Blood (13 page)

After Hamilton's first blood withdrawal, for which he flew in Armstrong's private plane from France to Spain so that they could conduct the clandestine procedure without detection, he, Armstrong, and another teammate went out immediately for a bike ride along the Spanish coast. At the time, Hamilton was in the best shape of his life. He had just beaten Armstrong to win the prestigious Dauphiné Libéré bike race, including a gruelling stage victory up the notoriously steep Mont Ventoux in France. But on this day in Spain, just minutes after having their blood withdrawn, Tyler Hamilton and his teammates could barely ascend “a tiny pimple” of a hill. “We joked about it,” Hamilton writes, “because that was all we could do. But it was unnerving. It shook me deeply: my strength wasn't really in my muscles; it was inside my blood, in those bags.”

Indeed. As we learned from the Olympic debacle of triathlete Paula Findlay, whose anemia sucked the vitality right out of her on what was supposed to be one of the biggest days of her life, there is much power in blood. Athletes don't merely require killer quadriceps, reflexes like cats, and lungs like bellows. They also need great blood.

To succeed at the elite international level, and possibly make millions of dollars in prize money, appearance fees, and sponsorships, elite international athletes must pay close attention to their blood. There are ways to alter the composition of your blood legally, which is to say, ways that do not contravene the rules of the World Anti-Doping Agency, established in 1999 to promote the fight against doping in international sport.

One way, of course, is to train very hard. This will teach your blood to transfer oxygen more efficiently to cells in the muscles. Another way, which offers at best minimal gain, is to sleep in a well-sealed tent with a reduced supply of oxygen. This also teaches you to cope with less oxygen, thus making better use of what you have. Another technique, which offers the possibility of greater advantages than the oxygen tent, is to get on a plane and fly to an altitude camp — perhaps in New Mexico or Kenya — and to spend several weeks training there. Both techniques involve driving up your red blood cell count.

People who are in the business of measuring athletic progress in endurance sports will regularly encourage athletes to get their blood checked for hemoglobin mass (the actual amount of the red, oxygen-carrying cells in the blood) and hematocrit level. Exercise physiologist Trent Stellingwerff of Victoria, B.C., who specializes in advising athletes about optimal training techniques as well as legal physiological and dietary interventions, told me that his wife, Hilary Stellingwerff, tried to maximize the benefit of high altitude training by returning to sea level exactly fifteen days before her heat in the 1,500 metres at the 2012 London Olympic games. The extra blood cell count derived from training at altitude lasts only so long, he said, so they had to time the altitude work precisely. She made it through to the semifinal two days later, but missed qualifying for the final by just one spot.

Another legal way to expand the blood's capacity to work well under exercise is to train in heat. The stress of heat training leads the body to increase the amount of plasma in the blood. When you increase the plasma and total blood volume, you might be more successful at warding off dehydration and perform better in a race on a hot day.

Altitude tents, training at altitude, and training in the heat offer the opportunity to bring marginal improvements to one's red blood cells and plasma, Stellingwerff notes, but they do not offer nearly the advantage of a blood transfusion: “There is no comparison. The advantage of the transfusion is immediate and large (about a ten- to fifteen-percent increase), and you don't have to spend months at altitude to get it.”

Prosecutors have been known to manipulate, suppress, or ignore evidence in order to obtain criminal convictions in court. Defendants sometimes lie. People cheat in business, every day of the year. Writers invent phony stories and label them as non-fiction, in order to attract more attention and readers. Teenagers lie; students, professors, and even school administrators plagiarize; presidents surreptitiously record the conversations of their political adversaries; and politicians of every stripe fabricate stories to protect themselves. Deception permeates human society. Athletes — especially those of the elite variety, who are in a position to earn huge sums of money — are no different. Some will be honest, and others will not.

Testing for performance-enhancing drugs and doping is improving every day. The World Anti-Doping Agency is now making use of a biological passport, which provides a sort of molecular and physiological blueprint of an athlete's blood values over time, enabling experts to arrive at conclusions about whether any given athlete has cheated, regardless of whether they catch a banned substance in their blood or urine. Using ever more sophisticated technology, testers will continue to chase athletes, some of whom are indeed cheating but will manage to avoid detection. But the athletes and their coaches and medical advisors are sophisticated and strategic too. To date, they have been the ones to develop ingenious ways to cheat. Sometimes, the testers catch up faster than the cheaters anticipate.

