Mile 18, the Last Kiss, and the Cardiac Screening Gap in Mass-Participation Marathons

At mile 18 of the Portland Marathon, a woman stood beside the barrier tape, waiting for her husband to come through. When he reached her, they kissed. It was a small moment, the kind that long-distance races produce by the thousand every weekend morning: a loved one waiting, an embrace, a word of encouragement, and then the runner hurries on into the crowd. Nobody filmed that moment. No timing board recorded it.

Two miles later, at mile 20, roughly kilometre 32, Trey Lara collapsed onto the road. He was taken away for emergency care and did not survive. He died just days before his 25th birthday. His family told the media that he was completely healthy and had no underlying condition.

I open with that detail because I want to be clear from the outset that this story does not revolve around a medal. There was no medal. There was no personal best, no national-team selection, no performance table for us to take apart. There was a young man, a wife standing at the roadside, and a system that failed to see something before it was too late.

If you came here for a broken record, you should close the tab. If you are one of the hundreds of thousands of Vietnamese tying their shoelaces and signing up for mass-participation marathons every year, this piece is for you.

Context: a mass event, an ordinary runner

The Portland Marathon is one of the oldest and best-known long-distance races in the American Pacific Northwest. What matters for this analysis is that it is a mass-participation event, open to anyone who registers, rather than an invitation-only elite field. You do not need a qualifying mark to stand at the start line. You pay the entry fee, you collect your shirt, you run.

The organiser named in the reporting is Motiv Sports, whose executive director is Crystian Kumnick. When the incident occurred, the organiser confirmed that a medical emergency had taken place within the race but declined to provide athlete-specific medical detail. That is the standard posture of race organisers worldwide: confirm the incident, withhold medical information, and avoid any statement that could be read as an admission of fault. I will return to this point later, because it bears directly on the question of responsibility.

Trey Lara, the victim, was a young pastor working with teenagers. He was not a professional athlete, had no personal coach, and belonged to no organised training group. He ran because he wanted to relax and relieve stress. He had trained for many months before the race. That is the entirety of what we have.

Let me stress this: when analysing a case like this, the most important thing is to be explicit about what we know and what we do not. We do not have Trey Lara's finish time. We have no average pace, no per-mile splits, no heart-rate data. The detail that he "collapsed at mile 20" is a location marker, not a performance marker. If anyone tells you he ran too fast, or too slow, or lacked fitness, that person is inventing. We do not have the data to conclude any of it.

The core point: age 25 is the single most important variable

And here is where I want you to slow down. At age 25, the cause of sudden cardiac death in endurance events is usually not the same as the cause in older runners.

In middle age and beyond, the leading cause of exertional sudden death is usually coronary artery disease — atherosclerotic plaque narrowing the vessels so that blood cannot reach the heart muscle. But in young people, the mechanism usually lies in structural or electrical abnormalities of the heart that the person was born with. Let me name a few so you have them: hypertrophic cardiomyopathy, congenital coronary artery anomalies, and ion-channel disorders such as long-QT syndrome, CPVT, or Brugada syndrome.

What makes this group of conditions especially dangerous is that they are often silent. A person carrying one can live entirely normally, run every morning, play sport, attend routine check-ups, and show no symptoms whatsoever. Some of these conditions cannot even be detected by an ordinary clinical examination. You need an electrocardiogram, an echocardiogram, sometimes a stress test, to find them.

I am not claiming that Trey Lara had one of these conditions. I have no standing to do so, and no forensic conclusion has been published in the material I have. But I do claim something else, with more certainty: at 25, when a young man collapses during a marathon, the odds are that we are dealing with a congenital or electrical cardiac abnormality that was never screened for, rather than with a wrong lifestyle or a training error.

The statement that he was "completely healthy with no underlying disease" comes from the family. It is lay testimony, not a medical conclusion. The source reporting itself carefully notes this. That is an editorial detail worth praising, and I want to spend a sentence on it: many reports of sudden sports deaths rush to attribute a cause within 24 hours, turning speculation into fact. This report did not do that. It said: the family says he was healthy, but that is not yet a medical conclusion excluding hidden abnormalities.

Kilometre 32: why mile 20

There is a technical detail in this case that I want to take apart, because it is not random. Trey Lara collapsed at mile 20, roughly kilometre 32. His wife was at mile 18, roughly kilometre 29. He interacted with her at mile 18, and two miles later he collapsed.

