The Pause

On Friday, April 11th, I ate shit off my bicycle. I hit a speed bump awkwardly a launched myself over my left handlebars onto my head, shoulder and trunk. I busted up my bike, mangled my body, and messed up my entire LA roll-out. I had to hit pause on everything. No training. No improv. No finding a new job.

⏸️

PREFACE

I assume most of you have read my race reports with two letter grades. One for the race performance and another for the overall experience.

Not the day I crashed.

This is different. I'm telling you right now, I am an unreliable narrator. I glossed over some key facts and imagined some important plot points. Like a crappy journalist, I just made some stuff up that fit the bits and pieces that I'd gathered from family afterwards.

If it was a race report, I'd give myself an F- and everybody else an A+.

Why the F-?

Guilt and dismay at putting loved ones through the emotional wringer. Not that I was careless or irresponsible. Accidents happen. It's just that as a grown ass man, it's difficult to accept that I made a mess that others had to clean up. Gross.

Why the A+?

My people handled the chaos, and I came out pretty clean. No property lost or stolen, no permanent damage, no loss of limbs. I'm so grateful that I have so many good friends and family that I came out of this with little more than a few cool scars.

ON THE BIKE

I like doing triathlons. On that Friday I went looking for a safe place for bike training. Anyplace where there might be other cyclists and not too many traffic lights or vehicles.

I got on the bike around noon. I rode on streets with bike lanes and followed traffic laws. I wasn't training or riding aggressively. Google Maps showed Sepulveda Park Basin was nearby so that was my destination. I remember cutting though a large parking lot onto a wide, bus-only throughfare. No cars or buses on a section behind a big white building.

At this point in the spacetime continuum I went offline. Blackness. Oblivion.

Somehow, I called Susan. With a few edits for brevity, here's what Susan told me I said.

"Hey. Where are you?" I said.

"In my office," she said.

"Which one?"

She said, "Uh. Chicago."

"Oh," said I, "I think I fell off my bike."

"Are you okay?"

Some stuff in here about me thinking I fell off my bike and that an unhoused person saw me on the pavement. Susan told me to hang up and call 911.

Some time passes. Not much, Susan says, before I called her again and repeated almost the exact same thing.

"Hey. Where are you?" I said. Again.

"Are you okay?" she said. This is when she said she started to worry.

"Oh," said I, "I think I fell off my bike." Again.

"Listen. Did you call 911?"

An unhoused person named Lanza Zelaya, Zabdy says, "Yes, he called 911. I'm going to stay with him until they come. I saw him on the ground, so I came over." We don't know what happened to Zabdy, but we have been trying to track them down to thank them. No luck so far.

Susan tells me we just kept the line open with the phone on speaker. Over the phone Susan hears a Los Angeles City EMT siren, and its's not long before she hears them doing their job. They start asking me questions.

"What's your name?"

"Greg."

"What year is it Greg?"

"2021"

Beat. "Try again."

"2022...2023..."

"Nope. I'm just going to tell you. It's 2025."

Susan says I laughed.

"Do you know who the president is?"

Susan says I said, "Trump." with a real tone.

Susan says she heard the EMTs explain that they are going to immobilize my neck. She heard them complete their assessment and get me into their rig. As they do this, she hears me making painful sounds, swearing and apologizing, swearing and apologizing. Somebody asks if I want to call anybody. I say I’m on the phone with my wife. She told me to hand it to one of the EMTs.

Susan says, "Do you see his bike?"

"Yes," the EMT says.

"Get it."

"What? I mean, it's kind of big."

"No, it isn't." she says. "Get it."

And. HE. DID!

This brief exchange between my wife in Chicago and an EMT in LA is big part of the F-/A+ grades. Why? First, while securing my bike was clearly NOT HIS JOB, Susan employed a Jedi mind trick via iPhone to get a professional first-responder to take my bike along with us to the ER.

My inner cynic thinks Susan knew my Cervelo Soloist (with e-shifters and carbon wheelset) was very expensive and that replacing it would be even more very expensive. My inner romantic chooses to believe that she knew how much I loved that bike.

Susan got a few more details from EMTs, hung up, called Tami and Veronica and

left her Chicago office to get directly on the next flight to LAX.

