Sunday, May 18, 2014

When Are You Obligated To Intervene?

There's an interesting video making the rounds, with commentary here.

It's a bit disturbing to watch, but anybody who has watched an endurance event has seen similar situations. Of course one difference is that at amateur events, there's not even a paycheck waiting at the end. Potentially major medical issues are risked with the result of gettign one's name on a webpage of finishers. Even ignoring the all-too-frequent stories of death-by-car on brevets, there are plenty of anecdotes of participants at endurance events suffering severe medical consequences, or even dying.

I've never seen serious issues first-hand, but I've seen plenty that could have been serious. A few that I recall:

  • Years ago I was volunteering at a 1200K (the exact event and participant to remain nameless, of course). One of the entrants was a fellow who had the willpower of Tyler Hamilton but, unfortunately, not the engine to match. From the first day he was hitting the controls right at the cutoff, a sure recipe for disaster on a 1200 where you need to bank time early. After two completely sleepless nights and riding through 100+ degree days he arrived at a control, again at the cutoff, clearly out of his gourd but unwilling to withdraw. I'm not sure what the official obligations of a rando ride organizer are but I think that for various reasons they aren't supposed to "pull" a rider. I'll leave the details a bit murky here, but the organizer had a volunteer feed and re-hydrate the rider while the organizer, shall we say, sabotaged the bicycle to ensure that the rider would opt to drop out of the ride.

  • While volunteering at an ultra event, the rider I was supporting reached a state of complete delirium. The best parallel I can draw is the stage that Jure Robic's team described in Bicycle Dreams, where he was imagining mailboxes as soldiers trying to attack him. In my rider's case, on a course he'd ridden many times before, he simply refused to believe that we were going the right way. Several times he stopped riding, and refused to go further. Despite this, however, he was able to continue riding his bike at a reasonable clip, and he finished the ride without a problem. Interestingly after a short rest after evening, he was more lucid than the rest of us the following morning.

  • Max and I were riding paceline on the BWR 1200K when a mischievous rock found its way in front of Max' front wheel. My recollection of what followed is a series of snapshots. In the first his front wheel is turned nearly 90 degrees sideways. In the second, his front wheel is ejecting from the fork. In the third I'm endo-ing over him. He wound up with a concussion but neither of us had any broken bones. Presumably it would have been possible, though highly unadvisable, for him to continue the ride. I certainly could have, but we both opted to abandon.

In fact, I can think of very few > 600K events where I haven't seen something happen that, on a different day or slightly different circumstance, could have been a medical emergency. This seems utterly insane. There's no glory in these events. You pay a bunch of money to participate, you suffer for a prolonged period of time, and then at the end nobody really cares what you've done but you.

But that aside, more interesting to me is how few of these potential medical issues result in real medical issues. For every story like the first above where the rider clearly needed to be pulled, there are 10 stories of riders who complete a 1200K or longer with single-digit hours of sleep. Yes, at the end they are incoherent. But they finish.

My rider in the ultra event finished safely. On the BWR, despite what could have been a serious mishap Max was, after a few days of rest, fine. If we usually survive weaving down a highway at 20 MPH (OK 14 MPH), sleep deprived, with heavy semi-traffic it makes it apparent how large of a safety buffer we have in our daily routines when we operate on a full night's sleep. Most of the time that we feel like we need to quit an event, it's because we're experiencing mild discomfort, not because there is any real danger.

The appeal of the amateur ultra events is seeing what your limits are, and seeing if you can push your own boundaries. Honestly for anyone in decent physical condition, the events are (far) more mental than physical. We've all seen riders who would be considered obese to the casual observer finish 1200s or marathons.

But what obligation do we have, as volunteers or spectators, when things start to go sideways? Once you start to intervene it's a slippery slope. If your rider is is clearly in dire straits, do you pull him? Or perhaps adopt a more neutral stance and let him decide? What if he's ready to drop; do you encourage him to keep riding? What if you do, and he weaves into oncoming traffic? Any supported event is a team effort, but it's a fine line between the support crew providing needed encouragement or pushing a rider beyond where they should go.

The video at the top is of course a completely different situation. The runner is a professional who, based on his race number is probably quite accomplished. The dangers a professional runner faces in a 2 hour marathon is are completely different than what an amateur endurance cyclist faces in a 2-3 day ultra event. But you can see the same dilemma facing the vounteers. Do you encourage him to keep running (as his agent, allegedly the guy yelling in the video, was doing)? Should the EMTs have pulled him as soon as he was clearly having major issues? It would be a real shame if his collapse had been followed by death, with EMTs jogging alongside him immediately prior.

Since I really don't have a point I'll stop writing. I'm signed up as crew for two ultra events this year, and these are the things that run through my head, at 3 in the morning.


Unknown said...

A thoughtful post.

I've never crewed an ultra event, although I'd like to sometime soon. I've ridden in a few (BWR on 3 hours' sleep, Sebring 24, etc.), but I'm fortunate in that my cycling problems have been of the inevitable "this is the polar opposite of fun" variety.

