Moments before she got the news on that fall Seattle day in 2010, Megan Goethals felt trapped. She was confined within the four walls of her psychiatrist's office, within her own body, within her own mind.
Then the crushing blow was dealt.
Goethals -- one of the country's most-decorated high school runners the year before, one of the University of Washington's biggest recruits ever, regardless of sport -- had caused so much damage to her body that her days as a runner were likely over.
Crushed by what her psychiatrist told her, the college freshman burst into tears.
"I kind of already knew it," Goethals said, remembering she feared the worst that day.
Prior to the start of the 2010 season, everyone in the running community already knew Goethals. As a high school senior in Rochester, Mich., she was undefeated and a national champion in cross country, as well as in indoor and outdoor track.
Goethals was the 2009 Gatorade National Cross Country Runner of the Year, and in her final prep meet Goethals ran what was then the second-fastest high school two-mile time ever (10:01.16) to win the New Balance Nationals. What most people didn't know, though, was that dominance had taken a toll.
The success brought pressure, and Goethals started to suffer from depression. She was also struggling with obsessive-compulsive disorder, something she battled as early as the sixth grade.
Skinniness ran in her family. By the time she won the 2009 Foot Locker Cross Country Championships, she had been seeing a nutritionist for two years to ensure she was properly fueled to compete at such a high level. Goethals ate 3,000 calories per day; however, her OCD soon took over her eating habits, and she began weighing herself daily and counting every calorie she consumed.
Heading to Seattle, Goethals pressured herself to immediately be a national contender. Her goal was a top-five finish that fall at the NCAA cross country national championships. So, she upped her mileage from the 60 per week she had been running as a high school senior to nearly 80, and began to incorporate cross-training and weightlifting without letting Washington's coaching staff fully know what she was up to.
What she didn't increase was her caloric intake.
"I just thought that I was kind of smarter than everyone else and that what I had come up with was the plan," Goethals said.
At first, it worked. Goethals led the Huskies during preseason workouts. But by the time the team traveled to the Notre Dame Invitational on Oct. 1, things had taken a turn for the worse. Goethals looked like a skeleton. At 98 pounds, she was down 11 pounds from the 109 she weighed roughly 10 months earlier.
Goethals' legs felt like cement as she warmed up for the race on Notre Dame's golf course, and it wasn't long before things went wrong. She was gassed just 200 meters into the 5,000-meter race, but refused when her coach asked if she needed to come off the course. Instead, she toiled over the relatively flat terrain and finished 165th out of 194 women in 18:59, nearly two minutes above her 5,000-meter time at the Foot Locker meet.
"The bottom needed to fall out and at Notre Dame, it did," said Greg Metcalf, Washington's head cross country and track and field coach. "It allowed us to rebuild the machine."
Following the race, Metcalf shut Goethals down from competition and sought help. At that point she couldn't throw a five-kilogram medicine ball over her head. Walking up stairs was taxing, running a grueling endeavor.
"I couldn't run 100 meters in 30 seconds if my life depended on it," Goethals said. "It would have been so easy just to tell me to go home and use my scholarship money for someone else, but they never gave up on me."
Building a support system
Goethals' psychiatrist was part of a group Metcalf and his assistant coaches assembled to deal with her issues. Dubbed "Team Megan," it also included the cross country team's doctor and trainer, as well as an on-campus nutritionist.
She met with each at least once a week. Occasionally, Goethals was joined at appointments by members of Washington's cross country coaching staff, but it was only when she went alone that she felt capable of opening up about her struggles.
The psychiatrist specialized in eating disorders and OCD issues with athletes. In a quaint, inviting office near the water, Goethals worked through her official diagnosis of OCD. And while the psychiatrist never labeled Goethals as having an eating disorder, the now-21-year-old says her OCD led to EDNOS, or an eating disorder not otherwise specified.
Goethals wasn't starving herself (anorexia nervosa), or bingeing on and purging food (bulimia nervosa). Rather, knowing she had to eat to perform, and not seeing any athletic setbacks, Goethals' OCD had dictated her eating habits since high school. Megan wondered if she would ever recover and compete again, and wondered what she would do with her life going forward.
She bought in to Team Megan, though, and set her sights on returning to competition for the Huskies that school year.
"Might as well try because you don't really have anything else going for ya," she thought to herself.
