Monday, August 10, 2020

Vacation, 2020 Style | Part 2, The Lost Day

Restless

It must be something I ate.

I was lying in bed, subject of a quiet battle waged between the pain in my abdomen and the inertial vestiges of sleep. As the unfortunate owner of a fickle digestive system that frequently lets me down, I am no stranger to abdominal pain in the middle of the night.

With the pain increasing, inertia surrendered to discomfort and I staggered out of bed grumbling quietly to myself. 

Growing wakefulness brought a realization that the pain was unusually intense and that it was oddly localized to a single point on the right side of my back. I was slow to realize it, but this was not "tummy trouble". Something was wrong beyond the norm.

Appendix?

Years ago, two of my friends survived severe bouts of appendicitis and I remembered well the graphic descriptions of their experiences.

Correct side, but wouldn't appendicitis cause pain lower down and closer to the front?

With a surge of pain-induced nausea, I lost nearly everything in my stomach. So much for Emma's Raspberry Roadrunner ice cream. It was not even remotely as enjoyable when traveling in reverse, another life example where polarity matters.

My mind was still working the problem.

Kidney stone? I had never experienced one before. But the symptoms fit my perception of how that might feel. I was in no condition to browse the internet to verify my thinking.

"Are you OK?" Kristy's voice, quiet in the dark to avoid waking The Bear.

"I don't think so."

Kristy's internet sleuthing strongly supported the kidney stone hypothesis. While she was engaged in being useful and supportive, I threw up two more times. As the night wore on in an excruciating blur, the locus of pain seemed to move lower.

Although Lake Placid boasted an urgent care clinic and a small, four bed emergency room, neither would be available until the next morning. I took Motrin to manage the pain and somehow fell asleep shortly before 6:00 am after being awake all night.

DIY Sarcophagus Kit

I awoke like a resurrected pharaoh, flat on my back with arms banded tightly across my chest in a weird kind of self-embrace. Each hand tightly gripped the upper portion of the opposite arm and all of the muscles involved were sore as though they had been clenched for the entire time I slept, about 1.5 hours. I eased the tension by deliberately relaxing my hands and arms.

"How are you feeling?" Kristy asked when she saw the movement.

I paused to self-assess. "Pretty good, actually." It was true. Aside from my self-induced muscle soreness, I felt no pain whatsoever.

After an excursion downstairs, Kristy and The Bear returned with breakfast. I managed a small container of yogurt, but my stomach balked at the thought of anything more substantial. Sorry mini omelet, there is no room at the inn for you today. We made a plan for me to get checked out at Lake Placid's urgent care facility when it opened at 9:00.

With The Bear happily reconnected with Izzy and her family, Kristy and I hopped in the car and I drove us both to Mountain Medical Services. It was closed, the sign on the door referring us to a sister facility in Saranac Lake approximately 20 minutes away. Back in the car, we headed northwest through the same notch in the mountains that I use when departing the Lake Placid Airport for home in the Warrior.

Check-in at Mountain Medical was accomplished by calling the front desk and leaving a voicemail. Much like vampires, patients could not enter the facility until invited. We waited in the parking lot for the better part of an hour as it emptied of patients that arrived before us. Without much warning, the pain came back with a vengeance and, just as I reached the dry-heave stage, my phone finally rang.

Still retching, I explained my symptoms and self-diagnosis. "You should go to the ER," said the nurse. "We don't have any way to check you for kidney stones." I was going downhill quickly and threw the car keys to Kristy. She entered the Lake Placid ER into Google Maps, started the car, and got us underway. My only job was to groan every time we hit a bump and I did it well. Because of a miscue from the iPhone, we turned the wrong way in exiting the parking lot.

That wrong turn was our best break of the morning. After travelling about a mile in the wrong direction, we encountered the hospital run by Adirondack Health and it looked like a much better solution than driving all the way back to Lake Placid to visit a four bed ER.

I cannot say enough good things about the staff at Adirondack Health. Seeing that I was in distress when I stumbled through the entrance, they triaged and admitted me to the ER within minutes.

"Sounds like a classic description of a kidney stone," commented Denise when I explained my symptoms as she took my vitals. 

Yay for a plausible self-diagnosis?

