A Game of Millimeters | Trail Runner Magazine


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I’m 33 years old, and have been running for over 20 years. I ran cross country and track in high school and college, and have been running marathons and ultras since then.

I’ve worn size 30 pants since high school, I eat a nearly vegan diet, and, while I’ve drawn a genetic short straw and am predisposed to high cholesterol, for 11 years I’ve been on medication that manages it well.

All of this is to say I was a little surprised, lying on the exam room bed at the hospital, when the doctor told me I’d had a stroke.

The day before, I was in my office gym when my left hand just seemed to shut off. I don’t have a better way to describe it, and even though I wasn’t using my hand at the moment it went offline, I could tell something was wrong. I tried moving it right-to-left, but it lagged, moving slowly and choppily, like a mouse cursor when the computer freezes. I tried making a fist and wiggling each finger, but they were stiff and unresponsive, the same as when they’re cold and numb from a winter run.

Alarmed, I got my phone and—with my good hand—Googled my symptoms to assuage my fears. I saw phrases like “slipped disc” and “pinched nerve.” Those didn’t sound so bad. Then I saw names like “multiple sclerosis” and “ALS.” I texted a friend who’s a doctor, who mentioned words like “TIA” and “stroke”. He assured me it was probably nothing serious, but advised me to go to the doctor as soon as I could. I followed that advice—kind of: I waited until the next day. After all, I reasoned, my face wasn’t drooping on one side, which I thought was a classic stroke symptom. Besides, I thought, I’m young and healthy. Strokes don’t happen to people like me.

The next morning, the urgent care doctor sent me to the Emergency department for an MRI, post-haste, when I dropped my coffee in the exam room. “That’s probably just allergies,” I deadpanned. She didn’t laugh.

After the MRI—a solitary procedure that lasts the exact amount of time needed to fully ponder and dread how expensive it will be—I sat on the cold exam bed for a couple of hours before the doctor came in and delivered the news. For a moment, I stopped worrying about the upcoming bills.

A stroke? I thought. A stroke is what my great grandmother had. It’s not something that happens to young people, fit people. I repeated the thought I’d had the day before: strokes don’t happen to people like me.

Apparently they do, though. After I asked him to repeat the diagnosis, the doctor confirmed I was one of nearly 800,000 Americans who have a stroke every year. But he followed it with good news: I was very likely to join the 10 percent of stroke victims who fully recover. I’d experienced the neurological equivalent of a fender bender, if the difference between a scratch on the bumper and a flame-engulfed rollover was only a couple millimeters.

***

It’s said that baseball is a game of inches: a few inches are the difference between a home run or a heroic catch by the center fielder; a couple of inches separate that heroic catch from the ball bouncing off the wall for a triple. But I’d argue it’s a game of millimeters. A couple millimeters in either direction, and a curveball misses the sweet spot of the bat—the difference between a clean hit and a groundout or a foul ball. A couple of millimeters too choked up and a high inside pitch might deflect off your pinkie finger, earning you a hit-by-pitch instead of a foul tip. I got hit by a lot of pitches playing Little League, often by more than a few millimeters. A lot of the time, like when I struck out, baseball felt like a game of feet.

Pee-wee football didn’t go much better. I was both short and slow for my age, so I played tight end, where coaches determined my presence would do the team the least damage. My main assignment was to stay out of the way of my own teammates. My only memorable play on the gridiron was being clipped so hard defending a kick return that the parents’ section let out a collective “Oooh,” and I stood, crying and picking sod out of my facemask, as the ref asked if we wanted to accept the penalty. (I was also the team captain—a designation that rotated each game.) The other team’s hubris had backfired: when I took the block to the back, I was the last defender between the kick returner and the end zone, and I had as good a chance of making that tackle as I did of winning the Nobel Prize in Chemistry that day. They would have been six points richer if they’d left me untouched.

My clearest memories on the court are of being clocked in the head by a basketball that had bounced off the rim. I was an OK skier but my aggression on the slalom course was permanently tempered after I hooked a gate by a couple of millimeters and faceplanted on an icy hill. Streaks of blood stained my jacket the rest of the season.

My parents never bothered signing me up for hockey, and by then I knew better than to ask. So I think they were a little caught off-guard—but pleasantly surprised—when I approached them the summer before eighth grade and announced I would join the cross-country team that fall.

