Recent Adventures in Robustness and Fragility: Travels to Panama and back

Here is a <block quote> from John Doyle's auto reply email Sept 2007 account of his adventures in Panama.

Sept 11, 2007

EST, Tu, Sept 11. I am now it ATL recovering from injuries and have Internet access but will take some time to answer emails. I’m nearly caught up so hopefully this will be the last automatic reply. I plan to return to LA later this week, though not as soon as originally planned.

I’m sorry if I don’t get back to you soon or if you get this email repeatedly from me. I’ll try to get back to regular email and remove this automatic reply in the next few days. I’m doing great. Thanks for all the concern and love so many of you have expressed. So the good new is I’m doing great, am out of intensive care, out of the hospital, and am back in Atlanta at home. The bad news is I’ll probably be more or less back to my usual self soon.

I’ll give a quick update on injury status and then the rest will be unchanged since Sept 6. I’m continuing to recover. (The rest of this paragraph is probably more detail than you want.) I had all stitches out yesterday so the only wound still open is on my lower back and it is closing well, probably another week. Had a right shoulder MRI this morning, definite rotator cuff damage, not sure how bad. Can walk mostly ok now. Last 2 days have walked 1 mile to and from gym and did light workout. Leg injuries are probably all sprains, no tears. Still have some fluid in hematomas and “holes” in muscles where tissue was lost due to impact injury.

Aug 20 - Sept 6, 2007

Itinerary

Panama is fantastic in so many ways and I wish I could do it justice, but I’ll just tell you about what happened to me so you won’t worry. I’m hoping to write a more complete version at some point. I was in Panama for two weeks starting Aug 20, the first week a wonderful “eco-touring” vacation with Marie in various parts of the country. We were planning to return on Aug 28.

Aug 26-Sept 4, 2007

Brief Outline

Briefly, on Sunday, Aug 26, in the late afternoon I fell down a long steep rocky face while hiking near the top of Gaital, the highest peak around El Valle (about an hour west of Panama City). I suffered extensive cuts and bruises and 3 mild lumbar vertebrae fractures but no other breaks. I was rescued on Tuesday, and transported to Punta Pacifica Hospital in PC, arriving around 1am Wed morning. I was outdoors for 2+ days, lost roughly 3 pints of blood, the cuts were badly infected, and my various bruises and hematomas give my body a rather strange shape, sort of like a (late) Picasso or Francis Bacon portrait. I was in the Intensive Care Unit (ICU) until Thu nite, transferred to a regular room until Tues, Sept 4, when we returned to ATL. I’m at home in ATL recovering, will be back in LA early next week. I’ll miss the LA triathlon. Couldn’t swim with open wounds anyway.

Rescue and ICU

The hiking/falling/crawling/being-rescued/ICU/hospital/rehab has allowed some detailed exploration of further aspects of my intrinsically “yet fragile” complexity, particularly as manifested in extreme stupidity and cascading failures. I’ve also been getting interested in theory problems motivated by ICU care (though I’d hoped to have a purely scholarly study of the ICU( and so took this event as an opportunity to see an ICU from the patient side.

Marie, the rescuers, and the doctors where fabulous and I should have a full and rapid recovery. Richard flew down to generously offer support. Having the world’s best doctor and systems engineer handling the medical and support issues has obviously been ideal, but the Panamanians have just been wonderful too.

Read on for details.

Hiking, Falling and Fragility

At 3pm Sunday I went for a quick hike suggested in Frommer’s (mostly excellent) guide, telling Marie I’d be back at 5pm. Frommer’s suggested an “easy to moderate” 2.5 hr loop whose highlight was a peak roughly 600m up from the hotel (at 1200m) that had views of both oceans and El Valle de Anton. The route up was wet and muddy with lots of use of hands and a few short roped spots but safe and non-technical but didn’t seem “moderate” so I was expecting the return route to be easier. I got to the top at 4ish but accidentally cut my right hand on some vegetation near the top. That limited my use of my right hand (and the cascading failure starts), but also my left to keep the blood from flowing too freely.

I decided (unwisely) that using the up route to go down needed too much hand work so looked for the continuation of the (as it turns out apparently nonexistent) “loop” and pursued the most promising path down. I proceeded just a bit on what increasingly appeared not to be a trail but a mix of vegetation and fairly sheer cliffs of rock with lots of streams. About when I was deciding to go back, the vegetation gave way and I slid down and fell off a cliff. I don’t know how far I dropped but I tumbled several times before hitting an outcropping and stopping the fall. (I’m hoping to get an exact location where I was ultimately found and figure out what route I took on a topo map.) Fortunately, I tumbled and hit lots of rocks rather than a straight fall, as this slowed me and kept each hit from being too severe.

I was conscious (eventually, not sure if I was ever out), but pretty sure this fall would be ultimately fatal as it seemed to be too far and have too many body hits to be survivable. Initially I couldn’t move anything, but gradually was able to start moving at least my hands, feet, and head, which was really encouraging. I had deep cuts on my head, lower back, and right elbow, and these were bleeding freely. (Later analysis of my hematocrit drop of a 41 to 31 suggests I lost about 25% of my blood volume through bleeding. This seems consistent with my observations, though much of that bleeding ended up in lots of large hematomas, the rest was left on the hillside.) Everything else hurt and my right leg was nearly useless. I could wiggle it but nothing worked. My left arm and leg seemed mostly ok (I realized later that this was just relative) so I could crawl on my butt using the left hand and foot, dragging the rights. My lower back was a mess so I had to avoid scraping it on anything.

