On the last day of May, Kathleen Thomas, my partner at the Park City Family Health Center, was eagerly waiting for me when I arrived at the trailhead of Glenwild, a private golf community set amid the expansive, flower-filled meadows and majestic alpine slopes in Park City, Utah. Excitedly, Kathleen, or “KT” as she was known by her friends, and I were about to embark on our first mountain bike outing of the year, and I was surprised that she had beaten me there because I was, as is my custom, early. (Kathleen’s clock usually runs about fifteen minutes behind everyone else’s.)
“I’m soooo motivated, Winnie!” she yelled as I opened my car door. “But we’ll need to go slow since I’m not in shape yet.”
Kathleen, forty-five years old and fourteen years my junior, was being modest. In reality, she is in better shape than most people I know. She was a college athlete and is still trim, possessing a runner’s physique. She can talk incessantly while she pedals even on the steepest inclines, while I have difficulty answering “Uh Huh” or “No” to her many questions and breathing at the same time. I was relieved to hear the pace wouldn’t be too aggressive.
We unloaded our respective Giant Anthem full-suspension mountain bikes, grabbed our Camelbak M.U.L.E. hydration backpacks, and steered up the trail. Unlike our much longer rides later in the season, it would be a forty-minute ascent to the summit, much of it switchbacks at a reasonable grade with only a few steep sections requiring our lowest gear and our highest energy.
“I don’t think we’ll need our ‘blueies’ long, Winnie,” she declared. “It’s really warming up.”
Kathleen has lots of names for things. “Blueies” are the blue windbreaker shells we utilize for warmth and rain protection. The temperature, a chilly forty-four degrees, made our ears and noses tingle as we left the parking lot. It was only 10:35 a.m. and the thermometer was already rising faster than the climbing sun. The effort required for the uphill leg of the journey would certainly produce extra heat.
“Sounds good,” I replied. “Let’s pedal for ten minutes and then take a break so we can shed our outer shells.”
Frankly, to be back on my bike was glorious. We rapidly left the parking area and with each successive switchback faced a more commanding view of the scenery below. The entire valley, christened the Snyderville Basin by the Utah pioneers, was encircled by the majestic backside of the Wasatch Mountains, a north-to-south range that defines the western edge of the Rocky Mountains. Nestled snugly into the base of the distant peaks to our right was “Old Town,” once a silver mining community and now the cultural center of Park City. Distinct clusters of homes extended toward us like the spokes of a wheel.
Despite the explosive growth over the nearly three decades that I have lived in the area, much of what we viewed remained open space. A patchwork of gentle farmland displayed squares alternately tan, green, or gold reflecting crops of alfalfa, hay, and triticale that would soon be as high as an adult’s waist. Small clumps of quaking aspen and Douglas fir trees, sitting like islands in a sea of homes, provided additional space that was undeveloped. But the most impressive and vast expanse of untouched beauty comprised the alternately smooth and jagged tops of the distant mountains. Fortunately, neither homes nor development had ventured to that elevation. The still white-capped peaks blended splendidly with a sky the light-blue color of the Mediterranean Sea.
Puffy wisps of clouds dotted the sky, and among the many shapes and sizes were a towering giant holding a big stick, the upper half of a dolphin leaping from the ocean, and the lateral view of a woman’s face as angular as my riding partner Kathleen’s. The breathtaking panorama alone validated the considerable effort required to push uphill.
With crisp air that smelled as fresh as newly washed laundry, my breathing rate increased as we ascended skyward. To our surprise and delight, the entire trail was dry and without the ruts that appear after heavy use. Under these ideal conditions, mastering the roots and rocks only added to the enjoyment of the first bike adventure of the riding season.
On both sides of the trail, the Bitterbrush trees were teeming with buds and ripening blueberries. In all directions, we were greeted by the first wild flowers of the season. Tall clumps of yellow arrowleaf balsamroot stood guard over delicate yellow glacier lilies. Vast expanses of lavender and plum mountain daisies lined many stretches of our track. An entire field of tiny blue forget-me-nots swayed lazily in the breeze. And an orange flower whose name escaped me nestled beside the first Indian paintbrush. I was hypnotized by its bright-red hue. In those sections of the trail that had been cut into the mountain leaving a ledge, the clematis vines dangled tentacles strung with large purple flowers that shimmered in the sun like Christmas tree lights.
