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BILLINGS GAZETTE (Montana) 10 February 08 Snakebite turns trip into fight for life (Eve Byron)
Helena: Lee Gatchell saw the snake quiver. It lashed out too quickly for him to see the strike, but he felt it just below his right knee, on his outer calf.
It was the last day of 2007, the last day of the 14-year-old Capital High freshman's Costa Rican Christmas vacation.
In the blink of an eye, it became the first day of a 26-day marathon to save his life and leg.
This was the second visit Lee's family - mother Tamara Blank, dad John Gatchell and sister Jaya - took to the rain forests of Costa Rica, a Central American country with white, sandy beaches and a family-oriented society that made the Gatchells comfortable. For 10 days, with aunts, uncles and their grandmother, they stayed at one of three guest lodges at the southwestern tip of Costa Rica. The family played in the surf and hiked through the forest, marveling over sloths, macaws and other exotic species. On the final day, Lee planned one last adventure, rappelling down a series of four waterfalls.
Eight tourists signed on for the trip, but six backed out at the last minute, leaving Lee, a young woman and two guides on the morning excursion.
The first waterfall was narrow, with the water falling 20 to 30 feet. The second was similar.
"They start out with an easy one, then a relatively easy one to gauge how good you are," Lee said. "Then there is a third waterfall, where you couldn't see the bottom from the top because of a bend. That's about 50 feet."
Lee said the third was a little scary but not a problem. The final pitch was ahead, 70 feet of water thundering into the pool below.
It was shortly after 9 a.m.
He was focused as he jogged to the final waterfall. Lee almost didn't hear a guide yell a warning.
It was too late.
"I looked down and there was this snake, coiled up. It was the color of sand with a diamond pattern on its back.
"... It looked like the snake quivered or shook. Then I saw two bite marks, or slashes. The weird thing is I didn't feel it bite me. They said it went in this deep," Lee said, holding his finger and thumb a good inch apart.
Lee had chanced upon one of the most feared snakes in Central America, the fer-de-lance. It's an irritable viper that strikes with little provocation, unhinging its jaw to throw forth fangs like a switchblade.
At lengths of up to 5 feet, it's also one of the largest and deadliest poisonous snakes. The fer-de-lance's venom is "hemotoxic." It causes massive tissue destruction and profuse internal bleeding. It works by killing the victim's veins and capillaries, causing severe internal swelling.
In recent years, the ready availability of antivenin has reduced annual fatality rates to five or six people, but it's not something a guide typically would carry.
They had to move fast.
"I kept going, but they said to sit down on a rock and they pulled a suction thing out and tried to suck the venom out of it. Later I learned that did nothing," Lee said.
"They started to get me up the hill. I started to faint or go into shock or something. My vision went 2-D - green speckles covered my vision. Even my sense of touch seemed to lose dimension. By then, moving my leg was painful, so I put one arm around their necks and they hoisted me up the hill on a little, tiny trail."
They reached the wider beach trail where the other tourist ran ahead for help.
"I pretty much lost control emotionally there," Lee said. "They had me sit on a beach trail, and I calmed myself down, put those emotions under lock and key. It was kind of tough, but I knew the calmer I was, even on the surface, it would be better."
Lee knew what he was battling. One of his hobbies is studying poisonous snakes.
"I had kind of lost my rationality going up the hill. I kept needing reassurance," Lee recalled. "You hear about situations where people got bit in the leg, go into shock and a little while later they're dead."
It took 15 minutes to reach the lodge.
They threw Lee into a waiting vehicle and raced down a bumpy road, stopping to pick up Lee's grandmother, who was hiking nearby.
They met up with an "ambulance" - a glorified van with a gurney that kept sliding around - and transferred Lee and his grandmother.
They arrrived at the clinic, less than two hours after Lee was bitten. A doctor started the antivenin.
His grandmother counted 15 or 16 vials.
Meanwhile his parents, John and Tamara, were at the base of the fourth waterfall, waiting for Lee to make the final rappel. When Lee didn't show up, Tamara began walking back to the lodge.
"I met the owner, and he said, 'Your son's been bitten by a snake.' I said 'A bad one?' He said 'Yep. A terciopelo,' " Tamara recalled.
"But he said it was a dry wound, a glancing blow, and we had to wait for a taxi, which would take about 20 minutes."
The lodge owner continued down the trail to find John.
