[at-l] Derailed at Blue Mountain - Part Three

[RET33@PRODIGY.NET (Robert Tomlinson)]

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Derailed at Blue Mountain - by Robert Tomlinson
(part three - parts one and two are reprinted below)

As I lay there on my ER bed, I was fairly comfortable, but it was mid
afternoon and I did not know when or where my wrist would get treatment.
Although I was reasonably confident the doctor was working on finding a
place, I was still concerned as to how I would get there. As I pondered
that, I began to vaguely remember something about my medical insurance
coverage including transportation to get emergency treatment. There was a
phone in my ER cubicle, so I went over to it and called the customer service
number on my insurance card. Although it took some time to explain my
unusual situation to the nice lady on the other end of the phone - she never
heard of an ER that couldn't handle broken bones either - good news! She
finally agreed that such transportation would be covered.

Shortly thereafter, the ER doctor strolled into my cubicle with more good
news - he had confirmed that the visiting orthopedic doctor from Gainesville
(Georgia) was in nearby Blairsville that very day!  The bad news was that
they weren't sure if they had the proper facilities in Blairsville for him
to work on my particular problem, but for now Blairsville seemed to be my
best bet. And so the good ER doctor had already set the wheels in motion to
have me transferred. A nurse came by to ask when the ambulance would be
needed to transport me, and the ER doctor, who had been so helpful up to
then, responded with  "He won't be needing the ambulance."

What ?!!!! Seems I had mentioned Gene, the hiker shuttle guy, in passing and
the doctor assumed that was how I was going to get transportation. I had no
idea if Gene was even in town that day, and nothing against Gene, but I wasn
't sure that it was a good idea in my situation to let myself get out of the
medical network, even for a short ride to another facility, especially if
the as yet unknown but sure to be exorbitant, costs of that ride were
covered by my (also exorbitant) insurance. I quickly asserted myself and
announced " My insurance company said that they will cover the ambulance."
The EMT guys were there in minutes.

The two young EMT guys were obviously a bit baffled by a patient who could
walk without their assistance, and based on what they could observe of my
condition, didn't really understand why I needed their services in the first
place. But one of them grabbed my pack, the other one grabbed my X-rays and
other paperwork, and they walked with me to their waiting ambulance. Once I
got in the back of the ambulance, the EMT guy assigned to ride back there
with me insisted that I lay down on the backward-facing gurney. He then
strapped me in, apologizing but saying it was "required procedure".

The 30-minute ambulance ride to Blairsville was actually a pleasant
interlude in what had been a mostly unpleasant day so far. I enjoyed
watching the small-town streets and the mountain scenery out of the back
window, while chatting with the pleasant and respectful EMT attendant,
although I felt like an old man once I realized that this earnest young man
was just a little older than my own sons. He had been on the Appalachian
Trail and other trails in the area, so we had some nice hiking related
conversation. I was also interested to find out that he spent time as a
volunteer fireman before becoming an EMT, since my own nephew wants to be an
EMT and has also spent a good amount of time as a volunteer fireman.

When we arrived at the emergency room of Union General Hospital in
Blairsville, it was almost 4PM. But they were expecting me, and so I was
immediately shown to a treatment room. The EMT guys dropped my pack there,
gave my X-rays and other records to the ER nurse, wished me good luck, and
were on their way. While he took my blood pressure and other vital signs,
Donny, the ER nurse, filled me in on the "visiting doctor." Donny used to
work for Dr. Weiss at his practice in Gainesville and had nothing but good
to say about him. According to Donny, it was my lucky day - an orthopedic
doctor and an orthopedic-trained nurse in the same hospital on the same day.

Actually, Dr. Weiss was not at the hospital, but he was in town. Donny had
already spoken to him, and the doctor would come over as soon as he could.
They had decided that they had adequate equipment at the hospital to treat
me, although Donny confided that it was very rare for an orthopedic doctor
to work at that hospital. Hmmm, I was feeling pretty good until he said
that.

 But in the meantime, Donny had to get me ready. The main thing was to put
an IV line in me, which the doctor would use to fill my arm with anesthetic
when he arrived. I hate needles, and recently passed out onto the floor when
blood was taken from my arm as part of a routine physical, but that hardly
seemed to be worth mentioning in light of my current medical problem. But I
made sure that I was laying safely on the ER bed before offering up my arm.
After Donny unwrapped the splint they had put on at the previous hospital,
he announced that due to the swelling he would probably have trouble finding
a blood vessel and might have to stick me a few times in search of one. Oh
goody. But Donny was golden that day and when he stuck me on the back of my
right hand, to my relief (and his), he had found one on his first try.