It was hard to not run off our winding dirt trail because too much attention was being paid to the surrounding splendor and too little to the ground in front of our wheels. As we reached the top and laid our bikes down for a well-deserved snack of M&M’s and pretzel mini-sticks, I took an extra deep breath that was not the result of exertion. Even though my hands throbbed a little and a small twinge of discomfort in my lower back reminded me that I was not a teenager, there was no doubt—this was a perfect day.
Resting on a verdant knoll well suited for our little resting place, the grass was soft to the touch. I pulled a long blade and dangled it in my mouth like a country boy on a farm, even though I had been born in the suburbs of Philadelphia. For a while, Kathleen and I talked as only longtime friends can about kids, medicine, and the mundane details of life. Refreshed, we stood and absorbed our summiting accomplishment before slapping hands in a triumphant high five and prepared to re-saddle for the blissfully easy trip back down. Startlingly, the moment was interrupted by the sound of a harp emanating from my mobile phone, the screen revealing a familiar number and an even more familiar image—Nancy, my wife and best friend. In her job as a flight attendant, Nancy was on a three-day trip back East.
“Hi, Winnie. Sorry to disturb your bike ride.” The previous night, before going to bed in Cleveland, Nancy had asked during our routine daily good-night conversation about my plans for my day off. She had been pleased I would be enjoying my favorite outdoor passion.
“No bother. KT and I are at the summit and about to head down. What’s up?”
Nancy and I had been married for twenty-seven years. Though I encouraged otherwise, she was generally loath to call me at work or at play. I detected some concern in her voice, which troubled me. Blood flushed my face slightly and the sweat on my hands was no longer entirely from exertion.
“On my flight this morning, I had a nosebleed. It stopped in a few moments, but I’m at the hotel now in Boston and it’s started again. What should I do?”
As a primary care physician for over thirty years, I have treated countless patients with nosebleeds. But hearing this particular news gave me an inexplicably peculiar feeling deep in my stomach. Instead of merely telling Nancy how to squeeze her nose or how to pack it with Kleenex, I asked additional questions.
“Is the bleeding on one side of your nose or both?”
“Have you been sick at all?”
“Do you have a fever or chills?”
“Do you have a rash?”
And so on . . .
When I finally hung up, Kathleen asked, “What’s up? You seem more concerned than I’d expect you to be for a simple nosebleed.” Kathleen was the most gifted nurse practitioner I knew. She was my daughter’s primary care provider.
“I must be a little tired from our climb, and I’m worried for some reason. I honestly don’t know why.”
Goosebumps crept up my arms even though the ambient temperature was now quite comfortable. Like many doctors, I possess an extra “sense” that sometimes gives me pause. My intuition is often potent and instinctive.
Just the week before, a longtime friend had come into the office with a common everyday complaint—a bad headache. Stan had not scheduled a doctor’s visit in five years, and as a stoic lifelong rancher who had been thrown off his horse more times than I had ridden one, he once told me, “Don’t like doctors much, Winnie. No offense.” Stan wouldn’t have been sitting on my exam table unless the headache was really bad, though you wouldn’t have known it based on the look on his face or the sound of his voice.
Instead of trying symptomatic care when his medical history didn’t raise any red flags and his neurologic exam was normal, I uncharacteristically decided to send him immediately for a CAT scan. Something in the pit of my stomach told me this was the right decision. He was admitted to the hospital as soon as the test was completed and had brain surgery that same evening. The neurosurgeon told him later that the cerebral aneurism was ready to rupture at any moment.
“Nancy will be fine, Winnie. It’s probably the dry airplane air. Didn’t she have a cold last week? Maybe she had a scab inside her nose break loose.”
Riding a mountain bike downhill is exhilarating. The challenge is not cardiovascular as it is on the way up; rather it is skill based. Which rocks to avoid and which ones to simply jump over while letting your hands and the bike’s shock absorb the bumps is mandatory know-how. Proficiency is crucial. A good rider knows how to lean into a sharp turn without wiping out and when to slow down to avoid a serious fall.
