Hiking Buddy Pt. 01

"Aren't antihistamines for allergies?"

"They are, but most of them also produce drowsiness, including the one I gave you. In fact they're used in some over-the-counter products for insomnia. I gave you enough to put you out."

Dan smiled slyly at me and asked "Are you sure you'veneverbeen a doctor, or a pharma¬cist?"

"I'm sure" I answered. "I told you, that stuff just interests me. And it's good to see you smile."

"I really appreciate your doing all this" he responded, and the smile was now warm rather than sly.

"I feel awful when I see you suffer" I told him. I reached over and brushed the back of my hand lightly over his cheek, adding "I care about you".

I would like to have kissed him again, but I didn't dare do that, even if it were on the forehead, now that he was awake.

He was silent for a minute, and I thought I might have stepped over a line by brushing his cheek and saying that I cared about him, but he replied "Well I'm grateful foreverything".

That alleviated my concern, but his statement was also provocative: He had emphasized the word 'everything'. Had he possibly been wakeful enough while I was fondling him to know what was going on? It was not likely, because at that time the blood level of antihistamine would have been high, so even if he had been dimly aware, he should have forgotten it afterwards just as he had forgotten about the hikers.

Yet I wondered just how carefully he had chosen his words. Eventually though, I decided that I try too hard to analyze things.

It was another half hour before we heard the sound of the approaching medical evacuation helicopter. Dan had been sleeping on and off, and was still slightly groggy, but the analgesic had largely worn off and he was again in considerable pain. He was fighting back tears.

I told the two EMT's about the drugs I had given him, and asked if they were going to give him something for his returning pain. They said that they needed permission from the hospital, and warned me that the ER doctor who was on duty at the time rarely gave permission for palliative medication except in extreme cases.

They took Dan's vital signs and examined his foot. I asked whether they concurred with my opinion about the nature of the injury. The senior EMT said that they were not allowed to express an opinion on the matter but then he added, with a wink, that if theywereallowed, he would agree with my diagnosis.

They used their field radio to contact the hospital. As they expected, permission was denied. The Emergency Room physician said that based on the vital signs and the results of the examination, Dan's pain "should be tolerable".

I asked the EMTs whether the doctor would think it was tolerable ifhewere the one in pain. They looked at each other, smirked, and declined to state their opinions. One of them was willing, however, to say that with rare exceptions doctors are the worst patients and the quickest to demand palliative drugs.

They put Dan on a stretcher and covered him. As they were carrying the stretcher toward the helicopter, I noticed that the blanket seemed to be moving. Dan was trembling in spite of the covering and the fact that the weather was now warm and sunny again. I glanced at his face. He looked like a terrified little boy.

I took one of Dan's hands between my own two hands and smiled at him as I walked next to the stretcher.

His trembling stopped.

Dan didn't want me to let go when we got to the aircraft, but the EMTs told him that we had to separate so that they could get the stretcher inside.

Dan asked me anxiously if I was coming with him. Seeing him so afraid, I said "Of course", but the EMT's told us that they were not supposed to transport anyone except the patient.

Dan begged them tearfully to let me come with him. I know they see heart-rending situations all the time, so I was astonished that his piteous pleas got to them. They agreed to take me along, saying that they would think of some excuse if challenged at the hospital.

As soon as they had secured the stretcher and I was buckled into a seat next to Dan, he reached over and grabbed my hand. He told me in a shaky voice that he had never been in a hospital except as a visitor. He was petrified by the prospect of being there as a patient.

I asked the EMT's which hospital we were going to. When I heard the name, I told Dan that it was an excellent facility and that he would get the best of care.

"Do you really know which hospitals are the good ones?" he asked nervously. I told him that I have a physician friend who has told me which are the best hospitals in the area, and that this was one of them.

Some of the fear left Dan's face, but he kept hold of my hand throughout the flight.

At the hospital, in spite of Dan's request the Emergency Room physician flatly refused to let me come into the ER with him, and Dan was too worn out by then to plead.

