Ultrarunner Megan Roche is in her fourth year of medical school -- while claiming national titles in her sport

Megan Roche is a four-time national champion in ultrarunning and has been a member of the U.S. world ultrarunning team six times. Courtesy of Megan Roche

At 5 in the morning in Arizona's Sonoran Desert, hundreds of costume-clad, endurance-oriented ultramarathoners begin lining up at the start of the Hoka One One Javelina Jundred 100-mile race. In a culture of extremes, the ultramarathon start includes a diverse group of elite athletes, weekend warriors and tattooed renegades eager to venture into the dry heat for the next 13 to 30 hours. In addition to their ambitions, these runners have brought along entire support crews to help them maintain fuel and hydration, pace through the night and face the mental demons that appear after 24 straight hours on the trail.

It's an unlikely scene that takes place several times a year at the biggest ultramarathon races. With runners, volunteers and crew accounted for, there are all types, shapes and sizes of human represented. At this race, though, there is one notable omission from the start line: Megan Roche, the 2016 USATF ultrarunner and sub-ultrarunner of the year, four-time national ultrarunning champion, North American Mountain Running Champion and six-time member of the U.S. world ultrarunning team.

"I wanted to be there so badly!" Roche said in a phone interview. "I had to take my boards for medical school the next day. I tried to make it work, but getting on a plane at midnight and taking boards hours later just wasn't going to fly." Although she couldn't attend the race, many of the athletes enrolled in her coaching program -- Some Work All Play (SWAP) -- did. Through their social media posts, mutual cheers and camaraderie, her presence did not go unnoticed.

Roche is a fourth-year Stanford medical student, soon-to-be-doctor, professional coach to an entire community of runners and one of the best ultra distance runners in the country. Like her sport, she lives her life in extremes.

Born and raised in Philadelphia, Roche's first love was field hockey. She pursued an NCAA career at Duke University, where she took a fifth year to race on the cross-country and track teams.

"My junior year of college, I entered in a couple of running races in the offseason and realized how much I enjoyed running," Roche said of the discovery that would change her career. "After track, I thought I'd just focus on medical school, because I felt so burnt out from running in circles. Then I spent the summer in Colorado and found that I could cover ground on beautiful trails. That's when I realized that I could get into ultrarunning and take my love for exploring beautiful places and channel that into a competitive mindset."

And so she did. Roche began training and racing at ultra distances, while attending medical school and building a coaching business alongside her husband and fellow professional runner, David Roche. In order to do so, she learned to prioritize school, training and recovery through intense planning and a knack for creativity.

"There are times that I will be on the treadmill as early as 2:30 in the morning to make it to the hospital floor for rounds at 5," she said, explaining her daily routine. She plans her nutrition far ahead of time, always having snacks on hand, and makes sure that above all, she knows the limits of her body and mind.

"Recovery is ultimately more important than training," she explained. "Sometimes, I have to adjust my expectations. If I wake up exhausted, I will scrap my workout and go for easy miles instead. Being able to listen to your body and understand that stress affects your workout is important."

In the face of these work-life complications, Roche pulls from the simplicity of her sport to find perspective as she chooses on which goals and priorities to focus.

"The beautiful thing about ultrarunning is that it's simple," she said. "All you need is a pair of running shoes."

To Roche, finding simplicity in the swirl of pressures and to-do lists means finding joy in fresh air, long runs and time spent on the trail. In so many ways, it's easy to think that she is a woman who has it all: career, athleticism, brains, love. Yet, she feels that her ability to function at a high level comes from simplifying her life into a few key priorities.

"My general life philosophy is that you can do three things really well in life, and it's up to you to choose those three things and find joy in them," she explained. "For me, I'm a medical student, a runner and I have a family. There are so many female athletes trying to do it all, which is amazing, but I think that there's a danger in spreading yourself too thin."

Her on-the-ground eyes and the understanding of the pressures of life and sport combine to make her an optimal running and life consultant to her SWAP athletes. She brings with her an understanding of strength training from field hockey, physiology from studying medicine and psychology from her own athletic pursuits. This combination allows her the perspective to see beyond results to the human who steps to the line, which is why, above all, she prioritizes finding fun in running.

She and her husband are currently working on their first book, "The Happy Runner Project," which investigates how athletes and coaches can discover joy in the process of training. She includes her dog, Addie, as co-author and co-coach, to help bring home their motto: "Live like a puppy, run like a rock star."

As for what's next, she will take a year after graduation to finish her book, continue to compete and coach her growing SWAP community. Applying for a residency as a physician still lies on the horizon, but at least for now, she's going to see what it's like to run in daylight.

"I'm finding so much simple joy in what I do that I don't feel the need to do much else," she said.