The New and Improved First Aid Kit

I have two doctors, my left leg and my right.

George Trevelyan

A few days after I posted last week about my oversized first aid kit, I came upon the “new and improved version” I created a couple of years ago when I was preparing to hike the Pacific Northwest Trail and wanted to lighten my load. It was nothing more than a Zip-Loc bag containing bandages. . .lots of them: gauze pads, bandaids, tape, all in assorted shapes and sizes, blister repair products, antibiotic ointment.

“I wonder what it weighs?” I asked myself as I took the kitchen scale out from the cabinet and set it on the counter. Ten ounces. That was a vast improvement from the eight pound version I used to carry, but considering that a small box of bandaids weighs less than an ounce, it still seemed heavy. Then I considered why I carried a bag full of bandages. I will tell you. Come with me on another adventure in the Olympic Mountains.

I arrived at the trailhead on a hot July day, excited to begin an eighty mile loop through some backcountry in the eastern portion of the park, an isolated area that was far from the popular trailheads, rugged and lonely, just the kind of place for me. I put on a brand new pair of hiking boots that I had purchased less than a week earlier, and though I had worn them around the neighborhood a bit as I went for my daily walks, it was not possible to break in a pair of sturdy leather boots in so little time. I knew this was not a good idea, but the old and comfortable pair had fallen apart on a trip the previous weekend and could not be mended. I could either cancel this trip or start out with new boots. That was an easy decision for me.

I left the trailhead and began the steady uphill climb towards Deer Park Campground, where I would be spending my first night. The “hot spots” on my heels were there before I had even gone a mile. I stopped to apply Moleskin, hoping that would be sufficient to prevent real blisters from forming, but by the time I made it to camp that night, I had blisters not just on both heels but extending on either side, the result of a U-shaped “heel clip” embedded in the layers of leather that was designed to wrap around the heels to keep the boots tightly in place and prevent rubbing.

The sensible choice at that point would have been to turn around and hike back down the trail to my waiting car. I could even have done so without further damage to my feet, since these heel blisters were the result of going uphill, not down. But sensible in those days was to minimize risk and exaggerate my abilities, what today would be called optimistic bias. I was a Registered Nurse. I certainly had the first aid skills as well as many years of hiking experience to prevent these blisters from getting any worse. I got up the next day and continued my journey, carefully bandaging my heels before trekking along the summit of Grand Ridge.

By the end of hiking that day I had angry looking wounds, matching perfectly the evil clip that wrapped my heel in a vise. From my campsite that night in Badger Valley it was a short hike to a trailhead at Obstruction Point, where I likely could have hitched a ride to Hurricane Ridge and used a pay phone to call someone to come and pick me up. There were of course no cell phones in those days.

Nonhikers who read this post will think my decision to continue hiking foolhardy. They would be right. Hikers, however, will remember the words of John Muir, “The mountains are calling, and I must go,” and so I did. I went. Adventure rarely wears comfortable shoes.

By day three I was pausing frequently to take off my boots, air out my painful feet, and reapply the bandages along with a generous supply of antibiotic ointment. I had studied the map and determined that I could make a shorter loop and still hike through some of the wild country I was aching to see. This decision enabled me to take shorter hikes, only about five miles a day, which gave me considerable time in camp to walk around barefoot, airing out my painful feet.

I also discovered that by placing a rock into the heel of each boot at night I could stretch out that heel clip, loosening its painful grip on my feet. The rocks had to be just the right size, rounded, and big enough to force the clip open just a bit. Since I wasn’t about to carry rocks in my pack, I had to look for new ones each afternoon when I got to camp. This effort was well worth the time. My heels were not getting any better, but they were not getting worse either.

By day four however my ankles were starting to swell slightly. I had now entered an isolated part of the park, where I saw only about two to three hikers a day and was far from any trail that would be close enough to a road to seek help. I had reached the halfway point of the shorter loop, and decided the best action would be to keep hiking and get to my car as soon as possible.