I recognized the doctor's voice: He was the same one who had refused to give approval for analgesic medication.

At least I was allowed to watch through the window. I saw them undress and examine Dan and wheel him off to the X-Ray department. When they brought him back, there was a minute or two of conversation and I saw him shake his head emphatically "No" in response to a piece of paper the ER doctor presented to him.

The doctor came out and grudgingly led me into the Emergency Room, telling me that I needed to "talk some sense into the patient".

I learned that the X-rays had revealed a fracture. A bad one. Dan had been told that he was being admitted to the hospital and that the following morning they would put a pin in the ankle. He had been assured that it was "a routine surgical procedure", and the ER doctor had handed him a consent form. The reason the doctor had to let me in was that Dan refused to sign any document unless I reviewed and approved it.

Dan was still in great pain. When I asked whether he had been given anything for it, the ER doctor told me that in order for Dan's consent to be an informed one he had to be fully alert, and that a narcotic would prevent it.

That made me furious! I stood within inches of the doctor's face and asked, in a raised voice as I pointed to Dan: "Wouldyoube able to think clearly ifyouwere in that much pain?" Then I shocked him by mentioning several powerful non-narcotic analgesics, using their chemical names rather than their brand names, and demanding to know why he had not administered any of those. "They're not as effective as opiates" I continued, "but they're better than nothing.Now you give him some pain medication! Otherwise I'll yank him out of here and take him to a hospital where the ER doctors are actually concerned about their patients and not just about covering their own asses!"

He glared at me but directed a nurse to give Dan an injection of one of the drugs I had mentioned.

Only when I judged that Dan's pain had subsided sufficiently did I let the doctor explain the situation. He informed us that if they didn't pin the ankle, the bones would not remain in proper alignment during healing and the resulting permanent deformity would make walking difficult.

I irritated him some more by requiring him to show me the X-ray. As I scrutinized it, he asked skeptically: "Do you want me to point out the fracture?"

"If you mean the major fracture near the talus" I replied, "it would be hard to miss. But did they notice the hairline fractures on the tibia and the medial cuneiform? Let me see the radiologist's report."

For a moment he just stood there speechless before handing me the report and saying, in a newly respectful tone: "You didn't tell me that you've had medical training. Where did you go to school?"

I told him that I was an autodidact. His blank look showed that he didn't know what the word meant, but he didn't ask. It removed any doubt that he was one of those people who can't bring themselves to admit that there's anything they don't know.

The radiologisthadseen the hairline fractures, but had written that the navicular fracture (the one near the talus) was the only one requiring surgical intervention. He stated that the other fractures would heal on their own during the time weight was kept off the ankle for the repaired major fracture to bond.

I read the consent form, had the doctor fill in a few blank areas and cross out several inapplicable items, and then told Dan that it would be best to have the surgery and he should sign the form. I asked whether another operation would be necessary to remove the pin. The doctor said that in the absence of complications, the pin would be left in place permanently.

They made me wait in the lobby while they admitted Dan, but eventually they said I could go up to his room.

Dan's face brightened when I walked in. "Hi" he said. "Thanks a million for standing up for me" and added admiringly: "Boy, you do know a lot about medicine! I thought the ER doctor would have a coronary."

He said he was feeling much better, but I could see that he was very uneasy about the upcoming surgery. I reminded him that despite my words to the ER doctor, this was a topnotch hospital. I assured him that everything would turn out well.

When a nurse came in and told us that visiting hours were over, I went to the Nursing Supervisor's station and persuaded her to let me stay a little while longer in view of Dan's severe anxiety, but when I asked to stay overnight she said that the hospital had no accommodations for guests. I offered to sleep in a chair in Dan's room. She said that she was sorry but it wasn't allowed.

I thanked her for the extra time, and returned to Dan's room.

After another hour, a nurse came in and said I had to leave.

I told Dan I'd be back in the morning.

"OK" he said. "Thanks for staying so long."

As I was passing the Nursing Supervisor's station, she called me over and said in a low voice: "You seem to be very devoted to your friend. Are you a couple?"

