Triple complete!

Whoa whoa whoa. What’s that? CT just underwent a triple bypass surgery? No, although one of my texting friends did totally misunderstand me.

This past Sunday, I spent 14 hours on my bike completing 118 miles and climbed 10,000 feet over 3 mountain passes.

But, I get ahead of myself. Lets go back to December.

My Davis Double cycling jersey from 1994.

The Triple? No way.

Moving to Colorado decades ago, I had heard of the fabled Triple Bypass bike ride.

My biggest athletic achievement at that time, was riding the Davis Double Century in Central California in 1994 (yes, 30 years ago). That ride was at sea level, flat, and when I was 30 years younger. The precious trophy of that ride, my Davis Double cycling jersey, pictured above, had hung in the dark reaches of my closet for three decades, nearly untouched.

Moving to Colorado in 1995, on the other hand, I had never thought myself capable or interested to ride Triple Bypass. I considered that it was beyond my capability.

And then, things changed.

Three of my physician friends at University informed me they were going to ride the Triple Bypass this year, and by January of 2024, I thought “If I’m ever going to attempt this ride, this would be the year.”

By March, I began training, taking longer rides on the weekends. My colleagues introduced me to the Lookout Mountain climb: 4.5 miles and 1200 feet of climbing. They introduced me to High Grade Road:  About 3000 feet of climbing in 10 miles. I learned to survive and then repeat these climbs. By June, gradually increasing my hours on the bike, I was able to climb High Grade twice in a day. Whew. Was I ready for July 13? I did not know.

The start: before dark

The start was in Evergreen. I knew that I would be one of the slowest cyclists on the course. On my uphill climbs, I would average 5 to 6 mph. With the first Aid station on the ride being at mile 11 on Juniper pass, I calculated that it would take me 2 hours to climb. I wanted to be at the aid station when it opened. So, I planned to start at 4:30am.

Yep, a bottle of Gatorade and a bottle of water and a double-fistful of energy bars. I planned to replenish at all 5 of the aid stations with additional energy gels and food that were supplied.

The official start was between 6am and 8am. And yet there were already a couple dozen cars in the rider drop-off parking lot at Bergen Park church with other cyclists getting their bikes prepped to go. I was in good company. I flipped on my head and tail lights, and off-we-go, onto Juniper Pass climb.

The first few miles were completely in the dark, the occasional car and police motorcycle keeping us company. Uphill immediately, we settled into a steady pace. The air was cool and still, the pine forest scent calming. I would be getting a huge dose of forest bathing today.

Flashback to training heart rates

This spring was the first time I had been interested in checking my heart rate during cycling. Most of my cycling up to now as on the flats. I enjoyed distance rides from Denver to Brighton and back: 60 miles, or long loops from central Denver to Parker and then Chatfield and back home, about 80 miles. I’m not a fast cyclist, and I never maxed out my heart rate except on brief hill climbs along the way.

I’m generally an optimistic guy. I like to find the silver linings on thunderclouds, I like to seek the win-win situation when a work meeting turns to finger-pointing and raised voices.

It was a surprise, then, to hear a loud pessimistic voice emerge on my hill climb rides. This voice would frequently yell: YOU’RE AN IDIOT. WHAT ARE YOU DOING HERE? ARE YOU ENJOYING THIS? NO, YOU ARE NOT. THERE IS NOT ENOUGH OXYGEN. JUST LIE DOWN, CALL A CAB AND GO HOME. The sudden pessimism was surprising, in hindsight. Was I pushing my body too hard? How could I find out?

My physician colleagues listened patiently when I told them about my internal monologues, and suggested that I get a heart rate monitor. “Oh, yeah? What will that do?” I thought. But, I went home and read about it.

Now, I would need to learn what my anaerobic threshold was, or the modern term being lactate threshold, and try to keep my effort at or below that threshold. Seriously people, the rabbit hole goes very deep and you can read about this online forever.

I found that, instead of purchasing a Wahoo or Polar chest strap for a heart rate monitor, that my Apple Watch would be good enough for my purpose, and that I could link it by Bluetooth to my Ride with GPS app, since the Triple organizers sent out a Ride w GPS map for the route. So be it.

