It was the night of Oct. 4 and I was sitting with my pile of James F. Fixx yearly runner's diaries—my personal catalogs of pulse rates and patellar twinges, of bananas and breakfast cereals eaten, of athletic glories and despairs. I was flipping through the pages of the diaries, searching for a clue to help explain two recent traumas. Only hours earlier, I had written: "Central Park—6 mile route. Quit after 4. Flash of pain across mid chest—second time in five days."
Having been a runner for 25 years, I'd always assumed that my heart was textbook perfect. But Fixx had been logging 70 miles a week to my 20, and on July 20 he had gone out running in Vermont and suffered a fatal heart attack. At 52, he was only six years older than I, yet an autopsy revealed severely blocked coronary arteries. What's more, he had been ignoring chest discomfort.
I told my internist about the pains. He prescribed a treadmill stress test with an electrocardiogram (EKG), to be followed by a more sensitive and supposedly more reliable test called a Thallium Scan. On Oct. 16 I stepped aboard a treadmill at St. Vincent's Hospital in Manhattan, never anticipating the weeks of emotional turmoil that lay ahead.
After 10 minutes on the treadmill, the stress test and EKG nearly complete and indicating nothing untoward, the doctor injected the thallium intravenously, and that set in motion a chain of events that would last seven weeks. In that stretch, I would have five more tests, including two that I would fail and another that has killed more than a few people. I would have personal consultations with four cardiologists, including one who would say that I very likely had coronary artery disease, and two more who would say that I almost certainly did not. And as the weeks passed, I would grow more and more reclusive and despairing. I would be unable to work, fearful that each halting step might be my last. Finally, after running up a medical bill of $8,983 ($8,023 of it going for the tests, and most of it covered by various medical plans), I would receive assurances that my coronary arteries were normal, that the pains had almost certainly been of musculoskeletal origin.
Perhaps the most important lesson to be drawn from my experience is that it could have happened to millions of others, especially—perversely, it would seem—to those who are most conscientious about being physically fit.
When I had received the injection of thallium, I lay down on a table, and a camera the size of an airport searchlight began to describe slow half-circles on my chest, scanning to pick up the course of the thallium. After lunch, I was scanned again, and a week later a St. Vincent's cardiologist named Robert Braff phoned to say that my electrocardiogram and stress-test results had been normal, and that the fact I'd had no pain during the test was a good sign. But he also said that portions of my heart had not taken up the thallium the way they should have. "It's not definitive," Braff said, "but it may be related to insufficient blood flow to your heart with exercise."
Arrangements were made for me to have another test, a Stress Wall Motion Study, on Nov. 1. Before then, I had an assignment to write about a series of off-road bicycle races in Tampa. It wasn't really necessary for me to enter one of the races, but I was not going to roll over and play dead just because of one inconclusive test. So there I was, a possible cardiac case, halfway through the first bicycle race of my life, a half-mile event, when a burning sensation welled up in my throat and upper chest. My main concern was not that I might expire on the spot, but how embarrassing it would be to do so in front of the large crowd. A minute or two later, the sensation disappeared and I finished the race. I was still a few weeks away from any big league anxieties.
The Stress Wall Motion Study was to measure how my heart contracted and ejected blood during exercise. I lay on my back beneath another camera at St. Vincent's, pedaling a sort of recumbent stationary bicycle. Every now and then Braff made the going tougher. There were five tension levels on the bike. In the previous five years, few patients at St. Vincent's had been able to complete them all. Well into Level 4, Braff asked, "You sure you want to continue?" I nodded. "Let's go for the gold," I said, thinking that a great performance might influence the results.
Minutes later, when I pedaled through Level 5, the technicians actually cheered. As I staggered away from the bike, someone called out, "What an animal!" I would have given all the raves, and tossed in my bank balance, for a better review six days later. The Stress Wall Motion Study report read: "Abnormal stress cardiac scan with the patient developing septal akinesis...." At least one portion of my heart, the septum, was not responding normally to exercise, and the implication, again, was arterial blockage.
I was advised by Braff to undergo a coronary angiogram, a test of the coronary arteries that should be performed before the patient reads too much about it. Among the risks of angiography listed in Aaron E. Klein's Medical Tests & You are heart attacks and "allergic reactions...that could cause death." The process can strike terror into one's heart. A 32-inch-long catheter is inserted into an artery in the groin or arm, and it is then edged through the body for more than two feet, up, up, and into the heart itself, where a radiopaque dye is injected into the coronary arteries. Meanwhile, an X-ray movie camera is focused on the area, searching out blockages. The procedure lasts up to two hours, and people who do angiograms refer to the dye as "a contrast, because it sounds so much nicer than dye," which, one supposes, sounds too much like die.