Big Scares and a Happy Ending

No amount of sleep would prepare me for the dangers that I actually encountered on the next leg of my trip. Obviously, a happy ending allowed me to post my next entry, but I certainly came very close to death on the way to the happy part of my story. Over the next 16 days, I experienced three medical emergencies in varying degrees of severity.

Unaware of what awaited me on the next stretch of trail, I took one last shower before checking out, and I left the creature comforts of Franklin. After one last celebratory coffee, I made my way to the free 11:00 AM shuttle to return to the trailhead. The weather I met as I took my first steps was perfect, sunny and warm. I felt as eager, clean and rested as I had yet on my hike, and I set off energetically on my ascent away from the road and into the woods. I made a good day’s walk that day, and as the day turned into evening, I set up my tent for a dry, quiet night.

The next day, I continued on until I came to the “Wilson Lick Trail”, which led .2 miles west to what was described in my guide as a “historic site.” Some thru-hikers can only take the time away from the real world once, and pass up on detours like this for time constraints. I decided that I had enough time to see this, so I decided to investigate. The big attraction here was an old house and ranger station, which, although locked, had a sign with pictures and some historical information about the people who had lived and worked there since the early nineteen-thirties. I’m not entirely sure if all of this was worth the detour, but it was nice enough. One never really knows what exactly they’ll come across on the trail, but I meant to take notice of as much as possible! The AT plans laid out by Benton McKaye in the early 1920’s have changed their formal course over the years since, and interesting sites like this one appear from time to time. The land around the trail supported the American Revolution and the Civil War, as well as the general other comings and goings of civilization. Sometimes there are headstones that predate the trail, left by homes that have long since disappeared. I took pictures of most things I came across, but that depended heavily on whether I thought it deserved using up precious battery power.

Once I finished the detour and returned to the AT, I hiked on and eventually came to a cool stone tower that had originally been a fire tower, but now remains open to visitors for the sole purpose of climbing for some really nice views. I decided that this actually deserved the battery power. I climbed, and grateful for cell signal, I posted some pictures. The following day I came to a taller observation tower, but it was both cold and rainy. So I didn’t bother to climb it- after all, thanks to the haze of rain and fog there was nothing to see, much less photograph.

That night, I found a small spot in which to camp and went to sleep. I hoped that the weather would clear up a bit, but it didn’t. I woke up the following morning with my tent having collapsed in the rain, and myself more than a little bit tangled up in the sides of it that lay all over me. After finding my way out, I began to gather my stuff together. In doing so, I found that I couldn’t move very well. My legs didn’t seem to want to move. It was bizarre; they felt like someone else’s legs, and just did not want to respond! My whole body behaved the same way- hesitant and uncertain, as though the instructions I gave might be wrong. I stood up and almost immediately fell down; I did not land on my face, sparing my already precariously repaired glasses, but on my head. This did not help matters. I attempted to get back up, but couldn’t. Eventually, I rocked back and forth enough to change the way I was facing, and to crawl in the wet dirt back up the slight hill to where my equipment waited. Someone came by, and asked me how I was doing. I tried to answer, but found that I couldn’t really speak, my speech badly slurring in an unwilling mouth. Finally, I got the word “hypothermic” out, and Strider introduced himself. He took off his pack and made me a cup of soup while he waited for his friends to catch up. After a while, with the aid of a tree and my new friend Strider, I stood up, hoping that movement would help my body resume a more normal temperature. My speech improved enough to be able to communicate, and I thanked him for slowing down for me. The rest of the group arrived, and between them they gave me a bit of cheese, some Gatorade, and a little bit of peanut butter. As they helped me gather my supplies and pack my things up, we noticed that my sleeping pad lay deflated. Some examination revealed that a two-inch hole now graced the side of a tube. The repair kit I carried would repair only a puncture, and this injury required a seriously substantial patch. The flatness of the pad meant that I‘d slept directly on the ground, in a down-filled bag, which held the moisture in. No wonder, I thought, that could not have helped the hypothermia! Fortunately it was a sunny day, and with the help of soup and movement, I began to feel much better. Enough so that I hiked with them over four miles down to the Nantahala Outdoor Center, or NOC. They insisted that I hike in the middle of their group, so they could perhaps catch me if I fell or keep an eye on my symptoms. Although I didn’t think it necessary, I agreed to do so because of their kind intentions.

