Nothing about 18-year-old Jimmi Small’s workout a few weeks ago seemed dangerous.
“Everything was normal,” Jimmi said. “I felt sore. But like a normal soreness, like when you get done working out.”
She wasn’t a first-time athlete. She played on the basketball team at Colstrip High School in southeast Montana for three years, and played for three years in middle school before that.
Now, having graduated from high school, she wanted to keep up on her fitness and went to the gym in her hometown of Lame Deer, Montana, to use the treadmills and the stair master.
“I never felt like I was overdoing it,” Jimmi said. “It just felt like a light workout.”
The next day, she said she started to feel sore but still didn’t think much of it. Then it started to get worse.
She remembered laying in her bed and feeling like her legs were hot from the inside out.
“Then they got really tense,” Jimmi said. “I pushed on it, and it wasn't soft. It was rock hard, and I tried to bend my legs to get off my bed, and I couldn't bend my legs at all.”
Within a short time, Small would be hospitalized and near death.
The diagnosis: Rhabdomyolysis, a rare life-threatening condition that breaks down muscle and can shut down the kidneys.
The condition is little known but made national news last week when it was revealed that 24-year-old Rachel Apa of Lewisberry, Pennsylvania, who collapsed just a couple miles short of the finish line in the New York City Marathon on Nov. 1 and died in a local hospital, had rhabdomyolysis, also called rhabdo.
‘Mom, It’s Worse’
At home that afternoon, Jimmi told her mom, Jenny Small, that her legs were hurting beyond typical soreness. But Jenny wasn’t yet ready to believe that anything was wrong.
“I told her, ‘Jimmi, you're just sore. Go get a load of firewood,’” Jenny said. “So she goes and gets a load of firewood, and she comes back, and she's like, ‘Mom, it's worse.’”
When Jimmi’s dad, Brandon Small, got home, he also thought she was just sore from working out. But Jenny had started to notice something that set off alarms.
“She was walking weird,” Jenny said. “She was walking like the Monster Mash, almost like zombie. Her leg was moving really weird.”
At that point, Brandon said they should take her to the emergency room in Lame Deer. But Jimmi already had an idea of what it might be.
“I had started like looking on TikTok like, what could this be,” Jimmi said. “Then it told me it was Rhabdo and I was like, ‘OK, I’m kind of freaking out.’”
Jenny said that they got to the emergency room around 4:30 p.m., barely catching one of the last lab techs before they went home for the day.
When they tested Jimmi’s creatine kinase (CK) levels, which measures the amount of CK enzyme in the bloodstream, it became clear that her condition was worse than just a sprain.
“They did lab on her, and they came in with the papers,” Jenny said. “And they're like, ‘We need to get her to Billings soon on the ambulance.’”
Normal CK levels are supposed to range from 22 to 198 units per liter of blood. When Jimmi was first admitted to the emergency room, her’s were at 16,000.
But even as she was in the back of the ambulance on the way to Intermountain Health St. Vincent Regional Hospital in Billings, Jimmi said it still didn’t feel real yet.
“In my head, I feel like I'm faking it,” Jimmi said. “Like I’m wasting everyone's time and now we're going to be up here just because I let my thoughts get to my head. But they were saying it was pretty bad.”
‘Kept Getting Higher’
As she drove to Billings to meet Jimmi at the hospital, Jenny went on Facebook live, an easier way to update everyone who had heard Jimmi was at the emergency room and was messaging Jenny to ask if she was OK.
“Jimmi is going to be fine,” Jenny said on Facebook Live. “I don’t think Jimmi is passing away tonight or tomorrow. It’s just crazy, they said this could happen to athletes, people who have worked out before and work out all the time.”
But things were progressing faster than Jenny knew. By the time Jimmi was admitted in Billings, they took her levels again. In the hour drive from Lame Deer, she’d gone from 16,000 to 23,000.
Still, the treatment plan seemed clear at that point. Jenny said the doctors told her that young, healthy patients like Jimmi typically stayed in the hospital for a couple of days while fluids flushed the elevated CK from their bloodstream, then went home with no lasting impact.
That’s what they tried with Jimmi, but it didn’t work.
“Pretty soon they were giving me two bags every 30 minutes,” Jimmi said. “But my levels just kept getting higher.”
Twenty-four hours after being admitted, her levels had jumped to 39,000, well above the 15,000 mark where the risk of acute kidney injury rises, according to the Merck Manual.
The doctors said they might have been even higher than that but couldn’t figure out why.
“After 39,000, the machine don't read it anymore,” Jenny said. “But the way her kidney and liver were acting, she was way past 39,000.”
‘Indian Humor’
At that point, the doctors said that if her levels didn’t drop within the hour the young Northern Cheyenne woman might have to be admitted to the intensive care unit. When the doctor delivered the news, Jenny, Jimmi and Jimmi’s sister, Mabel, all started cracking up.
“That doctor turned around, she goes, ‘This is really serious,’” Jenny said. “And then we just kept laughing. I don't know if that's Indian humor.”