OFF AND ON THE ASTRAL PLANE

I started coming back online... in a big white room with my daughter Veronica (A+) next to me and a woman in scrubs asking me questions from the foot of the bed I was in. There was a lot of background noise. Hard to focus. I had the impression of three people:

1. My daughter Veronica (A+) next to the bed. Maybe she was sitting.

2. A woman in scrubs. I want to say they were green.

3. A large blonde man in a white coat.

Next "memory" was that I was in the Northridge Hospital Trauma Center, which felt and sounded like chaos.

Next "memory" was I had broken two or three ribs. I'd broken my left clavicle, which was not displaced. I was told I had a concussion. I had a small pneumothorax.

At some point the blond guy in the white coat identified himself as a doctor and that he was not recommending surgery for the clavicle. At some point the woman in green scrubs told me that they were concerned about the pneumothorax, which is a puncture in my lung where air can escape into the chest. Getting air between the lungs and the thin lining in the chest is very bad. Something to do with the physics of air pressure in the trunk and abdomen.

These bits and pieces of information were definitely explained to me more than twice.

Some more time passed as I lay there rebooting.

Next "memory" was when Veronica (A+) said that Susan (A+) was flying back from Chicago, I said something like, "She doesn't have to do that! No, it's okay. Tell her not to come." I was crying big salty tears over the fact that she would miss her meetings. Yes, I felt and thought that Susan’s meetings were more important than my trip to the Northridge Hospital Trauma Center. Veronica (A+) said it's too late, and that Susan (A+) was already on the plane.

I also remember seeing something else in Veronica's face. Panic? Reflecting on this later, I realized she was in the impossible position of having her father (Freud says her first male role model) suddenly and dramatically acting absolutely untethered to reality. And Veronica still kept it together. A+

Next "memory" was a woman in different scrubs (I want to say purple) explaining to my daughter that mood swings are consistent with a concussion and crying is part of it. Somehow that helped me stop feeling so bad about Susan (A+) missing her meetings.

Here are the bulk of the chaos that A+ friends and family handled while I was rebooting:

• Tami explaining to Susan over the phone that she would get to Northridge Hospital in about an hour but that LA traffic being what it is, my daughter Veronica would get there quicker, and Susan should call her. A+

• My son-in-law Brady staying calm and collected as he drove an anxious and downwardly spiraling Veronica to the hospital. A+

• My daughter and son-in-law planning how to deploy and communicate as they parked. Hospital policy only allows one family member into the trauma ward. A+

• Veronica finding me and dealing with hospital administration. A+

• Veronica putting hospital administration on the phone with insurance to correct the computer mistake that our insurance was inactive. It was and is, in fact, active. A+

• Veronica asking hospital Security to find my bike, please. A+

• My son-in-law Brady overhearing the hospital Security staff discussing "somebody's bike is in the entryway." I imagine him saying, "Yup. That's the bike I've been looking for," and putting it in his car. A+

Next "memory" was getting what I call the nurse's Empathetic Scold look when patients say unhinged things like, "Oh I'm okay. When can I go home?" She gave my daughter the We-Must-Be-Patient-Mustn't-We look before, "No. No. That's not happening," she says, "We are just waiting on a room to admit you."

Next "memory" was being helped from a gurney into a bed in a small upstairs room.

I could have sworn that Susan was there. She was not.

Transport, aka "Super Nice Slow Support." I remember a smiley, ageless man with light brown skin helped me into bed. I also remember how much it hurt.

It hurt so bad, I kept wondering how they didn’t know how many ribs I’d broken. I kept thinking something like, "Two or three? Feels like all of them. How many ribs do I have? How do they not know whether it's two or three?"

I was plugged into monitors. Nurses came in and left. I slept. Nurses woke me up to check stuff. Somewhere during this super fantastic Friday fun times party, a portable x-ray made an appearance, and I may have had another CT scan. Peed in a plastic bottle. Turns out my bed has an alarm to let the nurses know if I've gotten out of bed.

Which I apparently tried to do a few times, despite the pain.

Tami showed up with a bag of snacks and beverages for Susan. Tami and Veronica left. I remember being overwhelmingly sad and telling Susan, "I really made a mess of things, didn't I?" She said something kind to me.

CORRECTIONS PROVIDED BY SUSAN:

Everything after "...helped from a gurney into a bed in a small upstairs room." is WAY off. I was transferred into my room around four-thirty. Tami never came into the hospital. She very thoughtfully bought drinks and snacks for Susan. Veronica and Brady left to eat when Susan arrived around seven Friday night. A+ A+ A+ and one F-

IN BED

Friday night and all-day Saturday was spent shifting around the bed, rating pain on scale of 1-10, discussing and adjusting meds...sitting up with and without help. Meeting some very capable and very positive young Physical Therapists. Healing, I guess.