When we made it to the NOC, I got a room. This was a planned stop for me as it is for many thru-hikers and an easily accessible and popular starting point for day- or section-hikers. Shortly after arriving, I lost track of all of the people with whom I’d hiked down with in the crowd. I ended up staying at the NOC for 3 nights, as it was cheap ($18/night), and there was everything I needed: laundry, showers, several restaurants, Wi-Fi (so I could use FaceTime for a few minutes, as long as I sat somewhere near the router), and even an outfitter. Pax sent a mail drop express via the Post Office since I needed a sleeping pad and new glasses. At least I only had to sleep one night on the ground, and my sleeping bag had time to dry out thoroughly. I sent home my split open sleeping pad, thinking that maybe it could be returned or repaired. The unit was pricey, and the replacement pad, though lightweight, had also been expensive. The failure, however, disappointed me for more than a medical or financial reason. I liked the concept, but apparently it requires more development. I never figured out exactly how it split like that.

I dropped off the box to be sent home and left the NOC. From there, I hiked about 8 miles, mostly uphill, to a shelter. There were a few people there already, making dinners and getting settled in. I decided I didn’t feel particularly hungry, so I ate a couple of Snickers bars. By the time I went to sleep, the shelter had filled up. I drifted off to sleep, feeling slightly irritable and crowded.

I thought someone was waking me up, I thought I was asleep, but now, the next thing I knew someone was talking to me. Behind them, I heard radios and other people stirring. Much later, I got the details of what had preceded that strange awakening. Apparently, during the night, I’d started shaking in my sleep. This happened four different times, with varying intensity. Beyond that, I repeatedly cried out, as in a nightmare. The disturbance I created woke those nearest me, who probably initially just wished I’d shut up. Eventually, someone realized that I lacked control over the shaking- and called 911. Luckily, there was cell service at this shelter! I’d been having seizures as a result of my blood sugar crashing.

If you don’t know, type 1 diabetes works like this. My body doesn’t produce the insulin it needs to break down food into nutrients it can use. If blood sugar goes too high, insulin brings it back down to the “normal” range. I take two kinds of insulin. One is short acting (for after meals), and one is long acting, that I take at night. At home, this routine maintains my health. On the trail, I carried both with me. Since I was eating carbs and Snickers bars, I would keep taking both so my blood sugar did not get too high.

In this case, my blood sugar went too low, and since I was asleep, I couldn’t eat sugar or carbs to bring it back up. The fellow hikers did not know that I was diabetic, and didn’t know that this had caused the seizing. The paramedics gave me glucose, and shortly had it under control. They really wanted me to come down the mountain with them, but I decided not to, thinking that since it was now under control, there wasn’t really anything else anyone could do. The fact that I hadn’t made dinner was compounded by the fact that I had taken the normal amount of insulin, so naturally my blood sugar had crashed. I acknowledged my fault in failure to eat dinner, and promised not to let it happen again. I gathered my things the next morning, and resumed hiking. With no reason to lack confidence, I set off.

That day, I hiked about 7 miles to Stecoah Gap, NC, where I found a couple of jugs of filtered water and a Tupperware container containing a pile of business cards for both a cabin that cost $60/night and a hiker hostel that only cost $18/night. Since it was late when I arrived, about 7PM, and in light of the previous night’s experience, I decided to call the number- especially since the hostel also provided a free shuttle to and from the trailhead. Donna, the owner, picked me up a short time later. She informed me that since her husband hadn’t finished the plumbing in the hostel, she would put me in one of the cabins for the same price. I expected many people to be already there, but I had the entire cabin to myself. Not only was the room equipped with a coffeemaker, but coffee! This cabin was also equipped with satellite TV, a microwave, all manner of dishes, a covered, screened porch, and of course, a shower. It was fantastic! Again fortune smiled on me, because that night 13 states, including this one, had severe thunderstorms, which brought devastating tornadoes and flooding. In fact, when Donna came to get me at about 10 AM, she pointed out that not only could we not see the intersection at which she’d gotten me due to the heavy rain and fog, but that more storms were coming that way. She told me that her husband would shuttle me up to Fontana Dam, NC for $15. Now- I hesitated to do this, not only because of the money, but because I’d miss about 13 miles of trail. While hiking, one doesn’t normally get forecasts about coming bad weather, so when you do, you look for ways to avoid getting stuck in it. If I couldn’t make the 13-mile hike that day, through storms, then I’d certainly be sleeping in the rain. Not only rain, but possibly also tornadoes and hail.

