By Joshua Davis
Bill Goggins was in the best shape of his life. So why did he collapse and die during the San Francisco Marathon? The answer: a genetic flaw that afflicts a shockingly large number of men. Are you at risk?
On a crisp, sunny July morning in San Francisco, my good friend and jogging buddy Bill Goggins began his push to post a 3-hour marathon. I'd decided not to join him; Bill always ran too fast for me. On any given jog, he'd invariably say, "How about we pick it up a bit?" It took me a year to develop the mental fortitude to resist.
The day before the race, I met Bill for lunch. He looked great, and he was clearly happy. The next morning, he got off to a good start. For the first 71/2 miles, he averaged a little over 7 minutes a mile. Runners generally slow as they tire. Not Bill. At the halfway mark, he sped up. And then, at the marathon's 24th mile, Bill smiled for the cameras and, mid-stride, dropped dead.
It was inconceivable. Bill was 43 years old and, by all accounts, in the best shape of his life. For as long as I'd known him, he'd stay out late drinking Fernet Branca, a bitter Italian liquor, and still meet me at 7 the next morning looking fresh and indomitable. He'd run a step ahead of me, glancing over his shoulder to tell me stories about the people he'd laughed with through the night. And though I had surely been asleep while he was having these grand adventures, I still couldn't keep up.
During the 6 months after Bill's death, I felt numb. But slowly, my denial morphed into a series of questions. Today I'm left with just one: Why?
In December 2005, 8 months before Bill died, he and I went for an early-morning run along the Embarcadero, the walk way beside San Francisco Bay. The air smelled of salt water and creosote from the wharf pilings. Sixty years ago, the area would have been crowded with longshoremen and ships from around the world. Today it's dotted with joggers in fleece jackets and leggings.
Back in 1951, an enterprising University of California at Berkeley doctor initiated a study of the men working these wharves. The researcher, Ralph S. Paffenbarger Jr., M.D., wanted to know whether cargo handlers, who performed strenuous physical labor all day, had different rates of heart disease than men with more-sedentary jobs had. He did an initial exam and then, 18 years later, checked them all again. He discovered that the less-active workers had a 27 percent higher death rate than the cargo handlers did. In a seminal 1986 report that laid the groundwork for the exercise boom that followed, Dr. Paffenbarger concluded that physical exercise prolongs life.
This year, that assertion quietly received an asterisk. In April, the American Heart Association released a scientific statement noting that although regular physical exercise is now widely advocated by the medical community, studies show it can increase your risk of early death. A study published in the Journal of the American Medical Association found that joggers in Rhode Island were 7.6 times more likely to die early than people who didn't run. In another study, published in the New England Journal of Medicine, researchers reported that the incidence of cardiac arrest during exercise was 25 times higher than during light activity or while resting. The AHA statement concluded that exercise "acutely" increases the risk of sudden death in "susceptible persons." For these people, "the health risks of vigorous physical activity almost certainly exceed the benefits."
Susceptible persons . . . was Bill one of them? Did he suffer from something he had no knowledge of? The only way to find out was to dig up his autopsy report, so, with consent from Bill's family, I called the San Francisco medical examiner's office and requested a copy of their findings. The following Tuesday, a little after 9 in the morning, a man with a skull tattooed on his fore-- arm slid me a white envelope marked with both my name and Bill's, as if our collective fate was sealed within.
I returned to my car and began reading. The case history was concise: "The subject, Mr. William Goggins, a 43-year-old male, collapsed while running in the San Francisco Marathon and was transported to [San Francisco General Hospital], where he expired." The autopsy findings came a couple of pages later: "Cause of Death Due To: Hypertrophic Cardiomyopathy."
Hypertrophic cardio-what?
"If your friend hadn't run that marathon, there's a good chance he could have lived a long life," says Lisa Salberg, president of the Hypertrophic Cardiomyopathy Association. I've called her looking for answers. She asks me to read Bill's autopsy findings to her, and when I reach the section about the thickness of the wall separating the chambers of his heart--1.7 centimeters--she stops me.
"Anything more than 1.5 centimeters is definitive," says Salberg. She explains that HCM is characterized by the thickening of heart muscle. As the muscle wall separating the right and left ventricles bulges, it obstructs the flow of oxygenated blood leaving the heart through the aorta, making it more difficult for the heart to function, particularly during exercise. It's caused by a genetic flaw that can be passed down from either parent. So far, researchers have pinpointed 14 genes associated with the condition. Those who carry any one of these genes generally develop HCM during adolescence or early adulthood.
Then she drops a whopper: One in 500 people has HCM. It's more prevalent in the United States than is HIV and Parkinson's.
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