Archive for January, 2020

THE FOUR PART DAY, COURTESY OF MIDAZOLAM.

January 29, 2020

It was really all my fault: it was I who suggested to my cardiologist about a year ago that maybe I should be screened for abdominal aortic aneurysm.  I didn’t think I had one, but I’m old, male, and have a waist size that is borderline large for my height.  I don’t think the cardiologist agreed that I had any risk factors, but he scheduled me for a CT Angiogram in a year. He was in no hurry.  He  first wanted to get a CT of my heart, looking for calcium in the vessels, 

That exam showed almost no calcium, good news, but a small hiatal hernia, a fairly common finding, but which I could have done without.  A year passed, I had the angiogram, and the aorta was normal.  That was the good news.  The bad news was that I had diffuse esophageal thickening, which is always abnormal, and which required evaluation. The likely possibility was reflux esophagitis;  maybe I had Barrett’s esophagus, where the lower esophageal lining changes and appears more like the stomach’s, Esophageal carcinoma was a fortunately more remote possibility.  

I initially didn’t think I had significant reflux, but three years earlier, I had a nagging cough that went away dramatically when I started an H2-blocker for acid reflux, again confirming what we know about one cause of chronic cough: reflux.  And when I started thinking about it, I did have some symptoms of reflux, especially if I did some bending over activity when working trail.  I had such reflux up the Aufderheide last August in the Waldo Lake Wilderness that I upchucked, fortunately with nobody else on the crew’s noticing.  Barfing on the crosscut saw would have upset everybody.  Anyway, It’s like my body is trying to tell me that my heart Is doing OK, deal with my esophagus.  

So that is how I found myself one dark morning in the GI lab, about to get an upper endoscopy (EGD), at least with half my clothes still on me, including my shoes.  I was hoping I would only have to ditch the shirt for the study. Given what was going to happen later, I could have walked out of the hospital nude and not been aware of it.

The nurse told me what medicines I would be given, and I heard something I wasn’t sure I heard right, and I didn’t really want to hear it, but I asked her to repeat what she said.

“Versed.”

“Oh,” I replied. “I did have that in 2001 for a colonoscopy, and afterwards, the nurse asked me how I felt, and I said fine, so they let me leave the lab.  Unfortunately, they didn’t ask me if I knew where I was, because the next thing I knew, I was wandering around the hospital parking lot, fortunate enough that my wife, in the car, found me before someone ran me over.” I had no recollection of walking out of the GI Lab, leaving the hospital, and ending up in the parking lot. The hospital later heard about my experience and promptly changed the system to require all patients to leave in a wheelchair, accompanied by a staff member.  The next two colonoscopies I had were done with Propofol, and I did just fine. I actually woke up in the GI lab, rather than leaving the hospital without a clue as to what county I was in. Such a relief.

Just sayin’ be careful with that stuff with me, and don’t believe much I say when I come out of it.  The nurse laughed.  I was serious.

The last thing I remember before the procedure was telling the Indian-born doctor that I really liked the birding at Bhartapur in India, when I was there in 1995.  Incredible place.  Saw 30 species that day.

The next thing I vaguely remember was trying to read the report and understand the pictures from my study, but as I tried to turn the pages, I couldn’t do it. The feeling was like one has in a dream where simple things just can’t be done, and words don’t quite make sense.  The next thing I remember in this induced dream/reality was making my breakfast at home, hearing my wife saying that the bag of blueberries I had picked and frozen last summer had a hole in it. I then remember eating, reading the paper online, and doing some writing.  I even read my report.  I looked at the clock and was surprised it was 1050. The last time I had seen was 0800. Nothing else surprising happened for the next hour, when I had lunch and then let the heater service man in the house to take care of the annual servicing. The gap in my morning was still a gap, and I still wasn’t aware of it.

