Dream struck

Snakebit

Last week my wife and I and our two sons went canoe camping at Jocassee, a beautiful South Carolina lake at the foot of the Blue Ridge escarpment. At 1100', I knew the piney woods were exceptional copperhead habitat (these pit vipers are quite rare at 2700’ where we live in the WNC mountains). While walking around the peninsula on Monday night, I used a light (I prefer not to use them at home), keenly aware that copperheads are mostly nocturnal in mid-summer.

10 hrs after the bite

It must have been on my mind at various levels of consciousness, because Tuesday morning I woke at dawn from a dream in which I was bitten on the leg by a venomous snake (I've had a few such dreams in my life). Four hours later, getting ready to head out for a day exploring waterfalls and jumping rocks around the lake, my son M and I went to "bear-bag" our food so it would be safe from racoons and marauding teenage bears in our absence. Walking back to the campsite, just a few steps from the tent pad, I felt a powerful sting on my foot. I hopped away and looked back, expecting to see ground hornets, and to warn M who was a few strides behind. My eyes immediately picked out what I had missed at first, and had likely stepped on: a copperhead. I don't have a picture of my own -- I briefly thought about pulling out my phone for a shot, but decided to focus on other things.

M said, "Should I kill it?" I said, "No!" Copperheads are notoriously confused with non-venomous snakes in these parts, but as an aspiring herpetologist since age 6, I was confident in my snake ID, and saw no reason to disturb it any more than I already had.

Same species, not the individual encountered on this occasion.

By now a drop of blood had emerged from a single puncture wound between my 3rd and 4th toes. Swelling commenced immediately. I knew that copperhead bites are not fatal, and that there wasn't much to do other than get closer to a hospital with antivenin (now it’s usually called antivenom, but I grew up reading the old-timey herpetology stories of Raymond Lee Ditmars). Some friendly neighboring campers had a motorboat and took J and I across the lake 30 minutes faster than it would have taken in one of our canoes. The boys held down the fort (we figured they'd either be spending another night out there, or would be needed to pack up the stuff and paddle it across to the boat ramp).

J drove my truck to the nearest hospital. On the way, I consulted over the phone with an ER doctor from our community at home (despite our rural location, we live in a special world of privilege), and kept an eye on the swelling. We pulled up to the hospital in Seneca, SC, about 80 minutes after the bite, and were immediately confronted with the reality of emergency medicine during Covid. A screener was posted outside the ED and told us J wouldn't be allowed in. I was not ready to make the leap into Covid-saturated hospital-world in my swim shorts, wielding just my cell phone and my flimsy medical cost-sharing card (check out their Better Business Bureau page). The screener summoned a nurse who told us it was our decision, and that we could take a few minutes in the parking lot to decide. So we pulled over to consider our options. I had no systemic symptoms other than some mild, likely pain-induced, nausea.

It took more than a few minutes, and the nurse must have wondered what happened to the guy with the snakebite; next thing we knew, he’s standing next to the truck introducing us to a very friendly ER doc. Dr. C looked at my ballooning foot, and told us what they would do if I were admitted (run some labs and watch the swelling, before deciding whether to administer tens of thousands of dollars of CroFab antivenin). He said his gut told him that I'd be OK, and that it was fine with him if we wanted to continue waiting in the parking lot. My gut told me that ER doctors’ guts store a lot of wisdom. Dr. C said he'd come back in an hour to check for himself. Exactly one hot hour later, he came back and checked on the progress of my swollen foot and ankle. He told us that out of 30 patients admitted with copperhead bites last year, they only administered CroFab to 5 of them. With even more confidence than earlier, he said he thought I’d be OK. So we headed back to the state park.

I decided I'd be more comfortable convalescing at home, so we told the boys to pack up camp. After a 3-hr wait at the boat ramp while severe thunderstorms rolled across the hills (not great conditions for crossing a lake in canoes), the boys heroically paddled up and everyone loaded up the truck and trailer (except me -- my foot was firmly planted on the dashboard).

Recovery

As I’ve aged, I’ve learned the importance of distinguishing between pain worth heeding, and pain best ignored. For the first few days, I had no choice -- my foot was a balloon and my calf demanded rest. The swelling shrank dramatically on day 4, and I eagerly resumed modest amounts of walking and active work. My lower leg turned a sickly yellow for a couple days, but I thought the residual pain was OK to ignore. My leg quickly contradicted me. By the end of day 6, I realized there was still lots of tissue reconstruction underway throughout my lower leg and foot.* Swelling quickly returned, the pain doubled down, and I was back to the only position that kept it in check -- keeping my leg elevated. A friend put me in touch with a friend of hers who had been bitten by a copperhead 4 years ago. She told me to expect a bumpy, but eventually thorough recovery. Now, on day 10, I see light at the end of the tunnel. I’ve reached a detente with my leg, I’ve learned how much I can use it on a daily basis without causing it to flare up, and I’m gradually able to do more and more.

I still love snakes (even venomous ones), but will definitely be more cautious in copperhead country. Even flimsy water shoes would have provided some protection in this instance (sandals would not have). I hope to be fully back on both feet in a few days, with few lasting problems. People may think I'm fictionalizing when I say that I dreamt of it the night before, but fortunately I told J the dream between waking and getting bit, so at least one person in the world (the most important one!) doesn’t think I’m either crazy or lying. Here's to the power of dreams (and human eyesight), the miraculous healing abilities of the human body, helpful strangers, competent sons, and a loving, patient, sympathetic, and hard-working life partner!

Footnote full of juicy medical info:

*Copperhead venom is a complex cocktail of compounds, each of which play a role in wreaking havoc, and even pre-digesting, a mammalian body. In this analysis of copperhead venom, researchers summarize a primary effect of the venom as “the deterioration of homeostasis and cell adhesion.” Essentially, on a microscopic level, the venom tears you apart and dissolves your insides. Some cells are destroyed, many cells are pulled apart from each other, and fluid freely flows through barriers meant to contain it. The paper goes on to describe particular proteins that attack the endothelial cells lining your veins -- these cells are normally responsible for controlling the flow of fluid in and out of your veins. So essentially fluid is leaking out of my veins, while my body is frantically trying to repair and replace destroyed tissues. Fortunately, copperhead venom is the least myotoxic venom of American pit vipers -- so my muscles are relatively unscathed. Also of note, as toxic as the venom is, it is “weakly immunogenic.” Unlike a bee sting, the swelling is a direct result of tissue damage, and not caused by a strong immune response. Doctor friends, or others who know more than I, please add your thoughts in comments or emails -- I’d love to know what I have wrong or right about what’s happening in my leg.

I've done a lot of reading, and I could go on and on in this footnote. In the future, I may develop this into a resource page. In the meantime, one of the better summaries I found is published by the Alabama Nurses Association.