Roughly 600 brave souls lined up for the start of the 100 mile course of the 2017 Lost and Found Gravel Race. No mere Gravel Grinder, this race has a reputation for being much harder and feeling much longer than its advertised miles. All of this was true. It also has a reputation for being an incredible weekend with great people, stunning scenery, and exceptional organization by the Sierra Buttes Trail Stewardship, a group that advocates for and builds trails in the Portola, Sierraville, Downieville, Quincy areas and is responsible for the Downieville Classic. This also turned out to be entirely true. A week before the event SBTS put out some photos of the route, new this year due to most of last year’s route being under snow and water cover still (It was an exceptionally harsh winter this year in Northern California) and while the 10 mile/3000ft climb at mile 72 was gone, the road surfaces were looking particularly “challenging”. Be prepared, they said. Run wider tires, they said. Maybe consider using a lightweight mountain bike, they said. All very good advice, all of which I did not follow as I was reluctant to run gear I hadn’t been training on. As the race instructions were read over the loudspeaker, I was confident, physically prepared, with my gear tuned up and in top condition. In other words: ready. The pros were let go at 8:30, and 5 mins later the rest of us were turned loose into the outdoor playground know as the Lost Sierra. The race was on.
Resilience is a subject I’ve been talking about a lot lately. Both as it relates to my athletic pursuits (Bicycles, Muay Thai, and Brazilian Jiu Jitsu), and in the context of the EMS work I do. For a quick overview of my professional work (which is not racing bicycles) see here. For a bike event, you would never (or at least it is ill-advised) start from nothing, get a bike, and after making sure everything works and fits properly, go out and ride 100 miles at a hard pace with no previous training. You would likely not complete the event and, finish or not, you are going to be hurt, possibly with joint/connective tissue damage that may be permanent. You build up, you put in base miles, you work intervals to test your body with hard efforts in small doses, you learn to rest and recover properly, and build resilience and work your way up to long distances and harder efforts to get ready for “the big one”. You don’t wait to learn how to lightly spin a recovery ride until AFTER your first big race. And yet, that’s the exact psychological training plan for working in EMS. You gather lots of tools and equipment, and then you head out and work hard and go race pace non-stop everyday on “the big one” and then, when it all goes wrong and an injury occurs, we sit down and talk about how to recover. And by waiting until then the damage can be difficult to repair. You haven’t built any resilience. You have no practice on how to recover. I’m sure we all know someone who said “I want to ride a century”, bought a bike, and 3 months later toughed it through their first 100 mile charity ride despite an inadequate training plan, and then hung the bike up and stopped riding because of how terrible the experience was. EMS work is like that, but with potentially more long term consequences or the loss of a potential career or most distressingly sometimes the loss of a life. It’s something that we at Managing the Ghosts want to fix. But how?
The Lost and Found starts amicably enough. A smooth high speed descent on pavement that gets you to the first two climbs of the day. At mile 4 it’s onto forest service roads that have been scoured to chunky bedrock in most places. I’ve been riding fire roads and single track all spring to get ready, and these roads are in much worse shape. Bumpy and rutted are inadequate descriptors. It’s around 2000ft of climbing from miles 4 to 12 and I’m already starting to think that a 45c tire would have been a better choice over my 40’s, but it’s a little late for that now. I take an easy pace of those first two climbs and while my legs are warming up and feeling pretty good, my body is taking a pounding. There is an impressive number of people with punctures on the climbs, and we are all about to find out what devastation going downhill at speed will bring. The descents are pretty hairy! Not just rutted, not just loose over hard, not just big rocks randomly strewn everywhere, but also water-bars that have been carved deep by all the snow melt, sometimes without warning. Many are narrow enough that you can bunny-hop them, others are wide with steep sides and the only option is to slow way down and carefully pick your way through, others are 10 plus feet wide and have fresh loads of double-fist size rocks poured into them which makes for an unstable-at-best surface to clamber over. It’s a parade of people at the side of the road fixing punctures, and the occasional person crashed out. I’m starting to think that carrying some first aid supplies when I ride would be a good idea. The moniker of “more Adventure Ride than Gravel Grinder” is holding true. If you didn’t pre-ride the route, it’s a new experience around every high speed corner. Things level off and become a more or less proper dirt road for the push into the first aid station at Mile 18.
