Death of Runner Places His Sport Under Scrutiny

New York Times/March 7, 2004
By Jere Longman

To ring in the new year, Mark Heinemann chose not revelry but a challenge of punishing endurance. He competed in an ultramarathon in Arizona, intending to run more than 220 miles in 48 hours, sleeping little or not at all.

At 46, Heinemann did not possess the most fluid running style or the greatest talent, but he was disciplined and driven. In 15 races that extended for 100 miles or more, he had always crossed the finish line. He won the previous 48-hour race on New Year's Day in 2003.

Heinemann finished a disappointing third this year, running 207 miles but trailing far behind the winner, John Geesler. Heinemann had seemed distressed at times during the race, other competitors recalled, though they said his struggles appeared to be nothing beyond the familiar toll that a 48-hour race takes on the mind and body.

The next day he was found dead in his hotel room. The Maricopa County medical examiner's office ruled that his death was natural, caused by pneumonia related to a bacterial infection.

Heinemann's death has focused attention on the extreme world of ultrarunning, which involves races beyond the standard marathon distance of 26.2 miles. An estimated 5,000 to 10,000 American runners compete in ultraevents, from trail races to multiday and transcontinental races. While courses are marked with exactitude, ultrarunning is only loosely regulated and lacks uniform safety standards. Even so, deaths are rare.

Heinemann's death has also brought renewed attention to his running group in Boulder, Colo., known as Divine Madness. The group has enjoyed much success in ultramarathons, but its charismatic leader and coach, Marc Tizer, has been called overly controlling by some former members and by Heinemann's mother, Gisella. These critics say they are concerned that the group's alternative life style and its intense challenging of people's limitations may have made Heinemann vulnerable to exceeding safe boundaries. Gisella Heinemann blames Tizer and the group for her son's death.

"They call themselves a running club," she said. "It's a cult."

Tizer did not respond to requests for an interview. In 1997, when some former members of the group made similar accusations about cultism, Tizer disagreed. "This is something else," he said in an interview then, "where people who are sincerely trying to improve themselves have a teacher who is more or less evolved and is trying to help them lead a more balanced, harmonious life."

Discomfort Is Expected

Susan Hart, a spokeswoman for the group, wrote in an e-mail message that the group had carefully monitored Heinemann during and after the race. "We took every reasonable precaution and care," Hart wrote. Had any medical personnel insisted that he stop racing or be checked, the group would have not hesitated to comply, she said. Heinemann did not have his usual hearty appetite on the second day of the race, Hart said, and looked extremely exhausted afterward, but that was his history.

"Having done as many races as he had, why suddenly be alarmed?" Hart said.

A number of questions remain. Did Heinemann know he was sick before the race? Did anyone miss signals that would have indicated that he was seriously ill? Was he sufficiently recovered from running an ultramarathon in San Diego in November to run another one in late December?

Laura Nagy and Alene Nitzky, the co-directors of the New Year's Day race, which is called the Across the Years ultramarathon, declined to be interviewed. So did Dr. Jordan Ross, an osteopath in Mesa, Ariz., who is identified on the race Web site and by runners as having volunteered to supervise and treat runners.

"It's very difficult to have to relive everything over and over and wonder if this or that should've warned me that he needed attention," Nagy wrote in an e-mail message sent to a friend of Heinemann's, Celia Bertoia, who provided it to The New York Times. "As a race director, it just makes you so paranoid and conservative about how to handle runners in the future."

Dr. A. L. Mosley, an assistant medical examiner for Maricopa County who performed the autopsy on Heinemann, determined that the cause of death was bilateral lobar pneumonia. He said that Heinemann's lungs had filled with fluid and bacteria.

"It can take off rapidly," Mosley said of the bacterial infection. "Forty-eight hours is enough to do him in."

It seems likely that Heinemann did have a touch of pneumonia entering the race, even if he experienced no symptoms, Mosley said, adding, "I'm sure he had it during the race."

There should have been signs, especially after the race, that Heinemann was ill, like coughing and spitting up as he tried to clear his lungs, Mosley said in a telephone interview.

Asked if he believed that Heinemann should have been allowed to enter or complete the 48-hour run, Mosley said, "I would have stopped him."

But Mosley also said this was the first autopsy he had conducted on a person who had run more than 200 miles, noting that pain, discomfort and difficulty with breathing are to be expected in such an event.

"A normal person would say, 'I feel bad; can I sit down?' " Mosley said. "These people are not normal."

Heinemann collapsed once after a race, a 100-miler in August 1996, and suffered dehydration, hypothermia and suspected pneumonia, according to medical records of St. Vincent General Hospital in Leadville, Colo. He ran in numerous races after that.

Across the Years, which consisted of races of 24, 48 and 72 hours, was held at an estate in Litchfield Park, Ariz., west of Phoenix. The course consisted of a 500-meter loop, with an aid station, food and beverages, and a heated tent for those who needed to rest and get out of the cold evening temperatures.

Heinemann experienced good and bad stretches during the race, as did many others, competitors said. Geesler, who won the 48-hour race, said that he had seen Heinemann vomit several times but that he appeared lucid.

Mike Brooks, a retired firefighter who participated in the race, said Heinemann had piled up the miles impressively until the final six or eight hours, when he appeared "completely out of it," zigzagging on the course, hardly acknowledging exhortations, almost incoherent.

