COVER STORY

ACE SWIMMER. PEAK FITNESS. THEN A CARDIAC ARREST.

Madhu Nagaraja’s name is listed among elite swimmers in the world.

By SHAGORIKA EASWAR

Open water marathon swimmer.

Marathon runner. Swimming mentor.

Swimming coach. Arc’teryx adventure athlete.

International Marathon Swimming Hall of Fame executive committee member.

Great Lakes swim administrator and marathon historian.

Co-founder, Great Lakes Trust.

Entrepreneur. Technology leader.

Husband, father.

The last person you’d imagine would be a candidate for a massive cardiac arrest.

Madhu Nagaraja is all of these, and more.  He has crossed the English Channel, Lake Ontario, and the Strait of Magellan. His name is listed among elite swimmers in the world alongside legends like Marilyn Bell who crossed Lake Ontario in 1954 and has a Toronto park named after her.

He has participated in the Marathon des Sables, a 256-km self-sufficiency run in the Sahara desert in which you carry your own food and water.

He co-founded Great Lakes Trust, a collective of adventurers, artists, and scientists that oversee a charitable endowment for addressing water issues in the Great Lakes by providing small grants.

But a massive heart attack changed his perspective on life. From riding the waves to plummeting the depths of depression, it’s not been an easy journey, but he’s opening up and sharing his experience in the hope that it will help others, that it will show them what it takes to get back into the swim of things.

The story, in his own words:

“I swim and I run, but not together. When I pick an event, I focus on one activity, I cross train. When it comes to skills, I’m no Michael Phelps! I have to work very hard to get to the finish line. But I believe in working hard, I enjoy training.

“Last July (in 2021) I was training for a 100-mile race in the Rocky Mountains. It takes place at an elevation of 7000 metres and on tough terrain. It’s very popular, though very few people finish the run, only as estimated 23 per cent. So my friends and I staged a 100-mile run in Sulphur Springs in the Dundas Conservation Valley – up and down hills so all the different muscles get used. We were to start the second level. It’s a significant launch pad, similar to mountain climbing when you get to the base camp, get acclimatized, then move to the second base.

“My family wanted to go to the beach for the day, but the run had already been planned, so I said I’d do one loop and be back in time to join them. But 6 km into the run, I noticed that something felt different, though I couldn’t quite put my finger on it. I slowed down, took a deep breath and continued on. On the spine of the mountain, that strange feeling was back. ‘This is something new,’ I thought. When we run, we tend to keep each other in sight and when they didn’t see me, Pascale and Russell, my running buddies, came back to see what was up. I told them I wasn’t sure what was happening with me. I walked 100 metres or so and said okay, I feel good and started running again.

“And then it hit me. My left shoulder was aching like crazy, I felt dizzy. All the classic symptoms, but I didn’t see them as such at the time. I sat on a tree stump for a few minutes, felt better and started running once more. A heart attack was the last thing on my mind that beautiful summer morning. But when it happened again, I felt things were getting tricky and that it was better to get down from the spine.

Madhu Nagaraja at the Canadian Consulate in Chile after conquering the Strait of Magellan.

“By then, I was throwing up. I just crashed on the trail. Pascale, who is the CEO of a company and was a Lt. Colonel in the Canadian military, took off to try and bring the car closer. There was only a patchy phone connection on the trail, but Russell was able to get through to the EMS, but how does one give directions in a conservation area, on a trail? These guys were thinking on their feet and using an app called What3Words provided our GPS location.

“I was aware that this is out of my control and getting dangerous. I was asking myself how I got myself into this situation. We assess risks, and yet, I realized, we take certain things, our bodies, for granted. I was thinking about my wife Suman and our kids Vivek and Meghna. I held Russell’s hands and asked him to tell them that I loved them.

“Two young firefighters came jogging up with backpacks. Just seeing them, every word they said, was reassuring. Help is here. There is hope. The EMS guys followed, and pumped me with morphine to slow my heart down and to ease the pain. They’d give me some and ask me to rate the pain on a scale of one to ten. It wouldn’t go below nine. Now? they’d ask, what about now? It was still nine. There was also the challenge of how to get me to the hospital, there was no way an ambulance could come to where I was on the trail. It’s truly amazing how everyone was thinking on their feet. A pick-up truck was summoned and I was transferred to the parking lot in it, all hooked up to the IV. We were in Ancaster and of course the 403 was clogged, but they got me to Hamilton General. We don’t stop to appreciate the great Canadian medical system until a crisis hits, but they registered me with just my name and date of birth and I was in the ER and getting the help I needed.