It appeared that I was maintaining consciousness ok (well, more or less like usual for me). The bleeding slowed quickly (the coagulation cascade worked robustly), and I was near a stream bed/waterfall so I might be able to have a water source. So I assumed this could be survivable and there was maybe an hour of daylight so I wanted to max my chances of rescue.

I “crawled” down the mountain to a point that seemed promising. It showed signs of human landscaping (it was dark enough as to be hard to tell), had a stream/waterfall, a place to sit, and had a broad view of the large valley below. It was dark, foggy, and rainy so I yelled for help until I decided I should save my voice for daylight.

Aug 27, 2007

On Monday morning I started yelling help before daylight (6am) and various things hoping to get the attention of rescuers that I could hear above me and in the valley, but by the time darkness (6pm) was approaching there was no sign of rescuers. Having not slept and eaten in 24 hours, and lost lots of blood I was hallucinating distant rescuers that were unlikely to exist. Apparently, lots of people heard me but could not locate me.

Aug 28, 2007

Rescue and Robustness

I moved Tuesday nite using the twilight and then the (fortunately) full moon to crawl to a more promising location, yelling all the time to attract attention. On Tues morning I was spotted early, but the rugged terrain meant it was afternoon when rescuers arrived. It was getting dark by the time I was moved, heroically, by a team of dozens of people to an ambulance that took me to a local clinic for a quick checkup and some shots and IV fluids and then on to Panama City about an hour away, arriving in the middle of the night.

The Panama hospital and doctors were fantastic. They cleaned the wounds, started IV antibiotics, and confirmed by CT scan that there was only minimal bone fracture, all of it in lumbar vertebrae. I was swollen into very strange shapes but by Wed the massive swelling of my right leg was down to less than 2x, and by Th it was only a small amount larger than normal. On Th I was able to move around the ICU room a bit with lots of help, and was moved to a regular room Th nite.

Sept 1, 2007

Robustness and Recovery

On Fri I was able to walk with a “walker” (it is stable platform that you move with your arms and allows you to support your weight, and can walk using only one leg), and put some weight on my right leg. I did physical therapy starting Fri which included ultrasound and electrical stimulation for the hematomas and as much movement of my right leg as possible. I saw my back (though heavily bandaged) and upper legs for the first time in a mirror and nearly fainted it was so gross. Large purple blobs seemed attached to my body. I was assured it had improved massively, which was consistent with my view of my legs, so I’m glad I didn’t see it earlier.

Fri afternoon a plastic surgeon sutured 3 of the smaller cuts on my right arm that could be closed. The big (5cm or so) gash on the back of my head had closed and started to heal, and the dollar size gash and necrotic (dead tissue) spot on my back was also healing really well, but was too large to be closed with sutures.

By Sun I could shuffle around a bit without the walker, and all the healing was proceeding rapidly. All the doctors repeated what a miracle it was that I had recovered so rapidly. Richard flew back to LA. It was great having him there.

Sept 4, 2007

Returning from Panama to ATL, USA

On Tues Marie and I flew back to ATL. I was transported mostly be wheelchair, but walked (very slowly) on my own from the ATL gate area in Term E to the car, a total of probably 500m or so, but with breaks for the train, and the last part had a luggage cart for me to use like a walker.

Tues nite I got my first decent nite sleep as I finally can lay on my left side and with the right setup of pillows get in a position that doesn’t hurt too much. Lots of benadryl to make my sleepy. Ali J flew in to hang out for a day and keep me company and that was fun.

Sept 5-6, 2007

On Wed I went up and down stairs “normally” though slowly and did some repeats for exercise. Ali and I went shopping at TJ’s, and Ali flew back home in the afternoon. Great of him to visit, he’s entertaining on every level. Wounds continue to heal rapidly, and I was able to take my first real shower.

I’m writing this on Th morning Sept 6 and hoping to go to gym and do some rehab on my right leg. The swelling is almost gone, but there are funny “holes” in muscles where the big hematomas were and gross fluid-filled sacks instead. My hip doesn’t still work much and has limited range of motion. Also, seems like my muscles generally have wasted really rapidly, like I took months off with no exercise.

In Hindsight

There were some weird and/or wonderful things that I’ll try to write down. Everyone was fabulous, lots I don’t even know yet. Bizarre visual hallucinations on Tues nite for things too dark or distant to resolve unambiguously, probably due to no sleep, no food, blood loss, and exhaustion. The ICU is interesting from the patient sides, as is the rescue process, which I won’t understand until I can compare notes with the rescuers and look at maps. In the ICU my heart exhibited and then lost a new but mild electrical problem that was probably unrelated to the accident but was due to my (recently diagnosed) sarcoidosis (this has been an interesting year medically). Probably have to follow up on that.

See also

• Prof. Richard Murray's version of John Doyle's Panamanian Adventure.