Badwater 2014: Not Just Another Hot Flash

It's hard to put so much stuff down in a single blogpost, because so much happens in the space of a few days. I want to write about the race this year because the event itself was different, it felt different, and turned out somewhat different. I have been struggling with how to put all this down, because I have a gazillion pictures of the beautiful desert and my road trip, too.

At this point I have no idea whether the original course will be back next year, and we all hope it will be, but it sounds like there might be a variation of this year's course in the works for a separate and different ultra in the future, regardless of the outcome with the original Badwater course.

This year it was a learning curve for everyone, the runners, crews, and staff. There were a lot of rookies, or first-time Badwater runners. Even the race logo was different.

The Trip Out
Since I had the time this year, I decided to drive out. I felt like I needed a good road trip to clear my mind. As it turned out I didn't do any intense thought process while driving, I just sort of zoned out looking at the scenery. Utah is a beautiful state, and there was so much to see. The drive was 16 or 17 hours each way and it really wasn't a bad drive, I broke it up by stopping in St. George Utah both ways, and that made it manageable. It was only 10 hours to St. George and then another 6 or 7 to Lone Pine. The best part about staying in all those hotels was the AC. I slept more comfortably and didn't wake up hot and pouring sweat at night.

On the way out I took my time, I stopped at a lot of roadside view areas in Utah. I planned to pick up Megan's boyfriend Ray at the Las Vegas airport Sunday morning and drive him to Lone Pine with me. Ray is a firefighter and EMT. Megan is the Badwater medical director, she's an ER physician in Albuquerque. So I got a late start out of St. George on Saturday and took my time in Las Vegas. I stopped at my favorite sushi place, Sushi Koma, and unfortunately the AC was not working when I first arrived! They had a repairman there and by the end of my lunch it was blowing somewhat cooler air. I asked them if their refrigeration for the food was working, and it was. It actually wasn't too bad sitting in there drinking ice water since it was 110 degrees outside.

I stayed on the west side of Vegas, I avoid the strip. I am not fond of downtown Vegas, or it's inhabitants, I call them the Lost Vegans. I found a quiet hotel in Summerlin and Sunday morning I went for a run before going to the airport to get Ray. Arranging to meet at the airport was a little challenging but it only took about 10 minutes and we found each other. Ray has never been to Death Valley before so it was fun to play tour guide. Except I missed the turnoff to Badwater when we went through Pahrump so he only got to see the original course from Furnace Creek north.

We made our obligatory stop in Pahrump for gas and I had a McDonald's salad, figuring that would be my staple for the next several days. Then we drove to Furnace Creek ad stopped at the store and Ray got t-shirts for his kids and I got a t-shirt for Dennis and some other junk, and we drove on.

Pre-Race

We arrived in Lone Pine late in the afternoon and we were both hungry, but we missed the general pre-race meetings and they weren't done yet, so things were fairly quiet around the Dow Villa. We checked out the new restaurant next to the Dow and it was really good! They had salads, too. I felt relieved that I wasn't going to be limited to McDonald's and the Pizza Factory the whole time.

We walked around town to stretch our legs and I showed Ray where things were, Lone Pine only has a few blocks along the main street. Then we headed back to the Dow and Megan was back from the meeting. We checked into our rooms and then had the medical team meeting. There were a few new people this year, but we had George, Eric, Dave, Megan and me for the old crew, and Marco was back for a second year but this was my first time meeting him. Then Darryl and Aaron were two emergency physicians from Albuquerque that Megan invited, and Ray was new. And of course John Vonhof and Denise Jones on foot care as always. And Chris was with us for the first time on medical but he has been on the race staff for many years.

We had room 30 again, and we set up all our stuff after Megan discussed what we'd be seeing and how we go about doing things, especially for the new people on medical. We talked about how the course was laid out and the logistics of getting medical staff out on the course throughout the day and night. Instead of the point to point original course, Lone Pine was the hub, so it was a little easier and closer to get to the runners, but since no one had ever done this route before, we had little idea how the conditions at the different times of day might look in reality. Among the things we had to consider:

It wouldn't be as hot, the hottest part of the race would be in Owens Valley in the middle of the race for those who were out there in the daylight.

The big climb came first, up to Horseshoe Meadows at 10,000 feet, so there might be some altitude issues or bashed quads from the trip down.

There's always the potential for people to underestimate hydration needs when the temperatures are cooler, or at altitude.

There was the dirt section in the middle, the 15 mile section up and down the Cerro Gordo road, that would be mostly done at night, so we might see some foot issues from that. And there was no crew access for that section, so we had to have a vehicle for a potential evacuation, and medical staff up there until all the runners passed through.

There was Darwin, at the far end of the course, where we needed to have coverage just in case.

And then there was the finish line, the long stretch from when the first runner came in until the last runner finished.

And much more...

After our medical meeting, we all went to dinner, and I walked over to the Pizza Factory with George, and found my friend Bob Becker from Florida and his crew, and George and I split a pizza and we hung out and talked with Bob's crew. Bob had the number 69, which is his age. He looked very fit. He was being crewed by Bonnie Busch, whom I know from Iowa and running Cornbelt, she is an excellent runner with lots of Badwater experience both running the race herself and crewing. I met the rest of Bob's crew and they were all experienced runners and a really together bunch of people, so things looked good.

Most of us planned to be at the starting line to weigh the runners in and the first start wave was at 6, so I set my alarm for 5.

I went back to my room, which I was sharing with Marco, and we talked for a while, he's a nurse in Palm Springs and works in neuro and trauma. We both had a lot to say about nursing, and he asked me a lot of questions about my business. He's seeing the same things in California, except they have unions there, so they are a little more protected as far as staffing. But it doesn't stop things from being completely screwed up in health care.

The Start

I got a good 7 hours of sleep and made it over to the start at 5:30, and the sunrise over Mt. Whitney was the highlight of the morning. It was strange to be starting, looking at Mt. Whitney, but in a way, it felt right.

