Last weekend was one of the worst in Michael Poole's sporting life. The 23-year-old New Zealander was riding at 50km/h in Chicago's Life Time Tri Series triathlon in pursuit of US$8500 ($10,170) when he blacked out.
Boom! He hit a barrier as a grand mal epileptic seizure overtook his body and his will. He woke in an ambulance after suffering a 15-20 minute loss of consciousness, which messed with his system to a point where it took hours longer for his body to return to normality.
The sum of the accident was largely cosmetic -- a few cuts, grazes, bumps and bruises.
Yet, deeper down, Poole suffered lasting damage to his confidence built since first encountering epilepsy five years ago.
On his own in the United States, Poole was out of contact for over four hours from loved ones back home and organisers didn't call his emergency numbers.
After some checks, he was let out of hospital but had no clothes so was given hospital pants and an old shirt. New to Chicago, he received bus money and directions back to race headquarters.
He had to convince an official of his identity before collecting his race possessions and riding a damaged bike back to his hotel. Now he's contemplating his future.
Poole is a high achiever. Rather than contest a place on the Triathlon New Zealand elite programme, he opted to study chemical engineering at the University of South Florida in Tampa. Epilepsy has also provided an outlet to give back to the community through charities such as the Epilepsy Foundation, fundraising through the Tear Fund and attending summer camps for affected children.
He has ambitions to compete for New Zealand on the world circuit but, as a strong cyclist, that would involve sacrificing the American circuit which doesn't allow drafting over the Olympic distance to the peloton-filled World Triathlon Series where races are largely decided on the run.
The recent accident has given him perspective and further justified his decision to combine sport, study and community work.
"I felt bad on the bike, like my head was not there, but sometimes that happens when you exert yourself racing," Poole says. "I hoped it would pass. It could've been worse. If it had happened on the swim, I could've been dead.
"I don't know what the future holds. [Chicago] was an important race to me in terms of prizemoney and prestige. I was ranked third in the series before the race, now I'm sixth. It's ruined my chances for the series.
"I have an appointment with a neurologist to figure out what's going on but, until it's observed how my body goes over the next few weeks, I can't think about the future."
Poole started taking medication after first suffering seizures at age 18. He had been a promising schoolboy athlete at Auckland Grammar, winning the New Zealand Secondary Schools title in 2009.
He tried not to let epilepsy get in the way, hoping to make it to the top of the sport.
The effects had been relatively minor until last weekend. There had been the occasional faint but he didn't revisit a neurologist. He assumed the medication was largely working because incidents became less frequent. The latest episode came out of nowhere but Poole's wisdom in building study around his sport is a worthy lesson for any elite level athlete.
"It gets tough and there's not much of a social life compared to the normal college student but it's definitely worth it," he says.
"I had a couple of years out of school just doing triathlon and got bored. I am a good academic and felt my brain was going to rot. I wanted to start using it again.
"I perhaps haven't done triathlon as professionally as I would like, but last weekend proved your career can be over in a split second.
"Luckily I'm two-thirds of the way through a chemical engineering degree, so, if it's all over, it's not as big of a deal as if I had nothing to fall back on.
"It's quite a cultural thing to be a student athlete in the US whereas in New Zealand I found the trend tended to be that you were one or the other."
He took inspiration from visiting Sir Peter Snell in Dallas. Snell pursued his education in the US from 1971 in the field of physiology and has lived there since.
"It's hard to know what to expect from someone like that but he was interested and shared a lot of wisdom," Poole says.
"It was special to be out there racing and having him cheer you on. I had one of the best races of my life. I think he appreciated I was doing something similar to him."
Poole has also had the surreal experience of fronting a Florida press conference with Lance Armstrong before his doping confession. Poole still struggles to put the occasion into perspective.
"It's hard to look back because he was a role model for me. I talked to him briefly and raced with him. I still have some respect because he was a phenomenal athlete but [the aftermath has created] such a complicated situation. I don't know what to think."
Anyone witnessing a grand mal epileptic seizure for the first time will realise they can shock bystanders.
Part of Poole's vision is to open up on the topic so people understand the circumstances with which they are confronted.
"It depends on the environment. There's a social stigma surrounding epilepsy because it's perceived as a bad thing. People are embarrassed and shy about it.
"There's no need to be that way because it's a common condition and you'd be surprised to know how many people have it but keep it hidden. I am trying to inspire others to come forward so it's less secret.
"Seizure is quite a broad term. It can be anything from blanking out for five seconds or appearing drunk but the grand mal is when people typically fall on the ground shaking.
"I'm only 23 so hopefully I've got plenty of years left. I want to focus on the Olympics at some stage but, if I move to the drafting races on the world [ITU] circuit, I'd need to change my style. It's unlikely to be for at least two years."
Epilepsy doesn't have to end careers
Veteran sports doctor John Mayhew says epilepsy doesn't have to interfere with a sporting career and has worked with two high-profile All Blacks.
Mayhew, who was All Blacks doctor before teaming up with the Warriors, says it needs to be managed the same way in sportspeople as non-sportspeople.
"A number of medications don't interfere with sports performance," he said. "I've monitored sportspeople with epilepsy who have managed the problem at international level, including two high-profile All Blacks. Generally it can be managed medically to allow the person to have a normal life.
"Seizures can be brought on by many things, such as brain infection, brain trauma and brain tumours or they can be idiopathic where the cause is unknown. If someone has a skull fracture, there's a higher chance of seizures.
"I would not recommend some sports activities such as scuba-diving and urge caution with other water sports.
"The most common reason for seizures is because patients forget to take their medication. For instance, on an All Blacks tour to France, a cameraman was filming an interview and suddenly had this tremendous convulsion. As it turned out, he was an epileptic but had never told anyone and forgot to take his medication before jetlag hit. Seizures can be brought on by all sorts of things such as strobe lights, tiredness or dehydration."
Dr Mark Fulcher worked as medical director at triathlon's world series grand final in 2012 and has worked with the All Whites, Silver Ferns and the Olympic team at Beijing and London. He says epileptics are encouraged to participate in sport.
"Historically, it created social issues and withdrawal from society. Doctors have since found exercise improved patient's chances with seizure control, including contact sport. The only issue with someone in triathlon is if they have a seizure in the water.
"They need to be confident they've got that aspect under control, or at least have an action plan where they either swim close to shore, make a lifeguard aware at the pool and have officials on watch during races. There could also be consequences in a bike group.
"They need to mitigate the risk. Fatigue can make seizures more likely, so then it comes down to getting suitable rest and decent nutrition."