New York Marathon tragedy: Her mother filmed her smiling, her father received disturbing text messages before

About 15 kilometers into the run, Rachel Apa texted her dad, Steve, to tell him she felt great and had never felt better. He tried to temper her enthusiasm, reminding her that it was her first marathon and urging her not to push herself too hard. Less than four kilometers from the finish line, Rachel collapsed. A few hours later, after long efforts to save his life, he was pronounced dead in hospital.

The New York City Marathon was her first and she had spent months training to achieve it. But beyond the sporting challenge, the race had deep personal meaning. Apa was running to raise money to fight Parkinson’s disease, which affected her beloved grandfather, who died in 2022. “My grandfather was my role model growing up,” she wrote on her fundraising page. “He taught me to stay active, push my limits and embrace challenges, which shaped my love for sport and movement.” She described how the disease gradually deprived her grandfather of the freedom of movement he loved so much. Last Sunday, his mother, Michelle, came to New York to encourage him along the way.

At mile 22, Michelle managed to film her daughter running ahead of her, smiling and waving happily in a light green running outfit. From there, she headed to Central Park to wait for Rachel near the finish line. Meanwhile, Steve monitored his daughter’s progress remotely via the marathon app, sending her messages of encouragement along the way. But at mile 29, Rachel replied, “Ouch,” and at mile 31, she wrote again, “Ouch, ouch.” She continued running for the next few miles but stopped responding to messages. At kilometer 37, his father texted: “Final stretch.” No response came.

Near mile marker 39, around 85th Street in Central Park, Michaela Nicholas, a hospital social worker, standing among spectators, spotted a young woman dressed in green. “Come on, Rachel, you can do it!” » she shouted after noticing the name on his bib. Seconds later, Rachel collapsed to the ground. Nicholas rushed to her side and tried to check her pulse but found none. His fiancee called for medical assistance and three people, two of whom identified themselves as doctors, began performing CPR. Nicholas held Rachel’s hand and told her she was not alone. Marathon medical personnel later arrived and used a defibrillator until paramedics arrived on scene and took him into an ambulance.

Rhabdomyolysis is a condition in which muscle cells become damaged and break down, sometimes as a result of extreme physical exertion. The damage releases various substances into the bloodstream, including myoglobin, which can cause kidney damage, and potassium, which, when present at dangerously high levels, can disrupt the electrical activity of the heart, trigger life-threatening arrhythmias, and even cause cardiac arrest. “It is important to emphasize that death from rhabdomyolysis is an extremely rare complication,” says Dr. Flor Diez Gramoy, a specialist in family and sports medicine at Maccabi Health Services in the Southern District of Israel.

So how could a 24-year-old athlete in excellent physical condition, who had trained for months for the marathon, develop such a serious complication? “Even well-trained young athletes can develop serious medical complications,” says Dr. Diez Gramoy. “Good physical fitness is not the only factor that determines how well the body copes with intense, prolonged effort. Cumulative training loads, insufficient recovery, illness just before a competition, heat stress, certain medications, and sometimes a genetic predisposition or underlying muscle disorder can all increase risk.”

One of the main challenges in identifying rhabdomyolysis is that its initial symptoms may resemble ordinary muscle soreness after exercise. Warning signs include unusual muscle pain, weakness, swelling, and sometimes very dark urine. Symptoms can appear hours or even days after physical exertion. “It is important to watch for warning signs such as unusual muscle pain, extreme weakness, dark urine, confusion, dizziness or feeling faint,” emphasizes Dr. Diez Gramoy, while warning that “sometimes serious medical events develop without clear warning signs.” In Rachel’s case, although she reported pain to her father during the race, it is impossible to determine whether these messages reflected warning signs of rhabdomyolysis.

It is also important to emphasize that rhabdomyolysis is not necessarily the initial cause of collapse during exercise. “A collapse during a marathon can occur through several medical mechanisms, including heatstroke, significant electrolyte imbalances or cardiac arrhythmias,” she explains. “Sometimes, multiple mechanisms develop simultaneously and compound each other. For example, severe heat stroke can also cause rhabdomyolysis, kidney damage, and dangerous electrolyte imbalances.”

Rhabdomyolysis is diagnosed in part through blood tests, including measuring levels of the enzyme creatine kinase, also known as CK or CPK, which is released into the bloodstream when muscle cells are damaged. Doctors also assess kidney function and blood electrolyte levels. Severe cases require urgent hospital treatment, which may include intravenous fluids and additional interventions depending on the complications that develop.

Despite the risks, Dr. Diez Gramoy emphasizes that rare cases like this are no reason to fear running or physical activity. To reduce risk, athletes should gradually increase training intensity, allow ample time for recovery and sleep, avoid strenuous exercise when ill, and adjust their hydration and exercise levels to weather conditions. “The most important message for people who exercise is not to ignore signs of distress,” she says. “Unusual muscle pain, extreme weakness, confusion or dark urine after physical exertion requires stopping the activity and seeking urgent medical attention.”

“Excellent physical fitness reduces many health risks, but it does not confer absolute immunity,” concludes Dr. Diez Gramoy. “The goal is not to stop doing sports, but to do it intelligently, safely and by listening to your body.”

Meanwhile, Rachel’s tragic story has attracted attention across the United States, and the fundraising initiative that inspired her to run the marathon has received immense support. According to the Associated Press, donations to fight Parkinson’s disease continued to pour in after his death, far surpassing his initial goal of $4,000 and reaching more than $53,000. Rachel never crossed the finish line of her first marathon, but the cause that inspired her to run, honoring her grandfather and helping him fight his illness, continues to have an impact even after his death.