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Hyperthermia on the Run: A Collegiate Athlete’s Frightening Tale

Kierann Smith runs at Nationals. Courtesy of Greyson Christoforo.

Stanford Medical School student, triathlon team member and Impala Racing Team member, Kierann Smith, was on pace to race her best race ever when she passed out at mile five of the run at USAT Collegiate Nationals on April 9. This is her story.

Tuscaloosa, Alabama, April 9, 2011.  USA Triathlon’s Collegiate Nationals.  I’m having the race of my life.  I’ve just swum and biked harder than I ever thought I could.  Except for one little glitch involving a dropped chain that got stuck and took two minutes to fix, I’m flying.  My mental focus has reached a new level.  Nothing is going to get in my way, not the 90 degree heat and 90% humidity, not the Cal girl in front of me, not the fire in my feet that is spreading up my legs.

My goal is to run a sub-39 minute 10K, and I’ve run 6:15 per mile for the first 4 miles, right on target.  I am thinking about the crew video I watch for pre-race inspiration, “Inches,” and feel truly like I am going after each and every inch.  I am thinking about my teammates out there with me, Marissa, Sara, Ellen, K-Bell, and Lisa.  I see the 5 mile mark up ahead, this where I usually start to let loose, because I was a miler in college and I always tell myself I can always run a mile.

I barely notice the first time I lurch to the left.  I keep running.  Another lurch to the left.  All I think is, “Oh gosh, that girl I just passed is going to think there’s something wrong with me.”  Never did it cross my mind that there might actually be something very wrong with me.  I don’t know how many lurches ensued, but I vaguely remember bystanders saying things like, “Are you okay?” and “Whoa!” before somehow I’m down on the ground in a pile of woodchips under the hot sun.

I struggle to get back up.  Someone whose face I can’t see comes to my aid.  I tell them I tripped, I need to get back up and finish.  Strong hands push down on my shoulders, and I can’t get up.  “Here drink some Gatorade,” which I attempt to refuse because I just want to get up and finish.  I can’t stand the thought of any of the girls I’ve passed passing me back.  I can’t stand the thought of leaving my team a girl short.

All I remember of the next period of time is being put on a stretcher…then nothing…then being in the med tent and briefly seeing the faces of my fiancé and coach, then they disappear and six guys are working frantically over me.  One is putting an IV in my left arm.  Another tells me he is going to roll me on my side because he needs to measure my core body temp…if you know what that means.

“She’s at 106,” he announces.  Someone is doing something to my ankle (I never figure out what).  Another guy starts pouring buckets of ice water over my torso, bags of ice are placed over my extremities, and I realize I’m lying on a stretcher over a huge ice bath.  I start puking red Gatorade all over the place.  I am asking for my fiancé.  They say they don’t know where he went.  A few moments later I realize my race shorts are pulled halfway down and they keep checking my core body temp (“She’s still 106.”), and I tell them I actually don’t want my fiancé anymore.

They ask me the date.  I think hard.  April…9th…20..11.  I only remember because the only thought that is still in my brain is this is nationals…the date has been locked on my training calendar for months…and I am not going to get to finish.  I have never been so miserable.  I want to die.  I start praying the rosary on my knuckles because it is the only thing that distracts me and I want so badly to pretend this isn’t happening to me, on so many levels.

At some point the physician comes to check on me.  Apparently we’ve talked before because I told him I went to Harvard for undergrad and he said he’d forgive me for that (he had gone to Dartmouth).  Then we find out he had dated a friend of my mom’s back in Minnesota.  I am starting to like the guy until, when I confide in him that I feel utterly stupid about what has happened, he replies, “Hey, if it weren’t for people like you, I wouldn’t have a job.”

I know he was just trying to make light of the situation, but from my perspective there was nothing lighthearted about it, and he made me feel as if he wanted this to happen to me.

As dire as my own situation feels, when I regain a few threads of consciousness, I become even more traumatized by what was going on around me.  The girl next to me hasn’t moved or made a sound since I awoke.  They keep announcing her temperature is also 106.  She still isn’t responding by the time my temp is down to 103.7, which they deem sufficient to send me to the unobserved part of the med tent to let my IV finish running.

