To speed or not to speed

Cape Town is pretty. I mean like air-brushed pretty. Pretty like you would see on a postcard, or on the pages of a magazine. You almost forget that you’re in Africa, almost. The faces look like the faces of the people that you know, see meet and greet in the Eastern Cape just a few hours drive away. The accents are the same too… Well no, not quite. Everything in Cape Town the capital of the ‘Republic of the Western Cape’ while being no different to the rest of South Africa (SA), has a certain sterility about it. That is if you look no deeper than the surface. Even the way the service in restaurants is really slow is almost charming…

Anyway it’s really pretty and nowhere in my opinion is it more so than when seen from atop one of the numerous viewpoints on Table Mountain or from any other place that allows you to take in Cape Town along with it’s most famous landmark.

Me. Table Mountain...

Me. Table Mountain…

Late Friday afternoon on Easter weekend Meryl and I were at Signal Hill, one of Cape Town’s better known view points. Signal Hill overlooks the Sea Point area to the East and Cape Town’s Green Point stadium to the North. Roughly in between those two, one can also see Robben Island, the critical piece of South African political history that it is, in the distance. We did the walk from there up to Lion’s Head on one end of Table Mountain. We had first done this little hike in October last year and absolutely loved it. Walking away from Signal hill towards ‘the mountain’ one has a view of the city of Cape Town to the left and on the right beyond Sea Point the ocean with the sun slowly setting. It is the stuff that moments are made of. Beautiful, and well worth doing more than once. Hiking. We were hiking and I was due to run the longest race of my life the next day. “I’m sure you’ll be fine,” my girlfriend said. Sure, this could be like a little warm up…

Meryl and I. Sea Point in the background

Meryl and I. Sea Point in the background

Looking back at Signal Hill. Sea Point on the left, and Cape Town city on the right

Looking back at Signal Hill. Sea Point on the left, and Cape Town city on the right

When I first started running (about 4 years ago) it was all about how fast I could go, I was trying to get my times down with every race I did. My personal best times over 10, 15 and 21.1km are were all done during that first year or so of running. I ran all my races at about 4min 30secs per kilometer. A year or 2 later I ambitioned to run longer races, and my thinking and therefore race strategy was that I should run slower in order to preserve myself over the longer distance. As of March of this year I had run 4 marathons and 2 ultra-marathons using that same race plan, usually giving me finishing time that averaged out to about 6mins/km.

I always crossed the finish line at the end of these long races with a slight but nonetheless distinct feeling of dissatisfaction looking at my finishing time. 4hrs 11mins was my best effort over 42km, and a little over 5 hours for the two 50km races I had done. Over the last little while I have become a little more confident about keeping up a good pace over a long distance. My recent 30km race in Uitenhage and a couple of 32km races also at a good fast pace over the last couple of years has me thinking that it would be ok to forgo the conservative approach for the marathon.

South Africa has two world renowned ultra marathons, the 87km long Comrades Ultra marathon, run from Pietermaritzburg to Durban and vice versa on alternate years and the scenic 56km Two Oceans ultra marathon in Cape Town. The latest edition of the latter was run on Easter Saturday 04 April, and I along with 11 000 other runners was lined up at the starting line on Main Road just outside the University of Cape Town (UCT) at about 6am that morning.

Pre-race zone

Pre-race zone

The starter’s gun went off at 6.30am. I had qualified with a 4hours 38min marathon earlier in the year so I was at the back of that large field.”E doesn’t stand for elite?!” Said Barbara with a mischievous grin on her face. She and I and a handful of others from Crusaders, our running club in Port Elizabeth, were at the back of the large field. More like ‘E’ for everybody, we all laughed. We had a couple of runners further forward in the starting field, in C and D, I think.

Crusaders peeps, from left to right: Mushroom Charles, Christine, Shaun, Barbara, an yours truly

Crusaders peeps, from left to right: Mushroom Charles, Christine, Shaun, Barbara, and yours truly

Starting toward the back of such a big crowd means that one literally walks, or shuffles forward at the beginning of the race as everyone is bunched together initially, and quite frustratingly there is a delay before one actually crosses the start line. As soon as I could I moved myself to the left side of the bunch where I could run a little more freely on the pavement. I made good time in this manner, moving back onto the road a few kilometers into the race when runners were more spread out. ‘Spread out’ is overstating it a little, the sheer number of runners present on that day meant that throughout the 56km there were always many other runners immediately around. I have never run in such a busy congested race before.