For a bike race or long ride, it’s easy to find plans for maximizing your ability to perform well, and comfortably, and not spend the next month on the couch because you overdid things. EMS work is very different. 1600+ hours of schooling before you are qualified as a Paramedic, but fewer than 4 hours spent on teaching you how to take care of your self mentally and emotionally. It would be like prepping for a bike race with 1600 hours of fast tempo riding, and 4 hours of light recovery spins. Total. It makes no sense in those terms, and that’s what we do. We don’t even talk about care and recovery until a horrific and/or catastrophic event happens. And it’s not because we, or our employers, don’t care about each other or we are uneducated. We just don’t know any other way. It’s a system perfectly designed to fail the needs of caregivers. Which it does. At an alarming rate.
Out of the aid station it’s a quick jaunt on pavement before turning back onto dirt roads. I’m in and out of the aid station pretty quick and I estimate that I’m somewhere about middle of the pack of this point, and the coming 10+ miles suits my riding style pretty well so I’m going to try to start overtaking. This next section is mostly level with a couple small rolling hills, but the road surface continues to deteriorate and it’s tough to conserve any sort of momentum (I drove part of the course the next day to show my wife some of the scenery and it was uncomfortable sitting in the car at the same speed we had been riding) but the bumps are tamed a little bit with some speed so we are all working hard to keep our pace up. You can’t really follow anybody too close though, because a water-bar trench will appear out of nowhere and some of the more hop-averse folks will slam on their brakes instead of keeping speed and jumping. You have to be really aware and leave yourself some outs. It’s becoming a proper test of fitness, bike handling, nerves, and visual acuity. And every once in a while when you look up from the road in front of you, you are surrounded by a wild and deserted splendor that is pretty rare, at least for me, to ride a bike through. The views stir the soul while the roads go to war with your body.
Training on the bike, you introduce small stressors and gradually make them more intense and for longer duration. You rarely put in intense efforts multiple days in a row. Maybe a better plan for EMS workers would be to start talking about mental and emotional health, how to recover from situations that we know are damaging, early on in a career. Start with the little stressors, mildly bothersome calls and situations. Practice those skills when the stakes are low. Get it right. Even if you “feel fine”. I use my foam roller, and I stretch, regularly. Even when I “feel fine”. Because those things build up, and it’s good to practice healing small damage to get better at it for when the large damage occurs. Or to put it another way: Building Resiliency. It’s just another skill to learn, and like any skill needs to be practiced to be improved.
At the 32 mile aid station there are ample staff and they come over and grab your bottles for you so you don’t have to get off the bike, just a “what can I get for you” and then someone runs off to do the effort for you. It’s nice to save some mental and physical energy. I get off the bike anyway because my Nordic skin demands another layer of sun protection, which mostly turns into the weirdest muddy sunscreen paste with all the dust that has collected on me over the last two-ish hours. I think you could measure my dust coating with a dip stick. The rumor starts going around that the next 20 miles are going to be the worst roads of the course, and a couple people decide to abandon the 100 miler and take the right hand turn for the 60 mile course. My back and shoulders are pretty hammered but I decide to stick with the plan and make the left-hander and keep pushing deeper into the wilds.
The problem with EMS is two-fold. One, because we don’t learn to recover from small damage, those things build up over time and all that damage is still there when “the big one” happens. And we all come together really well to recover from “the big one” but my bias is that by then there is so much to recover from that it gets pretty complicated trying to untangle it all. Two, because we don’t spend time practicing learning how to recover often the first time you start being exposed to these tools is when you are pretty overwhelmed and damaged and that’s a difficult place to learn. “Oh, you just finished a 400k Brevet? Great, let me show you how to start doing VO2 Max intervals right now!”. Those two problems multiply on each other, and I know many really good people, caring and kind and wonderful people, who will never work in EMS again because we didn’t teach them how to recover. Couple that with a cultural expectation of always being at the top of your game, that anything less than being exceptional is a catastrophic failure, and we set people up to burn out.
