The final text messages sent by a 24-year-old woman during the New York City Marathon have been revealed after she tragically collapsed just two miles from completing the race.
Rachel Apa, a former college athlete from Pennsylvania, was participating in her first marathon on Sunday, November 1, when she suffered a medical emergency in Central Park.
Her father, Steve Apa, had been tracking her progress from his home in Lewisberry, Pennsylvania, using the marathon's official app.
As Rachel approached the final miles of the race, the pair exchanged messages that would later take on a heartbreaking significance.
Her family has since revealed what she wrote and the medical condition they say caused her death.
What were Rachel Apa's final text messages?
According to The New York Times, Rachel began messaging her father after reaching the 18-mile mark of the marathon.
Her first message was just one word:
"Ow."
Despite experiencing discomfort, Rachel continued running and completed another mile.
At approximately mile 19, she sent a second message to her father.
"Ow, ow."
Steve continued following his daughter's progress through the marathon tracking application.
When she reached mile 23, he sent her a short message of encouragement:
"Final stretch."
Tragically, Rachel never replied.
She collapsed near the 24-mile point of the course, just over two miles from the finish line.
The messages have since become a heartbreaking reminder of the final moments her family was able to communicate with her.
What happened to Rachel during the marathon?
Rachel was running through Central Park, near East 85th Street, when she collapsed at approximately 1:30pm local time.
She was subsequently pronounced dead later that Sunday.
Her father had been following the race remotely and noticed that her progress had stopped.
Speaking to The New York Times, Steve described his daughter's death as unfathomable, particularly because she had appeared to be in excellent health before the event.
Rachel was just 24 years old and had a background in competitive athletics.
She had previously competed as a Division I student-athlete at Bucknell University in Pennsylvania.
Her death has devastated her family and prompted an outpouring of sympathy from the running community.
What caused Rachel Apa's death?
According to her father, Rachel died from a condition called rhabdomyolysis, sometimes shortened to rhabdo.
Rhabdomyolysis occurs when skeletal muscle tissue breaks down rapidly, releasing substances from damaged muscle cells into the bloodstream.
These substances include myoglobin, a protein that can cause kidney damage when released in large amounts.
Severe cases can also cause dangerous electrolyte imbalances, abnormal heart rhythms and other life-threatening complications.
Although the family has identified rhabdomyolysis as the cause, the reporting does not establish whether a final medical examiner's determination has been publicly released.
What are the warning signs of rhabdomyolysis?
According to the Cleveland Clinic, the condition can develop following intense physical exertion, muscle injuries, overheating or other medical circumstances.
Potential symptoms include:
Not everyone experiences all these symptoms, and some people may develop serious muscle damage without obvious soreness.
Symptoms can appear within hours of the triggering event or develop over the following days.
Anyone experiencing severe or unusual muscle pain, weakness, swelling or dark urine following strenuous exercise should seek urgent medical assessment.
Why can rhabdomyolysis affect marathon runners?
Endurance events place considerable demands on the body's muscles, especially when someone exercises at an intensity beyond what their body is accustomed to handling.
Although normal exercise causes small amounts of muscle damage as part of the recovery process, unusually severe muscle injury can sometimes trigger rhabdomyolysis.
Marathon runners, people undertaking high-intensity workouts and military personnel involved in demanding training can face an increased risk under certain conditions.
Dehydration, overheating and inadequate recovery may also contribute.
However, rhabdomyolysis remains relatively uncommon, and most people who participate in endurance events do not develop it.
The condition can also occur in people who are otherwise young, active and healthy.
Rachel was running in honour of her late grandfather
Rachel's participation in the New York City Marathon carried a deeply personal meaning.
In September, she announced on LinkedIn that she would be running the race to raise money for the Parkinson's Foundation.
She chose the charity in memory of her grandfather, who died in 2022 following a battle with Parkinson's disease.
Rachel described her grandfather as an important influence on her life, particularly her passion for sport and physical activity.
On her fundraising page, she explained that he had encouraged her to stay active, embrace challenges and push herself to achieve her goals.
Her fundraising campaign had exceeded its original target of $4,000.
For Rachel, completing the marathon was an opportunity to honour someone who had played a significant role in shaping her life.
New York Road Runners pays tribute
New York Road Runners, the organisation responsible for the New York City Marathon, released a statement following Rachel's death.
The organisation said it was deeply saddened by the tragedy and extended its condolences to her family, friends and the wider running community.
Rachel's death has also prompted discussion about the importance of recognising potentially serious medical symptoms during endurance events.
Although marathon running is generally safe for appropriately prepared participants, medical emergencies can occur, and unusual symptoms should never be dismissed simply because someone is young or physically fit.
Can rhabdomyolysis be treated?
Rhabdomyolysis is treatable, particularly when identified early.
Doctors typically diagnose the condition using blood tests to measure creatine kinase, an enzyme released when muscle cells are damaged.
They may also examine kidney function, electrolyte levels and urine samples.
Treatment can involve intravenous fluids, careful monitoring and management of any complications.
In severe cases, patients may require dialysis if significant kidney damage occurs.
Many people recover with appropriate treatment, although severe cases can be fatal.
Family left mourning a promising young athlete
Rachel's death has left her loved ones facing an unimaginable loss.
She had been an accomplished college athlete, was taking on her first marathon and had chosen to use the experience to support a charity close to her heart.
Her final messages to her father offer a painful glimpse into the closing stages of her race.
What began as a day of determination and remembrance ended in tragedy just two miles from the finish line.
As her family mourns, Rachel is being remembered for her athletic achievements, her commitment to helping others and the love she had for her grandfather.
