My First Prescription

6/15/22

Whether she provoked it was moot. The wild dog attacked, scared her face for life, and fled to the safety of the concrete jungle of North Chicago. We all knew it would never be found just as we knew that her next two weeks would be filled with the pain of our rabies shots. I felt the need to give them myself – why I’ll never know.
As I raised a burning whelp in the soft skin of her nine-year-old belly quiet tears streak down her cheeks. Fear mixed with blind trust caused her to look brave just as I, like all medical students, pretended to be brave.
Two babes in the woods bonding through the act of a wild dog.
I dried her tears but knew something more was needed so I wrote my first prescription.


The rose graced her home and each day she came back the bond grew stronger. It lives now as this memory.


I’ve written many prescription since then …some helped…some not. I often wonder that years from now you will look back and find our therapeutic modalities barbaric, misguided, or based in myth.
Many ideas of merit come from youth… from the mouths of babes. Truth is clearer, less clouded by education. You know these truths… Deep inside yourselves they are safe… You must not let us teach them away from you… You must save them for those who desperately need them. Time will never out date kindness or compassion.
I find it ironic that my first prescription may have been my best. Good luck with yours.


This brief story was shared with a graduating medical school class in 1985, 11 years after the event. I was asked to share my thoughts about aspects of being an MD.
Last night while sitting in front of a fan with shaking chills and a fever from my own rabies shots I thought of that barbaric treatment I have given to a nine-year-old child. Yes we have moved on as the years progressed.
I think often of time. I don’t believe it is linear but rather a spiral or even a Möbius strip

too long for us to see an end that does not exist. Somehow in the midst of the shaking chill I was there with her again in an emergency room from years ago. Perhaps I looked up to the spiral above and saw her there smiling down at me…
I think to compassion shown to me just 72 hours ago as I myself was loaded with immunoglobulins and vaccines and to the compassion shown to me this morning when I got my second of four shots…. I dread the next two days…
Nonetheless I know that compassion of others has eased the burden just as I hope my first prescription did so.
Time maybe a Möbius strip or a spiral around but compassion and kindness definitely make the path more than a bearable one…

What I Learned in Summer Camp

6/13/22

The events of the past 96 hours have been so “rich’ they take time to sort out.

I awoke in my tent after a 24 hour ride full of pouts and self pity that I had been removed as a route leader on the ride. Sitting on my big lower lip Angel and Flossie laughed at their perch and reminded me the trip was Chief to Indian heavy and my role had been reversed. And then with great wisdom they both remind me that being a “leader” had nothing to do with a title but rather with ones actions. 

I cleaned up my gear and approached the rider I had been helping and told her I would hold back and ride with her to get her through the day. Her relief was palpable. The ride included 3 climbs, the 3rd the steepest and most difficult of the first ten days pf the ride. At 45 miles I congratulated her on making it through with a still slightly injured knee and told her to stop for the day and I would go on alone. She readily agreed and thank me for the help in the first part of the ride.

Off I went to climb to Hayder’s  Gap. I had done this before and knew it would be  slow and difficult . In the past I had stopped at a library at the bottom of the mountain to get water but this time found it closed. Instead I met Ms. Davenport, a 90 year old wonder sitting on her front porch. She welcomed me for a rest, gave me fresh water to drink and filled my bottles to the brim . Stories of her youth and family entertained me as I rested on her porch.

With a heart felt “thank you” I left and headed up the sunlit side. 4/5 the the way up my phone rang and a panicked route leader told me there had been crash on just the other side of the top. My medical help was urgently needed. 

One of our riders had hit a gravel patch on the way down and crashed into the embankment wall. I gave instructions to a nurse riding with us to immobilize his neck and quickly called 911 to get an ambulance to the site. !0 minutes later I was at his side…a mld concussion but saved by a broken helmet from more serious head injury. It was obvious his clavicle and shoulder were broken and a swollen left chest suggested broken ribs. At least he made sense as I talked to him. When the rescue squad arrived I was able to listen for breath sounds with a borrowed stethoscope  and assured myself his lung had not been punctured. With the help of other riders, a rattled policeman ,and two young female rescue squad drivers we loaded him into the van and they sped away to the mountain bottom where a helicopter was waiting to take him to a Johnson City Trauma Center in Tennessee.

He was admitted and has since been discharged and is home doing well. 

That night any thoughts of pout had dissolved and I was just glad I was there to help.

The next morning we arose early for a ride to Breaks Interstate Park for a night of rain but calm.

The next morning before we left we had a team meeting about entering Kentucky.