Speed in road running is relative. My personal best time over 10km is 42 minutes. The average elite runner might do that kind of pace on a slow run, when they are actively trying to hold back. For a little perspective: runners at that level zip along at approximately 3mins/km, with the best of them able to maintain that pace over 30, 40, 50+ kilometers. Super-human stuff! Also, runners are different. I caught up to Rose, one of our club captains at about 13km. She is over 50 years old and one of the best runners at our club and in PE. She builds up pace slowly, eventually settling at about 5min 30secs/km. She is able to keep going at that pace for hours, literally. She can’t do what I can do over 10 or 21.1km, but as of yet I have never bested her in anything longer than the half-marathon. On this day I managed to stay with her until about 45km, she ahead sometimes, and me leading at other times.

From just after 25km there was an steep incline called Ou Kaapse weg (Afrikaans for Old Cape Road) added to the Two Oceans route at the last minute the previous week due to fires and the risk of rock slides on Chapman’s Peak, the usual route. It is a gradual climb from just above sea level to about 300m above sea level (ASL) just before 35km. The news of the change had runners in absolute hysterics in anticipation that it would make the overall Ultra marathon more difficult as Ou Kaapse Weg is steeper than the Chapman’s Peak climb (see: How to Run Ou Kaapse Weg – Old Mutual Two Oceans Marathon | News24 – http://www.news24.com/MyNews24/How-to-Run-Ou-Kaapse-Weg-Old-Mutual-Two-Oceans-Marathon-20150330) My strong suspicion is that the reactions had more to do with having to miss out on running up the beautiful, scenic Chapman’s Peak. Anyone who has ever been a tourist in Cape Town will attest to the fact it is one of Cape Town’s treasures.

Ou Kaapse Weg certainly majes the Two Oceans route a little more challenging!

Ou Kaapse Weg certainly makes the Two Oceans route a little more challenging!

Despite all the trepidation my new found bravado had me all but attacking this monster of a hill. When I arrived at the beginning of the ascent that is Ou Kaapse Weg I just kept running, refusing to give too much thought to the incline. I made what I thought was steady progress, Rose caught up to me about two or three kilometers up. Having to maintain a conversation when you’re working that hard isn’t much fun but she isn’t nearly as chatty as other runners I’ve come across. From about 30km other runners and Marshalls along the route would chirp that the end of the hill was just around the corner. This was a blatant lie, of the type that often gets told from the side of the road at road races! Three more kilometers of uphill is not ‘just around the corner’. Nothing like being given false hope when in a state of suffering that makes one lose one’s sense of humor. Best to just block out what was happening outside of my zone. Focus on the pain, much more fun!

Going up Ou Kaapse Weg

Going up Ou Kaapse Weg

Once we were finally over the top of Ou Kaapse Weg we started a three or four kilometer descent. I normally accelerate on a downhill to try and least partly make up for some of the minutes lost in pace going up the hill but I was in such pain after that particular hill that I did no such thing. My legs felt like two poles made of lead and every step I took felt like something sharp was being stabbed into the belly of each of the individual muscles in my thighs. I proceeded along, the messages from my motor cortex to my lower body were simple: put one lower limb in front of the other and just make sure we are at the very least going forward. Pace is not an issue! A couple of kilometers onwards still going downhill (unbelievably) I was in less pain, I allowed my strides to get a little longer, having had a quick look at my running app I realized that I was on track for a good marathon time. I passed 42.2km at 4hours 6minutes, better than my previous personal best. I was quite happy although the official clock had me at 4hours 12minutes due to the delay at the start. (official race time starts with the starter’s gun, I usually start my app when I go across the start line, usually resulting in a one or two minute discrepancy. Longer in this big race obviously. Irritating, but can’t be helped)

