THE TELLTALE HEART

Was the chest pain the author felt while running a sign of serious heart trouble? Trying to find the answer cost him many sleepless nights—and $8,983
May 19, 1985

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.

After reading about it, I didn't see how I could subject myself to the procedure. At the same time, I realized that if I didn't, I might never know the truth about my arteries, and I couldn't live with the uncertainty. How could this be happening to me, of all people?

I was a runner. I hadn't smoked even one cigarette in my life. I had the blood pressure of a college oarsman (110 over 70) and my recent cholesterol count of 133 was well below the national average. I was selling myself to myself, whistling past the graveyard, so to speak.

The newspaper stories on Fixx's death had said that his father had suffered a heart attack at 35 and died at age 43. As far as I knew I had no such problems with heredity, but with the dangers of high-fat diets now medically accepted, I began wondering about my yearlong peanut butter obsession, only recently overcome, and my even longer-lived obsessions with ice cream and cheeseburgers back in the days when cholesterol was a word for The New York Times crossword puzzle. In 1974 my cholesterol count had been 282. Had I clogged up my arteries then?

I decided that before my emotional roller coaster ran off its tracks I'd better get some advice—the more the better. I wanted a consensus, especially about the need for an angiogram. I sat down and detailed my plight in a letter, photocopied all 19 pages of my test results, enclosed my telephone number and sent the bulging parcel off to 10 physicians. Among them was George Sheehan, cardiologist, author and running guru, who had once sent me a two-page letter in response to a question about orthotics (special shoe inserts). The nine other cardiologists, their names collected from friends and from the Yellow Pages, included both doctors who specialized in cardiovascular testing and "new age" preventive-medicine types. I had no idea if I would get any responses, but it felt good just to make the effort.

Five days later, Sheehan phoned. He said that having seen my stress test/EKG, he would never have administered the thallium, and added that "You can continue running, as long as you don't race, and you'll probably be all right." He paused. "But you might not be comfortable living like that, and the only way to really free your mind is to have the angiogram." He referred me to a Dr. Ralph Oriscello, a cardiologist and director of Critical Care Medicine at the Elizabeth (N.J.) General Medical Center. "Ralph is a national treasure," Sheehan said. "He's a runner and he's well versed in everything going on in cardiology today." It was Friday, Nov. 16, and I immediately made an appointment with Oriscello for the following Monday. But later on Friday I kept an appointment I had made earlier with Dr. Judith Hochman at St. Luke's Hospital on Manhattan's West Side. I hadn't written to Hochman; a Massachusetts doctor friend had given me her name. When I'd phoned to make the appointment and told her about my case and that I was continuing to run, she'd suggested I might be better off taking "a nice walk." Given my increasingly suggestible state, she may as well have said, "You're his nurse? Well, if it's a nice day you might wheel him around the yard a bit, but make sure that he's bundled up."

At St. Luke's, Hochman, director of the Cardiac Care Unit, examined me, then lingered over my test results, apparently weighing her words. Finally, she said, "You seem to be the kind of person who would want to know the facts."

I began to experience a barely perceptible buzzing in my ears. I took a very deep, slow breath and asked, "What is it?" From some place far away, I heard the words, "high likelihood" and "coronary artery disease." Suddenly, I thought that it wouldn't matter very much if a 10,000-pound safe came crashing through the ceiling. It wasn't that I believed my life was in imminent danger, but my sense of myself certainly was. For the first time in my life I felt frail. Hochman seemed to sense my reaction and said, "Nine out of 10 people with this condition lead normal lives."

I looked down and away from her, my mind a jumble of thoughts: "Normal lives? I didn't want a normal life. I've run marathons. I want to run one when I'm 90. I've been good to myself. I haven't eaten an egg in years."

Hochman suggested that I begin taking a daily aspirin, a therapy popular with some physicians as a possible hedge against stroke and heart attack, and she offered me a prescription for nitroglycerin tablets for the vague tightness I'd been feeling at the top of my chest and in my throat. She called the tightness angina. I shook my head no. She seemed offended. She did suggest that I have the angiogram because, as she later explained in a letter to one of the other doctors I consulted, I was "so anxious about the whole issue and [seemed] to have a personality that could deal better with certainty than uncertainty."

