Still Grounded

The past two weeks have been characterized by very slow recovery. I take the bus to the hospital every few days where a quick look though the scope shows marginal gains, but things are definitely improving. The quantity and strength of my medications is going down, where steroids and simple lubricants make up the bulk of the +23 eye drops I take daily. Doctors frequently readjust the balance of medications in order to prevent problems (and remittance) while also reducing the overall “toxicity” of the eye. This toxicity may cause irritation and slow healing, but it's important not to back off mediation to fast. I am off all oral and pain medications which has solved my stomach problems. Things are getting better. I can see and feel the improvements. The eye is clearer and more comfortable, but often closed as it is not useful for seeing just yet. The “pin hole” eye test shows good results, which is promising for a good recovery.

I was told this would be a long recovery. I suppose I was hoping for something faster, but I can't complain that things are going in the right direction. I've been laying low at the hostel for about three weeks now, where a steady cast of characters have passed through. This really is an international backpacker's type hostel, so there are no kids running around, but there are many languages and aromatic cuisines coming from the self serve kitchen.

A large world map shows where hundreds of people have visited from (one from Albany, unbelievably) with many different currencies posted around it. There is also a dining room, comfortable seating, games, and generally fun and relaxed atmosphere assisted by good décor and upbeat music. Its been a good place to stay. I'm in a six bed dorm, which has been fine, except for the usual annoyances of people snoring and thermostat wars that could be called cultural differences. I've been sleeping a lot, which I allow myself to do as part of my “recovery,” and I often get up late where my
body feels heavy and stiff. I've been meaning to do some stretches but haven’t been very good about it. I really haven’t been very productive at all, which I feel somewhat guilty about. I've spent a lot of time on the hostel's free wifi, downloaded some free games, and now have a good hand at casting lightning strikes at endless streams of cave goblins. I also you-tubed a bunch, and caught up on my classics like “Birth of a Nation” (1915) if you have three hours to kill. I also fed a short obsession with remote control rally cars, and may have bought one if there was room to take it in my panniers. But I've also done some research on travel plans, routes, and languages using Babble's Spanish program. I also found a pocket guide to Arabic at the hostel book swap, which I though was a good sign for Morocco. I also bought a pocket Bible and am about half way the book of Mathew, which is another “some day” I've now had the time to do. It's been somewhat cryptic but rewarding.

I try to get out of the Hostel at least once a day. My light sensitivity is less intense then it used to be, and I am comfortable in most daylight now. The downtown area is few blocks away and has nice pedestrian areas, varied shopping and dinning (with “American Candy Store”), a museum, and some cultural events as part of a week long program. There are many gift shops featuring plush Loch Ness monsters, and of course, plenty of kilt shops. I think I could get behind it, but a little drafty on a bicycle. (Then you need a matching shirt, jacket, shoes, socks, accessories...). Although I tried cooking at the hostel I usually eat my main meal out somewhere. I have been getting adventurous with Indian, Greek, and Caribbean foods including curried Goat last night, which was spicy, but good with a little pineapple ginger juice. I eat slowly so this becomes the night's activity. Maybe I'm feeding my adventurous side with food? I'm glad the city is nearby to get necessities, a little exercise, and breakup some cabin fever. Unfortunately I have I've also witnessed some of Scotland's problem alcoholism with incidents on the street. There appears to be economic stress as discount and fast food stores are always packed with people while more moderate stores and restaurants appear to be quite vacant. I don't know what the long term effect will be if this trend continues. These not withstanding, I would consider this to be a nice, tourist city with good vibe and plenty of things to do.

As time slips by I have been somewhat concerned about the weather. It was my plan to head south as the colder seasons approached, and now I am very much behind. Fortunately, from what I understand, Scotland does not get deep show or as frigid temperatures as what I've ridden before. I still plan on riding from where I stopped, though I may need to pick up a few things I wasn't anticipating needing. I already bought a layering jacket, and am planning warmer coastal routes that avoid higher elevations. I'll need to take more direct routes, and take ferry connections that will cut riding distances, but this is all part of being flexible. I am anxious to get going again, have a beer,get back to life!

So now it's just a waiting game, where everyday brings a little progress until I can get going again. Thank you all for your well wishes.

Eye, problems.

The ride out of Tongue was pretty straight forward, and continued through wide open grasslands and rolling mountains with great scenery throughout. Roadside info boards made claims of abundant camouflaged wildlife, but the sparsely spaced abandoned stone buildings were more obvious from people who once tried to eek out a living here.

