(PC: Lifemed Alaska. I was not in a state to take photos)

I learned my biggest lesson about backcountry travel with an ostomy on my third hike in Alaska.This hike was back in October 2014, about a month after I moved to Alaska. I had moved to here in September without knowing a soul and having never stepped foot in the state prior to getting off the plane the day I moved.  A family member suggested that I might need helicopter insurance in case I needed a medivac out of Alaska. I laughed that off. I didn’t foresee myself having any more ostomy issues since my revision 9 months prior.

I had recently started work, was still orienting and settling in, and weekends were my only time to meet new people. I joined a Meetup group for a hike up Tiehacker Mountain just out of Seward, AK. I hadn’t travelled out of Anchorage yet and thought that would be a great orientation to the area. I met the Meetup group at a local grocery store to make carpool arrangements. I ended up in a car with an experienced group of fellow hikers, Jennifer, Wayne, and Craig. I had met maybe one of the people in the group before, but everyone else was new to me. As we drove to Seward, I soaked up all of their knowledge as they talked about hikes in the area. I was eager to learn as much as I could.

Everything was going great until we reached Turnagain Pass, about 60 miles from Anchorage. My stomach started to hurt. A lot. Oh well, I thought, once we get hiking, I’m sure I’ll be less focused on it and I’ll be okay. We reached the parking area and the other three or so cars full of people joined us. Everyone was gearing up for the hike, so I decided to take my pre-hike bathroom trip and assess my stomach situation.

I went into the woods to check out my ostomy and my abdomen. As soon as I opened the bag to empty it, whoosh, blood came flowing out. “That’s not good,” I thought to myself. “Well, maybe I’m just having a Crohn’s flare. I haven’t had one of those with my ostomy. Maybe this is what it looks like,” I thought. So I closed the bag back up, pushed the blood to the back of my mind, and joined the group to head out on the trail.

We were about a mile out from the trailhead when the pain in my stomach grew worse and worse. I stopped making small talk with anyone in the group and dropped to the back of the pack to be by myself and contemplate what to do. I thought, “I drove with four other people. My car is all the way back in Anchorage. The only person I kind of know is my craigslist roommate in Anchorage and my co-workers of two weeks.” At first I thought, “I’ll just continue hiking. It will get better and then I can go to the doctor this week.” I didn’t want the other hikers to think I had something wrong with me or that I was out of my league hiking in Alaska. I had moved to experience adventure, and to get over my days of being “sick.”

But then my rational brain kicked in, and I knew I needed to take action. I pulled my carpool mates Wayne and Craig aside and I calmly say, “I need to go to the hospital.” They looked at me with concern. “Don’t worry. It’s not a big deal. I have Crohn’s and it’s flaring, so I just need to go get checked out. I’ll call my roommate in Anchorage and she can come get me.” They appeared uncertain, but told me to give her a call. The three of us dropped even further from the group. I got on the phone and tried calling my roommate. Service wasn’t great and I couldn’t get her to answer. I texted her and she was able to answer saying she would have to drive back across town to the house and then drive down so it would be about 2 hours and 45 minutes. “Perfect!, I can go back to the trailhead and wait for her to pick me up,” I said. “That’s a long time” they responded. “No, it’s okay. I don’t mind waiting,” I said out loud. Internally, I was dreading waiting that long, at the end of the road, in a town that I’d never been in, in a state that’s 4,000 miles from anyone I really knew.

Then, Craig came up with another option. He offered to drive me. I adamantly refused, as I did not want to ruin his hike. He then decided to let me borrow his truck so that I could drive myself to the hospital, and then he would come pick it up after the hike. I agreed. I remained calm, but internally my flight instinct was kicking in, and I just wanted to get out that forest. Craig handed me his keys and we exchanged contact information. We said goodbye and I walked in the opposite direction of them and the group. As soon as they were out of sight, I took off at a limping jog, as fast as my abdomen could endure. Finally the parking lot was back in sight. I hopped up into the giant trunk with a cap on it. I have never driven a vehicle so big and I couldn’t see out the back. I punched the directions for the emergency room into my phone and drove off toward Seward. I calmly pulled into the parking lot and walked and walked around the parking lot until I found an open door. It was Sunday and there didn’t seem to be a lot going on.

