A couple of weeks ago, I did a metric Ironman and was really pleased with my fitness. I thought that things were looking really good for race day on July 20th. I then took an easy week, and at the end of this easy week, had a couple of sessions of sports massage on the Saturday and Sunday. The week that has just passed was supposed to be my final tough week of training, before a 2-week taper prior to race day. Everything was looking good, and I had put so much effort in - training-wise, I hadn't missed a single session, I had been really consistent, and I had also put huge effort into controlling everything else, in an effort not to get sick or injured. So I felt that I was in great shape and ready for a really good performance at Ironman UK.
The day after this massage, my legs felt great. Or rather, my leg muscles felt great. They felt light and fresh and strong, in a way that they haven't done for a very long time. Because of all the training I do, and because I don't really get anywhere near the amount of sports massage that I should, my legs are usually very tight, but they had been well loosened out by the sports massage.
My leg muscles felt great, but my legs themselves (or rather the skin on my legs) didn't feel so great. During Monday, the skin on my legs gradually worsened, on the fronts, backs and insides of my thighs, and on the backs of my lower legs.
Monday morning...
Tuesday morning...
It was obvious that the hair follicles had become irritated and sore, but I put some E45 cream on my legs and went to bed at 7:30pm on Monday night, thinking that a good long sleep would help things. I didn't sleep a single wink on Monday night. My legs got worse and worse, and because very painful. I developed an excruciating headache that left me curled up in a ball, in agony. I started alternating between hot sweats and cold shivers. My bed ended up soaking wet with the sweat.
However, the athlete mentality is to shrug problems off and get on with things, so I carried on. As it turned out, I was on a course at Westminster on the Tuesday and Wednesday. I got through Tuesday, although I was struggling. Any pressure or touch on my legs was very sore, and wearing trousers meant that there was constantly pressure and pain. I got home from work, having snapped at an arsey taxi driver, and continued to carry on as normal. I got on the turbo trainer and did an hour, but I kept it easier than normal.
By Tuesday evening, my legs were tuning septic and the skin was going yellow. They looked like this:
Disgusting
I had another terrible night on Tuesday night, and started to think that I might have serious problems that weren't going to resolve themselves in a few days. After my course had finished on Wednesday afternoon, I went to a local pharmacy and showed them the photographs. The head pharmacist said I should go to the doctors' surgery around the corner and request an emergency appointment. I said that I wasn't registered with that particular surgery, but the pharmacist assured me that I would be able to get an emergency appointment.
So I stood in a queue in the doctor's surgery, listening to people in the waiting room coughing and spluttering. It's the last place I wanted to be, even for 5 minutes. It turned out that they wouldn't give me an emergency appointment, but they suggested I go to St Thomas's, the nearest hospital, to the Accident & Emergency (A&E) reception.
I knew I needed answers, but I also knew that I had training planned for this evening, I was hungry and thirsty, and didn't want my routine to be disrupted. I knew that A&E waiting times can be hours and hours. I needed sleep, and didn't want to be getting home at 2am, having missed the last train and been forced to pay a fortune for a taxi.
Anyway, I went to A&E and explained myself. It took about 3 hours to see a doctor, which was better than I thought. I still hadn't eaten, and I had resigned myself to not training this evening. The A&E doctor was a no-nonsense Spanish or Portuguese girl, not much older than me. I started off by explaining about my Ironman training, and upcoming event in less than 3 weeks, and that I was aspiring to compete at the sharp end of this race and qualify for the world championships. She seemed to understand my mentality.
She looked at my legs. "Oh my God", she said. Not exactly reassuring. I told her about my other symptoms - the sweating, the shivers, the sore heads. I was shivering now and had to put my coat on, despite it being the warmest day of the year. She did some quick tests, and established that I had got a temperature, although she said that my heart rate seemed normal. It was 75bpm. I almost laughed. I told her my resting heart rate is usually about 40bpm.
She said that I needed treating as soon as possible. She asked me how I would feel about staying in hospital for a course of IV antibiotics. I was still clinging to a faint hope that this wouldn't be so bad, that it wasn't going to compromise my Ironman, that she could give me a pill or two and send me on my way.
And now she's asking me how I feel about them shoving an IV line into my veins, and pumping me full of drugs, sticking needles into me and taking blood, and she's asking me would I like to stay in hospital for a few nights with people who are truly sick, and give up control of my sleeping and diet, everything that I've worked so hard for.
How do I feel about all this? "No, I'd really rather not do that if possible..." is what I say. But in truth, the prospect is appalling. Horrific. No way do I want to stay in hospital. I've never been in hospital in my life. I can't bear even having my blood pressure taken. A hospital stay? Less than 3 weeks before the biggest day of my life? No way. I ask about the alternatives. Can she not just give me a course of oral antibiotics and send me on my way? What if I do nothing, how long will it take me to recover?
