The rest of the story

(Most of this text is from March 2018)
About 14 months before Paula and I started the same route.
We had been up tougher peaks (like Bridge Mountain), but
when we came to the dryfall on Muddy (after hiking 5 miles)
she couldn’t face it, so we just had a pleasant hike in the
desert that day. So in the back of my mind, I figured some
day we would come back, with more equipment, and more
training.

I enjoy helping people overcome fears and gain skills.
Perhaps there is some deep psychological reason. I grew up
without a lot of positive reinforcement, lots of predictions
of doom and failure, and I hope I can get some good karma
by helping people succeed. And I’m partly crippled, and like
to push myself. I had a freakish stroke in 2002, and am
partly paralyzed on the right side of my body. I’ve done
remarkably well.

The stroke was in the cerebellum at the base of the brain;
this is a part of your brain that works unconsciously to
coordinate fine movements of your muscles, to supply
proprioception. About 90% of the cerebellum's signals just
tell muscles “STOP!” I’ve trained my cerebrum (upper,
conscious brain) to be more alert and stead for the cerebellum.
This substitution works well as long as I’m not too tired. If
someone distracts me with something that requires a lot of
cerebral (upper brain) processing (such as parsing indistinct
language), especially when I’m engaged in a task that would
involve cerebellar use in a normal individual, I can stumble.
Normally, when blindsight and my peripheral vision detect a
dangerous situation on my right side, the amygdala reacts,
and my cerebrum intercepts to decide an action. If I’m really
tired or distracted, a message to “STOP” is sent to my
cerebellum without that cerebral interception, and nothing
happens, because that right side cerebellum is partly gone.
Somehow this all makes me sympathetic to people with
mental blocks.

Paula is very athletic, and quite clever; she picks up skills
quickly, and has a well-trained cerebellum, as evidenced by
her ease with gymnastics. But in 2018, she was open about
thing: she had anxiety attacks, particularly if she felt “remote.”
It took me till February 2018 to understand truly what that meant.
You can never know what is going on inside another person’s
head, and it is arrogant and presumptuous to think another
person can do what you do to deal with fears.

(2019 Update: Paula has tremondously improved, and has
mostly lost her fear of "remote." She has since climbed
Muddy solo, as part of a 19 mile- 2-peak day. The panic
attacks are mainly gone -- check out her "Squirrel" solo:
 https://www.youtube.com/watch?v=7O_7pFVRAPg&feature=youtu.be)

We had advanced her skill on rock a lot in 2017-18; I got
her to rappel much better, to set up rappels on a munter herself
(she really taught herself once shown), and I got her to trust belays.
As a training culmination, we went to a dryfall near Red Rock,
in limestone like the dreaded Muddy dryfall, but technically
harder. We rapped down that dryfall, and I got her to climb the
4th-class rock on belay, which she did with little effort. She sent
me a photo of her rapping off her porch.

There was one bad omen; four days before our trip, I had
a routine cystoscopy at the urologist's office. Before the visit,
I called the office to make sure they would give me an antibiotic
OTHER than a fluoroquinalone (like Cipro), as I have a bad
reaction to Cipro, with connective tissue damage. Cipro was
actually on my chart as forbidden. Well, the nurse didn't read
the chart and gave me Cipro. I was horrified, and even thought
of cancelling the trip; but figured I'd just be extra careful not to
stress any connective tissue (or for that matter, anything with a
collagen layer, which Cipro destroys in susceptible people).

So Feb 4, 2018 arrived, and we started off for Muddy with
lots of water. The day that was supposed to be about 10F
above seasonal average; maybe 74F by the end of the day
down low, never above low 60s at 5000’. We had lots of pleasant
conversation, and got up to the infamous dryfall. I climbed up,
found an anchor, and put down two lines; one with loops
(overhands-on-bights) tied every 3’, and one as a belay with
a figure 8-on-a bight, which she could just clip into her waist.

And for about 20 minutes, Paula was caught in a panic attack.
I climbed down, and talked to her. “I have to get through this
myself,” she said, “I have coping mechanisms.” And it dawned
on me that unlike our harder practice waterfall, this place was
really remote. I didn’t try to reason, I just made gentle commands.
“First, get into your climbing harness,” and she did, mechanically,
but had the presence of mind to check the buckle. “OK, let’s go
over to the belay rope, and clip on the figure 8.” She did, and
made sure the screwgate was completely locked. I climbed back
up, anchored myself, and prepared for a hip belay over a lip of
rock. I pulled and hit some resistance. “Is that you?” “No not yet.”
Then she started on the wall… and in 30 seconds the hard part
was over. While she rested I checked the anchor for a rap down.