“I need to be seen by a doctor,” I said to the receptionist. “There’s something wrong with my ostomy and I have terrible abdominal pain,” I continued. Being the only patient there, they took me right back. “Is there anyone here with you,” the nurse asked. “No, I just moved here. I was out hiking with a group, and one of the guys let me borrow his truck to drive here,” I spouted out. I’m sure I sounded like a lunatic.

The doctor came into the room. She asked me to take my bag off. I took it off, and my stoma was the size of a baseball and completely black. I internally freaked out, and thought that I was playing it cool, but the shock in my eyes did not conceal my thoughts. “It’s okay,” the doctor said, trying to calm me down. At that point in time, I knew she had no idea what was happening either. “Let me call my surgeon in Boston,” I said. “I know he’ll answer.” So I called my doctor on the east coast. He didn’t answer at first. I sent him a picture of this black baseball hanging out on the outside of my abdomen. He called me back immediately and asked to talk to the doctor in Seward. I put her on the phone. She talked to him and hung up. She said, “we need to find some sugar.” “Huh,” I said. “Sugar helps reduce the swelling, right?” she asked. “Umm yeah sure. I think I had read that before,” I mumbled back. She went and found sugar from the coffee cart, and we dumped it all over my stoma. “Let’s wait and see what happens,” she said. Nothing happened. We contacted my surgeon again. He got in touch with the surgeons in Anchorage and they created a plan. I needed to go to Anchorage to be seen by one of them. That sounded like a better plan than hanging out in Seward and using up all of the sugar in the hospital. And so I waited, and waited.

It didn’t feel that long, but suddenly I heard Craig’s voice outside of my curtained off room. He was explaining to the front desk staff that he let me borrow his truck. I told them the story already, so they knew who he was. “How’s she doing,” he asked. “Oh she’s doing well,” they said trying not to give too many details to this man who didn’t actually know me. He left. I’m thinking, “I’m doing pretty well. My intestines are hanging out of me. I’m waiting for a helicopter to come take me to Anchorage. I know nobody. I can’t tell my family because they would freak out, and I don’t even know what’s going on right now. This is going to be fine. I’m going to be fine.”

I kept waiting. The helicopter couldn’t make it because of bad weather, so they sent for an airplane. They put me in an ambulance to drive over to the airport. They zipped me up into the emergency transport sleeping bag on a backboard and loaded me into the plane. “How’s it going,” asked the nurse as I stared up at the ceiling. “Oh, great,” I replied. “I always wanted an aerial tour of Alaska. Maybe not under these circumstances though.” We landed at the airport in Anchorage. They loaded me into another ambulance, and we took off toward Providence. I asked my roommate to meet me there. I arrived in the emergency room and there she was. She was probably asking what she got herself into. She didn’t even know me. “You have to have emergent surgery,” the surgeon in Anchorage said. “Oh, umm okay,” I responded. “Your intestines are strangulated and necroding,” he reported. I thought, “thanks, I kind of figured that since I’ve been staring at this black blob hanging out of my abdomen all day.” “It shouldn’t be a big deal though, we’ll just cut out the dead intestine and create a new stoma,” he said. I knew my surgeon in Boston had spoken to him, and after further explanation, I felt comfortable with the plan. As they took me back to the OR for surgery, all I could think about were the poor hikers who had no idea what happened to me, my new job, my new roommate, and my family 4,000 miles away. I didn’t need helicopter insurance, but I sure could have used some airplane insurance.

(Top: Necroding stoma in Seward before surgery. Bottom: New stoma in Anchorage after surgery).

A Few Lesson Learned:

• After becoming more comfortable with my ostomy and my friends/support network, I learned to share my story more. When those around you are aware of your medical conditions, they can help you better in emergent situations. Typically, for every trip that I go on, at least one person knows my health history, including that I have an ostomy and Crohn’s.
• I’m now a member of the AAC, which includes some domestic and global rescue coverage.
• I established local providers, so that I am not relying on a surgeon 4,000 miles away.
• My intestine being “strangulated” was likely due to a blockage, so I learned to self-irrigate my stoma, to reduce blockages.