The guides returned to the waterfall, found the snake and killed it. It was five feet long, with two-inch fangs.
Once at the clinic, John and Tamara were shocked.
"The last time I saw him he was an eager young man excited to go waterfall rappelling. The next time I see him he's pale and frail with an IV and all groggy because he's not only been given anti-venom, but also some kind of antihistamine thing," Tamara said.
It was decided that treatment would continue at a rural hospital in Golfito, which meant putting Lee in a small boat for the trip across Golfo Dulce.
"They had neutralized the venom, mostly, but my leg was still swelling. My foot was purple and cold, and I couldn't feel it," Lee said.
John showed the snake photo to the doctor. She winced and turned away.
"She knew exactly what kind of snake it was, and when she saw how long it was, she agreed he would get the best help at this other hospital," John said. "But Lee didn't want to be moved."
As a dozen more vials of antivenin were pumped into Lee's body, the family opted to transfer to a larger hospital at San Jose, which required chartering a plane. The 210-mile flight had to take place before dusk, because the landing strip had no lights.
After a flurry of phone calls by their friend and lodge owner Joel Stewart, they took off. Once word spread about Lee's bite, they were cleared for an emergency landing after the hourlong flight, hitting the tarmac at dusk.
An ambulance rushed Lee to the San Jose hospital, they met Dr. Hugo Villegas del Carpio, whom Lee considers his savior.
"He's just amazing. Every time he would come in he would give us a very thorough explanation of what was happening," Lee said. "He also told us what the problems were, and he mentioned several."
The fer-de-lance's venom decreases the blood's ability to thicken; in Golfito, they timed Lee's coagulation rate at two minutes. By the time they reached San Jose, it was 32 seconds, still considered a long time for blood to clot.
But swelling was Lee's main problem. He couldn't feel his toes, and his right foot was purple, cold and hard as marble.
Surgeons cut open Lee's right leg from ankle to thigh to relieve the pressure.
"I was scared but understood that surgery by far was my best option at the time," Lee said.
The doctors also sliced open Lee's inner calf from ankle to knee. An incision was made near the arch in his right foot.
"The fang went into one of his calf muscles - you have three - and those are the muscles involved in lifting your foot and your ability to walk," Tamara said. "Fifty percent or more were black, affected by the toxin."
"The fatty tissue in the area was just brown fluid," John said.
"It washed out like water when they opened him up," Tamara said.
"But they told us only time would tell," John said.
Lee's incisions weren't stitched up, because surgeons had to go back every other day to check the muscle and let the toxins drain. During this time, doctors watched for the potential recirculation of venom.
"A pocket of venom could be trapped for days in tissue, and as dying tissue is cleared away, the venom could get back in my system," Lee said. "That would be serious."
During all this, Lee stayed calm - so much that his parents weren't sure if he understood the depth of the danger.
To Lee, though, all that mattered was he was alive.
"I was like - lose the leg? Who cares now? I couldn't do anything about it," he said.
The next few days were a blur of surgery followed by recovery. In all, Lee went into the operating room five times. The fourth surgery closed the inner wounds.
In the fifth surgery, doctors closed the outer wounds and performed a skin graft, where they used a tool - they described it like a high-tech potato peeler - to remove skin from the back of Lee's leg, then affix it to his calf where the skin no longer could stretch across his muscle.
"That was the most pain I was in since the first day," Lee said. "The skin is full of nerves, and they really didn't like being chopped in little pieces."
Lee counted 130 staples holding his leg together.
The graft took. Two weeks of physical therapy followed.
Finally, 26 days after their vacation was to end, Lee's plane touched down in Helena. He was greeted by friends and family displaying banners, as well as shocked looks when they saw his wounds.
Lee wears shorts, even in cold weather, since the doctors told him pants can rub against the wound and irritate it, increasing the risk of infection.
He returned to school right away, trying to make up the homework awaiting him. Like a typical teen, he grouses that his Spanish teacher won't give him extra credit for all the new words he learned, most relating to emergency medicine. However, he is allowed to substitute physical therapy for gym class.
And one day - probably not soon, but one day - Lee plans to return to visit his newfound friends in Costa Rica.
"But I think I'll do a little less hiking and a little more sticking to the beach," he said with a smile.
Snakebite turns trip into fight for life

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• MT Press: Snakebite to Fight for Life - W von Papineäu, Sun Feb 10 08:02:07 2008