And it all went pretty smoothly for the rest of the trip to the
summit. At least 2x, I got her to climb harder stuff, easily;
perhaps it helped that I had no alarm in my voice, and I still
had 160’ of rope. Gracefully she found her way over my
navigation mistakes. We hit the top joyfully, spent some time
basking, descended, and hit the dryfall. I tied the sling for the
anchor, put on a quicklink, and set up a double-rope rap. She
tied her own Munter as I watched, she checked the water knot
on the anchor several times. I climbed down to give a fireman’s
belay. With just a touch of nervousness, she showed great form
coming down en rappel. I climbed back up and took down the
rappel sling, and suddenly noticed that I was tired—not
physically, but mentally.

And the hard part was over; we just had less than a mile of
sometimes precarious boulder-hopping to reach the safety of
the wash, then 4 easy miles out. She began talking about what
it was like to have a panic attack. She hides her attacks, so other
people don’t have to accommodate her. Sometimes she feels
like just dropping her pack and fleeing, even though she knows
how irrational that is. She can’t stop that inner voice; just like
claustrophobics in an MRI tube can’t just tell themselves to
relax. Hmmm I thought, we are still a bit remote. But I can
often read the starting signs of the panic on her face. So we
started back to the wash, me leading. I knew my brain was too
tired to deal with the slippery rocks in the wash, so I chose an
easier route on the east bank of the wash.  After a while Paula
started disappearing in parallel washes; I couldn’t see her, but
I would often shout and she would answer. I didn’t think this
was a situation for “I just want to flee.” In fact Paula told me
later that she was just feeling happy and confident and picking
her own way. I got very close to the final wash, and shouted.
Nothing. Hold that thought; it’s time for a flashback.

---flashback------------
It was December 23, 2007, more than 10 years before.
Other friends and I were doing a "hike" up Tunnel Vision
Peak, with some class 4. The rock was still water-saturated
from recent rainfalls, even though that day was beautiful with
blue skies. At one point, there was a bottleneck ahead, so I
climbed up onto a slab that was attached to the rock below it.

As I started to push off the slab, it broke free, probably because
the moisture had weakened the rock. Immediately it occurred
to me that there were people below me, so I jumped back off
the slab, and used my right arm to slow it down. I felt like my
arm had been pulled out of the socket-- and in a sense, it
probably was, but the angle was such that I didn't dislocate the
shoulder. As it was, my friend Jacquie, who was right below,
had already reached up around a bush, and rock had so crushed
the bush that she couldn't remove her hand. I was able to
lift the end of the rock enough for her to extricate her hand.
People thought I had done something heroic, but in my mind,
I had created the problem, unintentionally or not. If Jacquie
had been injured (or even killed), my life would have taken a
very different, sad path. The injury was a very small price to pay.
At the time I didn't put all the pieces together; no time for deep
analysis when the spidey sense tingles you have a second to act.
I'm very glad I chose the right action. I continued with the
climb, even though my arm hurt a lot. For the next year and
half, just when I thought my arm was OK, I'd reinjure.
---end flashback------

So, back to 2018... I had just shouted to contact Paula. I started
to get that spidey sense; was that foreboding due the shallow
wash I was about to step into, or was it due to a problem with
Paula? The tingling, the "foreboding" got worse as my brain sent
my right cerebellum a message to stop; but there was nobody
home, and my upper brain was too tired to notice. I fell face-first
into the wash. Instincts took over, I tucked and rolled, protecting
my head. But when I rolled onto my back, my pack—stuffed
full of rope and emergency gear—hit first and my head whip-
lashed, even cradled in my hands. I sat up;  no head injuries,
but boy the muscles in my neck were sore. Paula came over the
rise, shocked. We took a few minutes for a snack, but I just shook
it off as another whiplash, and walked out 4 miles, pretty much
pain-free. Paula was upset, sure she had “broken me” by using
up too much of my brain.

(One of the worst things about the tired-cerebellum "foreboding":
it actually feels somewhat euphoric, like the feeling one gets just
before slipping unconscious, when one has general anesthesia.)

My neck was sore for another 2 weeks, and I had some vertigo.
My left ear felt stuffy, with minor pain. But I did lots of balance
tests, vestibular training, etc. I got a cervical X-ray: no damage.

