The Andiamo Trail Run is a low key event. A handful of people make their way from Purcelville to Shirlington, thereby covering all 45 miles of the W&OD Trail. The event only runs in even years and doesn't bother with race numbers. Participants are indistinguishable from the thousands of other trail users.
Normally, for me, this event serves as preparation for the JFK 50 Miler. Normally, finishing is a foregone conclusion. Normally, I try to see how long I can maintain ten minute miles. Normally, I aim to finish under eight hours. Normally, I don't have a care in the world. Unfortunately, 2006 has been anything but normal.
Indeed, 2006 has been a tour of medical hell. I'll be lucky if I get to start.
Let me hasten to clarify that I am grateful that my medical issues are not of the terminal variety. Still, anytime the medics screw around with your heart, it's serious. The consent forms make clear that you are on the edge; a slip here, an anomaly there, and down you go, dragging your family along with you. Just thinking about the possibilities is enough to give you vertigo.
In 2006, it will be an accomplishment simply to DNF at my house, three quarters of the way down the course, with my body still functioning normally. As 2006 winds down, I am trying to once again find my heart's rhythm.
But I have gotten ahead of myself. The story starts at the end of 2005, when I find that some runs don't go so well. Sometimes I am dizzy afterwards. Sometimes I can't catch my breath, even standing still. Sometimes I am exhausted for no apparent reason. Obviously, I'm sick. The symptoms recur every week or so, but seeing the medics seems like an overreaction. Eventually, I'll get over it. I always do.
Then, one bright winter day while touring our garden, Becky watches me pass out stone cold and plant myself headfirst in the daffodil bed. For a split second, she thinks I am just joking around. Then she sees my face. For a few seconds, I am lost. The Talking Heads have lyrics for this:
And you may ask yourself,
Well, How did I get here?
There is water at the bottom of the ocean.
And water under the water.
Becky screams my name from impossibly far away. In those few seconds, my entire universe plunges down. My descent into medical hell begins right there among the daffodil shoots.
I soon find myself in doctors offices, watching in bemusement as the medics trot out equipment clearly meant for other people. I get my first EKG, an experience I am sure was decades in the future. The first few rhythm strips are normal, as is a stress test, and a bunch of blood work. Negative test results serve as excellent props for someone in the state of denial.
Eventually, however, rhythm strips show up that are not normal at all. My cardiologist paints the picture. Just like the joke, there is good news and there is bad news.
The bad news is that I have a heart arrhythmia - ectopic atrial tachycardia, a variant of atrial flutter in which a group of renegade heart cells think it's cute to pace the heart on their own. Frankly, they do a pretty lousy job of it.
The good news is that treatment is a snap. Through a procedure know as "catheter ablation", the EPs propose to toast part of my heart like a marshmellow over a campfire, thereby teaching it a sharp lesson in the importance of running smoothly. Weird stuff, this medical science. At this point, I have a hard time understanding if I am on set at Monty Python's Flying Circus or in the midst of a legitimate, scientific medical process.
Naturally, I want to know why I have an arrhythmia, on the theory that treating what might be a mere symptom might be misdirected. However, the cardiologists are unanimous in their disinterest in identifying a root cause. "Everyone always wants to know why", one says, as if discussing a silly request from a wayward child. I refrain from commenting that perhaps if they took some time out of their overly busy schedules and did some research, they might be able to answer that question instead of just brushing it off.
What the EPs do know is that 4 out of 5 people are "cured" with ablation. This may not sound all that reassuring, but in medical circles, 80% counts as a serious win. If chance favors you, you are good to go.
Unfortunately, if you happen to be the 1 in 5, the story has a different ending. My first visit to the EP lab was declared a rousing success. The only problem was that I was back in the arrhythmia a couple of weeks later. No problem, according to the EPs, who proposed toasting my heart a tad crisper. The second visit terminated when the EPs were unable to induce the arrhythmia on the OR table.