“A doctor walked in and said, ‘Madhusudan, I’m going to take care of you’. I learnt later that Dr Kyle was an intern, but in that moment, all that registered was that he was able to say my name, my full name, like he knew me. These positive human connections, these are the magical moments that take us through difficult situations in life.

“I’d been given morphine and also fentanyl and was knocked out, but as I came out of it, I began shaking my arms about. Stop! they exclaimed. They’d cut an artery to relive the pressure. It was 100 per cent blocked. The moment they cut it, I felt I can run again. There was such a difference. But the next procedure, inserting two stents, was done on the third day. The first procedure had to be done ‘under duress’ they said, or they’d have lost me, but they wanted me to stabilize before removing blockages in the other artery which was 80 per cent blocked.

Madhu Nagaraja with fellow adventure sports enthusiasts from the Original Canadian Ice  Swimmers.

“Suman is a scientist and very level-headed. She took control of her emotions – looking back, I guess she didn’t have the luxury to give into her emotions – she didn’t want to dramatise what could have happened.

“We had to focus on what came next, on our kids, on keeping things going at home. I was so well looked after that though she was at the hospital every day, she didn’t need to stay with me.

“It’s a good thing, the medical team said, that I crashed where I did. If I had kept pushing ahead, we’d not only have lost valuable time, my heart would have suffered more damage. As Dr Kyle said, ‘Madhusudan, you came in at the right time’.

“After discharge, I came home and talked to my parents. I called my uncle Dr Prabhudev, who had performed the first open heart surgery in Karnataka. I promised to be good. And I was sure that with the help of the cardiac rehab program, I’d be fine, back on my feet sooner rather than later.

“And then I came crashing down. On my birthday, October 13, the magnitude of everything just hit me. I was on so many meds, there are chemical changes in the body, the body produces hormones trying to protect itself.

“Everything combined pushed me into a depression. I found it hard to have this conversation with Suman as I’ve always thought I had to be the strong one, to protect them. I was 50, getting close to retirement. Our years of work were translating into some kind of financial freedom. My first obligation has always been to my family, but we were approaching the stage when we were almost through and I felt – selfishly – that I would soon be free to do what I want. Now I was plagued with questions like how long will I live? What will my quality of life be? Does having swum across the English Channel even matter? I’d look at all my awards and wonder if they meant anything in the larger scheme of my life and that of my family.

“At work, my role is more at a strategic level, but I was just getting through the daily tasks. I couldn’t think big, I was scared to. I reminded myself of the privileges I enjoy. I’ve seen what poverty can do to people. I thought about the labourer toiling for a daily wage in India, if he had a heart attack, he wouldn’t be able take time off to deal with depression, he wouldn’t have the luxury to be depressed. But I realized I needed help.

“I am so grateful that I received the help I needed, thanks, again, to the Canadian medical system. The cardiac rehab program is about the physical aspect of patients, but they connected me to social workers who understood what I was experiencing. There’s a lot of push to help. Because I didn’t need the fitness regime, I asked them to help me with my head. ‘My head is a mess,’ I told them. ‘Please help me deal with this.’

“I’m still working to get my confidence back.

“While recuperating, I had so many questions for the medical team. What had gone wrong? What had I done wrong? Every nurse who came in would also ask, ‘Why are you here? You look so fit!’ My grandmother on my mother’s side is diabetic and so is my dad. I was diagnosed with Type 2 diabetes in 2019, but I watch my diet, I was in peak physical condition. Before each event we undertake, we have to have ECG, stress ECG and Echocardiogram, blood work, etc., to qualify. I’ve been regularly monitored. They check the heart efficiency rate and the ejection rate and if anything is off, it’s flagged. I’ve always been clear. So why did I suffer a massive heart attack?

