A couple of minutes later Matzger zooms around the final corner into view alone, sprints, and finishes first. No sign of other skaters. After an uncomfortably long pause I thought oh no, Olivier Jean must have crashed, we better go find him in case he’s hurt. I scanned the crowd and they had worried sick looks, so they were thinking something similar. Then Jean appears around the corner and finishes, and some 30 sec after him is the lead pack.

I write this to bear witness to a ferocious sprint by Matzger to conclude a 100 kilometer race. To witness it would have been a treat for the entire world had it the opportunity to watch what I watched. The event deserves TV cameras.

I paused my striding and coasted wheels together a few moments to glance at them, pinch me I am competing on the same track at the same time, and then focused back on the ground before my wheels.

While inline skating yesterday uphill I noticed on the heart rate monitor with my Garmin 405CX GPS watch that my ticker had pegged at about 160 beats per minute (bpm). Even though I didn’t think it’d work, I decided to try an experiment–heck, sometimes you want to junk the theory and go gather some facts.

Since my speed going uphill and my heart rate had both pegged, I thought this meant my body had reached its aerobic capacity, meaning its maximal rate of O2 consumption. But I thought, maybe it has only reached its maximal rate of CO2 exhalation. So I decided to slow down a bit, hyperventilate with4 extra deep breaths, and then get back to speed.

When I kicked to get back up to speed, after about 10 seconds I felt light headed and my vision started to gray out. Whoah. I mellowed out, relaxed my muscles, remained still and balanced on my moving Apache Vaypors, and just coasted. Another 10 seconds later I felt great again, and resumed pumping hard up that dang hill.

So my aerobic capacity was O2 intake limited, not CO2 excretion limited.

Personnel in high performance jet aircraft train to recognize this. At altitude the molecular density of oxygen is diminished, so you need compressed air or supplemental oxygen to breath. If the cabin pressurization is lost or the supplemental oxygen is interrupted, they increasingly lose cognitive function, feel lightheaded, and their vision starts to gray out. If this hypoxia is not corrected, they’ll start to lose brain cells–the critters have but minimal anaerobic capacity–and then, well, if the hypoxia continues there’ll be seizures, coma, and death in as little as 4 minutes. So these personnel have to be able to recognize internally these symptoms in case of equipment failure in time to be able to execute corrective measures.

If the US Navy wants its aviators to recognize and then correct hypoxia in a less expensive way than flying a $32,000,000 F-18 to 30,000 feet burning 3,700 pounds per hour of jet A kerosene, they can have the chaps skate hard uphill, and when they reach their aerobic capacity, hyperventilate and keep skating hard. I’d suggest that they wear full skating protective gear.

The map above depicts a common round trip course I run from Lexington center to Thorndike Park in Arlington, MA, about 11.48 miles round trip. The vertical altitude change is about 220 feet. On the way down you feel great, striding at 20 mph at stretches. On the way back up huffin & puffin just gets you ~12 mph.

The relation of speed across altitude change to heart rate is a measure of aerobic efficiency. Unlike soccer where you run and kick a ball or baseball where you run, throw a ball and hit it with a stick–these are natural hominid activities–skating is an unnatural activity. You have poor instincts as to what is efficient skating technique.  You need to train for it. One way is with aerobic efficiency as feedback.

So I could skate back uphill faster by working harder, gaining greater aerobic capacity, training harder and harder.

My heart rate hits a maximum and plateaus. There is some evidence regarding the predicted maximal heart rate versus age, for example HR_max = 205.8 − (0.685 × age) as summarized in wikipedia. According to these formulae, on the uphill leg I am at my ~max predicted heart rate (I whited out the vertical axis on the left of heart rate to keep my age under wraps).

If you’re at your max predicted heart rate, to go skate uphill faster you need better technique. Indeed, the worlds best skaters are master technicians.

Sometimes when you step back and analyze the data, you find that tunneled focus leads you into a local maximum and blinds you to the possibility of a global maximum elsewhere. Sometimes to perform better, you may need to step back, review the data freshly, and find a different direction. Don’t just skate harder, but develop better weight transfer, use the outside edge more, maybe it’s time to learn the double push inline technique.