There was one occasion where I was strongly advised to drop out of an event: Ironman Cozumel 2011, where I suffered a self-inflicted bike wreck that left me on the ground for 15 minutes, largely unable to walk due to my back seizing up, and with road-rash blood streaming from my left shoulder and knee. I managed to convince two sets of volunteers (bike aid station, and second transition area) to let me continue the race, but that became tougher a couple of miles into the run, when I could barely move and needed to stretch my back out with some yoga on the ground. But, because I couldn't bend over to get onto the ground, I found a grassy patch in the median, stuck out my hand, and tipped over. That was the plan, but volunteers noticed, and I was basically manhandled into an ambulance for 20 minutes, where they informed me that my race was done. My position was that I'd had a very fast swim, a very fast bike split (despite the wreck), and therefore I had about 11 hours to walk a marathon, which was possible in virtually any state of consciousness. Ultimately they let me go, after my promising to seek medical attention at the finish line. I'm glad they did, although I can understand how it put them in an awkward spot; I was perfectly lucid, just very banged-up.

Crewing for ultra events has to be tough at times. The competitors they attract are, by definition, almost pathologically driven. The exhaustion and sleep deprivation make it even more difficult for them to assess their situations objectively. On the other hand, they do know their bodies very well, and they'll have faced difficult situations before, and they'll therefore have past experience to draw from in trying to figure out how bad the current situation is.

A couple of years ago, Max and I set off on a legendarily difficult 300k course. (It wasn't a brevet, although we used a brevet route for the ride.) It was my longest ride at the time, and it was a summer day of constant mountain climbing. Because we'd (imprudently) left relatively late in the morning, the last several hours were finished after dark, and they wound up being down the side of a rural highway, where we encountered startling numbers of semis and trucks full of malevolent locals. With about 15 miles to go, and both of us just hoping to survive the experience, Max and I had a confrontation on the side of the road -- his system had shut down dozens of miles back and he thought himself unable to finish, but I had no interest in leaving him on the side of the road for who knows how long as I picked my way to the end, in the dark, on very unsafe roads. If something were to happen to me in that stretch, things could have gotten truly messy. And there was also the principle of the thing, i.e., trying to motivate someone to finish who's obviously in a terrible place, but so close to the line. Ultimately we did both finish, but I'm not sure whether Patricia was happy with me afterward, and I'm not sure whether I did the right thing at the time by giving him a hard time about calling it a day before the end.

Anyway, it's hard to know how to play things, but that's all the more reason to agree in advance on the criteria according to which crew should act. An "endurance sport living will," so to speak. That will of course involve discretion, but presumably the crew members wouldn't have been chosen if their judgment were questioned. (I think there's a reason why spouses often don't accompany athletes as crew members -- civilians often aren't helpful in these situations.)

Max said...

A highly freighted post and a highly freighted response. First, to defend myself: the 300K was 9 days after my Vineman race. So yeah, I was a freaking puddle, and hugely grateful for the assistance, but the dumb part of the thing was deciding to start!

As one who has _no_ difficulty dropping out of an event! I have a hard time understanding the opposite mentality. My view is this: if things go that far south, the shame is my punishment for a lack of preparation.

The observer's and crew's dilemma boils down to "am I my brother's keeper, and how do you 'keep' someone who has specifically opted out of your assistance?" My response is that if you want to kill yourself go for a solo north-to-south Americas ride, or trans-Canada, or whatever. If you want to enter an event you agree to accept the help provided by anybody who wants to interlope. If you are running that means you are at risk of being pulled off the course so long as a volunteer or spectator can run as fast as can you.

sam said...

I'm with Max on the willingness to drop. When things get tough, it generally turns out that I'm not.

And I think that he's right on an individual event. Maybe that's what the question on an ultra event comes down to. Is it an individual event? I suspect that the strongest rider/crew combinations are those in which it's not. Yes, only the riders name gets recorded for posterity and the rider and crew have different responsibilities, but they're equally important.

So ultimately it probably depends on an agreement between rider and crew. The rider needs to be clear about his expectations up front. And the crew needs to be hard-nosed about following through.

But all that said, there still will come a time when the line is fuzzy and the stakes are high.

Unknown said...

I knew there was some complicating factor for the 300k; just couldn't remember what it was. I had a similar catastrophe on a 200k a week or two after Ironman Wales. I'm not sure why I thought that was a good idea -- I'm willing to blame Max -- but I do remember that I had about 45 miles in me that day, and things went south rapidly thereafter.

I think it's no mystery why ultracyclists and long-distance runners structure routes as long loops, rather than as a series of short ones. As with my 600k this past weekend, it's easier to keep going if that's the only way home.

Max said...

Yes, we discussed that parallel at the time. If turning 40 has done anything, it has kept me from starting this year's 400K and 600K under circumstances that might have led to similar results.

Full circle: if one wants to kill oneself, that is one's prerogative (at least in Oregon), but don't burden the rest of us with your decision. And building on the video Sam posted, the linked commentary, and our various experiences related here, I conclude better to pull the plug for somebody (or carry that person on your shoulders -- cf. the 300K Damon references) than to sit idly by.