Here is one stunning example of magisterial deception. When Lance Armstrong had banned substances in his body and learned that a drug tester was setting up shop in his hotel lobby, one of his doctors slipped past the testers, retrieved a saline solution, stuffed it inside his jacket, and snuck it back into the hotel. In the privacy of Armstrong's room, and before the tester was ready, the saline solution was hooked up to the cyclist and allowed to drip into his blood. This drove down the hematocrit in Armstrong's blood — changing the percentage of red blood cells in relation to plasma — thus making the cheating impossible to detect when Armstrong was required later that same day to submit a test. For years, Armstrong used the argument that he had never tested positive — not completely true, by the way — to protest his innocence and deride those who didn't believe he was riding clean. But the only reason he didn't get busted for testing positive was because he and his advisors managed — for a time, and only for a certain time — to stay one step ahead of the testers.

In the end, Armstrong was dethroned by many bits of evidence that had little to do with the accuracy of laboratory tests. For example, fellow cyclists Tyler Hamilton, Floyd Landis, and George Hincapie testified under oath about the doping they had done and seen Armstrong do. They testified, as well, that he not only took drugs and doctored his blood but compelled cyclists racing for him — cycling is a team sport, with one leader supported by a cast of “domestiques” — to do the same. But Armstrong was also undone by the testing laboratories. Years after his final Tour de France victory, in 2004, testers were able to go back and review his old samples again, using more advanced technologies than had been available when the samples were taken. In this way, they found incontrovertible evidence that Armstrong had indeed used performance-enhancing drugs and banned processes. When the truth could not be suppressed, Armstrong came clean on television, in two back-to-back confessions to Oprah Winfrey.

It is too soon to say what will become of Lance Armstrong. It had once been rumoured that he would enter politics, but it is hard at this time to imagine him persuading voters that he is a credible candidate for any public office. More interesting, to me, is the future of international sport. We have seen many ugly incidents in the recent history of sport: the Tour de France and its multiple drug scandals; the dethroning of Ben Johnson. It should be noted that we are not just talking about men. In the 1980s, there was such rampant cheating in sprints and field events in women's track and field that many of the records set back then remain completely out of reach by today's most successful women athletes. Contemporary female athletes are tested far more rigorously than were their counterparts three decades ago, and are able to get away with far less use of testosterone, steroids, and other aids.

Will we one day give up, and agree that cheating is a fact of life? Will we simply allow the best-conditioned athletes to use the best cocktails of blood, drugs, and genetic alterations and see who ends up on top? I doubt it, and I hope not. We won't allow our athletes to cheat with impunity any sooner than tax authorities allow offenders to lie on their tax returns, or voters allow liars to return to public office.

Will we convince more athletes of the health risks associated with performance-enhancing drugs and blood transfusions? Some of the related dangers include liver damage, blood as thick as sludge, heart damage, and heart attacks. It is imperative to educate young athletes, especially, about the danger of playing with drugs to enhance their performance. We can't let those efforts flag. But let's be honest. Most people who cheat know what they are doing. And to hell with the consequences, especially if they win.

As long as the benefits associated with success in sports are substantial, and the risk of getting caught appears minimal, I suspect that the ways some people pursue changes to their blood composition will be no different than the myriad other ways that some people try to weasel ahead in every other arena of life.

BLOOD, IN ALL OF
ITS IMMENSE COMPLEXITY
, has become merely another field in which we can try to gain an advantage. If we can gain this advantage by playing within the rules of the day, we are considered to be of moral character. We are unlikely to lose our medals, be banned from competition, or be shamed publicly. Now that we know just how vital our oxygen-carrying hemoglobin is, and how necessary water is in our plasma, we will find it increasingly easy to boost the blood or manipulate a gene. Those who believe in fair play — not just as role modelling for children, but as an approach to living well at any age — will continue to feel hurt and betrayed by the deception that some will employ to nab an Olympic gold medal or pocket all of the money and fame that comes with winning the Tour de France. We will continue to be astounded by the ingenuity of those who behave as if the end justifies the means, and we will be comforted and encouraged by detectives of the blood, who will occasionally not just catch an individual scammer but bring down entire networks of deception. The audiences — in the Olympic stadium, or seated before their own televisions and at their computers — will cheer loudly and vociferously for the noble winner, but they will jeer, prod, and mount a ceaseless moral attack against any hero who is brought down for having manipulated his or her blood. Don't believe me? Just ask Ben Johnson and Lance Armstrong. They played with their blood. And they were found out. And they were ruined.