In pediatric neurosurgery, sometimes you work under the operating microscope at high power. Let us separate this medulloblastoma from the dorsal pons on the floor of the IVth ventricle. It is adherent, so let’s go to higher power and look for finer yet attachments to release sharply.

When you have an impulse under the scope to go to higher power, ask yourself, should I go to lower power instead and survey the dissection from a more global perspective. Even if the dissection is going well, intermittently you do well to go to lower power and capture the big picture. You may find that there is an easy and safe dissection pathway over the dorsal surface of the medulloblastoma, find the inferior surface of the cerebral aqueduct, leading to a nifty plane between lesion and floor of the IV the ventricle coming from the superior approach. The lesion comes out, patient wakes up great with a gross total resection, and you’ve had a good day at work.

The difference is in the dissipation of the horizontal energy. The lateral friction of a moving body on ice is much less than on asphalt. So if you fall while inlining you will dissipate your horizontal kinetic energy fast, hence your road rash. If you are skating fast you jay be moving in the low 20 mph range. A fall might give you quite a luxurious road rash and even enough to fracture bones, but I don’t think it’d be enough to kill you (unless a motor vehicle intrudes into your workout). If you are ice skating then you will dissipate your horizontal energy slowly. If you have a lot of open space, then fine you can slide to  some relatively distant point down the way as you slowly decelerate. However if you are hurtling toward a wall in some twisted body position then the collision will absorb a relatively high fraction of your horizontal kinetic energy

The map is generally consistent with the observation by Wolfers in the Freakonomics blog that “1) Rich people are happier than poor people. 2) Richer countries are happier than poorer countries. 3) As countries get richer, they tend to get happier.”

Wealth to an important extent is an inherited feature, and where not, how tedious would it be to string to be rich to be happy to be rich to be happy homo economicus ad infinitum?

The wisdom is with the outliers, countries with happiness but not great wealth. Look at Latin America, great outlier region of the world. Many Latin American countries experience greater well-being than for example the much wealthier Italy, Germany and France. This region has a lesson for us. What it is?

Part of what drives us to become neurosurgeons is the passion for taking something that is intrinsically dangerous and making it safe. We don’t want danger for its own sake, for the adrenaline rush–that’s just insanity, and has no place in medicine, neurosurgery, or, for that matter, mountain climbing. But we don’t want a desk job, either.

The passion is for the journey, the process and the discipline.

On several occasions when we operated, we had a chance to chat while stitiching a wound closed. He described his many climbs, such as of Mount Everest, at first from the conventional Nepal route, then from the more challenging (!) China route.

His passion was not for the actual summit, but for the process that made it possible. He described to me the preparation, training, fitness, study, rehearsal, inspection, equipment maintenance, hours spent studying maps, communications, teamwork, and contingency planning. This was his passion. This is what he wanted most to talk about. He trained and trained and imagined himself in various situations and game played the potential outcomes of decisions made. When you’re on the mountain at altitude, you would have to gather information quickly, assess it, make quick decisions and execute them promptly and precisely. He prepared and trained for this ceaselessly.  This is what also was going to make him a great neurosurgeon.

See, our survival as individuals or as a species is not assured. We need individuals who love to seek danger and tame it, because they carry within them an attitude and a method that is essential to all of us. They develop and polish these styles of thinking so that we can learn from them and survive.

But to develop and maintain the knowledge and skills needed to face and tame danger, you actually have to face danger.  Intrinsic to the definition of danger, you risk death or injury. If it’s no longer dangerous, you move on.

So at his death, Dr. John Mislow was pursuing a task that is essential to our survival, in my view. The newspaper reports of his death on Thursday 11th June, 2009 mention that he and his companion, Andrew Swanson were roped together when they fell 16,500ft height to 14,500ft to their death when on Mount Denali (McKinley) in Alaska. If I were climbing that mountain, I too would have wanted the safety of being roped to John Mislow.