When Melanie Oudin was diagnosed with arrhythmia last November, her first reaction was one of relief. Relief at finally knowing why her heart would sometimes accelerate out of control for hours at a time, draining the blood from her head and leaving her on the verge of passing out. Relief that after years of confusion, she could begin to confront a problem that had dogged her life and career since 2011.
“Doctors told me I was having panic attacks,” says Oudin, now 23 and ranked No. 309 in the world. “And I thought it was all my fault. The worst feeling was trying to play through these matches where my heart was literally beating out of my chest, and thinking it was all me. That it was all in my head.”
Still a teenager when the symptoms emerged for the first time, Oudin lost count of the hours of soul-searching spent trying to identify a pattern behind the apparent attacks. “There was none,” she says. “Mine could literally happen whatever the match situation. It once occurred when I’d won a set 6-0. And another time at 4-4 in the third.”
It’s now six years since Oudin announced herself to the tennis world as a fresh-faced 17-year-old with a tenacious baseline game, reaching the fourth round of Wimbledon and then, improbably, the quarterfinals of the U.S. Open. When she beat Maria Sharapova inside Arthur Ashe Stadium in an unforgettable third round clash, it seemed a new star was born.
Oudin’s last match at Flushing Meadows was just as unforgettable, but for very different reasons. Twelve months ago she made it through to the final round of qualifying against Ashleigh Barty. Out on Court 13, just a stone’s throw from the show courts where she made her name, it was to be the longest night of her life.
As the first set moved towards a tiebreak, Oudin felt the familiar signs of her heart starting to malfunction, the relentlessly pounding beats thrusting the walls of her chest back and forth with unnatural haste.
Her mind was a mixture of confusion and fear. Why was this happening? Why couldn’t she control it? Was she at risk of cardiac arrest? “I literally felt like I couldn’t swing my arms,” she says. “I was light-headed and I could feel all the strength and power draining out of my limbs. And I just couldn’t move, my whole body was so tight. It was horrible and I didn’t know what it was. I was sitting in the locker room later, I looked down and my chest was just pumping up and down, on its own.”
That night Oudin’s heart rate reached 230 beats per minute, way above the typical average for a tennis player of around 150. Even after her straight-sets defeat, it didn’t subside for another eight hours. But while the episodes appeared to be getting increasingly longer, after three years of fruitless medical consultations she was running out of options.
“When it first happened I thought I was just getting tight in matches,” she explains. “Then in 2012 I told my mom and ended up seeing a cardiologist and getting pretty much every test in the book done. But everything came back completely normal. I was told, ‘There’s nothing wrong with you, you’re totally fine.’ And then when it kept happening year after year, they just said it was panic attacks, which confused me. I’d never had panic attacks in my life and why would they start now?
“So as traumatic as that US Open experience was, it wasn’t like I could go to the hospital. I felt I couldn’t do anything and so I didn’t tell anyone.”
Such is the dog-eat-dog world of tennis, this most individual of sports. With the lines between friendship and rivalry permanently blurred, players are wary of giving away the merest hint of a psychological edge. Oudin hid her condition from everyone except for two players: Her best friend Alison Riske, and occasional doubles partner and roommate Grace Min. She still remembers the small clay-court tournament in Dothan, Alabama last year when she confided the severity of her distress to a startled Min, after experiencing a severe episode during the singles quarterfinals.
“We were due to play doubles and I had to tell her, ‘I don’t know what’s happening to me but I feel horrible. When it happens, I can’t eat anything, I feel light-headed and I just want to lie down.’ And she was great, she was really worried for me. We still talk about that time now. But besides my family, I didn’t want the tennis world to know I would sometimes be feeling weak during matches.”
It was family who eventually intervened. Towards the end of 2014, Oudin was staying with relatives while competing in her hometown state of Georgia. After another particularly brutal attack, concerned grandparents drove her the following day to urgent care. It proved to be the stroke of luck she had been waiting for.
“The doctors managed to catch it while it was happening and recorded it on ECG (electrocardiogram). Without that, there’s no way they can tell if anything’s wrong which is why all these previous tests had come back negative.”
After three years of endless questions and self-doubt, she finally had an answer: Arrhythmia. But her relief soon turned to panic. The only treatment option was a catheter ablation, an invasive procedure which involved inserting a catheter through her groin and up to her heart, injecting synthetic adrenaline to simulate the feelings of a tennis match, and then locating the exact spot or faulty electrical pathway. Once identified, this rogue piece of tissue would be burnt away.
