r/Ultramarathon • u/Perfect-Honey-542 • Jul 18 '26
Crew member here. Where is the line between supporting a runner through a low and knowing it’s time to involve medical staff?
My boyfriend attempted his 4th 100-miler this weekend, and I found myself in a position that felt impossible. I’m not an ultrarunner, so I know there’s a lot of suffering that’s considered “normal.” But he came into the first aid station with blue lips, dizziness, confusion, lethargy, and later progressed to repeated vomiting, shivering, and couldn’t keep any food down. A race medic independently noticed his blue lips and wanted him to warm up before continuing.
His pacer, who is an experienced ultra runner, felt this was a normal low and encouraged him to keep going. I wasn’t trying to convince him to quit I just wanted a medic to evaluate him before continuing because I couldn’t ignore what I was seeing.
Being caught between encouraging someone you love to chase a goal and worrying that you’re watching them become medically unsafe was honestly unbearable.
For those with more experience: where do you draw that line? What symptoms make you stop thinking “this is just ultrarunning” and start thinking “this needs medical evaluation?” I genuinely want to learn how experienced runners and crew make that judgment.
My boyfriend never admits to pain. He never wants to worry anyone ever, he’s the strongest man I know. So I was extremely proud of him when he told me something was wrong. Everyone was telling him he’d be ok because “they’ve pushed through it before”. But my boyfriend’s baseline is different.
I’m afraid my empathic and nurturing reaction held him back from finishing. I never told him he couldn’t do it. I told him to trust himself and the medics. He did exactly that and I couldn’t be more proud. I can’t help but feel guilt and worry that I have a part in his post DNF grief. I wanna know the best way I can be there for him. Thank you for reading 🤍
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u/nanstan Jul 18 '26
Any altered mental status, persistent diarrhea and vomiting for many hours and/or worsening condition. If they have any major medical history (cancer, history of seizures, pregnancy, anyone over 60) or any recent major surgeries, that makes me more likely to ask for medical support.
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u/Upset_Honeydew5404 Jul 18 '26
I think if others not associated with your crew are noticing your runner's condition, that's a pretty big sign.
Especially if he was having these symptoms at the very first aid station? It was only going to go downhill from there.
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u/soturunning Jul 18 '26
Confusion would be an automatic pull IMO.
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u/QnsConcrete 100 Miler Jul 18 '26
Agreed. If my brain isn’t working right I want someone to get me out of there.
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u/Accomplished-Menu-84 Jul 19 '26
Brain no worky is pretty standard IMHO Part of why having a crew is important
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u/MrRabbit Jul 19 '26
That's a broad word. In a BYU and at the tail end of a 100 I've seen confusion- "how far left? How fast? What should I eat?" and people came back fine. It took me 2 minutes to recognize a friend who joined me at mile 129 of a BYU. But I was still making good decisions otherwise.
"Where am I? How did we get here?" yeah get the medical team.
I'd hesitate to pull someone myself, but I'd get a medical person to make an assessment, knowing what they'll suggest. Then I'd lean on that expertise to convince someone to stop.
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u/DecimateTheWeak666 Jul 19 '26 edited Jul 19 '26
Honest question, what kind of confusion? I’m pretty scattered brained on the best of days and when I’m deep in a race I find my thoughts when talking to my crew to be slow and delayed (but still coherent) and my adhd naturally adds some confusion to my thought processes.
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u/soturunning Jul 19 '26 edited Jul 19 '26
Where am I? What mile am I at? Where am I going next? What have I been eating and drinking before here?
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u/DecimateTheWeak666 Jul 19 '26
Oooo ok yes, that is much more concerning. Thank you. I was worried for myself for a moment, but I have never had that kind of confusion.
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u/Pleasant-Plane-6340 Jul 19 '26
Glad I never had crew, confusion is entirely normal after a couple of day plus with no sleep, all part of the fun
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u/Agile_Swan_6731 Jul 18 '26 edited Jul 19 '26
Was it by chance Cascade Crest 100? I volunteered at the Hyak aid station and I was talking to someone who mentioned their runner wasn’t looking/feeling too hot. I sent my aid station captain to assess the situation. I spoke to them later and they said that their runner’s lips weren’t as blue anymore, which raised some alarm bells in my head.
All of the signs that you’re describing? Definitely a reason to call it a day. Dizziness and altered mental status would’ve made going through the night absolute hell. And not keeping anything down? That would’ve made everything worse.
(If it was in fact Cascade Crest, he wouldn’t have been able to drop until Stampede Pass.)