My medical training tells me that “maximum predicted heart rate” is the formula “220 minus age.” MPHR is a good estimate for the heart rate one would have running for your life from a forest fire or a mountain predator: the absolute max heart rate I was capable of. For me, that worked out to 160. Then, the aerobic zone recommended heart rate is 85% of MPHR, or for me, about 145. OK, I thought, lets see if I can keep in this range.

On my first training ride watching my heart rate

I started my steady climb up Lookout Mountain. Imagine my surprise to see my heart rate at

170

No wonder I was feeling terrible. I had already exceeded my MPHR.

I was already climbing slowly at about 6 mph. Fortunately, I did have a larger chainring so I could gear down and then spin my cadence a little easier to slow my heart rate, slow my mph, and watched my HR descend to 155.

Amazingly, I felt better. Science FTW

For the remainder of my training rides, I would watch my heart rate. I would instantly jump up to 160+ at the beginning and then gradually I would shift my gears and pedaling cadence to achieve 150-165 range. I would occasionally hit 170 and then have to pull over, to let my rate slow. During these breaks it would take a minute or two to slow my gasping enough to allow me to take a drink of water, much less chew an energy bar.

Yes, the 220-age formula is only an estimate. I came to understand that if I felt reasonably strong and consistent on the bike for 30-minute stretches with a heart rate in the 155-165 range, then maybe 160 was my lactate threshold.

Having learned these heart rate lessons, I applied them on Juniper Pass, our first 12-mile climb. The sun gradually peeked out and the vistas were spectacular: layers of blue-gray mountains like a Bierstadt painting stretching into the distance, contrasted with blood-orange rays filtering through horizontal shadows through the pines.

I would take heart-rate recovery breaks disguised as photo opportunities. Just like my experience hiking the Quandary 14’er with my kids, starting before dawn, seeing orange light reflected off the bottoms of rocks was surprising and beautiful.

Nerve-cited

Thanks to colleague Tyler Anstett who told me of his daughter’s neologism: “Nerve-cited.” This was a combination of being nervous and excited. I think this should be a real word. I love it.

I built myself a 30-item checklist to ensure I would not leave anything behind for my big day. Part of the list was: Set your watch on Low Power Mode, which, amazingly, turned off most monitoring and display functions, but allowed heart rate to be transmitted by Bluetooth. Perfect.

Back on the climb, heart rate was showing 155-160, exactly where I wanted it to be. No overt pessimistic thoughts, the sky gorgeous, a handful of cyclists nearby starting early with me, seemingly on-track and on-pace.

There it was! I arrived at 6:40am at 1st Aid station. Perfect. I was able to maintain 6mph uphill as expected for the first 2 hours. Bananas, peanut butter sandwiches, water, snack bars, a quick porta-potty visit, and back on the bike. 10-minute break. Check. 

Next, an amazing zoom-y descent to Idaho Springs. I would stuff my mouth with a snack bar and some water, and then spend minutes chewing while coasting downhill. As the hill steepened, we hit 35-40 mph, and I had to squeeze my knees together to stabilize the bike frame. I got into my tuck position and gave thanks for my soft-touch disk brakes that would not overheat on long descents. Thirty minutes of flying down twisty mountain roads, watching the spectacular Rocky Mountain vistas erased some of the mental pain of climbing for 2 hours. 

From the Idaho Springs turnoff, we met a surprising number of cowbell-ringing fans sporting signs: ‘Good job Dad!’ ‘You got this!’ I’m a dad, so I accepted the kudos. Thanks, y’all. 

Idaho Springs to Georgetown was not bad. I sustained 9 mph slightly uphill and felt like I was making good progress. I ate half of a CLIF Kids’ Z-bar every 30 minutes and emptied a bottle of water every hour. Hey, if Alex Honold prefers this energy bar when he goes Free Solo on El Capitan in Yosemite, it’s good enough for me.

I had to remember to eat and drink even when my body wasn’t calling for it. We know from the athletic literature that it is impossible to keep up with energy expenditure and that waiting for hunger or thirst signals is just wrong: by then it is way too late. So, I would eat until my stomach signaled full, and then every 20-30 minutes would force myself to stop, eat and drink even if not hungry. This worked … mostly.

