Hermit Trail

I tried to sleep at the trailhead after parking at 3 am, but all I could think of was whether or not there were mountain lions in the Grand Canyon. Sitting in my car, waiting in the darkness, I remembered that best practice was to never hike alone. I remembered that if you chose to hike alone, then you should let people know when you expect to return, but my people were down in the bottom of the canyon without cell phone service. My thoughts spiraled… this was a bad idea.

Despite these fears, I laced up my hiking boots and hoisted my pack onto my back. I wasn’t going to let these last-minute doubts ruin all the planning and dreaming that had gone into this moment. Walking into the Grand Canyon from the rim it was pitch black except for the tiny beam of light coming from my headlamp. The silence was broken by my shoes crunching rocks, my breath quick. With each step the darkness slowly lifted and soon enough I turned a corner to see the Earth drop away into the depths of the canyon, while the sun grazed the walls rising around me. I continued to hike, following the trail that hugs the canyon wall while slowly descending deeper, and I felt like someone in “Honey, I Shrunk the Kids”; a miniature version of myself picked up and placed on a topographical replica of something imagined.

After hiking for several hours, I began to wonder when I would run into Leah. According to our newest plan (hatched over the spotty satellite phone connection), she would start hiking on Hermit Trail from Granite Camp at 4 am. We would hopefully pass each other on the trail, she climbing out, me climbing in, but I left the keys at the car. Just in case.

The moment I saw Leah approach me was the moment I was first able to breathe deeply, and a weight lifted off my shoulders. Maybe this crazy thing was going to work out all along. We exchanged a hug, some snacks and I checked in about the first part of the trip while Leah checked in about my exam the day before. We snapped a selfie and departed in our own separate ways.

The next big hurdle was meeting the rest of the group at the beach before Hermit Rapids. I arrived around 9:15 and sat down to wait; stripping my shoes off and dipping my toes into the cold, clear Colorado River for the first time. It was hard to relax (I wasn’t quite on river time yet), so I paced, applied sunscreen and checked to see exactly how squished the cupcakes were that I brought with me for Garrett’s upcoming birthday. They were only **slightly** squished. Around 9:45, I spotted a single raft at the bend in the river. Then two, three … four. Okay, now I could relax and it was going to be an FA day.

The 5 Letter Word

I recently spent a morning on palliative care and I wondered, “How do you deal with so much death and dying?” My preceptor declared that there were many things more terrifying than death. With her patients, she has the opportunity to consider quality of life and contemplate death on a daily basis; things like, where do we go when we die? While it seemed calming to her, it sounded terrifying to me.

We went to visit a patient who was admitted to in-patient hospice. According to the doc, death was near.

She looked comfortable, sedated with pain medication, but to the touch she was very warm. Her heart beat fast, her breathing irregular, her eyes closed. I introduced myself before placing my stethoscope to her skin. Did she hear what I was saying? Did she understand who I was? Her husband sat next to her and held her hand. Their tiny, fluffy dog moved about the room. For just a few moments, it didn’t feel like a hospital.

Death would not happen today, but maybe tomorrow.

So, I asked her, “How do you deal with so much death and dying?”. The doctor said there were things more fearful than dying, and maybe that’s why there are so many books, movies, and bucket lists on death. Maybe the thing we fear more than leaving this earth, is leaving this earth without truly living our lives. Were you present with the people in your life? Did you tell people you loved them? Were you vulnerable in that conversation even though it scared you? Did you take risks, laugh often, cry freely? These aren’t the things that make a life lived-well, but they might mean that you were truly yourself and maybe that makes a life well-lived.

Suction, please

I arrived at the hospital as the sun was rising, the sleep slowly wearing off and the coffee ran through my veins. I planned to sit down at a computer in the office to start reviewing my patients charts before going to see them, but the morning had other plans for me. My doc walked in moments after me saying, “There’s a patient in the ED trying to die on us”. My sleepy brain registered the labs he’s relayed to me – pH of 6.9, base deficit of -10, possible dead gut.

If you didn’t know, now you know, a pH of 6.9 is bad. It’s a measure of how acidic your blood is and normal is ~7.4. When the blood becomes acidic it’s a sign that lactic acid is building up, a sign that there are tissues that are not getting any oxygen.

She needed to go to the OR, stat. He showed me the scans and we took the stairs to the emergency department. There our patient was writhing in pain, conscious, but barely able to answer our questions. I’ve never seen anyone as sick as her and she was sick. My doc was saying she might die, but would she? I wondered how I would handle another patient death so early in my third year. Would it be like the patient before?

There was no time to ponder these questions as we wheeled her to the operating room, scrubbed our hands clean and approached the sterile field. This was going to be quick my doc told me. We were going to open her belly, see what was going on and get out as soon as possible.

That’s what we did. The first cuts through the abdominal wall revealed dead gut, revealed a stench, revealed a new life for this woman. Black tissue popped free the moment we broke through the fat into her abdomen. It was her colon and small intestine that were causing the problem. We removed them both, leaving healthy small intestine behind.

Her abdomen left open and she was transferred to the ICU in order to receive fluids and blood products. She was alive.

We took her back to the OR the next day for another operation. She was still alive.

She would go back to the OR again another day. She is still alive.


The opportunity to save this woman’s life does not escape me. We didn’t really do that much, but what we did do will change the course of her story. It allows her story to continue. It allows her grandchildren to know her more fully, for her family to spend more days with her. Life, it’s a beautiful thing.

Surgery was on my list of possible specialties going into my third year. It’s been at the back of my mind since I was an undergraduate performing surgery on rats, and I suppose since I was a child. My grandma recently reminded me of when I was younger and determined to be an orthopedic surgeon.

I learned this week that my left hand is uncoordinated. I learned that dead intestine smells horrible. I learned that six laparoscopic cholecystectomies can all be different, but every patient will be grateful for the removal of their gallbladder. I learned the three keys to success in surgery –

1. Eat when you can

2. Sleep when you can

3. Don’t touch the pancreas.

I learned that being in the OR is exhilarating and I learned that surgery is definitely staying on my list.