"I'm kind of like an older brother to him" I told her. "This is his first hospital stay and his first surgery. He's very frightened. When I'm there it calms him."

"Well he's fortunate to have someone who looks out for him the way you do" she said. She chuckled and added, barely above a whisper: "I just heard about how you took on Doctor Pendleton in the ER. Good for you." She put a friendly hand on my arm and added "I wish I could let you stay overnight, but there are strict rules against that and it would mean my job. Don't worry, though. We'll make sure your friend is well taken care of. He'll get something for the pain, and something else to help him sleep. I'll get him as much medication as he needs; I know which doctors I can go to when I want authorization for anything."

I asked whether she could get in trouble with Pendleton. "Up here" she answered, "he's not in charge". Then she put a hand on my arm again, and smiled at me: "Go home and get some rest. We'll keep a close watch on your little brother." And she winked.

I thanked her for her consideration, and took a taxi back to the trail head to pick up my car.

Back at my apartment, I took a shower and went to bed, but I was awake much of the night thinking about Dan lying there by himself, probably apprehensive despite the medication. I was sure that if I were there it would give him confidence. I resolved to be back first thing in the morning. With that in mind, I finally fell asleep.

I woke up with a start and looked at the clock. I had slept later than I intended. I threw my clothes on and left.

When I arrived at the hospital, I was devastated to learn that Dan was already in surgery. I hadn't gotten to see him beforehand and let him know that I would be there when it was over. I had also wanted to speak with the surgeon and the anesthesiologist.

I waited agitatedly in the lobby, making a pest of myself at the Information Desk with constant requests for updates, until they told me that the operation was finished, that Dan had come through "with flying colors", and that he was in the recovery area. They let me go right up to his room even though officially they were not supposed to allow me in until he was there and the Nursing Supervisor gave permission.

They probably just wanted to get rid of me.

Dan was still asleep from the anesthetic when they wheeled him in on a gurney and put him to bed. I was so happy to see him that I didn't ask why he hadn't been kept in the recovery area until he was awake and they were sure he was alright. (I later learned that this hospital's policy was to transfer patients to their rooms as soon as their vital signs are strong and stable.)

A few minutes later, a nurse came in and gave him an injection. In answer to my question, she told me that it was a sedative to combat post-operative pain. As I settled into a chair, she told me that between the periodic injection of sedatives and the lingering effects of the anesthesia, Dan would be asleep all day and wouldn't even know I was there. Then she looked at me and asked: "Haveyouhad any sleep? Did you eat breakfast? Forgive my bluntness, but you look awful."

I admitted that I hadn't slept well and that I had skipped breakfast.

"Go home" she insisted. "The surgeon left orders to give him plenty of pain medication, so even if he wakes up before tonight he'll be so out of it that he won't know who's in the room. You might as well take off until tomorrow."

I managed to find the surgeon, and asked for Dan's prognosis. He said that the bone was strong and should heal well around the pin if Dan didn't try to use the foot too soon.

I went back home, but I was plagued by the possibility that Dan would wake up alone in the intimidating atmosphere of the hospital, so I went back.

I pulled a chair up next to his bed. Thinking of what he had gone through, my heart went out to him. I ran my fingers through his somewhat disheveled hair, took his hand in mine, and although I doubted that he could hear me I said in a soft voice: "I'm here, Danny. It's all over. The surgery went beautifully. You're going to be fine."

I had never before used the junior form of Dan's name, but he looked so vulnerable lying there that it had just popped out.

After a while, I leaned down and whispered "I wish I could be holding you when you wake up".

I wanted to kiss him, but I was afraid that someone entering or passing the room might see.

I sat with Dan the rest of the day except for a quick break to buy a sandwich and a drink from the vending machines downstairs and bring them back to the room, dreading the thought of not being there when he woke up. Several times during the afternoon, I heard him whimpering and saw that he was struggling to open his eyes. I stroked his forehead and said "I'm here, Dan. The surgery went great. Everything is ok. Go back to sleep.". That always quieted him down.

