For Timothy O’Donnell, hours of denial gave way to the emergency room of a South Florida hospital late on the night of March 13, 2021, when the trauma care specialist called the resuscitation team and told him said to stay close.
“I thought, ‘Oh, man, are you going to die here? “That’s where the athlete mindset came in. Just clear the negativity from the mind and focus on survival.”
And yet, a few hours earlier, this state of mind had nearly cost him his life. It sparked a series of events that illustrate the limits of the tough guy mentality that permeates endurance sports, sometimes with deadly consequences.
For about 20 miles on his bike and throughout his 11-mile run in the Miami Challenge Triathlon, a 62-mile championship competition, O’Donnell had battled severe tightness in his chest and pain running down his arm. left as he competed against some of the best triathletes in the world.
The attitude that made him so good at ignoring pain drove him forward when he lost track of how far he had traveled and got off his bike a lap early. That mindset was there when he started the 11-mile race, the final segment, even though he was struggling to breathe and felt like he was having an asthma attack.
O’Donnell, 41, from Boulder, Colorado, was making a mistake that too many seemingly healthy middle-aged men make every year, often with catastrophic consequences. He just couldn’t accept that someone like him could have a heart attack, let alone someone called the widowmaker because of its severity and frequency in unsuspecting middle-aged men who are in shape and have no idea they might be at risk.
“It’s not such a rare story,” said Aaron Baggish, O’Donnell’s cardiologist and director of a clinic at Massachusetts General Hospital that provides comprehensive cardiovascular care for athletes. “You can exercise and stay healthy and reduce your risk, but no amount of exercise provides complete immunity against heart disease.”
After a year of rehabilitation and medical research, and much soul-searching and long talks with his wife, three-time Ironman World Champion Mirinda Carfrae, O’Donnell is ready to compete in earnest again.
He had planned to return to his racing form, starting two weeks ago with the St. Anthony Triathlon in St. Petersburg, Fla., but a cold forced him to pull out. Now his comeback will begin in earnest this weekend in Chattanooga, TN at the Ironman 70.3 North American Championship, followed by the full Ironman Continental Championship in June in Des Moines.
“The idea is to come back to Kona,” O’Donnell said, referring to the Ironman World Championship, which takes place in Kailua-Kona, Hawaii, in October.
Continuing brutal endurance testing just over a year after a near-fatal cardiac event may seem reckless, and O’Donnell and Carfrae, who have two young children, were apprehensive at first. They agreed that if there was any chance that continuing the race would harm his heart health, he would quit.
“His racing career was not on our radar,” Carfrae said as he recently breastfed his 16-month-old. “We were trying to get him back to good health so he could live a long and healthy life.”
Heart attacks like the one O’Donnell suffered happen when a piece of plaque that has built up on the inside lining of the arteries ruptures and causes a blockage, preventing blood from flowing properly to the heart.
After his own, O’Donnell learned he had a genetic predisposition to heart disease, specifically the buildup of plaque on the walls of his arteries, a condition difficult for doctors to detect.
Doctors used a common procedure to repair O’Donnell’s left anterior descending artery with a stent – a coil of mesh that dilates the artery – then continued to treat it with drugs, which made the comeback running safer than it looks, Baggish, her doctor, said.
During O’Donnell’s run, his body worked so hard to pump blood that it was able to force blood through the clot. He finished 11th, in 2 hours 44 minutes 56 seconds, but he couldn’t get up afterwards. He called his primary care physician from the recovery area and told him about the tightness in his chest and the pain that shot through his arm while running. The doctor told him to take an aspirin to disrupt the clotting and to go to the emergency room, where he saw the traumatologist call the resuscitation team.
“At that time, in the hospital, I finally understood it,” he said. “Like, wow, this is actually happening.”
A week after the heart attack, O’Donnell got on a treadmill for a stress test and was soon cleared for light aerobic training.
Once O’Donnell, Carfrae and his doctors felt comfortable with his general physical condition, they resumed discussing the race, including any medications he might stop taking as they might inhibit his performance .
The mental challenges were tougher, especially for someone with an analytical bent, like O’Donnell, a graduate of the United States Naval Academy with a degree in naval architecture and marine engineering. Doctors told him this heart attack was going to happen whether or not he competed in a triathlon, but he still thinks about how his wife and children almost lost him.
Carfrae also had his moments. Early in O’Donnell’s recovery, as Carfrae was coming downstairs for a nap with the kids, he told her he was going to get on the treadmill. She woke up two hours later to hear the television exploding and the treadmill still running. She believed there was no way O’Donnell could continue training and must have collapsed. She burst into the room fearing the worst. It turned out that he had started training later than expected.
This year they competed in a couples short triathlon in Florida. She watched him head for the water and thought: should he be there?
“I had a horrible race,” Carfrae said. “I was so emotionally drained.”
They are reassured by the science, the words of their doctors and the calculations which indicate that the chances of him having another heart attack have been greatly reduced because the main potential cause of a heart attack has been corrected.
“Tim is more likely to be injured in a serious cycling accident than in any other coronary event,” Baggish said.
That doesn’t mean he won’t have another heart attack at all. No matter what O’Donnell looks like on the outside, he has heart disease. Being absurdly fit probably saved his life after ignoring the symptoms. He won’t do it again, but ex-Navy officers don’t often live their lives in bubble wrap, and he knows the only alternative is to accept the uncertainties.
“There are always variables that you can’t control,” he said.