That’s great, they said: now you have to train, even though it’s early July and the season starts in September. They surmised that if I showed up the first day in decent shape, I’d enjoy it more and be less likely to quit. So my dad took me to a local sporting goods store, we picked out some nondescript training shoes (I don’t remember if they were actually running shoes), and I ran every other day: one mile at first, then two, then two consecutively without stopping. And when I showed up to the first practice, I not only ran the two-mile route to a nearby park and back without a break—I led the entire way. I’d finally found my sport.

***

Not all strokes are the same. If you’d asked me, the day before I had mine, to describe what a stroke is, I’d have said it’s when a blood vessel bursts in your brain. I’d have been partially correct. That’s the kind that befell my great grandmother, and it’s called a hemorrhagic stroke, which accounts for around 13 percent of incidents.

The more common kind—the kind I’d had—are called ischemic strokes, which occur when a blood vessel in the brain is blocked by a blood clot or other means, cutting off blood supply to that area. This quickly kills brain cells and affects your motor skills, speech, memory, or whatever functions are handled by the sector of the brain that’s losing oxygen – in my case, the functions of my left hand. (A third type of stroke-like events —transient ischemic attacks, or mini-strokes, the “TIA” to which my doctor friend was referring—occur when blood flow in the brain is temporarily interrupted but usually only last a few minutes or less.)

I learned all this from the revolving door of nurses, doctors and technicians who passed through my hospital room in the day after I was admitted. It turns out there is precious little private time when a team of medical staff is monitoring your condition and is looking out for the entirely likely event that you have another stroke, since recurrences are especially common in the first 24 hours. The brief uninterrupted periods took on profound value: things like my fiancé, who had first rushed into the room in tears, later spitting out her dinner, laughing. She had brought in Thai food and, and since my right arm was unbendable thanks to an inserted IV, I was forced to operate chopsticks with my partially numb, stroke-addled left hand. I spilled more pad Thai than I ate.

Or things like watching the waning minutes of a college football game. (While the expense of my stay, and the overall circumstances, outweighed this perk, the hospital had every conceivable sports channel.) I was watching two overweight coaches in their 50s grow red in the face as they screamed at officials and their own players, wondering how it was I had suffered a stroke but they hadn’t, when the neurologist and his team came in with test results: they’d found a patent foramen ovale (PFO), a hole between the atria of my heart.

It’s a common congenital heart defect: the PFO is a standard feature in an unborn baby, and it’s supposed to close shortly after birth, but it fails to do so in an estimated 25 percent of the population. In most cases, the PFO is so small it never causes an issue and goes unnoticed for a lifetime; in some, it’s large enough that it’s detected in infants and young children, and can be closed via surgery.

Mine was in between: small enough it slipped under the radar for 32 years, but big enough that there was, in any given year, about a one-to-two percent chance a blood clot would escape its prescribed jettisoning from the left atrium and slide into the right chamber, where it would have unfettered access to the carotid artery—the superhighway to my brain. It seemed one had done just that, floating through an intricate web of blood vessels until it finally found a tunnel too narrow to pass through and lodged itself squarely in my upper right hemisphere when I was in the gym that day.

***

When I was in high school, I liked running because it gave me a sense of control. As with academics, my success was largely a matter of how hard I was willing to work: putting in summer miles before the cross-country season and hitting the treadmill or the icy Minnesota streets to prepare for track and field.

Inherent talent still played a role, to be sure: if Scott Fauble and I followed identical training plans, for instance, he’d crush me in any race. But it seems to play a smaller role than in other sports. If you don’t believe me, ask yourself which is more feasible: that you train yourself to run a sub-2:40 marathon, or that you train yourself to play point guard or running back at a similarly high level?

On my high-school team, I was dedicated and humorless about putting in my mileage. It got me teased, but it was largely good-natured—enough teammates apparently respected me that I was elected captain as a senior. (This time, the designation didn’t rotate.) I was never our team’s fastest runner, but I improved steadily and spent most of my junior and senior years as our third or fourth man. This was good enough to entertain running in the NCAA—in Division III, granted, but I hadn’t imagined I’d be any kind of college athlete back in fourth grade, when my only recorded attempt to score an in-competition basket whiffed by at least three feet. Basketball was a game of meters for me.

