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As a sports medicine physician I have been fortunate to cover a lot of exciting sporting events and I have seen a lot of interesting cases. I have taken care of a wrestler who had a stroke. I have rushed an NFL player to the hospital with a pneumothorax. I have stitched up my share of hockey players bleeding all over the ice and I’ve evaluated countless unconscious athletes on the field. I have been a ringside fight doc and I have even been at the bottom of the X-games mega ramp to evaluate a skateboarder who fell 50 feet in the air and landed on his head. These have all been unforgettable and sometimes frightening experiences. But no matter how big the athletes or how extreme the sports, nothing really scares me anymore as a sports medicine doctor… That is, except for one. There is still one sports medicine nightmare.

Being a sideline team physician can be a little scary at first because you never know what kind of trauma to expect. Sometimes it is the subtlety of a concussion and sometimes it is the obvious fracture/dislocation. But ultimately all trauma, no matter how scary, can be simplified to stabilizing the patient and calling for paramedics. But sports medicine is more than just trauma. Of course it also includes all of the less acute overuse injuries but these are hardly scary either. But there is so much more than musculoskeletal injuries. What if any acute medical emergency could happen? What is most scary is knowing that ANYTHING could happen during a sporting event and that you need to be prepared for it ALL. There is only one event that could provide anything and everything all on the same day and that is why its what scares me the most. Its the Ironman triathlon.

The day starts early in the morning with the largest mass of swimmers you could imagine. There is trauma and pulmonary edema and near drowning and even hypothermia. After the transition to the bike comes the more significant trauma from the bike crashes that often occur many miles and sometimes hours from the nearest trauma center. For those that make it to the run the dehydration starts to set in. Then all of the electrolyte abnormalities and the mental status changes and the hyperthermia threaten to stop the athletes. And these elite athletes are hard to stop. Some have been training their entire lives for this event and convincing them to stop, receive medical treatment and be disqualified can sometimes be a battle. But surprisingly they aren’t all elite athletes either. I am always surprised by how many older or overweight athletes compete in these events. Cardiac issues, stroke and sudden death are always threatening. Finally the sheer number of participants in mass events like these make a football game seem like a walk in the park. Especially when the mass event is a high profile one, and no Ironman is more high profile than the Kona World Championships.

I am now amongst the thousands who have come here to Kona for this spectacle and tomorrow I will be an Irondoc. This will be my third time being an ironman physician traveling up and down the course in a mobile van unit searching for athletes in trouble. I have no idea what I will encounter tomorrow and that is the scariest thing for a physician. But I love doing this and I am only one of many who volunteer their time and efforts for these events. And no matter how scary it gets, I am just glad that I am not the medical director responsible for coordinating all medical care for an event like this. That truly is a sports medicine nightmare and I have the utmost respect for those willing to take on that challenge. As for me, it is nightmare enough just driving in the van.

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