Back in the early 1980s, in the midst of winning race after race, Salazar accepted an invitation to visit the Australian Institute of Sport outside Canberra. It was there that testers measured his cardiac output and declared him to have the most prodigious heart of any elite athlete they had seen. I guess I'll never have heart trouble, Salazar told himself at the time.
Only a few years ago he reminded himself of that test Down Under and the longevity it seemed to promise, even though he had lost both grandfathers to heart disease, one at age 52; his father is a survivor of two heart attacks; and his late mother suffered from high blood pressure and diabetes. "I had one of the strongest hearts in the world," he says. "I was so naive to think that." The heart may be a muscle, but it doesn't lend itself to applications of Ben-Gay—and there's all sorts of plumbing that goes with the pump.
After the photo shoot Salazar's cardiologist, Todd Caulfield, pulls him into an empty office for a quick checkup. Salazar peels off a long-sleeved tricot. A Nike swoosh tattoo graces his sleek upper torso, and a defibrillator, installed after the heart attack to treat arrhythmia, bulges like a pack of Luckys beneath the skin on his left breast. Caulfield listens with a stethoscope, then takes a marker to a white board and sketches welters of arteries. He points to the right coronary artery, from which in June he cleared the 70% to 80% blockage that had caused Salazar's heart attack. (The cardiologist had to custom-make the stent because of his patient's unusually wide-gauge arteries—which may explain why Salazar had such extraordinary cardio output.) Then Caulfield indicates another obstruction, in the left anterior descending coronary artery, a blockage of 50% to 60%. He had left it alone, Caulfield says, because there was less risk in leaving the blockage than in going in to treat it. The best course, Caulfield says, is for Salazar to monitor his own symptoms and come in for "surveillance" stress tests every six months or so.
Caulfield had mentioned the second blockage in the early summer, but there had been so much for Salazar to process that he hadn't entirely grasped its implications. Today he's alarmed. How is he supposed to recognize an imminent heart attack? The onset of his episode in June had been marked not by sharp, anginalike pain but by a much vaguer discomfort. He almost went for a run on the morning he was stricken but didn't, as much because he was running late as because his primary-care physician had told him not to run until an echocardiogram could be taken for his neck pain.
"I'm just supposed to know?" he asks Caulfield.
He's just supposed to know.
The day after the consultation Salazar feels out of sorts. "Crappy," he says. He'd like to think it's because Caulfield dialed back his high-blood-pressure medication. He still feels headachy, and when he runs (with a heart monitor to make sure his pulse never exceeds 130 beats per minute), he feels discomfort again at the back of his neck—the same place he felt it just before the heart attack. "He's not," his wife, Molly, says dryly, "one to call attention to his aches and pains."
The discomfort will persist over the next several weeks. Finally Caulfield schedules an angiogram for Oct. 16. By actually seeing inside the artery with ultrasound, an angiogram can provide the best possible read on the extent of blockage. In the meantime Salazar is on orders not to run at all.
On Oct. 11, in Eugene to meet with Rupp, Salazar parks his car a block and a half from Rupp's apartment and jogs over. "Right then it became apparent," he said later. "I had that uncomfortable feeling in the back of my neck again. Nothing should happen that fast just from a short jog. I knew it wasn't the high-blood-pressure medication." Rupp drives Salazar to Eugene's Sacred Heart Medical Center, where Alberto and Molly's three children—Tony, 25; Alex, 23; and Maria, 16—were born. An emergency angiogram reveals that the 50% to 60% blockage is actually 90%. Doctors insert another stent and tell Salazar that, if not for this intervention, he probably would have suffered another heart attack within 24 hours.
So it turns out that there might be virtue not only in imposing one's will but also in submitting it to something else. "It's all reinforced by the events of the last few months," Salazar says. "When it's all over and I'm done coaching, I want my athletes to feel I've helped them runningwise, but lifewise, too. I still want them to run well, but not at all costs, where it overpowers everything else. If I were to question Josh's decision not to run on Sundays, I'd deserve to get another heart attack, on the spot."