There are drug testers and there are those who decide to strip former winners of their medals. But there is also the court of public opinion. In that court, if you alter your blood to win on the track, or on your bike, you have made a pact with the devil. To win a medal and a few million dollars, you allowed your morality — your very blood — to become impure. The devil will dance with you, and when your time is up, he will dance on your grave. But what about the friends, the lovers, the children, the former elementary school teachers, and all the unnamed armchair athletes who cheered for you as you transcended the challenges of cancer or poverty to inspire us with the magic of your strength and your resistance to pain? Their judgements will last forever, and in their eyes, there is only one observation. Once you were pure, and then you were not.

The world of sport serves as the perfect mirror. We look into it and we see our deepest values either respected or trashed. Blood, to us, is sacred. We offered it to the gods for thousands of years. In blood, we see the brightness and the movement of humanity. We open up a hole in our arms and give it away to extend the life of someone we will never meet. There is hardly a substance we hold more dear, or consider more valuable, than our blood. This is how much blood matters: even non-believers treat it as sacred. We want our sacrificial gestures, our gifts, our artists, our scientists, and our athletes to respect blood. In a world where we fret that nobody seems to care about anything, blood still counts. And we want it clean. As clean as spring water.

THREE

COMES BY IT HONESTLY:
BLOOD AND BELONGING

IN
1979
— JUST
A YEAR OR TWO
before stories about
HIV
and
AIDS
began to appear in the media — I travelled as a volunteer with Crossroads International to spend the summer working in Niger. The country has a population of about sixteen million people. It is the largest country in West Africa, consisting mostly of the Sahara Desert and including a small, more densely populated, arable strip in the south of the country. Niger often enjoys the dubious distinction of being named one of the poorest countries in the world. It was my first trip to sub-­Saharan Africa. I was twenty-two years old. I thought I had embarked on the adventure of a lifetime, but did not expect that the journey would be an introspective one.

I was travelling with six other Crossroads volunteers — all white francophones from Québec. I liked and trusted them, and some of them have remained good friends for more than three decades. However, as soon as the plane landed in Niamey, Niger's capital city, and I stepped down onto the tarmac, I felt not just an oven of heat but also an explosion of unanticipated emotion. My very molecules, it seemed, screamed with desire to connect with the people of Niger. I longed for their acceptance, and for their recognition of my own ancestral history. Through my father's family, my ancestry dates back to the abduction of millions of Africans who were shackled and shipped against their will to be enslaved in the United States. I had grown up in a mixed-race family in a white suburb. By the time I was twenty-two, I had been searching for years to cement my own growing sense of black identity, and this was my first opportunity to travel meaningfully in Africa.

In the Americas, if your black ancestry dates back to Africa prior to the transatlantic slave trade, you can't return to connect with your distant relatives in the same way that a Polish-Canadian might go to Kraków, or an American or British citizen of Chinese descent to Shanghai. You have a general idea of who your people are, but this is made abstract by the diversity of the continent. Africa is the second-biggest continent in the world. It has fifty-four countries and one billion people speaking countless languages, celebrating many cultures and religions, and embracing a range of lifestyles. Africa is so big and complex that it is no more meaningful or helpful to generalize about it than it is to generalize about the entire planet. So if you happen to be a black Canadian, American, or Jamaican whose people came to the Americas via slavery, chances are next to zero that you will track down the exact villages of your distant African ancestors.

Alex Haley became one of the world's most famous writers for appearing to overcome these barriers in his novel
Roots
. First published in 1976,
Roots
purported to trace Haley's African-American family history all the way back to a man named Kunte Kinte, who had been abducted from the Gambia and sold into slavery in the United States.
Roots
sold millions of copies, was adapted for a major television miniseries, and encouraged a tidal wave of zeal among African-Americans and others who felt inspired to track down their genealogies.

Later, Haley paid to settle a lawsuit having to do with plagiarizing the work of another novelist, and he was roundly criticized for having used an unreliable griot, whose role is to memorize and recite many generations' worth of family and village history. It is possible that the griot was bribed to drum up a convenient story about Haley's family connection to Africa. In fact, Haley was so criticized on these fronts that, although his novel stands out as one of the most famous twentieth-century African-American literary texts, it remains excluded from the prestigious
Norton Anthology of African American Literature
.

Most people I have met who read
Roots
don't appear to care that the family history was somewhat fictional. It was a novel, after all.
Roots
still stands out as
the
twentieth­-century literary celebration of the deep ties between America and Africa. It certainly had burrowed deep into my own soul by the time I found myself exploring the streets of Niamey.