Then I fell. I was making the steep ascent towards Lost Pass, where large snowfields lingered on the north slope from an unusually heavy snowfall that winter, followed by a late spring. I was kicking toe holds into the icy snow when I felt myself slipping, gradually at first, then gaining momentum as I slid on my belly down the length of the snowfield.

As I fell I experienced a strange kind of calm, wondering how I was going to land, whether I would be injured, and with an unexpected detachment knowing I could do nothing about the outcome. When I did land I heard a kind of plop, the sound of my bare thighs landing safely on the rocks below. I was sitting upright, seated as if I’d planned it that way, my legs stretched out in front of me. There were no mangled extremities, no unnatural positioning of my legs. I was just sitting. I got up and resumed the climb, traversing the slope by a switchback that lessened the steepness of the ascent, exhilarated by my good fortune. I made it to the pass, body and soul intact, feeling lighthearted and invulnerable.

I had gone only a short distance from the pass when I felt something on the back of my legs. Thinking a fly was pestering me, I reached back to swipe it away, and was shocked to find my hand covered with blood. I had not felt any pain, thanks to the adrenaline that surged as I slid down the slope. Now I was twisted around, watching the blood trickle down the backs of my legs, my upper thighs and buttocks looking rather like hamburger.

I made camp as soon as I found a suitable site with level ground, little more than a wide spot on the trail. I wanted to regroup, to consider my options, and to have a cup of tea. The vista of the Dosewallips River Valley extending below me and Sentinel Peak rising above it on the north calmed the flurry of worst case scenarios that was going through my mind. I could walk. That was all I needed to do to return to safety.

That night I crawled into my sleeping bag without bandages on my thighs. Most of my first aid supplies had already been used. I had cut the large gauze pads into smaller rectangles to cover the blisters. As I slept the mangled flesh stuck to the nylon of my sleeping bag so that when I turned I ripped off the loose flesh.

The next day I got back on the trail. There was nothing else to do. I was taking a rest by the creek at Bear Camp. My boots were off, and I was airing out my feet, as I did at every rest stop. I had been sitting for only a few minutes when a couple of hikers came up the trail and sat down nearby. We exchanged the usual greetings, then the man looked at my feet gravely, and stated, “I am an emergency room physician. I need to examine those feet.” It was not a request. He pulled out of his pack a first aid kit the size of a small suitcase and began spreading out supplies on a sterile drape. I half expected a gleaming stainless steel operating table to appear. He proceeded to lance the blisters on both heels, pack them with antibiotic ointment, and then carefully dressed each heel with a gauze wrap to hold the smaller dressings in place. When he had finished he handed me a bottle of tetracycline with instructions to take one capsule immediately and then four times a day on an empty stomach and to go to an emergency room when I got back to my car if the swelling persisted.

At this point I considered standing up, turning around, and pulling my pants down to display my bare butt so that he could examine the lacerations, but discretion saved the day. I still had my dignity intact. I had been graced by something hikers these days call trail magic. On an isolated trail, a physician and a bottle of antibiotics had arrived.

The following day, as I made my way over Gray Wolf Pass, I began to remember what it was like to set my feet on the ground without pain. The swelling of my ankles was down, and I hardly noticed the debrided flesh of my upper thighs. Each step was a celebration.

I have never again needed so many bandages on a single trip, though I continue to carry a generous supply. When my daughter and I section hiked the Pacific Crest Trail in 2015, I was surprised to meet many through hikers who didn’t carry any first aid supplies at all, so I was happy to give them out when needed, sometimes just a bandaid or two, sometimes a few gauze pads, sometimes a roll of tape. And because I am old, I felt entitled to add a short lecture: “Bandages don’t weigh much. Get some.”

But here is the real gift I carry with me from that trip, and it doesn’t weigh a thing. It comes to me most often when I am on the trail but can occur at any time I am walking, sometimes at home, sometimes while pushing a cart in the grocery store. I notice that my feet are touching the ground and that the earth is holding me upright. It feels no less miraculous than if I were to suddenly sprout wings and fly off into the sky.