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8162X: Beyond the Angle of Repose
Contemplating mortality far from rescue

I am entering an age where my friends are starting to have grown-up health problems. There’s been a stroke, a couple cases of CTE, and then last week, a good friend had a heart attack. He is fine now; however, the docs pulled a goodly chunk of plaque out the coronary artery and left a couple stents behind before they sent him home. Sobering stuff.

Turns out, he had his heart attack while in bed on the Front Range, in the company of a partner who did not hesitate to call 911. He was in the ER in 15 minutes; out of surgery in two hours; and back home in two days. He could not have done better if he had passed out on the floor at a cardiologist convention.

It might have been different; a week earlier, he was hiking up to Frying Pan Lake, near the Continental Divide, and about as far from telephone and rescue as you can get in Central Colorado.

So there I was, a week later, of similar age and constitution and lifestyle as my friend. Climbing a scree field at the head of a valley near the Continental Divide, up where the air is thin and trails are steep. As my lungs begged for air and my heart tried to pound its way out of my chest, I could not help but think about my friend, and think about my couple extra pounds of weight and couple extra ticks on the blood pressure meter. Too late to schedule a check-up now. So I climbed some more and thought about these things some more and enjoyed the view. There are worse places to go, I thought. It's a cliché, but it’s also true.

Distance from rescue. Many people do not contemplate this topic until it stares them in the face. There can be a lot of time involved in getting to a phone, mobilizing rescue personnel, reaching the victim, and then safely removing them. Several hours, or overnight perhaps. Helicopters can shave a lot of time off that, and are increasingly available to the task; nevertheless, at best case a number of hours will still be involved between accident and hospital care. Heart attacks, for example, may have an entirely different outcome when occurring in the backcountry versus in an urban setting. My backcountry risk assessment has gotten a little more complicated, as I moved this sort of calamity from the theoretical column to the realm of possibility.

Years ago, my wife and I were exploring the Flat Tops by truck, and came upon a fishing lodge and cabins deep up a dirt road bordering the wilderness boundary. Within moments of arriving, a wrangler galloped up in full panic; one of the cowboys had his horse fall on him, and the saddle horn had rammed the rider in the pelvis. The lodge owner called for rescue on a satellite phone, thus shaving more than an hour from response. The paramedics arrived a couple hours later; they had deployed a series of radio relays on their way in, ultimately arriving on a special ORV, having left the ambulance behind when the road got too rough. 

While we waited, we tried to keep the cowboy warm and attentive, as he lay in the dirt and rain, the wranglers held a tarp over him, while they cursed and paced. We wondered if he was bleeding internally, and watched for signs of deterioration. On arrival, the paramedics called for a helicopter, which led to more waiting. Perhaps seven hours after the accident, the air ambulance departed into the dusk toward Denver. After relaying my backcountry anxiety story to a physician friend, he said this: “Congratulations, you just gave yourself a cardiac stress test and passed.” 

Yet to be on the safe side, I decided it was time for an old-guy exam. Therefore, I dutifully, if not belatedly, scheduled my mid-century wellness checkup. Men of a certain age are unified by the terror of anticipating their wellness exam, because there is a certain procedure that accompanies the visit, and it is the Inspection We Dare Not Name. Well, here’s what I learned: physicians no longer routinely perform digital prostate exams. Turns out that despite all the angst and stand-up comedy routines, the exam itself wasn’t very effective. I was strangely disappointed by this revelation, after the cumulative anticipation, I felt gypped — yet another rite of passage denied the modern male. A billion used latex gloves disposed in a landfill somewhere just had an existential crisis about the meaninglessness of their brief lives.

One of the changes affecting this Valley is the availability and character of medical care, while the backcountry remains relatively remote; the Valley’s medical care system is no longer quite as rural. Our first child was born in the old Aspen Valley Hospital maternity wing, a row of institutionally bland cubicles that reminded me of a 1970s middle school classroom. Our next child was almost born on Highway 82 (apparently mom and dad had gotten much more casual about the process between the first and second), but he held off to arrive in Valley View Hospital’s lovely new birthing facility – purpose-built, full-featured, and only a short walk from the latte bar.

As I recall from that time, the availability of obstetricians was a challenge, being a baby doc in a small rural practice meant serving on night and weekend call, continuously. There’s an old joke about a town being too small to support an attorney, but plenty big enough to support two. Pregnancy care practices struggled to balance the small size of the population with the 24/7 demand of its customers. We had our babies during the transition between the Valley’s more rural medical orientation, and its current incarnation seemingly inundated by high-end jogger strollers popping up like weeds along a fresh road cut. There’s another old joke about the relative attractiveness to physicians of dermatology and its banker’s hours, yet in fact, during that era, the primary dermatologist to the Valley came up from Grand Junction for special office hours.

Another facet of the rural character was the comparative lack of specialization among orthopedic practitioners – a knee replacement today, a shoulder repair tomorrow. One feature of small town life is there’s no need for an Angie’s List to get opinions on local surgeons – ask enough people and you will get a range of feedback. The orthopedic sector has undergone a lot of change as the area’s hospitals expanded, and it has evolved along with the expectations and wealth of its customers, as well as the changes in technology. 

This idea of nonprofit hospitals seems conventional on its face, yet does not necessarily behave in ways one ordinarily expects of the nonprofit sector. The two nonprofit hospitals for the Valley went on a spending spree, buying up practices and funding facility expansions at an astonishing pace. Yet the cost of procedures and tests is also astonishingly high, and shockingly out of sync with our regional neighbors.

However, by all accounts, the capabilities and service are top notch (as well as top price). Nevertheless, they remain rural facilities, and must ship some cases off to Denver or Grand Junction for advanced care.

I had long known that the assumption of risk when recreating in the backcountry included an acceptance that you may be far from rescue. However, I had previously assumed this scenario would be precipitated by a nasty fall or natural calamity. The idea of a health crisis hours from rescue adds another dimension to the situation, but not as of yet justifying any changes in ambition on my part, although it may spur a change in lifestyle at home.

Once safely back on the Valley floor, we are offered a variety of medical service alternatives and providers that have multiplied exponentially over the previous decade. Yet, the region continues to struggle to find its identity between its rural roots and urban ambitions.

Malcolm McMichael lives in Carbondale with his family, family hamster and an extended family of outdoor gear. He is driven to find a way to lower his “bad cholesterol” without reducing his consumption of delicious red meat.