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A couple of kilometers later I seemed to run out of energy. I felt flat and all my strength seemed to leave me. I stopped to walk for the first time. I just had no fight in me anymore and the thought that there was still more than 10km left to run all but broke my spirit. At some point I was overtaken by a guy wearing a shirt that said ‘Two Oceans One God’ hec, I thought, it’s Easter weekend I should be at church on my knees not out here on the road wanting to crawl on my hands and knees! ๐Ÿ˜Œ

I was shuffling at about 48km when the 6 hour bus overtook me. This was a group of about twenty runners talking and encouraging other. They would stop periodically and power walk with their arms in the air, and then carry on running again. I thought I’d latch on. They pulled away from me after a little bit but I was newly galvanized and kept going. I past 50km at 5hours 7mins (app time) and I thought: surely I’ll get to 56km before 6hours? Sure, easy. Right!

I sprinted the last kilometer or so, and last little bit on the UCT rugby fields (the state of my legs at that stage means that ‘sprint’ might be somewhat too strong a word… it felt like a sprint in my head!๐Ÿ˜‹) and I snuck in for an official finishing time of 5hours 59minutes.

The rest of this pic shows me in a collapsed heap!

The rest of this pic shows me in a collapsed heap!

I was more or less useless for the rest of that day, my legs felt like they were separate from my body and every minute spent on my feet felt just plain unnecessary. Despite all of that I realized something right there and then, or more specifically sometime during the race. I felt that I had more or less conquered the long run! After 4 years of running I had new confidence, and I no longer feared the marathon. It was a quiet victory, and it felt good.

St Francis Bay

St Francis Bay

Meryl has a friend who’s family had a house in St Francis Bay for the Easter holiday. We spent the next two days out there with them.

St Francis Bay

St Francis Bay

Very early the next Tuesday morning I was driving us back to PE. Meryl was to catch a flight back to Johannesburg and I would go on to work. I decided there and then that another ultra marathon would be fun. Sooner rather than later. Good to use the momentum from a big race.

Back in PE and back at work all I could think about was all the studying I had to do. “You must read. Read, read, read, you must dissect the material…” An old acquaintance of mine back in Wits days used to muse, mimicking one of his lecturers no doubt. Every time I go past Dale, another doctor who I work with it’s “Dude did you get anything done yesterday? I sat for the whole night going at it till I was too tired!” Or the guilt-edged “Man yesterday was a write off I was lazy, gonna have to hit it today!” Or some variation thereof from either of us on any given day. A few weeks ago Dale decided to jump on the eager bus and write these blasted Part 1 exams. He’s got good energy and it’s good to have someone to compare notes with. It took me a couple of days to get back into a rhythm, but by the weekend I was flowing again, doing two to three hour stints at my desk with short breaks in between. The story of excitable tissue with characters including the action potential in it’s various guises isn’t new or mind blowing stuff to me but absolutely everything needs to be reviewed. I keep thinking about how much of a breeze this exam would’ve been if I had written it immediately after my BSc degree, that is in an alternate universe where that sort thing is allowed: BSc, then FCP… ๐Ÿ˜–

Having given my legs a sufficient rest I did a hard, fast 18km and 21km run on Friday and Sunday respectively. I was on call twice the following week, Tuesday and Thursday and I managed fit in an 8km time trial (for the speed work) on Wednesday evening, crazy!

Come Saturday (last weekend) at 6.05am I drove into a little town called Pearston, about two and a half hours inland from PE. I was 5 minutes late for the start of a 50km race, having woken up just before 3am and driven out there (the things we do for kicks eh! ๐Ÿ˜Œ). The race was to be run along the R63 east towards Somerset East, another of Eastern Cape’s charming little towns.