Across a little flat valley and then the road goes sharply up again. It’s rocky and steep and makes my trails at home look like smooth pavement. As I’m about 3/4 of the way up the climb, keeping a decent pace but with too much body tension, trying to keep the pedals going, I bounce over another in a long series of rocks and feel a rib dislocate along my back. Instantly it feels like someone is jabbing me in the spine with a sharp stick and I can’t take a deep breath. I keep trying to ride but I can’t get any meaningful power down into the pedals so I’m crawling up the hill and bumping along like a pioneer in a wagon. I pull over and get off the bike to think and regroup. I have roughly 55 miles left, and although I’m near the top of this climb, there are two bigger ones in the next 30 miles. My pride wants me to go on, I didn’t come all the way out here to not finish the long course, but I make the decision to turn around, go back to aid station two and finish on the 60 mile course. If there were a SAG van to get into I would probably pack it up and get a ride back to the start/finish, but that’s not an option so it’s either ride the bike or sit here for a couple hours and wait for a sweep vehicle. So I ride.
This year’s theme for celebrating EMS folks is “EMS: Always in Service”. And from a public expectation standpoint, I agree. The system doesn’t take days off. And I think it’s a really dangerous message to push at the people who work in EMS. “Always in Service” means never taking time to rest or recover. It means never going home in the middle of the shift because the call you just ran isn’t one you are going to bounce back from right away. It means never taking the day off so you can take care of yourself, instead of other people. It means giving and giving and giving until there is nothing left, all because you didn’t think it was ok to say “I need to be done for now”.
As I come limping back into aid station 2 I must be quite the sight. The EMT at the ambulance comes walking out into the road to ask me what I need, and I explain that it’s probably just a little dislocated rib and I’m going to finish on the 60 mile course. He nods and lets me go past. Someone marks a big black X on my number plate and I’m officially out of the race. And to be sure, I wasn’t going to win this thing. But, I was interested in seeing how well I could place in my division. That’s all done now. Now I just want to get myself and the bike back in one piece.
I don’t have all the answers, but I have some ideas for taking what I know about athletic performance, and applying it to peer support. I help coordinate the hiring for my agency and one of the things we ask people to tell us about in our interviews is what tools they have for managing stress. This does a couple of things. It acknowledges that we are going to be putting them into stressful situations. It notifies them to expect stress, and to need some strategies for managing it. It also allows us to see if it’s something they have thought about, and if not and we take them on as an employee, we know we need to start the conversation going about growing their tool kit. Much of the education around stress management in EMS is too general to be helpful. “develop meaningful and supportive relationships”. Ok? If it were that easy I probably wouldn’t need help. HOW do I develop a relationship that is supportive? And maybe more importantly, how do I identify which of my relationships isn’t very supportive so I stop trying to use them for managing my stress. These are the types of tools you can develop by talking peer-to-peer with people from a similar background.
The next section is pretty great dirt road riding, or it would be if my back was intact. It’s the best dirt surface we’ve been on all day and even with my breathing restricted I’m able to keep up a decent pace across a nearly flat and level valley and I start to feel a little bit better. It’s the type of scene from an old western movie, this long straight double path leading off to the horizon. At the next turn we are rejoining the 100 mile course and the first of the pro riders are screaming past. I am inspired and encouraged to see the type of speed they are carrying this late in the event, and knowing how much worse the conditions are that they just rode. This is one of the great occurrences in an event like this, when else do you get to share a course with pro riders going full tilt? It makes getting passed somewhat awesome. We hit pavement again for a couple miles as we make our way towards the infamous “Vicious Cows” section and sure enough there are some small herds crossing the road at various places (the whole area is open range land, and I’m guessing in some years the numerous cattle guards are a source of concern for riders, but this year are some of the most smooth road bumps all day). Another left and we are onto what seems to me the worst surface of the day. It’s just abysmal. Rocky, and rutted, and more sections of double fist sized rock road fill, and one pretty fun hike a bike section where a creek has completely cut out the road. Two ribs are dislocated now and the pain is wrapping around to my front. At one point, I’ve had enough of the constant pounding, round a corner and see the road going back up hill, paved with nearly bare rocks, and I start crying for a few minutes. It’s almost more than I can deal with, but being overwhelmed and crying while moving towards the finish sounds better than stopping and crying at the side of the road motionless, so I keep pedaling. After a couple of minutes it passes and I’m back to riding with a semi-manageable level of pain. It is true what they say, it never always gets worse. Aside from the “road”, we are in a pine forest wonderland, with zero cars, and the cleanest most intoxicating air you can breath.