Most of the ride, I kept my HR hovering around 160. When I paused on an uphill for a rest and refuel I let my HR fall below 130 before starting again. This would be 2-4 minutes. Sometimes I would make the excuse of letting a few more riders go by. It was clear, from the languages I heard (Spanish, ?Portuguese, German) that this was an international event. Fascinating. And, quite a few teams passed in synchronized jerseys in single or double-pace lines. 

I constantly had to remind myself to ride my own race. Having started at 4:30, I passed very few others, and in contrast, felt like for every person I passed on the bike, about 50 passed me. Some, jovial: “Hey, nice Davis Double Jersey!” Some, polite “On your left!” Some dead silent, whipping by at twice my pace.

I arrived at Georgetown Aid station 30 minutes ahead of schedule

Could it be true? I had expected that section to take 2 hours and arrive around 9:30 am, and it was only around 9 am. W00t!

However, I knew the worst parts were coming up. Georgetown to base of Loveland was going to be difficult.

Delightfully, we heard the Georgetown Loop train, one of my kids’ favorite activities, train whistle and steam locomotive on its way up. This photo was taken during a training ride up past the Georgetown train bridge. 

After that: pain. The bike trail rises and falls close by the I-70 rise toward Loveland ski resort. There are 12% grade rises on the bike trail. This time, though, I had my heart rate to guide me. 

Here’s where persistence becomes paramount

and distance cycling comes to resemble informatics work. Persistence. Grit. The trail seems unending at this point. We’ve been on the road for 50 miles. we are not yet half way there. The road gets steeper here. I begin my mantra: ‘Go one more mile. Keep a slower pace. Get HR down to 150. Sustain.’ In about 2 hours of steady effort, we get to the base of Loveland ski resort. 

Similarly for informatics work, our big projects (APSO notes, Open Notes, Open Results, Sprint funding, decreasing alert burden, order set synchronization) are long slogs where persistence and grit pay off.

Play the long game.

Lunch!

An eternity later, arrived at Loveland ski area base at around 11:15am, still ahead of schedule. Had a yummy lunch of mac and cheese, bacon, watermelon, energy gels, whatever I could stuff in my mouth. I see Mike Ho, esteemed colleague and Triple Bypass veteran. He started over an hour after me, and caught me at lunch. He looks great. I had shown him a photo of my Davis Double jersey with the big red 200, and he had picked me out of a crowd of 1000 at the rest stop. It was terrific to see a familiar face.

Next up: fill the water bottles with water and Mortal Hydration, a surprisingly tasty electrolyte mix. Fill my pockets with Endurance Tap gels, that are maple syrup and ginger. They’re quick 200 calorie slurps on the road, when I pull over for my gasping rest breaks.

We had National Weather Service alerts for extremely hot days of > 100 degrees in Denver, but in the mountains, despite the full sun, I was reasonably comfortable, with black cycling sleeves over my Davis Double jersey. Pouring water on my jersey and sleeves were an effective cooling method. The wetted sleeves kept cool for 2-3 miles after. However, I would wet the sleeves during rest stops. That water was too precious otherwise.

Loveland Pass: Four miles straight up

Cycling up Loveland pass was brutal as expected. My official time was 1h 6m, averaging about 3.7 mph. My experience alternated between singular focus, breathless recovery, and despair. It was impossible, even in my massive 54 tooth rear gear, to keep my heart rate below 160. I would start, keep as slow a pace as I could, think “this is faster than getting off and WALKING IN BIKE SHOES.” It sure is. I could do this for about 15-20 minutes at a time. 

I paused either 4 or 5 times by the side to gulp down the thin air (10,000 feet climbing to 11,999 feet) and let my heart rate settle from 165 to 130. The views: spectacular.

The base of Loveland ski resort parking lot and blocky Eisenhower Tunnel entrance under the continental divide, visible in the distance. This is about mile 3 of the 4 mile climb.

You can see the Loveland pass cut 2 road swerves away, just below the diagonal glacier remnant.

Gorgeous, brutal ride.

