Year 10 Begins

. 7 min read . Written by Russell Smith
Year 10 Begins

All-in for my December 11th stress test

Frank Miller’s epic Batman: Year One series came out in my formative pre-teen years. I loved reading the history of Batman in his first, foundational year – before his first anniversary. Ever since, I’ve appreciated counting milestones in that way: Year One begins on Day 1 and culminates a year later in the first anniversary. Maybe that method doesn’t speak to everyone, but it sings to me.

Today, Year 10 Begins. 

Nine years ago today, I underwent my second open-heart surgery. My first, in 1985, was performed at St. Mary’s Hospital, at the Mayo Clinic, in Rochester, Minnesota by Dr. Gordon Danielson, Jr. who passed away in 2017. He drew a picture of my heart on a piece of yellow, legal-sized paper, to explain my condition and what the surgery would accomplish. When he finished, he signed it, handed it to me and said, “Keep that. When I’m famous, it’ll be worth 15 cents.” During the  2014 surgery, I had a Fontan conversion, and also a pacemaker installed. It was performed at Lurie’s Children’s Hospital in Chicago, Illinois, by Dr. Carl Backer, who trained under Dr. Danielson. Dr. Backer now works at Cincinnati Children’s Hospital and he’s the Chief of Pediatric Cardiac Surgery at Kentucky Children’s Hospital in Lexington, Kentucky. Curious that I remember the surgeons’s names, even though I met each man only twice. In a life of constant medical oversight and a couple huge surgeries, I find the details I recall about my caregivers curious. I remember some names; for others I remember faces; for many I recall nothing except the profound care I felt emanating from them.

Today, I want to focus less on reflections across the last 9 years. Instead, I’m preparing for my stress test on December 11th at Cincinnati Children’s Hospital. 

The purpose of the stress test is to measure my cardiac and pulmonary functioning under, well, stress. I take a stress test about every two years. Let me explain what happens. 

In my stress test, I will ride a bike. Some patients walk on a treadmill. The technicians hook me up to various measuring machines – an electrocardiogram (EKG) and other cardiac gauges. They also fasten some measuring device across my forehead, tightly. I get a headache as soon as they tighten it, like a tourniquet on my head. In this year’s test, they’ll place an IV in my arm, taking assessments on a variety of pressures in my veins and arteries, as proxies for cardiac pressures. 

They place all these stickers and diodes on me (why, why, dear Heaven did you let my body grow chest hair in the last decade! Removing all these stickers is torture for a cardaic patient with chest hair! You let me go 38 glorious years without any chest hair! Oh why chest hair now!?) I lay down and they take measurements. I sit up and they take measurements. 

I get on the exercise bike. They take more measurements. I start pedaling, gently. They take more measurements. 

Then the fun begins. They clamp my nose. I then lean forward and place my mouth around a white tube; I will breath only by mouth through this tube for the duration of the test. 

I begin pedaling harder, ramping up to the 70 rpms they want me to maintain throughout the test. The simulated terrain remains flat for a minute or so. 

Boom! The test starts, officially! It’s go time!

At the start, I pedal easily and breath well. About 45 seconds into the test, teh technician holds up a chart. It shows a panoply of cartoon faces, from Extremely Happy to Extremely Sad, and a corresponding scale from 10 to 1 below the faces. The tech asks me how I’m feeling now. I point to the 9-10 face – Extremely Happy – and yet my own face, attached to my body with sticky sensors attached, a tourniquet plunging into my face and an IV in my arm, doesn’t show Extreme Happiness. 

Fifteen seconds later, the pedaling becomes slightly harder as the bike simulates heading up an incline. We’re a minute into the test.

We repeat these actions: 45 seconds in, I point to a face; 15 seconds later, the incline steepens. 

Four minutes in, I suspect my face resembles the face I point to: a 4-5 face. The simulation goes uphill and I go downhill. Each breath feels hollow, vacant, like no air wants to come through the tube, into my mouth and into my lungs. 

Repeat the faces. Repeat the incline. 

I feel the end coming. My legs feel like the Tin Man’s – metal and immovable. I’m panting like a dog on the worst days of summer. The test room is chilly, but I’m pouring sweat

The tech asks me to tell her when I feel like I only have a minute left. I tell her, and point to the face above the 1-2: Extremely Sad. They want 70 rpms….I can barely eke out 40 or 50. I push myself, screaming for more rpms, for more breath, for more strength, for only 10 more seconds….only 10 more seconds. Move, fucking legs, move! Move! Push! Go down, left leg! Go down, right leg! Push..10 more seconds….just 7 more seconds…just do 5 more seconds..one more turn of the pedals..one more..one more…Damnit, just one more!