The next day was Saturday, so I was surprised to hear from another of my 10 doctors, Stephen Scheidt of New York Hospital. When I'd phoned for an appointment, the secretary told me I would have to wait three weeks. That was before Scheidt had read my letter and seen my records. Now, on the phone, he said, "There are some inconsistencies [this word would soon become a major theme of my little drama] here. You've done an extraordinary amount of work in these tests." I thought I heard him shuffling my papers. "And yet, it's inconceivable that you have the disease described here." Scheidt agreed to see me the following Wednesday.

On Monday, I kept my appointment with Oriscello, a tanned, vigorous man of 47, who at 5:30 that morning had run his daily six miles in 43 minutes. The "national treasure" had received my records from Sheehan, and he proceeded to put my emotions through their paces with a 45-minute monologue. I had just sat down when he all but shouted, "Why did they do the thallium? I would have looked at that normal stress test and EKG and sent you out running. [I was delighted with his attitude.] But maybe it was divine intervention, because what they found was multiple perfusion deficits; the heart had cold areas. Then, when the radionuclide [the thallium] was allowed to recirculate, it was taken up by the heart muscle that had been cold. This means two things: a compromised blood supply to various areas of the heart ['Oh,' I said], but no heart muscle damage of any magnitude. ['Aha!'] If you had damage, the thallium would not have been picked up the second time around."

Oriscello held up the negative-like images called thallium tomograms that I'd spirited out of St. Vincent's. There were 20 or more pairs of little doughnut-like smudges that I'd assumed were cross sections of my coronary arteries but were actually two-dimensional "slices" of my heart. All of the doughnuts marked STRESS had blank, light or fuzzy areas. "See the lack of uptake here? And here?" Oriscello said as he pointed to them. But many of the doughnuts marked DELAY were solid. "And now it's picked up here," he said, pointing to the solid ones. "It's abnormal, Dan, and I don't know why. There are people who have a normal stress test—generally not to the level of yours—who can indeed have problems, but at least the EKG would be abnormal, even if they didn't have pain. However, there are strange things in this world. On the basis of what I see here, I'd have to say it was rather significant coronary artery disease.

"For some reason, someone then suggested that you have a Wall Motion Study, in which the radionuclide remains in the left ventricular chamber. One can watch as the heart contracts, ejects blood and then relaxes. Ordinarily, one sees a nice, uniform pattern of contraction, but in your case the study shows, according to the radiologist at St. Vincent's, that you have multiple areas of altered heart muscle contraction." That didn't sound as bad as "multiple perfusion deficits"; I was becoming a connoisseur of bad news. "So what do you believe?" Oriscello asked. "The thallium and Wall Motion, or the stress test/EKG and the fact that you feel fine and have been running for a long period of time?"

I said, "Another cardiologist told me, 'You've done an extraordinary amount of work in these tests. It's inconceivable that you have the disease described.' "

"No, it's not inconceivable," Oriscello said. "It's unlikely. Life is a bell-shaped curve. At one end is a group that can exercise interminably and feel nothing, yet has severe disease and abnormal tests. You may be at that end. You don't have the classic symptoms: the chest pain that comes and goes slowly, the EKG and stress-test changes, but you have two positive tests and you're a 46-year-old male."

"Even worse," I said, "someone said I almost certainly have coronary artery disease."

"Well, you could. That's what the angiogram would be done for, to rule it in or out."

What Oriscello wanted to leave me with came as a complete surprise. He said, "After I tell you what I think is going on here you're going to ask how I can justify telling you to go for an angiogram. Based on your history, your EKG and stress test, and having listened to your heart, I have to say that I think your coronary arteries are going to be totally normal. But Danny Boy, that's nice for me to say, but it's horse-feathers if you go out and do 10 miles and the next thing you know you wind up dead."

