by Jay Mueller

I work in a city emergency room as a fourth year resident in Emergency Medicine.  On a recent ride with Andy, I recounted to him one of the experiences that solidified my interest in the field.  As this story was also incorporated into my residency application, I didn’t anticipate having to create new prose.  Then I remembered that said essay was on my very dead external hard drive, so here I am rewriting and re-remembering.

In 2003, I was in reasonable shape.  I was doing an extra year of medical school conducting research in cancer genetics.  Loosely translated this meant I was training full time and trying to cure cancer full time.  I was mediocre at both, but in good enough shape to do the pro race at Fitchburg: I’d get my ass comfortably kicked but probably finish.  I sucked in the time trial, exploded gloriously in the one hundred degree heat finishing a little way down in the circuit race, but was reasonably recovered to hopefully finish the road race.

I am pretty sure it was at the beginning of the second lap as we were coming into the long, fast descent of Mile Hill Road that I had taken a bladder break and was semi-dropped (i.e. had to ride through the caravan).  I stepped on the gas and was riding into the back of the field with Navigators manager Ed Beamon, some Jelly Belly guy who had diarrhea, and one other lower food chain pro who said he had diarrhea (but never proved it the way said Jelly Belly boy did).  We literally flew down the hill.  This was prior to the resurfacing of the pavement and it was cracked with years of frost heaves, even worse than when I trained there at age 15…ten years prior.  The Statey at the bottom of the hill told me later we were going over 60 miles per hour.

From our vantage point, we could just see the front of the field rolling up to catch a break that had gone off the front and which included Navigators rider Henk Vogels.  As we were tucked and dropping like stones, we sped by a lifeless body at the end of a trail of blood.  He was wearing Navigator blue. 

It was clearly bad, I knew that.  I had spent two months on the trauma surgery service at Elmhurst Hospital in Queens as a third year medical student.  Pretty quickly you size trauma into three categories: probably okay, probably screwed, and definitely screwed.  This was definite.  In the time lapse that seems to extend milliseconds into infinity, I thought to myself “You race bikes, and everyone is here to race.  But if this guy dies and you didn’t at least make an attempt to save him, you are going to feel like a real turd for the rest of your life.”  So at 60 miles per hour, I hit the brakes.  I went through the better part of a pair of brake blocks, turned around, and rode my bike up Mile Hill Road to Vogels.

I don’t know why, but when these things happen, I just feel calm, like I am supposed to be there.  There’s usually no change in my pulse and it’s the only time my attention span is longer than a television commercial.  It’s the only time I have clarity of purpose.

As I got there, Beamon was arriving or had arrived just before me.  Vogels started to wake up and move, which was bad.  His helmet was off:  I cannot remember if it had popped off or if Beamon took it off.  I held Vogels’ head with inline cervical spine immobilization.  His scalp was bleeding like stink.  There was a trail of blood from the guardrail he had bounced off ending at his body.  His helmet was not just shattered, but compressed and incredibly thin.

“Where am I?  Where the hell am I?” he said in a thick Aussie accent.

Beamon and I explained he was in Massachusetts.  I asked if he knew his name.

“Henk Vogels!  Where am I?”

We explained again where he was, which was like telling my dog he’s not allowed on the couch: good for five seconds.  I asked where he was hurting.

“My leg!  My f—ing ankle!  Where the hell am I?!”

In my head, and probably out loud for all I remember, I was assessing him.  Trauma medicine is idiot proof (e.g. I practice it), so you just go through the alphabet: airway, breathing, circulation, disability, and exposure.  His airway was open—he was talking—and his chest was rising symmetrically with each breath, so he was breathing.  There was no way to take my hands off his head and neck to feel his pulses (circulation), but it didn’t matter, the ambulance had rolled up anyway.  

They put the collar on his neck and I started to give them my assessment.  At about the same time, the race doc showed up.  He was pretty relaxed.  I introduced myself as a fourth year medical student but he diplomatically said thanks and ignored me.  This was fine by me.  I was still on autopilot and—being a medical student—deferring to a more senior person was my life.