The three start waves were only one hour apart instead of two this time, which made it a lot easier and quicker than when the pre-race weigh in extends over nearly 5 hours. Also, the starting line was only 4 blocks from the hotel, so we could walk over, and even run out to get a cup of coffee between waves. On the original course it's a long drive to Badwater from Furnace Creek.

The starting line in all 3 waves had a different feel. Not as uptight, not as nervous or tense as the usual Badwater start. It almost had kind of a trail race feel to it, much more low-key. They still did the photo ops but it was easier to keep track of the runners since they weren't all off taking pictures at the Badwater sign.

Ben was out and hanging around, I made sure I talked with him as often as I could. Last year I think I was more upset about not seeing Ben than anything else about missing the event. He had some health problems last year and we were all worried about him. He seems to have bounced back and looked good. And of course, he's still sharp and remembers everything and everyone.

After we weighed the runners in, we all met over at the Alabama Hills Café which makes the best breakfasts ever. We knew it would be a while before anyone might need us, so we used the morning to organize the medical supplies a bit more and set up the room and chairs. Eric and Chris were going to do the Cerro Gordo section, Marco was going to be the finish line person, and the rest of us would stay put in Lone Pine and switch off roving the course.

We sat in the medical room for a while looking at John's books of icky feet pictures. You think Badwater feet are bad, you should se the ones from the jungle in the Amazon! John and George both gave me some foot advice as I was asking about keeping my feet from becoming macerated in case it's really wet in Cleveland in September. John gave me some samples of different kinds of foot goop to try. Denise came over with her foot kit and we talked, she brought Nike and Turbo with her for a short visit and I caught her up on the Buffaloes.

Original vs. Extra Crispy

As the runners headed up the 22 mile climb to Horseshoe Meadows, it was sunny and cool to start. The cooler temperatures and the 22 mile descent back to Lone Pine could make for some speedy times, so we sent the first roving crew out fairly early. I stayed in Lone Pine and talked with George and the others for a while. By early afternoon we hadn't seen any business so once Megan got back I went up toward Horseshoe Meadows to rove the course. Some people were flying down the hill, others were taking it easy. Everyone looked fine, there weren't any issues yet. I generally wave and cheer on all the runners. I saw Bob coming down so I waved at him and took a few pictures as he approached and went by. His crew looked happy.

I didn't drive all the way to Horseshoe Meadows because the last runners were already on their way down, so I waited for a while at a turnout, spoke with Scotty when he stopped in his truck, and looked out over the Owens Valley across toward Death Valley and Telescope Peak. This course was my kind of course, with the climb and descent on pavement at the beginning. Somehow I didn't feel all that excited about wanting to run it, though. It's like the difference between original and extra crispy.

When the last runner went by, I started heading down. I went back to the medical room and things were quiet, the runners had been coming through Lone Pine on their way out to Cerro Gordo. There were a few minor blisters and a question or two on hydration. People looked good, though you could tell that some were starting to feel it. Bob looked fantastic. There were a couple of runners whose crews were trying to get them to eat, they weren't interested in food, so that was a problem.

I spoke with the crew of one sluggish runner, who wasn't eating. He needed some carbs and I know he would have bounced back easily. But his crew, which consisted of some experienced ultrarunners, was feeding him avocados. Time for a nutrition lesson. I told the crew, "He needs to eat something with carbohydrates in it." The crew member said, "Yeah we're giving him avocadoes." I said, "He needs something with carbs, there are no carbs in avocados." The crew member said, "Are you kidding, there's a shit ton of carbs in avocadoes!" To which I replied, "No, it's only fiber and fat. He needs something with sugar in it. Do you have anything with sugar?"

You would think that experienced ultrarunners would know better, but then...

Megan and Ray had been out on the course. It's a narrow highway with little shoulder in some places, and cars are traveling at a good 70 mph. They aren't used to seeing runners on the roads. Around 7 pm Marco and I went out on the course to rove in my car, and drove out to the Cerro Gordo turnoff. I had to tell some of the runners and crews to turn their flashers on because it was getting hard to see. Most of the runners were on the Dolomite loop which is off the main highway for a stretch, but then rejoins the highway through Keeler to the Cerro Gordo turnoff. 

Marco and I pulled into the crew parking area at the bottom of Cerro Gordo. There were tons of cars jammed in there. Marshall found me and told me about one runner who was having problems, but it turned out they were okay. I saw Bob again and he looked great. Just cruising along with Bonnie.

When it started to get dark Marco and I headed back into town. He was waiting for the call from Chris to come up to the finish line, and I was headed back to hang out in the medical room. Marco went back to the room to get a nap and I hung out in room 30 while the others went to get food. John was getting ready to go out to Keeler to be there for foot care, and there had only been a few runners in with hydration issues. We did get some calls in the medical room, some odd ones. "Do you deliver ice?"

We did get one runner who hadn't urinated all day. You would think people would realize that's a problem a bit sooner than 16 hours into a race. He did eventually pee just a tiny bit for us, and it wasn't a bad color, but we gave him fluids and food and held him for a while.

Counting to Three

As we were finishing up with him, a crew member came to me and said he was worried about his runner, who was vomiting for 4 hours and hadn't stopped. They were at their room in town trying to get the runner to feel better. I told him to bring her in. When they drove up, I went to the door of the van to help her out of the car, and she looked wiped out, but as soon as she got out of the car, she started talking. Nonstop. Not in English. Complete with dramatic arm gestures and eye rolling. In my head, I knew she was still okay, because she wouldn't have all that energy if she were truly in trouble. Fortunately her crew member could translate.

Her vitals weren't bad at all, but she was down by about 8 pounds. I got her started on ORS (the oral rehydration salts that we mix in a liter of fluid) and her crew went to get her some saltines, and we actually got her drinking and eating. When she tried to have some soup, that came up, but fortunately it was only the soup and the ORS stayed down. I stayed up with her until we released her to go back on the course or drop out, depending on what she wanted to do. But she gave us a language lesson and she was quite lively and dramatic, so we got a lot of entertainment out of her visit. I have never heard anyone talk that fast, even my sister, and in a language you can't understand, you just sit back and listen in amazement. I did learn how to count to three in her language though. I kept counting for her as I gave her the cups of ORS and the saltines.

