The end of my Tanzania story is the beginning of a different story.
I’m not especially eager to relate the events that followed our return from Africa, because for weeks I repeatedly acted like a stubborn idiot. Reading my own words is like watching a bad horror movie, in which the main characters act with a complete lack of basic common sense. The audience, knowing what’s happening, is practically screaming out loud, begging the characters not to go into that dark basement, not to poke around in that abandoned warehouse, not to proceed without back-up when investigating the strange goings-on. Of course, the characters do these things anyway, usually getting what they so obviously deserve by plunging blindly ahead in spite of the warnings. So this won’t be easy for me. On the other hand, retelling the story reminds me how lucky I was, and how lucky I still am, to be around to run and coach and write. So here goes.
Don’t judge me too harshly, but instead, try to learn from my experience.
First signs of trouble
It all started a day or two after returning to snowy Boston, having endured thirty straight hours of travel that began in Arusha, Tanzania. The trip as a whole had been a wonderful experience, but the return journey had been taxing, with five separate flights: Arusha to Mombassa; Mombasa to Addis Ababa; Addis Ababa to Rome; Rome to Washington D.C.; and finally Washington to Boston.
Within a day or two of getting back, I had what felt like a cramp or muscle spasm in my right calf. My lower leg was swollen and painful, and running was out of the question. I remembered that I had done some stretching of my calf muscles on one of the flights, and I chalked up the pain to stretching a stiff and cold muscle and maybe pulling something. I’d had calf cramping before, and figured it would be a couple of days and then everything would be fine.
It seems obvious in retrospect that my symptoms and my diagnosis didn’t match up very well. Although I had, a few times, experienced calf pain that was so severe it kept me from running, it had never come with swelling before, and it had always been relieved by a few days of rest and gentle massage. This pain seemed impervious to those remedies.
A week later, the pain in my right calf went away, but now there was pain in my left calf. As ridiculous as it sounds now, I theorized that this new symptom was “compensation” for the first injury, as though I had been favoring my right leg and over-using the left. Never mind that I hadn’t even been running. It seems odd that it never entered my head to consider something other than a muscle strain. In retrospect, I’m surprised I wasn’t more open minded about the possibility of something else. I guess I was too busy being aggravated, and too impatient for the pain to subside so that I could resume running and training again. After all, I was missing out on indoor track workouts and long runs with my buddies. I had been looking forward to returning to my routine after all the travel, and this seemed like especially bad luck.
During this time, I made two attempts to consult professionals. The first attempt was talking to the Athletic Trainer at the school where I coach. He checked me out and detected several areas of tenderness along the shin. His recommendation was that I see a sports medicine person and get an MRI to rule out any bone issues. Considering how little I had been running leading up to the injury, it seemed to me very unlikely that I had a stress fracture, so I didn’t act on his advice. The second attempt to get professional help was a short visit to a muscular therapist to whom I go for massage and wisdom. He came closest to guessing the real reason for my symptoms. After checking me out, he told me that there didn’t seem to be anything wrong with the muscle itself. He told me point blank to make an appointment with my doctor. “He’ll know what to look for,” he said.
But before I got around to making that appointment, the pain in my left calf subsided, just as it had on my right side. I think this happened almost overnight; again, not like normal muscle trauma that takes weeks to slowly resolve itself. It was now February, and I started running again, relieved that my troubles were behind me. My relief turned out to be short-lived, however. Within a week, I had a new problem, a new inexplicable “injury” that showed up suddenly with no obvious warning. This time it was a pain in my left side that felt like I had torn a muscle or cartilage in my rib cage.
At first my new pain was subtle and manageable. Although I noticed it all the time, and felt it more when I ran, it didn’t seem like a big deal. I thought maybe I had tweaked something while out walking my dog — maybe it was one of those times he had strained suddenly against the leash, catching me off-guard. What else could it be? But whatever its origin, I assumed it was just one of those things that would get better within a few days.
Unfortunately, it was heading in the opposite direction.
The pain settled in, growing in intensity like a toothache, spreading all along the bony outline of my ribs on my left side. I took several days off from running, started taking ibuprofen, which made no difference, and complained to Ann, who told me I should see a doctor. It’s hard to explain why I still didn’t make that call. I know I was very busy at the time, but that’s not the real reason. I think that more than anything else I feared embarrassment, perhaps in the same way that men fear embarrassment when they ask for directions. I felt it was my job to tolerate discomfort and all the little aches and pains that come with being an athlete. As illogical as it sounds, I interpreted the feelings of misery and pain as evidence of my own weakness and lack of mental toughness, rather than evidence of the seriousness of what was taking place in my body. I had been making excuses for my injuries for over a month, and I was stubbornly clinging to the idea that I just needed to wait it out. When I thought about seeing my doctor, I imagined the shame of being told that it was nothing, or something really trivial.
On Saturday, February 19, exactly five years from my writing this, I went for what would be my last run for a while. Not only did my side hurt terribly, but I also felt weak and fatigued. I remember breathing hard, which hurt my side, but still feeling like I wasn’t getting enough oxygen. I don’t remember how much I had planned to run, but I turned around after ten minutes and trudged home defeated.
And still… still! I made no effort to seek a doctor’s advice.
“You need to come in… NOW!”
On the morning of Wednesday, February 23, 2011, I drove to work, feeling imprisoned by the constant pain around my ribs. Ann had been urging me every morning and night to call a doctor, and that morning, having run out of excuses and feeling extremely uncomfortable, I finally relented and promised that I would call when I got to work.