When I arrived home that day, my phone was ringing. It was respondent No. 3, Howard Bezoza, a specialist in preventive medicine and clinical nutrition. He started out in high gear: "From just the information you sent me, your anxieties are appropriate. There are definite Wall Motion abnormalities, and if I were you, I'd go for the angiogram."

Then Bezoza dropped a bomb. "Forty-six-year-old men with significant coronary disease do beautifully with surgical intervention."

I think I sighed. Bezoza retreated a bit: "I don't believe you're going to see a significant angiogram. I think you're going to see a solitary lesion, but if you don't do the angiogram we might miss you." Then he steamed ahead. "And you might be a person who's set up for sudden death [I sighed again]...10 years from now."

I said goodby to Bezoza and found a message on my answering machine from No. 4, a Park Avenue cardiologist named Marvin Mordkoff, whom I would speak with on the phone many times for nearly two weeks before I got to see him for more than 10 seconds. I soon began to think of him as Mordkoff the Mysterious. (Oriscello was the National Treasure, Scheidt was Inconceivable, Hochman was Hochman.) Mordkoff spoke so deliberately, with such lengthy pauses, that often I was forced to say "Hello?" just to check if he was still on the line. "...two tests that show something," he said. Long pause. "Hello?" "The probable cause has nothing to do with coronary disease."

"Certainly two people have thought otherwise," I said.

"There's nothing that's impossible. Uh [pause], I have a vast background with this type of problem, and I think [long pause] you write beautifully."

"What?"

"I have never received a letter like the one you...."

"That was just a scrawled note."

"It was a joy to read...so succinct. I was impressed."

So was I, with his sensitivity and literary judgment. Mordkoff's optimism about my arteries was easy to take, too. I decided that he'd earned a starting shot. I said, "I'm going to see a total of four people [Hochman, Oriscello and, in three days, Scheidt], and you're the fourth."

Mordkoff had already discussed my case with colleagues at The Mount Sinai Medical Center, and he said, "A lot of people are interested in you."

I thought, "Great, I'll die famous."

"You're not running now, I gather," he said.

The implication was disturbing.

"I ran yesterday, six miles," I said. "I felt fine."

He didn't respond.

"I held back," I hastened to add. "At the slightest sign of...." I had never encountered such eloquent silences. I threw out Scheidt's "inconceivable" remark, the nearest thing I had to a coup de grace.

"There are some terrible inconsistencies here," he said. "A guy as healthy as you...." Mordkoff wanted to show my tomograms to a colleague at Sinai, "one of the world's experts in evaluating thalliums." It was late in the day, but I took the tomograms to Mordkoff's office in a cab. He grabbed them from me wordlessly, rushed out to Park Avenue in his lab coat and jumped into another cab.

We spoke the next morning. "It's so unusual," Mordkoff said, "to have this many deficits in the thallium—[the colleague] and I agree on that—this many things wrong in the Wall Motion and have that great a stress test. I would go and do another Wall Motion before having an angiogram. Let's just do this one confirming test."

I asked, "Does my having an angiogram trouble you?"

"I hate to subject you to the risk, as small as it may be," Mordkoff said. "You can die from an angiogram. You can have a reaction to the dye or have a heart attack. These things rarely happen, but you certainly don't want to take the chance with someone who has a healthy heart."

"I want to resolve this," I said. "Every twinge, and I...."

"I know what you're going through. You'll be out running in the cold, you'll get a little constriction in the chest, and you'll say, 'Oh, my gosh, is this it?' But I would like a chance to listen to your heart [by now I had visions of cardiologists lining up for the privilege] and to attach a device called a Holter monitor to check out your palpitations."

For more than six months I'd been experiencing occasional fluttering sensations in my heart—floomp—when I ran, as if the whole mechanism were turning over. But in the previous two weeks they had been occurring more frequently, sometimes even when I sat reading.

"Everyone says they're nothing," I told Mordkoff.

"At this point, we can't be sure of that," he replied.

I went out and took a half-hour run on the treadmill at my health club, and when I noted it in my Fixx diary, I underlined its quote of the week, a line from Much Ado About Nothing: "He hath a heart as sound as a bell."

