ran the numbers and came back: 16 liters. Four gallons. In two days. And, I drank a lot of ginger ale, too.
  • I asked the attending if I could get special dispensation to sneak out on Tuesday night to go to the BSO for the Mahler (#hugenerd). He chuckled, asked what they were playing (the 9th) and then, to translate from doctor to English “what are you out of your mind?” Also, I had almost died a day before.
In the mean time, the press was reaching out. The Globe called. So did Runner’s World (I mean, we can’t all   be on the cover, although I did make the front page of the Globe). And the Philadelphia Inquirer (one of the guys who grabbed me is from Philly—he’ll be recruited). The next day the hospital PR guy asked if I was willing to do an interview with the press—sure, I had nothing better to do—and four hours later the Globe and Channels 4, 5, 7 and 25 were there. A fucking press conference. My only regret: there wasn’t enough time to get my johnny gown tagged. That would have made for tremendous television. Although getting to meet the ER doc and nurse (yes, hugs) who saved me there was pretty damn good on its own.
The second mitigating factor? All of you. I got on the social medias to let people know that I was okay—or at least on the mend—and there was such a fucking outpouring of support I can’t even describe it. When I got home I had hundreds and hundreds of unread messages to rummage through, most of them Facebook and Twitter notifications. Every time I picked up my phone the screen was scrolling with everyone wishing me a speedy recovery. Thank you for your calls, your messages, your wishes and prayers. The two guys who picked me up off the street? That’s the spirit of the Boston Marathon. I said on the news—and I believe it—that damn near everyone in that race would have done the same thing. That’s what #BostonStrong is all about. And while they don’t know it, that’s what November Project is all about.
My family fucking rocks, too. My sister using her volunteer credentials to waltz in to the finish and get my drop bag (with little things in it like my ID and keys) and then going to my house and finding my phone and clothes and bringing them to me. And my parents for spending way too much time in a hospital, giving me way too much ginger ale, and getting pho from down the street when another hospital meal sounded not-that-exciting. (In retrospect, it was a little rich, but carbs, water and salt, so not too bad.) Oh, yeah, and from time to time they #justshowup, too. They’re pretty great. And I scared the fuck out of them.
There’s a reason this was the viral, feel-good story of the marathon. Well, a couple. One, I survived. If I’d died—and it was touch-and-go there for a while, they tell me—this post wouldn’t be quite as cheery. Also, I wouldn’t be writing it. And two, there was no fucking bombing. There were no people with limbs blown off. No fucking eight year old kid with his life ahead of him killed because—well, who the fuck knows why. There was no lockdown, no shutdown, no cancellation of Friday hills. When the story is about people coming together and the outcome is good, well, yeah, that’s a feel-good story. We can—excuse the term—run with that. And it’s not about me. It’s about Jim and Mitch (who just did what we all do—what I did a month ago at ES20—but shit they damn well may have saved my life), the Marathon med team (definitely saved my life), Boston EMS (saved my life), and the fucking terrific staff at Tufts Medical Center (saved my life—and had I been routed anywhere else, I’m sure that it would have been just as good). And my biological family and my extended NP family and everyone else volunteering and cheering and running.
All of you. All of fucking you.
I actually didn’t say “hey guys, y’all come visit me, here’s where I am, here are the hours” because I was pretty sure you’d overrun the hospital. We could barely get four news cameras in that hospital room. I smelled like holy hell, had a big bag of pee hanging off my bed, and continue to be overtired, and it would have overwhelmed me and the staff. Also, hugs? Yeah, not so easy with all the tubes and wires. I can’t wait to see you all. Maybe next week. Not dropping a #verbal until I’m recovered. But soon.
In other words, I survived this shit. I can now say #FuckYeah.
A few more things:
  • To those of you in the tribe who work in the medical field: you fucking rock. From techs to attendings—everyone I dealt with was amazing. And all of you doing medical research (I hear that’s a thing here in Boston): keep it up. Modern medicine is intense. I almost died. Twice. And here I am, lying on a couch, with a sore fucking throat and some swelling in my feet, three days later. I want to hug all of you.
  • Buy insurance if you don’t have it. I don’t know what it cost for my hospital stay, but the deductible is manageable. If you are sleeping in to 7 and sitting on your ass every day, then maybe you don’t need insurance now (but damn, you need it later, and we all pay for it). But if you #justshowup to NP and run track workouts and #BBR and #NFECS and all, you never know when this kind of shit is going to happen. I may sound like an Obama-esque shill, but get yourself covered.
  • Respect the heat. I should know this. You know how I show up to stadiums on Wednesdays with a huge fucking water bottle? In the spring, summer and fall—if it’s over 60 degrees or so—that puppy is in the freezer the night before and I run with a bottle of ice (if it’s cool, half ice, topped off in the morning, in the summer, straight ice). It doesn’t have to be 85 and humid to kill you. I learned that the hard way. You don’t have to. You don’t want to. I don’t want you to. So, yeah, water. It’s good. Don’t overheat.
Anyway, I’m home now. I need a metric fuck ton of sleep. I’m guzzling water and I kind of feel like shit, but that’s kind of how I should have felt on Monday afternoon. It’s Thursday. So only three days. But I’m alive. I came close to the brink, but I looked death in the eye and said “fuck that” (and, yeah, I had a little help from a lot of people). Keep running those hills for me, and those stairs for me, and whatever the fuck it is we do on Monday for me, and I’ll see you all soon. With more fucking hugs than you can even imagine.
  • We are glad you’re here.  We say it a lot.  And we mean it every single time.  Let’s not take a single day, workout, hug or FuckYeah for granted.  #TheTribeIsStrong.
  • #HillsForBreakfast were so tasty this morning.  They had extra spice with some cross country and a Town of Brookline Recycling Bin hurdle in there too.  Record your reps, yo.  Tracker is live.
  • MONDAY Destination Deck is in Prospect Hill Park, Somerville.  Be there at 6:29AM.  RUN your ass there, hug, sweat, kick ass, and run your ass home.  See you there.
  • The North Face Endurance Challenge Series NY (Bear Mountain) #ESCNY is a mere week away.  If you’re not registered yet, just decide to go.  Get a team and show up.  It’ll be the only ECS race between now and #NPSummit4.0 in July.  Get all the ECS race info here.  Fucking show up.
  • #WeekendEarned
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