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The Sports Insider
A Life Among Champions
By Jack Ralston, Steve Kilgallon
Allen & UnwinCopyright © 2011 Jack Ralston and Steve Kilgallon
All rights reserved.
A SECOND CHANCE
Better than before
'WE REALLY didn't expect him to make it. We got called to the hospital a couple of times, saying you'd better make it quick.'
That's my brother Bill. I've allowed him the first say in this book, simply because I can't tell you how ill I was. I was in too much pain and dosed up with too many drugs to be aware of the severity of my situation. I wasn't really aware of much for those few days while my family waited anxiously by my bedside.
As early as 2004, I had been diagnosed with a rare blood disease, myoproliferative disorder, which caused my body's oxygen-carrying red blood cells to fail. At first, doctors could manage my condition, but slowly my levels of haemoglobin, which transports oxygen around the blood, dwindled. After six years with the condition, it became apparent the only way to survive this disease was to undergo a complete bone marrow transplant; a high-risk procedure because there was a substantial chance my body would reject the donor marrow. But without the transplant, I would die. I was 62, two years beyond the usual upper age limit for the procedure, and the survival rate at my age was a mere 30 per cent.
Despite those odds, I never once thought I was going to die. I knew I could die — the doctors had spelled the risks out very clearly — but never once did I think I would fail. In my mind, I thought we would get through it, and move on. It's the way I approach life: it's like a race. You could get beaten, but you never think you are going to be. Never once do you think you will get your arse kicked.
Marg Ralston, Jack's wife: He was pretty bad at one stage. It was grim and the doctors had told me they didn't think his new cells would engraft. It was time to tell our daughters just how bad things were. And I can remember sitting at his bedside feeling a little guilty that sometimes I would complain about the amount of time he spent running. It was because he'd done all that running and stayed fit that he qualified for the transplant and got through it. In a way, he was in training for this transplant.
Bill Ralston, Jack's brother:The level of suffering was huge, and the cure was almost worse than the disease, except he survived: you'd be really pissed off if you went through all that and died! There were days there when I didn't expect he would pull through but he was incredibly stoic and took it as a challenge. Like a big hill in one of his runs, one step at a time.
As I lay in my hospital bed, slowly, painfully beginning the long recovery, I thought about my life and the heck of a journey I'd enjoyed. When I did, abstractly, consider and reject the possibility I wouldn't make it, I asked myself: 'What have I achieved in my lifetime?' And I felt some peace from the thought that I'd had a wonderful life, shared with some wonderful people.
I've met the Queen, Nelson Mandela, Michael Jordan and Tiger Woods, the All Blacks and the Brazilian football team. I've worked with the world's biggest sports brand, Nike, in the Far East, South Africa, America and Australasia, and helped some of their most innovative, exciting projects with star athletes and elite teams come to life. I've coached over 300 athletes, who between them have won more than 100 national titles, and seven of them were Olympians, including a gold medallist. I've led some of New Zealand's major sports governing bodies, worked at the heart of the New Zealand Rugby Union and seen an All Black World Cup campaign from the inside. I married a wonderful woman and we raised two fine daughters. It's been a good journey. And that's what this book is all about. But first, how I came to still be here ...
FOR ABOUT four years, I had been feeling increasingly tired and listless. It was during my annual check-up that my doctor, friend and former runner, Brett Roche, discovered that my haemoglobin levels were low. He referred me to a specialist haematologist, Claire McClintock, who conducted a series of tests and monitoring to find out what was happening. The worst of these procedures was a bone marrow biopsy. They screw a needle into your hip bone to remove a bone marrow sample, and while they can anaesthetise you as far as the bone, once the needle pushes inside that bone, you really feel it. Anyway, that's how they discovered that I had myoproliferative disorder and that it was slowly destroying my haemoglobin and could develop into cancer. Having suffered during my running career from low blood counts as a result of heavy training, I had simply assumed that I was suffering from something similar. Having been fit and healthy all my life, I had certainly never expected that diagnosis. Claire McClintock's words felt like a sledgehammer.
Marg Ralston:We had no idea it could end up as a cancer, it didn't enter our heads. He was extraordinarily tired ... [but] when they told us what it was, we were stunned, because he still wasn't showing symptoms to be that concerned about. It was a huge shock.
Following the diagnosis, McClintock referred me to specialist David Simpson at North Shore Hospital in Auckland, whose staff monitored me closely over the next two years. My haemoglobin continued to drop, eventually becoming so low that I had to be given blood transfusions, at first monthly, then fortnightly. Even with the transfusions, the levels kept falling and I was referred on to the head of the haematology department at the Auckland City Hospital, Richard Doocey. It was Dr Doocey who produced those mortality graphs. When he told me about the survival rate, I remember taking a big gulp. Then Dr Doocey told me that 60 was the age limit for a transplant, because after that the risks are too high: I was too old.
Giving me some hope, he said it all depended on how healthy my body was. They ran some physiological tests on me — including analysis of my lung capacity, chest and heart scans, a skinfold fat test and blood pressure measurements — to see whether they could make an exception.