After my run, I went to Mordkoff's office and one of his nurses hooked me up to the Holter, a tape recorder-like device attached to a belt around the waist, with wires connected to electrodes on the chest. Late that night, so that Mordkoff might have something interesting to work with, I ran up 10 flights of stairs in my apartment house.

At 3 a.m., with the Holter on the floor beside my bed, I woke with a start, all tangled in wires. I'd been thinking that day about Barney Clark, the first person to receive an artificial heart. That man had wires. Extricating myself from mine, I was more annoyed than anxious, a welcome relief from what I'd been feeling at other recent 3 a.m. awakenings. I flicked on the bedside light and looked down at the tape twirling away, wondering what horrible secrets I was revealing. Then I reached for my watch and—I don't know why—took my pulse. My heart was beating 48 times per minute and it sounded mighty fine. But what did I know?

That afternoon, after the Holter was removed, and after I'd made one appointment to be examined by Mordkoff the following Monday, Nov. 26, and another appointment for a second Wall Motion Study on Tuesday at Sinai, I went, tomograms in hand, to see Scheidt. He listened to my heart and heard nothing alarming. He said that thallium and Wall Motion Studies have a 10% to 15% margin of error.

"But both tests say the same thing," I pointed out. I was such an expert now that I could argue either way.

"And you have a normal EKG," he said. "But we have more than three tests; we have a person. Take a group of 55-year-old men with chest pains that come when they walk up a hill and that go away when they take nitroglycerin, and most of the positive tests are going to be true positives—abnormal findings that properly indicate disease. But then take a group with a low expected incidence of disease—healthy 35-year-olds, nonsmokers, pretty much vegetarians with low cholesterol levels who have superb exercise tolerance. Then if you have positive tests, the odds of their showing disease are way under 50-50. That's where I put you."

I asked, "What if I do have blockage?"

"The obvious answer is coronary bypass surgery," Scheidt said. "But no one in his right mind would fix a blockage in someone who gets to Stage 5 on a stress test, unless your anatomy was crazy."

"Will diet open up arteries?"

"Getting your cholesterol under 175 may—and you have. And fish oils may help, though we don't have any long-term data yet." It seemed that I might have to start holding my nose and start swigging the fish oils.

"And what about exercise?" I asked.

"Exercise improves coronary circulation in young rats," Scheidt said.

"Well, I've been called a...." I laughed for possibly the first time in three weeks.

"But it's never been proved in an adult human. Exercise is nice because you don't smoke when you do it, you tend to be thin and to watch your diet, and exercise brings up your high-density lipoproteins [HDLs]—the good cholesterol—and lowers your total cholesterol."

I thought of a woman I knew who had made the sweeping statement: "Middle-aged men become runners because they're afraid of dying." I did love running. I didn't think that I'd ever done it out of fear, but I was also drawn to the story of Clarence DeMar, the great 34-time Boston Marathoner. He died of cancer at 70, and during an autopsy his doctors supposedly discovered that DeMar's coronary arteries were three times the width of the average man's, the implication being that running had made them that way. Did that sort of thing motivate me to run or was I out there for love alone? I had to admit that I now was afraid, but in a different sense, afraid that tomorrow, or next week, someone with a lot of degrees on the wall would tell me to come in off the roads to stay.

I told Scheidt that Mordkoff had suggested I have another Wall Motion Study. "That's what I would do," said Scheidt. "But the end of my spiel is this: With two positive tests, your risk might be 20 percent, and if knowing that will keep you from living in peace, let's do the angiogram. It's the only way you're ever going to know for sure."

That Saturday night, Nov. 24, alone in my living room, I kept glancing at a miniature orange tree I'd been given to "save" two years earlier. It had been nearly dead, with only three twigs and a few wan leaves. Now it was two feet high, with almost 100 little oranges. I wondered if I would live to see the oranges ripen.

