Lauren Puretz doesn't do things halfway. As an OB-GYN surgeon in Colorado Springs, she fixes problems. As a 100-mile ultra runner competing at UTMB and Hail, she works through them. Self-described as "fired up," she brings intensity to every role: physician, mom, runner, wife, person.

The parallel between surgery and ultra running is clear to her. Dissecting tissue during difficult endometriosis? One move at a time. Running 100 miles? One mile at a time. Both require troubleshooting when things go sideways.

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Running didn't enter Lauren's life until senior year of high school. She'd been a gymnast and soccer player, even joining the tennis team on a whim. After making varsity soccer junior year but sitting the bench the entire season, she decided to run cross country to get in shape.

"I was like, wow, this is way better than soccer. No elbows to my face at all," she laughs, acknowledging the irony before getting into trail running.

What captured her wasn't just the running itself but the team. The pasta parties, the bonding, the community that included you in all aspects of their lives. This happened during a rough period; she'd just been hospitalized for an eating disorder. The cross country team welcomed her completely, and she loved it.

She performed well enough to get offers to run collegiately but chose a D3 school, prioritizing education over athletics. After college came med school, then residency, and running took a backseat until after having her second kid in 2015.

Post-second-kid, Lauren decided to train for Marine Corps Marathon. It went okay, and she wondered how to get faster. A friend's advice was revolutionary: "You should try speed work."

That basic. She added speed work, forced herself to do weight training (not her thing), and started running with people. Training partners naturally push each other faster, creating accountability and motivation impossible to replicate solo.

Living in Colorado Springs, most running was trail. She dabbled recreationally, then decided to tackle her first 50K. While training, she ran the Four Pass Loop in Aspen. A friend suggested she might be good at longer distances. Her whole life — med school, residency before work hour restrictions existed — had been one big suffer fest testing how much she could endure.

Her curiosity shifted toward longer distances. First 50K in 2017 or 2018, stepping up slowly through the distances, nervous about going longer. She didn't attempt her first 100 until Hail four years ago.

The honest answer about balancing a demanding career, training, and family? "It's not pretty."

The biggest change came from dropping obstetrics, the care and delivery of pregnant women. That's where the brutal schedule lives: nights, weekends, holidays, 24-hour shifts, 72-hour calls covering large patient groups for multiple doctors.

Now she does GYN only: office visits, surgeries, on-call only for her own patients. Dropping OB transformed everything. Before, she felt she was doing all roles poorly: not training well, not sleeping well, not being the best mom or partner or physician.

The regular schedule and sleep pattern allowed her and her partner to figure out balance. As he puts it, she gets to "frolic in the mountains for as long as I want." The tradeoff works because she's not trying to do everything anymore. She's allowing certain areas to drop temporarily before picking them back up.

You can't balance it all. It's deciding what area you'll allow to drop for a bit.

There's jealousy sometimes, watching athletes who train full-time while she's shoving workouts into nooks and crannies of time, showering at work, slapping on makeup between seeing patients. But maybe that's her edge.

When races go sideways (which they always do) she's like "yep, just another day for me, balancing chaos." While others might crumble when perfection doesn't materialize, her life never looks like that. She's built to adapt and keep going.

Her former coach once texted during a rough training run: "At least you're not delivering babies." That perspective helps. Everything is manageable. It's just running. This is what she does to not be working. This is fun. Keep it fun, keep it real, keep going.

Surgery and ultras share problem-solving DNA. Difficult endometriosis case? One move, recognize the plane, proceed carefully. Hundred miles? One mile at a time. Both require confidence that if problems arise, you can handle them.

Lauren's high school eating disorder wasn't image-based. It started with perfectionism: getting in shape the "right" way, eating all the "right" stuff. She's been recovered since 1999-2000, but "you always have it."

She stays careful not to compare herself to others, staying intentional about fueling properly. Her period is her vital sign; if it's irregular or absent, that's a red flag for RED-S. Her competitive nature now works in her favor: she doesn't care what she looks like, she cares about performing well.

It takes years of internal dialogue: "Nope, doesn't matter. Not looking. Here's my goal." Slipups happen, but how quickly can you get back after?

How does under-fueling persist in a sport requiring massive calories? You can't run 100 miles without proper nutrition. Is it short-term thinking, burning hot for one result, then figuring it out later?

The falsehood that being underweight makes you faster persists despite being proven wrong repeatedly. Observation bias plays a role: we see results, not what happens when they stop. Social media shows the awesome until it's not.

Lauren's running community never emphasized weight. No pressure from soccer, cross country, or her D3 school where they'd occupy the cafeteria from open to close after practice. Her coach would send her home to study if stressed: student first, athlete second. That brunch-after-run community should be the norm.

Imperfect training gives Lauren freedom to race without pressure. If everything were perfect, she'd have to perform perfectly. When training isn't ideal, she arrives at start lines thinking "let's see what happens."

Working with coach Megan Roche for four years has reinforced this. Megan serves as the angel on her shoulder while Lauren plays devil. When Lauren's too hard on herself, Megan provides perspective. The shared medical background creates understanding about balancing demanding careers with training chaos.

Lauren will turn 43 this year. While she sees inspiring examples like Sarah Hall at 42 and Nell Rojas at 46, she feels time pressure.

"I don't know how many years left I have." That urgency fuels her racing frequency and willingness to tackle intimidating challenges. She wanted to do Run Rabbit and Leadville for years but fear held her back. Now she's throwing her hat into lotteries.

UTMB last year — her first overnight race, done across the world instead of in her backyard — exemplified this. The fire comes from time pressure and uncertainty about future chances. What she's most proud of? Keeping showing up on competitive, intimidating start lines regardless of outcome.

One step at a time works in surgery and ultras alike. Whether dissecting tissue during difficult operations or running 100 miles, the approach is identical: focus on the immediate next step, recognize the situation, proceed carefully without getting overwhelmed by the whole.

You can't balance everything, so decide what drops temporarily. Balance is a myth. Success means choosing which area receives less attention for a period, knowing you can pick it up later. Dropping obstetrics gave Lauren regular schedules and sleep, enabling better performance in remaining roles.

Imperfect training provides freedom on race day. When preparation isn't ideal, there's no pressure to execute perfectly. The mindset of "let's see what happens" creates space to perform well without the weight of perfect preparation demanding perfect results.

Your period is your vital sign for female athletes. Irregular or absent periods signal relative energy deficiency regardless of what others are doing or what BMI charts say. If your body isn't responding correctly, something needs adjustment.

Time pressure can fuel action when fear holds you back. Not knowing how many years remain creates urgency to tackle intimidating challenges. The fear of running out of opportunities often outweighs the fear of failure.

Community built around food, not restriction, sustains careers. The running communities that thrive long-term gather for brunch after runs, connect over meals, and normalize fueling. Restrictive cultures create burnout.

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Jon is a runner, cyclist, and podcast host from Boston, MA, who now lives in Boulder, CO. For The Long Run is aimed at exploring the why behind what keeps runners running long, strong, and motivated.

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