In 2002 I’d had that stroke, probably caused by a vertebral
artery dissection (after a neck injury), so my first priority was to
make sure I didn’t have another. To make things worse, my
urologist’s idiot nurse had given me Cipro, which was on my chart
as forbidden, just 4 days before; I’ve had lots of connective tissue
damage, probably related to Cipro. Paula and I even went on a hard
hike 10 days after the Muddy trip; intentionally I picked a place I’d
gone just before the older stroke. Everything seemed almost healed.
And now a new baseline.

On February 20, just as the last remnants of soreness went away,
I had a sudden onset of pulsatile tinnitus, in my left ear, when I lay
down. I actually first recognized the sound on February 21.
The sound is a “whoosh whoosh” synchronized with my
heartbeat, and is extremely annoying. My sleep was pretty bad until
I discovered a way to drown out the whooshes with brown noise;
I sampled a lot of mp3 players and earbuds before I hit a solution.
Pulsatile tinnitus is usually caused by a vascular irregularity. I
guessed I had opened up a dAVF between my occipital artery and
a venous sinus in my head; the whooshing was caused by the fast
artery blood dumping into the slow-moving vein, which happened
to pass close to my middle ear. I went to UCSF, and they found
the dAVF was actually at the base of my skull, causing the same
effect. My options now are a little scary, but I march on.

Count every day as a blessing, because you never know.

(2/21/19 Update: The whiplash ripped several small arteries,
stretched as they went from extra-cranial to intra-cranial. Nature
tries to minimize pressure gradients, so ersatz vessels started
forming at the rips, and eventually reached the signoid and
marginal sinuses, and the flow started refluxing into the cortical
veins. This situation left me at high risk for a fatal hemorrhage.
I had surgery August 21, 2018; that operation largely stopped the
PT, but has left me with somewhat scary after-effects -- visual
auras that leave me partly blind, make me aphasic, and
occasionally compromised balance.)

(2021 update: It has been 3 years since
the accident, and I still limit my driving to less than 150 miles in a
day; because the temporary blindness is correlated with holding my
head up in driving position, and losing sight when you are driving is
not a comfortable feeling. Driving at night is virtually out of the
question.

Perhaps the scariest issue is that I get transient aphasia,
when I don't really know who I am. I may now be heading to early
dementia, as new WMH appeared in my brain, and my thinking
became foggier.)

Whiplash injuries are actually quite common in outdoor
activities, especially among boulderers and skiers. The biggest
culprit here was the over-stuffed pack. Less than 2 years
before, I watched in horror as a guy with 300' rope in his pack
fell back and had a similar accident.

=======The stuffed pack==================
I normally wouldn't take much on a trip like this; for the modest
class 3 areas, I'd probably take 60' of 15mm webbing. Because
she was going to rap the dryfall, I ended up with 181' of
cordage, an extra harness, biners, quicklinks, and so on.
At that time, she had a fear of remoteness, so I promised
we would take enough to survive a night in the open.
So I had 2 headlamps, 2 small closed-cell pads, a full
3-layer blizzard bag, an extra aluminized tyvek zippered
mummy case, an extra aluminized poncho, and more
emergency clothes  (down jacket, fleece) than I felt I
would need, considering nighttime temperatures about
50 F. Besides, I had my SPOT satellite beacon. Two of
the items, the blizzard-bag and pad, were bulky.

The night before Paula e-mailed that "I will bring a bigger pack
to carry extra water and ropes." But when we parked to
prepare for the hike, she had a small trail-runner's pack.
When I asked to divy emergency gear, she looked forlorn
and pointed out her pack was already stuffed to the point
where she would have to carry water in her hands. That
left me to carry most of the emergency stuff.  I thought little
of this discomfort; I didn't want to make the day any harder
on her, and the extra weight was little burden for me.  But my
30L pack became like a turgid barrel. To make matters worse,
I lashed extra gear on the back of the pack. This has been
the elephant in the room for over a year now. 

(2021 update:  I found out later that she had
a 30L Osprey pack but found it very uncomfortable.)

In an earlier version of this page, I claimed I had a 45L pack
that I simply forgot to bring.  That was BS; I could see
Paula was distressed by anything that implied she was complicit
in the accident, so I said that to take the blame. The luck of the
draw; this day wore through all my carefully crafted defenses.
 
I'm a grownup, and I made the ultimate decisions "to be
a hero".  When Paula said she couldn't carry the Blizzard Bag
and foam pad meant for her, I should have said, "OK, I won't
carry them either."  When the nurse insisted she had the Doctor's
permission to give me Cipro (she lied about that), I should
have pulled my feet out of the straps, gotten off the table, dressed,
and gone home. In a lifetime of accommodating others, I
don't always speak my mind for fear of alienating people, and I
always think I'll be strong enough for other people.