A Mind Step Away

Have you ever had a moment when you feel as if you are far away and just touching life?

The clouds spinning across the sky in lazy waves. You observing them. Touching them with your mind but not part of the same world.

This is how I felt as the questions continued and decisions were made about securing my ankle. I was just there a mind step away, looking at it. Observing. The team deciding to splint my ankle. The sound of the cardboard being torn. The towels being wrapped around my foot to pad it. My wince as they shifted my foot for the first time. The partially empty water bottles tossed on the ground by the thirsty rescue team. Me wondering if they were going to pick them up. (Of course they did, these are forest people.)

They offered me fentanyl. Joel had a funny look on his face when he offered it, and I had a funny look on my face I guess as well. I didn’t know much about opioids, since I hadn’t had one since I was a teenager when my wisdom teeth were pulled, but isn’t fentanyl the drug they lace crack with that kills people? Is that what I want right now?

 My assessment was correct, when google later told me it’s about a hundred times stronger than morphine and fifty times stronger than heroin. Maybe I was the only idiot who didn’t know or care what it was. I was still high on natures natural pain med, adrenaline ripping through my body.  I recalled the last time I took an opioid, spending an uncomfortable afternoon vomiting with wisdom teeth stitches. I had never touched any kind of drug since then. Some life lessons are not to be forgotten.

I looked everyone in the eye and casually declined the pain med. I wasn’t really there anyways. The trees were floating and the adrenaline was still having a trauma induced party with my body. I didn’t think I needed to add anything to the mix. I’m not sure I imagined the grudging respect in Joel’s eyes. I guess most people don’t turn down pain relief when offered. (I mean fifty times stronger than heroin?!) Although, a few hours later I would possibly “pity the fool” who turned down the gift of modern medicine.

Two of the team gently splinted my leg, wrapping my foot in soft towels and then surrounding it with cardboard, taping the whole ensemble together. There was chatter on the phones (I’m guessing they had the same service as 911?!) as discussions were had about how to get me the hell out of there. They had arrived on site with a mono-wheeled litter. Imagine a fat ATV tire with a red plastic stretcher precariously balanced on top. Now I was officially scared.

The team had hiked up the slow, steeply pitched switchbacks of Dragon’s Back Trail, and now they were discussing how to get ME down it. I was resolutely staring at the litter, trying to make amends with it, when I overheard one of them ask if it was possible to take me up instead of down. “Yes, yes!” I interrupted, excitedly. “There is a cabin road directly above us, you can drive to it from Lake Mary Road.” They were as happy as I was about this. I couldn’t imagine going down that steep hill in the stretcher, and I’m sure they were equally stymied as to how to do it safely. Not to mention there was the one guy who kept complaining about his back….

Joel hopped on with the ambulance driver, who my friend Jen had discovered at the bottom of the trail. The location info was relayed, but concerns about the Lake Mary Road gate access were raised. Why don’t they have all the gate codes I thought to myself? Seems like a mandatory safety measure for the county EMTs. What if someone was bleeding out? I again interrupted, “You don’t need to access through the main gate, if he takes the Twin Lakes Loop Road past the general store towards the art gallery, the secondary gate there isn’t closed.” I truly felt like a small town mountain gal now. 

The moment of truth had arrived as the litter was placed next to me on the sloping hill. I took one look at it and realized my ordeal had just begun. I was considering asking if perhaps gin was an option instead of that heroin-ish drug? **Note to self, add a bottle of London Dry to the future safety kit.

“Okay,” Joel explained with an intake of breath, “We’re going to pick you up in tandem and scooch you into the stretcher and then we are going to lift you onto the wheel.”

I put my game face on as hands were placed under my arms and around my legs as I was gently shifted into the litter. That wasn’t so bad I thought to myself, right as I went airborne. It’s hard to describe the feeling of floating on one wheel while a bunch of strangers hold you in place. “It’s quite the exercise of trust,” Joel smirked at me. I wasn’t feeling so confident of my fellow man after the hiker abandoning me just minutes before, but these guys knew what they were doing. 

I gripped the sides of the sled as they started rolling me over the uneven terrain. One of the benefits of the mono-wheel is that they could roll you over boulders and logs. Sounds FINE right? NOPE. The litter pitched from side to side as each of my rescuers stepped and climbed about the rocky slope. I was fully and unapologetically white knuckling the red plastic of the stretcher as we climbed up the rocky terrain, each little jingle jangle sending an electric bolt up my strapped in leg. I had my eyes peeled for ice, imagining the rescuers slipping on that same stubborn culprit and taking a second spill down the slope.

The guys were huffing in the altitude, one even asked to stop and switch sides, our fellow with the tweaked back was having a hard time of it. I felt bad and a bit guilty, but also glad I was a five-foot-five woman instead of a six-foot-four man. I can’t imagine that scenario is pleasant for either party.

There was a collective sigh of relief when we reached the cabin road. I will never take a level surface for granted again. The ambulance was spotted a short distance ahead and I realized I was about to take my first ever ride in one. I was loaded in, the doors were shut, and I watched the forest drift past through the foggy windows.

