The Depths of Illness - Fainting (On the Appalachian Trail)

When getting blood drawn, I have always been prone to what's called vasovagal syncope (click here for a description from the Mayo Clinic) - a condition in which the body overreacts to certain triggers, causing heart rate and blood pressure drop and threatening the loss of consciousness.  I never actually passed out during one of these episodes, and it remained isolated to getting blood drawn, until 2005 when it would become a prominent force in my life.

I was hiking the Appalachian Trail, skirting the border of Tennessee and North Carolina.  I had not been feeling particularly well, fatigued, and had taken an extra day of rest at Elmer’s in Hot Springs, North Carolina.

Elmer's was a gorgeous inn on a small hill. It had two floors, each with a porch, and a plaque out front proclaimed it the Sunnybank Inn, built in the 1840’s.  The kitchen was richly adorned with dark wooden cabinets, a stainless steel refrigerator, an antique gas stove, tiled counter tops, and an island in the middle with an iron pot rack hanging from the ceiling.  The halls had richly-grained, dark wood paneling or accents next to decadent deep purple and gold or green and cream flower print wall paper. Framed news clippings of the Appalachian Trail, maps, and artwork adorned the walls. In addition to rooms, the inn had multiple bathrooms, two libraries, and two staircases - taking me to a time when these luxuries signified wealth.  It was comfortable and so I stayed, partaking of the organic vegetarian meals prepared in-house from ingredients grown on Elmer's farm.  But like all places on the trail, Elmer's was nothing more than a way station.  After the extra day of rest, despite the fatigue, I moved on.

In Erwin, Tennessee, my fatigue found a friend – digestive issues. I stopped for a night but no more. I crossed over a damp and snow-covered Roan Mountain, then through the trail-friendly town of Damascus, Virginia, before heading up into the Virginia Highlands.  As I neared Mt. Rogers (the highest point in Virginia) the trees grew sparse, giving way to grassy plains with large rock outcroppings. Sitting atop the first visible knob was the Thomas Knob Shelter, a three-sided structure that reminded me of an old prairie home.
  

I stopped to chat with some of my fellow hikers, Peeps, Morel, and Montana, but was so tired that I laid down on the picnic table for a restless nap.  I awoke a short time later in a cold sweat and pushed on, passing through Greyson Highlands State Park, where wild ponies grazed between the rock formations and scattered trees, to the next shelter where Peeps, Morel, and Montana had already arrived and set up camp.  Halfway through my dinner of instant stuffing my stomach twinged and twisted as if begging me to stop eating. I obliged and laid down in the shelter to rest. Sleep came quickly.

A few hours later, I woke up in a sweat, overheated, nauseated and desperate to find the privy. I scrambled to get my shoes on, grab my headlamp, and stumble out of the shelter. Within fifteen steps I was so dizzy that I crashed to the ground, landing in a pile of rocks beside a bush. The stars swirled, then darkness came. After a minute or so I came to and waited for my head to clear. I stood again and stumbled through the darkness in the general vicinity of the privy, which I hadn’t been to yet and didn’t know exactly where it was. Another couple steps and dizziness caused me stumble and fall to the ground once again. I did not pass out this time - I only laid in misery until the stars stopped swirling and I felt able to walk.  After another attempt, I made it to the privy but found a new dilemma – the privy had no walls. It was a toilet on top of a stage – common enough for a composting toilet, but leaving me unsheltered from the freezing mountain air. So as I sat, the wind blew across my sweat drenched body, quickly taking me from overheated to shivering. Too cold to remain at the privy, I went back to the shelter, doomed to go through this ritual once more. When morning came, I felt a little better though my stomach remained fragile. I put a few breakfast bars in my pocket, packed up my gear, and set off for the next town, some eighteen miles away.

This was my first fainting episode but not the last...

The Depths of Illness - Fatigue

It started on the Appalachian Trail (AT). I had been hiking upwards of 20 miles a day. A good hiking pace on the AT is around 3 miles an hour, meaning a 20 mile day would take somewhere south of 7 hours (not including breaks). For long-distance hikers, 7 hours of hiking is fairly enjoyable when you start early in the morning. But if you don't start early in the morning, 7 hours of hiking is much less enjoyable.

I don't remember when my mileage started to drop. But I do remember that it started when I no longer began hiking in the early morning. I remember being tired - too tired to wake up with the sun. I delayed getting out of [sleeping] bag until hours after the sun rose. When I finally did get up, I plodded around the campsite, delaying departure, for as long as I dared. Then, when I started to hike my muscles felt heavy, my feet ached, and my shoulders burned. Trekking up and down the mountain trail, over rocks and roots, through meadow and forest, seemed endless. A mile seemed like ten. Ten seemed like an eternity. I stopped to take naps in the middle of the day. I woke up groggy with many miles yet to go. I would usually push on. My mileage dropped to somewhere south of 15 miles per day. It would have dropped further had I not gotten off the trail to rest at my parents house in Gettysburg.

During the time I spent resting and looking for a cause to and treatment for my illness the fatigue was more bearable, but it did not get better. I had no schedule to keep, so I could wake up when I wanted, take naps when I wanted, lay around when I wanted. But after a month or so of rest and significant medical consultation there was no confirmed diagnosis. I could not lay around my parents house forever. Life had to go on.

To be closer to my girlfriend, I took a job installing solar panels in the north east. Once again, I had a schedule. No more sleeping in. No more naps. I woke up early. I slunk around like a sloth. I climbed ladders and lifted 100 lb. solar panels. My muscles weakened. Lifting and climbing became harder. My muscles felt like were filled with concrete that was slowly hardening. At the end of the day, I could do no more than lay down. Cooking dinner, nearly impossible. Bed time became earlier and earlier. The extra sleep didn't help.

On the weekends, there was a little relief. I could sleep in and take naps. My girlfriend wanted to do things - go for walks, go out to see bands, go hiking, go to the farmer's market, go to the beach, go cross-country skiing. I didn't. I wanted to be immobile. We did as much as I could bare. But our outings rarely lasted more than an hour or two before I was too tired to continue. My girlfriend understood that I was not well. She was gracious and accommodating. I felt guilty. I wanted to give her more. I couldn't.

In January of 2006, my girlfriend and I moved to San Diego. I got an engineering job. The fatigue continued, only now the fatigue in my body was mirrored in my mind. I could think and rationalize and remember, but not for prolonged periods of time. Mornings were best. Afternoons were difficult. My focus would drift. My eyes would become heavy. Working was nearly impossible. I faked my way through it, often saving drafting (mostly mindless) for the afternoon. At the end of the day, I could do no more than lay down. Cooking dinner, nearly impossible. Bed time remained early. Sleep didn't help. Making friends was virtually impossible. I remained at home while my girlfriend went out. I slept while the world moved.