I drove to my office, took care of a few things, and then — around 10 a.m. — called Newton-Wellesley Internists and left a message describing my symptoms. About twenty minutes later I got a call back. It was J., the head nurse in the NWI office. Normally, she was very friendly, but that morning her voice had an unfamiliar sternness and urgency as she told me to get to the Emergency Room. “Dr. M. says you need to come in now!” she insisted into the phone. Even then, this seemed to me to be an over-reaction, a precaution to rule out something really serious. It never occurred to me — never — that there was any real emergency.
After poking my head into my boss’s office to explain why I was excusing myself in the middle of the working day, I left the building and made the 20-minute drive to the hospital. If my first surprise that morning had been being told to report to the Emergency Room, my second surprise was that as soon as I checked in at the front desk, there was no waiting and I was immediately taken to an examination room. I remember being pleased and a little amused that my modest symptoms apparently gave me access to the express lane, and that I wouldn’t have to spend hours sitting in the waiting room flipping through the stale pages of out-of-date magazines.
Once undressed and settled in a hospital bed, I began receiving visits from a team of nurses and doctors who hooked me up to heart rate monitors, oxygen sensors, and various other devices, drew my blood, and performed some other tests. My memory is a little unclear about the sequence of events, but I think one of the doctors came in to say that my blood work had not ruled out the possibility of pulmonary embolus (a blood clot in the lung), so I would be getting an injection of an anticoagulant, and then a CT-Scan (radiological imaging test) of my chest.
The passage of time in a hospital emergency room is not like the passage of time in normal life. A sense of heightened urgency coexists with a sense of tedium. You’re surrounded by medical devices that measure your vital signs, and beep out their monotonous signals to the world. The clock on the wall sweeps out minutes slowly, but hours pass quickly. Long periods of waiting are punctuated by short bursts of what seems like immensely important activity. You put on what you think is a brave and cheerful countenance, but gradually that fades and you become more and more passive, as people do and tell things to you. You learn to cooperate and nod a lot.
I think that what you remember from such visits has a lot to do with what kind of image you have of yourself going in. Lynn Jennings, who was also stricken by PE, wrote about being visited by every doctor and nurse on her ward, a coterie of “admirers” who wanted to see and interview the Olympic athlete whose life had been spared by her prodigious cardiovascular system. Not being an Olympian, I received fewer visitors, but I do remember that the nurses figured out that they had to switch off the alarm on my heart rate monitor because it kept going off when my pulse dropped below 50; that, and the mild surprise they showed after getting the results of the CT-Scan and noting that the oxygen profusion of my blood was still 100%.
A conclusive diagnosis
When the results of the CT-Scan came back, there was no ambiguity about the diagnosis.
The scan showed that I had major pulmonary blockage in both lungs as a result of multiple, bilateral pulmonary emboli. In plain language, my lungs were about two-thirds clogged by blood clots. I guessed that probably wasn’t good.
I would have plenty of time later to appreciate how lucky I had been that the clots hadn’t done more damage. I would think about that often over the next days, weeks, and months. Ann has never let me forget (nor will I forget) that she was the one who got me to call the doctor before the worst happened.
There would be plenty of time for reflection, but for now, the game plan was focused on stopping any more clots from forming. In addition to getting injections of Lovenox that provided immediate protection, I was also started on Warfarin Sodium (brand name: Coumadin), a medication taken orally that alters the complicated chain of events involved in coagulation, slowing down that process to reduce the possibility of new clots.
I learned that there is no medication for dissolving blood clots; the body does that on its own, over time, and that the point of “blood-thinning” medications (a misnomer, since they don’t make the blood thinner, just less likely to coagulate) is to prevent new clots as the body slowly absorbs the old ones. I learned that pulmonary emboli damage the epithelial cells lining the blood vessels, meaning that once you have had clots, you are at greater risk for developing them in the future. That is one of the reasons that, five years later, I am still taking my blood thinners, which I prefer to think of as my “running pills.”
(My running friends — well, Kevin mostly — continue to tease me about my medication, confusing its anti-coagulant effects with the performance-enhancing properties of EPO. I’ve stopped arguing with him; maybe if he thinks I’m taking EPO, it will get in his head and he’ll stop thrashing me in track workouts and races.)
Over the next 24 hours, the pain in my side abated, and it disappeared entirely after a few days.
I spent Wednesday night in the hospital, and then, somewhat to my surprise, was discharged on Thursday afternoon and told to resume normal activities. That probably wasn’t the best way to describe my limitations, and I got into an argument with the doctor who was attending that morning about what activities were considered “normal.” I tried, in vain, to point out that if I could walk up stairs (normal), I could surely go for an easy run (normal, for me), which led to him writing on my discharge papers “no jogging!”
But notwithstanding disagreements about how strenuous it might be to run, once on the medication, I could carry on more-or-less as if nothing had happened. It’s true that, before they discharged me, the nurses made sure I was capable of giving myself the Lovenox injections, a process that involved sticking a very thin needle into the very small quantity of fatty tissue I could pinch together from my belly. Being thin, I didn’t have much to work with, and I felt that needle was going awfully close to things that I did not want to puncture. Although I didn’t like giving myself these injections, I also felt like a real tough guy when I saw that needle disappearing into the fold of tummy between my thumb and forefinger.
So in the end, my journey to the emergency room, diagnosis, and initial treatment took only thirty hours, almost exactly the same amount of time as our return trip from Arusha.
I appreciated the symmetry.