Running on Resilience

By Keith Gillogly

Shortly after he arrived at their home a couple of days later, Wax, now a third-year medical student at the Jacobs School of Medicine and Biomedical Sciences, started feeling unwell. He was fatigued, had a fever, and then started experiencing chest pain. He had been running just days ago; now he couldn’t go up a flight of stairs.

“At the time I didn’t think anything was wrong with my heart,” he recalls. “I actually thought something was wrong with my lungs.”

Sleeping in his childhood bedroom, Wax woke up gasping for air in the middle of the night. He sweat through the sheets. The pain made it difficult to lie down.

His parents took him to the ER.

At the hospital, Wax had an EKG and several blood tests. He was diagnosed with pericarditis, which is inflammation of the pericardium, the thin sac-like membrane that surrounds and protects the heart.

Yet, in the years since his diagnosis, Wax has hardly slowed down with running, biking, swimming, playing pickleball, competing, and staying active. Currently, he’s more than busy making his way through clinical rotations.

But living with a chronic condition has shaped his perspective on medicine and the patient experience, instilling empathy and resilience — qualities that will help him excel as a future physician.

After his initial pericarditis attack, Wax was discharged from the hospital the following day. He was given ibuprofen and told to follow up with a cardiologist. Wax didn’t think he’d have another episode; he was wrong.

About eight weeks later, his pericarditis struck again. Over the next nine months, episodes recurred every eight to 12 weeks. Recurrent pericarditis affects up to 30 percent of people who experience a first episode of pericarditis, according to the American Heart Association. It’s considered recurrent when an episode happens again at least four weeks after symptoms have subsided. 

At first, Wax was told to be cautious. But no matter what he did, resting or being active, his pericarditis flared up. “I had really bad chest pain. Shortness of breath. It was the same story over and over again.”

Each time, Wax would receive an echocardiogram to check for fluid around his heart. He’d take ibuprofen, and the inflammation would resolve after a week or so.

“I had to miss family events. I had to miss social gatherings. I had to miss races that I had signed up for,” Wax recalls.

Unlike many pericarditis patients, Wax was diagnosed with the condition quickly. Yet doctors couldn’t pinpoint its cause. For most, the condition is idiopathic.

Pericarditis is an immune condition, not, strictly speaking, a cardiologic condition. Wax had been physically active essentially his whole life; there was little doubt that his heart was strong.

His heart, and his whole body, would soon be put to the test. 

One day in March 2023, Wax went for a long 18-mile run. Not long after, symptoms of another pericarditis episode crept in.

This time it was worse.

Wax developed a high fever, bundling up in his winter coat and gloves while indoors. “I felt the weakest I’d ever felt in my entire life,” he says, recalling the agony and strain. “There was a fullness in my chest, and I felt overall just very, very sick.”

Wax’s cardiologist told him to go to the ER. There, tests revealed that Wax had a cardiac tamponade, a potentially fatal medical emergency that occurs when too much fluid builds up around the heart, making it hard to pump blood.

After the tests, Wax was wheeled into a room with the ER doctor and nursing team, all of them wearing grave expressions. Up until then, Wax considered his condition a nuisance at best and a debilitating hindrance at worst. Now, he was being told to call his family and tell them to get to the hospital right away.

Wax underwent a pericardiocentesis — a needle was inserted into his chest, draining fluid around his heart to reduce pressure and help it beat. Wax was already shaking uncontrollably from his sickness. He was sedated, but the procedure was not pain-free.

The medical team drained a substantial amount of fluid from his chest, Wax says, and more fluid had accumulated in his lungs and pelvic space.

Wax would spend the next five days in the hospital, receiving more tests to check for fluid buildup.

Since his diagnosis, Wax had to live with the anxiety of never knowing when his pericarditis would strike. “Emotionally, it took a huge toll with the stress of not knowing when another episode would hit.”

But shortly after his near-death experience, a breakthrough emerged.

Before his cardiac tamponade, Wax had begun searching for more answers. Pericarditis is a chronic condition. For some, symptoms can be managed but a cure remains out of reach. Wax would take ibuprofen to reduce inflammation, and he also tried another drug for treating autoimmune conditions, but with little success.

At that time between college and medical school, Wax was working with a prostate cancer oncology team at Memorial Sloan Kettering Cancer Center, so he was familiar with research and clinical trials.

“I didn’t want to settle for ‘this is all we can do’ at the time. So that really prompted me to search on ClinicalTrials.gov,” he says, recalling scouring the site for new drugs and clinical trials related to pericarditis.

Wax found a registry trial with a clinical site not far from his apartment in New York. When he met the trial’s cardiologist principal investigator, he told Wax about a recently FDA-approved drug that had successfully treated some of his own pericarditis patients.  

Wax began obtaining approval to take this new drug, an immune inhibitor called rilonacept, just before his cardiac tamponade. After that incident, Wax began taking the new drug and, for the first time, was free from pericarditis episodes.

In the initial weeks after his worst attack, Wax had to keep his heart rate to under 100 beats per minutes. Gradually, he was able to return to normal life and being active as ever.

“I’ve been on my medication since then. And I’ve been really active running, biking and swimming as much as I can,” he says.

Around the end of his first year of medical school, Wax did experience another pericarditis episode when he was attempting to go off his medication. When he took a dose, the symptoms subsided.

All that time spent in the patient bed, rather than beside it, has shaped Wax’s perspective on being an aspiring doctor. Living the patient experience has given him a new sympathy, a new empathy, he says. 

He knows what it’s like to live through a life-threatening situation, to navigate a chronic condition with few answers, and to take his health into his own hands.

Wax was drawn to the Jacobs School because of its “immense sense of community,” and he’s realized that medicine is ultimately about being there for people facing challenges.

During his worst episode, Wax says he knew that the doctors and nurses on his medical team were 100 percent committed to his care, giving their all to save him.

“For me, I felt the most comfortable when I knew that the people taking care of me were really there for me,” he recalls. “The way that I was taken care of made me feel that I was going to be OK.”

Being involved with support and awareness groups like the Pericarditis Alliance has also been key to managing his condition, Wax adds. Recently, the American Heart Association filmed a segment about Wax and his pericarditis journey, which Wax says has led to meaningful connections and helping others cope with the condition.

For now, Wax is still deciding on a medical specialty to pursue.

In the meantime, he’ll be preparing for his next race, his next medical school milestone, and for a future that’s full of possibilities.

“I know I went through a lot. I look back and I’m like, ‘wow, this is how far I’ve come,’” he says.

“It’ll take a lot to stop me.”