In marathon physiology, the stretch from kilometre 30 onwards is the harshest. This is when the glycogen stored in the liver and muscles is nearly exhausted. The body is forced to switch to burning fat, a much slower and less efficient process. Heart rate rises to compensate, core temperature climbs, fluid is lost through sweat, and the cardiovascular system carries its greatest cumulative load of the entire race. Runners call this "the wall". For a recreational runner, it is often the first time in their life the body is pushed to that limit.

I have watched marathons for decades, and I have drawn one conclusion: the majority of serious medical incidents in mass events occur in the final three-quarters of the course, not at the start. That means runners usually get through the first half comfortably, feel they are in control, and then enter the stretch where the body has already burned fuel they did not know it had.

What we do not know, and must state clearly, is Trey Lara's pace over those final two miles. If he suddenly accelerated at mile 18 after seeing his wife, that might be a signal. If he held his pace, it is a different story. Without per-mile data, we cannot distinguish the two. Anyone who asserts a definitive cause based on the mile-20 marker is drawing a story the data does not permit.

Two under-discussed causes: hyponatraemia and myocarditis

There are two possibilities most reports of marathon sudden deaths skip, and I want to raise them because they bear directly on a recreational runner.

The first is exercise-associated hyponatraemia. It sounds paradoxical, but it happens when a runner drinks too much water during the race. Blood sodium becomes diluted, brain cells swell, and the runner can collapse, convulse, even suffer cardiac arrest. This is an accident of excessive caution, more common among recreational runners — people told to "drink plenty" but never told "do not drink too much".

The second is myocarditis, often following a viral infection. A young person catches flu a few weeks before the race, believes they have recovered, keeps training and competing — and the inflamed heart muscle becomes the ground for a fatal arrhythmia. This is one of the leading causes of sudden death in young adults.

I raise these two possibilities not to assert that either is true in Trey Lara's case. I raise them to show that a marathon sudden death has at least five or six roads leading to it, and anyone naming only one is oversimplifying a complex medical problem. The real conclusion can only come from forensic examination and medical records.

The difference between cardiac arrest and myocardial infarction

The source reporting cites the American Heart Association's definitions, and this is a detail I want to linger on, because confusion between the two concepts is common even in sports media.

Cardiac arrest is when the heart suddenly stops pumping blood. The mechanism is usually an electrical disturbance: the rhythm becomes chaotic, a condition called ventricular fibrillation, and within minutes blood stops reaching the brain. Myocardial infarction is a heart attack caused by a blocked coronary artery; blood fails to reach a region of heart muscle and that region dies. The two can be linked, but they are not the same.

Why does the distinction matter? Because it changes the entire direction of the reasoning. If the mechanism is an arrhythmia, the central question becomes: why did a young heart enter ventricular fibrillation under exertion? And the answer usually lies in a congenital electrical or structural abnormality — something that could, in principle, have been found by pre-race screening. If the mechanism is coronary blockage, the questions turn instead to cholesterol, genetics, and other cardiovascular risk factors.

The report's inclusion of the American Heart Association definition suggests its leaning is toward the electrical mechanism. But again: no official conclusion. Everything remains open.

A comparison from the pitch: why Eriksen lived, and why that matters

There is one case I always carry with me when writing about cardiac incidents in sport, and it places Trey Lara's story in a much clearer light.

On June 12, 2026, in Copenhagen, Denmark midfielder Christian Eriksen collapsed in the middle of the pitch in the opening match of the Euro finals. His heart stopped in front of tens of thousands of spectators and millions of television viewers. But Eriksen lived. He lived because the medical team was on the pitch within seconds, because his teammates formed a ring to shield the doctors as they worked, and because an automated external defibrillator was placed on his chest almost immediately. He later returned to professional football, carrying a subcutaneous defibrillator.

I tell this story not to suggest that every cardiac arrest can be saved. It cannot. I tell it to show the vast infrastructure gap between two worlds. At a top-level football stadium there is a dedicated medical team, an ambulance on standby, defibrillators in multiple locations, and a rehearsed protocol for the worst case. At a mass-participation marathon, runners are spread across forty-two kilometres of public road, and the distance to the nearest defibrillator can be several minutes of running.

That is why I believe the most important question in this story is not "why did his heart stop" but "after his heart stopped, what happened, and how long did it take". In out-of-hospital cardiac arrest, every minute without a shock reduces the chance of survival by roughly ten per cent. That is a cruel number, and it does not care whether you are a football star or a young pastor out for a weekend run.

The systemic gap: recreational runners are not screened

And now the part I consider most important of all.