Turns out, to the staff, I was just another routine "non-vehicle related bicycle trauma" case. Routine is a good thing for everybody concerned. Being nothing special means we don't need specialists to have tough talks about difficult choices.

Somewhere in here I remember thinking about medical procedural shows. The dramas--ER, The Pitt, House--put a spotlight on heightened emotions when this doctor's personality clashes with this patient or that patient's two risky operations. The comedies--Scrubs, St. Denis--tend to be about how our human quirks butt-up against hospital procedures. In the very real Northridge Hospital, the personalities and emotions are constricted and compartmentalized to eliminate drama or comedy. Professionals follow the processes.

If my case were a medical board exam question, it might read:

Active 56yo male with multiple rib fractures, minor pneumothorax, non-displaced broken clavicle and concussion. Patient was found on the ground wearing a helmet, appears to be an experienced cyclist yet cannot explain how accident occurred. If no other factors are indicated, what was the most likely cause of the accident, and how do we treat it?

If my case were on a medical show, there would be some additional backstory

The sharp-eyed doctor or indefatigable nurse or plucky young staffer would discover two major plot points outside of my case history.

1. I'm a fainter. Syncope is the medical term for fainting. Vasovagal is the catchall medical term for describing people who faint for no obvious reason. I have passed out a few times when I've watched technicians take more than one vial of my blood. When I get blood drawn these days, I just say it'd be better if I lie down. Vasovagal, I say. They nod. We all move on with our life.

   
   

   The first time I passed out I was in a business meeting. I was twenty-three. I got all the tests. Bloodwork for diabetes (or something else), neurological panels where I watched flashing lights and light sequences for seizures (or something else), skin and gastrointestinal tests for allergies (or something else). Nothing conclusive has ever been identified and we've all moved on with our life.

   
   

   Thirty years ago, when I had to change my own bandages after a knee surgery in my bathroom, Susan had to catch me when I passed out sitting on the toilet. It was a real bonding moment as my deadweight slowly mushed us both between the toilet and the sink. When I got my IRONMAN tattoo about ten years ago, the tattoo artist had to stop when I briefly went offline. Which brings me to...

   
   

2. I'm a long-course triathlete. During training, my Garmin has tracked my HR as low as 54 bpm. That kind of incredibly low RHR can also increase incidence of Orthostatic Hypotension.

ORTHO = skeleton and/or limbs

STATIC = lacking movement

HYPOTENSION = HYPO (low) + TENSION. = low blood pressure

Orthostatic hypotension just means that if you're lying around too long and get up too fast, you might get lightheaded or even... faint.

Am I oversimplifying vascular response to fluid dynamics and cardiac responsiveness? Maybe. Is the human body a complex interconnection of organic systems? Yes. Can medical vocabulary like syncope and vasovagal and orthostatic hypotension make a common condition sound like a rare and incurable disease? Lord, yes.

I'm telling you all of this to explain why the next thing that happened seemed like much less to me than it was to everybody else working at Northridge Hospital.

⏸️

THE DANGEROUS PAUSE

By Sunday I'm starting to feel 78% back to normal. Head was getting back to baseline after a nurse offered meclizine (active ingredient in Dramamine) to help reduce nausea and dizziness. Felt like myself. Walked around. Used restroom, not the bottles. Ate well. Painkillers reduced from hydrocodone to ibuprofen. There was talk of Monday morning discharge. As I said, I was healing up nicely.

In the afternoon an orderly came to change the sheets, and I was feeling confident. Let’s take a lap around the floor, says I to Susan.

I'm thinking, "I've finished a handful of IRONMANs. I know a woman my age who crashed her bike heading into transition, got right back up and finished the marathon. Walking around a bit after two days of healing? That's a layup."

Susan walks down the hall with me. I feel some dizziness and nausea. We should go back, I say. No problem. We head back to my room, and I sit in the visitor's chair and tell Susan I might pass out. She tells the orderly that if I faint, she won't be able to hold me up. The orderly goes to get help. Procedure.

The edges blurred, everything faded to dark gray and stars. I passed out.

Susan told me that half a dozen people were immediately in the room. One of them says, “Greg!” I came back.

Two people helped me into the bed. A technician rolled in a machine and hooked something up to something.

I have this mental image of everybody in the room checking their procedural boxes, nothing to see here, just another male ego check, just part of my Sunday job routine, doo dee do. Susan said the technician said, "Nine seconds."

