The long way back

This is not a trail report. There is no route to map, no summit, no village kitchen handing food across the doorsill. It is the hardest thing I have written for this site, and I am writing it the way I write everything here: slowly, and only what I know to be true.

A few days ago I had a heart attack. I am still in the hospital as I begin to put this down. I want to keep it, the way I keep the routes — honestly, before the edges go soft.

The pressure that didn’t make sense

We came to San José on Saturday for the marathon. A little before six in the evening, I felt a light pressure in my chest. Not pain, exactly. Just a sensation I didn’t know what to do with.

We went out to eat and it stayed with me. I ate badly, uncomfortable in my own body, and on the walk back to the hotel the pressure began to climb into something else. By the time I reached the room I couldn’t do the simple thing in front of me — pack my bag — without stopping.

The room I couldn’t get comfortable in

I tried to lie down. I tried it every way a person can try: on my back, on my side, curled, flat. There was no position that the pain would forgive. That is the detail I keep returning to. A pulled muscle lets you find an angle where it eases. This let me find nothing.

I called the person I love most and told her what I was feeling. She didn’t hesitate: call 911. I called. There was no ambulance available, but the agent told me clearly — do not stay in that hotel room. Get to an emergency room if you can.

And here is the part I have to be honest about, because it is the part that could have killed me. For a moment I thought: maybe it passes if I just sleep. Maybe I’m making too much of this. I stood in that room and genuinely weighed lying down against walking out the door.

I walked out the door.

Triage

At the emergency room I described it as best I could, and they ran an ECG. The doctor read it, left the room without a word, and came back with a gurney. He told me, with the kind of plainness you don’t argue with, that I was having a heart attack.

I was awake for all of it. That is the strange thing I keep meeting in myself — I was lucid the entire time, watching it happen to me.

The acute ward

They took me to the shock room to stabilize me, and after a long stretch of needles and every monitor in the universe attached to my body, they moved me to the acute ward — the room for sudden cases, the ones with a real chance of dying without warning. They held me there through the night and brought me back to stable.

I did the arithmetic later and it frightened me more than the night itself: the pain had started before six, and I wasn’t truly under care until close to ten. Something like four hours of my heart in trouble before treatment reached it.

What the tests said

There was active damage to the heart muscle. An echocardiogram. An ejection fraction of 56 percent — the share of blood the heart pushes out with each beat, lower than it should be for someone built the way I am built. They referred me for a catheterization to place a stent and open the artery they assumed was blocked.

Then came the waiting. A cancelled procedure, a list I wasn’t on, days stacking up in a public system where my case, stable now, had quietly slid down the order of urgency. I lay there doing the math on private hospitals and insurance and who pays for what — which, it turns out, was only ever me.

Clean

When the catheter finally went in, they found nothing. No blockage. No obstruction. The procedure that was meant to fix the problem instead became the thing that told us there was no blockage to fix.

Sit with that for a second, because I had to. I am an endurance athlete. My resting heart rate is 38. And I had a genuine heart attack — confirmed, troponin and all — through arteries that were wide open.

The name for that is a heart attack with non-obstructed coronary arteries, and the cause they suspect is myocarditis: an inflammation of the heart muscle itself, most often set off by a virus the body was busy fighting somewhere I never noticed. The cardiologist was honest in a way I respected — the heart looks fine, and yet a heart attack happened. They referred me to an MRI and to cardiac rehabilitation.

What I know to be true

I stayed lucid the whole way through because I needed to understand. I asked the nurses and the doctors to explain every number, every word — ejection fraction, troponin, the strange acronyms. I like to understand. Lying in that bed, understanding was the one thing I could still do for myself.

I know now that being sick is not a thing you choose. For days I kept apologizing — to work, to people waiting on me — as if I had decided to step away. I hadn’t. My heart decided.

And I know that two small things stood between me and a much worse story: a person who said call 911 without a second of doubt, and a voice on the phone who said don’t stay in that room. I almost stayed in that room.

The road back

So this is where the road back begins — from a hospital bed, with a heart that looks healthy and just proved it isn’t yet, and an MRI and a rehab program ahead of me.

I am not going to pretend I know the whole route. I don’t. But I know how to do this part, because it is the only thing I have ever really done: start at the trailhead, move at the pace the day allows, and not lie to myself about the terrain.

There will be a first kilometre back. Then a long one. And somewhere down that road, a start line again, and a group of people behind me on a mountain in the dark, waiting for first light. I intend to be there. Slowly, and only what is true — one step, and then the next.