Exertional Heat Stroke and Lessons Learned

I didn’t know I was not okay. 

At the end of June 2021, I had a heat stroke while running a trail race. I’m still trying to figure out how this happened, what signals my body was trying to send me that I must have ignored. I’m still trying to move forward, both mentally and physically, with both grace and determination. To heal and grow from this experience, I am learning how to process responsibility, failure, and a new training approach.

I had three hours to run a 6-mile loop around a hilly county park in northeastern Pennsylvania. My hardest race to date, my goal was to finish two loops and to try my best. I was just about to complete my second loop, closing in on 12 miles. I remember talking to myself, “You’re doing great, you’re feeling strong, you’re so close to the end it’s just one more push around this section and you’re there.” 

And then I was not fine. 

I woke up in the parking lot, surrounded by strangers and a few faces I knew, everyone looking very concerned. They told me I was going to go for a ride in an ambulance, but I was okay, just hang in there. 

The EMT, Theresa, held my hand and tried to keep me talking. I couldn’t frame my thoughts to answer her gentle questions with more than a word or two at a time. My brain felt scattered like some parts hadn’t loaded yet. I started to cry, and Theresa asked me what I was feeling. “Failure. I feel like failure.” 

The story I was told went like this. Someone saw me, sitting along the side of the trail and stopped to ask how I was. I said I was dizzy. I passed out. Several people carried my limp body out to the parking lot. People responded quickly, putting ice all over me. I regained consciousness and was able to drink water and orange juice. I knew who I was, recognized my husband Denny and could tell everyone my dog’s full name (Detective John Kimble) and where I lived. 

But I don’t remember any of this. Not feeling unwell or sitting down on the trail, not waking up and having orange juice, not answering any questions. I lost 15-20 minutes of time. My memory starts with recognizing my friend Sarah at my right side, my friend Isaac further behind the crowd, and my husband in front of me. I was then quickly embarrassed when I realized I was laying on someone (a total stranger!). And then, into the ambulance I went, still confused. 

The doctors finally landed on a label after a full day of tests in the emergency room, an overnight stay in the hospital to keep an eye on me, and more tests the next day. The tests they had performed showed reason for concern with my heart, and my family history led them to keep this in the forefront of their thinking. My right atrium was enlarged, and triponum levels were high, but at the end of the day my heart situation didn’t clearly explain things. The best diagnosis for my collapse, memory loss, confusion, and neurological distress given the circumstances: exertional heat stroke. 

Temperatures that day were in the high eighties, with super high humidity. That’s life in the northeast. Runners here, myself included, pride ourselves on how tough we are.  We deal with rocky, rooted technical terrain, cold and snowy winters, and heat and humidity in the summer. You know what’s funny? I was thankful the weather felt pretty good to me that day, especially in the shade afforded by the ample trees. When I saw some of my friends while running the race, they told me they felt a little off, their heart rates unusually high and stomachs upset as the heat was really getting to them. But me? I thought I was feeling great.

I think about this event almost every day, trying to make sense of what happened and what it means today. Was this something that I did to myself? Or was this something that happened to me? 

I was running hard and my heart rate reflected that as I held an average heart rate above my threshold zone for almost three hours. Maybe I pushed too hard. 

The heat and humidity that day met “wet bulb” conditions. Wet bulb is when the air is so hot and humid your sweat can’t evaporate, so you can’t adequately cool yourself. Maybe the odds were against me from the start. 

So what about now? What have I learned since then? 

1. Take responsibility for what’s in your control.
2. Sometimes, your body will fail you. But you are not a failure.
3. Practice “easy running” using heart rate data.

Responsibility. What’s the answer to my question on the focus of control here? I still don’t know. I think it was both something that I did (running with a high heart rate for so long and stubbornly persevering) and something that happened to me (due to wet bulb conditions). 

Humility and vulnerability are required to recognize my part in this event. I must take responsibility for what is within my control and move forward. My attitude, focus, self-talk – these are all my responsibility. Learning from this experience and adjusting my training and performance habits – this is my responsibility. 

When I see quotes about how “your mind will fail you before your body ever does!” or “when you’re feeling done, you’ve really only reached 40% of your capacity!” I cringe inside and out. My mind was stubborn, with crystal clear focus on pushing hard to the end. All the signals my body was trying to send to me were not getting through my determination. I needed to listen to the central governing system’s messages in my brain and slow down. Plenty of people ran that trail race and I was the only one who left on a stretcher. 