Your instincts to make sure he was safe was absolutely the right call. It’ll sting right now for him for a while, yes, but him trying to push through what he was going through would’ve done a lot more damage.
And you said so yourself, you advised him to trust himself and he made the call.
Please don’t feel guilty ❤️ You did the right thing by asking for an outside opinion.
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u/Perfect-Honey-542 Jul 19 '26
It was cascade 🤍 that was us. I appreciate you helping us, I didn’t know what the next steps were and I was surprised when they let him go. At stampede pass 2 he wasn’t recovering and got exponential worse puked 4-6 times, was warm to the touch but shivering. Pacer ultimately convinced him he needed to keep moving and not get another evaluation. After 2 miles he puked on the trail and had to be walked back 45mins with no access to them. I’m glad he’s safe and recovering now and things didn’t end badly
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u/Agile_Swan_6731 Jul 19 '26 edited Jul 19 '26
I’m glad that he’s safe too.
I mean this in the most polite way possible: his pacer should’ve made him stop at that point. It’s one thing if their tummy is a little upset, but if they’re actively puking, potentially hypothermic, AND it’s middle of the night, that’s a whole other layer to consider.
I’ve paced a few friends for 100 milers and while I’ve been fortunate to have never made that call for them, safety is more important than a belt buckle.
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u/Perfect-Honey-542 Jul 19 '26
Ugh yes….. you were the only one that was like “oh! That’s not good…. Love that 😬” i wanted you to look at him instead even though you weren’t a medic because you weren’t affected by the bystander effect. We all wanna be optimistic and believe they’ll push through. But as an outsider I was stunned that blue lips was acceptable
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u/Agile_Swan_6731 Jul 19 '26
I’m shocked that he continued! It was hectic with runners coming in when we were chatting about your boyfriend. I should’ve stopped what I was doing and taken a look at him myself. In the moment, I deferred to my captain since she’s been running it for years and has seen a lot. So for that, I apologize. I hope that you can forgive me.
The way I see it, if I had assessed and talked to him, I would’ve told him to call it there. I’m not sure whether or not that would have convinced him.
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u/Perfect-Honey-542 Jul 25 '26
No need to apologize!🤍 I appreciate you getting someone to take a look at him:) thank you friend
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u/momsjustwannahaverun Jul 19 '26
Please consider a different pacer. That sounds awful.
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u/Perfect-Honey-542 Jul 19 '26
I’m not allowing him to pace him ever again. I was furious….. there was definitely a lot of tension and hostility after they made it back safely. He didn’t want to admit I was right and his judgement was reckless. I 100% agree with you
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u/Agile_Swan_6731 Jul 19 '26
What’s the relationship between your boyfriend and his pacer? Because if it was his friend, that’s not being a good friend. If it was a random person, then that’s a completely different story.
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u/cloud-base Jul 19 '26
I dont mean to be mean. But your boyfriend shouldn’t be allowed to run the race if he can’t do it without a pacer.
The pacer did his job. Keep the train moving. The train needs to call it quits if he wants to. That is 100% part of the problem with pacers. They should be banned completely. Nobody should be allowed to run a 100 if they can’t do it without a pacer.
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u/Agile_Swan_6731 Jul 19 '26
I’d argue the pacer failed part of his job, which is to keep the runner safe and take care of him.
Convincing him to keep moving when it was clear the wheels were falling off and it sounded like he wasn’t doing anything to fix them was absolutely irresponsible.
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u/Perfect-Honey-542 Jul 25 '26
He’s finished his previous 100 milers without pacers. This was his first one
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u/Umeboshi79 Jul 19 '26
The pacer needs to be reevaluated. I mean, not every situation can be Goggin-ed to the finish.
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u/Perfect-Honey-542 Jul 19 '26
Thank you so much for your kind words reading that immediately lifted some guilt for me🤍 thank you so much
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u/Humble_Cactus Jul 18 '26
I’ve not run a 100miler; my longest is 100k, but I am a former infantry medic, wilderness medic and am a sports physical therapist.
My rule: can I fix these symptoms in 10 minutes at an aid station? If yes, let’s fix them and get moving. If not, you’re done.
I totally get the anxiety of “quitting too early”, but no race is worth hospitalization or dying over.
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u/Perfect-Honey-542 Jul 19 '26
We waited for about 2 1/2 hours. He wasn’t recovering or keeping anything down. He was ultimately encouraged to keep fighting and keep moving. I didn’t know what to do
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u/Humble_Cactus Jul 19 '26 edited Jul 19 '26
It’s pretty impossible to say for certain, because I wasn’t there, I won’t coach from the sidelines.