She tells me that doing nothing isn't a viable option. In her opinion, oral antibiotics aren't a viable option either. She advises me again that in her opinion the best thing is to stay in hospital and have the IV antibiotics. She can see that I really, really, really don't want to do this. I think she understood the training mentality, and could see that I'd worked hard to get fit. I'd stood half-naked in front of her, and I know that I look lean and fit. Veins bulging everywhere. No fat anywhere. Muscles bulging out. Bones protruding everywhere. She knows by looking at me, and from what I've said, that I am a pretty serious triathlete, and she seems to understand that the upcoming race is a big deal for me.
She is also a medical professional, she knows what I need, and she can see that small talk isn't going to work. So, the head-in-hands moment arrives. Similar to Ironman UK last year, when I had just puked and crapped uncontrollably at mile 16 of the marathon when leading my age group, and when I flopped down, tried to get up, couldn't, and sat with my head in my hands. Similar also to Ironman Wales last year where I didn't pace well and couldn't summon more than 17mph in the later stages of the bike, on the flat. The horrible realisation that what you've worked so hard for, for so long, is falling apart and there's nothing you can do.
So, she got a bit tough. "Fucking hell man, this is serious shit. You've got serious problems, you have a serious infection that I think has developed into septicaemia and you need treatment NOW. You need to stay in hospital and have IV antibiotics to hit this hard. You are an intelligent man. If you choose to walk out of here, I think you might die. You have what you need to make your decision. Please make your decision." (I learned that hospital staff can only recommend treatment, patients must agree to it, and they can choose to disagree or walk away).
Head in hands. Blood drains away. Shit, there's no way out of this. Septicaemia? I don't want to die. Bloody hell. Dead silence. Finally I relented: "OK, do what you have to do."
She got straight on the phone, rattling off my condition and diagnosis, and what she thought I'd need treatment-wise. None of it sounded good. She also stressed to whoever she was talking to that I have "hospital phobia". I'm sitting in the corner, falling apart. And shivering even worse. I got taken to a temporary ward, and had blood taken for analysis. By this stage it was getting late, and when asked, they tell me that the blood results may not be back until tomorrow morning. Great, so I have all night to worry about what is actually going on.
Then they put the IV line in. It goes in my right arm, where my forearm meets my upper arm. It feels and looks horrible. This hideous thing sprouting from my arm. I can't look at it. I can't bend my right arm. Then they wheel over an IV pole, and bring the drugs. It's exactly 10pm. I have to grit my teeth and bear it and let them do what they have to do. First they flush out the IV line with saline. It feels terrible. A horrible unnatural cold, spreading up inside my arm. They hang a bottle of paracetamol from the pole and it drips into me. It takes 20 minutes. Then they flush the line again, and bring a syringe full of antibiotics. In they go, too. Then they flush the line again, close the port, and it's finished. For now. It's now 10:30pm.
Urghhhhh
It's after midnight before they bring me to my ward for the night. The emergency care short stay ward. They try to wheel me up in a chair. I'm not having that, I'm fine. So I walk. I get admitted, I get my bed in a little 4-bed bay on he 9th floor, overlooking Big Ben and the Thames. It's not a bad view. I do more blood tests, more admin, and they ask me if I need anything. I haven't eaten for ages and ages. I ask for some food. "What would you like?" "As much as you can bring me..." They say it's late and there might not be much left, but they'll try.
Some watery chicken soup and white bread corned beef sandwiches arrive. It doesn't look very appealing, or nutritious, nor does it look a lot. I wouldn't ever choose to eat this. I like my pasta, sweet potatoes, cabbage, broccoli, chicken breasts, peppers, onions, ginger, garlic, chillis etc. And I like big quantities of it. But, I've no choice and so I eat it. Now it's after 1am and I have no idea what I'm supposed to do. I ask the nurse if I can go to bed, and she says yes of course. But she also says that I might not sleep much. I have already established this. Not only am I in hospital, and I can't put any pressure on my legs (so lying down is impossible without pain), I'm stressed, and pissed off if truth be told, it's also noisy, and not very dark.
But there is worse in terms of the sleep deprivation. In my bay of 4 beds, there is one other guy. He's a mental patient, and he cannot keep quiet. He talks to himself, loudly, incessantly, incoherently. Sometimes in English, sometimes in another language. Sometimes he swears. He has a carer with him who is independent of the hospital, but she can't control him. He's agitated, and frequently gets up out of bed, tries to pull his IV line out, and walks around. I pull the curtains around my bed and try to make the best of it.
At about 3am, he swipes open the curtains around my bed, and stands over me, swearing. It's very intimidating, and I'm stressed enough as it is. This is too far. Too much. I shout at him to get away. The nurses come. I end up getting moved to another sub-bay.
Morning comes. I have more IV drugs, and breakfast. The other two in my sub-bay are foreign and don't talk much. One has a tube coming out of his chest, running into a sealed bucket of blood that they are draining off. Nice. I gather that this is because he smokes. Later in the day, someone smokes in the toilets. No-one can prove it was him. The other guy has a stomach ulcer. Later that day, they bring in an old guy who has fallen over. Scans and analysis reveal he has prostate and bone cancer. He probably doesn't have long to live. This helps to give me a sense of perspective. I may not get to compete in my Ironman in 2 weeks, but I'm not dying. This also makes me question why I continue to subject myself to breathing London's disgustingly polluted air. I don't want lung cancer, or any other disease, and living in London certainly doesn't decrease one's chances. I won't be here forever. It's short term now. I've been 2 and a half years here. Hopefully no more than a year left.
