Michael Roeger was on a training run in Canberra, when a few kilometres in he felt a sharp pain in his abdomen.
Then he started throwing up blood.
"I knew I was in trouble," Roeger said of the May 2022, incident.
The four-time Paralympian was rushed to hospital with a gastrointestinal bleed.
"I remember I went to the toilet and I fainted and remember coming to and there's like 10 doctors around me and it was just a pretty tough few days there," Roeger said.
"They're giving you blood transfusions, but it's coming straight back out the other end — it wasn't good."
His family was summoned from Adelaide.
"It was sort of an eye-opener," Roeger, 34, reflected.
"You know you're sitting on your hospital bed just lucky to be alive.
"You're not worried about medals or winning races."
Bleeding a risk for runners
Gastrointestinal bleeding is not uncommon for distance runners, but it is generally not a major issue, according to South Australia Sports Institute's (SASI) medical director Geoff Verrall.
He said there were thought to be two main causes.
For long-distance athletes, blood is directed away from the abdomen to be used in the legs when they are running and this makes the area susceptible to inflammation and bleeding.
The other cause of micro-bleeds was the use of anti-inflammatory medications.
Dr Verrall said 50 per cent of the time there was no prior warning for the athlete that there was a problem.
"And we have drugs that we can prescribe to minimise the effect with gastritis," Dr Verrall said.
Regardless of the cause, Roeger's brush with death has not stopped him from running.
"He's always been able to pick himself up and refocus and get his goals again," coach Philo Saunders said.
"He's unbelievable. He's one of the most dedicated, hardworking people you'd ever meet.
"He wants to be the best in the world as a para-athlete and he wants to win a Paralympic gold medal, so that's never wavered for him."
Dream of gold still intact
Roeger's dream of being on the top of the podium at the Paralympics singing the national anthem has been with him for as long as he can remember.
"That's still burning, and that's the desire and that's still the goal," he said.
It was about six months after his hospitalisation before he could return to full training.
"With losing so much blood, I was getting blood tests every week and I was getting monitored all the time by the doctors at the AIS," Roeger said.
"As soon as my blood went up to another level, training could go up to another level.
"In that respect it was easier than coming back from an injury."
Long run to victory
It is not the first setback for Roeger, who competes in the T46 classification.
He was a top medal hope at the 2012 London Paralympics, but a gastrointestinal bleed forced him out of his 800-metre race.
In Rio, four years later, he claimed a bronze in the 1,500m, but his performance was affected by a cold.
And in Tokyo in 2021, a stress fracture in his leg curtailed his goal of winning gold in the marathon.
He finished sixth.
Soon after the games, the International Paralympic Council announced the T46 marathon was off the program for Paris and Roeger's only option was to drop all the way back to the 1,500m.
"It was a hard one mentally when I first found out," Roeger conceded.
"But I didn't dwell on it too much."
When the 1,500m became the focus, his training regime needed to change.
Roeger was running 160–180 kilometres a week to prepare for marathons and had been doing that consistently since 2018.
For the 1,500m event, he cut that back to about 110km and has worked twice a week in weight sessions as well to get strong and powerful.
"The first thing was mindset, the second part was getting his body ready and the third part was getting his body ready for a 1,500 rather than a marathon," Saunders explained of the program.
Importantly, the 1,500m field has not moved past him.
The world record in the T46 classification remains at the 3:46.51 mark set by Roeger back in February 2017, in Sydney.
"Mentally and physically he's ready to get back to where he was or even better," Saunders said.
Roeger has conceded he has to "train smarter and listen to my body more" if he is to make it to a fifth Paralympics.
Quite obviously a little luck would not go astray either.
And despite all he has been through, he said he would not rule out going to Los Angeles in 2028.
"And how good would a Brisbane 2032 be," Roeger said.
"There's still a lot left in the tank if the mind is willing — and the body."