"I was walking faster than he could run," Brooks said in a telephone interview, adding that Heinemann "seemed almost like he was sleepwalking."

Yet, these runners also said that Heinemann's condition had not seemed worrisome because his anguish was something they had all seen or experienced before. They expressed shock that Heinemann died 25 hours after the race.

Even though a primary attraction of ultrarunning is to test limits, it is not always so easy to recognize the line between mere suffering and crossing a dangerous threshold, runners and race organizers said.

"There's no tachometer, nothing to indicate when you've crossed the red line," said Stephanie Ehret of Boulder, who finished first among women in the 24-hour race. "I've been ultrarunning for seven years and finally I'm getting a sense where the line might be. All of us want to say: 'This couldn't possibly happen to me. I'd never push myself that far.' I can tell you, you don't know when you've crossed that line."

Before the start of some trail races, runners are weighed and their blood pressure and pulse rate measured. Vital signs are taken again at checkpoints along the course, and runners who lose a certain percentage of body weight can be pulled from the race or halted until they rehydrate.

The Western States Endurance Run through the rugged Sierra Nevada mountains in Northern California has 200 doctors and nurses on hand to monitor runners, said Greg Soderlund, the race director. But such large medical staffs are uncommon.

Medical checks were not mandatory at Across the Years, according to participants. Race results indicated that the available nurse and osteopath, as well as Nagy, the race co-director, and Tizer, Heinemann's coach, all participated in one of the three ultramarathons being run simultaneously.

"If you are participating, you can't possibly be qualified to make an assessment of the physical condition of another runner," said Don Allison, publisher of UltraRunning magazine and race director of a 50-mile run in Coventry, R.I.

But some participants in the Across the Years races disagreed, noting that the runners passed the aid station every few minutes in the loop course. Geesler, the winner of the 48-hour race, said his pulse and hydration level had been checked by medical personnel. Ehret said that Ross, the osteopath, used running to speak with the participants and check on them.

Some people questioned whether Heinemann was truly recovered from the 24-hour race he had run in San Diego on Nov. 8, 2003, to run a 48-hour race less than two months later.

"That's really not enough recovery time," Soderlund said, adding that runners should take a day off for each mile run in a race. "He should have taken three months off."

But some ultrarunners do participate at a greater frequency. Geesler, the winner of the 48-hour Across the Years race, also ran in San Diego.

The lack of structure and regulation are reasons that runners find ultraraces appealing, said Adam Chase, a Boulder lawyer and president of the All American Trail Running Association. But runners are often exercising their own judgments about continuing in races at a time, Chase said, "when their faculties are not there."

Mandatory Checkups Both Mosley, the assistant medical examiner, and Heinemann's mother said medical checkups should be mandatory at ultramarathons. Mosley said of the runners, "I would not expect them to be the best judges of their own health status."

Heinemann, 6 feet 1/2 inch and 139 pounds, had a runner's rail-thin body. He grew up in Manhattan, studied music at Queens College and apprenticed with the New York composer Carman Moore. "He was a wonderful guitarist and mandolinist," Moore said.

Heinemann continued his music career while moving first to Seattle, then to Colorado, becoming affiliated with a group known as "the community" in Boulder. >From this group sprang Divine Madness, the ultrarunning club for which he began running in 1991.

Members who adhere to Tizer's teachings, which are rooted in Eastern philosophies, credit him with an enlightened path to personal development. But some former members have painted a more troubling picture, accusing Tizer of controlling members through fasting, sleep deprivation and isolation from friends and family.

Heinemann was the only one of the group's runners who ran 48-hour races, Hart, the group's spokeswoman, said. "He was not pushed into this," she said.

But Gisella Heinemann contended that Tizer, who is also known as Yo and Yousamian, controlled members. "You couldn't do anything without his permission," she said.

Gisella Heinemann provided a compact disc made from audiocassettes found among her son's belongings. In a conversation said to be with Tizer in December 1996, Mark Heinemann said that he had not been getting enough food to eat on Mondays, the day after the group typically did its longest weekly run. Heinemann suggested a piece of bread at a meal might help with protein.

Having to ask for bread was evidence, Gisella Heinemann said, that "Yo micromanaged everything."

Others familiar with the group said that its dynamics had changed over the years and that Tizer seemed to exert less control now that he spent much of his time at a compound in New Mexico.

Runners not connected with the group who participated in the New Year's races said Heinemann appeared to have a vigilant support team there. "I feel certain if they had known Mark was not up to par, they would have discouraged him from racing," said Ehret, the women's winner of the 24-hour race.

Nagy, the race co-director, wrote in an e-mail message sent to Heinemann's friend Bertoia that he had appeared tired after the race, but not in need of medical attention. "I cannot blame Tizer's group," Nagy wrote. "They gave him better support during the race than any other runner out there had."

After the race ended at 9 a.m. on New Year's Day, Heinemann returned to a local motel, according to a report by the Peoria, Ariz., police. He slept for a few hours in the afternoon, ate two meals and went to bed about 1 a.m., the report said.

Just after 10 a.m. Jan. 2, two members of the running group entered Heinemann's room looking for laundry soap and noticed that he was not moving. He could not be resuscitated.

"We love this sport," Hart said. "However, in the wake of Mark's death maybe it's not always all it should be, and we do think it would be good for those of us connected with the sport to more closely examine what other precautions/measures should be instated, short of discontinuing our sport, to reduce the risks of this ever happening again."