Initially, I justified taking the shuttle. We went to the spot that I’d been picked up to get another hiker, and I was glad to see that not only had the rain stopped, but that it was sunny! So, I got out and decided to hike to Fontana Dam. I made it 12 of the 13 miles, and decided to camp for the night so that the next morning I’d only have to hike a mile to the road crossing.

The next day, I made it to the road and the bathroom that had a house phone on which you could call a $3 shuttle to bring you the 2 miles to the village. As soon as I got there, and was reaching for the phone, an elderly gentleman in a pickup truck called out to me and asked me if I’d like a ride. He introduced himself as Gene, and ended up giving me a ride to the post office, where he waited for me to get the package I’d expected. After I got it, he offered to bring me to the general store, and then back. I didn’t really need anything at the store, so I asked him to just bring me back. Instead of bringing me back to the road crossing though, he brought me to the visitor’s center at the dam. This cut out about a mile of trail, but I didn’t really want to ask the guy if he could bring me to yet another place after he’d been so kind, so I got out there. I spent a couple of hours at the dam, indulging in Diet Coke, and some time reading. I also got a backcountry permit to allow me to camp in Great Smoky Mountains National Park. Without the permit, you can only camp in designated shelters and campsites, or risk a $230 ticket from a park ranger! The permits are free, though. I’d planned on staying in the “Fontana Hilton”, which is a large shelter with hot showers, but it was a half-mile uphill in the wrong direction. I felt good, so I just continued on, over the dam and into the park. I hiked about 5 miles to a campsite, and stayed the night there.

The next day I hiked about 8 miles total. I stopped to get water at the first shelter I passed, and knowing that I had to stay in a shelter because of the park regulations, I decided could manage to get a bit further. Another shelter was only 2.5 miles on, so I continued to Russell Field Shelter. It was only about 3 PM by the time I arrived, but I decided to make this my home for the evening, since the one after that was considerably farther. Others came along, and when night fell, there were 18 people there, including a ridge runner. I should have been considerably happier to not to be alone, but I did not know yet just how luckily it worked out that I did not sleep alone that night. I made sure to make dinner, as I’d promised myself and everyone involved in the previous shelter incident that I would, and went to sleep. Unfortunately, dinner was not enough.

I remember much more of the beginning of this incident. When I woke up, I was shivering uncontrollably. Someone sat up next to me, telling me to stay calm, and making sure I stayed on my sleeping pad. I was covered in an emergency blanket, as well as an extra coat. Not only were my clothes soaking wet, but the down jacket I’d worn to sleep was too, and my sleeping bag was drenched. I tried to communicate, but again, I couldn’t speak. I’d try, but I couldn’t enunciate. I remember the struggle of my brain fighting really hard to try to make my mouth work, so I could be understood, to no avail. This was extremely frustrating to me. I needed to tell them that I knew what was going on: once again, I was experiencing hypothermia. Not only was the temperature as low as about 40 degrees that night, which my down coat and sleeping bag could have kept me safe in, but once again my blood sugar was dangerously low. I had eaten dinner, I remembered feeling ok afterwards, all I needed was to tell them, but I couldn’t get it to come out of my unwilling mouth.

One of the side effects of extremely low blood sugar is that you break out in a sweat, and this was why I was soaked. Then, because the temperature was near freezing, I became hypothermic. The other hikers later told me that I’d had, over an hour period, four seizures. One of which was so bad that I’d hit my face, drawing blood. I also managed to hit my foot, hurting my big toe. I remember calling out for my girlfriend, and someone told me that they had called her. I’m not completely clear on the chain of events, but someone must have gotten my phone out of my pack and looked up her number.