I've always exercised regularly, don't smoke and don't drink much and the results of those tests, Doocey told me, showed I was as fit as the average 35 year old. He was prepared to nominate me for bone marrow transplant, and he successfully argued my case with the panel of doctors who make the surgical decisions. If he hadn't advocated for me, I reckon I would have had, at the most, three years to live.
There were some delays in arranging the transplant, so I kept going for my weekly blood transfusions. Determined not to let my illness slow me down I decided I would be well enough to go to the 2010 world triathlon championships on Australia's Gold Coast in late September because several of the athletes I coached were competing.
By the time I got home from Queensland, I was exhausted, and rather than running, I was barely shuffling. I headed straight to North Shore Hospital, where they were quite stunned I'd even managed to walk in. A typically healthy haemoglobin measure is between 130 and 170 grams per litre — mine had dropped to a mere 40 grams. There was so little oxygen getting to my muscles, that I had absolutely no energy. I felt like I'd run a marathon every day, even though I was doing very little.
Marg Ralston:When I picked him up from the airport, I couldn't believe how awful he looked. I didn't know how he was managing to walk; if he wasn't holding on to a trolley, I don't think he could have.
Before I could get a bone marrow transplant, I needed a donor whose tissue type matched mine. The obvious place to start was my close family. My brother Bill was a roughly one in four chance of being compatible, but tests showed he wasn't. For complicated genetic reasons, the possibility of my daughters, Kerryn and Nikki, being a match was so remote they didn't even bother testing them.
None of the 8000 potential bone marrow donors in New Zealand were a match, so the transplant team consulted the international network of donors, which extends to 14 million people. There are ten genetic markers which they assess to find a match, and they need at least nine to tally. Finally, in December, they found a compatible donor in Germany. I knew there was a long way to go, but it was a thrill that they had found someone so close a match.
A nurse was despatched to bring the donor's cells to New Zealand, ensuring the blood was kept at a constant temperature throughout the flight.
Dr Doocey set the date for the transplant for 8 January 2011. I went into Auckland City Hospital the day after New Year's Day. For five days, I sat up in bed, reading, listening to music, enjoying myself.
That all changed once I was given a huge dose of chemotherapy. The chemo left me with no immune system, and caused chronic mucositis — huge ulcers ran from my mouth all the way down my oesophagus. I had diarrhoea. I couldn't eat and began losing weight dramatically, so they inserted a feeding tube up my nose and down my throat. At first, the line went too far and went into my upper bowel causing an infection. Then they began dosing me with the big stuff — serious painkillers ketamine and morphine — and I began to hallucinate. As the ulcers worsened, nobody could understand what I was saying, and because of the drugs, none of what I was saying made any sense anyway.
The ketamine caused some strange behaviour. I would have some amazing dreams, then some horrific ones. There were several times those nightmares led me to attempt to escape. I packed my bag then walked out holding all the different lines attached to my body, and told the nurses that I was ready to go home. They would coax me back to bed, explaining that I couldn't go home until all the tubes were out.
So one night, I ripped out all the leads, including my feeding tube, packed my bag — I remember none of this, but the nurses assure me it's true — and stood at reception, saying, 'The tubes are out, I'm ready to go home.' Apparently, there was blood everywhere. All I can remember was getting back in bed and seeing the poor nurse mopping the floor. I looked at her and said, 'You're a mucky bugger, what have you done?' Clearly unimpressed, she responded, 'I could hit you over the head with a mop'.
Marg Ralston:We've got some very funny stories about his drug induced state. Just the other day, he was clearing his phone and he found a lot of text messages in his draft folder from when he was in hospital that were all absolute rubbish. And I knew he made some phone calls and people assumed it was a crank caller because they couldn't understand him.
At his worst, our daughter Nikki and I would stay alternate nights, but get no sleep. Jack would always be awake at night, and he'd sit up on the end of the bed, swing his legs around and then start falling asleep. You'd have to manoeuvre his legs back into bed because he couldn't lift them himself. As soon as you fell asleep, he'd be up again. I did look to my late mother for inspiration. All through my childhood my father was sick and he died of cancer at 57, when I was 19, so my mother basically raised seven children alone. Since having children of my own I thought, 'How did mum cope with seven of us?' That helped me.
I would ask the doctors, 'Is this normal?' They'd say it was within the normal range. Jack makes light of everything. When he came back from Australia really crook and one of the boys [his athletes] would ring and say, 'How are you?' and he'd say, 'I'm good, I'm great' and I'd say 'Jack, you're almost dead on your feet!'. He's really positive and I think that's what's got him through these past two years.
I can appreciate now the torment the family suffered as my body appeared to reject the bone marrow and my condition worsened.
One night, I can recall a great flurry of doctors rushing around in the room next to mine; in the morning, the guy wasn't there anymore. That hardens you up. Even faced with the reality of death, I still had no doubt I would survive. I had a will to live, to see my family grow and bring love back into our lives.
Just before I went into hospital for the transplant, our eldest daughter Kerryn had suffered a major car accident. She'd been driving along the motorway when some idiot cut her off, and she rolled her Land Rover. The crash left her with a fractured skull and neck, and broken wrist. Marg had to look after Kerryn and help with her daughters while visiting me every day.