We need peer support. And an environment where we come together to discuss the types of stress that working in EMS can produce. A place where we share our struggles, and our disappointments, and the things that we have tried that work and don’t work to recover from difficult shifts and situations. In cycling, we swap stories non-stop about training methods, tools, recovery strategies, equipment (Open the talk about which tire/rim set up is best for gravel and you aren’t ever going to be finished chatting) but in EMS we are reluctant to discuss even the most basic stress management experiences. Our mental and emotional health and robustness makes us uncomfortable in ways that our physical health doesn’t.
As we approach the turn onto a level-ish section we ran earlier heading into the first aid station (which doubles as the last aid station) I hear a guy yelling. He is waving everyone around the turn and finding something personal and individual to yell at each person. I hear him screaming that the person in front of me looks like a 5 year old painted their bike for them (I think its one of the Squid Bikes race day rattle-cans), and then he looks at me a bellows “Dark Lord! What the hell are you doing our here! 666 indeed!”. I can’t fathom why he’s yelling this at me and then I realize I have 6’s all over me from my team kit. I’m so tired and beat-up, and my back hurts so bad I can’t think of a proper response. So I just throw him the metal horns, which as I look back was probably the best response I could give. He laughed heartily, waved me through the turn, and started into his rant about/for the rider behind me. I don’t know who that guy was, but I am beyond grateful he was there. The mood boost he gave me was perfectly timed and probably kept me from getting off the bike and waiting for a ride.
By facilitating and encouraging peer support groups, we can begin the conversation early in peoples’ careers about how to build resilience, and how to recover from the inevitable emotional damage and mental soreness that comes with difficult effort. We can create the EMS equivalent of a “rest and recovery ride”, something to be highly encouraged, celebrated even, as the right thing to do following a hard effort. We can support one another during the times we struggle, BEFORE they become unmanageable. We can help identify the bail-out routes for when you need to abandon the current course and take a less effortful road home. Because sometimes you can’t keep pressing on. Sometimes you need to pull the plug, turn around, and cry a little while you limp yourself home, all while people around you shout encouragement and tell you you’ve done a hell of a job getting this far.
Back through the first/last aid station, I’ve been swapping back and forth (mostly back, especially when the grade goes up) with a few other groups of “Black X” 100 mile abandoners. The roads have taken a toll on people and machines and derailed many plans for the day. I think the finish rate on the 100 miler ended up being just over 60%. We make our way up a pretty nice paved grade and then hit the final dirt climb for the day. I’m moving slow and nearly everyone pushing past me has an encouraging and kind work for me. It’s the best group of strangers I’ve ever struggled on a bike with. I stop several times going up to sit down and try to stretch my back out, to ubiquitous calls of “Need a gel?”. “Thanks but no, I’m not bonking my ribs are dislocated” is my reply as I writhe on the ground. “Sorry dude, good luck” and they are off. It is totally comforting and encouraging just knowing that people care. A couple of time I start to wonder if I’m actually going to make it, but then we are finally over the climb and headed back to the finish line on pavement. Its been just under 65 of the hardest miles I’ve ever ridden as I peel back into the starting area, put the bike down, and sit by myself for a few minutes to try to get my wits back about me. I’m officially a DNF, but those three letters don’t convey the whole experience I had out there. My legs feel surprisingly great and really want to be out riding more miles, but my back, shoulders, hands, and connective tissue are wrecked. Standing upright has become a chore. The heavy BJJ session I did the Tuesday before the ride was probably (definitely) the wrong choice (likely reduced my resiliency instead of building it), but Nich only visits to roll once a year so I wasn’t skipping class. All in all I have some things to tune up so I can return next year: Bigger tires, less single track and more rutted fire roads, a better taper on core exercises going in, maybe more out of the saddle climbing. 2018 Lost and Found Gravel Race? I’ll be there with bells on! That is the great thing about a bike race. IF it all goes wrong and you pull the plug, you can always come back and try again next year.