Up to a point it's about how well you train. After that it's how much pain can you endure. More accurately, how hard can you work to inflict pain on yourself. You expect a marathon to test you physically. The mental and emotional tests come as a more of a surprise.
The hardest part was knowing I could simply stop. After everything I did to push myself up to and beyond my threshold of pain, to think maybe I could just stop. It is mental work to endure pain. The threshold can be increased, only to crash through it again. When you've spent enough time over your limit it doesn't matter anymore.
Oxygen depletion has its own side effects. The world comes and goes in waves.
To keep a steady pace while you undergo a steep decline, that is the game.
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