Saturday, August 08, 2009

Why I Live in Los Angeles

"If you ever experience a feeling like that, go immediately to a hospital emergency room."

My cardiologist had just responded to my description of the pain I'd experienced in my chest about 10 days earlier. I had been riding my bike uphill, at 8,600 feet above sea level, in Yosemite National Park.

I might not have mentioned it, except that people on the trip to Yosemite with me thought I needed tell my doctor. By coincidence, I saw him a week ago, just after I returned to Los Angeles, on a regular six month check-up after my mild heart attack in December.

In describing what I felt, I also told my cardiologist that I was fairly certain what I felt was due to my age, the altitude and most probably, a short warm-up. That's when he suggested what I'd felt seemed potentially less like an improper warm-up and more like potential heart damage. That's also when he brought up the subject of the emergency room.

"OK," I agreed, "next time, but I was in Yosemite."

"I know. If it ever happens again, though, go immediately to the emergency room."

Before I said goodbye to the doctor, I had an EKG (the readings were normal) and he ordered up a stress test for me later this month, on the theory that one of my other arteries could be partially blocked; perhaps my first stress test after my heart attack had missed it, or perhaps something had changed inside me in the past half year. He also wanted me to have my blood tested, although he thought, at ten days, too much time might have passed to show if my heart had betrayed me again.

"Take it easy until your stress test," the doctor advised.

After leaving his office, I realized the painful episode in Yosemite had taken place almost two weeks earlier. I decided to skip the test.

Late that afternoon, I rode about as fast as I could for ten miles through the streets of Los Angeles, zipping past and around cars and buses like a NYC bike messenger on steroids. It was for me part death wish, and part affirmation that I am, of course, immortal. Am I not, at least in my mind, still 24? Nor do I fear death. I'm with Epicurus, the philosopher, who said, "Death is nothing to us, since when we are, death has not come, and when death has come, we are not."

Admittedly, I wimped out a bit, by warming up with an easy pace for a while, and staying on the flats rather than challenging myself on the hills of the city. Any pain was minimal.

On the third day of riding hard through The City of Angels, I picked a few of the steepest streets in Los Angeles I could find. OK, it hurt a little bit to ascend to the heavens. Maybe I'd always hurt that way on tough climbs. Could I be in the process of becoming one the clich├ęd elderly, focused on more bodily functions rather than the external world?

Two days ago, I decided to bike, rather than drive, half a dozen miles to a non-medical appointment. Starting off a bit late, I hammered on the pedals without a warm-up. Back came the pain. It was half a sharp stab, half a burning sensation and it was high in the middle of my chest. Maybe this was a normal sensation when exercising without a warm-up. Or maybe not. Now, I knew, though, it was time for the blood test.

The test I took yesterday looked for higher levels than normal of a protein in my blood called troponin, a protein associated specifically with the heart. Anything above the normal 0.3micrograms of troponin per liter (mcg/L) would indicate heart damage.

A microgram is 1/1,000,000 (one-millionth) of a gram, and 28 grams equal on ounce. Peak levels of troponin would show themselves by 24 hours after damage to the heart, which is precisely when I took my test. Just a little more than 1/3 of a millionth of a gram of troponin would tell me I'd suffered more damage to my heart. With the technology required to measure and record such seemingly near-infinitely small amounts of matter, it becomes easier to understand why health care for everyone is an expensive proposition.

Two hours after the test, the result was emailed to me: my blood contained 0.1 mcg/L.

The stress test still awaits me. Now, however, it was time for a celebratory ride. This time, I slipped my little camera into a jersey pocket. This time, although I plunged back into heavy traffic, I slowed the pace down. This time I looked around me as I made my way along the four sacred directions, first north, then east, south, and finally west.

There was no death wish, conscious or unconscious, on this ride. Yes, I'm mortal, but this day I was still alive. The streets and boulevards became streams and rivers of life, my bike a boat carrying me over those waterways through the vital city.

On my ride I made my way ten miles through swaths of Los Angeles. It is a city where one of the most diversely ethnic populations in the world live, for the most part, in peace.

I pedaled past glass and steel skyscrapers on Wilshire Boulevard reaching into summer-blue skies, past the redolent restaurants of Little Ethiopia on Fairfax Boulevard, and past a martial arts school in Koreatown on Olylmpic Boulevard. I stopped to admire the produce in a truck parked on a residential street and I admired a the tenacious survival of Victorian-era house of somewhat faded glory.

I popped into Ramon's cane repair shop to meet and photograph Ramon at work. I accosted three women from India in their colorful saris, out on an early evening promenade. "Who is the most colorful among us?" I asked them. Obviously it was me, in my bike clothes. I made a portrait of cute Frieda the dog with her sister and papa. I photographed my own shadow as I rode by a lively crowd protesting the overthrow of the president of Honduras.

I still cast a shadow. There is still some life left in this old dog. That is why I live in Los Angeles, a city with a strong heartbeat of its own, a city with an unknown, but dwindling number of emergency rooms, none of which I ever want to visit again.

How do you live your days? Fearfully, carefully, fully, meaningfully?

Tech Notes: Panasonic Lumix TZ5

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