Kathleen and I have a shared and long-held mantra—no blood. We are pretty conservative riders compared to many of Park City’s younger mountain bikers. Still, after a long climb, the downhill leg is normally an unadulterated thrill ride—one that harkens back to the feeling I had when I dismounted my first roller coaster as a seven-year-old, screaming in complete joy to my waiting mother, “That was fun! Wow!” Even today, the memory makes my face hurt from a too-wide smile.
I had been so looking forward to the well-earned return to the parking area, but the twenty-minute descent was anticlimactic. The gnawing in my gut persisted. Instead of enjoying the wind whipping through my hair, the thrill of successfully mastering the bumps and curves, and the companionship of one of my best friends, I was preoccupied. I couldn’t shake my thoughts of Nancy. A scab letting loose couldn’t have caused the problem. The nosebleed was on both sides.
For nearly an hour after my arrival back at the trailhead where I had parked the car, I waited uneasily. I paced around the car like an expecting father in a delivery room. I spun my bike pedals backward again and again just to hear the click-click-click sound that was always music to my ears.
Finally, I dialed the number I know as well as my own. Nancy answered in one ring. “You were right, Winnie. I squeezed my nose. Five straight minutes by the clock. It did the trick.” She added that she felt “absolutely fine,” would get a good night’s sleep, and would see me tomorrow in the early evening.
Nonetheless, after Kathleen and I said our good-byes and I returned home late in the day, the sheep in my suddenly all-too-empty bedroom were out in flocks. I felt drained and exhausted, though not from the day’s activity. It was a restless, uneasy sleep that night.
The next day, my riding partner was another good friend, Chuck English, the director of mountain operations at Deer Valley Resort. During the winters, we worked together very closely because I was the medical director for the resort. And in the nonski- and nonmud-season months, we rode together two or three times a week. I was also his family’s primary care physician.
The day was nearly a carbon copy of my outing with Kathleen. We did the identical ride, Glenwild, because it was still the only major Park City trail that was entirely dry. After another classic spring excursion, as we were strapping our bikes to the back of my car, my phone made the familiar harp sound.
“Nancy, how are you? Did your nose bleed last night?”
“I’m fine, Winnie. I hate to bother you again before you get home. Are you still with Chuck?”
“I am, but no worries. What’s going on?”
“Remember you asked me if I had a rash? I was dressing this morning for today’s trip, and when I looked in the mirror, I do have a rash.”
“Where is it, Nancy?”
“Pretty much all over—especially on my arms and legs. On my left thigh, it looks like a bruise. And I don’t remember running into anything.”
“Have you had another nosebleed?”
“Well, a few times. But it always stops with pressure. I don’t feel sick, and I know I don’t have a fever. What should I do?”
“I think you should go to a doctor right now. You may have to miss your flight.”
“I can’t do that, Winnie. There’s no one to replace me. I’m actually on my way to the airport right now. I only work a few legs and should be home by early evening. I can see someone tomorrow if you really think it’s necessary.”
Twenty-seven years together. Whether it was our marriage, the kids, her many friends, or her job, Nancy was all about two things: dedication and commitment. Though I felt warmth in my heart, I felt tightness in my chest. I knew this was an argument I wouldn’t win.
“Fine, I guess. Call me as soon as you land in Salt Lake. You may need to go the emergency room once you get here.”
“Don’t be such a worrywart. I’m fine. I love you.”
“I love you, too.”
After turning away from Chuck, I wiped the tears that were beginning to drop down my cheeks with the back of my hand. When I turned back toward Chuck, he looked at me and immediately asked, “Are you okay, Winnie?”
My profession as a practicing family doctor has many wonderful positive qualities, including the ability to help others and to be an essential part of their lives, the academic challenge and pure delight of never-ending learning, the reality that my medical expertise provides reasonable compensation for me and my family, and the freedom to work almost anywhere in the world. However, like it or not, there is a very real negative that is a doctor’s recurring reality: sometimes you know too much. And this was one of those times.
As I looked upward to the mountain I had just traversed, the colors didn’t seem nearly as bright. My parking lot vantage point revealed more Gamble oak trees waiting for leaves than all the other trees already dressed in olive, jade, and emerald. The flowers and grasses were no longer visible, and there was more brown and gray than when I had been up at the summit. A cloud now covered the sun, and the sky had lost its luster. A sudden chill seized the air and I unthinkingly rubbed both arms for warmth. As the sky darkened with the threat of rain, I irrationally wondered, “Could mud season be returning?”