The transplant itself was actually an anti-climax after the dramas which had preceded it. They just hung up a blood bag and it's pretty much just like any other transfusion. Within an hour, it was done.
Marg Ralston:They say it takes anything from ten to 28 days for the transplant to take, but the average is 14 — that's when they usually see the numbers of neutraphils, your immune cells, start to climb. So each day he was tested, and we were just waiting on those results. He couldn't eat or drink, couldn't talk. He was a complete mess. He was in such a bad way they thought they would have to do something to stimulate the cell growth or he wasn't going to make it. They gave him a drug to do that, but for two days, it showed no sign of working, and that's when they told me they thought the graft wasn't going to take. They tried one more dose of the drug, and the next day there was a glimmer of light in the numbers. Without that stimulant he wouldn't be here today.
It was a slow, painful recovery. Everything had to be done for me at first, I had no strength at all; I felt utterly spent. Taking a shower took an hour. Just walking was an achievement: getting out of bed, walking to the door, turning right, walking five metres, and walking back again would completely wipe me out.
Then one day, Hamish Carter came to visit me in hospital, bringing with him his gold medal from the 2004 Olympics in Athens. He hung it from the TV stand and said, 'This stays here until you walk out'. Then he got me in a wheelchair, and wheeled me out for my first trip outside around the hospital grounds. It was a huge boost for my morale.
When I was released after six weeks in hospital, my weight had dropped 22kg to just 56kg. I had lost all my hair and I was gaunt. I had no immune system, so several times I was re-admitted with infections.
At first, my target was to walk up the driveway to the letterbox and back. It was probably a month before I could walk properly, and three months before I was totally independent and could do everything for myself; until then I was totally dependent on Marg. I would go through stages of feeling pretty good, then they would put me on the next course of medication and I would realise that I had taken another step up. Each time, it would mess with my short-term memory — we nicknamed it Chemo Head. If it was frustrating for me it was probably even more frustrating for Marg and the family. They'd ask me a simple question and I wouldn't have a clue. I'd leave the bedroom knowing I needed to pick up my wallet and watch. By the time I'd get downstairs, I'd have completely forgotten and then I'd have to go back upstairs.
Marg would send regular emails to family and friends, and kept every reply in a file for me to read later, when I was feeling better. Reading over these emails made me realise I had a lot of great friends. Two long-time Nike colleagues, Mike Wilskey and Geoff Hollister, had also been going through their own personal battles with cancer. Both of them were very supportive, and Geoff put me in touch with the One World Foundation, the cancer charity established by Lance Armstrong, and they sent me a superb manual all about cancer, which provided answers to every question you could possibly have.
One thing I learned from reading the Armstrong Foundation book was to live each day, for that day. Don't look forward and don't look back. Just get through that day and let tomorrow take care of itself. Don't worry about what happened yesterday. Live for now.
I used to get stressed about the politics of sport, the selection dramas, the battles with bureaucrats, the infighting and bickering. Now I don't bother. Life's too short; live for what you're doing and have fun while you do it.CHAPTER 2
THE EARLY DAYS (1946—63)
Yes, I want to tempt to you swim against the tide. I want to pass on to others, to younger folk, the taste of hard work, for improvement.
THE COUNCIL had laid off Mr Clayton, the night soil man, who came in his old Bedford truck on Wednesday evenings to collect our 25-gallon drum of human waste from the kerbside. Once Mr Clayton was gone, the council wouldn't give us permission to install a septic tank either so my dad wrote to them and asked what they thought we should do with our waste. The reply came that we should bury our sewage in the back garden. It did mean we had the best tomatoes and beans. That was Northcote on Auckland's North Shore back in 1963: it was quite primitive.
Over the years, I've lived away from Auckland — in Wellington, Hong Kong and Korea and I've spent long spells in the US during my career — but now I'm back living within a few kilometres of the home where I was raised.
When I was a child, the Harbour Bridge had yet to be built so North Shore residents still went into the city by ferry. Back then the lower shore suburbs of Northcote, Birkenhead and Glenfield were rural idylls with expanses of native bush, market gardens, and in particular, strawberry farms.
Mine was the third generation of Ralstons to live in Northcote. My paternal grandfather William Henry Ralston was a gumdigger — a tough job undertaken by European settlers in the late 19th century and early years of the 20th century, who dug for fossilised kauri gum. He went by the apt nickname of Ruka, a Maori word for loud and verbose. Ruka leased a big Northcote strawberry farm from the Catholic church, but lost it during the Great Depression when he couldn't afford the rent. He still had five acres of land in Northcote, where he grew strawberries and pumpkins but went to work for the council digging drains, a job he held until he was 74. He suffered a stroke at 80, but lived another ten years and even when he couldn't speak much he would laugh and laugh when anyone came to tell tales of the old days.
Excerpted from The Sports Insider by Jack Ralston, Steve Kilgallon. Copyright © 2011 Jack Ralston and Steve Kilgallon. Excerpted by permission of Allen & Unwin.
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