Day 78: Mile 903.0 - 908.7

Today we finished the brief 5 miles to Red's Meadow and got into Mammoth Lakes. And ate some cooked food, and ran some errands, but probably the most important--and possibly most interesting--thing was my visit to the emergency room.

I had originally wanted to go to an urgent care, but I didn't see one on the map. So I went to the hospital and walked up to an entrance as I pulled my mask out. Only it was exit and, it looked like, the place where the off-shift nurses hung out. No, there isn't an urgent care in town, they confirmed, only the emergency room, and it's on the other side of the building.

So I went, checked in, and got ushered into a room within 5 minutes (which was surprising--I was prepared to wait for hours). And got checked out by Jeremy (the nurse), got a few x-rays of my chest by Lars (who had also had bruised ribs before and commiserated with me), and sat around in one of those embarrassing--and chilly!--gowns for a while.

Here's the diagnosis: from the fall, I have a rib contusion. There's no obvious broken ribs or cartilege, but both the doctor and nurse were at pains to say that such things often don't show up on the x-rays--rather, the x-rays are mostly to check for damage to the internal organs, of which there were no signs. For the ribs, even if they were broken or cracked, there's no real treatment or solution other than time and waiting for them to recover. Jeremy did mention that one problem is that a lot of folks sit around on the couch all day during recovery and not breathe as deeply due to the pain, and since the insides of the lungs are somewhat "sticky", without full breaths portions of the lungs can get kind of stuck together and closed up. Then pneumonia can kick in, which is a bad complication. So the fact that I'm hiking--and neither doctor nor nurse saw any reason to stop hiking--should help with that, since the exercise will force breathing. (Although the doctor noted that I was obviously "splinting"--breathing much more deeply in my left lung on the uninjured side, rather than my right lung.)

For the shoulder, the story was much the same. Diagnosed as a shoulder strain--probably getting wrenched during the fall--and again there's not much you can do but keep it moving (but *not* with load) and wait for time to heal it.

So for my ribs and shoulder, the solution? Keep hiking. Yeah, it's going to hurt, but the treatment is just time anyway, and moving about should help prevent complications. The nurse and doctor were pretty calm about the whole thing--I think the fact that I managed to hike out meant that there couldn't be any serious problem--and both saw no issue with continuing to hike. They differed in only one respect: the doctor asked if I wanted any medications. Which are available? Basically just a muscle relaxant, he said, but it'll make you loopy. I don't think being loopy on trail would be a good idea--obviously I have enough problems even with a fully clear head!--so I passed on that. The nurse, though, was much more hesitant to recommend medications. I went over the regimen that AC/DC had recommended (listed below), and the doctor said fine, but the nurse said, well, look. If you don't have to take it, then don't, but if you have to, then certainly do. Why not take it? Just because if you keep taking such drugs they eventually become less effective. But it was interesting to see the two contrasting philosophies in this case: they were never in the room together, so I never got to see them argue it out, but there are clearly differing opinions in medicine.

So that's the diagnosis: nothing broken, and no major organs damaged. At this time, only solution for both ribs and shoulder is time (and even if things *were* broken or torn, that would *still* be the solution). How long for recovery? Probably on the order of weeks instead of months (which is good--I don't want to still be contending with this in Oregon/Washington!). Can keep hiking (and advice is to stay active so hiking isn't a bad idea anyway), so can get back on trail, can do my best to manage the pain, and just keep an eye out for complications (like pneumonia for the ribs, and for the shoulder, just keep track of any actions that consistently produce pain). Overall, a pretty good diagnosis--I had worried if I had ended my hike, and luckily I haven't.

I will say that the staff at the emergency room were really really nice. Very friendly, and Jeremy (the nurse) spent a lot of time talking to me and going over things slowly and repeating important points (I'm not that bright, so the emphasis was appreciated). There was lots of "signposting" where Jeremy would tell me what's coming up before it came up, which was also appreciated. Even Lars, the x-ray technician, was very nice: soft-spoken, asked about the injury, related that he had had broken ribs before and, yes, they sucked. Also was surprised when I mentioned Jeremy was my nurse--oh, he's back now? He was on vacation with his wife in Hawaii, good to hear he's back now. Wished me well when he brought me back to my bed. Even the doctor--who ended up different in the end--was good, not only willing to take the time to answer any questions I had, but patient enough to wait for me to pause and rumble them around my head before saying them. Overall a good experience--probably the best I could hope for--at the ER.

And when I left, and crossed from the parking lot to the road via a back driveway, I looked up and startled a deer crossing the road. I waited and let it bound off up the bluff to the left and over, and continued on me way.

And that was the ER!

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Some notes:

-- Deer Creek > Red's Meadow > Mammoth Lakes

-- Oh, it turns out that AC/DC is a nurse, so on Dylan's insistence, she checked me out at Duck Lake. Mostly a cognitive check--they had heard the story from McQueen, and evidently there had been some concern from Pain Perdu that I had hit my head--and a simple poking around to make sure nothing was broken. But she had recommended a pain regimen: take 800 mg of ibuprofen (4 tabs of Advil), then 3 hours later take 1000 msg of acetaminophen (2 tabs of Tylenol). Then 3 hours later repeat all over again. Do both dosages up to three times a day (so that's 6 x 800 mg ibuprofen, and 3 x 1000 mg acetaminophen). It's ok to have both drugs in your system concurrently, since they are processed in different organs (liver vs kidneys), and this regimen should get to the max daily dosage for each of the two drugs, and cycle things so that when one becomes less effective the other kicks in. And I took 4 tablets of Advil at Duck Lake, took another 4 tablets before I went to bed (didn't take the Tylenol, as it had been some time and I find Advil more effective for me in general).

-- I did send a brief email to my primary care physician at Kaiser--Dr Sacksteder--just explaining what had happened. Didn't want him to be blind-sided if I showed up at Kaiser with a bunch of complications. His response was a simple message: "Hang in their charlie. Just keep breathing even when it hurts." Which I found pretty funny: just keep breathing--yeah, doc, I'll get on that! But, honestly, it's the same advice that the ER staff gave, and though I may joke that it sounds flippant, it's actually serious and the proper medical advice!