I was guided through high school by a kind and inspiring young coach named Tony Kinzley. He had been a so-so athlete who turned himself into a successful collegiate runner through simple dedication and mileage, and his was an example I was determined to follow. He also instituted a Saturday practice schedule, where we would meet at a teammate’s house for a long run, instilling the notion that running needn’t be a joyless exercise: it could be social, even fun. It was a lifestyle, an entire culture, something we could do long after we hung up our spikes. I found running around the Minneapolis lakes with my friends, and eating bagels afterward, was a pretty great way to kick off the weekend.

After graduation, I enrolled at my coach’s alma mater, Saint John’s University in Collegeville, Minnesota, where a similarly inclined coach took me in. “I love 17:30 [5K] guys,” Tim Miles told me as a freshman, “because 17:30 guys know how to do the work, but you haven’t reached your potential yet.” He taught his runners to think long-term, big picture: summer mileage is designed to help you peak in late October or early November, for instance, rather than the first week of practice so you can impress in early workouts. He encouraged us to train hard, but also to train smart, because most of us had never run as much volume as we were doing in college. “Know thy body,” he said, “and train accordingly.”

His approach worked well: we won conference titles in cross-country and track and field, and I shared a locker room with several individual conference champions and All-Americans. On a muddy November day in Ohio, at the 2006 NCAA Cross Country Championship, our team ran smart from behind, letting the wet ground suck the energy out of the teams who had gone out too hard, punching dramatically above our weight and finishing fifth overall.

And I played no part in any of that success. A bull-headed 19-year-old, I nodded along when the coach dispensed his well-earned wisdom, then promptly disregarded it when the pace ratcheted up the Thursday before a race and I wanted to show I could hang. I often did, then raced terribly two days later.

Simply pushing myself harder every day had worked in high school, but now I was surrounded by teammates who had also cracked that code, so I ran myself into the ground. I arrived as a sophomore in August having completed four straight 100-mile weeks and was on the cusp of varsity in early workouts, but was reduced to a lead-legged puddle by the end of September, dragging myself to the finish line with progressively slower times as the season wore on. It was exactly what my coach told us not to do. I had not, as he urged, trained “accordingly.”

I wouldn’t say I burned out in college: I still loved the process, and labored through every bit of the work, happy to be there and to be among friends. I even mounted a promising comeback going into my senior track season. But right before our first indoor meet, my body put an unambiguous halt to things when I developed a tibial stress fracture. It felt like an ignoble end to my collegiate career, and I felt terribly sorry for myself. This sort of thing doesn’t happen to people like me, I thought.

***

“That was pretty slow.”

For the first time since I’d met her, my occupational therapist looked concerned. We’d run through a series of drills intended to test the dexterity of my stroke-stricken left hand— squeezing a machine that measured my grip strength, exercising resistance when pushed, touching my nose with my eyes closed—and I’d been breezing through them. But I had met a more formidable challenge in a bowl of small wooden pegs and a board with several holes: using only that left hand, I had to pick each peg out of the bowl and place it in a hole as quickly as I could; then, one-by-one, I had to take them back out and put them back. The whole thing was timed, like a game of Speed Battleship. I completed the task without any mistakes, but did it slowly. Too slowly.

“That was in the bottom 20 percent of patients,” she explained.

I had an idea. “Let me do it with my right hand.” She humored me, and her eyes lit up when I did it the second time.

“That was slow too!”

“Exactly,” I said. “I have pretty lousy reflexes, even without a stroke.”

The OT and I made easy conversation throughout my appointment. She was my age, was also an athlete, and—I’m just speculating —I was probably a departure from the normal demographic of her patients, judging by the average age and vitality of the others in the waiting room. We talked about climbing; I’d been using the local gym, and she told me it was excellent for my rehab. I told her I’d been playing the guitar and piano while I was on leave from work; both require hefty participation from the left hand.

“You’re lucky,” she said. “Most of the patients I see are just trying to mitigate the damage. You get to go back to normal.” My first OT appointment was also my last. My only homework was to try eating with my left hand once a day.

“With chopsticks?” I asked.

“Start with a fork,” she said.

***

For a couple of years after college, I didn’t really train. But I didn’t stop running, either. I couldn’t go too long without moving, it turned out. And when I’d get injured—something that was happening more as I spent time sitting at a desk—I would take up cycling.