Donny then left me to take care of his other duties (this ER seemed somewhat
busier than the other one), saying that the doctor should be there soon. But
as I continued to wait, the intense throbbing pain, like that I had
experienced in the other hospital until they wrapped my wrist, returned. I
tried to ignore it and focus on other things, but soon started frantically
pacing the room as I had done in the other hospital, which seemed to be the
only way to cope with the pain. After what seemed like forever, but was
probably twenty or thirty minutes, I left the ER treatment room to find
Donny. When I tracked him down, he was sympathetic, but could really do
nothing - he had recently called the doctor, who was supposed to be on his
way. Donny did not want to give me any painkiller so close to being given
the anesthesia. So I went back to the ER treatment room to pace some more.

Finally at around 5:30PM, Dr. Weiss blew in. He was a very energetic,
gregarious, friendly man, about ten years older than me I guessed. He asked
me a few personal questions about where I was from, etc., listened to my
story of what happened, and poked and prodded my wrist area a bit, asking me
how certain pressure points felt. He looked at the X-rays and then explained
to me what he saw and what needed to be done, very similar to what I had
been told at the previous hospital. After asking if I had any questions -
not really, I said - he told Donny they were going to start the
nesthesia  - conscious sedation, they called it.

Donny quickly attached several round cloth patches to my chest and stomach -
each patch had a set of wires running from it to a monitor that Donny was in
charge of watching - this was apparently serious stuff. The doctor then
attached the tube carrying the anesthetic to the IV port Donny had
previously placed in my right hand. Donny recited vital statistics from the
monitor while we all waited for the anesthetic to take effect. Dr. Weiss
then said something about my arm changing colors but not to worry. He then
attached a tourniquet, like a blood pressure cuff, to my right arm, just
under the armpit. I couldn't really feel my arm at that point but when I
looked over at it, it was green, just like Martian make-up in a science
fiction movie. I would have been worried if Dr. Weiss had not warned me
first.

The whole time this was going on, Dr. Weiss was talking to me about Florida,
hiking, his practice, my career, real estate, and a multitude of other
things - in other words, a normal, cordial conversation. Very rare based on
most (but not all) of the doctors I have run up against in south Florida.

Then Dr. Weiss lifted my arm straight up off the table, extending it fully
so the fingers pointed to the ceiling, and started what looked like a
two-handed massage on my wrist and lower arm. He was relocating the out of
place bones. The arm was like a slab of meat as far as I was concerned,
having nothing to do with me - I could feel nothing but a tugging up around
my shoulder. After no more than five minutes of this, Dr. Weiss put my arm
back on the table beside me. He unwrapped two splints, putting one on top of
my arm and one below and then quickly wrapped the splinted arm in gauze
mesh. The top splint extended past the elbow and served to immobilize it in
a 90-degree bend. In what seemed strange at the time, and looked strange to
me the whole time I had that cast (which I later learned is of the type
known as a "sugar tong"), he topped it all off with some white plastic tape,
wrapped sparsely up and down the entire arm, not very symmetrical and not
particularly tight.

Dr. Weiss then had X-rays taken of the wrist - I didn't even have to move
from the ER table! While we were waiting for the developed pictures, the
phone rang. Donny was out of the room for some reason, and so Dr. Weiss
answered it. The call turned out to be for him. As he continued talking, I
became concerned because he had not yet released the tourniquet on my upper
arm. I had earlier overheard him tell Donny something about me not being
able to "stand" more than a certain amount of time with the tourniquet on.
What exactly did that mean? And my arm being a Martian green piece of meat
didn't help any. How long was this phone call going to take anyway?
Everything I thought I might say something (like "HELLLLLLLLLP!"), it seemed
like doctor was about to hang up and so I wouldn't - and then the guy on the
other end would say something to re-start the conversation.

Just as I was about to get really frantic, the doctor finished his phone
call. He looked at me and laughed "Well, I guess we better get this
tourniquet disconnected - ha ha!" Very funny, doctor - you're a riot.