Ed Beamon said something kind to the effect that it was good to know there are people like me in white.  Obviously he was referring to a physician’s white coat, but I was so hopped up I didn’t catch the reference.  I thought he meant my pallor or else had a very odd white knight fantasy.  It’s funny how your body responds to its own epinephrine.

  I returned to my bike, hosed the blood off my hands with first Gatorade, then water, and went down the Mile Hill Road again.  

At the bottom, there was a race official with the Statey.  I went over to find out how far ahead the field was.  It turned out they had neutralized the peloton, who had all pulled over anyway to wait to hear whether Vogels had died.  I was told I could rejoin the race if I wanted.

I started to ride toward the field again, but started to shake uncontrollably and hyperventilate a little.  I couldn’t imagine racing or going down that hill again.  All I could see was the blood on the tarmac and feel it just soaking my hands as I held that big cranium.  I tried to calm myself for thirty seconds but that didn’t work, and I started to get nauseous.  I turned my bike around and rode into the ski area parking lot where my team van was parked.  I went over to the van and vomited.  This had not happened before and has not since, and I don’t think I’ve ever told anyone—even when I wrote about this as a residency applicant—that this once, I was scared. 

It was odd to have fear after the event—not before or during it—but that is the way it works.  You displace your emotion while you don’t have time for it.  Afterward, for me at least, it returns like a concentrated hangover, complete with nausea.  For a few seconds there, it was one skinny bike racer taking care of another…the fear came from the fact that the roles easily could have been reversed.

Things turned out okay for Vogels.  If I remember correctly, he had a bad fracture above his ankle from putting his leg through his wheel and multiple high cervical fractures (I believe…and some of you may know via google…numbers one and two). So it was good there were people there to immobilize him early.  Nerves from the third through fifth cervical levels of your spinal cord keep your diaphragm moving.  Sever the cord above that, no diaphragm.  No diaphram no breathing, no breathing, no living.  I am not staking claim to saving his life, but cervical motion (not the kind we all hope for), would have been bad.  For the record, it’s classic to have a “distracting injury”—in this case a leg—keep you from noticing the pain associated with the life threatening one (your spine).  Vogels is racing again, now on the Toyota-United Pro Cycling Team.

This story is not without a bit of irony, so I’ll drag it out further.  The day before in the circuit race, the field was strung out single file on a false flat after the little descent following the fed zone.  I had it totally pegged in a 53×11 and was going cross-eyed.  The rider in front of me, a Jittery Joe, let a gap open.  He hammered and hammered to close it, but couldn’t.  He then popped and went backward, leaving me in the wind.  I dug in and closed that gap to within 30 meters, but couldn’t get any more purchase.  From behind me I heard Aussie spite, something to do with closing a mothersomething gap.  I closed another 5 meters and got that feeling: my sphincter was barely under my control, vision getting blurry, legs burning a la Chernobyl and…boom, I popped.  But as I swung off, I had a few words for the guy screaming at me, telling him to go do something to a mothersomething kangaroo.  The way I tell this story, it was Vogels who yelled at me, but there may have been other Aussies on the team that year and I had my head off to the side with my tongue on the ground.  All I saw was his behind as he closed the gap with about two pedal strokes.  

I was dropped at that point, with only a little way to go to the finish.  There was no need to push as I was “saving myself” to try to finish the next day’s race.  Who knew?

My research year ended and I started my fourth year of medical school.  I had a decent idea I wanted to be an ER doc, but my experience at Fitchburg cemented it.  There were many reasons why, but it boiled down to this: I didn’t like being rattled that way, but I love that sense of purpose that comes when big things are on the line.  So it’s really not that much different than racing a bike.  You swallow your fear, prepare like mad, and the race begins.

Jay Mueller, M.D. is a fourth-year resident in Emergency Medicine at Bellevue Hospital and NYU Medical Center.  He is a self-described mediocre Cat 2 racing for Champion System/Cycles Gladiator Wines.