Paul Sibley knew they would be there when he needed them most: the pain and the helplessness, the anger and frustration, the humility and the gratitude.

He knew they would be there to keep him going when his joints and tendons screamed, when pain, fatigue and doubt deranged his senses, when the body that had suffered so much to save itself rebelled against the enormity of this latest challenge.

But this was not the time.

This was a time to look at this gathering of elite endurance athletes, this tribe of certifiable loons to which he had somehow miraculously returned, and feel the warmth of their welcome. This was the time to pull on that yellow jersey, the one on which a year earlier so many of these runners had scrawled their names as a testament of their faith in his strength.

The finish line was a hundred miles and a day and a half away, but Sibley couldn't, wouldn't think of it, nor of the longer, deeper journey that had returned him here again.

THE 'C' WORD

It was supposed to have been a routine procedure.

Sibley, a 35-year-old HMSA manager and seasoned ultrarunner, had developed a patch on his face that doctors identified as squamous-cell carcinoma, a common, normally easily dispatched form of skin cancer. The recommended treatment for a case like Sibley's involved a simple scraping away of the affected area. A successful procedure would give Sibley a better than 90 percent chance at full recovery.

But the initial scraping wasn't successful. The cancer ran deeper than the surface of the skin, so the doctor was forced to keep scraping — and scraping, and scraping — all the way to the bone. By the time the doctor finished, he had removed a softball-size chunk of Sibley's face.

A month later, another patch appeared on the bottom of Sibley's chin. Alarmed, Sibley showed up at his doctor's office without an appointment. A biopsy was immediately performed.

"When (the doctor) came back with the results," Sibley recalls, "he was crying."

Sibley had an extremely rare, aggressive form of the cancer, the sort a dermatologist or oncologist might only see a handful of times in a career.

To save Sibley's life, doctors knew they'd have to fight aggressiveness with aggressiveness. Taking Sibley's otherwise excellent health in account, they settled on a debilitating regimen of intense radiation treatment.

"They set it to the highest level of radiation," Sibley said. "And they literally fried me like a piece of raw meat."

ENDURANCE TRAINING

Sibley always had been athletic. As a teen growing up in Louisiana, he played tennis, baseball and football, the latter a bit of a stretch for someone who painted 125 pounds on a 6-foot-1-inch frame.

"I was always injured," Sibley said, laughing. "One hit and I was broken. I'd end up running at practice because I couldn't participate."

Sibley also ran the 5-mile stretch to and from school every day. The result: The sort of muscular and aerobic endurance that can take an average athlete beyond supposed limitations.

A mediocre tennis player, Sibley relied on his superior stamina to bring his opponents to their knees.

"I'd play for six hours because I knew I could outlast whoever I was playing against," he said. "I'd keep going until they were weak and nauseated."

Sibley attended San Francisco State University, where he would earn a pair of MBAs, to be near the ocean and the mountains. That's where he met Courtney, his future wife, and Erik Herman, an endurance athlete after his own heart, lungs and quads.

With Herman matching him step for step, Sibley stoked a new passion for mountain climbing and ultrarunning. Once, while indulging in late-night pizza and beer, the pair talked about doing the famed Double Dipsea trail run, a grueling 13.7-mile trail run that includes some 4,500 feet of hills. By the end of the conversation, "one day" became "right now." They took off on the trail just after midnight and finished in what would have been a top-10 time.

The next weekend, for good measure, they completed a 50K (31-mile) ultramarathon.

In 2001, the Sibleys moved to Courtney's native Hawai'i. Paul Sibley accepted a job as manager of strategic programming at HMSA on one condition: He would start after he completed the Utah Ironman.

Sibley's high-mileage pursuits continued unabated, often with Herman. A swim across the Maui Channel. A run across Spain. The Hawaiian Ultra Running Team's annual 100-Mile Race on the trails around Makiki, Tantalus and Manoa.

REAL CHALLENGE

Sibley had signed up for the 2006 HURT 100-miler, but his cancer diagnosis made it impossible. Still, he did what he could for as long as he could.

"Like anyone, you want to remain normal as long as possible," he said. "I tried to work and eat and work out, but there was a point when I was trying to run up Tantalus on the road but I couldn't anymore. It was like running on quicksand."