I’m told that Loveland pass is closed only one day per year from 10 am to 2pm, specifically for the Triple Bypass. For this, I am so grateful.

Normally, the Loveland Pass road is driven by sight-seers and also 18-wheeler tankers carrying haz-mat materials or flammable petroleum. They are diverted off of I-70 because they are not permitted to go through the Interstate Eisenhower tunnel.

On THIS day, however, to make the Pass safer for cyclists, they are permitted to go through the Eisenhower Tunnel, but only ONE truck at a time. Consequently, traffic disruption is substantial.

Thanks to everyone. The Loveland Pass ride, brutality and all, was a peaceful event.

I am in the 1%

Looking at the live tracker, the fastest time by the top 15 cyclists up that same stretch was 10 minutes, or 24 miles per hour. 

Later that evening, my wife and son and I marveled over these times. Then we ungraciously decided that these were probably e-bike times. After all, who can ride up a 9% grade at 24 miles per hour?!?!

After the top 15 times under 11 minutes, the next fastest time was 18 minutes. This works out to 13 mph. Yes, I can believe a fit human can do that without battery assist. 

If you rate all riders in the speed of ascending Loveland pass, I’m in the bottom 30 out of the remaining 3000 riders who made it that far.

Okay, surely, I think to myself, I should more appropriately rank against other old guys like myself. Filtering the Loveland ascent list down to 60-69 year old men, I see 300 riders, and I am … … …

Third from the slowest.

Darn, still in in the bottom 1 percent EVEN IN MY AGE GROUP.

Now, I’m a competitive guy, to get to where I am as a physician and a CMIO (surprise!). I am usually in the top 10% or top 1% of my class. Here I am being bottom 1% on the Loveland climb. And, it comports with the 50:1 passing-me ratio on the ride. Where do all these people come from, who clearly have a second set of lungs and endless thigh muscles?  

I have to comfort myself, that at least, I’m a busy and successful physician, not a triathlete. So there.

I notice, that BOTH endurance cyclists AND informaticists love data. Both groups care enough about our respective fields to capture and report the data in ways that we and others can use for analysis, reflection, and improvement. Perhaps the Triple is a salient metaphor for CMIO work.

The top of Loveland Pass, the continental divide at 11,990 feet.

I am breathless and overjoyed at surviving the climb. I snap a selfie. I slurp my water, stuff my energy bar in my mouth and prepare to head down the other side.

Hilariously, I do not notice the salt-encrusted sweat residue over my front camera with resulting “soft focus” of all subsequent selfies. My phone is mounted on my handlebars, is so convenient for navigation, heart rate display, and miles-to-go. It is also perfectly positioned to receive stray sweat from my helmeted head. So, there you go.

I observe that my water bottles were bone dry, and the top of Loveland was not an official aid station. There was a Medical Tent, but no hydration station. I walk over to the tent, mention that my thighs are beginning to cramp up, and did he have an emergency bottle of water to spare?

Yes, he did.

To all medical professionals everywhere who work at events like this. THANK YOU.

Then, I launch down the backside of Loveland Pass toward Arapahoe Basin, Keystone and finally Dillon Reservoir. Flying down back of Loveland I’m worried that I’m down to 30% energy in my theoretical tank despite eating and drinking as I can. 

The beauty of the Rockies continually astounds. My Pink Dog bike mirror (a Sacramento bike shop treasured memento), my Maui Jim wraparound sunglasses, my sturdy Trek Checkpoint gravel bike, my constant-feedback heart rate technology, I love all of this.

I am an Informaticist, Enduro cyclist, and grateful human.

Swann, the surprise mountain

This ride is called the Triple Bypass, for Juniper Pass, Loveland Pass, and Vail Pass. Nowhere is there a mention of Swann Mountain. And yet, here it was staring me in the face. There would be 1100 feet more climbing here, before we even get to the base of Vail pass.

WHY?!

Ok, I admit that I had done this training ride a few weeks ago and remembered Swann to be deceptively difficult. Only 1000 feet but not counted as an official climb. I took my time and did not suffer too much.

