In 2007, when I went to the Tour of Qinghai Lake to work in the Secretariat, I was jokingly told that every non local staff member is given one opportunity to pass out in the middle of the street and be taken to the hospital for supplemental oxygen, after which they are no longer welcome to come back to the event.

The evening of Stage Seven, shortly after I passed out in the middle of the street and had to be taken to the hospital for supplemental oxygen, Mr. Q—China's first UCI commissaire and the 80s era head coach of Team China—took me aside at dinner and let me know that even though they were joking when they told me this, they were actually quite serious and I would not be coming back to this event in the future.

Even if that hadn't happened, I probably wouldn't have been coming back to that Tour anyways. There was confusion over what my role at the event was (i.e. no one knew, including my boss) so I was left entirely doing stuff that a random local college student could be doing as well as confusion over whether I was being paid, what I was being paid, and how much. On top of this, even before I passed out in the middle of the street, I'd been in an incredibly bad mood from the combined factors of a lack of oxygen and poor organizational skills on the part of the parts of the organization that I was working for and had not been acting my nicest.

Making sure they had the traveling medical facilities to handle altitude sickness and various forms of altitude maladaptation were, perhaps, one of the best done things I saw at that event. This is in part because four years earlier, in 2003, at the second Tour, one of the riders with the Korean team briefly ended up in a coma with a stopped heart. Unfortunately for me, since I was in the Secretariat, I was generally nowhere near the racers and, as a result, nowhere near the traveling medical facilities. As a result, I only got oxygen one of the three times I collapsed.

Five years later, in 2012, when I started getting a persistent dry cough above 1000 meters, I remembered the Tour of Qinghai Lake. When the cough politely went away every time I went a bit downhill only to come back each time I went back uphill, I noticed. I started tracking things on my GPS. I confirmed that the point at which I started coughing was altitude based. I confirmed that it was slowly but surely getting higher as my body grew more red blood cells. I even tried to go to the doctor but, everyone knows that you can't get altitude sickness until at least 2500 meters (not true then, still not true now), and random doctors anywhere in the world aren't especially good at listening to random patients with unusual complaints.

When I got to Huating, the highest I had been all trip was a shade over 1500 meters; the highest I had slept was maybe 1300 meters. I decided, for reasons which I am sure were completely unrelated either to the rain or the fact that I'd just been sent all three Hunger Games e-books, to spend an extra day or two in Huating and get some extra altitude adaptation in before crossing Guanshan Mountain as, even with the tunnel, I would still be going up to 2200 meters.

All things considered, especially when you add in the 26 kilometers of uphill you have to do before you get to the Guanshan Tunnel, it's really not all that surprising that I ended up so thoroughly fucked up that I spent the night on oxygen in the hospital in Handian.

There are many reasons I chose to go through Ningxia on this trip. One of them is that I had never been to Ningxia. Another is that it gave me a perfectly good excuse to also go to Inner Mongolia—which I also have never been to. That's two additional provinces that I'd get to say I've bike toured in. Another reason that I chose for going to Ningxia is that it would let me gradually work my way up to high altitude. Instead of going straight from the middling-high where some people might feel shortness of breath (but not realize it's related to the altitude) up to actual high altitude in a single day, I would take it step by step by step. That way, even if the altitude medicine turned out not to be as effective as I'd like, I'd still have acclimitization on my side.

The drug I'm using, Methazolamide, has been recognized as being an effective altitude sickness medicine since 1983. However, altitude sickness is still an off-label use so it's hard to find any useful information on what my dose ought to be. I'd prefer the standard Acetazolamide but it's uses other than for altitude sickness have all been taken over by better and newer classes of drugs and my medical connections couldn't find it for me in China.

In-depth research into what dose I ought to be taking seems to indicate either 50mg once every other day, 50mg once a day, or 50mg twice a day. Since I've got twenty 50mg pills, and the half life of Methazolamide in it's on-label use for relieving ocular pressure is 14 hours, I've been doing 50mg as part of my morning rituals ever since I started going over 1500m for more than an hour at a time. Worst case scenario I'm still fully covered whenever I'm moving around.

This morning, just in case, I take two pills.

I also make a point, whenever I stop for any kind of a rest, to pull out the PulseOx and check my numbers; they remain acceptable, healthy even, all the way up to the tunnel.

There's a lot on the road up to the tunnel that I don't remember. A lot that I do remember and a lot that I can tell has changed but a lot that I don't remember at all. There is even more stuff on the downhill that is clearly the sort of stuff I stop and take photos of, the sort of stuff I stop on downhills to take photos of, of which there is zero recollection. 

Being in this place that I've been before and having such spotty memories of it kind of creeps me out actually. Sure I knew that I ended the evening so poorly that I needed help walking to the hospital from the restaurant where I had dinner and that even when I could still talk, I was slurring my words. But, for that much to just be gone? To have never been there at all? That I didn't even notice the dramatic towering cliffs on that last switchback when I was walking? That I missed the rock formations on the way down? That I missed the fort looming just above a bridge I know I crossed?

I'm really glad that I'm currently fine, that the lowest number I've seen all day was a 93, but even so, coming back to this place where I was once not fine, I find the condition I was in six years ago even more concerning than I did before. 

I find the hospital. It's bigger now. Definitely a new building. Still a long drop latrine instead of plumbing. Almost all of the staff who were there for the group photo aren't here any more. There are a few though and they remember me. Better than I remember them. I just remember that they were. That they existed. Not who they were or what they looked like.

I end up going out to dinner with three people who are there now who were there then. They still don't speak Mandarin very clearly so there isn't a whole lot of discussion to be had. The dinner is good though. Worst thing about traveling alone in China is the way in which Chinese meals are communal affairs for multiple people.

After dinner we walk to one of the newly opened nice hotels in town. When the expressway is finished, they'll be getting an expressway exit. Lots of changes are happening. Have happened.

We can't make the registration software work and I suggest that we call the police station for an old fashioned paper registration but they decide instead to just let me stay without registering.