It started half a mile into my run. A sensation in the left side of my chest, a cross between pressure and squeezing. I felt somewhat out of breath, too. It was bad enough that I slowed my pace to a walk.
Gradually it subsided. I was only planning on running four miles. For me, that's a fairly short distance. Pain or not, I could surely go that far.
I started to run again. A mile later, the pain returned. Just as bad as before, in exactly the same location.
I returned home, wondering what had happened. Hopefully it was one of those annoying little aches, familiar to anyone who exercises regularly, that comes and goes with no obvious cause. I hoped that it wouldn't be there the next time I ran. But it was. Each time I went out to run, I felt it.
I should have gone to a doctor, of course, because chest pain while exercising can signal a heart problem. But there was no way that I could be suffering from angina. I'm relatively young, with normal blood pressure and good cholesterol levels. I run between four and twenty miles per day, all year round, and I bike, and do strength workouts, and play ball with the kids. I've never smoked, and I don't even drink. I couldn't possibly have a cardiac problem.
And besides, the Boston Marathon was coming up. This would be my twentieth marathon, and my fifth Boston. My training hadn't gone particularly well, but I was determined to compete anyway. I wouldn't run fast, but I knew I could finish. Forced to miss last year's marathon while in Germany with the Army, I'd been training for two years. After all those workouts, I wasn't about to withdraw just one week before the race.
I discovered over the next several days that I could forestall the pain by running at a slower pace. As long as I kept my speed to around eight minutes per mile, I felt fine. So I kept running. And I went to the marathon. I started, and despite feeling lousy, I made it to the finish line.
For three weeks afterward, the pain persisted. Whenever I tried to pick up my pace, it would return. Finally I decided that enough was enough. I picked up the phone and called my doctor.
"Given your health history, this probably isn't a heart problem," she told me, "but you should see a cardiologist anyway. We'll eliminate the most serious causes first." She scheduled me for a cardiac stress test, which involves running on a treadmill while a cardiologist monitors the EKG.
But the cardiologist had other ideas. "I've looked at your old lab results," he told me in his office, "and I see some things that concern me. I think we should skip the stress test and go straight to catheterization. That's the only way to know for sure whether any of your coronary arteries are blocked."
The idea seemed ridiculous. I was perfectly healthy. Everyone seemed to agree that I was unlikely to have a cardiac problem. Yet there I was, being scheduled for a procedure normally associated with the sick and elderly. Sure, I'd go in for the catheterization. Once it revealed clean arteries, we could begin to search for the real source of the pain.
I reported to the hospital at 7:30 in the morning. A nurse started an IV and gave me some Fentanyl. It would make me feel drowsy, she explained, but it wouldn't put me to sleep. I didn't bother to tell her that I knew how Fentanyl works because I administer it to other people all the time.
In the cath lab, I quickly nodded off. I awoke to a tremendous crushing sensation in my chest, much worse than anything I'd felt while running. Through the haze of the Fentanyl, I heard one of the nurses saying something about "ST segments." An alarm bell went off in my head. ST changes indicate one of two things: either a shortage of blood supply to the heart muscle, or, worse, damage to the cardiac muscle in the form of a heart attack.
"Did you say something about my ST segment?" I asked the nurse woozily. Then I grimaced, as another wave of pain crushed my chest.
"Yes. We're opening a balloon in your artery to open it," she said. "That's why you're feeling some pain. That'll go away in a minute."
"Oh, crap," I remember saying. Even in my drugged-up state, I understood what this meant. The young, healthy marathon runner had been suffering from angina after all.
An hour later, I awoke in the recovery room. My wife was standing over me; she looked as if she'd been crying. I was hoping to learn that it was all a dream; that I didn't have a heart problem at all. But her expression told me otherwise.
"They told you?" I asked.
"Yeah," she said. "I'm sorry." She knew I'd be disappointed.
The cardiologist came into the room. He assured me that the procedure had gone well, and that the problem had been resolved. I asked him when I'd be able to resume my regular activities, like running.
"Oh, I don't recommend that you compete in any more races," he said. "That would be too stressful. But we'll talk more about it tomorrow." At that point he left, and I was glad. In the course of a one-hour procedure, my entire life had changed, and as much as I tried to fight it, the frustration, disappointment, and fear were making it hard not to cry.
Now that several days have passed, I can view the whole thing more rationally. I had been foolish not to see a doctor sooner. In fact, I was fortunate even to be alive. The pain, I learned later, had been caused by a 95% occlusion in my left anterior descending artery--the main vessel that supplies oxygenated blood to the heart. On any of those runs--and at any point during the marathon--I could have had a heart attack and died.
But the important thing is that I didn't. In fact, my heart suffered no damage at all. I stayed in the hospital for just one night, and I'll return to work at the end of the week. I reported the incident to the appropriate Army authorities, and it's not going to disqualify me from service. Even my running shouldn't be affected too seriously. The last time I talked to the cardiologist, he said, "I didn't mean that you can never run again, or even that you can never race again. Exercise is good. I just meant that for now, while you're still recovering, you should avoid the stress of racing. Go back into it gradually."
All this week, I've been sorting out my feelings. I wish it had never happened, of course, because I've always been proud of the way I stay in shape, and nobody ever wants to admit that they have a health problem. For several days I felt embarrassed about it. I went out of my way to ensure that nobody knew what had happened, because I was afraid of being perceived as weak. "Some athlete," I imagined people saying sarcastically. "See? He does all that running, and competes in all those races, and it doesn't mean a thing. That's why I don't run."
But after giving it a great deal of thought, I realize that this kind of thinking is idiotic. Having a health problem is nothing to be embarrassed about, especially when the problem has already been resolved. And running and other forms of exercise are definitely worth the effort. Sure, a runner occasionally makes news by dropping dead in the middle of a marathon. And, yes, I was awfully young to have a problem with my heart. But if I hadn't been so fit from running, then it probably would have happened sooner, and perhaps I wouldn't have recovered so nicely. As the cardiologist told me afterward, "The fact that you were able to run a marathon with a blocked artery is quite a testament to your cardiac fitness. Think of how healthy your heart must be, to do that with the blood flow nearly cut off."
It'll be interesting to see how this affects my view of cardiac patients. Since joining the military, I've developed much greater empathy for homeless veterans. Will the same thing happen when treating patients with chest pain? Perhaps.
When I return to the ambulance next week, I'll have the opportunity to find out.
This will be my final post. I've said this once before, but this time I really mean it. As much as I enjoy writing--and reading your responses--blogging is extremely time-consuming. I'd like to accomplish other things, such as writing a book about EMS. That will never happen as long as I continue to do this. There are other reasons, but that's the biggest one.
So, once again, thank you for reading. It's been fun. And if you ever see a book in Border's or Barnes and Noble with my name on the cover, be sure to buy it.