Then it was a 10-minute zoom-zoom down to Summit High School and the fourth and final Aid station. Here, I ran into another 1000 riders and saw my friend Tyler Anstett, who had started at 5:45, an hour after me. He looked great. Sorry about the smudgy look on our photo, Tyler. 

Last chance for loading up on double tap endurance gels. I grabbed 3, but should have taken more (ominous foreshadowing!), since this was the last refueling stop. The final stop at top of Vail would only be the Hydration Station. My iPhone battery pack, Zendure, that fit so nicely in my top-tube bag and recharged my phone from 30% back to 80% twice during the ride, had finally given up the ghost by  3 pm. Even my watch, on low power mode, had finally shut down. No more heart rate feedback for the final climb.

The final push to Vail

I was starting at mile 77 from the last Aid station, facing a 12-mile climb to the top of Vail. The ride around the southern border of Dillon reservoir was gorgeous.

Feeling good, I texted my wife, who would have implemented my bail-out plan: “I’m going to DO THIS. No need for early pickup. See you in Avon.” Confidence, thy name is, man.

Then onward. Up the hill from Frisco to Copper, the bike path is a 7-mile slight uphill climb. Every easy 1/4 mile was a gift. If you have young kids, this is a great downhill adventure in the other direction. My kids, aged 8 and 10 at the time, rode with me from Copper to Frisco, all downhill, and my wife was our shuttle. It was a memorable and beautiful ride. 

This time, was it was uphill for me.

I was exuding gratitude. My thoughts:

“I wish that all human lives are full of ease. I wish that all fellow cyclists on the Triple Bypass feel ease. I wish that my next 1/4 mile is full of ease.” 

Then, Copper Mountain! Our family spent countless winters here learning to ski and snowboard in our favorite resort town. Here I am cycling through Copper’s main street, connecting to the next bike trail. Darn camera salt.

Slurping energy gels as I go, 200 calories at a shot, every flat part of the bike trail is a chance to gulp and hydrate.

“Jet powered!”

When my daughter was born she was quite gaseous and farted extensively. We would call out ‘jet powered’ and laugh every time she farted. For some reason, that phrase stuck in my head during the ride, and every time I passed gas, which was frequently, with all the carbs I was consuming, I would say, with increasing volume and confidence each subsequent time: “Jet Powered!”

Remarkably I would laugh at myself and pedaled faster and felt better. Sorry to have alarmed any cyclists near me at the time. 

Then it steepens. Here is a section of 12% grade up into Vail Valley. I remember to turn around and take photos, flimsy excuses for letting my heart rate descend into the 130’s. It is a stunning landscape, with fellow cyclists sprinkled down-valley. Then time for up again.

Still, the constant stream of ‘on your left’ or the silent pass of cyclists.

The steepness takes its toll.

I’m at mile 90 of this ride. There isn’t much left in the tank, despite consuming all my gels. There are NO gels left in my pockets or my bike bag. Just a few ounces of water in the last bottle.

I find that if I look at the horizon, I see false summits all the time. “That must be the top!” Then, nope, I get there and there’s another hill. The brain wants to set expectations based on what it can see. It is hard to avoid disappointment.

On the other hand, I find I do better looking down the path just a few yards ahead, and the wildflowers and grasses adjacent. They are constantly moving past. There is a sense of forward progress. This reminds me of the book The Practicing Mind: Slow, simple, short, small. Looking down, instead of at the horizon, is useful.

I notice that I’m talking to myself out loud. ‘You got this,’ ‘one more mile,’ ‘One mile more,’  ‘you can’t quit now,’ ‘this is your year,’ and ‘look for the fence!” Where do all these sayings come from? Who is saying all this? Is it me?

Because I had ridden this section with Tyler before, he had told me ‘when you can see the fence up there: that’s the top of the Pass’. I was looking for the fence.

(not the same fence)

When I finally saw the fence a quarter mile ahead, I let out a “FENCE! YESSS!” I’m sure the other cyclists were confused and alarmed by my outburst.

I had arrived. At the Hydration Station I loaded up my bottles with water and electrolytes. I had again run out of water during the climb. 