Once, toward evening, Dan's eyes did open. When he saw me he broke into a sleepy smile and drowsily mumbled "Hiya Brandon". Then his eyes closed again.

I don't remember getting sleepy myself but the next thing I knew, I was coming out of a dream and the darkness outside the window told me that it was nighttime.

I rubbed my eyes and looked at my watch. It was 8:30 PM.

I looked over at Dan and was surprised to see him sitting up in bed, looking back at me.

"Hi" he said with a smile. "It was wonderful seeing you when I woke up. How long have you been here?"

"Not long" I answered, and was starting to ask him how he was feeling, when a nurse who was just coming into the room interrupted me:

"He's been here since this morning. He arrived early and was beside himself when he found out that you had been taken to the operating room before he got to see you. During the operation he badgered the reception people so often to find out how it was going, that they broke the rules and let him come up here while you were still in Recovery, even though they were supposed to wait until you were brought in and given your first post-operative medication. Then he wouldn't budge from your side even though we told him you would be asleep all day. When we finally convinced him to go home because you wouldn't even know he was here, he left but he came right back. He would stay twenty four hours a day if the hospital would let him. Yesterday he asked if he could stay overnight. The Nursing Supervisor had to say no, but she felt bad because it was obvious how concerned he was for you. We give the best of care to all our patients, but you can thank your friend here for the fact that we have orders to give you special attention."

Dan looked at me and his smile broadened. "I have a lot more than that to thank him for" he said.

As soon as the nurse had checked Dan's vital signs and left the room, he asked wonderingly: "You've been hereall day? And you wanted to stay overnight? I don't know what to say."

"You've already said the best thing I could hear" I replied. "You told me you were happy to see me." Then, partly to change the subject although I really did want to know: "How do you feel, are you hurting?"

"No" he answered. "They're always asking me if I'm in pain and offering to give me something for it."

"Did they tell you that the operation had gone well?"

"Yes, but they didn't have to. Somehow I already knew. Maybe it was intuition."

Had Dan heard me after all when I had spoken to him that afternoon?

I asked whether he had been awake long.

"I woke up a few hours ago. When I saw that my guardian angel was here, I knew I was safe and protected. I've been dozing on and off since then."

"Why didn't you wake me instead of sitting there listening to me snore?"

"You weren't snoring, but I wouldn't wake you anyway, I was just glad you were here. Besides, you didn't leave until late last night and they told me how early you showed up this morning. I knew you couldn't have gotten much sleep."

"I can always catch up on sleep. I came here to seeyou, not to nap."

"I still wouldn't wake you."

"Why not?"

"Because you looked ..." he paused, searching for the right word. "serene. Ever since I broke my ankle you've been looking worried, even while you were reassuring me."

"You noticed that?"

"Hey I may have been carrying on about the pain and whining that I was scared, but I saw how worried you were, and I felt bad."

"So even in the midst of all your pain and fear, you were concerned aboutme?"

"Sure I was! I knew you care about me long before you ever said so, and I care aboutyou. I care a lot. So I felt terrible to see you that upset. And knowing I was the cause made it worse."

"Why did you think you were the cause?"

"Duh. You were fine until I fell."

"Point taken" I admitted.

"Well when I woke up today, seeing that you were here made all my fears vanish. And seeing you looking so much at peace, that made it even better. There was no way in the world I would have wanted to disturb you."

He stopped speaking for a moment but then he added: "I can't tell you how sorry I am for all the trouble I've been".

"You haven't been any trouble" I told him.

"No of course not. How could I think such a thing? Youenjoycoddling hysterical friends and arguing with doctors."

"Dan, stop beating yourself up" I said. "You weren't hysterical. You behaved the way anyone would when they're in that much pain. Except that most people wouldn't be concerned about anyone else. What's the word for the opposite of selfish? Whatever it is, it applies to you. And as to arguing with that ER doctor, I had it up to here with arrogant and unfeeling physicians like him when I was working in a hospital. This isn't the first time I've challenged a medical S.O.B.".