If you haven't read the first part of this post, it's right here.
* * *
The stress test involved me trading a shirt and sports bra for a hospital gown, which was so big that Sean, the burly, bearded technician administering the test, gently placed two pieces of Scotch tape over the front opening to keep it closed while I first walked, then jogged, then ran. The treadmill faced a wall where someone had thumbtacked a plastic tarp with a beach scene printed on it. "Can't you just feel the sand beneath your toes?" Sean joked as I ran, and I laughed. A fanny-pack-like device bounced against my hips, and I was moderately worried I might trip over the wires protruding from the blood pressure monitor and the sticky electrodes placed strategically along my chest.
I lasted eleven minutes before reaching a heartrate around 210 and gasping, "Okay! Okay, I'm done." Sean told me that was about the average time for people my age to reach peak heartrate. Later, it occured to me ask him if their peak heartrate was the same as mine, but later is not a very useful time for medical questions to occur.
At my followup appointment, the cardiologist said that for the most part, my chambers and ventricles were functioning just the way they were supposed to.
"For the most part?" I asked. As in all matters of the heart, "more or less" didn't seem ideal.
She told me that, yes, my heartrate was high, and toward the end of the test, it had (I'm paraphrasing here) gotten a bit wonky. There was a chance, she said, a very small chance, that I could have a congenital abnormality, the kind that fells 22-year-old athletes in the middle of the soccer field, leaving the world to wonder how someone so young and so fit, and with such a promising future, could suddenly die of a heart attack. It was a small chance, she emphasized again, but it was worth investigating.
"And if I have it?" I asked.
"We'll need to do surgery," she said. "But first thing's first."
First thing's first would require repeating the stress test, only this time, there would be a resting echocardiogram performed before I hopped on the treadmill in order to compare before and after pictures. In the meantime, she agreed with David's phone-call diagnosis of POTS and suggested that, if my high heartrate was bothersome, I go on beta blockers after this second round of tests. The beta blockers would not address the root cause, of course (whatever it was), which meant nothing would actually be fixed. It just meant I'd be taking medication indefinitely, which might be acceptable if my heartrate were negatively impacting my life, but it wasn't. I'd gone 29 years without even realizing it was different than most other people's. And besides, after working with David and Tom, another functional medicine doctor, on their books, I knew there was more to medicine than symptom reduction; or, at least, there should be. I told her I'd wait on the beta blockers.
"Is there a Buy One, Get One Free offer on the stress test?" I joked.
She humored me with a small red-lipped smile. "You should call your insurance," she said.
I left her office feeling vaguely worried (I could maybe drop dead at any second?), vaguely vindicated (for the most part, I was fine!), and entirely sure I would not be scheduling the next round of tests anytime soon.
* * *
"We have Christmas," I argued to Adrian. "The wedding. As it is, I'll be paying this stress test off for the next four months. The chance is so small, seriously. It just doesn't make sense to spend another two grand on this right now. I'll do the tests after the wedding. I promise."
He wasn't happy, but he let it go with that promise. As I write this, his original question comes back to me: What do you have, if you don't have your health? Why did I place more importance on saving money than potentially saving my own life? (Probably because I felt then, as I do rereading that line, that posititing one against the other like that was fairly dramatic.)
So instead, unable to continue working with my trainer and ten pounds above my typical weight, I did what any reasonable person would do: I registered for a half-marathon. Over 12 weeks, I trained diligently. I'd completed two half-marathons before, but never had I actually managed to run more than half of them; typically, mile five saw me slow to an already-painful walk, dreading the 8.1 mile trek before me. This year, I was determined to run the whole thing--and I did. I ran 13.1 miles, and though I could hardly walk for days afterwards, I was joyful with pride.
After Christmas, when whatever weight-loss headway I'd made through half-marathon training was long gone, I decided to trade distance running for sprints. I Google imaged photos of women sprinters' bodies, admiring how muscular and strong they looked in comparison to the strange, knob-kneed leanness of distance runners. With the wedding-body countdown officially on, this, I decided, would be my new approach. I found a treadmill workout that promised to "torch up to 1,000 calories" in an hour and I went for it.
Sprinting felt good. I grinned at the winter darkness beyond the windows of the gym, hyperware of the first rush of endorphins. I pushed myself, faster, faster; longer. The furious strain of total effort, followed by the sweeping relief of slowing down, was deeply satisfying. Invariably, I came home slick with sweat, happy but limping. My shins, I'd noticed, were starting to hurt. I'd had shin splints before, but this was different: this felt like bone. In the baths I took to soothe my muscles, I looked down and was surprised to find that my legs weren't covered in bruises from the knee down, the way they felt. Usually the pain was gone by the next day, but it returned more quickly and with greater intensity each time I ran. Finally, it came to be unbearable, a crack of lightning each time my feet landed. I remember the quizzical look Adrian gave me when I arrived home one night twenty minutes after leaving for the gym. "I had to cut it short today," I said, wincing as I walked upstairs.
I knew I'd injured myself, possibly seriously. A quick symptom search told me what I instinctively knew was true, even before x-rays confirmed it: I'd stress fractured my shins. Both of them.
I remember the swell of frustration as I read article after article saying I'd need to stop running for at least twelve weeks. I felt as though something was being taken from me, something challenging, that I enjoyed, and in which I was slowly progressing. Exercise, to me, tends to be all or nothing. Either I eat whatever I want and get my marathon training from watching six hours of Law and Order: SVU, or I work out every day, competing with myself to improve. The idea of stopping, of being forced to admit I couldn't do something, that mind over matter doesn't apply when that matter is fractured shins, could have been devastating if I weren't so damn stubborn.