Small wonder. As an endurance athlete, Sibley was used to consuming upwards of 6,000 calories a day to fuel his energy output. But with his mouth and throat cooked by radiation, it took all he had to choke down 1,000 calories a day. His salivary glands no longer functioning normally, Sibley had to drink as much water as possible. But his sense of taste was confused, and ordinary tap water now tasted "like cat litter — used cat litter."

PAIN, GAINS

The man who had embraced prolonged discomfort as recreation found himself working with a specialist to manage the excruciating pain that was the fallout of four months of radiation therapy. Though he tried to shield his young son from his suffering, Sibley was miserable and angry. He lay in bed, unable to talk, often too weak to move.

Sibley's ill-fated run on Tantalus occurred just a day before a series of storms initiated 40-plus days of rainy weather in Honolulu. When Sibley's treatment ended, so did the rains, as if by literary conceit.

The toll on Sibley's body was severe. His face was scarred by radiation, the right side of his mouth tugged upward by tightened skin. His lymphatic system was ruined. And the superb conditioning that had allowed him to endure the treatment had been tapped to the sinew.

In April, a wobbly, determined Sibley took his first steps to spiritual recovery with a gentle half-mile hike. A month later, he jogged up a 900-foot ridge near Jackass Ginger Pool. Sibley used to top the climb in 27 minutes; that day, it took him 41. And he was "extremely happy," he said. "Definitely crying."

Decked in protective sun gear, Sibley ran and lifted weights every other day. The pain was considerable, and he still had problems staying hydrated, but Sibley slowly increased his speed and rebuilt his stamina, running for six miles, then 10, then 15.

With the next HURT 100-miler approaching, Sibley set his mind to a successful return to the race, and with it a return to the life he fought so hard to keep.

But he wasn't willing to do it without Courtney's blessing.

"She was there holding my hand through every stroke of the scalpel, every bite of food, every mile," he said. "I told her, 'I'll do whatever it takes to finish. The only thing that can stop me is you.'

"And she told me, 'whatever it takes, you'll do it.' "

RACE ROUTINE

Before the 2007 HURT in January, Sibley, as had been his ritual since arriving in Hawai'i, made an offering of ti leaf and lava rock "to the beautiful powers that be" that they might look out for him on his 100-mile journey. He wore the yellow jersey his fellow runners had autographed at the previous year's race "so that when they saw me out there, no one would quit, no one would stop."

The race, considered one of the most difficult ultramarathons in the country, consists of five 20-mile laps around Makiki, Tantalus and Manoa trails.

Sibley, who had been force-feeding himself ice cream to gain back some of the 17 pounds he lost during the four-month treatment, completed the first 60 miles in just 17 hours. But his tendons and joints, still not back to optimal strength and resiliency, were in agony.

Despite the company of his triathlon coach, who had volunteered to escort him on the fourth lap, Sibley said the next 20 miles found him at his lowest.

"My lower legs were past the pounding point and I had to push myself to stay awake because I didn't have any fat left to pull on," he said. "I knew I'd suffer. I told myself, 'Just go. Just do it.' "

And he did. With a new escort on the final lap, Sibley pushed past the pain and actually picked up the pace.

On the 93rd mile, Sibley made his way up a steep hill and realized it was the same hill he had climbed when he started his recovery, the same hill he had cried and rejoiced on. He was going to finish, whatever he had to do.

"In life, you come to look forward to pain," he said. "You look at it like food, and you digest it for a while until you know that it won't come back up. It might come up later, but not now.

"The last five miles, I thought of nothing but the surgery and the radiation and all that pain, all those emotions. That's what they were there for."

Sibley completed the race in 34 hours and 41 minutes, collapsing into his wife's arms at the finish line. His 2 1/2-year-old son Aidan was there, too, and, carefully regarding the sweaty, mud-covered man that emerged from the forest, responded with "Ewwie! Gross! Yuck!"

ROAD TO RECOVERY

The woods, as Robert Frost would say, are lovely, dark and deep, but Sibley has miles to go before he sleeps.

He will tackle the 36-plus-mile Haleakala Run to the Sun this month, one of about 30 punishing events Sibley has scheduled for the year. And somewhere, squeezed between his 60- to 70-hour work week, he'll continue to work toward a full recovery, whether by running the Tantalus trail system at night ("just me and the pigs"), cycling from his Kailua home to his office in town, or waiting for perfect swim conditions.

"I love rough water," Sibley said. "I love a good storm."

Reach Michael Tsai at mtsai@honoluluadvertiser.com.