She was the last runner I saw at the end of a 19 hour day and as soon as she left I went back to my room to get a few hours of sleep, and George and Dave had the medical room for the night.

Marco was awake when I got to the room and he still hadn't heard from Chris. It was almost 1 am, I was exhausted and took a shower, then crashed. The air conditioner was awesome, it was cranked to the max, what a relief after being hot and sweaty all day.

At 5:30 am I heard a knock, I jumped up because my bed was closest to the door. It was Anna looking for Marco, he was supposed to be at the finish line. The first runners had come through Lone Pine already. I looked over and he was still there. He jumped up and got his stuff together, but I couldn't go back to sleep after he left. I got up and had my instant Starbucks packets of coffee, and dragged my butt over to the medical room. George hadn't slept all night, so I told him he could use our room to shower and take a long nap. There had been some business overnight, but so far, nothing major, and no one had needed any trips to the hospital or anything. There were more DNFs, though.

Day Two

As the day unfolded, there were people in for foot care, a few more hydration issues, and a few soft tissue injuries, like calf muscles or Achilles problems, but nothing really serious. The crews and runners thanked us for our care, they were so appreciative, and they remember you. As I was out on the course I made sure to check on the runners we had treated, and it's always so satisfying to see the runners get back out on the course and finish after they've been in medical for an issue. That's the best part of doing this, and that's why I love to come back.

Harvey Lewis won for the men with Grant Maughan close behind. Alyson Venti won for the women. Other than that I really didn't pay much attention to where people placed because I was too busy with what I was doing. I usually don't pay much attention to the times, places, or stats. There had been quite a few DNFs as the day went on. 

I went back to town, and George was taking a nap so I stayed out of the room and just hung out at medical. People would come up and ask me how the race was going. We were only two doors down from headquarters, but they are so busy in there, I never want to bug them with questions about the race. They post things when they can, but they are usually on the radio talking to other race staff out on the course.

I went to eat lunch, and the restaurant was quiet. As I was sitting there, I heard the couple next to me marveling at the runners, they couldn't believe people looked so good after running that many miles. The woman turned around since I had my Badwater shirt on, and she started asking me about the race and about ultras. I talked to her for a while, explaining that being able to run that many miles takes a commitment. You make running and training a priority in your life. It's not necessarily THE priority, but you make a choice to take the time to put the training in and take care of your body to allow it to adapt to these distances.

Ultraendurance athletes pursue their capabilities and push past their limits to surpass what for most people is untapped potential. Most people never explore themselves to learn what they can do. I was trying to explain this to them, and they looked like they had never even thought of that before. Imagine where we could be in this world if more people would do that!!!

The rest of the day and evening, the runners continued to proceed up to the Portals and finish. We didn't get too much business except for a few people who had already finished and wanted something checked out, like their feet, or their swollen hands. Antidiuretic hormone is secreted in response to stress and it just takes time for that puffiness to go away, Rest, food, and fluids are the best thing, and ice on any particularly sore places. But it's just time, and allowing your body to recover.

I'm not sure if there were any other medical issues because during the times we're there in the room, we see people, but if we're away or out on the course we miss the things that other medical people see. But as far as I know, there were none.

 I spend a lot of time just talking to runners and their crews, educating them about I & O. That is intake and output. It's mostly about fueling, hydration and electrolytes, and staying cool. Most crews are pretty good about listening. Occasionally there are the completely out there, misguided, clueless people, but fortunately there aren't too many of those at Badwater.

Tuesday evening George and I started doing the inventory of supplies for next year and everyone on medical who was there pitched in and we got it done quickly. I stayed up late cleaning the equipment, and I even put the chairs in the shower to wash the grunge off of them. Things start to get really stinky and nasty after two days of sweaty runners using them. We change the sheets on the bed in between each runner, but those dirty sheets start to give the medical room a certain odor by Wednesday. Ugh.

Wrapping It Up

Tuesday night I got about 6 hours of sleep then woke up Wednesday morning feeling not too bad. Megan wrapped things up with medical, then I went out to breakfast with Bob and his crew. Bob finished in 39 hours and change, an awesome performance! He was very happy.

After breakfast I went over to the elementary school to see if they needed help setting up for the pizza party. When I got there, Don Meyer was the only one there. So I grabbed a broom and paper towels and started sweeping the floor and cleaning the tables and benches. There was no air conditioning so we had a big fan going and we had to keep people out so the room wouldn't get hot. As the runners started to arrive, I decided to become the bouncer and stop people at the door so they'd wait in line outside until the food arrived. 

I only stuck around for the very beginning of the event, I wanted to get on the road and make it to St. George so my drive on Thursday wouldn't be too long. I said goodbye to as many people as I could, and then left by noon.

Driving home I just went forward, didn't stop much except to stretch my legs. Driving back through Panamint and all the curves in the road from Father Crowley Point on down and over the pass to Stovepipe, I realize just how familiar I am with all the details of this road, and all the colors. It always blows my mind just how colorful this road is, and how much I have fallen in love with this place. Every rock, every big Joshua tree, every curve along the way carries a memory for me. I find myself smiling as I remember bits of conversations I've had with my crew, or things that happened in different places along the way.

I did one last trip to Sushi Koma when I went through Vegas, to fuel myself for the trip. I stayed in St. George again. Great AC in the hotel. But did you know that at 7:30 on a Thursday morning there is NOTHING happening in St. George. Even the breakfast places aren't open until 8. No one is out on the streets. Where was everyone? At the Temple? I had to drive to Cedar City before I could find something to eat for breakfast.

I drove all the way home Thursday, getting in before dark. The Buffaloes howled so all the neighbors would know I was home. I think Dennis was happy to see me too, once the Buffaloes let him.

I haven't had much time to process my thoughts about this year's race or what I learned, so as those things occur to me, they'll be in other posts. But that is about as short as I can make a blogpost on what is always one of the most enjoyable three day stretches of my summer.