In my first days there, while we stayed at a centre for young people and waited for the signal to begin a rural tree-planting mission, I took every opportunity to slip away from my fellow volunteers from Québec, and to meet one-on-one with the people of Niger. Every morning, I ventured to a street corner to drink the coffee made by a man named Moussa. He was young and friendly, and asked me a million questions, and taught me a few phrases of Djerma, his language. I spent several mornings in Moussa's company, sipping a bizarre mixture that he called “café” but which contained instant coffee powder, a tea bag, sickly sweet and syrupy condensed milk, and water that had been heated over a three-stick fire. I kept returning, anxious to learn more and more Djerma and to test out a series of salutations on Moussa and his other customers, until suddenly I could return no longer.

The last thing I remember eating, before becoming sick, was green olives, which some kind person had served to me in his modest home. I suspected that bad water caused my illness, but since the green olives were the last thing I'd eaten, I would not eat them again for decades.

At any rate, I became violently ill, with a high fever and bouts of vomiting and diarrhea. Soon, I could no longer walk or stand. The illness raged on. It is possible that my friends from Québec saved my life when they lifted me into a taxi and took me to the hospital in Niamey. It was crowded, but the staff made room for me. They found me a bed, but as for food and drink — when I would be well enough to have any — it would be up to my friends to bring it to me. This was the case for all other patients too. If you had to be hospitalized, you needed someone to bring you food.

I remember a doctor saying that I had gastroenteritis. I was so dehydrated that I required an intravenous drip. My blood was tested. The doctor said that my red blood cell count had fallen dangerously low and that I needed blood transfusions. As I now know, the adult body contains about six litres of blood. In the simplest terms, it consists of plasma (which is mostly water), white blood cells for coping with infections, and red blood cells for transporting oxygen. The oxygen transport function is so important that, as we saw in chapter two, elite athletes in endurance events experiment with various means to boost their red blood cell count.

Many Africans die needlessly of gastroenteritis because of lack of clean water and advanced, affordable medical treatment. My friends and I did not hesitate: we accepted the advice of the doctor. It was 1979. Nobody had heard of
HIV/AIDS
yet. (I was lucky to have become ill before the disease turned into an epidemic, taking thousands of lives and affecting blood safety around the world.)

I have always had a mild fear of needles. Before developing diabetes in mid-life, I dealt with it by turning my head away when I had blood withdrawn for tests. (Now I have to look when I inject myself with insulin.) But that summer of 1979 in Niger, as I dropped from about 150 pounds to a skinny 125, and even as fever, nausea, and pain racked my body, I could not stop thinking and worrying about those bags of blood that took all of an eternity to drip into me. I wanted it over and done with in the time it takes to insert and withdraw a needle, but instead I lived with that needle in my arm, with those intravenous bags, and with that blood for hours. At first, I tried not to look but couldn't avert my eyes perpetually. Next, I stared at the hanging blood bag, which was shrinking by reluctant degrees, in an effort to overcome my fears. It didn't work. I imagined the person or persons who had donated the blood. African? European? North American? How far had the blood travelled to arrive in the Niamey hospital? Had it been flown or trucked in a five-hundred-millilitre bag in a cooler packed with ice? In my state of illness and anxiety, I hoped that they had accurately tested the blood of the donor so that it would match my own: A-positive.

Now that I was on a hospital bed with blood to absorb, I no longer felt preoccupied by the idea of having my own heritage — my own blood, or so it felt — accepted by the people of Niger. It didn't matter in the slightest whether I received blood from an African, an Asian, a European, or an American. What mattered was that our blood types matched. What mattered was that someone — living near or far, I will never know — had provided blood so that I might go on living.

My friends from Québec took care of me every day, bringing food and water and sleeping on a mattress by my bed. It became instantly possible for me to love and accept them, while simultaneously wanting to discover Niger and its people. One love did not preclude the other. One aspect of my own heritage did not rule out the other. I made a promise to myself: that when I recovered and left the hospital, I would never worry again about how people imagined or interpreted the nature of my blood. Why should I worry about what others might think? I knew who I was, and I knew my family background, and I no longer felt any need to prove or establish it in public. This became the gift of my illness, and of the donated blood that helped me recover.

The experience of falling ill and receiving blood changed my emotional makeup and relaxed my self-concept. If the donor had been a black man or woman, did the transfusion make me more African? Of course not. My blood had been boosted, and changed, but I was the same person. Its real impact, in terms of my body and soul, was an entirely private matter. Race has nothing to do with one's true blood, or skin colour, and everything to do with perception — self-perception, and the perceptions of others. I finally came to this understanding in the hospital room in Niamey.

As far as the body went, the physical changes brought about by the transfusion were locked in my bloodstream. Assuming that the medical diagnosis was correct, the donated blood restored my red blood cell count. I regained my health within a week.