The EMT had a clipboard and more questions were asked as we approached the main Lake Mary Road gate, and stopped.

Another very definitive road block as calls had to be made again, and another gate code secured. I tried to tell the EMT they could just go back the way they came since I had the code to the campground gate, but alas we sat and waited. Again, a conversation definitely needs to be had about gate codes and who has them, I can’t be the first emergency ever to happen when the gates are locked for the season. Or am I?

The hospital arrival was a bit stressful, Covid protocols, paperwork, the cabin, my car all running together in my head as the adrenaline started to wear off. Jen met me at the hospital and waited with me while I was examined. I had gotten in touch with my boyfriend and we were trying to figure out how to get me and my car home. At this point I was thinking, well I’m pretty sure it’s broken, but if they cast it maybe I can still drive? Wow, that was a serious walk down delirium fantasy land.

One thing I will say about hospitals in mountain towns, everyone is fun and cool and all outdoors enthusiasts. The X-Ray tech had me laughing, and determined pretty quickly it was broken. Three bones, matching those three pops I had heard on the trail. I had also managed to dislocate it and tear some things. Ya know, go big or go home

At this point I’m still thinking, okay get the cast on, head back to the cabin with Jen’s help to pack up and close, and then can possibly drive home in the morning, that’s about the time the surgeon showed up.

He introduced himself and started walking me through my injuries ending with “We’d like to take you in for surgery immediately.” Hold the phone, SURGERY? Oh jeesh. It was a trimalleolar fracture, pretty much the worst thing you can do to your foot. Again, well done Michelle. He and his physician’s assistant quickly walked me through the process. “What about my insurance?” I asked. “Do I need to get approval before getting surgery?” I was worried about it being out of network, and boy was I right to be, more on that later. It was Sunday night so no one could get through to my provider.

The doctor explained “Look, we could splint your ankle as best we can, give you pain killers for the five hour car ride home, but by the time you get home the swelling will be so intense you will have to wait for a week or two before the swelling reduces enough to operate.” As if that wasn’t enough of a reason, he continued, “There are also two dangers associated with ankle fractures, one is the potential for blood clots that could potentially be fatal, the other is that if your pulse is lost in your foot and not treated immediately you could lose your foot.”  Umm, yes excuse me sir where do I sign? The physician’s assistant continued, that since I was being admitted through the emergency room that my insurance HAD to cover it. Would stand to reason, right?

While we were having this discussion and I was filling out the consent form and getting admitted to the hospital, a more emergency case came in and stole the sole anesthesiologist. Now I was going to have to wait till the next morning for surgery. I berated myself for being worried about my health coverage and it made me sad that as Americans our first thought isn’t our own health and safety, but will the insurance I pay a billion dollars for cover it.

I was moved to a room, the nurses awkwardly trying to manage me, my hiking pole, and backpack. Hiking poles really have no place in hospitals. Jen offered to run back to the cabin and get me some things, as well as pick me up some dinner.

I settled in, the nurses offering me pain killers through the IV, again like a complete idiot I turned it down. I was managing the pain okay and was still terrified of getting nauseous. My night nurse came in and introduced herself and asked what had happened. As I made my way through the ordeal and came to the part of the hiker who left me, she was completely astounded. She left the room and came back a couple minutes later and exclaimed “Did he really just LEAVE you there? You were in extreme shock, you could have died!!”( Another non-fan of the most disliked man in the Sierras.) 

At this point I had never thought for a moment my life was in danger, but after reading up on shock a bit I stand corrected. I also thought I was in good shape at this point. I was settled in and finally been allowed to use the bathroom after seven hours of holding it. A plan had been made for surgery and my return to LA, pizza was on its way, and while uncomfortable and in pain, it was all reasonable. Mischief had been properly managed. What is it they say about not getting too comfortable?

Pizza had just been delivered and I was about to bite into a slice when the nurse came in on her rounds. She checked the monitors, assured the compression device on my leg that was used to prevent blood clots was operating properly, and then checked for the pulse on my foot, and got NOTHING. She switched devices and positions, and again nothing. Another nurse was called in, nothing. She left the room in a hurry and told me not to eat any of the pizza yet. I recalled what Joel had said on the mountain, “If you don’t have a pulse in your foot, you are on a helicopter to Reno.” Mischief decidedly not managed.

The doctor came in in a rush dressed in a parka, the cold emanating off him, his face red from the pre-blizzard temperatures outside. He had been called in from home and was in a word, furious. He checked for my pulse, and checked again. “I told them to splint her in the ER before sending her up,” he pronounced exasperated, “I had a strong pulse in her foot in the emergency room.” 