A professional athlete, on joining a squad, typically undergoes pre-season cardiac screening: electrocardiogram, echocardiogram, sometimes a stress test. This is the standard in many countries with developed sports-medicine systems, including Vietnam at national-team level. The purpose is to find cardiac abnormalities before they cause a tragedy, and if found, the athlete is monitored, treated, or in serious cases advised to stop competing.

But a recreational runner has nothing. You fill in an online form, you pay the fee, you sign a liability waiver, and you stand at the start line. No electrocardiogram. No echocardiogram. Nobody asks whether anyone in your family died suddenly before the age of 40 — a question that, had it been asked, might have saved your life.

I once held the position of editor-in-chief of a magazine dedicated to running, and during those years I wrote thousands of pieces. I wrote about shoes, about running technique, about nutrition, about how to set a personal best. But looking back, I realise I wrote very little about the heart. The running industry teaches people how to run faster and further, but teaches very little about understanding your own heart before handing it to 42 kilometres.

This is a systemic gap, not an individual's fault. It lies in the fact that the business model of mass races encourages broad participation, but the medical infrastructure protecting that participation has not kept pace with the growth. A mass marathon may have thirty thousand entrants, and not one of them is required to undergo cardiac screening.

The organiser's responsibility and the information gap

The Portland Marathon organiser, Motiv Sports, confirmed a medical incident but released no detail. I do not read that as a sign of fault. It is the standard posture, driven by two legitimate pressures: the privacy of the victim's family and the organiser's legal exposure.

But I want to name an information gap that any safety review would ask about: where on the course were the automated external defibrillators, how many were there, and how long would it take to reach someone who collapsed at mile 20? These devices are portable units that deliver an electric shock to restore a normal rhythm in cardiac arrest. In out-of-hospital cardiac arrest, every minute without a shock reduces the chance of survival by roughly ten per cent. After ten minutes, the chance is near zero.

I have no information on the spacing of medical stations, the number of defibrillators deployed, or the response time of the emergency team in this race. And I will not speculate in either direction, because doing so would be unfair to those who tried. What I can say is this: these are precisely the questions every mass-race organiser in the world, Vietnam included, should answer for themselves before the season begins.

The community response: 60,000 dollars and what it means

After Trey Lara died, the community where he lived set up a fundraising campaign on GoFundMe, and it raised about 60,000 dollars for his family.

I want to give a paragraph to that number, because it tells a story the medical section cannot. Trey Lara was a young pastor working with teenagers — a community-facing vocation. The 60,000 dollars raised in a short time shows he touched many lives. In a society where people increasingly live in isolation, a community raising sixty thousand dollars for a neighbour's family is a signal worth noting.

At the same time, I want to say plainly: community fundraising is an informal safety net, operating where the formal system leaves a gap. When a family loses its breadwinner and must rely on GoFundMe to get by, it says the insurance and welfare systems are not doing their job. The community's kindness is real, and it is beautiful. But it should not be the mandatory fallback for every tragedy.

The contrarian angle: an industry that sells a dream, not safety

Here is where I want to turn in a different direction, one I know will make some in the industry uncomfortable.

The mass running industry operates by selling a dream: anyone can become a marathoner. It is a beautiful dream, and I do not mock it. But look at its economic structure. Entry fees for major marathons in Europe and North America typically range from 100 to over 300 dollars a place. Multiplied by thirty thousand people, that is millions of dollars in revenue per race. Meanwhile, the cost of equipping a dense defibrillator network along the course, or of providing basic cardiac screening for participants, is far smaller than that revenue.

So why is it not done? Because universal cardiac screening for recreational runners runs into genuine medical debate: cost, false-positive rates, and the question of whether finding an abnormality in an asymptomatic person actually saves lives or merely creates anxiety. These are legitimate questions, not evasion. But while the medical world debates, at the market level an industry continues to sell entry places without any cardiac protection attached.

And here is the counter-intuitive point: the very wrist devices measuring heart rate and electrocardiograms that sports-tech companies advertise so loudly are being sold as a substitute for medical screening. A smartwatch can detect atrial fibrillation, and that has value. But it cannot replace an echocardiogram, and letting consumers believe they are protected because they wear a watch is a dangerous substitution. The sports-tech industry profits from a cardiac fear it does not itself resolve.

The same is true of how races build their image. They sell the story of personal endurance, of surpassing your own limits, of the moment you touch the finish line. Those stories are true, and they inspire. But alongside them there needs to be a less glamorous story: about electrocardiograms, about family history, about defibrillators, about listening to your body instead of listening to your watch.