She would soon realize there were no quick fixes.
Initially, Metcalf and his assistants planned to shut the still-withered Goethals down completely. No racing, training or running. However, they feared that would backfire and prove more harmful to her psyche. So, they agreed to let her attend practices and go on 15- to 25-minute runs four days a week with the team's walk-ons.
Practices began at 8 a.m., and the freshman girls would leave their dormitory around 7:30 to walk down together. All except for Goethals.
Megan is a self-proclaimed homebody, and leaving her family behind in Michigan only made her depression worse. She became reclusive and made a point to leave for practice at a separate time and walk alone.
Some days were better than others, but her short runs often felt so difficult that they could have been marathons. On the days that running did come slightly easier, Goethals would lobby for longer runs.
"We said, 'No,' to her a lot," said assistant coach Lauren Denfeld.
So, not seeing the point of hanging around, Goethals would return to her room while the rest of the team was still training.
"I couldn't really bear to be around and watch them," she said.
Back in the safety of her tiny room, Goethals often killed time until her first class of the day by calling one of her parents. Diane and Kevin Goethals hadn't seen their daughter since she left for Seattle, so they were in the dark about what was going on.
At first, Megan wouldn't call at all to avoid telling them, and when she did start calling she would simply say she was "the slowest girl on the team."
Her parents were used to hearing things like that. In high school, Megan was notorious for overly-dramatic accounts of practices or races in which she finished just short of her goal. She was always a success, though, so her parents thought nothing of it.
"They had no idea how bad it was," Megan said.
Academics were tough, too. Her mind was scattered and she would sometimes let two hours pass doing nothing but staring blankly at a wall. Then she'd trek back to her room, hole up and stare some more, or dial her parents for another conversation until dinnertime.
Athletes at Washington eat in Windermere Dining Hall, a spacious area with floor-to-ceiling windows that look out on Lake Washington. Many Huskies would spend hours at a time eating and hanging out with each other, but not Megan.
"I was so embarrassed that people knew that I wasn't looking to really make friends with them," Megan said, despite the fact her peers tried to treat her normally by not bringing up her issues.
When it was time to eat, Megan would rush in, get her food and finish it as quickly as possible to avoid interacting with others. Dinner usually lasted 15 minutes. Then, back to her room to read or talk to her parents again.
"I really didn't do anything," Megan said. "The days just went by."
Nights didn't provide much more comfort.
When she was first shut down Megan wasn't given medication to help her sleep, and she suffered nightmares. Every night she'd wake, heart racing, her sheets drenched in sweat. Often unable to fall back to sleep, Megan would stare into the night with her mind a blur of unidentifiable thoughts. When was able to concentrate on her thoughts, they revolved around food, and she would randomly fixate on a specific kind.
At those times, Megan wouldn't know what to make of her thoughts. Was she hungry or not? She had unintentionally deprived herself of adequate nourishment for so long that her body wasn't able to understand hunger, essentially leaving her numb to the sensation.
So, she would lie awake and wait for the morning, for breakfast and a structured period of time during which she knew she was supposed to eat.
Washington's on-campus nutritionist put together a plan for Megan that started at 3,600 calories per day, and would eventually increase to around 4,000. The goal was to first get Megan up to 110 pounds and then increase her weight gradually over time, something the cross country team's trainer tracked weekly.
At this point, Megan's OCD was still dictating her life. She continued to count every calorie, and when suggestions were offered she followed them to the letter and didn't deviate. If chicken and rice were suggested for one night, they became the entrée for two months. Despite the routine, she still worried a lot.
"What if they don't have chicken?" Megan would wonder. "What am I going to do?"
Eventually, her psychiatrist started easing Megan into changed eating habits, something that took considerable time and effort from both sides. Each new food required discussion.
Megan recoiled when peanut butter was brought up, saying it simply wasn't something she ate. The psychiatrist mandated that Megan would have to have eaten some by their next meeting, and would describe the experience.
After the appointment, Megan picked up a jar of peanut butter and, too embarrassed to eat it among her peers in Windermere, brought it back to her room. There, her private battle with herself began. She sat staring at the peanut butter, mustering up the courage to put some in her mouth, telling herself it would be OK.
"OK. Three, two, one. Just do it," she told herself before taking a small bite, then realizing nothing bad had happened and she could incorporate the food into her diet.