Then I collapse on the handlebars. Baked. Flattened. Finished. For the official stress test, I made it a little short of 7 minutes. 

Seven minutes. It’ll take me the rest of the day to recover, to feel back to normal. To breathe without a scratching sensation in my throat. 

I collapse off the bike and lay down on the bed next to it. They record...you guessed it, more measurements for several more minutes. A few minutes in, I can have juice and a snack. 

Later, my heart doctor will debrief with me. In 2021, he and I expected me to do a bit better. My results were not bad, but still, we anticipated better. What does “better” mean? Well, that’s hard for me to say. I don’t know everything the doctors care about as they evaluate my test. But we both seemed to believe that, given my exercise routine for the previous several years, I might have endured the test for a bit more time. 

In retrospect, perhaps that result shouldn’t have surprised me. My weekly exercise regime focused on strength, flexibility and muscular endurance. I’d been training to ruck 12 miles in under 5 hours, for instance. I had not trained for increasing cardiovascular output over an intense, short period of time. I never have.

These 2021 results have grated on me for two years. Less than seven minutes. What the eff! I do not think of myself as normal or as settling for okay, alright, pretty good – even on a stress test.

Starting this week, I’ve begun training for my stress test on December 11th. I’ve generally avoided hills in my rucking. Well, bring on the hills. Throughout life, I’ve avoided sprinting. Bring on the sprinting. I’ve avoided the flaming sensation in my lungs and legs, gasping, reaching for air, for life, for one more step, one more inhalation. Bring on the flames. 

Last weekend, I rucked two miles on the treadmill, carrying 10 lbs. Then I stopped for a minute. Then I rucked 6 more minutes, at a 3.5 mph pace, but now with inclines, moving from 3.5% to 7.5% incline in that time. 

I played my “All Kick-Ass, All the Time” playlist. I fought and fought those last two minutes. They sucked. I did not, as GORUCK would have me do, Embrace the Suck. I fought the suck every damn step. 

The words of a long-forgotten song poured into my ears, Stand by Blues Traveler:

“The answers are getting harder
The answers are getting harder
The answers are getting harder
(If an answer comes to those who pray)
The answers are getting harder
(If an answer comes to those who pray)
The answers are getting harder
(If an answer comes to those who pray)
The answers are getting harder and harder
And there ain't no way to bargain or to barter
But if you've got the angst or the ardor
You might faint from the fight but you're gonna find it
For every challenge could have paradise behind it
And if you accept what you have lost and you stand tall
You might just get it back and you can get it all
So now you know why it's a long way to fall”

I felt my eyes well up with tears. I felt in my core how much pain I will have to endure the next two months, if I want even a chance at improving my performance on the stress test. My daughter sat outside the fitness room, reading, waiting for me. I didn’t want her to see me cry, see me in pain. That made more mist envelope my eyes. 

I tried to feel the hurt that would come my way the next two months, but I knew I have only a faint appreciation. That’s the point of training like this – I have only a glimmer of the goal before me – not even a goal – more an aim – so my only aim in training is “more, more.” Can I do 7 minutes rucking uphill next time? If I do that, can I do 8 minutes? 

Six minutes passed. The Blues Traveler lyrics pierced my soul as I finished. I do feel faint for this fight – I don’t want this pain or any pain or these tears or any tears – but I will find it.

I’ve never trained like an athlete – all-in – exercise, diet, sleep – every aspect of life targeted on one endpoint. For the next two months, until this stress test, I’m pretending to be Tom Brady (sans the avocado ice cream). In every moment, I will remind myself that my decision could affect the outcome of the stress test. Maybe by only 10 seconds, or even 5, or even one revolution of the pedals. I want those 10 seconds or 5 or one revolution. They belong to me, the best version of me, not to a poor decision.  

I don’t really know if these two months of pain and hurt and tears and agony and deprivation will make any difference come December 11th. It may simply be a fact that I can’t improve my cardiovascular and pulmonary output in these conditions.

But I am going to find out. 

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Image created by Midjourney.