The Edge of Endurance

In the prologue of Heart of Darkness as Marlowe drifts on the Thames he laments “at the time there were many blank spaces on the earth, and when I saw one that looked particularly inviting on a map (but they all look that) I would put my finger on it and say 'When I grow up I will go there.' ... True, by this time, it was not a blank space any more. I had got filled since my boyhood with rivers and lakes and names. It had ceased to be a blank space of delightful mystery--a white patch for a boy to dream gloriously over.”

That was over a century ago, and now as the edges of the unknown seem even more distant, epic journeys have almost come familiar. Not that you should travel up a river to see the dangers of colonialism - we are learning this in a desert instead, but there are now training programs for our personal physical limits, clubs that train together for Ironman distance triathlons, sherpas to help with major peaks, and cushy vacation packages that follow the Tour de France and practice the same hills. Instead of black ink, our world is being marked by chalked arrows, mile markers, and first aid stations.

But that edge is still there. There are impossible distances; like ultra-marathon runs, twenty-mile swims, and cross-country bike rides; as well as exotic places; such as Death Valley or the jungles of Borneo that linger both in our childhood consciousness and adult apprehensions. The most difficult of these races combine both of these elements. In March I traveled north with the Team in Training cross country ski program to see the start of one of the most challenging events on Earth, the Iditarod, and perhaps see one of the legends. The race has produced its share. Rick Swenson has won the race five times in three different decades. Col. Normal D. Vaughn completed the race at the age of 86. But the most famous of them is Susan Butcher.

The event is a 1,161-mile journey across the top of the world, over two mountain ranges and endless tundra. The sleighs are pulled by up to sixteen dogs, which is twice the number of reindeer that Santa uses. Granted he is only going long for a single day, and the Iditarod in a best-case scenario is an eight-day affair.

To succeed at endurance races requires months of training to gain not only fitness but also wisdom to make the correct series of decisions when racing in the artic. The choices that the mushers have must be brutal, a constant tradeoff between resting and pushing against the cold. Against the muted tones of wintertime and deprived of sleep the mind wanders, and the victors have to fight against the strong survival instinct to stop with the mental tricks they have practiced.

The ability to keep sharp is critical, because sledding isn’t just a physical task but a managerial one as well. The modern CEO dreams that all of his employees could be roped together and pull him towards greatness. A musher has to do this without the benefit of a stock option plan.

And like a CEO, a musher also needs to be an expert navigator. Rule 37 says mushers are restricted to traditional forms of navigation. Electronic or mechanical devices that measure speed and direction are prohibited i.e., Loran, night goggles and GPS. The rules have not been updated for IPods, but the call of the wild isn’t heard with headphones. It is the sound of paws on snow, and the swish of sleds on ice.

Susan has won the race four times, and was the first person to take a dog team to the top of Denali. She had an article written about her in the New Yorker, became a spokesperson for dog food, but still prefers life out in the deep bush than the comforts her fame brought her.

The one race that got away from her was when a crazed moose attacked her in 1985. The beast came into the team and started kicking the dogs. Susan held her off with her axe and parka, but the moose managed to kill two of her dogs and to injure 13 others. She spent the next two weeks in the hospital saving the lives of the injured dogs.

It would be tempting to say was her toughest trip to the hospital, but in December Susan was diagnosed with acute myelogenous leukemia (AML). With current standard chemotherapy regimens, approximately 25-30% of adults younger than 60 years survive longer than 5 years and are considered cured. It is a brutal thing to get.

The boundaries of the natural world maybe smaller these days, but the human condition is still frail. Just as we once learned the safe trails to travel the wilderness, this century we are learning the routes around the map of the human genome. On the sixth chromosome is the major histocompatibility complex (MHC) region, a collection of genes that determines the proteins on the surface of cells used for the immune system to recognize its body’s cells. Cells that don’t have those protein markings, say of a parasite, are attacked like a moose going through a pack of dogs. The trick of transplants is to transfer organs that have the same MHC proteins. In the case of a bone marrow transplant, if the marrow is not completely compatible, the new cells can also attack the body – a graph versus host rejection.

Susan and her supporters looked for a bone marrow match. Her two daughters and sister were tested, and the hope was that whatever the allele is for bravery on midwinters nights that manifests on her cells was out there with someone else. If the Iditarod is about a solo voyage using crudest of navigational technologies, the race against cancer is the opposite of that. It is a journey of a community, a network of support that uses the best of friendships to ease the burden and the best of science to help find a cure.

But both are long to point of blurring. She took on the treatment with the same determination she always has. Her husband wrote :

You can imagine a walk with Susan though. She will not go on a usual walk. We of course have to push her chemo cart around wherever we go. I asked for the all wheel drive off road type but they didn't have any so you can imagine what it was like. There we are hauling the cart over mud puddles, through the brush, up hillsides, down gravel roads and finally through a fence and up some stairs to get back to the hospital. As a result of my experience I have and idea that I am going to try to market to the medical supply companys.

The CHEMO BACKPACK. This is the latest inovation for those active cancer patients who don't want to hang around the ward pushing their carts. You just strap this handy device on your husband or wife and take off.

A few weeks later they found a match and on May 16 she had the transplant. But about a month later the newly planted immune system began attacking her. The doctors managed to suppress the new immune system from attacking her stomach, but in this weaken state the AML returned. Her husband wrote:

I cannot describe what this weekend has been like. Even if I could I don't think I would for a long time. Seeing someone you love in pain is too personal to share. Seeing the mother of my two small children struggle to be brave for them. Seeing the kids treating there mom with the same gentle compassion that they would a new born baby. Hearing the youngest one cry for her mother at night. Seeing the older taking on a mothers roll to care for her sister. Thinking of these things is almost to much to bear.

If Disney were writing this story, Susan would recover by the love of her dogs and her two girls, Tekla and Chisana. They do one last race and someone manage to go the distance against the tundra and then credit would roll as Hillary Duff sang.

But these are not the sounds of this story. Conrad’s book spins a darker fate to the champions of the frontier. On Saturday Susan Butcher passed away.

I want to believe that Marlowe was wrong about the edge of the natural world; there are worthwhile boundaries to explore. The last century came not only with the brutality that he found in the jungle but also with the achievement of voyages to the major peaks of the world. In our new century we will struggle with the power of biology as the last one did with the dangers of atomic physics. These boundaries are never approached easily for the edge of endurance is at the threshold of human tears.

We lost one of our bravest.