I start to learn that there's a routine to hospital life. You get your treatments, you talk to your nurses, you get your meals, you go and wash, and by and large you are left to your own devices to pass the time as best you can. I was totally unprepared for hospital, all I have is Chrissie Wellington's book, which I soon finish. She was on antibiotics until a few days before her final Kona triumph, having crashed her bike 2 weeks before the race and developed a leg infection. I take some comfort from that. I got in touch with work to let them know I wouldn't be in. I've never missed a day of work, or university, or school, and I was disappointed to break this.
I didn't have any clean underwear, so I was given plastic disposable Y-fronts and socks. I had nothing else to do. My phone had died and they couldn't find a charger. Someone gave me a newspaper and I polished off the easy, intermediate and tough Sudoku puzzles in a single sitting. I went down to the hospital shop. I wandered around the hospital. It was boring.
I spoke to the doctor later that day. He had my blood results. Thankfully, I didn't have septicaemia, but I did have a very bad infection and I was lucky that I had got treatment when I had. Another couple of days without treatment could have had far worse consequences. He said I needed to stay in hospital another night, and continue with the IV treatment. He took more blood, to see how I had responded to the treatment so far. He came back later in the day and was pleased with the results. Admittedly, I did feel better in that I wasn't sweating or shivering any more, but my legs were worse again. Horrible green pustules all over my legs were oozing pus and blood, the legs were red, swollen and angry, and very painful with any kind of touch or pressure. The worst parts were the backs of my thighs.
And so it went on. Treatment, eating, and killing time. There were TV units above each bed that looked expensive. You had to pay to use them. No-one was using them. Despite a fortune obviously having been spent on these TV/internet machines, the blood pressure machines were ancient and didn't work properly. It took four tries on one occasion to get my blood pressure reading. I can't help but think instead of fancy unused TVs, better blood pressure machines would be more useful in a hospital.
Night came. I actually managed to get some sleep this time, although fitful and interrupted. I think I was just so tired that it would have been impossible not to sleep. Morning came and I had my 6am treatment. They told me that I might get out of hospital later that day. They took more blood. I managed to borrow a phone charger. The doctor came round that afternoon and again my blood results were showing that the internal infection was subsiding, even though my legs still looked horrendous. We went through a few questions I had, medically and with regard to Ironman. Medically, my questions were answered. I just needed to give everything time and rest, and to keep taking oral antibiotics for another week. My legs would clear in time. My infection was already clearing. I no longer felt ill, although I was very tired and very hungry.
My discharge notes officially stated that "John has been advised that participation in the Ironman event in 2 weeks is not advised." Unofficially, they told me I can see how I feel, and speak to a doctor before the race. So they haven't completely forbidden me from taking part, but they have told me that if I do, my performance will be compromised.
I was released from hospital that evening, and I have to say that I was really well cared for. I've spent the weekend trying to rest as much as possible. It's so frustrating. So gutting. I want to get on and get back in training, but I know I can't. I know I have to rest. I know that no matter how well I recover, my performance will be compromised in the race. 1% of my race time is about 5 minutes. If I'm even a few percent down, I'm going to lose 10-15 minutes. I can't afford to lose that time. I'm not interested in destroying myself to come 10th. I had set out to qualify for Kona and try to win my age group, and in doing so I would have been one of the top non-pro finishers, if not the top non-pro finisher.
More than anything, I wanted to finish the race and say "That was as good as it possibly could have been." If I was able to say that, it probably would have been good enough for Kona and there's no reason to think I wouldn't have placed really highly overall. Regardless of how well the next 2 weeks go, I won't be able to say that.
On the other hand, the body is capable of amazing things and I might get to race and I might yet qualify for Kona. It's just frustrating being in this limbo situation right now, not really knowing. I'll make some enquiries about seeing a proper sports doctor next week and getting a good opinion.
And the big question, why on earth did this all happen? Where the infecting bacteria came from is open to debate. The doctor said that the most likely scenario was that the massage oil or the masseur's hands were probably infected. There are natural bacteria on the skin. Maybe my trousers or bed were harbouring bacteria that got in through the irritated hair follicles. I don't know. It should never have happened. A sports massage shouldn't be life-threatening.
My really high level of fitness meant that my immune system is weak and on a knife-edge, leaving me less able to fight off infections. Waiting 3 days before getting treatment didn't help. Also, having such a sports massage is stressful on the body because it releases muscle toxins into the system, to be processed and removed, and this would have put an additional strain on my body. Maybe I sat beside or talked with someone with a bug on the train or at work. Maybe I didn't wash my hands properly. An unfortunate combination of things might have conspired and caused the problem. It should never have happened. But it has happened, and these are the cards I have been dealt, and I'll deal with them as best I can and hope that I can still compete strongly on July 20th.
Urgh.