Mabel said it wasn’t that she wasn’t scared for her sister. In fact, as soon as Jimmi was diagnosed, Mabel started researching rhabdomyolysis and its effects on the kidneys, and was prepared to give her sister one of hers if it came to that.
Mabel told Cowboy State Daily she laughed when the doctor gave the warning because it was just her sister’s luck for this to happen.
“Jimmi was really trying to be on her fitness journey,” Mabel said. “Then she works out one time and has to go to the ICU. That's something that would only happen to her.”
Jimmi didn’t end up going to the ICU, but she was moved to a different floor for more serious patients.
“I was looking in all those rooms, and it was like people that were really pretty sick, like dying,” Jenny said. “I walked in Jimmi’s room and I looked at her and I was like, ‘You need to fix yourself because you're dying. You're on the floor with people that are dying.’”
Jimmi remembered that moment, too.
“I was like, ‘Sh*t, you're right,’” Jimmi said.
‘She Locked Eyes With Me’
But even as Jimmi’s condition was worsening, she was still thinking clearly, still joking and still seemed like her normal self.
That changed on her fourth day in the hospital. Some friends were in the hospital room visiting when Jimmi got up to use the bathroom. She ended up on the bathroom floor feeling like she was going to vomit and suffering from a terrible, sudden headache.
“Pretty soon, they brought me back in and I lay down,” Jimmi said. “That’s when all that started happening.”
To treat the headache, doctors gave her a combination of pain medicine through her IV, Jimmi said. The combination set off a near-deadly reaction.
Soon she lost her vision and felt the air leaving her lungs, as if she could no longer breathe.
“All these doctors rushed in,” Jimmi said. “My mom comes in. Like 50 people are standing around me. And I'm like, ‘I'm dying.’ That's what I thought.”
As doctors put an oxygen mask on her, Jenny remembered leaning over and looking Jimmi straight in the eyes.
“It sounds so stupid, but it was like a connection,” Jenny said. “She locked eyes with me.”
As everyone was panicking around her, trying to save her life and keep her from going into kidney or liver failure, Jenny said she remained calm and had a nonverbal exchange with her daughter with just a nod of her head.
“I was just looking at her like, ‘Jimmi, you're going to get through this,’” Jenny said. “You can't breathe. I know you can't breathe, but just try to breathe because if you don't breathe, you're going to die. That's exactly how we talk to each other.”
But even as she started to breathe again, Jenny watched her daughter’s stomach begin to bloat on the hospital bed. Having seen several people with cirrhosis, Jenny said she knew a bloated stomach was a sign that her daughter’s liver was starting to fail.
She said that was the only time during the hospital stay that real fear hit her.
“I think it’s the one time I got scared because I visually saw it,” Jenny said. “I called her dad and said her stomach's getting big.”
‘Indian Doctored’
Jimmi’s dad and her brother sped over to the hospital from Lame Deer and began a different sort of treatment on her.
“Her dad came and doctored her twice, like Indian doctored her,” Jenny said. “And it's weird because the first time he did it, her levels started dropping.”
The family is traditional ceremonial Northern Cheyenne, and both Jimmi’s dad and brother are trained in the ceremonial practices they brought with them to the hospital.
After the first time they performed ceremony, Jimmi’s levels started dropping but they rose again the next day. So her dad and brother came back for another round of treatment.
That was when things turned a corner, though Jenny said she did not believe ceremony alone was responsible. She also credited the doctors and the care Jimmi received in Billings and Lame Deer, as well as the power of prayer.
Throughout the hospital stay, Jenny shared updates on Jimmi’s condition on Facebook. The videos reached well beyond her friends and family, drawing tens of thousands of views and messages of support from people across the country.
“I was shocked at how many people were messaging,” Jenny said. “Being ceremonial and believing in our ways, I do think the doctoring helped. But I also believe it was a mixture of prayers, good doctors and good staff at the hospital, and then just her wanting to live.”
Jimmi’s dad did the second round of ceremony on the morning of the fifth day in the hospital. By that evening, Jimmi’s levels had dropped enough for the hospital to send her home just in time for her dad’s birthday.
“Her dad’s only wish for his birthday was for Jimmi to come home,” Jenny said. “It didn’t look like she was. And then they walked in and said, ‘You're getting discharged.’”
‘That Could Have Been Jimmi’
But it’s not lost on the family that her story could have ended very differently.
When Apa died suddenly at the New York City Marathon just days after Jimmi came home from the hospital, friends quickly messaged Jenny to tell her the cause of death was rhabdo.
“When I saw that I got kind of choked up for her family,” Jenny said. “That could have been Jimmi.”
Jimmi is home now and mostly back to normal, but not quite.
A few days ago, she was helping her dad, who manages the tribal buffalo herd, when her legs started hurting after only a couple of hours on her feet. On Friday, she has an appointment where her doctors will let her know whether she can get back to her fitness journey or needs to wait a little longer.
However long the road back takes, Jenny has no doubt about why her daughter made it through.
“It wasn’t her time yet,” Jenny said.
Emma Jane Jackson can be reached at emma@cowboystatedaily.com.