While the paramedics hurried through the dark towards me, the dispatchers at the Smoky Mountain Park Ranger’s office called her to get my medical history or anything that might help. Pax relayed as much as she could, my mother being the only one who might know more, and at present she slept under heavy sedation following back surgery. Michelle from the ranger’s office checked back with her every half hour or so through the night, so that she knew how things progressed. Some time later, Pax told me about the calls. Each time, Michelle would ask if she recalled anything else they might need to know when they got to me. Did I have medicinal allergies? Other conditions? While her concern was apparent, the woman kept her tone soothing, assuring her that everything that could be done, would be.

The shelter sat high on a mountainside, far from roads, and medical attention does not come quickly. Paramedic ridge-runners, employed by the U.S. Park Service, would have to climb 9 miles in order to inject me with glucose, and put an I.V. in. And they would have to hurry: if low blood sugar is not treated, I would, at best, go into a coma, and death was certainly possible.

Around four thirty, I had the final seizure, and the others in the shelter reported to dispatch that my breathing was shallow and irregular. Pax didn’t hear from dispatch with the usual quickness this time and called them to check in. Dan, another dispatcher, had Michelle call back in a few minutes. Very gently, she relayed this development, and suggested that Pax pack a bag and be ready to reach out to my family. The Park Ranger’s office had begun preparations to launch a rescue helicopter, in case the ridge runners could not find me soon. If that happened, I would be hospitalized, and someone should be there.

The helicopter never deployed. Fortunately, the paramedics made it to the shelter at about 5 AM. They put an IV in, giving me 50 units of glucose. Shortly thereafter, I was suddenly able to speak again, and they tested my blood sugar, which was only 28. Now, normal range is anywhere from 80-120, so mine was extremely low. I felt confused and weary, but I was in able hands, and alive. They checked it a couple more times and then told me to get some sleep, and that they were going to stay there for a while. About 7:30 one of the paramedics woke me to say that I should make some breakfast, so I boiled water for oatmeal and hot chocolate. By this time, my blood sugar had risen, and they continued to check. I don’t remember all of the readings, but I remember it was 175 at one point.

I felt restored. Dawn was breaking and my sleepy shelter-mates re-filled their packs and set off. My blood sugar stayed at a normal level, and I decided I felt well enough to hike on. The paramedics really wanted me to come down the mountain with them. An ambulance would meet us, and take me to the Hospital in Gatlinburg to be examined by a doctor. They expressed concerns that this could happen again, if it was related to something more than my diet. They told me that next time I might not be so lucky. I told them that what the ER would do. I would be put in a bed, where they’d test my blood a couple of times, and then discharge me with a $1,000 bill. I didn’t want to backtrack to pay for a hospital bill when I knew that there was really nothing an emergency room visit could do. I suggested that I make a phone call to the hospital and talk to a doctor, so they called their on-call doctor, and he and I spoke. We agreed that all could do was monitor me and then set me loose. I’d be stuck in Gatlinburg, to hitchhike back to the trail. I knew they’d think me insane for wanting to go back on the trail, and I didn’t need the discouragement.

The doctor and I discussed how to keep from having another scare, because remembering to eat was clearly not enough. He advised that I should reduce the amount of long-acting insulin that I take, as that was the likely cause of these crashes. My body undertook changes during the hike, and while my diabetes would never be cured, the ongoing need for insulin injections lessened under large amount of physical exercise I got carrying my pack up and down the mountainous trail. I definitely underestimated the exertion of this hike, and the resulting drop in blood sugar. Now I know.

I signed a waiver, against medical advice, which released the medical team from liability due to my refusal to go the emergency room. After several more warnings, the rangers left. I spent much of that day at that shelter, drying out my sleeping bag and down jacket. I called my very relieved girlfriend and told her that I would not be going to the hospital, and that I was fine. She made sure that I felt certain, and I did, that my hike would continue, and I promised her, just as I promised the paramedics and the doctor, to get a (lightweight) blood test computer. When my gear had dried in the sun, I finally hiked about 3 miles to the next shelter. That night, I had popcorn around a campfire, had some good conversations with some good people, and slept through the night. Uneventfully, which was all I could possibly have hoped for. I felt absolutely, completely fine.