Death in Death Valley

I'm very sorry to say that I am reluctantly blogging about the death of a runner, again. I've already been asked about it, people always want to know what I think, with a blog about ultras, Badwater, and heat running, so I decided to post, carefully.

I don't mean for this to sound judgmental. It's not intended that way. The grief of his family and friends is too painful and too great, there hasn't been enough time for them to process all that has happened, and right now, we don't even have all the details or the results of an autopsy.

There have been comments and articles on the Internet and in Outside magazine and various blogs, and discussion on ultralists. I've steered clear of it, but I've had too many e-mails yesterday and today asking me if I know about this, if I knew him, if I know what happened, what do I think, etc. I got tired of writing back to people saying, I really can't comment on this right now. So here's what I know:

Most unfortunately, it was in Death Valley. It was not connected with the Badwater race, not connected with any multiple crossing of the valley, not connected with any organized event. It wasn't even intended as an ultra run.

I don't know all the details beyond that. I didn't know Michael Popov, I ran in one race with him 4 years ago but we never exchanged more than a few words and well-wishes as we ran laps at Across the Years. He was young, a fit and accomplished runner.

It sounds like he was trying to cross the bottom of the valley from the West Side Road to Badwater, a distance that, as the crow flies, is only about 10 kilometers. He underestimated what it would take to cross that way, it appears he didn't have enough fluids to keep him going in the event something went wrong, which it did.

I wish someone had told him that Ben Jones had done an autopsy before on a guy who tried to cross the valley like that, looking across and thinking, it's not that far, but died doing it. I don't know if anyone told him. I don't know if they did and he decided to do it anyway. It's not the first time that someone has attempted to go across that way and died.

Crossing the valley that way isn't what it appears. There are obstacles, wet, muddy, marshy salt flats, variations in terrain and footing that make it a lot longer crossing than a few hours. It's not pancake flat as it appears from the eye or even the topo maps. There's no shade, and no drinkable water. There's also no access to a road without going a long way out of the way...

It doesn't matter who you are, how well-conditioned you are, how experienced or accomplished you are. Whenever you set out on an adventure run of any distance, but especially in an extreme environment like Death Valley, you need to do your homework, and you need to plan for the worst with a workable backup plan.

It was 123 degrees. He died of heat stroke. I don't know if he had a backup plan. It doesn't sound like there was one. It doesn't take long between the time someone gets in trouble in the heat and death from heat stroke, without intervening quickly. It sounds like he didn't have a chance by the time someone discovered him. Even though he was conscious when found, it didn't take long before there was no way to revive him.

There is nothing anyone can do to ease the grief of his family, his friends, and the people who were closest to him as they go through this loss. It is unfortunately one of the most difficult lessons to accept for people who love adventuring and extreme sports. We are not infallible.

We CAN do everything in our power to keep the worst from happening, and having a safety plan, a backup plan, and doing your homework before you go might not save every life in every instance, but it might save yours.

My own feeling is that it didn't have to happen, and unfortunately, it did. Do your homework. Don't think you're invincible, because you're not, no matter who you are.

Please be mindful of this as you go on your journeys.

Beyond Blisters: Working on a Medical Team

I just got back from my third year volunteering on the medical team at the Badwater Ultramarathon.

It's almost as much fun as running the race. Almost.

But in some ways it's even more fun because I get to watch and learn from the runners and the other medical team members.

When people ask what I do in that capacity, they often think I treat blistered feet. That is actually only a small part of what I do, we actually have foot care specialists for that and I rarely have to do any more than a minor thing involving blisters. Mostly what we treat are varying forms of heat illness, but we see a lot of other problems, too.

I am going to share some of my observations with my readers, with the intention of improving runners' and crews' future experiences at Badwater or other races in the heat.

I consider volunteering at Badwater an honor and a privilege, it certainly is not something I take for granted. I am thankful to Chris Kostman, the race director, and medical director Dr. Megan Dell, and I hope to continue to volunteer on medical at Badwater in the future.

It's a huge task that Megan takes on as medical director. She needs to make sure that all the runners and their crews are safe so that Chris can focus on his duty as race director to oversee it all. The goal is for everyone, runners, crews, and staff, to arrive at the finish line intact and keep anything from happening that endangers their safety, lives, and the future of the event.

Given the unpredictable factors: weather, judgement of the runners and their crews, the presence and behavior of several hundred people involved with the event, in addition to spectators, tourists, the general public, and highway traffic spread over 135 miles, that's a huge responsibility.

Before I go any further, I'll state that what I write here is my opinion and does not necessarily reflect the opinion of anyone else on the medical team or associated with the Badwater Ultramarathon. I'm not writing as a representative of the event, this is solely my own personal opinion from my experiences and observations.

My background

As a registered nurse, I have a certain type of training and background complemented by my 20+ years of ultramarathon experience, and two Badwater finishes, including a double road crossing of 270 miles in 2011. I have worked in critical care nursing in the past and now I'm an oncology nurse in a hospital-based clinic. Both of these nursing backgrounds have been amazingly helpful at Badwater. And I'm not even giving chemotherapy. Let's just say I'm used to treating really sick people.

I also have a background in exercise science and behavioral science from my academic training in natural resource recreation. So I'd say I'm pretty well-rounded in the various aspects of running as a recreational and human performance event. At the same time, I'm certainly not an expert on any one particular thing and I rely heavily on the judgement of the other medical staff at the race.

I see some common themes every year and those are what I'm going to discuss in this blogpost, along with how I view the runners' decisions and what I think about when I am out there on the course or seeing runners in the medical area.

What nurses do

First it might be helpful to explain what nurses do, since a lot of people don't really understand what our role is. Then you can understand how I look at my role on a medical team. Nurses act as patient advocates. We do everything possible to ensure that the patient we are caring for has the safest and best possible outcome from their treatment for a certain condition. Normally this occurs in a health care setting.

We don't diagnose or prescribe, we carry out orders from a physician when it comes to medications and medically indicated treatments, but in terms of total, holistic care of the patient, we act independently and have our own practice.