As it turns out the race hadn’t actually started yet, lucky! So I rushed into the little town hall adjacent the main road, got my race number pinned to my chest and ran out just a few minutes after the rest of the runners (about one hundred in number) had set off. Off I went then, at exactly 4min 33secs through each of the first 2km (uncanny, I know). I felt good in that cold drizzling early morning dark as it slowly gave way to the first tentative light of the day. I caught up and overtook a bunch of runners, and crossed the 10km mark at about 49 minutes after which there was a slight but perceptible drop in pace to just over 5mins/km as we began a slow elevation from approximately 700m ASL where we were to an ultimate elevation of 1000m ASL at approximately 25km, where I was going at over 6mins/km. I crossed the halfway mark at about 2hrs 18mins and since we were at the highest point on the route I could see what was coming and as tired as I was I liked what I saw, the rest of the R63 to our destination was a windy route with several peaks, none of which had anything on the hill we had just summited. So I leaned into that initial descent hitting a fast but comfortable 5min 20sec/km, and keeping that up for the next 13 or so kilometers, surprising myself. This was uncharacteristically aggressive for me in the middle of an ultra marathon but in keeping with the new long race strategy of don’t-hold-back-just-go-for-it.

Dusk. Long road to Somerset East

Dusk. Long road to Somerset East

At 36km I stopped for the first time to walk up to and past a water point. I then kept going. All I could think about at that point was the 42km mark which I eventually crossed at 3hrs 57min, faster than I ever had before!! Just 43, 44, then 45, 46km… I said to myself. Almost there chap. At 47km there was the final little hill, the universe’s last little attempt to break your spirit if that hadn’t already been done by then. By this point I would’ve needed to stop and not run for a considerable spell to undo the good work I’d done thus far so it didn’t matter that after I dragged myself over that last hill the last couple of kilometers were quite slow, I felt fantastic. I entered the grounds of Bruintjieshoogte, the venue and host of this race and did the last lap around the rugby field in a surreal daze that I’m not quite sure how to describe, crossing the finish line at 4hours 45mins, surpassing my previous personal best by over 20 minutes.

Another ultra in the bag!

Another ultra in the bag!

I got a medal and a water bottle for my troubles and went to find a spot on the grand stand to give my legs an overdue rest. Then I was on the phone with Meryl trying to relay my excitement as I watched other runners coming in, their club members cheering them in.

I got a ride back to Pearston to get my car and made my way back to Port Elizabeth. I was buzzing for the rest of that day, and the next for that matter. Odd thing, being excited, happy and tired and sore all at the same time.

Sunday morning came and the realities of self-inflicted goals and commitments returned and I plonked my backside down in front of Ganong’s chapter 9: Vision. Each rod and cone photoreceptor is divided into an outer and inner segment… This is my #beastmode morphing into my #geekmode I thought as I hunched forward…

Meryl and I on top of Lion's Head, overlooking Cape Town after sunset...

Meryl and I on top of Lion’s Head, overlooking Cape Town after sunset…

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Write when inspired?

 

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Yesterday was a long day ๐Ÿ˜ The kind of day that I normally wouldn’t write about, but precisely because it had been that type of day, I found myself sitting on my bed bored, uninspired and writing. I really shouldn’t have been (writing, that is) but there you go.ย I think that the main reason I was so bummed was that I didn’t study yesterday. I didn’t put in the usual 2-3 hours. There was no valid excuse, not really. What I did do with the time wasn’t nearly as good, or as rewarding.

 

The day had started out well. Alarm clock 5.30am; snooze; out of bed at 5.45am; bathroom (the regularity of my bodily functions is starting to scare me, I’m only 31, why is everything becoming so predictable aaargh! ๐Ÿ˜“…) 5.55am (at least ten minutes later than initially planned) push-ups: sets of 32, no… 35 (this was decided halfway through the first set ๐Ÿ˜) done with that by about 6.15am; weights: 10km dumbells aren’t much but when you get to about 28 of a set 35 reps there is some pain in the places where you want some gains. Done with all of that by about 6.50am. Kitchen, fix fruit and cereal quick, fix some lunch for work, quick. Shower, then seated at my desk/dining table at 7.15am, quick breakfast. 7.30am Housekeeper arrives, “Aren’t you late for work?” she asks, “Only by a little bit,” I say while chucking the bowl and spoon into the sink. I’m outta there within the next 5mins.