Disconnecting the tourniquet proved to be another two-man operation - the
doctor explained that letting all of the blood flow at once was not a good
idea. So he did it in stages while Donny looked at the vital signs provided
by the electronic sensors that were still glued to my upper body. By this
time the x-rays came back - Dr. Weiss looked at them, showed them to me, and
pronounced himself satisfied. He asked me to wiggle my fingers and to make a
fist - I was able to do both satisfactorily. He wrote me a prescription for
pain medication, gave me a few suggestions for taking care of my wrist and
the cast, told me to see a doctor at home in a week or two for follow-up,
made a few notes in the file, and he was gone. It was past 6PM and I was in
Blairsville, Georgia with  my arm in a sling and only a backpack to my
name - what now?

to be continued ............................................................


 ----- Original Message -----
 From: "Robert Tomlinson" <RET33@PRODIGY.NET>
 To: <at-l@mailman.backcountry.net>
 Sent: Friday, October 18, 2002 7:52 PM
 Subject: [at-l] Derailed at Blue Mountain - Part One

Derailed at Blue Mountain - by Robert Tomlinson (part one)

October 9, 2002 - 9AM. It had been a great backpacking trip so far - we had
covered almost twenty miles over two and one half days, with two and one
half days to go. Much rainier than we had experienced in previous trips, but
really nothing too bad. But as we left Blue Mountain Shelter that morning,
continuing south on the AT, it was very foggy and I noticed that the ground
was pretty wet. Two of the group had already gone ahead - Bette and her son
Tom - expecting to be the slowest and wanting a head start on what was to be
our longest hiking day. Then us remaining three, with me in the lead and
Greg and Noel, our strongest hikers, right behind.

We expected just a little bit of downhill at the start of the day and then
were looking forward to an extended section of fairly even terrain, which
had been a bit of a rarity so far in this trip. As I eagerly hit the trail
and headed down, Greg remarked that I was obviously eager to tackle the day
and jokingly called me "a horse". About one hundred yards down, I passed the
little water source that we had nicknamed the Golden Arches, after the
crossed trees that marked the spot. I remember thinking that after that
point the trail looked like it dropped off steeply, but as I got closer it
seemed to be just an optical illusion caused by some boulders in the middle
of the trail, that weren't really that tall but obscured the continuing
trail from the angle I was standing. I stepped on the boulders and before I
knew it I was sliding feet first - I was going down and put my right arm out
behind me to stop the fall. Other than being a little embarrassed, this did
not seem to be that bad a fall - just down on my butt like I had done more
than a few times before. I then felt a little pain from the heel of my right
hand and realized it had hit the rocks - I'm not sure my butt even actually
hit the ground. At first when I inspected my right arm and hand, nothing
appeared to be unusual. But when I turned my hand over - palm up - it was
bent very strangely, causing part of the wrinkled area where the arm
connects to the hand to almost disappear. I also realized that my fingers
were in a half-closed claw and would not open further.

I never had a broken bone in my 45 years, but I instantly knew what this was
and what it meant. I looked up the trail to see first Greg and then Noel
behind him, coming down the trail behind me. I said "Guys, I broke my wrist"
and I remember Noel saying "no", as in "you must be mistaken". Greg by this
time was standing still, watching me from the top of the not-very-tall rocks
I had just slid down. And before he could say much, he started to slide down
those rocks also, but caught himself without falling.

The guys went into action, taking my pack the rest of the way off and Noel
insisting I take some Advil he offered me with a swig of my Gatorade, as
well as to put on my jacket. I remembered that I had a long gauze strip
bandage in my pack (which I debated every trip as to whether I should take
or not), but not exactly where. After a couple of misdirections by me, Greg
finally found it and started to wrap my wrist - Noel came up with some duct
tape to finish off the job. By now, I was a little woozy and a little
panicked but not much and thankfully it stayed under control.

Then we started to strategize, at first excitedly but quickly settling down
into a rational discussion. After we quickly considered our options, it
became clear that our best bet was getting me to the main highway we had
crossed the day before at Unicoi Gap, about 2.5 miles back up the trail.
Although this might not seem that close to some, we had not been that close
to a highway for most of our trip so far and would not cross the next main
road for another two days. Most of the way back was downhill, but it was
steep (from about 4000 feet down to less than 3000 feet), wet and slippery
just like the terrain we were standing on - so, as has been well said
before, I was not out of the woods yet.