We educate patients, which is a huge part of what we do. We teach them how to manage their condition, about the medications they are taking, about the treatments or tests they undergo, what complications to look out for, and what symptoms to report to a doctor.

We look out for the safety of the patient, provide hands-on care, and help the patient access resources that will help them restore their well-being, and lead to the best outcome.

You might ask, How does that differ in a setting such as running a race under extreme conditions?

I ask, Why should Badwater be any different from the health care setting?

The answer to both of these questions is, at Badwater, not only are we paying attention to things like heat illness, we act in a preventive role and as safety educators. And safety is the number one, overarching thing we look out for.


What I do at Badwater

So when you come to me in the Badwater medical room and I weigh you, and you're down 8 pounds from your starting weight, your clothing is all full of salt, here's what I'm going to look for: First, are you making sense when you talk to me?

I'll say, Tell me how you're feeling. I'll ask questions like: Have you urinated? How often, how much, what color? How much and what kind of fluid and electrolyte replacement are you taking? Have you been eating? How's your stomach? Are you swelling anywhere?

I will take a set of vital signs if you feel "off" at all. I will help you regulate your body temperature. You'll be hot and sweaty when you come in and then you'll get cold as you sit there in the air conditioning.

We have to assess how dangerous the runner's condition is: low sodium can progress to seizures, coma, death. Dehydration by itself is usually easy to fix if it hasn't progressed too far. A cardiac condition can be life-threatening, especially in this heat.

The medical room gets jammed with people so we have to kick them out if they don't have a legitimate reason to be there. We can't listen to patient's lungs, heart, etc. with all the noise. So we have to be the bad guys sometimes and throw everyone but the runner and one crew member out. Sorry, but it's in the runners' best interest.

As long as you can keep fluids down, I will make you drink and eat something, I'll keep you there until you have to pee, if you haven't been peeing. Your kidneys and brain and gut and other organs need blood flow to keep functioning and if you're hot, all the blood has gone to your skin to keep you cool. Your body produces stress hormones that can make you retain fluid and make you puffy. After you sit there cooling down, you might start to feel better: mentally, and by eating, drinking, and urinating.

Once you're feeling better mentally, I am going to talk to you and your crew member about how to keep you out of the trouble you got in that brought you in here in the first place. And what to look for, if and when to follow up or come back to us at medical.

I'm going to explain to you what's going on with your body, electrolytes, fluids, about the blood flow, about heat stress, and why you need to stay cool. How you're more susceptible to blisters when you're not hydrating properly.

So when you're peeing, have regained some weight, and you're functioning better, plus keeping fluids down, we're going to let you go. And the time spent will more than pay for itself, because by fixing the things that slowed you down in the first place, you will perform much better.

There's a lot of education to be done in every case, both with crew and runners. They need to be more careful about intake and output. We try to pat them on the back for coming in to see us, because it was probably the best thing they could have done at that point- gives them a chance to turn things around when they're going bad.

You might ask...

Should I have a medically trained person on my Badwater crew?

Well, it's not a bad idea, but don't let that give you a false sense of security. That person also needs to have some idea of how this event differs from the setting in which they practice medicine.

I can tell you that even if a person has medical training, until they have experience working at some of these endurance events in hot weather, and know what's the reality out there, they don't really know how to treat the runners.

I say that because we get a lot of runners who have medical personnel on their crews, but they don't necessarily have experience themselves racing in the heat, or have no prior Badwater experience, and they really have no idea how to manage their runner.

I can't even tell you the number of times I've heard some version of this statement from a runner: "My wife is a doctor and she's on my crew". Well, if she's not an athlete, has no experience at endurance events in the heat, hasn't been to Badwater before, her telling me how much urine output you've put out on the average over 8 hours is not going to help me determine the integrity of your kidney function when you're catatonic and dehydrated 40 miles into the race.

"Well he's been averaging 30 cc an hour of urine output" the wife says.

REALLY.

This tells me nothing. He might have peed the entire 240 cc (1 cup) an hour into the race and hasn't peed since. Which ain't much of a pee. This isn't the air conditioned hospital, folks. Sorry, but 30 cc an hour at Badwater doesn't cut it.

The same parameters we use in emergency and critical care for the general unwell population in hospital settings doesn't apply here in this group of people and in 120 degree heat and physical exertion. The runner is also power breathing and power sweating out there. The runner had better be processing a lot more fluids than that through their kidneys or they're in big trouble. That means they need to be taking a lot of fluids in, and peeing a good portion of them out.

What gets runners in trouble most often is not taking the time to cool down so they can do a better job of processing fluids and calories.

What can I do to make the medical team's job easier?

1. Fill out your racer medical history form accurately, honestly, and completely. Don't omit any of the medications you take, including supplements or herbs. You would be surprised how many people in general, including endurance athletes, take things like high blood pressure medications or anti-depressants. These things can sometimes affect your ability to tolerate the heat or exercise, and we need to know about them, especially if you get into trouble out on the course. You'd also be surprised how much we find out when runners come into us, and they start talking, we learn a lot and then we go back to their medical form and they have left out a lot of important information.

2. Use us when necessary, but appropriately. We are there to ensure the runners' and crews safety. Don't occupy a medical team member's time and resources by asking for things like massages, special visits by the roadside for non-emergency situations, looking for a place to take a nap if you don't have a motel room, or in chit-chat if there are other runners around who need help.

3. Choose your crew wisely. I'll talk more about this in a later section, but it's very important. We treat a lot of crew members for heat illness and other issues out on the course.

4. Crews, when your runner is done with the race, have a blanket ready because they will cool down rapidly. After the medal ceremony and photographs at the finish line, get your runner off the mountain. The rapid ascent to 8300 feet makes altitude sickness a complicating factor with dehydration and electrolyte imbalance, sleep deprivation and exhaustion. Take them down to Lone Pine so they can begin recovering as soon as possible.

Safety on the course

This is the other thing we do when we're roving between medical stations.

I'm interested in preserving the runners' safety and the race itself. The importance of the rules becomes even more apparent when the sun starts to go down the first day. The biggest mistake I see crews making on the road is not paying attention to oncoming traffic. They park too close to the edge of the shoulder so when they open their drivers side doors, they are obstructing the roadway.