I was thinking about my father that night. At the age of 47—only a year older than I was now—he had undergone open-heart surgery to repair the mitral valve that had been damaged (we'd always been told) in a childhood episode of rheumatic fever. He developed circulatory problems in his 50s, supposedly related to the valve problem and to heavy cigarette smoking. He died at 61. My father had been a great athlete, not to mention the life of every party he ever attended, and as I watched his illnesses subdue and depress him, I received a subliminal message: If you lose your health nothing is ever much fun again. Now I wondered, what if there had been no rheumatic fever and my father's heart disease had been congenital? All weekend my heart went floomp.

On Monday, on a scale in Mordkoff's office, I weighed four pounds less than I ever had in my adult life, and I hadn't been trying to lose weight. But Mordkoff said that the Holter was normal, that my pulse rate ranged from 152, during my stair climb, to 38 at 7:31 a.m. during sleep. Then he spent 20 minutes giving me an echocardiogram, an ultrasound study of my heart's valve functions, rolling a ball-ended sort of prod all over my chest. But the valves were normal, including the mitral valve.

Then it was Tuesday and I was at Mount Sinai, going for the gold again. The hypothetical top score on the Sinai Stress Wall test apparatus was 200 watts, though no one had ever achieved it. I did. Again I heard cheers—and again bad news. "It's not as bad as last time," Mordkoff said, "but the septum is still abnormal. I would go ahead with the angiogram. You can be admitted to Sinai next Thursday, Dec. 6, have the angiogram Friday, and go home that night, if all goes well. I suspect that your arteries are going to be normal, though two other doctors at Sinai don't. Personally, I think you'll find the angiogram to be a wonderful experience; you're going to find out you're well."

"Sure," I said, "I'll want one every week."

"No, but you're blowing it out of proportion. They'll make a tiny hole in the artery, and advance a very narrow, hollow tube. You'll see it on the screen."

"I'll see it?"

"Yes, it's like a snake, up inside your arm and down into your chest." (I couldn't imagine that watching a snake slither into my chest would be a wonderful experience.)

"Your angiographer, Dr. John Ambrose, has great hands." (Were we discussing a shortstop?)

"You'll see your heart beating, and the dye, moving out of the tube and into the arteries." (This guy sounded like the lady in the traffic helicopter: "Tunnel traffic is barely moving, and the southeast artery is a mess.")

Why did I suddenly find Mordkoff so amusing? Maybe because the decision had been made and some of the uncertainty was gone, though I was still about to have a wonderful experience that might kill me. My coronary arteries were going to be normal, though two doctors didn't think so. I would go home that night, unless all didn't go "well."

I muddled through the next few days, running slowly every afternoon, hoping to raise my HDLs and lower my cholesterol, going for the lowest count in the Western Hemisphere. One night, I dragged myself to a party, where a friend greeted me with "If it isn't Napoleon Bonaparte." She pointed to my right arm, which was thrust inside my jacket, hand over my heart. I realized that I had been doing that a lot.

At 6 p.m. on Thursday, after an elderly technician at Mount Sinai took blood from my arm with one of the world's dullest needles, I was taken to the first $360-per-night room, hospital or otherwise, I'd ever stayed in. I had brought along a book, The Exercise Myth, to help me face facts in case my running career had to end the next day. The author of this book, a cardiologist named Henry Solomon, said exercise was a killer. In a chapter titled "The Dangers of Exercise," I read: "I know patients of exceptional fitness who have severe coronary artery disease.... They may have no symptoms and may be capable of outstanding physical performance with hearts that will kill them." I wished there were a way to unread those lines.

The next morning I was given 10 milligrams of Valium, routine for angiogram patients. Then I was wheeled up to the "cath lab" and strapped into a cradle, a troughlike inset in a table that rotates on its longitudinal axis. EKG leads were fastened to my arms and legs to monitor heart rate, and an IV tube went into my left arm—"In case," I was told later, "we needed access to a vein in an emergency." They jabbed the crook of my right elbow with a local anesthetic. I felt some pressure, then a sense of something going up inside my arm, and then I was staring at a fluoroscope screen, transfixed by the sight of a dark little stick poking around inside my chest. It looked like some protozoan blindly searching for a mate. As I watched, the dye spurted out and my coronary arteries filled; they blossomed, first the left one and then the right, both with multiple branches.

