The Pursuit of Two Passions; Ultramarathoning as a Resident Doctor

(The Western States 100-Mile Endurance Run is the world’s oldest 100-mile trail race. Starting in Olympic Valley, California near the site of the 1960 Winter Olympics and ending 100.2 miles later in Auburn, California, Western States, in the decades since its inception in 1974, has come to represent one of the ultimate endurance tests in the world.)

It was 1 o’clock in the morning, I was 78 miles deep into the Western States 100 Mile Endurance Run, and I had been vomiting forcefully every 30 minutes for the past 23 miles. As I threw up this time, I stared hard at the bright red puddle on the ground and breathed, “Oh, that’s blood.” Less than 5 minutes later, I was shuffling down to a raft with my brother who was ready to pace me from the Rucky Chucky river crossing to the finish line in Auburn. Always two steps ahead, my brother led me for hours along the dark trail, stopping occasionally for me to throw up. I remember feeling so thirsty and my mouth so dry, but every greedy sip I took quickly made its way back up my irritated esophagus and out of my mouth. I told my brother at one point that I needed to walk, because I was so tired and nauseous. He told me to “stop having a pity party.” And I did, after a little griping. This was Western States!

The quickness of my turnaround from vomiting blood to continuing on the Western States trail was a decision I made with little thought at the moment, but one that had been wired into my psyche over many months. The week before, I had just finished my first year as a freshly minted resident doctor. For the past 12 months, I averaged working 60 to 70 hours with one day off per week. I spent multiple shifts awake in the hospital for more than 24 hours -- admitting patients, answering pages, sprinting to emergencies throughout the night. I was 6 months into my residency when I found out that I had been accepted into the coveted Western States 100, and I was beside myself with excitement. It felt like a dream. This was a million times cooler than anything I had ever done (and I’ve competed in the National Spelling Bee!), and I was ready to give everything I had to training. It wasn’t long before I started to feel intense anxiety.

How was I possibly going to prepare for this race working the job I had? I started becoming jealous of runners I saw on Instagram who had time every day to be out on the trails, strength training, making recovery smoothies. My “strict” training schedule was punctuated by 24-hour hospital shifts, night-to-day transitions that threw off my sleep cycle, ICU rotations with distressing patient outcomes that emotionally drained me, and there were hardly any weeks where I could actually complete the training I felt that I needed in order to finish Western States. Even more, when people meet me - a 5 foot tall, 100 pound Asian female - they often are surprised to learn that I run ultramarathons. This sport has long been dominated by white men, and racial minority women are definitely on the fringe. I felt pride in breaking up the stereotype, and I knew I could never accept failure in such a high profile race. With that in mind, I sought out all the best hills, and even carried rice bags up and down a ski slope, constantly worried I was not doing enough.

"With this attitude, medical residency became an unexpected part of my ultramarathon training, and I became a happier and stronger runner and resident.

It wasn’t until I talked to my brother, who had his own crazy endurance feats, that I was reassured: I had done well in every other ultramarathon, and I should not stress this time (also, vert’s not real). With his help, I started to change my perspective on training while working. I began to see the long nights at work as challenges to stay mentally engaged and energetic when I was tired. When I ran after work already fatigued, I imagined it was how I would feel late in the race. I learned not to compare my 6 mile run in downtown Cleveland after a 12-hour work day to a stranger’s 20 miles on single-track trails after eating pancakes for breakfast, because that would have been comparing apples to oranges. Western States might be a once-in-a-lifetime opportunity, but as a physician, I experience moments every day that few people ever will, like caring for a dying newborn or helping a young veteran through drug addiction.

When I saw that blood on the dirt at mile 78, it was natural for me to acknowledge it matter-of-factly, and to keep moving. I had created a foundation of as much mental toughness as physical strength over the past year. The last 22 miles took me 7 hours. The sun rose smoothly over the northern California foothills, and even though my muscles throbbed horribly with each step, I made an effort to run the flats and the downhills. I reached No-Hands Bridge at mile 97, and it was the first aid station in more than 40 miles that I was able to tolerate drinking fluids. That was the best Coke I’d ever had. More of my brothers joined me on the final mile, and I crossed the finish line overwhelmed with happiness and pride. Looking back, my time at the hospital had not taken away from my training; it had enriched it. Now especially, when I’m working a particularly grueling shift, I think back to how challenging Western States was and how every experience leading up to it helped to make it wonderful, and I stop myself from having a pity party.

Hong is an ultramarathoner and third year resident physician in combined adult internal medicine and pediatrics. She is half first generation Vietnamese/half White and runs ultras for many reasons, one of them being the satisfaction of surprising people who don’t expect a small Asian girl to be so gritty and strong. She plans to specialize in adult hematology-oncology after her residency, and hopes to tackle a 200 mile race in the near future.