I'm going to pull over and talk to the crew if your door is open into the road even if there's only a couple of inches to spare when you pull all the way off the roadway. That's why those vans with the doors on both sides are so useful- the crew can use the passenger side to do their business in those narrow areas instead of the side facing the road.

Look both ways before you cross the street! Wear your reflective gear. Use the lights on your vehicle appropriately and according to the rules. Remember there are lots of people not associated with the race on the road. When it's dark outside, visibility is poor, even with your lights and reflective gear.

The later it gets in the race, the more tired everyone is, and it gets harder to be alert and aware of your surroundings. That's why crews need to rest and rotate shifts, and take care of themselves as well as the runner.

About crews

Since it seems like we treat almost as many crew members as we do runners, this is important to mention.

Runners, please think about your crew members when you choose them. Not only is it important for the runner to have their own head screwed on straight to run this race, but they need reliable, healthy crew members to help them do it. Physically and mentally healthy.

Not only does it affect your performace as a runner when you have crew issues, but it affects the other people on the course, runners and everyone else.

If a crew member is not physically fit to withstand 48 hours in extreme heat, sleep deprivation, heat stress, and can't manage their own stuff- meds, food, drinking, proper clothing, and they become incapacitated and do something that endangers everyone, it's not only a safety issue for the runners and everyone else, this is a threat to the future of the race.

Runners really need to be the gatekeepers when they choose their crew members. Know your crew well: do they have medical conditions that make it inadvisable for them to be out in the extreme heat? Can they adequately prepare for the conditions they will be exposed to for up to 48 hours at Badwater, with sleep deprivation to top it all off?

Let me repeat that in different words. (Because I can't emphasize this enough.)

When a runner makes poor choices as to the crew members he or she chooses for an event such as Badwater, the runner is not only endangering their own ability to finish the race safely, they are also endangering their crew members, other runners and crews, and the future of the event.

If one person becomes ill, they have just compromised the health and safety of everyone else on the crew. There are fewer people to cover the roles needed, less rest, everyone is more stressed and tired, on top of the already demanding event. Crewing for Badwater isn't like any other race. It's constant, it's intense, there is no break. The crew is heat stressed and needs to take care of themselves. As the event goes on, people become more tired, less alert, it's harder to keep on top of things like hydration, food, etc.

Do I need to say it again?

Psychological Issues

Nurses often joke about how much of what we do is psychiatric nursing. I think the same thing applies in ultramarathons.

If a runner is struggling, sometimes they just need to talk, to talk out loud through their decisions, or to see if what they're doing makes sense. And sometimes we just need to let them cry, and sit there with them as they process their disappointment, when they realize the best option is for them to quit.

I always observe how the runner is interacting with the crew. Is that an added source of stress for the runner? What I want to know is, is the crew doing anything that is hindering or endangering the runner? And if they are, can it be fixed through communication or just a little education on the spot?

Some crew members forget that the reason they are out there is to crew their runner and help them successfully and safely get to the finish line. That is what a crew is for. Being a crew member is not so you can get a training run in, or wield control over other people. We see a lot of interesting dynamics out there. Occasionally, the best thing a crew member can do is leave. See my blogposts "So ya think ya want to run badwater" and "Big Bad and Superhot".

What The Medical Team Does, and Does Not

The medical team is there to help runners and their crew members in the event of some physical problem such as dehydration or heat illness that can be turned around or fixed so the runner can continue the race, or to keep such a problem from developing into a serious or life-threatening emergency which would require full medical attention and transport to a hospital.

If someone has a minor injury that is in no way life-threatening or endangering their runner's safety, they can come in to see the Medical Team at the nearest station. Sometimes people just need to talk and we are willing to listen.

We don't do IVs. An IV is only done when medically necessary and it always means the racer will be disqualified. If you're of the mindset of some of the triathlons and other races out there that provide IV rehydration to participants at the finish line, you're in the wrong place. Placing an IV, especially in non-sterile conditions such as a race medical tent, increases the risk of infection or bacteremia from contamination.

If the race is over and you're feeling like you need IV rehydration, there's always the emergency room of the local hospital. I don't encourage this unless the runner is unable to keep food and fluids down. The best thing to do is to rehydrate and recover by drinking, eating, and resting.

I'm not a shrink. Roadside psychiatry is not really one of the things I do. If anyone has a concern, they should feel free to come to one of the medical stations, but unless someone is in danger, we generally don't make roadside visits for non-medical issues like massages, pep talks, and hand-holding.

What's it like working on the medical team?

It's a good mix of physicians, nurses, first responders, an exercise physiologist, and foot care experts. (I think we could use a clinical psychologist too.) We're all professionals who are committed to our areas of expertise in our real jobs, and the combined level of education, experience, and skills make this particular bunch of people top notch.

We don't get a lot of sleep. We share duties like covering different stations, the finish line (where we all freeze), getting sleep and naps, getting food or short run breaks. We have to do inventory and keep organized for all the equipment year after year, making sure supplies don't expire, having enough of certain items and discarding what we really don't need. Also, we need to be anticipating runners' needs at each station and being ready for that.

In a successful year like this one, there were no IVs, almost all the runners we saw were able to go back out on the course and finish with oral fluid and electrolyte replacement.

During the post-race party, we always get runners who come up and thank us for our care. We were able to help them turn the problem around, get them back on the road, to a successful finish. Sometimes they amaze us, someone who looked like death coming in to Stovepipe Wells spends a couple of hours cooling off and rehydrating, and they blast off to the finish line. Nothing makes us happier than to see the runners we treated 90 miles down the road cross the finish line with a big smile on their faces and their crews faces too.

It's really fun, we're a big bunch of nerdy people, and we all have a sick sense of humor. Yes, almost as much fun as running the race.

As you can see, we do a lot more than blisters. And we wouldn't come back year after year if we didn't love it.