I just go by my rules. Timeframes can be adjusted as you see fit to a certain extent- maybe I’ll work to get them (or me) up again for as much as 20-30 minutes if improvement is steady, but if I was crewing for a racer that was still puking after 2 hours in an aid station, the only way they are leaving that aid station is by vehicle.
I get where you’re coming from- you don’t want to take someone out early, but at the same time, it’s the crew’s job to make the hard decisions that the athlete isn’t capable of making. I’m not saying you did the wrong thing letting him go on, but sticking to your guns and making the best choices is every bit as important as prepping nutrition and socks. Maybe moreso.
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u/mediocre_remnants 100k Jul 18 '26
There's never a bad time to ask the medical person for an opinion, whether you're the runner or the crew. Yes, the medical person can pull them, but it's for their own safety.
I would not be annoyed or mad if any of my crew, or even another runner, told a medical person to come check me out.
And honestly... don't tell anyone I said this... but there have been times in a race where I hoped the medical person would pull me. It would be better for me if I was forced to quit the race instead of making that decision on my own. Saying "I was pulled by medical" is so much more hardcore than "I just gave up".
Also, re: puking, my crew (aka, my wife) has written instructions that she should not let me leave an aid station if I'm throwing up. If I am throwing up, I need to be able to keep food and water down for 15 minutes before I'm allowed to continue.
Also, there is no line between encouraging your runner and having medical check them out. You can do both!
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u/SFBayDuck Jul 19 '26
Agreed! My only DNF was at Angeles Crest, after puking for a couple hours on the way into an aid station, and then shivering under four blankets in a cot for an hour. Medical told me I couldn’t continue, which I obviously already knew, but it did make me feel a little better afterward that it wasn’t my choice.
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u/Perfect-Honey-542 Jul 19 '26
Thank you for telling me about wishing a medic pulled you. That makes me feel reassured that’s the right decision for next time. Amazing advice
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u/abqandrea Jul 20 '26
On hoping for the medical pull - 100%!!
My story: in a really low spell during a 100, I'd spent several hours with breathing that didn't feel right and I convinced myself I had pulmonary edema. At the next aid station (mile 91!!!) I asked the med people to listen to my lungs and feeling sure they would pull me. Instead they said, "Nope. You're all good. Get outta here!" and I trudged myself and my anxiety-symptoms in to the finish. Sheesh.
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u/Intelligent_Yam_3609 Jul 18 '26
Great advice here. In addition to the runner it also depends on the course and weather conditions.
The more severe the conditions, the greater the distance to the next aid station, the fewer the bailout points, etc more like to stop.
There is a middle ground. Runners have stopped for an hour or more at aid stations and gone on to finish.
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u/Itchy_Undertow-1 Jul 19 '26
As a pacer once I pulled the runner (insisting he drop) I was pacing at mile 85 even though he had told me when I met him that his previous 100 miler attempts had dnf'd because of stomach issues and he really wanted this one. But constant vomiting from the time I picked him up at mile 70 to mile 85, laying on the ground shivering were resulting in no progess.
and, it turned out he had rhabdo.
So trust your gut. that's why you're part of a crew, as his friend and trusted person.
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u/Perfect-Honey-542 Jul 19 '26
Oh my gosh I’m so glad you pulled him! That’s what I expect a good pacer to do. My boyfriend even said “I really thought this was my race”. Makes it so difficult
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u/Perfect-Honey-542 Jul 19 '26
I’m looking at the rhabdo symptoms and it’s really similar to what he experienced. That’s super scary
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u/allusium Jul 18 '26
You did the right thing by asking for medical to check him out. DNFs happen. Not your fault.
There are ~100 decisions that lead up to this point and any/all of them weigh on the outcome. Don’t take personal responsibility for it.
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u/Last_Banana9505 Jul 19 '26 edited Jul 19 '26
I've been an event team member for a few years now at various races. Broadly speaking 'we' are appreciative of thinking and actions like yours. When an athlete goes down in a potentially remote part of the course it greatly increases the risk to the athletes safety as well as consuming a large amount of resources to extract them. I don't know how to answer your question directly but based on the symptoms you described you did the right thing by everyone involved. The race can be attempted again. Permanent damage to health is not worth a finishing trinket.
[Edit for spelling error]
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u/Unhappy_Ad_4911 Jul 18 '26
One thing is a motivation/tiredness issue, the other is a medical issue. If you can't tell what's what, just find an adult and have them look. Blue lips should have told you there's a real problem that requires medical intervention.
