Emergency physicians have several personalities. Take the wilderness type (you can already picture which of your colleagues fit this role): He hikes, camps, rock-climbs, and enjoys backpacking through Antarctica. A similar but slightly different category is the active emergency physician. He is always snowboarding or surfing or doing something like CrossFit. It is important to note for this column that I am not, in any way, shape, or form either of these two categories. (If I had to pick a label, I'd probably go with “Sarcastic; Subtype: Brainy.”)
If you need any proof of this claim, all I need to tell you is that it was in mile 3 of 545 when I asked myself, “Dear God, Graham, what have you done?”
I had just left the San Francisco city limits, pedaling down the California coast on a seven-day ride to Los Angeles as a part of AIDS/LifeCycle. ALC raises money for two nonprofits that focus on LGBT health and HIV prevention and treatment. The 2,500 other cyclists and I each raised more than $3,000 to ride this year, supported by 650 roadies who volunteer a week of their time to support the cyclists and the ride itself. The entire group camps out in provided tents, and then gets up in the morning to ride again the following day. It was a marvel of logistics and planning. The volunteers were able to guide more than 2,000 people of varying ages and cycling skill levels up 2,500 feet of elevation (and back down), feed them, keep their bikes and bodies in sufficient condition to keep going, and manage 3,000 suitcases and 1,700 tents. (Navigating through 58 cities also apparently requires more than 100 permits.) Talk about organization and planning. Some of my other favorite facts:
- We ate 44,600 eggs.
- We devoured 3,880 pounds of bananas.
- This led to the group using 1,641 Porta-Potties.
- We also used more than 18,000 packets of butt balm. (You become intimately familiar with your ischial tuberosities by day 2, and “Butt Clinic” forms a line every morning in the medical tent for those who do not appropriately lubricate and care for their perineums. Or is it perinea?)
I am not an active, wilderness guy, but I am definitely a morning person, so the 4:30 a.m. alarm I set (to be on the road by 6:30) wasn't too painful. The ride itself was certainly challenging in some physical ways (thank you, IT band syndrome) and in some mental and emotional ones as well, but the amount of support and encouragement from everyone on the ride was simply incredible. Bike through any of the many small towns, and you ride past random strangers ringing cowbells, holding up signs, and cheering you on. At the beginning of the infamous QuadBuster hill, experienced riders encourage you to keep pedaling. Halfway up, a woman is blaring the Rocky theme song next to the road and wearing inflatable boxing gloves to applaud you. At the top, a drag queen spritzes your face with water, and another supporter hands you a Red Vine licorice or fresh strawberry as your reward. Later on, a man wearing a blue pill costume labeled “You are my Viagra,” claps as you ride past him and tells you to “keep it up!” (It is every bit as ridiculous, crazy, and fun as it sounds.)
Living in San Francisco and having done residency in New York, it's easy to think that the HIV/AIDS epidemic affected only the urban world. And practicing in the United States in today's world of antiretrovirals, sex education, and PREP, it's easy to forget that there was a long time in our not-so-distant past when HIV was not treated as yet another chronic condition. Biking through central, rural California, I was somewhat surprised to see so many people cheering on a ride about HIV made up of gay (and straight) riders. It wasn't until I started seeing their signs — a photo of a loved one with dates of birth and death — that I realized that these communities were affected by HIV as well, in their own towns or from ostracized men or women who traveled to the cities looking for acceptance. A whole cohort of men and women is missing from the world — they would be in their 40s or 50s or 60s now — who were decimated by HIV, and millions worldwide still suffer from it.
You meet people from all walks of life on the ride, of all ages, all body types, with any number of medical conditions and all experience levels, and every single one has a story to tell about why they ride. Many of us — myself included — were new to the ride. Many others had ridden for the past five, 10, or even 20 years. Some people rode on a dare or on a bet; others wanted to challenge themselves. Some rode to remember a loved one; others rode to try to make amends for guilt they felt about how they treated a family member, past homophobia, or HIV stigma. And still others ride to see the beauty of California or meet others who enjoy cycling.
Washing Away Cynicism
The ride leaders talk about the ride as a transformative experience, and it is certainly is. It really helped me wash away some of the cynicism and negativity that can easily cake up along the edges of my core as an emergency physician, and, boy, did I need it. But I think the reason the ride felt so special was that I realized how rare transformative experiences are as an adult. The ride felt to me like a service trip in college or a volunteer opportunity in a foreign land: complete strangers supporting each other, working together. They all put aside whatever role they play in their normal lives to focus on one thing. One cause. For one week a year, this group creates something bigger than any one person can be. As I get older, I find this feeling to be more difficult to recreate than in my younger, more idealistic years, and it's really invigorating to be able to feel that again.
There's something refreshing and unifying about being lost in a sea of people all working toward a single goal. On the very first day, I couldn't finish the ride; my IT band was a corkscrew driving into my right knee with every revolution of the pedals, and it really put me into a funk. I had six more days to go, and already my knee was giving up on me? Irritated, I did my best to enjoy what I could of the experience after the day's ride (hot shower, all-you-can-eat dinner, free massage), hoping that day 2's 108 miles would somehow be better. And you know what? It was. After resigning myself to going slowly and allowing what felt like every single rider pass me, my knee let up, and I finished my first 100+ mile ride that same day, and went on to have no more knee problems with my slow and steady approach. Being a competitive person by nature, it was difficult at first to let other people pass me. But at some point, I realized that no one on the ride knew or cared if I were faster or slower than they were or if I finished before or after them. The only person who actually cared about that was me. To them, I was just another rider. Being able to take on the group identity and shed my own when I hopped on my bike allowed me to realize I was only competing against myself. Everyone else just wanted me to succeed and get to the finish line. No one cared who was first. “It's a ride, not a race,” as they say.
At night, the CEOs of the San Francisco AIDS Foundation and the Los Angeles LGBT Center would share their stories, jokes, and thoughts with the entire camp, and educate everyone about the services that their organizations provided. Initially, I felt like my career in emergency medicine had very little in common with these organizations' missions, but the more I learned, the more I realized they are helping to string together that same health care safety net that we support. We both provide medical care and services to the uninsured and underinsured, and we both provide social and support services to patients. And let's be honest: If organizations like these two didn't exist or weren't sufficiently funded, where do you think their patients would go? Our registration window in the emergency department, of course.
So for that reason, (and because I couldn't ride on day 5 because of a fever and rigors), I've signed up to ride again in 2017. (Also, I got a cool T-shirt. I'm a sucker for a cool T-shirt.) As an emergency physician, I feel like we should all find some way to contribute to a cause or a community in a meaningful way. If not by riding, by financially supporting something we believe in, something bigger than us, or by volunteering our time or expertise, whatever the cause. The medical directors for this ride, no surprise, were emergency physicians: Jo Feldman and Chris Belfour.
If any of this sounds remotely fun or enjoyable, you may be a wilderness or active emergency physician, or, like me, you are just human. Consider joining me on the ride in 2017. Or supporting me instead: http://bit.ly/2aShA77. It's a fantastic way to get in shape, see some of the most beautiful parts of the United States, keep burnout at bay, help a cause, and get intimately familiar with how much you appreciate every single muscle in your body.