However, one small breakthrough didn't snowball into an avalanche of success. Megan would go through the same process for all of her eating changes, and it wasn't until December that she was able to vary her diet.
Weight gain was another slow, frustrating process. She shot up to 103 pounds relatively quickly, but it would take two months until Megan had enough reserves built up to erase any more of her caloric deficit and tack on additional pounds.
"I felt like I had no control over my body," she said.
During the holidays Megan returned to Michigan, where she was known as a champion. That made it hard, because the locals wanted to know how their star had fared in her first collegiate season.
Her response? An injury.
"Yeah, I hurt my knee," she would tell them.
During her time off, though, Megan's passion for running began to return and she wanted badly to compete again. Her focus on her recovery became razor sharp. She continued to work on her eating habits and began building up her runs.
After returning to Seattle, Megan went to the first practice of the indoor track season and snuck into a group of runners about to go on an eight-mile run, a distance she hadn't covered in some time. She handled it with relative ease and made short work of the strides drill that followed.
This didn't go unnoticed.
The coaches had a checklist for Megan's recovery that included deciding factors that could green-light her return to competition: her weight and mileage, how she handled 100-meter stride work, her emotional state and whether she could handle specific workouts necessary to race.
"You'd watch her run and the bounce had returned," Metcalf said. "She looked like Megan Goethals."
On Feb. 12, 2011, Goethals made her indoor debut, running unattached at the Flotrack Husky Classic in Washington's Dempsey Indoor Center.
She was nervous leading up to her 3,000-meter race, knowing a competitive race was different than the workouts she had been through to that point. She refused when a coach offered to put her in a slower heat, though, wanting to test herself.
Megan toed the starting and saw Alice Schmidt, a decorated member of the pro running circuit, next to her.
"Oh, my gosh, like, she could be my mom!" Megan thought to herself. "This is so crazy!"
Nerves gave way to excitement, though, and the race was over before she knew it. Megan finished in 9:18:09 (well under her goal of breaking 10 minutes), finishing third in her heat and fourth overall.
Megan's recovery had become a success, and roughly 16 months and five All-America honors later she was in Des Moines, Iowa, for the 5,000-meter run at the 2012 NCAA Outdoor Championships.
It was a hot, windy day, and with many of the runners entered in other events, the first mile of the race seemingly unfolded at a snail's pace. Denfeld was in the stands with a group of parents, many of whom figured Megan was out of the race, but Denfeld knew better.
On the track, Megan heard Metcalf barking out orders to stay patient, knowing that Megan tended to get antsy and shoot to the front of the pack. She held back until a group of runners made their move with about a mile left, and Megan took off with them.
The pace was relentless, and as the finish line got nearer she saw Colorado's Jessica Tebo and Dartmouth's Abbey D'Agostino battling for first place up ahead. Megan thought about settling for third and satisfying her goal of a top-five finish, but with 150 meters remaining she decided to go for it.
"Coming down that straightaway, it honestly just felt surreal because I was chasing down Abbey D'Agostino," Megan said of the four-time national champion.
Goethals caught up to D'Agostino and leaned across the finish line, sure she had won. However, the scoreboard showed her three one-hundredths of a second behind D'Agostino for the national championship. Still, Megan was thrilled. She celebrated with a hug from teammate Katie Flood, who had become a training partner and close friend over their first two years as Huskies.
"It was a great day," Megan said.
During Goethals' first three years on campus, Metcalf's office overlooked Lake Washington and the Cascade Mountains, and on one wall was a 3-foot-by-5-foot white board that laid out a roadmap for Megan's entire collegiate and (potentially) professional running career.
"When you have a very goal-oriented, driven athlete, I think you have got to be able to look at the road, look at the path to where you want to go," Metcalf said of their method.
Numbers and information spread out on the white board, some areas neat and tidy and others a little messier. Each year from 2010 -- Megan's freshman year -- to the 2016 Rio de Janeiro Summer Olympics was listed. Arrows indicated where her performance and weight currently stood, and where she wanted to go. Metcalf would talk and jot down parts of what he'd say, further filling up what open space remained.
"Every time I went in there, the white board would turn out different," Megan said of the meetings that helped build her confidence.
The roadmap focused on the positive, though, and couldn't predict the stress fracture in Megan's right femur that sidelined her during the first half of the 2012 cross country season. What it did predict was a record-setting junior season on the outdoor track.