Here's the amazing part. As I was deciding whether to try to carry my pack
out or just leave it at the shelter with a note, Greg said that he would
carry my pack out, and his too. That was a total of 60 pounds and an
additional 5 miles of strenuous hiking added to Greg's already long day. My
Kelty pack has an external frame, so Noel and Greg lashed Greg's frameless
"Go Lite" pack to the top of mine, sideways. Noel and Greg agreed that Noel
was to hike ahead, brief the rest of the party what had happened and stay
with them until Greg caught back up, hopefully at that night's camp, which
to complicate matters was not yet decided but had only been narrowed down to
a few options. But it was important that Noel continue on, since he was
carrying food and equipment that he was sharing with the other two. Also,
since we had learned a hard lesson about the treacherous terrain, it was
important to pass that on also.

Greg hoisted my pack, with his pack now lashed on top, and we were off.
Leading the way, and cradling my bad hand with my good, I carried only my
Gatorade bottle and, for some reason, Greg's water canteen. At first the
trail went back uphill, and then was fairly level for a bit. Then began the
relentless rocky and wet downhill, heading down to Unicoi Gap. Watching
every step, I picked my way down the trail, worried that I might fall again,
or even worse that Greg might fall and wipe us both out. I never was in
shock, but the injury throbbed pretty badly sometimes and I felt mildly
nauseous or lightheaded almost all the way down. We chatted some, but mostly
just watched our footing on the trail. Greg was talking about staying with
me even after we reached the road, but I told him that I had no problem with
continuing on by myself and that I was sure I would be able to hitch a ride
to a hospital fairly fast in my obvious condition.

In less than two hours, and with no further mishaps, we were at the bottom
of the mountain and standing by the road (Highway 75). We crossed over to
recheck the directions to the nearest hospital, printed on a sign in the
parking area. I had remembered reading these directions, along with the
other information on the sign, in some abstract theoretical way when we had
crossed through there the day before. Now reading with new interest, I try
to focus on the directions so that I can relate them to whatever hapless
stranger I wind up getting a ride with. There are too many roads, numbers,
and distances, so I condense them in my mind as "go into Helen, take the
road north to Hiawassee, and then go 11 miles west on Highway 76 to Townes
Hospital".


to be continued ............................................................


----- Original Message -----
From: "Robert Tomlinson" <RET33@PRODIGY.NET>
To: <at-l@mailman.backcountry.net>
Sent: Monday, October 21, 2002 4:29 PM
Subject: [at-l] Derailed at Blue Mountain - Part Two


Derailed at Blue Mountain - by Robert Tomlinson  (part two)


By now, I had suddenly lost my confidence about hitching a ride and so had
asked Greg to get out his cell phone and either call 911 or the sheriff's
emergency number posted on the sign. While he was doing this, a friendly
looking fifty-something fellow drove up, rolled down his window, and said
something along the lines of "you guys sure picked a day to go hiking",
alluding to the wet and rainy weather. He started to tell us of his hiking
plans, now aborted by the weather, but I was not interested in small talk
and so I interrupted with "I have a broken wrist - can you take me to the
hospital?" At first, he was concerned as to whether there was room in his
car, filled with hiking gear, but when I said it would just be me going, he
agreed. Turns out he was a fellow Floridian, working for a screen/pool
enclosure company in Naples. Greg threw my pack in the guy's trunk and after
I rather impatiently waited through a bit more of their hiking chitchat, we
were ready to go. I gave Greg a hug and croaked out a "thanks", but was too
choked up and teary to say more - after all, he had done a lot for me. Then
the newly drafted trail angel and I drove off, leaving Greg to start his now
very long and very alone hike to catch back up with the others.

I recited my version of the directions to the hospital and based on that the
trail angel took off towards Unicoi, but after about thirty seconds he said
"You don't want to go this way to Hiawassee, you want to go the other way!"
He made a U-turn - we headed back the way we came, past Greg, already
occupied with packing up and didn't see us. Mister trail angel said he had
just been in Hiawassee, so I wasn't worried - at least not too much. He
carried most of the conversational ball, which I was grateful for - I was
too preoccupied with planning my next move, and yes, worrying a little bit
if we were going the right direction. Pretty soon we hit Highway 76, so
based on what I remembered from the sign at Unicoi Gap we turned left
(west), but instead of 11 miles we started seeing blue hospital signs within
one mile and shortly after that the signs led us to "Chatuge Regional
Hospital", with a big Emergency Room sign. I asked my trail angel to wait
while I went inside to check it out. He agreed so I jumped out of the car
and ran in. By now, it was about 11:30AM, two and one-half hours after my
injury.