Double Vision: Badwater 2009

This year I worked as a medical volunteer at Badwater instead of running the race. Last December at Across the Years I talked with Lisa Bliss about doing this while we ran laps around Nardini Manor. I'd met Lisa the year before at Across the Years, before I sent in my application to run it in 2008. She's the medical director of Badwater, a physiatrist (M.D.), not to mention an extremely talented runner and an all-around genuinely nice person. I figured with my nursing skills I might be able to help the runners, and Lisa welcomed me on the team.

There is no better place to be in the middle of July.

I flew into Las Vegas and rented a car, staying in Pahrump the first night. I wanted to take pictures, photographs for inspiration to paint desert scenes. I had time to take a few pictures on the way into Furnace Creek on Sunday morning and then I arrived at the visitor center and helped the race staff with preparing for runner check-in. I met up with at least a dozen of the regulars at Badwater, people I've known for several years through the race. This was an opportunity to get to know some of them better.


It was strange being on the other side from where I was last year. All the fuss and high energy and stress that revolves around being the racer, checking in, having your crew pampering you like bridesmaids, all of those feelings came back from last year. I was glad to be stress-free.












During check-in I was the "splitter", sending runners one way to get their mugshots taken, and directing the crews the other way to go shopping for shirts and race paraphernalia from the Zombies. I felt like half traffic cop, half social butterfly. It was very fun greeting everyone.

When Pam Reed's crew checked in, one of her crew members looked familiar, and then listening to his voice, I knew him from somewhere. Then I put the pieces together. Pam is from Tucson, and Rob, her crew member, is someone I went to college with, for a couple of years, at NAU. He eventually transferred to U of A but was roommates with the guy who lived next door to my friend (and ultrarunner) Kirk Apt. I haven't seen Rob in over 25 years. He is now running ultras too. Pretty cool.

After all the socializing it was time for our race staff meeting, and then the pre-race briefing, where Chris (Kostman, the race director) introduces everyone and talks about rules and other business. Lisa talked to the group about medical concerns. Right afterwards we had our medical team meeting over dinner at the restaurant in Furnace Creek. It took forever to get our food, with the big crowd of race people, but it was a chance to get to know everyone.

There were 10 of us. It was a big group, Lisa and Tim from Washington, Kim and Jeff from Pennsylvania, me, George, Dave, and Steve, all paramedics from different parts of California, and Woofie from Arizona. Woofie is one of my old running partners from Scottsdale. And Mary, who is also a physiatrist, from Pennsylvania, who was to chauffeur Chris on the course and stay at the finish line with him to provide medical support there for the last day and a half of the event as the runners finished.

What a nice bunch of people, and we worked well together as a team.

The night before the race started we all got together, went through the equipment and made our plans. Most of the medical team would go down to the start and weigh the runners in at each of the three starting waves. Steve and I stayed in Furnace Creek and got the medical room organized and got our supplies divided up for the boxes we would need later when most of the team would be in Stovepipe Wells and the others would go ahead to Lone Pine for the faster runners. We ended up not having to treat anyone in Furnace Creek. It seemed like it was going to be a hot day but the high temperature in Furnace Creek on race day was only 122. Not so bad.

We moved on to Stovepipe Wells. While I was driving toward Stovepipe, I stopped a few times to check on runners who didn't look good, or people we'd heard about that we were concerned about. Everything was pretty good, but a few were starting to suffer, which is always the case in that long hot stretch in the afternoon.

Once we got set up at Stovepipe Wells the runners started to come in, first slowly, then we got full. We had 6 cots set up and they were full for most of the evening! We were busy. Mostly dehydrated runners, who were down 8, 10, or more pounds. We'd give them oral fluids and electrolytes and they'd cool down for a while and then they'd get up and go back out. We had a small number of runners where we were concerned about hyponatremia, but we were able to fix them and they went on to finish.

There were a couple of more serious issues, one of which was a crew member, where we did end up contacting EMS, and one runner late in the race who went to the emergency room in Lone Pine. But everyone turned out okay in the end. And there was one runner in Stovepipe Wells who wasn't able to keep oral fluids down and eventually ended up agreeing to IV fluids, so he ended up as a DNF.

The runners would come in, we'd weigh them, ask them how long it had been since they peed, ask questions about drinking and eating, and we'd give them fluids and electrolytes if they needed it, and we'd hold them until they were able to keep fluids down, eat, and pee, give us a clear enough urine sample, gain a few pounds, and felt ready to go back out on the course. Occasionally I'd have to keep them moving along, sometimes they'd get too comfortable. And then there were a few runners and crew members who seemed to think the medical area was a recovery room, or a cooldown station, even though their runner wasn't in distress. Then I'd have to be traffic cop again.











Eventually the pee cups started to look more like a tasting selection at a brewery. Interesting colors, from dark amber to light wheat. We had a few colors outside of the beer spectrum, too.


The first night I got 4 hours of sleep. We had a few rooms at Stovepipe and we slept in shifts. I slept until 4 am and then woke up to drive to Lone Pine. I left in the darkness and there were very few runners left on the stretch going up Townes Pass, and the sunrise was spectacular. It lasted all the way until I got to Darwin. I did have to make a stop in Panamint Springs at the store to get coffee, and I wasn't to sure of what might be brewing in their coffee pots, so I opted for two pre-packaged Starbucks drinks from the cooler. $4.00 each, but I needed caffeine bad, so it was worth it. I thanked the guy at the register for putting up with us, since they had the store open all night just for the race. He said, "Everyone has been so nice this year!"

I passed the front runners on their way into Lone Pine and most everyone looked great all the way in. I saw Jamie Donaldson who won it for the women last year and this year. She gave me the thumbs up. She was a good hour ahead of Pam, the 2nd place woman.

Not long after I got to the Dow Villa in Lone Pine, where race headquarters is, the Brazilian runner won the race, and they radioed from the finish line that they were sending him down to us. He only spoke Portugese but I managed to communicate with him using Spanish. Note to self: Learn some Portugese before next summer. At least the basics, like drink, pee, eat, etc. Turned out he was fine, just a little dehydrated.

