09-03-93 23:08
.sp
Your letter this evening reads a bit sad and depressed.
I hope you are getting a good night's sleep now,
and that tomorrow you will have the energy and the humor
to appreciate the drama of leaving the island,
and that you will have a safe and not too strenuous trip home.
.sp
I spent the morning with "vi", elaborating on some of the topics
I raised in my last letter to you, but I hesitate to importune
you with these explorations, because you have other things on your mind,
and the difficult and arduous professional work waiting for you.
I only wish that I could help you.
.sp
At about 11 o'clock, Mommy suggested going out for a hike.
It was the first sunny and relativily non-humid day since our
arrival. We drove to the park and walked up Wilburn Ridge.
About a quarter of a mile beyond the State Park Boundary,
on a fairly well graded segment of the Appalachian Trail
as it rises to skirt one of the pinnacles,
Mommy lost her balance and fell backwards onto the trail.
Fortunately she did not strike her head.
Her back was protected by the light knapsack she was carrying,
a whole package of cookies was crushed, but no vertebrae.
She did strike the olecranon process of her left arm,
no fracture and only a superficial abrasion there,
but about 10 cm below the elbow she sustained a 
1 cm long puncture would of the soft tissue.
There was profuse venous bleeding which I readily
controlled with digital pressure. Mommy had taken
along bandaids for her feet, and with one of these
I was able to approximate the wound edges quite closely.
She wanted to go on a bit further to see the 
fruits of the mountain ash, but after a few more minutes
of easy walking we turned back, in part because I wanted 
Mommy to get some tetanus toxoid, and because on Friday 
before Labor Day pharmacists and doctors might not be
too easily found. It turned out, that the local pharmacies
do not carry tetanus toxoid, so I tried to negotiate
with Dr Luck, asking him to sell me a bottle.
However, he said he had only a 10 ml. vial, and wanted
Mommy to come down. When I demurred, he offered to
have his nurse provide me with a syringe and the toxoid,
so that I could give the injection in his office myself,
without Mommy having to register as his patient.
And this is what we did. I gave her 0.5 ml. tetanus toxoid
subcutaneously without any obvious ill effect.
.sp
Dr. Luck was pleased to see us and was very gracious.
He told us that about a year ago
he sold his practice to Bristol Memorial Hospital
which now owns and manages it,
employing him and another physician,
each of whom work three twelve hour shifts a week.
The office is open twelve hours a day, six days a week.
Dr Luck professed to be well satisfied with this arrangement,
but one can only infer the economic and professional
pressures which forced him into it.
.sp
This evening Mommy seems to feel reasonably well.
She went for a short walk with Marguerite Jarmon,
and has gone to bed now. 
In addition to the injuries which I described,
she has a large 20 x 30 cm. ecchymosis on her left buttock,
underlying which is a hematoma of corresponding size.
Please talk Mommys injury over with Laura,
and tell me if I should have done anything different,
or if I should do anything different now.
Mommy did not strike her abdomen,
and there is no reason to anticipate any
intra-abdominal complications.
Subject to your approval, I thought I would not
give prophylactic antibiotics, but to use them promptly
if there is any evidence of infection at either
of the sites of injury.
It occurred to me when we were yet on the mountain,
that one could not be sure of the absence of foreign
material in the depth of the wound,
except the vigorous bleeding is likely to have carried out
any non-impacted material. Thereafter I considered
whether we should have the wound explored under local anesthesia,
but Mommy was not eager, and my judgment, for what that is worth,
was that nothing more should be done. I hope I was not wrong.
.sp
I am sorry that you will have to start working so hard
so soon after your return. There are only two things I need you
to do for me, which togethert should not take more than 15 minutes,
I will not be offended if you wish to delegate them to Laura.
One is, to change the call-forwarding  from the telephone
in our living room to 1-703-388-3111; the second is to read me
a list of the modem commands from a manual
which is on the book shelf on the porch,
so that I can get the satellite computer started, if possible.
.sp
Our tentative plan is to leave Thursday noon,
and to be back in Belmont Friday night,
to be available to help with the children on Saturday.
However, if you need us, we can leave Monday noon
to be back Tuesday evening and available on Wednesday.