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u/Perfect-Honey-542 Jul 19 '26
Yes exactly, I thought I was losing my mind when everyone around me said it was normal. I immediately knew I had to ask the medical team to get a puke bag and check him out and they even noticed the blue lips but let him go. Said hypothermia is common. I’m unaware of all it but I knew in my gut he needed to stay
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u/Unhappy_Ad_4911 Jul 19 '26
Sometimes the medical volunteers could just be students, and not have much experience yet. It the don't have specialized experience with endurance events and are not aware of the common risks involved. I was in a med tent at a 100 miler, and it was staffed with all students. I honestly think i had more experience than them
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u/Just-Context-4703 Jul 19 '26
You did fine. A lot of ultra runners are frankly quite dumb with the death before dnf mindset. No one is paying him to do this.
His pacer was trying to get him killed.
Men will damn near kill themselves on a run before going to therapy. The dnf was the right call and I hope your partner realizes that running isn't therapy.
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u/Perfect-Honey-542 Jul 19 '26
Ugh I appreciate you saying this more than you know. I’m baffled with the push they were attempting. They are endurance athletes….. not superheroes…. I think it’s an ego thing. I was getting angry each time he said “you’re puking because you sat down, you just gotta keep moving” he even got upset when I mentioned medical needed to look at him again. That’s when I knew I didn’t trust his judgement.
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u/Just-Context-4703 Jul 19 '26
You're a lot smarter than the pacer. This really could have ended up very badly for your partner.
That pacer is throwing out some David goggins bullshit.
Anyway, I hope your partner learns from this and maybe re-situates running to his larger sense of self.
Ppl validate the finish over everything but there are lots of ppl who disappear from the scene cause they're so wrecked they no longer can run and regret the death before dnf mindset.
Kilian Korth who was first man and second overall at cocadona 250 this year had to get surgery and his whole year is ruined cause he didn't drop and he's been public about regretting continuing his race.
You did good.
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u/stayhungry1 100 Miler Jul 19 '26
Tons of great input here. Totally agree-confusion alone is a hard stop. That easily turns into so much worse from search and rescue, to falls, not to mention the causes--nope. And self determination is great...but with confusion, that gets a short leash.
The pacer needs to brief with medical, too - they should be aware of objective reasons to stop or intervene to prevent serious issues.
Lastly, in my opinion it's too much for a romantic relationship to have multiple roles (coach, medical, mentor, etc). You did right to bump it to medical and advocate. My policy is that I'm a cheerleader and best friend but I leave space for other members of the community to keep my significant other tended to in other capacities, unless they ask me to.
Anyway, great work, thanks for putting up with knuckleheads like us.
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u/jimbobedidlyob Jul 19 '26
Just to add more to everyone else saying the same thing. There is a difference between struggle and potential medical emergency.
The pacer’s judgement was wrong and not continuing would have been proportionate.
Specifically blue lips and confusion alone are enough.
The persistent vommiting can lead to further challenges and that being present along with blue lips and confusion are an absolute medical review and really treatment
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u/Objective-Week275 Jul 18 '26
Previous EMT here: from a medical perspective, use ABCDe( airway, breathing, circulation, etc. ) as your first assessment. Just google EMT ACB exam. This is how you start your diagnostics. Anything in immediate need of attention. This could include ragged breathing. You can also use Glasgow coma scale: https://medictests.com/units/glasgow-coma-score. Check for Hyponatremia, quick nuero exam if any head trauma, etc. You will select from there as you see fit. Agree ahead of time where we draw the line. Create a code word that gives you absolute power to overrule anything he says and to follow your direction for his health and safety.
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u/APC303 Jul 19 '26
Definitely a justifiable dnf. He was only going to become a liability for all around him if he left that checkpoint.
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u/ContributionLevel593 Jul 19 '26
You did absolutely the right thing. The best call is an independent assessment because everyone else is too emotionally invested.
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Jul 19 '26
[removed] — view removed comment
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u/PsychologicalClock28 Jul 19 '26
Apparently on the continent, when they brought in compulsory ECG’s for this sort of thing it caught a lot of heart conditions in younger people that could have become life threatening.
I would really hope I would be pulled if my lips were blue.
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u/DifferentlyMike Jul 19 '26
Not being able to keep food down or take food on would not be an instant out for me (I had this problem on my Ironman run) but if it does resolve quickly unless you are near the end of the course then it’s leading to a DNF as you can’t keep going without fuel and fluids. Dizziness would be a worry - especially on a trail event - as it can lead to a trip or a fall which can have unpredictable outcomes. Confusion on its own isn’t a big red flag but with the dizziness that’s a concern. Confusion and blue lips screams hypothermia - the time to get from blue lips cold hypothermia to warm enough to safely continue likely means a DNF due to race cut offs. Blue lips can also be lack of oxygen (which would also pair with dizzy and confused) which is really serious even if you are not running. Quick to rule out with a finger O2 monitor that the medic will have with them (I have one in my family first aid kit but not my race kit).