Thanks to a transfusion that helped me avoid dying at a young age — before falling truly in love, raising children, writing a book, or even understanding the meaning of my first volunteer stint in Africa — my soul shifted. It changed weight. I felt the weight of identity preoccupation lift off my shoulders. I no longer cared who saw what in my ancestry, when they looked into my eyes. I was both black and white, and no longer needed affirmation from the people of Niamey. It's as if a higher power had been looking down at me and said, “Hey, that coat looks heavy. May I hang it up for you?” The transformation of my blood had its most significant impact not on my body, but on my way of thinking. The confluence of my blood and that of another human was like two rivers meeting. One set of corpuscles merging with another kept me alive, and in the truest sense of the word, made my own blood truly mixed.

In this chapter, I will explore the meaning of blood, particularly in light of how it defines us in our private and public lives. I will look at how notions of blood affect the relationships we create with our families, careers, and nations. Situations of racial ambiguity tend to expose our unexamined assumptions about blood and belonging, so I will meditate on topics that have held my attention for years: how governments, courts, and social groups have navigated through disagreements on matters of black, white, Asian, indigenous, and national identity.

Blood has entered our minds as inextricably linked to personality and destiny because our earliest, foremost Western thinkers suggested that was so. It's an awfully seductive fluid. When it leaves the body, it's a big deal. People might die. People might be accused of attempted murder, or worse. Even when it is supposed to spill — think of menstrual blood, for example, or of the blood from the broken hymen of a virgin on a wedding night that unfolds according to all the ancient rules — it has power and significance. Maybe it is impure. Maybe it could damage you. Maybe that menstrual blood could spoil food or rob a man of his hunting power. Or maybe it is the blood of the virgin, suggestive of innocence and perfection. In addition, blood acquires holy significance in the world's pre-eminent religions. Christians consider Christ's blood to be sacred, and imagine that they drink of it when they lift the holy cup of wine to their lips. Judaism and Islam have intricate rules about how animals are to be bled and how blood must be absent from food.

Blood filters into our consciousness in ways that surpass any other bodily fluid or any bone or tissue. It has become such a powerful metaphor for personality that we have forgotten that it is an idea — not a reality. It helps us imagine ourselves. But perhaps it helps us too much. We have bought the metaphor so fully that we have come to believe it to be fundamentally true.

MY FATHER (A HUMAN
RIGHTS ACTIVIST
) and older brother (a singer-songwriter), both named Daniel (or Dan) Hill, were known across Canada in their respective fields and had each written books long before I wrote novels. By the time I was in my late teens, Dan's songs were playing on radio stations across Canada and around the world. With his long hair, romantic eyes, soulful voice, bare feet (on stage, at least), arm wrapped over guitar, and gut-wrenching lyrics of heartbreak that a friend of mine teasingly called “songs by which to slit your wrists,” Dan's voice permeated cafés, the back seats of cars, and wedding halls.

I adored my brother, and still do, but his fame added to my motivation to leave Toronto after high school and forge my own identity somewhere else. We met up here and there to play squash, go for a run, or share a meal, but even when oceans separated us, Dan followed me. On the southern Atlantic coast of Spain, in a village called Sanlúcar de Barrameda, where I had gone to write and where the only non-Spaniards apart from my first wife and me were two lonely Mormon missionaries who seemed wanted and loved by nobody, I heard his big hit “Sometimes When We Touch.” I heard Dan's song in a taxi in Yaoundé, the capital of Cameroon, where I had gone to work as a volunteer with Crossroads International. Perhaps the most haunting reminder of his omnipresence reached me in Québec City, where I had gone to study at Laval University. Not yet fluent in French, I'd been in the city for only two days and was hunting for an apartment to rent. I was having a hard time of it. Prospective landlords had been hanging up on me when I phoned them to ask about their apartments, and I had taken to the streets to scour for “
à louer
” signs in the windows of houses and apartment buildings. One man had just made me an offer that, I suppose, he felt that an octoroon — this is what he called me (“octoroon” being an antiquated Southern term for a person who is supposed to have one-eighth black blood) — could not refuse: free rent in exchange for certain “nocturnal services.” I kept on walking and soon found myself hungry and despondent in the Carré d'Youville, near the gates to the Old City. Cars and taxis buzzed about, and pedestrians crowded the tourist shops. But then I walked past a theatre for the performing arts, and there on the massive advertising billboard was my brother's name and giant face. Figuratively and literally, I felt that Dan's successes were spiking my own blood pressure.