February 2015

The Medicine

Ironman and medical exams

By Karen Hitchcock
How a gruelling physical challenge became a welcome relief

Around Australia the registrars are about to sit part one of the medical specialist exams, the rigour of which makes medical school exams seem like hopscotch. I feel sorry for them: five years on the wards and now trapped inside cages of heart-thumping ignorance. Physicians in their 80s still have nightmares where they’re forced to repeat the exams. I sat them in 2008 and sacrificed a year to that relentless act of endurance. I stuffed myself so full of facts that eating made me sick. I listened to podcasts of the review lectures as I drove to work, as I jogged and showered. I sat with summaries in front of my face while my family played; I littered the house with Post-it notes that described pathways and diagnostic criteria. For a year I didn’t glance at a newspaper or a novel or a movie. Like an obsessive-compulsive loop, my every thought ended with the same punctuation: Must study. When it was all over, my reams of notes packed in cardboard boxes, I walked through air without gravity, each thought now ending in a cliff dive.

After the exam I had to choose a sub-specialty and train for a further three years. Unsure of what I wanted to do, I took a last-minute advanced-training post in nuclear medicine. I was plucked from hectic in-patient wards and dropped into a sleepy office where I rarely saw a patient in the flesh, except to tattoo the skin above their sentinel lymph node moments before the surgeons hacked out a tumour. Mostly I sat behind the boss’s shoulder, trying to interpret ghostly scans. All those years of study, of smacking up against the raw humanity of the desperately ill, so I could sit in a padded chair in a dark room.

We interpreted images of limbs and lungs and entire bodies riddled with black spots – cancer, infection, broken bones – using rote phrases. In the tearoom, the technicians who ran the scanners talked about something called ironman, an event where they voluntarily paid big money to swim 3.8 kilometres, then cycle 180 kilometres and then run a full marathon (42 kilometres). Why? I asked them. Why? They shrugged, lifting salad sandwiches to their mouths, tight biceps flexing beneath polyester uniforms, chewing with cut jaws. They talked training hours, diet, drills, PBs (personal bests) and squads. My legs started to twitch. One second I was thinking they were a bunch of monomaniacal psychos with rather pretty bodies, the next I was buying a waterproof, heart rate–monitoring GPS wristwatch. I got a coach. He wrote me a training program that read like a job – two sessions a day, 22 hours a week – and I felt a deep relief.

I’d rise at 5 am, drive to the Olympic pool and join my squad. In the fast lane were the semi-pros and the coaches, guys with tattoos of the Southern Cross and the ironman symbol, cutting through the water like sharks. I swam with skinny boys, tough girls and a 65-year-old woman who once finished an ironman event with her foot dangling from her ankle like a flag. She’d severed a tendon at kilometre 22 of the run. “It didn’t hurt,” she told me. “Only the partial tears hurt.”

After work I’d go to sprint and hill training, or on long solo runs. I bought an Italian bike, light as a bag of flour. I rode with a peloton of men until I grew tired of their chitchat and went out by myself, riding for hours along the fine line that divides effort and pain, my cleats clipped into titanium pedals, trucks beside my elbow, thinking of nothing except how far I’d come, how far I still had to go.

In the squads I was no one; I came from nowhere. People who didn’t know my last name or my job knew I was gaining on them by the character of my footfall, could recognise me by the colour of my bike. We were a strange sort of community, linked by what we were forcing our bodies to do. You didn’t have to be fast; you just had to keep going. I spent my spare time adding up hours trained, kilometres covered, grams of protein consumed. I studied textbooks of exercise physiology and triathlon magazines. The techs and I DEXA-scanned our bodies to learn the precise percentage of muscle and fat we carried. We diagnosed each other’s kaleidoscopic aches and injuries. I tried to calculate the physiological age of my 35-year-old heart: I pushed myself to my maximum (196 beats per minute) and ended up facedown in the grass, misbeats racking my chest. You can mine a lot of data from your body when you’ve got nothing else to study.

I raced a half ironman alongside Tony Abbott and beat him by an hour. I raced the Australian long course triathlon and qualified for the amateur worlds. I’d have to train harder, but I’d get my own racing suit with a golden “Hitchcock” printed across the green arse. I was right in there, wet and steaming and laughing along with all the other biceps and quadriceps, the wetsuited, kickboarding swimmers, the aerodynamic riders and the high-tech runners. And then one morning I stood at the edge of the pool and felt a sick sort of shock: I stared at those people – my squad – and they seemed in that moment a collection of exotic, curious and utterly anonymous creatures in an aquarium.

I quit the squad and my job and started training as an acute and general medicine specialist. Ironman had been nothing more than an elaborate, frankly exhausting way of moving from the exams back into life.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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