I'd taken my first Pilates class with a friend a couple of months earlier, and I'd been surprised at how much I enjoyed it. Maybe, I thought, I could try that for awhile. Still in the bathtub where I'd diagnosed myself (ha), I found a studio two miles from my house that offered the first class for free. This was a Friday. I signed up for class on Monday and committed to a monthly membership immediately afterward.
I started Pilates with a goal: I was getting married in Hawaii in three months, the same three months I would not be able to run. I wanted to look good in my wedding dress and feel confident in a bikini; same old song. Sarah, the owner of Stone Oak Pilates, was happy to oblige.
A former college athlete with bright blue eyes and the flat stomach I aspired to, Sarah was neither aerobics-instructor perky, drill-sergeant tough, nor yoga-mellow; I supposed I'd expected her to be one of the three, or perhaps a combination. She was, instead, knowledgeable. She adjusted our feet on the footbars and backs on the mat, explaining the "pelvic clock" and offering modifications for those whose shoulder or hip or back injuries she knew about. She helped us understand how our backs would overly compensate for weaker abdominal muscles (and how to prevent that), and how pressing our right leg into the mat would keep us aligned while our left leg rotated in circles ninety degrees in the air, and what, exactly, it meant to "articulate the spine one bone at a time." Every move built on the previous one, and every move was not just one move but many, dozens of muscles working in tandem to complete tiny, yet incomprehensibly difficult, movements.
At first, I couldn't touch my toes; I mean, my fingers hovered eight inches away from the ground. I couldn't isolate the muscles of my lower abdomen--it was as though you'd told me to swing my ponytail without shaking my head; my mind and the muscles felt entirely disconnected. My arms, shoulders, and back were woefully undeveloped, startled and resentful of the work I was now asking of them. There were times Sarah demonstrated a move and I laughed, thinking she was joking by expecting us--well, me--to repeat it. There were times I felt like vomiting by the time I left, and my body has been sore, almost without interruption, for the past six months. This was hard. Harder than I expected. Harder, in some ways, than running had been.
Sarah expected us to challenge ourselves, to focus, but she also said things like, "This should be work, but it shouldn't be painful. Don't muscle through. Don't work to pain. If it hurts, let's modify."
Don't work to pain. Don't muscle through. Huh.
I once went to a Bikram yoga class where the flushed blond instructor kept yelling, "Go MORE down! MORE down! If it hurts, keep pushing!" And though I didn't like the class (or the phrase "MORE down"), that had more or less been my approach to exercise--possibly even to health in general--my entire life. If it hurts, keep pushing. That means you're strong. But here, in Pilates, I was slowly learning a different approach, a different way of being with my body. I was learning how connected each muscle, each bone, was to every other. I was learning how to access and strengthen specific, individual muscles. I was learning how to be patient with myself, how not to work to pain; and, conversely, how to appreciate and celebrate small milestones without obsessing about improvement. Every day, I fold forward and touch my toes, just because I can, but at some point, I stopped taking progress photos, because "progress" became redefined.
It happened gradually, but Pilates has become something of a sacred space for me. It is one hour of being entirely present, of focusing on the body to the exclusion of anything else, but doing so in a way that feels . . . forgiving. And fun, and rewarding. In the studio, nothing matters but the closeness of the heels, the drawing together of the inner thighs, the control of rolling up and lowering back down, one bone at a time. Everthing else--the writers' block, the spousal argument, the financial stress, whatever--becomes a spectral outline and then vanishes altogether, for one hour of focus and sweat and progress and laughter. And the beautiful thing is that afterwards, those things still seem smaller than they did before.
* * *
I kept my promise to Adrian and scheduled that second round of tests, but it wasn't because he reminded me or even out of ogligation to him; it was because my relationship to my body had slowly, unexpectedly, changed. I was grateful to it, I was proud of it, and I wanted to take care of it. It seems strange that it's taken so long to get here and that it was Pilates, of all things, to spark a change I didn't even know was needed, but there it is.
Before I returned to the treadmill, a technician named Irene, who wore scrubs covered with cartoon hearts, asked me to unclothe from the waist up and cover myself with a small towel. She positioned me on the cot, apologized for how cold the room was and how cold the ultrasound gel would be, and then pressed a microphone-shaped transducer along my chest, pushing hardest at my ribcage right below my breast. On the bulky Phillips screen that reminded me of a nineties-era IBM, a dark conical shape waited to be filled.
"Ah," Irene said. "There it is."
It reminded me of movie scenes in which expectant parents see the grainy form of their baby for the first time, only now, it was a heart that appeared on the screen. My heart, contracting and releasing. One angle showed two wriggling parts that alternately looked like an orchestra conductor and a child clapping; another angle transformed the heart into a dark mouth, opening and closing. The hollow sound of my heartbeat filled the small room, and for twenty minutes, I didn't look away from the screen. How often do we get to see our own heart, to perceive its constant effort? I felt strangely vulnerable, my insides made visible in this way. I also saw that it--my heart--was a real thing, not abstract, not a metaphor, but solid and destructible. I felt protective of this heart on the screen.
In the end, I do not have that congenital abnormality. I have a heart that beats quickly, a chest that's lately been aching (which, yes, I intend to explore), and a new and long overdue gentleness with my body. Any real change, I suppose, comes slowly, and waits to be built upon.