On March 29 at the Stanford Invitational, Megan ran her first 10,000-meter race and broke Regina Joyce's 30-year school record by more than 20 seconds with a time of 32:52.78. Even more impressive was that Megan missed most of her training runs the previous week due to illness as well as back and digestive issues. She followed that up by snatching another record away from Joyce at the next meet, this time Joyce's 31-year-old mark in the 5,000-meter run.
"She is the toughest athlete I think I've ever known," Denfeld said. "She just can always find another level, another gear."
In three years Megan had gone from the brink of disaster to a three-time individual conference champion and eight-time All-American. However, things were about to go on hold once again.
Another crushing blow
Last June, Megan was back in Des Moines for the 10,000-meter run at the 2013 USA Outdoor Track and Field Championships. Her mother, Diane, and her younger sisters Jennifer and Jessica had come from Rochester to watch.
Something wasn't right with her mother, but Megan didn't know exactly what until the day before the race: Diane, 46, had breast cancer, and the severity was unknown.
The Goethals family left Iowa for Michigan shortly after the race, and two days later Diane was taken to the emergency room with stomach pain and advised to stay overnight.
"I thought she'd come home the next day," Megan said. "She was there for six weeks."
Diane's cancer was found to be advanced, having spread to her stomach and basically carved a hole in it. Multiple surgeries followed, and chemotherapy only made her weaker. Due to her low white blood cell count Diane was kept in protective isolation, with only two visitors in hospital scrubs allowed at a time.
There came a brief period during the summer when Megan wasn't allowed to visit at all, and when she did return the family was no longer required to wear scrubs. When they entered Diane's room they saw her stripped of all but the most essential IVs.
"I knew automatically what was happening," Megan said.
It was now mid-July and Megan's mother was given two weeks to live. "There's nothing worse than hearing your mom say that," Megan said.
Diane didn't die, though. In what could be described as a miracle, Diane woke up one morning a week later and her vital signs started improving. Her test results improved. She moved out of protective isolation, began to regain her strength and soon was able to stand and eat. The cancer hadn't gone away, but the family was told in August that Diane might soon be able to leave the hospital and return home.
"We didn't think she'd ever come home again," Megan said.
Megan became her mother's nurse when Diane returned home in mid-August, assisting with pills and draining special tubes. When she wasn't helping her mother, Megan found sanctuary in her running. It was the only time that nobody brought up what was going on at home.
In Seattle, Metcalf and his staff devised a plan for Megan to stay with her mother in Michigan during the fall and fly to meets on weekends. Megan didn't wait for an invitation to come to campus for the preseason, though.
She knew it was important for the team that she was present, so she emailed Denfeld to say she would be on campus when the team returned from training camp on the coast. When three vans full of Huskies rolled into the parking lot at Conibear Shellhouse around 2 p.m. on a Monday, there was Megan. Her teammates poured out of the vehicles to give to her a teary hug.
"She'd just gone through so much that summer and to see her and be able to give her a hug, it was -- it made me feel really good to kind of look her in the eye and actually see how she was doing," said Denfeld, her voice wavering with emotion.
An hour after the reunion, Megan and the team were in the weight room. It was back to business as usual, or as close to it as they could get given the circumstances. Megan trained throughout the week, but was forced to stop that Friday when another stress fracture surfaced in her right femur.
Metcalf wanted her to stay a little longer, but facing the prospect of missing much of the cross country season she decided to return to Michigan to be with her family. Metcalf understood, and Megan's teammates showed up at her house to say goodbye.
Right now in Rochester, Diane is battling Stage 4 cancer that has spread throughout her body. There isn't a timetable for how long she has left to live.
The family tries to live life as normally as possible. With Megan's father working, two of her siblings in college and a third in high school, Megan takes care of many of the family's domestic needs and drives Diane on various outings.
"I'm very thankful that I have this time, just her and I," Megan said. "It's really special because we didn't think we'd have it."
Megan is also rehabbing her stress fracture and juggling online courses in order to keep up with her school work. She misses competition and is eyeing a return in time for next month's NCAA national cross country championships. Her coaches, though, have told her to take as much time away as she wants, even if it that means not putting her uniform on again until next school year.
Said Metcalf: "Running, right now, it's not that important."