At this point, the story turns ugly. Suddenly, the EPs didn't want to have anything to do with me. They couldn't bolt out of the OR and back to their offices fast enough. I had the temerity to ask for an interview to discuss available options. An EP showed up under duress, and treated me like the failure of the operation was my fault. He seemed honestly unable to understand why I would want to speak with him following a failed operation, and he made it clear that he thought I was wasting his time.
Becky was so furious during the interview that she crushed the tubular arms on her metal chair. What Becky really wanted to do was tell the EP a few home truths about basic patient care, a dissertation he richly deserved. She refrained because it hadn't yet sunk in that we were no longer making forward progress with this particular set of doctors, and so she wasn't ready to burn the bridges. Instead the EP went home for the day, confident in his knowledge that he was doing good work, even if, regrettably, some of his patients were morons.
Although roasting my heart didn't stop the arrhythmias, it did change their pattern. My cardiologist cautioned that things were unlikely to improve of their own volition, but, as it turned out, that is exactly what happened. The episodes became far less predictable, but also - eventually - less frequent.
I am under no illusion that I am "cured", whatever that means. But I can run. For me, that's huge. I'll take it.
In mid September, I try a 20 miler. I'm fine afterwards. The next week I run another. And the week after, another. Still fine. As I finish Andiamo I high-five Matt, who accompanied me on his bike. I can't quite believe it, but the long runs are clearly independent of the arrhythmias. In late October, I run the Marine Corps Marathon about an hour slower than usual, mostly because my heart ran like crap during the preceding week. But I feel great, and even talk Bert into some bonus miles to make up for the slow pace. The Saturday before Thanksgiving, I run JFK in a more or less normal time, again without problems. In fact, I feel good the entire day, which verges on bad manners in a 50 miler, since it is customary to work in a certain amount of suffering somewhere along the way.
There is no dignity in medical hell. I knew this from watching my father progress through his series of cardiac issues, but it is still different to experience it yourself. In principle, this is a solvable problem, but I doubt that the medical establishment as a whole will do so anytime in the foreseeable future. To the contrary, since people stripped of their dignity are generally easier to control, I would expect medical care to drift towards less dignity, not more.
Doctors are just people. Usually very busy people. They are not supermen, or superwomen. If your particular medical problem fits inside your medic's universe of knowledge, then your medics are fabulous. If it doesn't, they're worse than useless. Only occasionally did I find a doctor who was willing to look at the big picture and help me devise strategies for coping. These doctors have my profound gratitude.
Never underestimate the power of family support. Neither Becky nor Bert ever told me what I needed to do. They just helped me to see what was possible, and then supported my choices.
But the main lesson is much simpler:
Every day is a gift.
All of them. Cold ones, hot ones, hard ones, easy ones, tough ones, joyful ones, arrhythmic ones, normal ones. Every single one.
I don't know what condition I'll be in tomorrow. All I know is what I can do with today. So, each day, I try to make the most of it.
It took me many months to decide whether to publish this essay. I wrote the essay to help me come to terms with my arrhythmia. But sharing the result is an entirely different question. On the one hand, I have jealously guarded my medical privacy. On the other, I am trying to wrest back control of my life. Eventually, I came to the conclusion that private secrets bind more tightly than public stories. In a way, publishing this essay sets me free. I am who - and what - I am.
It is also possible that my story will help someone else. Heart arrhythmias are surprisingly common, even among the very fit. Becky found it incredibly reassuring to learn that Stuart O'Grady, a marquee professional bike racer from Australia, suffers from a heart arrhythmia. Watching O'Grady hang off the Tour de France race doctor's car with an atrial flutter pulse in the 200 range helped us put my arrhythmia in perspective. If O'Grady can make it through an arrhythmia episode and still finish Le Grand Boucle in the hunt for the Green Jersey, then maybe I can bang out the occasional ultramarathon in the middle of the pack. I definitely intend to find out.