July, 2021 – In the two days after we returned from our six-week trip, I’d unpacked, gone through the mail, and sorted out the urgent tasks from the important tasks.  I was anxious to go for a hike at the earliest opportunity to see how my newly fixed heart would perform on familiar ground.  Despite having no obvious issues with my recovery thus far, it still seemed prudent for me to go with someone in case anything changed.  Marty agreed to go with me on one of my favorite trails, the Perseverance Trail, as it follows Gold Creek up into a verdant green canyon surrounded by forested and brush-covered steep slopes and snow-capped peaks that once hemmed in a glacier.  We hiked up a side access trail that gained elevation to the main trail and then climbed steeply to an overlook at the mouth of the canyon, where multiple cascading creeks descended the surrounding slopes to meet Gold Creek at the bottom. 

As we climbed the access trail, I began to feel the heat rise in my chest.  It was similar, though not as pronounced as what I felt before my heart attack.  I couldn’t seem to keep pace with Marty, who was a few hundred feet in front of me.  I needed to stop and catch my breath.  As I stood there waiting for my breathing and heart rate to slow down, questions flooded my mind.  Why is this happening? Did I lose that much conditioning in just a few weeks?  Is this just part of the healing process and will get better over time?  I didn’t know what to think.  I checked my heart rate on my watch and found it was within normal limits for an uphill hike.  After a minute or so of rest, I continued up the trail.  The heat in my chest came back, though it didn’t seem to be as strong.  Perhaps my heart vessels weren’t responding as quickly to the demand for oxygenated blood as they should so soon after the stent placement.  Marty waited for me at the overlook where we stopped for a short rest.  Another short, steep climb lay in front of us before the trail leveled out and gradually ascended through the canyon.  I knew that part of the trail would be easier.  As I summited the last rise, the burning in my chest was barely perceptible.  Perhaps I was just expecting too much too soon from my newly repaired heart.

We continued to the end of the trail, and I reveled in the scenery that surrounded me.  Gold Creek was bank-full and rushing over its granite-bouldered bottom, more akin to a river than a creek.  New spring growth covered the flanks of the mountains, interrupted only by wide swaths of snow flowing into drainages set against a backdrop of a rare blue cloudless sky.  Birds chattered in the pockets of conifers and flitted about in the salmonberry brush alongside the trail.  Large-leaved skunk cabbage, red western columbine, bright yellow buttercups, and chocolate lilies bordered the moister sections of the trail.  Every unique sound, scent, and sight of the natural environment permeated my senses.  I breathed deeply to take it all in, focusing on how each element touched me.  The crunch of gravel under my footfalls.  The pungent odor of skunk cabbage mixed with the sweeter bouquet of wildflowers.  The vertical dominance of the surrounding mountains above the canyon pathway.  I soaked it all in.  Gratitude rushed through me.  My body functioned well enough to hike this trail, to receive these gifts of the natural world.  I thanked God for the opportunity to be immersed in nature once again, knowing that my story could have gone very differently but for the interventions I received.  I was lucky.  I was blessed.  I could have lost my life at just 58, but I didn’t.

We finished the seven-mile out-and-back trail and returned home to enjoy the rare sunny day on our back deck.  The burning in my chest had not returned during the remainder of the hike.  Still, the question lingered in the back of my mind…why, if the stents fixed the narrowed arteries, did I have burning pain in my chest again?  My release instructions from the Idaho hospital were to make a follow-up appointment with my family doctor and to participate in cardiac rehabilitation.  I would also need to find a local cardiologist, although I didn’t think Juneau had any.  One of the challenges of living in Alaska is access to advanced and specialized medical care.  I put those appointment tasks on my list for Monday morning, even though the last thing I wanted to do was see more doctors.

The following week, I made appointments to see my regular doctor and attend my first cardiac rehabilitation session.  As I waited for the next five days to pass until my doctor’s appointment, I tried to pay attention to when I would feel heat in my chest.  Sometimes it was in the morning, and sometimes when I was moving around.  Because I wasn’t certain what was happening, I didn’t try to do any more hikes.  I was perplexed.  Everything in my heart was supposed to be fine, but something in my gut told me it wasn’t, but then logic told me there was no reason why my heart shouldn’t be fine.  The angiogram had looked at all of my heart vessels, and the cardiologist had fixed the only two that had blockages of any kind.  The follow-up electrocardiogram showed no damage to my heart muscle.  Everything in my heart should be fine.  But somehow, despite all of this evidence supporting a perfectly repaired heart, I feared something was not right.  And I desperately wanted to be wrong.  It must just be part of the healing process that I wasn’t told about.  Uncharacteristically, I was looking forward to my appointment to get some answers.