On that super scary day, I didn’t know I wasn’t okay. I have to take ownership to learn how to listen to my body. I can use heart rate data to adjust. I can humble myself and acknowledge messages from my body, like a headache, soreness, and how I’m breathing. I can improve my mental game beyond just mental toughness to move toward sensitivity and humility. Life is too precious for my pride to block vital messages from my body that I need to receive and understand.

Could I have prevented the heat stroke if I had approached the race with more ownership and humility? It’s hard to say; heat stroke can happen to people sitting in the shade. Can I approach future training and races with responsibility and humility to hopefully prevent injury? Yes, one hundred percent. 

Failure. When negative thoughts come to mind, I have to combat them with the truth and with love. Exertional heat stroke happens quickly, without much notice to its victims; it is dangerous and scary. I need to choose “life” with my thoughts so that those negative seeds of failure don’t take root in my heart and mind. I would tell this to a friend I love, so I need to tell it to myself too.

I am not a failure because I had a heat stroke. I am not a failure because I have a “DNF” in my running resume. I am not a failure because I was afraid to run for weeks afterward. I am not a failure when I feel anxious about running now. I am not a failure because I’m physically still recovering from this incident. I am not a failure because I needed to learn more and change my training. I am not a failure because I couldn’t achieve my 2021 running goals. 

A beautiful poem in Psalm 139 says that God knew us before we were born, and that He wrote every one of our days in his book. God knew I would have a heat stroke, that I would be afraid, that I would be crushed to lose all of my running goals. Yet He still loves me and sees purpose in every single one of my days. I am not a failure because God says I am significant and known and loved. 

Heart rate training. Prior to my heat stroke, I had never heeded advice to use heart rate monitoring to train in proper zones. Afterward, I took my ultra-friends’ heart rate training advice seriously – I needed to slow down and embrace building a strong aerobic base. I won’t be able to achieve my goal of running an ultra with an anaerobic effort. In addition to this motivation, I had several follow-up visits and tests with a cardiologist to look into the oddities found in my heart in the ER that day, and my doctor wants me to keep things well below heart rates I was used to running at before.

I started running in early-2018, but didn’t get a watch to monitor heart rate data until mid-2019. By that time, I was well into the mindset that I needed to be tough, keep trying, do my best… and so my high-heart rate runs were normal. I naively had thought, “I just have a really high heart rate” and accepted that all of my runs in training and in races leading up to this point were in high effort zones. Perceived effort only provides so much guidance when I had only ever run at harder efforts. 

So, I’m leaning in to trust all the research I’m reading and advice I’m hearing. Easy running needs to be paramount. Which means I need to use heart rate data to keep my easy runs actually easy. When I started using proper heart rate training zones, my easy runs started at about five minutes slower per mile than my old “easy” pace. Over the last five months, my aerobic engine has improved, and at the same heart rate my pace has improved to about three minutes slower than my old “easy” days.  Mentally, this has felt brutal and painstakingly slow. But I’m clearly seeing the physical benefits; easy running is so much easier on my body than I had ever imagined. Recovery is super smooth, nagging injuries have healed, and my heart rate is steadier now. 

If I have a strong aerobic base will I never have a heat stroke again? There’s no way of knowing, but I must take ownership of right now, and that means training with more knowledge and patience. 

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For this article, I focused on my emotional and mental journey up to this point because I want to be vulnerable. I don’t have this all figured out. There’s a waiting list for a counselor’s office with my name on it because I want to process this well. I hope what I am learning about responsibility, failure, and easy running can transcend my heat stroke-specific incident and encourage you. 

Will I ever get to achieve my goal of running an ultra? Hopefully soon. See you out there, Trail Sisters.

Note on heat stroke: If you’re around someone who is hot, is confused, maybe has passed out, and it’s a hot day, don’t wait for a heat stroke diagnosis. Get them cooled off as quickly as possible. Submersion in an ice bath is the most effective method, but if that’s not possible, just do what you can. Incredible strangers probably saved my life because they acted fast to cover me in ice, take off my shoes, pour cold water over me, and get cold fluids inside me.