“We only understand about 10 per cent of the human body, they said. It’s just your biology. But don’t beat yourself up. Because what brought you here is also what made you survive. One of the things that the doctors who took care of me mentioned was that I survived this just because I was fit with a strong heart.

With swimming legend Marilyn Bell, after whom a Toronto Park is named, and his family.

“Life has become divided into two sections, before my heart attack and after.

“At 5 feet 11 inches, I weighed 168 pounds before my heart attack. I’m down to 160 now. Not because I needed to lose weight, but because I was scared to eat. It was very difficult for Suman to figure out what I would eat and how much. I was complicating everything. It was very stressful for her. I will confess to having indulged occasionally in the past, having eaten more than I need. But if I had the extra rasgulla at a buffet, I always had the thought that I can swim off the extra calories the next day. Now I will only allow myself half a rasgulla – and rarely. Because I find that stopping at half a rasgulla requires more discipline than not having any! But jokes apart, it’s about finding my new normal. I had replaced rice with high fibre oats, but these past few months, I’ve gone back to simple foods I enjoyed in my childhood. Rice, sambhar and a vegetable, what used to be my comfort foods.

“Before my heart attack, in the last year leading up to the ultra marathon I was training for, depending on the cycle of the training, I was averaging between 50 to 100 km a week. The longest time I’ve spent in the water in one stretch was in Lake Ontario, at 24 hours, 26 minutes. The water was rougher than predicted and from midnight until 4 am, I was swimming against the current. You know that carnival ride called the Teacup in which you are wiggled around as you go round and round? I was in that teacup in high waves. On my first attempt to cross the Strait of Magellan, it was so cold, there was a bad current. You learn to fight the demons in your head and you go back – I crossed it in my second attempt.

“ I take 10 tablets a day. My physical activity is limited because of the damage to my heart and also because of the heavy meds I am on. For instance, I feel dizzy if I stand up suddenly. I was told not to shovel our driveway because the cold and the effort would be too much for my heart.

“Now I have to reassess every step. Will I be able to run and swim again like I used to? I don’t know. I’ve lost so much muscle. You know how they bench a player who is not performing well in a team? I feel like that benched player. I’m hoping some level of physical fitness will return, hoping that muscle memory will kick in.

“I hear of young people who are having heart attacks. Movie stars and sports stars. Shane Warne’s was such a shock. People attribute all sorts of causes. Some say it’s because everyone wants to look like Hrithik Roshan and young men are pumping iron without medical supervision. Some people push boundaries every day for perceived ideas of physical beauty, someone with a six-pack body wants an eight-pack. It’s unending, but a body can only take so much. Others say its due to substance abuse. Or the increased levels of stress we are living with.

“For me, it’s about self reflection. I have, as I said, indulged occasionally. I have to go back and evaluate so many aspects of my life. It’s a period for personal course correction.

“I went to India in March to see my parents, to bring closure to this health episode for all of us. I’m taking things one day at a time. And I struggle through it. Some days are harder than others. Suman catches the signs and tries to cheer me up. Or something my kids do distracts me – Vivek, who is 18 now,  is always tagging me on some conspiracy theory or the other! But some days I feel so low, I start bawling. I will admit that in the past, too, winters have made me miserable. But I was able to snap myself out of it. Now I can’t even hang out with my friends, they’re all faster than me! I used to reach out to people, enjoy connecting with them. Now, most days, I don’t want to be with others, I feel comfortable being alone.

“Suman has a very philosophical, very positive outlook and that anchors me.

“I continue to mentor open water swimmers but it’s taken a back seat. If somebody wants my help to get across a body of water, I am open and upfront with them. I tell them that this is my situation right now. I am willing to help, to share everything I’ve learned. I tell them I can help evaluate swimming styles and identify mistakes, but I also need to focus on myself right now and can’t be the guy taking care of someone else.

“Being in the International Marathon Swimming Hall of Fame committee is super cool. I’m helping out on the operating and technology side. I’m currently not contributing as much as I’d like to, but they know my situation. It’s very rewarding being associated with a good group of people who are invested in identifying and promoting talent in swimming. Part of my role involves helping set mandates and guidelines and it’s a source of pride and immense satisfaction to be involved in upholding the ethics and integrity of a sport that has given me so much and helped define me.”