Before long I passed Smoo Cave, which was well signed and marked on many maps, so I decided it was worth a side trip. Ocean waves and ground water had eroded Scotland’s complex geology making the area rich in caves. Smoo Cave was right on the coast. The huge main chamber reached maybe 200 feet in all directions, and was tall enough to break through ground level and let in skylight which dispersed to most of the chamber. Fresh mineral water ran through and rained down from above, which spawned an abundance of mosses and green plants which were unique for that climate and lined the walls and climbed to the roof. This was a pretty epic location, and I have no doubts an action movie could be shot here with little alteration or enhancement. Adjacent to the main chamber was a waterfall room accessed by a wooden walkway. Here a formidable waterfall ran into a large pool of water, where rubber rafts tied up on a dockside opposite. Guided tours were available to the interior portions of the cave but were canceled due to high water levels. Pictures on the ads made the interior portions of the cave seem equally impressive.

Winds developed during the day and built to the predicted 20mph by the afternoon, and, wouldn't you know it, in the direction I wanted to go. As I made the clubhouse turn south, it quickly became apparent this was a non-starter, especially with the remoteness that lay ahead. So, I decided to take short day, and hope for more favorable conditions tomorrow. There was a campsite, but I decided to forgo the shower facilities and utilize Scotland's open access policy by setting up right on the local beach.

This is something I've always wanted to do, but I never found a campsite on the beach in the US. The beach itself was alluring in its beauty; good quality sand backed by vertical cliffs, with bounders and rocky outcroppings throughout. The wave action made some nice spray and flow over into tidal pools, fresh water springs seeped through the sand and ran down to the ocean. This was one of many beautiful and sparsely populated beaches along the north coast, this one had apparently won a bunch of awards. I picked a spot at the back of the beach in the lee of the cliffs; the same offshore wind helped keep the surf down. This didn't stop local surfers from trying the marginal waves in water so cold I could not stand more then shin deep. Instead I took some time to boulder along the beach, had a few good moves, but often fell back onto the sand from trying to traverse low slung inverted slopes. I made some simple dinner on the stove, and finished my sample whiskeys while watching the tide run out till it was dark. It was one of the first times I'd actually stopped to reflect on where I was and how the trip was going, and felt it was an important time to reflect without distraction.

Although I checked the weather reports, tide tables, and high water marks, I had still some trepidation about getting swept away by some huge wave. This did not occur, but I did have a dream that someone kicked sand in my face while I was sleeping, and awoke to really intense pain in my right eye. I do sometimes have problems with eye dryness, so I used some over the counter eye drops and went back to sleep. But began to have problems when I was riding a few days later.

The ride south the next day was probably the most remote I've ever been. I also got a taste of some downwind riding. There is a point, where wind speed just matches traveling speed, where everything seems very still. You realize just how quiet your surrounding are and how barren and solitary your situation is. The rhythmic mechanical sounds of the bicycle and rolling tires brings the same sort of comfort as a diesel engine at sea. The warm weather had allowed the insects to form an intense offensive that made even short picture or map stop intolerable for more then a few minutes. It was a relief to get going and be just a little faster then them. I stopped at the eerie and supposedly haunted Ardvreck Castle before before the midges (bugs) drove to stay at a hostel rather then camp. I still hadn't a proper night solo camping in the highlands, but the hostel was nice. I got some travel advice from a local who marked up my map over dinner, and there was the sweetest hostess who sang in the morning as she went upon her chores.

The next day I continued south, stopped in Ullapool for their famous Fish & Chips, and also stopped at a few other parks and overlooks that were worth seeing. At this point my eye started bothering me more, as if there were some sand in my eye. I used some lubricating eye drops I had with me throughout the day, and gave it a good rinse in the shower that night. The next morning it was clear something was majorly wrong with my eye as I had pain and extreme sensitivity to light. By this time I was in quite a remote area, and being unable to ride my bike in such condition, the nice people at the hostel drove me to town where I saw the local doctor, who after using some florescent die to identify a scratched cornea, prescribed some lubricating and anti-inflammatory drops. A big thank you! Again, to the folks at the hostel who waited for me at the doctor's office, brought me to the pharmacy, then the the supermarket (since I was out of food), and to the ATM to pay for it all. Least I could do was get them a bottle of wine. The drops did make the pain go away, but my condition did not improve the next morning as my vision quickly became poorer. It was not until the next day that I was able to catch a ride to Inverness, the closest city with a hospital, where I walked to the emergency room.

Although I was concerned about my eye, I was much more relieved to be out of isolation and be in place with specialized care. The ER folks took some details and declared me blind in my right eye after I couldn't make out the eye chart itself. I was moved to the eye clinic, and although they were busy, was seen by two doctors with twenty minutes. At this point I was still hoping I'd get some drops, pop them in few times a day, and be going again in a week, but I was surprised at their level of concern. They explained I had ulcerated infection, and it was serious, and needed immediate and constant attention. I was then admitted to the hospital.