I spotted my colleague Jeff Sippel and his East coast friend. Smiles. We were still alive. Mile 94, and only downhill miles left until Avon at Mile 118.

I must say the support for the ride: aid stations, volunteers, motorcycle police, SAG wagons, signed directions, flaggers ahead of hairpin turns on descents, electronic tracking for ascents and checkpoints and athlete wristbands, food and drink and porta-potties and trash and so on. It was very well run.

Vail summit. It’s all downhill now. Right? Right?

The final descent, as my medical colleague and Vail expert Wagner Schorr noted: amazing. Recently upgraded bike paths swooping in and out of aspen groves and pine forests. Zooming up to and under I-70. Some of the descent was on a repurposed state highway now converted to bike path. I’m sure I hit 45 mph on some stretches.

Once into Vail, I liked that the police had protected all the roundabouts to prioritize cyclists. For once, WE had the right of way. There are MANY roundabouts in Vail.

From Vail to Avon the descent flattened. And yes, dear reader, the last 6 miles were difficult. In hindsight, I bonked and ran out of energy. And, pockets empty, no gels left to refuel, Baaad planning. Frailty, thy name is, man.  

How I felt: looking at the “remaining miles” on my GPS app, it was a question of whether I would finish the ride or my phone’s 12% charge would deplete first. Perhaps you’ve had this feeling. Those last 6 miles took forever.

Arrival in Avon: amazing. The finish gate, the metal medallion for the ride. For the most part, I’m not a trophy hunter. But, my heavy Triple Bypass medallion is now a treasured item.

My physical discoveries at journey’s end:

• A new limp due to R knee pain. (resolved in 48 hours)
• Sitting down risked not being able to get up.
• Stretching my quads risked cramping my hamstrings.
• My neck muscles ached from holding my head up.
• ALL of my muscles wanted my attention.
• The hotel shower: disappointingly, only lukewarm. I got actual rigeurs (shaking chills) from the water temp. I had no energy stores left to regulate my body temp. 
• At the hotel, our dinner reservation was only about 150 feet away from the hotel room and apparently I limped so badly that my son felt obligated to hold my hand getting there.
• When our server asked for our cocktail selection, I interrupted and said ‘Hot water and a tomato soup IMMEDIATELY. Please.’
• That tomato soup was the best I have ever had.

I slept under extra blankets for 11 hours. And felt tremendously better next morning. That evening, conversing with family, was I cognitively impaired, speaking in unedited streams-of-consciousness? Did my executive function and verbal and profanity filters come down? Reader, I will never tell.

CMIO’s take?

To me, the Triple Bypass was many things at once.

IT WAS

• an unthinkable goal and a tangible marker to train for.
• anticipating anxiety and excitement: being Nerve-cited.
• a joyful community of athletes.
• literal peaks and valleys of experience.
• a demonstration that I am not just eyes on a screen and fingers on a keyboard generating 1-pagers and consensus statements.
• the joy of being in-the-moment.
• the joy of stretching the edge of what I thought possible.
• Data used for self-reflection and improvement. 
• Teamwork, friendships, moments of joy. Mindfulness in the midst of chaos

IT IS: an opportunity for storytelling, now and forever

The octopus part of my brain links these ideas to:

• The book: Flow: at the edge of my ability. 14 hours on the bike, with many hours spent at my lactate threshold. And yet, it was a joyful experience.
• In storytelling tradition, as in life experience, there moments when time slows down and everything is sharp. This entire day was a stream of those moments.
• Jane McGonigal’s TED talk. She argues that, unlike in real life, games and sports give us a tangible goal and the payoff of achieving that goal.
• Seigan: The idea of a seigan (誓願), or “vow,” appears in Japanese Kendo and related martial arts and consists of the completion of an arbitrarily long and hard period of training. Tackling something this hard can change your idea of what is possible.
• The book: Grit. Develop the mindset to persist at something to achieve a long term goal.
• The book: The Practicing mind: Break difficult tasks down into 4-S, slow, short, simple, small. Eat the elephant one bite at a time.
• Define your own success, don’t worry about being passed by others

Finally, I was asked: would I ride the Triple again?

My reply: ‘I’m glad I did it, but NO effing way.’