Later that morning, I was asked to describe my pain on a scale from one to ten in reference to definitions on a nearby wall chart. The pain had definitely ebbed somewhat since my arrival. "Six," I responded. I noticed from the chart that pain severe enough to induce nausea was defined as an 8/10. So, I was at an 8 last night, I thought. As a scientist, the ability to quantify that sensation on a known scale was oddly satisfying to me.

My primary nurse was Bri, a young professional with a fantastic bedside manner who recently transferred to Saranac Lake from central New York. "These infusion sets are put together differently than the ones I'm used to," she commented as she made a bloody mess of my arm while inserting an IV.

"How recently did you start here?" I asked as she cleaned up my arm.

Sheepishly, "Today is my first day. I don't even have access to the computer systems yet." Despite the unfamiliar tools and environment, Bri took great care of me.

Meanwhile, Kristy's phone periodically announced incoming photos from Dena showing Izzy and The Bear playing miniature golf, "bungee jumping", and paddleboarding on Mirror Lake. The girls were having a great day.

The Oklahoma City Perspective

From an FAA perspective, kidney stones are a big deal because they can incapacitate a pilot. A one-off instance is not necessarily concerning in the long term, but recurrence can be medically disqualifying. Repeat offenders may still be granted a Special Issuance medical certification if data exist to demonstrate that the pilot will not be suddenly and unpredictably debilitated by their condition. 

Let's hope that my case stays in the one-off category.

Regardless, I was grounded until the present issue was resolved. This meant that I spent part of my time in the ER scheming about how to get everyone home safely. Flying Warrior 481 home in my current condition was a nonstarter. We could always drive back to Rochester with Dena and Mark, but after stranding the Warrior in Dansville for four months this year, I was determined not to abandon my airplane in Plattsburgh. If I could get two pilots to fly out and rescue us, one of them could take Kristy and The Bear home and the other could fly Warrior 481 back with me as a passenger. I created a mental short list of pilots whom I'd trust to fly my airplane home. It was a good scheme and I made a plan to reach out to my most trusted pilot friends once I was discharged from the hospital.

After a visit to the CT scanner, the ER staff confirmed that I had a single stone that was on the large end of being small enough to pass. "Congratulations, this is the closest you will ever come to the sensation of childbirth," deadpanned Lauren, the PA in charge of my case. She advised me to drink a lot of water and speculated that it should pass within the next 24 hours based on its current location.

After about four hours at the ER, I was discharged. I had entered the little Adirondack hospital anxious about the quality of care I would receive there and departed utterly grateful to Denise, Bri, Lauren, Crystal, and the rest of the ER team who took such excellent care of me. Kristy handled the driving duties back to Lake Placid. We made a brief stop at the most alpine looking Walgreens I have ever seen for meds and a good supply of potable water.

Free Beer!

While the girls played games and ate their own "picky kid" dinners in Mark and Dena's hotel room (seriously, The Bear regressed back to her chicken fingers phase), we adults waited a long time to be seated outside at the Lake Placid Pub and Brewery next to our hotel. For my part, I relied on a big dose of Motrin to manage the pain. Fortunately, I had no more severe episodes for the rest of the evening.


If we waited a long time to be seated, we also waited a long time for our food. Even the kids were texting to ask when we were coming back. But I hardly noticed the passage of time. My cloudy pint of cold Hefeweizen really hit the spot and face to face adult conversation with Mark and Dena was very welcome. When our food came it was good; Kristy and I split a margherita pizza and the ADK Power Salad.

"I comped your drinks because the kitchen took so long," our waitress explained. "Anyone want any more beer? It will be free!"

I looked at Mark and Dena with incredulity. Once was a fluke. Twice hinted at a pattern. Was there something about the culture in Lake Placid or did our friends have some kind of undisclosed super power to get free stuff?

Managing Through Uncertainty

Monday ended far better that it began, but with a plethora of new questions. I now knew that I had a kidney stone. I also knew that I only had one, so that once it was passed, my woes would be over. Beyond that, everything hinged on when the stone passed. How long would that take? How were we going to get home? Was it ludicrous to even consider an additional side trip to Maine on Wednesday? The Bar Harbor hotel cancellation policy required notice before 6:00 pm on Tuesday, so there was still time to make that assessment. If I wanted someone to fly Warrior 481 home for me, who would it be?

Sometimes, playing it by ear is the best strategy. This was one of those times.

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