The reason now became clear as to why I was told not to eat, if they couldn’t get my pulse back, then I was going to be heading straight into surgery. Not something that anyone seemed to want at this late hour. I certainly wasn’t keen on an exhausted surgeon having to operate at 11 p.m. after spending all day at the hospital. Not that I thought he couldn’t handle it, but let’s just say conditions weren’t optimal. Thank heavens I didn’t get in that car back to Los Angeles! If this had happened on the drive with us unknowing, I could have lost my foot. It was eerie to think back to that earlier insurance conversation, what if I didn’t have any savings and couldn’t risk the insurance and had to drive home? Thus, dooming myself to a possible amputation.

The E.R. team sheepishly came up with a splint. I sense words had been had. The doctor told me what happened next was really going to hurt, the nurse held my hand as the surgeon took my big toe and yanked. I surprised myself by screaming, I had never felt anything like this. I also considered having words with the E.R. team. 

The pulse was back, thank the hiking gods. You could see the relief in the surgeon’s face. He explained that my veins had possibly seized from the trauma or possibly been twisted or compressed, hence why he had ordered the splint to keep me immobile. I’m not sure why at this point I didn’t ask for morphine. I was now in intense pain and knew sleep was going to be impossible. The splinting was over at least, and now I just had to get through the night.

The hospital became quiet. I kept trying to sleep but could never get comfortable. The loneliness set in and I realized how much of a comfort having Jen there earlier had been. The reality of the situation became apparent. I was going to have my first surgery and I was completely alone, far away from home. I realized at that moment I was finally scared. 

I must have dozed off as the next thing I remember is the nurse coming in and waking me. Surgery was happening shortly and they needed to change me into a gown and get me prepped. I barely had time to check in with my boyfriend and make sure he was all sorted and clear on the crazy plan for the day. They had told us the night before that the need to get me home as soon as I came out of post op before the block anesthetic wore off was crucial, as I would be in excruciating pain once that happened. To continue with the adventure movie events, there was also a massive blizzard hitting that night, so if we stayed in town we would be trapped there for a few days, and moving me then would be a much more painful journey. 

The plan itself was a bit crazy. I had my car which needed to be driven back to Los Angeles, so a last minute one way car rental to a small town needed to be secured after hours on a Sunday night. The earliest car rental near our house opened at 8 a.m. The latest car rental return in Mammoth Lakes was 1:30 p.m. which left us only a half-hour window. Not ideal on a five hour drive. It also meant he had to get in and out of the rental car vendor in Los Angeles in minutes, and we all know that was never going to happen. After turning in the car, Jen would pick him up and drop him at the cabin, where he would have to pack up all my clothes, food, and other belongings, basically going on a scavenger hunt around the cabin to see where I had left things, and close up the cabin for winter. Closing up the cabin for winter means not only closing shutters, emptying the fridge, and cleaning, but also disconnecting the water system and freeze proofing the pipes. THEN he had to run around town picking up the various prescriptions as well as lunch for the drive home, since they advised him not to waste any time getting back. He then would have to load me in the car and drive straight back to LA, then get me into the house up a flight of exterior stairs and a flight of interior stairs. It felt a bit like a Mission Impossible or Ocean’s 11 plot with the amount of planning and layers of things that could go wrong. What if my post op recovery took longer than expected (it did), what if the blizzard came in early (it didn’t thank heavens), what if he missed the rental car return window (he did but he called and they waited for him).

I was thinking about all this as the gurney made its way down the hospital hallway. I was counting the overhead fluorescent lights as they passed by, blinking in the harsh glare in an attempt to calm my nerves. My main fear was the oxygen mask, claustrophobia being my lifelong enemy. I expressed this concern as I was moved onto the operating table and shifted into place. The anesthesiologist was definitely the cool kid in class, he said “Don’t you worry I have something for that…”, and before I could even get uncomfortable, I was out. 

When I awoke it felt like moments had passed, not the several hours the surgery had taken. I was groggy and confused, the nurse coming over right away. The brightness of the room was startling, like coming out of a deep dream onto a lake of sun reflected ice. The first thing I was surprised about even with the block anesthetic, was how much my foot already hurt. Initially with my fear of opioids they had discussed giving me something milder, it became quickly apparent that I was going to have to move on from my nausea concerns. Bring on the Percocet! 

I was shown my post surgery scans and all my fancy new hardware. I tried to read the operative report but I was already feeling quite nauseous, still not sure I’ll ever be able to read the whole thing without my stomach turning over. I think I got as far as an incision was made. There is the term they had me at hello, and for me it was they lost me at incision.

I could tell you all about the rest of the day and the long car ride home, the awful process of getting up two sets of stairs in excruciating pain that night as the block wore off, and the long weeks that followed, but mostly I want to mention that almost a year later my emergency surgery insurance claim is still in appeals. 

After being denied by my insurance, as well as my medical group for being out of network, I am still fighting the battle to get it covered. While my E.R. and hospital stay were immediately covered under my emergency room deductible, for some reason the hospital coded the surgery as an outpatient visit. Because you know, I chose to drive five hours away from my house, deliberately break my ankle, only to be able to have an outpatient surgery at an out of network hospital. Gotta love the U.S. healthcare system!