“I was lucky.  I was blessed.  I could have lost my life at just 58, but I didn’t.“

The doctor opened the door of the exam room, holding my patient chart in her hand.  My eyes met her surprised look.  “Holy crap, huh?” I asked.  She repeated my words, acknowledging the shock value of learning I’d had a heart attack.  I described our hiking adventure in the Tetons, and how I’d hiked over 40 miles with what I thought was a bad case of heartburn until I woke up to a heart attack.  We reviewed the treatment I received at the hospital in Idaho Falls, and how everything seemed fine during the bikepacking trip.  I told her about the reoccurrence of the burning sensation during my recent hike up the Perseverance, and occasional chest pain during the day when I wasn’t doing anything but sitting.  I asked about the possibility of the stents causing the pain as the arteries adapted to them, referred to as “vessel stretch” in my internet research.   She didn’t respond to that question but asked me if it might be heartburn.  Perhaps it was possible, but I doubted it, I told her.  She left the room briefly and came back with a tiny cup of white chalky liquid, asking me to drink it.  “Does it feel better?” she asked, just moments after I’d swallowed it.  “Maybe,” but I didn’t think so.  The doctor suspected I was experiencing heartburn and suggested I take an over-the-counter medication for thirty days to see if that solved the problem.  There was no harm in seeing if it worked, she said.

I left the appointment feeling confused.  My question about the vessel stretch phenomenon – whether it was a real occurrence or just a theory to explain post-stent pain – went unanswered.  Heartburn seemed an unlikely suspect for exercise-induced chest pain.  I’d already made that mistaken assumption, and it landed me in the hospital.  I felt simultaneously frustrated that my concern was potentially being dismissed again, while also doubting my own experience given the unpredictable, inconsistent nature of my symptoms.  I could only follow all of the instructions I’d been given and trust that the doctors knew better than I did.

Cardiac rehabilitation began the following week.  A frail, grey-haired older man astride a stationary bike was the only other patient when I walked into the room.  His breathing was ragged and shallow as he struggled to push the pedals of the bike.  The contrast between our outward appearance of malady unsettled me.  I knew I didn’t look ill or weak.  I had full mobility and strength.  I could go out and hike, and but for a bit of discomfort at the beginning, cover a good bit of distance without a problem.  Perhaps I didn’t belong there.  My situation was quite different from his.  But my appearance was also deceiving.  My heart survived a catastrophic event, but there was no external indicator of this.  I felt a tinge of guilt for showing up looking healthy, but I also knew everything I had been through.  I needed to be there.

The rehabilitation specialist handed me the EKG leads to slip under my shirt.   He reviewed a few minutes of data sent from the leads to the computer.  Everything looked good, he said.  We talked briefly about my recent medical history, and then I got on the treadmill with the EKG leads still attached so he could monitor me as I walked.  The pace was very slow at first, but then he bumped the speed up periodically.  After a few minutes of walking at each pace, he’d ask me to identify which of a series of facial expression emoticons represented how I felt.  The expressions ranged between one – the happiest, and ten – in significant pain.  At first, I chose the happiest emoticon, but as the pace increased, I felt some warmth come up in my chest.  There it was again – the familiar hot sensation, even if it was tolerably mild.  The next level emoticon was more representative of my comfort level.  The rehab specialist told me there were no changes in my EKG throughout the different levels of walking.  All indicators were that I was doing well and there should be no reason for any pain.  I was scheduled to return twice a week for several weeks.  We would see if I continued to have pain with exercise and re-evaluate from there.

I returned home, hoping and praying that the burning pain I felt was just a product of the recovery process, or that this time, it truly was heartburn.  I tried to reassure myself.  If I gave it time, it should resolve.  All I could do was keep my activities within a comfort zone, and pray that the doubt that kept creeping into the back of my mind was wrong.