That afternoon, 5 hours after I got Versed, I took a walk.  I felt fine, but only then did I realize I hadn’t a clue what happened earlier that day.  There were four parts to this particular day, and so far, I had only been aware of two: right now, and before I had the procedure and acting normal at home.  The third part was being at home, eating two meals, and having lunch, but not being aware I had had a deficit. That deficit itself was part four, when I was able to remember anything.  I did not remember the doctor’s talking to me after the procedure, my getting dressed, walking out of the hospital, to the car, riding home, getting out of the car, and going inside.  None of it.  

I walked for nearly an hour, came home, to where my wife had some concern that my note “Took a walk” didn’t include the needed comment, “I really know who I am now.”

This loss of memory is known with Midazolam (Versed), and a friend of mine had a similar problem after a colonoscopy, although hers was more like Transient Global Amnesia, a disorder of unknown cause, that typically lasts about 12 hours, or Global Amnestic Syndrome, which typically follows a significant head injury.  The way I would test for these two disorders was to tell the patient my name, then leave the room, and come back in a minute later (or even after 30 seconds) and ask if they knew me.  With the above conditions, they would not know me.  

Once again, we are fortunate in our house to have medical knowledge. I don’t know what an older couple would do if they suddenly heard their partner ask over and over again where they were.  My wife knew that I would eventually return to the world of memory, but she didn’t know exactly when. 

I didn’t turn in my smiley evaluation to the GI lab, because I when I left the lab, didn’t know who I was, let alone where the box was to turn in the evaluation. I felt like the man in Blazing Saddles, who woke up in jail, so maybe I need an “in jail” smiley. My review will be the one of my favorite lines in response to the black sheriff’s asking, “Are we awake?”

“We are not sure. Are we black?”

“Yes, we are.”

“Then we are awake.  But we are very puzzled.”

SEVERAL MONTHS AT BRICE CREEK

January 15, 2020

In the first ten yards there were two large trees down over the Brice Creek trail, blocking access and part of the view down the trail, although when I stepped off the trail to look through a gap in the mess, I could see more downed trees ahead. By large, 24-30 inches in diameter. They definitely were not the step over variety, but rather the too high to climb over, too low to go under variety.

One of our group in the Scorpions Trail Crew had actually walked the entire 5.7 mile trail and said the whole trail was like this. It took her 4 hours to do it, and she is a trail runner.  Maybe she flies, too, which would explain the 4 hours. I hike at a decent pace, and a couple of months later, with far less to scout, I quit after about a mile, because I felt the blowdowns were too dangerous to negotiate. 

Brice Creek is 25 miles east of Cottage Grove, Oregon, a popular place to go to hike, picnic, camp out, see waterfalls, swim in the creek, and cool off in summer.  Further up the road and uphill leads to Bohemia saddle and mines, other places to go, but Brice Creek is a gem of the Umpqua National Forest. Unfortunately, their sawyer was seriously hurt doing work earlier in the winter, and they had nobody to clear trails.  That’s how we got called.  

The Scorpions themselves began 14 years ago, after a Forest Service employee retired and realized that some of the trails she liked were not getting maintained and would soon be impassable if nothing were done. She and Ron Robinson, a retired executive, started the organization, and Larry Dunlap, a retired ED physician, was part of the original group. There are about 90 members, and I began as a trail scout, hiking the trails, taking pictures of the blowdowns, putting GPS coordinates in them, and getting the information back to Ron. 

I had heard from a couple of hikers in the Club who had worked on a trail hauling rocks, saying it was a bad idea to try to work for the Scorpions. But I felt I should go out and see what they did and see if I liked it. I had to sign a waiver, and I didn’t need any training, Ron’s saying that I would get plenty of OJT with them.

On a dark morning at 7 am,  mid-December, 2017, I met up with a group of about a dozen in Springfield, headed out to Rebel Rock Trail in the Three Sisters Wilderness. It’s about an hour and a half from town, and we arrived at the icy trailhead with the temperature somewhere in the twenties, and a bunch of old guys pulling out Pulaskis, 5 foot long crosscut saws, McLeods, Pick Mattocks, a rock bar, and a Peavey.  Mind you, I only knew about saws and Pulaskis, and that was because I had done trail work in the Boundary Waters back in 1992. We each matched an arm with a tool and started hiking.  I figured we would go in about a quarter mile, but we hiked for more than an hour, uphill, before we reached the blowdowns.  Twelve hours later, I was home, really tired, realizing how out of shape my arms were, figuring we had cleared maybe a half mile of trail in addition to a 9 mile hike that gained 2700 feet of elevation.  