The theme was sobering:

  1. Beware of the Coal trucks, they don’t care for riders and travel in pairs so if a cyclist is hit the second truck can testify it was the rider’s fault
  2. Beware of dogs, they are loose and viscous. A quick lesson on how to kill a dog that is on top of you going for your throat
  3. The local people are not happy about riders watch yourself on the narrow roads
  4. There will be no phone service

So off we set. 

As I approached the border, a cloud covered bridge, I felt like I was entering the tight zone.

Beautiful mountains with cut segments revealing million year layers rocks spoke of a tranquility that was not to be. 

As coal trucks approached I was careful to get off the road time and time again.

30 miles in on a flat I encountered my first dog hidden in the grass like a lion on the Savana. I warned him off with stern words  but at 20 feet he lunged for my bike and nearly knocked me off. I screamed and yelled and he backed off and I sped on. 40 yards later the second dog attacked but my loud “no!” stopped him long enough for me to speed past. 40 yards the third attacked but also backed off. A climb lay ahead of me and I slowed to 5mph. 30 yards in a pack of 5 dogs rushed at me from the left. I kicked and yelled but at such a slow pace I was an easy target. Three times I got them to back off but the fourth they lunged at my left foot and latched on. I felt a tooth enter my skin and I knew I had been bit. I jumped off the bike and kept it between me and the still attacking dogs and yelled to the rider behind me to stop. Finding grapefruit sized rocks I started bombing the beasts…I missed every time, but at least they backed off. Walking up 30 more yards I stoped to examine my foot now bleeding through my sock. I knew then my ride was over.

With much frustration and anger I rode to the top and down the mountainside to the first rest stop where I borrowed a land line to call home to share the grim news.

I knew I needed to get rabies immunoglobulins as soon as possible so the route leaders agreed to take me to the nearest hospital 15 miles farther down. Arriving there I entered the ER to find it full of sick patients all suspected to have Covid 19. The clerk informed me that I might get seen by midnight…it was 10 AM…

With no cell service I asked to use a phone to try to find a way home for quicker care. The hall phone was out of order, my cell phone had no service and after an attempt at the clerks phone I found I could not call out

“Yep its like that here, we are kinda curt off” ….Twilight Zone…

Looking at a waiting room full of Covid patients, a bleeding ankle and cut off from the world I walked out of the ER and decided to start over. Atop a mountain just out of town I finally got service and called home asking to be picked up ASAP for care in my local ER.

14 hours later I was greeted by people I knew, rushed into an ER room and loaded with immunoglobulins, my first rabies vaccine and started on antibiotics. I was treated to a McDonalds breakfast while sitting on two apple sized lumps deep in my buns.

20 hours later I awoke sore in both arms, both lower cheeks, and my left ankle a little swollen and red from the bite and local injections.

Angle and Flossie were sitting there on the beds as my eyes focused…with a grin on their faces

” Going to test your fate again ?”

I moaned “Go away” and they did… until next time.

Blacksburg

6/6/22

Time serves humble pie over and over again.

Today we rise early for a short ride to Blacksburg, just 47 miles with a climb at the end. A welcome rest day awaits us on the morrow.

Cool temperatures help with an easy exit from a main road into the valleyed countryside. Everything is so green and lush, the winter hay in harvest time. Life smells fresh here.

Deeper into the foothills of the Appalachians we go, not called mountains here but mountains to me from back home. Undulating roads bordered by thick forests, some riders see bear today.

How welcome we are here by locals is not clear. We are not only surrounded by taller peaks but going back in time by at least a hundred years. On one occasion we hear gunshot close by…” Are they shooting at us

?” from a rider in front…”No, they’re not “ but deep down I’m not so sure.

Ahead a rider falls , an uphill stall. I get off my bike to help, she is ok and we move on. She is afraid to take the next few hills and walks but I coax her back on the bike “ you can’t walk to San Francisco” and finally she is brave enough to ride again.

I stop by the side of the road to let her get ahead and notice a most beautiful tree…where I get off my bike…to think a while.

We have with us a young man I met several years ago on a ride out West. At the time we mixed like oil and water and were miles apart. I thought never to see him again…no great loss.

Last Fall I did in fact meet him again on another ride and was impressed by how he had matured and grown. A self assurance beyond reality was replaced by a quiet genuine gentle humbleness.

This time he is with us for just the first week of the ride and I am amazed by his maturity and growth. He has become one of the finest young men I have ever met and I am proud to be part of a team with him.

I look to the thin new trees nearby, and to the solid oak in front and think about mistakes to be made by judging one before their time.

How many times each day am I humbled on this ride, by the beauty of my surroundings, by the tenacity of riders who fall and get up again, by young men and women who grow up to be gems, by the workings of a diverse team that safely moves a small vulnerable group 4000 miles across such varied terrain.