 

At 8.05am I parked my car in the doctor’s parking lot at Dora Nginza hospital (actually on the grass next to the lot along with a bunch of other cars as there aren’t enough parking bays for everyone employed at this institution) At 8.10am I walked into the ward. Here we go: 30 patients between myself and another doctor. Our intern had been on call the previous night so she did not join us. I saw 17 patients throughout the day, in addition to three call backs. Call backs are patients that I had seen in admissions the previous Thursday when I was on call, discharged home and asked to come back for review of their condition or blood results or to discuss with the specialist physician who runs my ward.

 

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There are two patients in my ward who have multidrug resistant TB (MDR TB). Both are HIV positive, one also has end stage kidney disease, and the other has cryptococcal meningitis (CCM). Serious stuff. The lady with CCM is one week and a half into her course of treatment, and once she completes the two weeks of amphotericin B we will be able to transfer her to the local TB hospital, a much more appropriate place for someone with her condition. We won’t be able to transfer the other lady, she is very ill, cachexic, with decreased consciousness. Her prognosis is very poor, we’ve discussed it with her family. We’re keeping her comfortable, as pain free as possible. Blood tests every couple of days to review her kidneys and make sure her electrolytes stay in check.ย These two ladies are ‘isolated’ in the side ward. They are receiving the right treatment, a veritable cocktail of pills that would frighten even the bravest of souls. It’s just that they shouldn’t be here in a general medical ward.

 

Our other patients are more of the general medicine variety, I discharged five today. An old hypertensive diabetic lady who had suffered her second stroke. No sense in keeping her here, she needs to be at home with with her family. Regular follow up with physio- and occupational therapy. Another lady who had completed five days of intravenous antibiotics, now no longer dyspneic, not coughing, and overall looking much healthier. A clear sputum sample had excluded pulmonary TB. Off back home you go. The other three were the same simple sort of cases.

 

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Then there’s a 41year old with frightful blood pressure readings despite our escalation of her antihypertensives. She has been in the ward since last Thursday, and also has very bad kidneys. Possibly the cause of her refractory hypertension? Maybe. One could be the cause of the other in this case, and conversely. How does one have bad kidneys at age 41 anyway?! We’re doing a full work up on her, to exclude causes of secondary hypertension, hyperthyroidism for example or some sort of rheumatological abnormality. Once we have all the results together if we haven’t found an obvious answer we will discuss her with the renal unit at Livingstone hospital (LVH).

 

My last bit of work for the day was a lumbar puncture (LP) on an old lady. She is somewhat confused and none of her blood results or her initial lumbar puncture show a possible cause. It could just be good old dementia (pun intended ๐Ÿ˜› but she doesn’t quite fit the bill for that diagnosis) The consultant had me do a second LP (unusual as it’s quite an invasive procedure) to look for cytology in cerebrospinal fluid. “Cytology?!” I asked. “Malignancy maybe. What else could be causing the abnormal normal protein levels in the first sample?” He replied, almost shrugging.

 

Done with all of that (work and stuff) by about 3pm. Gotta get some studying in today, I thought as I walked to my car. To follow up with the good bit I did over the weekend. I had spent all Sunday morning and the early part of the afternoon at the books.ย I had to pop by the bank on the way home, then make a quick stop at a sports shop in town to fill in an entry form for the next road race, even as I felt the residual pain in my legs from last Saturday’s marathon. I then stopped at the Spar not far from where I stay, as I had finished the milk that morning. Meryl called. I probably shouldn’t chat to her the phone while I’m driving but hec she’s far away and I miss her. I got home much later than I would have liked and used that as an excuse not to study. Not good. Physicians don’t make themselves man! I mentally scolded myself. It didn’t work on that particular day. It’s ok I thought, it probably means that I’ll hit it extra hard the next day.

 

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So there I was yesterday evening feeling guilty, bored and unispired. So I thought I would write about it, and I did. I did not post it up yesterday though, as I have this idea that I should only really write when I am inspired? Yes and no. I have had a bit of a think about it. To only write when I’m inspired would be to only write the good stuff, the fun bits of my experience here in Port Elizabeth. This was an example of an average day. Average uninteresting day at work. ย Average day in terms of inspiration, or more appropriately the lack thereof. To study I suppose, and to write…

 

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