By the time I started on Brice, it was eighteen months later and 40 more times out with the crew. I had stopped for 5 months, not sure I wanted to do it again, but again signed up for the early morning departures, long drives, hikes in, chain saws (if outside the wilderness), cross-cuts if in the wilderness, trying to stay safe, do my part, stay hydrated and fed. 

We tackled Brice Creek with multiple saw crews, the way we had other low elevation trails that the winter storm had plastered.  There was cutting to plan, pushing cut logs out of the way, trimming branches so the cutter could get to the trunk, clearing 12 or more inches of often frozen, always wet branches on the trail so we could get down to dirt. The days were long, the work hard, wet, and cold, but we gradually cleared the trail of major blowdowns over several weeks.  It was gratifying to see the trail again reappear and be usable. Many of us swampers (not chain sawyers) moved to the high elevation trails to clear them in the summer.  I left Brice in early July to go up into the Waldo Lake and the Diamond Peak Wilderness, clearing several trails and getting an excellent mental map of the trail system, the geography of the place, water sources and campsites.  

As fall came, there was a need to do trail work on Brice. The trees that had fallen had root balls that came out of the trail, leaving a big hole. We needed to clear the dirt, rocks, branches and route the trail either through the hole, fill the hole, or route the trail around the hole.  Fortunately, there were three entrances to the trail, so the hiking in was limited, leaving more time for work.

Upper Trestle Falls remained, however. There had once been a small railway where the trail was, and from that area two trails went to a lovely waterfall a mile and a half up and 700 feet climb. This had been logged out, blowdowns removed, over the summer, but now the trail there had to be rebuilt, too. 

First job was for me to go in and scout the trail.  I did that with the Gaia app giving me the trail, the contours, and a way to photograph the trail defects with location.  I mapped about thirty spots in the 3 mile loop and a hiked seven more miles to check out other parts of the trail.  Now the weather was different, with a wetter, much muddier trail, and significant work to be done with tools being carried uphill.

The eastern portion of Brice Creek Trail, with the triangle at the right the two branches to Upper Trestle Falls.. The waypoints are areas I felt needed work. There were about ten more on the right side part of the loop that also got work.
View from behind Upper Trestle Falls, at the highest point of the loop.

The pictures really do tell the story.  So here are some.

The mess of logs and branches on the trail.
Starting after a lunch break. One can tell this because two people don’t have hard hats on.
Sometimes, we cut steps through logs, especially if there is a risk that if we cut them all the way through, there might be unintended slippage of what is left behind.
I’ve worked with a dozen different sawyers, and it is my job to be there immediately with something if they need it, requiring anticipation, and to stay out of the way while cutting is occurring, but watching for anything that might suddenly become a hazard that the Sawyer can’t see.. Along the way, I start learning about where the log compression is and what we think will happen when it is cut. We think will happen.
Brice Creek was always nearby, with nice views of many pools, rapids, and cool spots.
A typical pair of blowdowns. In the high country wilderness, these must be cut with two man crosscut saws.
This requires extensive digging out below and above and rerouting the trail slightly to the right.
The trees were about 300 years old.
Four people, one day.
Part of my scouting. I took this out with a small hand saw.
The close tree above the trail has to stay, because if it is cut, there is a good chance the whole downhill part will slide down to a road below. It is safe and possible to walk under it.
The original trail was where the log on the left is. We moved it by digging out in the obvious mud and making a more gentle gradient. The log at the top can’t be removed safely in winter, so a streamer was attached,
Before
After. The sawdust was from cutting two smaller logs nearby as well as the big one.
The author, left, with the “flying” trail scout, doing work on the Upper Trestle Falls trail on a day with snow flurries and temperature in the mid-20s. (-4 C)