There was an extra challenge for the mid-pack runners. There was a fire in the lower campground, just below where the finish line is, and the top 4 miles of the course were closed for several hours during the race. Chris had to come up with a creative solution to deal with this, so runners were given an option to finish at 131 miles, or to come back later when the course was open and finish out the last 4 miles. Fortunately the fire was contained and the course was re-opened later so many of the later finishers were able to do the full course.

I learned a lot about the effects of heat stress on the body, how to treat dehydration, what to look for if you are not sure if a runner is hyponatremic or dehydrated, or both...I had a great time, met so many nice people, and got to hang out with so many of the people I already know from ultras.

Badwater has become another family for me and it's hard to imagine being away from it. Chris was so generous and appreciative of our efforts, he has turned this event into something that I think everyone on the staff and involved in the race was proud to be a part of.

Stovepipe Wells was the busiest spot for medical, as expected, it's at the end of the hottest part of the day. In Lone Pine it's been cooler and everyone has worked out their issues, and if they had bad problems they usually dropped out by then. There was a lot of foot care on the last day in Lone Pine, but not too many runners needing medical treatment. Mostly routine stuff. But some of the strangest requests came at the end of the race.

A crew member came in, telling me his kid had not had a bowel movement for 2 days. I felt like telling him to go down the street and get a salad at McDonald's, it worked for me. But I told him to go get something over the counter at the drug store if drinking more water and eating fiber didn't work. Sorry dude, I only play Poopsmith when I'm getting paid...

Then another crew member brought his teenage daughter in, she was sick, probably with some kind of viral thing, with a fever and vomiting...or maybe just dehydration, but I am not a pediatrician either. If you're crazy enough to drag your child to an event like this at least take responsibility when they get sick.

Most runners and crews were well informed about heat illness and took good care of each other out there. It was only a small percentage of the runners we ever saw in the medical station. Running in those conditions can put even the best trained runner at risk but it seems like the crews and runners are mostly very knowledgeable and well-prepared.

The only thing that I thought was weird were the very small number of crew members who brought their runners in afterwards and told us the runner needed an IV, as if we were a recovery tent. That was not our job either, and it annoyed me that they were telling us what their runner needed when clearly they had no clue. They just needed to drink, eat, rest and sleep. Sure we could all feel better after a few liters of normal saline living in this dry climate but IV fluids are just a quick fix for what they really need to do, which is take care of themselves and let their bodies recover. People expect things to be fast and easy. There is nothing about this race that falls into either of those categories.

The post-race party happened Wednesday evening and it was fun to see everyone one last time. I got to spend some time talking with Nattu and his crew, including Bob from Florida. Nattu kicked butt this year, he ran 37 hours, in his 3rd Badwater. We miss him around Colorado, he's been in California all year.

We were all exhausted, so we all got sleep and then Thursday everyone took off for home or wherever they were headed, some to Lake Tahoe, Lisa and Tim to climb Whitney, and I headed back into the valley to take pictures. I first dropped off the sharps containers at Ben and Denise's house so Ben could dispose of them for us. Being the coroner, he has the connections! Then I left to drive back across the course, in the heat of the day.

I wanted to catch both sunset and sunrise on Thursday night and Friday, and it was worth it, I got nearly 1300 pictures and probably 300 good ones. I spent the afternoon at the pool in Furnace Creek and then went out at sunset toward Badwater. The next morning I woke up at 4:30 and got out again to take more pictures along Artist's Drive. Then I drove back to the Las Vegas airport.

When I go back to run Badwater again, I hope it will be to do a double. I want to go back and run Badwater again in 2011, but I'm not sure if I'll actually do the double so soon. If I don't do a double then, I'm making it my age 50 goal.

When I was 40 and was just starting to get my health and energy back after getting my thyroid problems straightened out, I made a promise to myself that I would be fitter and healthier at 50 than I was at 40.

I know what you're thinking. I didn't say anything about being crazier.













There is something about turning around and going back across Death Valley after the race itself. For me, it's like closure. I can't just leave it with my back turned, I have to go back and see it in reverse.











Last year I can remember the morning Ken and I were driving back home, we left Lone Pine and drove back over the course and saw the few runners who were out there doing a double, and I wanted to be out there. I didn't want it to end at the finish line at Whitney Portal. I need to turn around and go back.


The colors in the rocks, the plants, and even the man-made objects in the landscape make you feel like you're on another planet. I know my running friends, even the ones I've known for many years and who share my love of running, don't understand why I love running in Death Valley in the summer. They don't understand how I can want to run, much less enjoy a race that covers 135 miles on asphalt. But they don't understand that this is the most beautiful, colorful, vibrant asphalt in the WORLD!


When I'm there, I have lost interest in how fast I run, where I finish in the pack, and in putting the race behind me as fast as possible. Running here is not an event to be put behind you. The elements are not separate from you, you are part of the surroundings. You become part of the landscape, the wind, the heat, the road, and the colors while you're moving through it. And there is nothing else like it.

This is why I want to go back. I want to see more sunrises like this, and as the day goes on, the relentless sun, the hot wind, the intense colors, the dramatic landscape that dwarfs you, while at the same time you belong to it. You become part of the whole picture. There is no other way to describe it, except to experience it.










Photos (from top): The temperature on the odometer on my rental car, Badwater sign near Golden Canyon, Artist's Drive, Badwater pools, the medical room at the Dow Villa in Lone Pine, George and Kim working on a runner's feet, runners along the course headed toward Lone Pine, the Dow Villa sign that changes colors throughout the day, celebrating the finish with a "Badwater ale", bottom of Artist's Drive, sunset over Furnace Creek looking toward Stovepipe Wells, road looking back toward Badwater, 3 photos of rocks along Artist's Drive, Panamint Dry Lake Bed at halfway along Badwater course, outrageous red rocks going up Father Crowley's, view from Father Crowley's at sunrise, near Darwin with lone Joshua tree in background, colors around salt pan around 5 miles into the course, gold rocks near Artist's Drive, more gold rocks looking back toward Badwater, sunrise over Stovepipe Wells from the road up Townes Pass, Alene at the park entrance.