From here I was provided with high strength anti-biotic drops, on the hour, around the clock. After 48 hours and no progress (or much sleep), the drops were changed to different, stronger and-biotic, hourly, for another 48 hours. Still there was little progress. The sample swabs they took for analysis came back clean for bacteria, so the thought went to viral or fungus infections, which were rarer, and there were more drops and pills for. It was nearing Friday afternoon and I was brought in for a doctor's meeting, where about six or eight physicians took a look through the scope in succession, then went off and had a meeting about me. I agreed to have a biopsy done, which was a short procedure in the OR where they took small samples of eye tissue at the infected site. Around this time it started looking like the rare Acanthamoeba organism, not a bacteria but actually a multicell creature that can take hold in the eye if it can get past the protective cornea, such as a through surface scratch. Although the creature is common in environment, infections of the eye are vary rare and the hospital had only a few cases in their history. In fact, there have been only a few thousand cases ever, which put my odds at about one in 300 million, even less for non-contact lens wearing healthy eyes with normal immune systems. And, I always wear glasses when riding to prevent this type of thing from happening! One of the doctors describes this as “extraordinarily unlucky” which defied explanation, save my night on a haunted beach?

The organism is dynamic, can take many forms, and is highly resistant to chemical attack. There are mixed methods and reviews for treatment, and the path forward was much unknown. I was advised that treatment would take months, and this would not be a quick fix. So with about a week of treatments under my belt already, I began getting treated for the Acanthamoeba. These again were around the clock, on the hour, day after day for about a week. The pain meds they had me on helped. I started having crazy dreams like flying over candy land, and having an M&M character jump up and pull my left sock off. I went down to confront him and retrieve it, but he was a real asshole about it. I too, would have been interested to see how this turned out, if the door hadn't opened letting hallway light in... another hour had passed. This defined my week; falling asleep accidentally to remember reality on the hour.

Fortunately we started seeing slow improvements in my eye. Some of the drops either stung at first, or stung over time as my eye started getting sore of the chemicals. One of the doctors who I saw regularly (there were about five) described my eye as “well pickled,” and I think that describes the vinegar like sensation of an eye full of chemicals. However much it sucked, it was important that we hit it soon and hard to eradicate it. Otherwise, the organism could insist (hibernate) or otherwise build tolerance to the treatments. I think the underlying plan was to hit it as hard as we could, unless I cracked or the treatments were doing more harm then good. I put no contest to the doctor's orders, and always felt that I was under good supervision and care of the team of doctors who saw me regularly, often waking me up at 9:00, strait tied, me, still in my pajamas.

The time at the hospital was up and down. Fortunately my work in government readied me with high patience levels and low expectations, and I found it surprisingly easy to sit in a room by myself for nearly three weeks, which may say something for my psyche. I was concerned, but tried to laugh rather then cry. Inconclusive test results and lack of sleep started driving down my patience. I was concerned about loosing my eye site or not being able to make a full recovery from the damage that had already been done. I remember sitting on my bed thinking “Even if I do loose my vision, I made a hell of a go of it towards the end there.” The doctors tried to reassure me that we had identified “the bug” and I was doing well in my treatments. The ulcerated portion of the eye was off the pupal and away from the “visual axis” that made things less dangerous for vision damage. My current loss of vision was more a function of the obscured shape of the eye, which should go back to normal when it becomes less inflamed.

Obviously, this has been the biggest obstacle of the trip, and I've often thought of going home. I really don't want to end my trip, especially on such a sour note, but I cannot continue on bicycle until I have clear bilateral vision. I'm still operating on one eye, and I frequently walk into people or things that are to my right, at least at an angle that my left eye can see over my nose. Things like crossing the street become much harder. One of the doctors, also an avid rider and bicycle commuter, offered to store my bicycle if I wanted to go home and return at a later date. His offer was, and still is taken seriously depending on how things turn out. Still, I can't feel like a kid who got hurt on the playground and went running home, but that's what makes this an adventure rather then a vacation is opening yourself up to risks and being vulnerable. Further, I do feel that I am getting quality, first world care (not that I'm in Chad or something) and I doubt that returning home would do me much good except unnecessary changing providers midstream. At this point I have quite a case history. My pink case folder is becoming quite thick.

