DOHA, Qatar -- Simone Biles spent a portion of the night before her return to the world championships in the emergency room. The sensation she chalked up to usual pre-meet stress had evolved into searing agony that at times left her crawling on the floor.
When a CT scan revealed a kidney stone -- one she nicknamed "the Doha Pearl" -- the reigning Olympic gymnastics champion grabbed her stuff and discharged herself from the hospital, telling the staff she'll deal with the pain later.
"I heard roller coasters might help kidney stones," Biles said. "And I'm like 'Well, I'm basically like my own little rollercoaster out there.'"
Smiling through each twist, flip and turn, the 21-year-old Biles was nearly flawless during qualifying Saturday. She posted the highest scores on uneven bars, floor exercise and vault en route to a total of 60.965 on a day when the Americans put up a team score of 174.429 -- a staggering 12 points clear of second-place Japan through six of 11 qualifying groups.
"She's Simone," U.S. high performance coordinator Tom Forster said. "You'd expect the same out of a Michael Jordan or a Tiger Woods, and that's who she is in our sport. And she showed it."
Biles didn't get back to the hotel room she shares with teammate Riley McCusker until after 1 a.m. on Saturday morning, and she skipped the early workout as a precaution. She also couldn't be treated with the same pain medication typically given those dealing with kidney stones because it would put her in jeopardy of failing a drug test.
No matter. Biles' all-around total marked the highest in the world since her gold medal-winning total at the 2016 Summer Olympics.
Biles was initially concerned she had appendicitis, which would have forced her to sit out the competition entirely. Instead it's "just" a kidney stone, albeit one Biles believes she won't be able to pass, meaning she's going to have to deal with it throughout a very busy week that will include team finals, the all-around final and all four event finals.
She finished five points ahead of teammate and 2017 world champion Morgan Hurd, whose score of 56.465 edged Japan's Mai Murakami for second halfway through qualifying and assured Hurd of a spot in the finals.
The public address system played a bell akin to the start of a boxing match when the U.S. headed to uneven bars. What happened over the next 90 minutes was the gymnastics version of a technical knockout.
Hurd led off with a 14.466 that seemed to send a message that, while the faces change for the United States, the expectations and results do not.
"There's clearly a lot of pressure there," Hurd said. "How many world championships has the U.S. won? We have to keep the pedestal."
Looking for a way to give McCusker, Grace McCallum and Kara Eaker -- each of whom is making their world championship debut -- a breather before stepping onto the podium, Forster opted to have Hurd lead off in three of the four events. Forster called the move a "gut feeling," one Hurd eagerly accepted.
"It honestly makes me a little less nervous because I have less time to get even more anxious," said Hurd, who hardly looked nervous while qualifying for event finals on floor exercise and uneven bars.
McCallum competed in three of four events, and her 14.6 on vault probably earned her a berth in the event finals. Kara Eaker, who turns 16 next month, drilled a 14.466 on balance beam. McCusker overcame a stumble on beam that left her "frazzled" to finish fifth in the all-around.
McCusker, however, won't qualify for the all-around finals thanks to the rules that limit countries to two athletes per event in the individual competition. Still, she'll be part of the team final, and extending the U.S. win streak -- the Americans have won every major international competition since the 2011 world championships -- has always been the focal point.
"We all have different qualities that we can bring to the team," McCusker said. "We can all shine in different places."