In the dry words of a cardiac electrophysiologist, this is a mere morning’s work. But to a young tennis player wondering if she still had a future in the sport, the idea was terrifying. So Oudin consulted the only person she knew who had been through such an ordeal: Mardy Fish.
Fish, a former world No. 7, has never been the same since the symptoms of arrhythmia appeared in 2012, leading to an onset of anxiety attacks. But having been through multiple catheter ablations, he could explain exactly what to expect.
“Mardy was really nice,” Oudin recalls. “I’ve always looked up to him and he called me, shared his experiences, gave me some tips and just calmed me down about it. He understood how scary it seems but he kept explaining that it’s one of the simplest procedures you can have done to your heart.”
Simple it may be, but unsurprisingly, the initial aftermath of having faulty electrical connections removed from your heart isn’t a walk in the park. “Yeah, I guess it sounds like pretty extreme stuff,” Oudin laughs. “Your chest is so tight when you wake up and you feel exhausted. They’ve made your heart beat like crazy to pinpoint where things are going wrong so you feel like you’ve just run a marathon. It was exactly like how Mardy described.”
A few weeks later Oudin was back in training, identifying Indian Wells as her comeback event, the same tournament where Fish would play his first singles match in eighteen months. “I thought I was fine. Everything was going well. And then one practice session, it happened again.”
Panicking, Oudin returned to the hospital where she had been treated with such apparent success just a few months earlier. “No one knew why it hadn’t worked. Some of the doctors didn’t believe me that it really was happening again, even though I told them it was the same feeling, everything was exactly the same as before. They eventually agreed to take another look but it was almost like they were only doing it because I was a pro athlete.”
But as fate would have it, while considering her options Oudin bumped into Robby Ginepri, the 2005 US Open semifinalist who revealed he had been treated successfully for arrhythmia by a cardiac specialist called Dr. Jacob Blatt, with an excellent reputation for performing catheter ablations.
“I met him at his clinic,” Oudin says. “He explained that basically I was born with this but it doesn’t show itself until you reach your late teens, early twenties, and it’s triggered by a combination of adrenaline, stress and intense activity. A lot of people can have the same thing but they’re never in an environment which sets it off.”
Blatt could help Oudin understand why she had arrhythmia, but there were no guarantees of a cure, especially after one failed operation. “That was the scary part. I was so worried,” she says. “But as soon as I met him, I really felt he would to do everything possible to help me. Because there can be multiple spots, multiple defective areas on the heart which need to be burnt off and that’s why people end up needing multiple procedures. And that was the case for me. There was more than one spot, and the doctor before hadn’t removed the first spot all the way.”
Three weeks after the second operation, Oudin was once more back in training. But she still faced a long and emotionally grueling wait for the all-clear to compete. “They wanted to absolutely certain because if they hadn’t removed everything, I could pass out on court,” she says. “They allowed me to hit, but it all feels so pointless when you’re not working towards anything.”
When the green light eventually came, Oudin made her comeback, first on the grass courts of England (she went 2-2 but failed to qualify for Wimbledon) and then the North American hard-court swing (she's played in four ITF events, reaching the quarterfinals at Stockton). It’s been a summer which all returning athletes can identify with. Encouraging wins tempered by deflating losses, the highs and lows all players face on the long road back from injury or illness.
While one might expect Oudin to embrace the conventional clichés of simply being grateful to compete again, she offers a far more realistic outlook on the frustrations felt by an elite athlete trying to re-trace their steps back to their previous level.
“I know people often come out with these statements,” she muses. “But honestly I don’t agree with that. I don’t think that’s true. Obviously I’m happy to be back but you want to play at your normal level. And that’s almost impossible. It takes a lot of time, patience, hard work, a lot more than people think and it’s not easy. It can be very frustrating.”
Oudin pauses before explaining how finely tuned the mind of a professional athlete has to be, and how quickly that sharpness can be lost. “The strokes are still there, right now I’m just not match tough,” she says. “I’ve always been a player that plays well when I have a lot of matches. The mental part is huge, you know being able to pull it out from 4-4 in the third. And then there’s a little bit of timing that’s gone and a little bit of focus. I just feel like I’m missing some shots that I’d never miss. I’m not able to focus for every single point like I used to. I suppose you just lose a little bit of everything.”
Next week Oudin will return to Flushing Meadows for the first time since the traumatic events of last year. Having played just a handful of tournaments in the past twelve months, she can enter the qualifying draw on a protected ranking. But while she may be physically healthy for the first time in a long while, like all arrhythmia suffers, she knows that the mental battle can ultimately be the hardest to win.
“It’s always going to be there in the back of my head.”
David Cox is a freelance writer and a contributor to TENNIS.com.