All afternoon, I waited in my $360 room for Mordkoff. First I decided that he had far more serious cases than mine; then I became convinced that he wouldn't keep me waiting if the news were good. Finally—I think I had dozed off—I heard someone say, "Next time you're out running, and you get a little pain, just run a little faster."

"What?" I practically shouted.

Mordkoff the Mysterious, henceforth to be known as Mordkoff the Magnificent, stood grinning in the doorway. He said, "Your coronary arteries are normal."

I did shout. "Unbelievable! But what about the three tests? How does the science of cardiology explain...?"

"There is no science," he said. "I was outraged when I saw the Thallium Scan. The inconsistency was too great."

"Don't you have any ideas?" I asked him.

"None. As far as I'm concerned, you have a normal heart. It's just dilated. That's what every athlete has."

"O.K., but do I have a heart condition?"

"You do not, and you can do any and all exercise, to any extent, with no limitations at any time."

The next day I phoned the National Treasure. "But I knew you were normal," Oriscello said. "This kind of thing happens so often. I've had three similar cases recently. One of them concerned a 34-year-old woman, a 25-mile-a-week runner, who saw a psychiatrist twice a week because several cardiologists told her that she was in danger of suddenly dying. All she had were five consecutive premature beats, felt to be ventricular, on a Holter monitor. This is a normal phenomenon in many healthy young people.

"There was a 2:24 high school marathoner who wanted to get into one of the service academies and was disqualified because his EKG showed a phenomenon called second-degree heart block. This is the ultimate in physical conditioning, and yet his parents were told. There's something wrong with the electrical system of your son's heart.'

"And then I had a superb 17-year-old high school soccer player. He had some isolated T-Wave changes on his EKG, and his echocardiogram showed some ventricular thickening. This was a normal echo. It wasn't a reflection of cardiomyopathy, but of changes brought about by training, and yet several reputable pediatric cardiologists told his family that he, too, was in danger of sudden death."

Four days later, I brought the film of my angiogram to Scheidt. After coming this far, I wanted to be an expert on the subject of my coronary arteries. Scheidt studied the film and said, "Your coronary arteries are quintessentially normal. You do have a mild abnormality of the ventricular wall, which is irrelevant. And one area at the bottom of your heart doesn't contract normally. In 90 percent of males that means arterial blockage, but not in your case. Overall, your heart works at the highest limits of normal."

I was satisfied. I was ready to start living again, but seven weeks of my life were missing. So I started filling in the blanks. One day I even ate two slices of pizza, and somehow I knew they wouldn't kill me. I started running faster, and on a blue-sky day in the new year I found myself passing the Friedsam Memorial Carousel in Central Park. Children were going up and down on the horses, and I was singing and dancing to the music.

ILLUSTRATIONRICHARD SPARKS ILLUSTRATIONRICHARD SPARKSAfter I'd spent 10 minutes on the treadmill, thallium was injected into my arm. ILLUSTRATIONRICHARD SPARKS"Let's go for the gold," I said, and moments later I pedaled right through Level 5. ILLUSTRATIONRICHARD SPARKSI had run marathons, but now I was wondering if I would even live to see the fruit ripen on my miniature orange tree. ILLUSTRATIONRICHARD SPARKSA tangle of wires from the Holter made me think of Barney Clark. ILLUSTRATIONRICHARD SPARKSMordkoff gave me an echocardiogram, rolling a ball-ended prod over my chest. ILLUSTRATIONRICHARD SPARKSAt a party I was greeted with, "If it isn't Napoleon Bonaparte." ILLUSTRATIONRICHARD SPARKSI was staring at a fluoroscope screen, transfixed by the sight of a dark little stick poking around in my chest. ILLUSTRATIONRICHARD SPARKSMordkoff the Magnificent stood grinning in the doorway. ILLUSTRATIONRICHARD SPARKSAs I ran past the carousel, I was singing and dancing to the music.

HOLE YARDS PAR R1 R2 R3 R4
OUT
HOLE YARDS PAR R1 R2 R3 R4
IN
Eagle (-2)
Birdie (-1)
Bogey (+1)
Double Bogey (+2)