I went up to the front desk and explained my problem and the lady said yes,
we have an emergency room, but we don't have an orthopedic doctor here and
so can't do anything about broken bones. Well, where can they help me? Well,
you would probably have to go to Murphy, NC - about 50 miles away - or down
to Gainesville, GA - about 50 miles the other way. While they are explaining
this set of circumstances that seem crazy to a city boy, I have asked for
the yellow pages and am crazily flipping through them to see if I can find
any holes in their story. No luck. But what about the hospital that was
supposed to be 11 miles west on Highway 76 and you were just two miles west?
They didn't really know what I was talking about, but they must be the same
place, because - get this through your head, hiker boy - THERE ARE NO MORE
HOSPITALS!

Well, it looked like I would either have to try to strong-arm my trail angel
into a really long drive or just stay there and see what they could do for
me - they did have some sort of doctor there, after all, didn't they? Maybe
the lady at the front desk didn't know it all - ? Maybe, this is a kind of
minor fracture that they can treat here, without needing an orthopedic
doctor?

Anyway, based on this somewhat wishful thinking I went back outside, told
Mister Trail Angel (his name was Terry) I was staying here, he brought my
pack inside for me, I said thanks, he said bye, and he was off. I went back
to the emergency room. A very quiet emergency room, I might add. No waiting,
a pleasant change from my big city experiences.

The nurse assigned me a bed and told me to lie down on it, dirty boots and
all. She took my blood pressure while she listened to my story. I would get
a lot of practice telling this tale before the day was over. I gathered they
don't see many injured AT hikers in this hospital, which I guess is a good
thing. After a little bit a doctor appeared, a friendly guy about my age or
maybe a little younger. He also asked for my story and after unwrapping and
examining my wrist, he said that although x-rays were needed to be sure, he
was pretty sure it was broken and therefore pretty sure they would not be
able to do anything much for me there. But let's wait and see how the x-rays
come out and we will discuss it more then.

After the doctor left me, someone else came and rode me in a wheelchair to
the X-ray room, where yet another person took a few pictures. Then they
wheeled me back to my ER bed. Oh yeah, sometime during this process they
made sure to ask for my medical insurance card - good thing I had carried it
with me on the trail, instead of leaving it in the car or even at home, as I
learned afterward that some people do.

Soon after I came back from getting x-rayed, my pain started to get
significantly worse. My fingers were becoming very swollen and numb and I
had to get up and pace around the ER cubicle just to try to keep my mind off
of the throbbing. Where was that doctor anyway? Finally, after more than an
hour (the lunch hour, I might add), he came back. Based on the x-rays, he
saw three separate areas of trauma, but only one that needed attention, and
the way I understood it was that while technically a break, the necessary
procedure was a manipulation to reduce (relocate) the "right radial" (one of
two bones in the lower arm, connecting the wrist and the elbow) from where
it was to where it should be. And that needed an orthopedic doctor, with
access to anesthesia and the necessary equipment. Which as I had been told
before they did not have in Hiawassee, or anywhere near that fair city.

But there was some possible good news. The good doctor indicated that,
during his rather long absence from my bedside, he had been personally
checking into my options for treatment, due to his sympathy for my untenable
position as an injured stranger with only a backpack's worth of worldly
goods (but a valid insurance card), and he had heard that an orthopedic
doctor from Gainesville, Georgia made occasional teaching visits to a
Blairsville clinic, less than fifteen miles away, and he had someone
checking into that as a possible option. Otherwise, I would have to get
myself to Murphy or Gainesville.

Although the Blairsville possibility sounded good, it was still more than a
few miles away and, short of more hitchhiking, I was not sure how I would
get there, or worse and more likely at this point, to an even more distant
medical facility. I thought of 80 year old Gene, who shuttled my group on
Sunday from Woody Gap to our starting point at Dick's Creek Gap, and who had
done a shuttle for another hiking group I was in last July. He did live in
Hiawassee, but I had no idea whether I would be able to reach him and if I
did, what his plans were for the day.

The doctor interrupted my quiet worrying when he said, well I can at least
temporarily splint your wrist until we figure out what we can do with you.
He did it himself, using a gauze-like cloth, which after he soaked in water,
hardened over the next thirty minutes or so. He straightened my wrist and
hand out some as he applied the splint, which improved the circulation and
in turn reduced the swelling in my fingers - while I waited, the terrible
pain finally began to subside.


to be continued .................................................