Pass me another serving of humble pie…it will help me grow wiser still…

Go with the Flow

6/5/22

I have not been able to post over the past two nights, the first I was too exhausted, and the second we were in a beautiful hidden valley with no phone service. I will try to summarize the three days now.


We enter the beautiful foothills of the Appalachians and begin to climb into the Blue Ridge Mountains.

On day one we head towards Charlottesville the famous city of Jefferson.
For 60 miles and gradual climbs I help a rider in the back of the pack one with a lifelong ambition to make this trip. Living in the flatlands close to the Chesapeake Bay with minimal hill training it is very difficult for her to climb the 3500 feet.

Nonetheless after eight hours of pedaling she is able to complete the task.

We are hosted at a local Unitarian church and treated to breakfast by alumni the next day and then head higher and higher into the Blue Ridge Mountains to the top of the Parkway. At 20 miles sweeping I come across a rider who cannot make it to the top. We stop, I make sure she is safe, and I continue on. The rescue van will come back later to pick her up. Higher and higher I go up to the mountain tops and after 6 hours and 6500 feet I reach the peak of the Vesuvius.

its almost a straight shot down to the valley below and I know that without brakes I could easily reach 60 or 70 mph. Suddenly Angel and Flossia appear to my great relief. Purched on my shoulder and on top of my head one looks forward one looks back. Rocketing down the mountain side I watch closely for gravel and debris and use my brakes sparingly so they do not overheat. I do not look at the speedometer on the way down hill trip but rather concentrate on the 50 feet in front of me with each hairpin turn. Within 12-15 minutes I have sped down what took me six hours to climb on the other side. At the bottom of the hill is our campsite. We are hosted by a local grocery store who allows us to camp outback next to a flowing creek. Under the stars I sleep soundly my tummy full of food cooked by locals to celebrate our safe arrival.

Today we have a 60 mile ride to Roanoke one of the easiest of the trip. It is 90% downhill along streams , creeks and rivers .I am so tempted at times to get off and wade into the waist deep cool waters. Instead I ride on. As I listen to the gurgling water I think to the flow of life.

How gently the water flows around rocks ,boulders, and downed trees little impediment to motion towards the sea.

Today the person I help does not get lost for the first time, climbs all the hills and reaches the end in the middle of the pack. yes it took me 3 hours more than usual… but so what?

I think of some riders who have doubts, uncertainties, and fears, how they look ahead to see boulders rocks and downed trees. It is not easy when one has not done this before to let the water flow ,to glide past to the sea.

Yes it is very exhausting and more work than usual to help others in need but who am I to protest if I can help them reach a lifelong dream.

Angel and Flossie wink at me… “Just go with the flow”.

There is more to us than we know. If we can be made to see it, perhaps for the rest of our lives we will be unwilling to settle for less.” — Kurt Hahn, Founder if Outward Bound

PS . i am taking care of myself… here i am rolling out cramps…

Day 2 Mineral

6/2/22

97 degrees, 81 miles . Trial by fire.

I start at 6:10 AM. Cooler temperatures. As sweeper my duty is to help those who fall to the rear. I help when they get lost, frustrated, anxious. I assure them not to panic… this is America, they speak English and they have cash. Whatever happens they can’t really get “ lost”.

At 35 miles a second sweeper takes over and I can ride on.

It is hot, really hot, I am going through two liters an hour. 50 miles approaches, I have been in the sun 6 1/2 hours.

I am out of water and see ahead a church. It looks as if a funeral will be held in a few hours. More importantly a spout from the ground, fresh well water!

i pull up and whisper a prayer of thanks, open the spout and stuck my head under the near frozen stream. I sit on the church steps and drink my fill.

Loose thoughts enter my head and I wonder what in the world am I doing out here? My brain is too fried to carry on the thoughts.

Refreshed I ride on .

At 62 miles i pull into the rest stop where Dear Cassie is with us ( for a few hours more still).

She smiles and approaches me ” How is it going Nick?”

I tell her I had one of those ” what the hell am I doing here” moments back at that church with the funeral in hand.

Her smile droops but I quickly add. ” Cassie I am where I most want too be. “ The smile returns and I get a welcome hug.

Angel smiles at me ” Yes you are where you belong”

Such Different Times

6/1/22

Dawn comes to Yorktown , the sun casting warm rays into the cave where Cornwallis hunkered down avoiding Washington’s canon balls.

Local folk has less protective holes in the wall.

Meanwhile down on the beach riders assemble for an East Coast tire dip, the next 4000 miles away.

So the journey begins…