The Ladakh Marathon is not about speed, it’s about resilience—hanging in there, getting used to the low oxygen levels and not giving up. If you survive the race, complete it without a physical or mental breakdown, it’s an achievement. Running in such beautiful surroundings is the icing on the cake.

I first heard about the Ladakh Marathon in January at the Mumbai marathon. I didn’t consider it until April when I mentioned it to my running coach Shreyas Karnad, who is also the founder of Bengaluru-based running group, Runners 360. He was very encouraging.

You can’t do the Ladakh Marathon without some sacrifices. As a surgeon I have erratic working hours and often assist in fairly complicated surgeries which take hours. So professionally there was no leeway. The sacrifices were personal. For 100 days starting May, I would be up at 5am, running, cross-training, strength-training and doing yoga; it took all my free time. I missed out on family time.

I run without music, focus on my breathing and pay attention to changes in the body. As a doctor I know the physiology and anatomy, the science of how things work. But running is also psychological, and a marathon teaches you how it’s mind over matter after a point.

It’s mandatory to arrive in Ladakh a week before the race to acclimatize. The day I arrived, I felt lightheaded and breathless climbing the short flight of stairs to my room and so I rested a lot. I took a half tablet of Diamox (acetazolamide) that night to get over the altitude symptoms. I met several runners who were also working on their acclimatization.

After a day, I began my preparation with a 12km run in Nubra Valley, lower than Leh and, therefore, more comfortable. The next day, I ran 5km around Pangong lake, which is 800m higher than Leh with terrific wind chill.

The day before the race, a runner friend and I did a reconnaissance trip on a motorbike with our Garmin watches. It was the best decision ever. We grabbed the route map and set off to track altitude, distance, road surface, ascent and descent. We drank in the fabulous views of barren mountains, glassy rivers with green banks and an endless sky. It really is the roof of the world.

On the day of the marathon, I felt as tense as one writing a medical entrance exam. I had barely slept the previous night. I was up at 4.15am. I had to keep telling myself that I had worked hard for this and trained well...I reached the NDS stadium—the starting point—at 5.30 as per schedule.

At 6, we were off, all 200 runners (140 would finish). That’s the only time I saw the local runners who sprinted ahead in a matter of minutes and I never saw them again. They would take a few minutes over 3 hours to finish, which is about an hour more than regular timings for marathons with normal oxygen levels.

I hadn’t expected it to be so cold, but my compression vest and tights helped. The organizers had done a fine job: the roads were cleared of traffic, there were multiple aid stations and landmarks were clearly marked. I started slow and planned to build intensity. While training, I had worked on keeping my heart rate steady through a run. When the heart rate is steady, you can run longer. This approach is expected to help at high altitude.

I kept looking for the aid stations and used them to calculate my distance; I knew they were 3km apart. I was waiting to reach the seventh aid station—halfway—just to feel a sense of achievement. It took me 2 hours and 21 minutes to reach there. The natural thing is to double the time taken to cover half the distance and estimate your final timing, but that is dangerous as you start pushing yourself and might end up not finishing at all. And at this altitude, it’s more necessary to not push at all and run at a steady pace.

I was worried about “hitting the wall", the point in a marathon where you feel exhausted, breathing becomes laboured and energy levels plummet. I had “hit the wall" at the 30km mark in my previous marathon and so was prepared with small packets of instant energy gels which I kept popping at regular intervals. I was also carrying rehydration salts, which I had twice.

Despite these precautions, at around 33km, I felt a twinge in my right hamstring. I popped a salt tablet. The twinge subsided. Later I would see pictures of myself with my face crusted with salt (because of sweat drying up).

I was in the final lap of the race—5km from the finish line. The sun was sharp and I was getting dehydrated. I was also hyper ventilating due to fatigue and the lack of oxygen. I slowed down to a walk, got my breathing under control and then increased my pace very slightly. For half a kilometre, I felt disoriented and considered stopping. I had hit my “wall". Luckily for me, I had run a big part of the race with an Italian, both of us urging the other on. “Keep going, you’re almost there," she said encouragingly and that was just what I needed to hear at that point. I picked up speed, and despite a cramp spreading along my hamstring, I limped along, not sure how much was left, when suddenly it was over—I had crossed the finish line. The organizers came up to check on me. I drank some water, took a selfie and called my wife to tell her I was alive.

This marathon is definitely special because it is not about speed, it’s about endurance. The organizers, Rimo Expeditions, have rightly tagged it as the race for “the resilient and the brave".

Will I run another? I don’t know. I want to do other things, and with my family. Running a marathon is a solo journey. You spend long hours alone, introspecting. Running in Ladakh was not only scenic and pleasing, but also a spiritual journey. I’m thrilled I finished it and that’s what matters.

—As told to Priti David

Dr Jeevak Shetty, a paediatric surgeon at the Ramaiah Medical College Hospital in Bengaluru, has been running seriously for the last five years and has one marathon and many half marathons under his belt. Shetty decided to run the Ladakh Marathon to raise the bar.