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Simone Biles was in the emergency room past 1 a.m. on Saturday in Qatar. Didn’t look like it in world championships qualifying 17 hours later.

The four-time Rio Olympic champion endured a large kidney stone she named the “Doha Pearl,” coming back with the top all-around qualifying score thus far and all but guaranteeing a place in all four apparatus finals. The last gymnast to run the table like that in qualifying? Biles in 2013.

“I heard roller coasters may help kidney stones,” Biles said, according to the International Gymnastics Federation, “and I am basically my own little roller coaster out there.”

She totaled 60.965 points, a whopping 4.5 points clear of second-place Morgan Hurd with half the gymnasts to go in qualifying.

She has the highest score on balance beam, floor exercise and vault and the second-highest on uneven bars. She also got a vault named after her after becoming the first woman to perform it in a major international meet (video here).

Biles said she felt stomach pain on her right side for two days before getting it checked out. She thought it was her appendix before tests showed the stone that was too large to pass.

“Even when I’m walking and doing some stretches, I’m in a bit of pain,” she said. “The adrenaline definitely helped.”

GYM WORLDS: Results | TV/Stream Schedule

Biles, Hurd and Riley McCusker had an internal competition Saturday for two available spots in the all-around. Hurd won last year’s world all-around title in Biles’ break from gymnastics.

McCusker all but took herself out of the running on the first two rotations, bending her knees on her bars landing with a big step forward and falling off the beam.

Biles hasn’t lost an all-around in more than five years. With a gold Thursday, she will break a tie with Russian Svetlana Khorkina for the most world all-around titles for a woman.

The incomparable Biles can break more records in apparatus finals Friday and Saturday. She is currently two gold medals shy of Vitaly Scherbo‘s career record of 12 at worlds. She can also fill the biggest hole on her résumé with a first uneven bars medal.

Women’s qualifying ends Sunday, highlighted by China and Russia.

Biles and the Americans next compete in Tuesday’s team final, where they are massive favorites for a sixth straight Olympic or world title.

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MORE: Sam Mikulak has best U.S. results in qualifying in 39 years