The actual stay at the hospital was another first for me that this trip uncovered. I was fortunate to get a private room at the end of the hall, and I could pull the window shade to keep the room dark, warm, and reasonably quiet for whatever on and off sleep I could get. I was tired, but had few tasks to complete except fill out the food forms where surprisingly good food was brought to my bed.

This was a refreshing change from having to search for food and lodging every night, and I didn't mind laying around all day with nothing to do, at least at first. My eyes hurt, so I often just lay with my eyes closed. My only real complaint is the damn tea. It seemed that every 10 minutes people would poke their head in and offer you tea to the point it turned into a running gag. I almost put a sign outside my door so people would stop waking me up for damn tea service. That's England for you. On that note, Scottish independence was voted down during my hospital stay, but I was much removed from the media and the fanfare of it all.

The nurses were all very nice and accommodated my needs in trying to try to keep me comfortable. I was not used to this, or really anyone caring for me like this. I have to admit I fell for one of the night nurses who first took care of me. I didn't mind being woken by her. She seem excited that I was from New York, and I told her to call if she ever wanted to visit, but I doubt that call is coming. The other nurses were equally friendly, and encouraged me to get about the hospital as being in bed all day was not good for me either. I think they just wanted an opportunity to change the bed sheets which was done daily with militant neatness. As I walked around the hospital I realized how large the place was. I doubt any better care would be given in the US. I saw people with very serious conditions; large casts, people attached to machines, lying in push beds with IV bags getting carted through the hall. I passed the heartbreaking children's ward, cancer center, and the morgue. It wasn't lost on me that a lot of people leave the hospital wrapped in plastic. Experiencing this helped put my eye problems in perspective as I was still able to get about on my own fairly well. Coincidentally, I saw yet another front page news story of cyclist that was killed by a logging truck just outside of John O'Goats, where I had ridden about a week earlier.

On a lighter note, my vision was improving (20/200, then a good as 20/60), pain was going down, and the drops were reduced to a manageable daytime only schedule, so I requested a discharge. I wish this wasn't a financial decision, but I was motivated by an up ticking hospital bill that in two weeks was twice as costly as the rest of the trip combined. I'm glad I got traveler's insurance, but policy wording required I come up with money then be reimbursed. People at the hospital are helping me with this, but this saga continues to unfold. The hospital set me up with drops, pills, and a schedule, and I checked into a local Hostel at about 3% of the cost of the hospital. Getting about on my own was harder then I thought it would be. I think he hostelers are afraid of the antisocial eye infection guy, and though it is not contagious. I also have headaches and swallowing/digestive problems from the medications and side effects. I just can't be be social when I'm like this. I eat most of my meals out, and still have limited vision and much discomfort in sunlight, which is an issue when trying to get about town or to my follow up appointments.

There was a disappointing setback in that the eye was not healing properly. This prompted another round of tests. The results that have come in have been negative for further infection, which is good, but not helpful in isolating the problem if the eye continues to get worse. Here I really started to do some of my own research. There was no internet at the hospital, and I was avoiding knowing too much an outpatient. I found and managed through some scholarly articles on the disease, and was really terrified by the language used. Inconsistent treatments and mysterious, unexplainable results, and images of entire eyes being taken over. The organism is dynamic and can harbor complementary bacteria, build chemical resistance, or change forms when under attack resulting in frequent “complications” and “setbacks” during recovery. My progress was stinted, my vision was getting poorer and pain was increasing. This was one of the handful of times in my life I really prayed hard. I brought all my belongings to my next follow up appointment, sure that I'd be admitted to the hospital again. Surprisingly, the eye was healing a bit, and not only did they send me home but prescribed steroid treatments to help with the healing, confident that the Acamthamaba was gone. They believed that the antibiotics were causing inflammation problems, though the actual ulcer site was healing. Still, I have some scratchy feelings now and again, and things are up and down on an hourly basis. My eye drops and follow up visits are farther apart, which gives me hope, but I also understand that we're not out of the woods yet, and it could be weeks or months of treatment more. There could also be dormant cysts in the eye, which could relapse at a later date. My vision will likely be permanently effected to some degree, where I may have to where glasses again, which I would be fine with. I think I'm going to stay away from contact lenses.

So, lastly, my apologies for the late and long posting. I went to the hospital for a day treatment, and after being held, have been living in the same set of cloths (plus cell phone) for about a month. I don't have my camera and photos have been limited. It's taken me a while to organize and put all these thoughts down. I still hope to continue on my trip, bit I'm not so shallow to understand that I may never ride a bike, or operate a car, and be half blind if I don't take these treatments seriously and be thorough on the recovery. I'd appreciate if you keep me in your thoughts and prayers, as I too, now have some promises to keep to the man upstairs.