Then, one winter, a college teammate cajoled me into running a 50K in Wyoming with him that June. I had been vaguely aware of ultrarunning before that—Scott Jurek would get the occasional write-up in running magazines, and Born to Run had just come out—but wasn’t sure how someone was supposed to run that far, much less over mountains. My longest run to that point had been a 17-miler in college that got progressively faster until I got dropped and staggered, dead-eyed, back into campus. My race would be almost twice that far.

A little research revealed there was an active-and-growing community of trail and ultrarunners online, and a local shop was run by a trail-obsessed ultra veteran, Kurt Decker. I learned about concepts like pacing oneself and nutrition. I liked my new handheld water bottle so much I started using it on every run, even if it drew side-eye from the roadies I sometimes trained with. Soon I was doing four-hour trail runs and lined up at that 50K fully confident, if only because I didn’t understand the pain that lay ahead.

That was the day I learned that descending can be harder than climbing. After miles of hammering downhill, I was sure my quadriceps were slithering off my bones like an overcooked turkey. I had been looking forward to the flat 10K section that led to the finish, but after being spit out by the Bighorn Mountains, that homestretch turned out to be the hardest 45-minute trudge of my life. My friend and I had raced close to each other all day and were comically deadlocked on this section, one of us pulling ahead only to develop a side stitch and be reduced to a shuffle; the other gaining ground until a hamstring cramped, clutching it like a gunshot wound and hobbling on, pulling the dead leg with them.

I didn’t realize it right away, but I loved it. True to the ultrarunning cliché, I spent two days after the race convinced I’d never do another, and on the third signed up for my next one. I was all-in: reading the magazines, learning about the professional ranks of the sport, working at a running shop, all while training my defective heart out. A few years after collegiate running had left me broken and bitter, trail running had rekindled my passion anew. Upcoming races taught me to once again love the process of seeing my fitness build week after week, with sore muscles and groggy mornings in the middle of a hard training block signifying that type of victory that’s uniquely familiar to amateur endurance athletes. I’d done this to myself, for no one other than myself, for no reason other than: because I could.

Early mornings on crunchy, snow-covered singletrack; the solitude of the trees and birds on a summer outing; the vista from a high point of a run, whether I was on a mountain in Colorado or in a Minneapolis city park; they reminded me that I had loved running all along. They taught me that setbacks and disappointments are often just a reminder to recalibrate a frame of reference that has outlived its useful lifespan.

***

I didn’t quite land in the 10 percent who recover fully from a stroke. My left hand still has episodes of slight numbness, and my pinky finger quivers with a tremor if I extend it fully. (It’s a cool party trick.) I get visual migraine symptoms, which isn’t too big a deal unless the aura would present itself, for example, when I’m descending a mountain on my bike. Fortunately, my memory and cognitive function have not been affected.

So if I ever even think about feeling sorry for myself, I know I’m not being honest. Though a blood clot came perilously close to rejiggering my personality or scrambling my ability to communicate, it didn’t.

As it is, my life is unaltered. The same can’t be said for the plurality of stroke patients who live with moderate to severe impairments, the 10 percent who require long-term care, or those who don’t survive. It can’t be said for too many young and healthy people who are stricken down with cancer, or cardiac arrest, or any number of afflictions that are anything but fair.

My fiancé got to see me wheeled out of an operating room six weeks after the stroke, a brand-new implant sealing the PFO in my heart. I was awake throughout the procedure, though very much under the influence of fentanyl, and I’m told I ruined what could have been a nice moment by demanding a breakfast burrito, forthwith. It was December 2019, and in the year that followed a lot of things didn’t go according to plan. In a weird way, I felt prepared for it. COVID—like my stroke or disappointments with running—didn’t vaporize the fundamentals of what makes me happy, lucky or privileged. Sometimes I just have to remember to look for them.

To paraphrase my OT, I got my life back. And being alive means feeling pain, because moments of pain better illuminate the moments of joy. It means having your goals derailed because the failures sweeten the moments of triumph. It means finding dead ends because that forces you to find new, better paths. And maybe it means being reminded of your own mortality here and there because it makes you breathe the fresh air a little deeper every time you have the chance.

You’d better believe those sorts of things happen to me. What a gift that they do.

Alex Kurt is a Contributing Editor for Trail Runner. He lives in Santa Barbara, California.

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