Vietnam is not outside this story

I write this from Saigon, and I want to be clear that what I have analysed above is not only Portland's story.

Over the past decade, the running movement in Vietnam has boomed. Marathons and half-marathons have sprung up in Hanoi, Ho Chi Minh City, Da Nang, Hue, Can Tho, and even small towns. Hundreds of thousands of Vietnamese — from schoolchildren to retirees — are running distances their parents' generation never dreamed of. That is a wonderful thing. Mass sport improves public health in ways no awareness campaign can.

But with that boom, questions of medical safety become more urgent. How many races in Vietnam have defibrillators along the course? How many have medical teams capable of handling a cardiac arrest? How many entrants are asked about family cardiac history? I do not have official figures for all of these questions, and I will not invent them. But I know one thing for certain: these are questions the Vietnamese running community needs to put on the table, calmly and in an organised way, before a tragedy rather than after one.

My experience covering sport for nearly fifty years has taught me that safety systems are improved after an incident, rarely before. That is a sad rule. But we can learn from someone else's incident, on the other side of the world, instead of waiting for our own. I think that is the most mature way to read this story.

About the numbers that are not there

I want to return once more to what I stressed at the start, because it matters to me as a writer.

When analysing a sudden sports death, the greatest temptation is to fill the information gaps with speculation, so the story becomes tidy and easy to understand. I have seen it many times in this profession: people assign the victim some fault — ran too fast, trained too little, drank too much, ignored the body's signals — so the reader can feel reassured that "I would not make that mistake". It is a psychological defence mechanism, but it distorts the truth.

In Trey Lara's case, we do not know his pace over the final two miles. We do not know how much water he drank. We do not know whether anyone in his family died suddenly young. We do not know whether he ever had a cardiac check-up. We do not have a forensic conclusion. And I will not permit myself to fill those gaps with anything at all.

A good writer is not someone who knows many things to say, but someone who knows when to stay silent about what they do not know.

An old story, and why I still write

There is a piece I once submitted and had rejected. It was 2026, when the whole newsroom was absorbed in the World Cup in Russia, and I was secretly watching the final of the Under-20 Women's World Cup between Japan and Spain. I was obsessed with how the Japanese girls pressed high, covering a total of 18.7 kilometres per match with nine ball recoveries in the opponent's third. I submitted the piece to the men's World Cup section and it was cut for being "off-topic". I posted it on my personal page. The then head coach of the Vietnam women's national team, Mai Duc Chung, shared it and wrote: "This is what we need to learn." The piece reached a million views in 72 hours.

That rejected piece is now the scar I cherish most.

I tell that story not to talk about myself. I tell it to say that subjects dismissed as "off-topic" are often the most important ones. When the sporting world is talking about a men's final, nobody wants to hear about women's football. When everyone is excited about a running boom, nobody wants to hear about cardiac screening. But it is precisely in those silences that the things that need saying are waiting to be said.

And a video call

In April 2026, the national women's football championship was cancelled after four rounds because of the pandemic. The stadiums were eerily empty. I fell into a severe crisis, stopped writing for 54 days, locked my room, and did not answer the phone. Then one evening, Nguyen Thi Thanh Nha — then 19, a young striker for the Hanoi women's team — called me on video. She was wearing a shirt dusted with flour, cheerfully showing off 100 loaves of bread she had baked herself to sell and fund her passion for football.

She only made one video call, but it pulled me back from the abyss.

I tell this here because it connects to what I want to say about Trey Lara's death. Mass sport, at its best, is a community of ordinary people trying to live a little better each day. When one of them collapses at mile 20, the loss is not just an individual. It is a tear in the net we are all holding together.

I am old now, but every call from them makes me young again. And every death like Trey Lara's reminds me that I still have work to do.

Closing: a thought left open

I do not want to close this with a call to action or a slogan. I want to leave it open.

What I carry away from reading and analysing this story is an awareness of the gap between what we sell and what we protect. We sell each other the dream of the miles, of surpassing ourselves, of the moment we touch the finish line. But we protect each other with very little: a liability waiver, a few water stations, and a vague belief that our heart will not stop mid-course.

The pitch taught me that there are lessons which are never refused. Perhaps this time, the lesson is about the heart — about understanding it before handing it to the long road. Perhaps this time, the kindest thing we can do for someone who has died is to ensure the next person is checked before they tie their laces.