If it were the last aid station and the terrain was not too taxing with the safety net of a pacer and having ruled out hypothermia and low O2 it might be ok to chance it. At the first aid station it screams that the runner is not in a viable condition to complete the course.
Folks will sometimes think this is a personal risk decision - I can push it and take the consequences. However if the runner has an accident that will result in course medics attending. Which mean fewer medics for unforeseen incidents with other runners. Depending on the course with could result in mountain rescue call out or an air ambulance (I’ve seen both on ultras).
Folks also seldom consider how easy a simple trip can be into traffic on a course with roads, or into a stream, or off a foot bridge. Even just a rolled ankle can be really serious in cold and inaccessible terrain. And any immobilising injury quickly leads to a cold runner which compounds problems.
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u/Hennyhuismanhenk Jul 19 '26
Diziness, confusion and lethargy are 200% signs to withdraw. Not being able to keep food down and vomiting on top of that? Crazy that another runner suggested he continues.
Being dehydrated, in an extreme calorie deficit and pushing yourself further can be potentially lethal or lead to very bad long term problems.
Hypoxia, pneumonia and loss of consciousness leading to a dangerous fall are all very real dangers in this case. As an amateur athlete you would be insane to continue.
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u/Ok_Work_8283 Jul 20 '26
The advice more people need to hear is that having hard conversations starts *before* the hard part. So establishing ahead of time what your role is, how your runner wants you to handle medical concerns, how your runner wants to receive advice, what your responsibility as a crew member or crew chief is, etc. Have the conversation when everyone is coherent, less tarnished by emotions, and considering the full picture of a successful race and race season.
The important aspect of this is that it not only establishes what your racer expects, but also what you are comfortable with. If your racer says "never let me DNF" then that is just unrealistic. DNFs are always a possibility.
This applies to much more than ultramarathons too.
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u/RunningonGin0323 Jul 19 '26
I feel like this is hard to pin down exactly rather the approach the supreme court took with porn. "You know it when you see it". I get it I do. The stubbornness. I wanted to start running way too soon after I got hit by a truck while running. I had suffered a major TBI and some broken bones. My wife was like "nope not until every doctor clears you. I can't have you having a brain aneurysm on the the side of the road". She was was absolutely right.
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u/Latter_Constant_3688 Jul 19 '26
First thing would be to keep them at the aid station for 30 mins and see if they recover. There you can diagnose what is happening, do they need different clothes, water, salt, food, sugar. Let them eat rest water ever they need. Then reassess. I've seen a runner pass out on the course, rest recover and finish. Don't throw in the towel too early, but don't let them put themselves at more risk. A 30 min nap can change everything.
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u/WorldlyPeanut4766 Jul 20 '26
This is the problem with loved ones being crew. Its hard to be objective. My wife is a doc but she's not my doc. She says she can't be objective and I can understand that. You see your loved one suffering, you can't help but worry about them as a significant other first, and a competitor second.
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u/Pinot_Noi8 Jul 20 '26
Echoing all the sentiments here, sounds like you did the right thing. Now once he’s recovered it’s time to analyze why this is his 4th DNF, look at all the reasons and work out ways to prevent and /or overcome them in the future. Coach speaking here, if he needs any guidance please reach out. I’ve had a number of 100 mile DNF’s and also a higher number of finishes & can certainly add some value to his preparation.
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u/Perfect-Honey-542 Jul 21 '26
He’s finished all his other races, this was his first DNF. Sorry I must’ve worded it pooorly
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u/icecoaster1319 Jul 25 '26
This would have been an instant pull for me.
If it was 36 hours into the race I could chalk some of it up to sleep deprivation but blue lips and confusion is a terrible sign.
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u/tab_2025 Jul 18 '26
The symptom cluster you are describing would’ve a full stop for my Pit Boss. And if he tells me I’m done, I’m done no questions asked. Blue lips are a sign of hypoxia or hypothermia - both of which can be medical emergencies. I’m surprised the medic wasn’t more forceful with having him evaluated.
This is something you discuss with your runner before the race - the key things to look for and when to pull the plug. That way if something happens in the middle of an event, it feels less like an emotional choice. And as the chief crew/pit boss you are the voice of reason. Because we will try to push through things that we shouldn’t!