I am still barely aware of what is going on at this point, I don’t realize they’ve picked me up and moved me on the stretcher, just all of the sudden I feel like I am falling backwards as they dump me on the cot.  My fiancé Jason is back along with my coach Bruce.  Both have these amazingly sweet concerned looks on their faces.  Jason asks if it’s okay to pull up my pants.  I can’t get any more flushed than I already am but I am not even aware enough to feel embarrassed anyway.

At some point, the girl on the cot next to me starts screaming and flailing her arms and legs.  She breaks her cot.  Several people come to attend to her and start carrying her into the other part of the tent.  They drop her right in front of my cot because she is writhing around so much.  Half a dozen other people come to attend to her and they cart her off to another room.  I wake up more fully to the war zone that is surrounding me.  Some cots have 3-4 girls on them, all in various states of hyperthermia.  My fiancé tells me there is a line of girls on stretchers waiting to get into the acute side, and I am lucky I went down when I did.  He says he overheard the dispatcher saying, “We’ve got three down on the course still without aid.”

I am further pained thinking of my fellow competitors suffering.  I remember thinking on the run, “Everyone out here feels this bad because we are all in the same conditions.”  I also remember thinking that I couldn’t possibly stop to walk as I passed some absolutely amazing girls who had done just that.

A moment after my IV finishes, an EMT rushes in, asks me if I am able to drink water on my own, I’m not sure but he seems convinced enough.  He whips out my IV and runs away.  Another person comes in and asks if I can walk.  “Dude,” I think, “I can’t even sit up!” He makes some comment about what they have to do if I can’t walk and it doesn’t sound desirable so I struggle to my feet.  That satisfies them enough to send me outside, they need the space they say.

I go outside and sit on a cot in the shade.  My mentation is still fuzzy.  I see my other coach Gina, thank goodness, because she knows exactly how I feel.  She knows immediately how heartbroken I am on top of feeling physically awful, and she focuses on the former because she knows there is nothing to be done at this point about the latter.  She tells me story after story about world champions who have done the same thing.  She tells me she is proud of me for pushing myself to my absolute limit.  “You are going to learn SO much from this,” she says with just the right amount of confidence.  “Just stay positive.”


In the ensuing days, I have wracked my brain for anything I could’ve done differently.  I had known it would be hot in Tuscaloosa, so I had been drinking bottles of water and CarboPro for days leading up to the race.  I was well-rested.  I had visualized every bit of my race.  Maybe it was the visualization that was my undoing.  I was so mentally focused that I shut off any feedback from my body.  I wasn’t wearing a heart rate monitor, which may have given me some external feedback to make up for my lack of the internal.

One thing is for sure, I should’ve started the run more cautiously in that heat, but I don’t even remember processing how hot it was by the time I got to the run.  I wanted the finish line so badly, it was all I could think about on the run, and I wanted to pass as many people as possible to get there.  What I failed to process was that several of the girls I passed were great runners and better swimmers and cyclists than me, people I had never passed at other races.  My vanity overshadowed my humanity.  I thought I was somehow superhuman compared to these other women, as though they were subject to the heat while I was not.  That isn’t how I actually processed it at the time, but that is how I acted.  I’ve learned this lesson many times before but with less severe consequences.

There is little consolation when one doesn’t finish a race, especially a big one like nationals.  A big blow was when I found out that I had sustained marked muscle damage and even some liver damage.  Knowing what my mind is capable of doing to my body, I am now a little distrustful of myself.  My body is taking revenge.

Four days out and I still hardly have the energy to buy groceries or even walk around for more than a few minutes.  Even worse, my best method of dealing with stress is forbidden for at least a week.  Not only am I in agony from the event, I face a week or more of no workouts.

There is no quick fix to this, mentally or physically.  I’m going to have to slowly learn to trust myself again.  My body is going to have to learn to safely push itself again.  For years I have been working to overcome all mental barriers, but now I’ve gone too far.  I need to center myself and keep seeking for that perfect spot where mind and matter meet, that is where I’ll be able to leave it all out on the course without leaving myself out on the course.

“I returned and saw under the sun, that the race is not to the swift, nor the battle to the strong, neither yet bread to the wise, nor yet riches to men of understanding, nor yet favor to men of skill; but time and chance happeneth to them all.” –Ecclesiastes

–Kierann Smith