Susan said she felt the whole energy of the room change.

I was laying there thinking I've passed out before, doo dee do, no big deal and let's move on with life.

Turns out that what the technician had communicated to the nursing team was that my heart had stopped for nine seconds. At real world Northridge Hospital, that's a code blue. Cardiac arrest.

I think the energy of the room changed because they knew that nine seconds is too long for a man's heart to stop and then restart on its own.

Turns out that big-D Death had slunk into the room while everybody was doing their procedures, took the remote control of my life into his cold hand, and put his bony finger on the pause button. When Big D crashes the party, it changes the whole vibe.

Maybe they knew in that moment that no matter how chipper and optimistic the Physical Therapists were, no matter how crisply the bedlinens are folded and delivered, no matter how quickly and efficiently they ran their procedures, a patient might still just die.

Maybe that's the real reason we like hospital procedural shows, to examine what humans do, despite knowing that Death can crash any party anywhere anytime. Our humanity is somewhere in the work we do and the time we spend on a bike and flying in planes and raising children who find spouses who can help them handle emergencies. Our humanity is in doing the best we can with the time we are given.

I doubt they consciously thought all that. But I imagine the words, "Nine seconds." floating there like a cartoon text bubble that suddenly pops. Because, inexplicably, Death took his finger off the pause button and moved on.

So, the only thing to do is for everybody to continue, to move on. For a code blue, you call the cardiologist.

The Cardiologist Makes the Scene

Take a moment to ponder what it takes for a cardiologist to turn up on a Sunday afternoon, because at the time I really could not grasp what the big deal was.

Back to the medical board question... how do we treat it?

The cardiologist thinking went something like this. "Hmm. This experienced cyclist can't explain how he fell off his bike. Now we have this syncope with a nine second cardiac arrest. I wonder if there were prior arrests that we can identify... well now looky here, HR data since he's been here indicates four slightly shorter, smaller arrests occurring randomly but increasing in duration..."

"Based on this newly learned data," he concludes, "logic indicates that he most likely passed out on the bike. Okay. How do we treat it?"

Physicians are trained to ignore why because trying to answer why quickly becomes abstract philosophy. But they're extremely well trained to identify HOW. And based on HOW, they can recommend science for HOW TO TREAT.

Small sample size.

Now ponder the patience and professionalism he had to maintain as I made the following kinds of juvenile and hair-brained arguments:

• Correlation not causation between the bicycle accident and fainting in the hospital.

• Nine seconds is about the same time as an Olympic 100m.

• For me, it probably only skipped a few beats.

• And it started right back up!

• I do not want to be a pacemaker guy.

• That's too small sample of data. I have moved on with my life for decades.

• I am a triathlete.

• I have never passed out during training or a race.

• I HAVE NEVER PASSED OUT ON A BIKE.

Sunday afternoon was spent arguing WHY NOT against my cardiologist, as he patiently and repeatedly explained HOW TO TREAT a repeat cardiac arrest.

I hate how cool this pacemaker looks.

In calm and I daresay clinical tones, he presented his assessment of the data predicated on his expertise and experience along with his recommendation to placing a pacemaker. He lays out the case to me and my stressed-out, sleep deprived wife that placement of a pacemaker is the best way to all but eliminate the risk of future cardiac arrest.

Monday a pacemaker was inserted through my femoral vein and installed inside the right ventricle of my heart. Wednesday I was discharged from Northridge Hospital. Routine. I've followed up with the clavicle doctor and the heart doctor and a primary care physician, all of whom did their jobs exceedingly well.

I brought the EMTs a gift basket of food. I brought the nursing staff a gift basket, too. Still looking for the unhoused helper! Guardian bros are everywhere.

I guess I'm just a pacemaker guy now. That might be a tad reductive, I know, but I already said I'm an unreliable juvenile with hairbrained ideas.

Epilogue

I love you all and hope nobody ever does to themselves what I did to myself. But if you do, I will gladly:

• bully an EMT into putting your bike in the rig,

• make sure somebody we know finds and secures said bike,

• handle any and all necessary administrative and/or bureaucratic processes,

• facilitate/mediate/reconnect any disconnections between insurance and hospital,

• cover areas of your memory loss (as often as needed),

• advocate for you,

• listen to your babbling complaints before/during/after medical procedures,

• and get you home afterwards.

I have pressed PLAY and gotten on with my life. Stop reading. Go do a triathlon or see an improv show.