May 13, 2010: My first ski injury. Part 1: Boring Chronicle.
It was Saturday, May 8, 2010. Chris, Juya and I were on a day backcountry ski trip to Coleman Glacier, Mount Baker. We skinned up to about 9000 ft of elevation, and started skiing down.
A few pitches later, at about 7000 ft of elevation, I was the last of the three to ski a short pitch and a long flat runoff following that pitch. Chris and Juya were waiting for me at the end of the flat runoff. The time was around 5 pm. As I was skiing that flat part, losing speed without making any turns, I fell (probably because my ski caught something), my left ski rotated outwards, the binding released, and I then immediately felt serious pain in my left ankle. As I hope people would realize from the rest of this article, when I say "serious", I mean "serious". I have experienced exactly three kinds of pain that I classify as "serious": root canal without anesthesia, shoulder dislocation and this ankle pain.
It took me a few minutes to regain myself after enduring the pain, get up and find my ski in the deep snow. I attached the ski, and snowplowed through the pain to Chris and Juya. I told them that I had injured my ankle and that I could not ski aggressively. I asked them that I ski in between them for the rest of the way. Chris skied down. When I attempted to make my first turn, I realized I couldn't make a turn; I stopped trying to understand why. At that point I realized that even if my leg was turning, my foot was remaining still. I immediately suspected torn ligaments, possibly a fracture or dislocation: the joint just was not there to transfer the force.
My first reaction was to check the reception on my cell phone: there wasn't any, and the calls weren't coming through. From where we were, we could see a camp set up by a climbing party that we passed on the way up, probably about a mile from where we were. Juya and I decided on what we were going to try next: I would take care of first-aiding myself, she would ski down, informing Chris about my inability to ski any further, and she would then go on to the climbers' camp to see if they could connect to any cellular networks. I gave Juya my GPS device so she could relay coordinates of our location to the Search and Rescue if she's able to reach them.
I immediately remembered the RICE (Rest, Immobilization, Cold, Elevation) acronym from my MOFA (Mountaineering Oriented First Aid) class from the Mountaineers' Basic Climbing curriculum. I hesitated for a second about icing the joint, as I was realizing that keeping myself warm might well become a priority later in the day, but I proceeded with adding some snow into the boot, which greatly helped relieve the pain. I then took a dose of the painkiller in my first aid kit, which happened to be ibuprofen, and started putting layers of clothing on. I had a down jacket and a rain/wind parka in addition to the base and middle layers that I was already wearing, but none of the three of us had a bivy sack or a sleeping bag. I had a space blanket.
When Chris skinned up, he proposed to construct a sled. I had recently read a chapter on sled construction in my backcountry skiing book, and I was skeptical about our ability to either properly construct the sled without any specialized equipment, or to actually safely transport me with such a sled, particularly through the trees. I insisted that we should concentrate on securing outside help as soon as reasonably possible, perhaps before the night sets off, which assumed that one member of the party would ski down to the car, checking the cell phone reception while descending, and then possibly driving the car into a cell phone reception zone. Chris didn't want to ski down alone, reasoning that if he injures himself, there would be nobody to help him. He didn't want to leave me alone either. We eventually decided to get me to the climbers' camp, where I would stay overnight if necessary, while Chris and Juya ski down to the car. They also took my pack to the climbers' camp, to reduce the amount of load on my ankle (one of the first things Juya thought about).
Chris and Juya started skiing to the car, while I started my slow descent to the climbers' camp. Chris and Juya sent two climbers up to help me. I tried various ways of descending, eventually settling on side stepping with my downhill (healthy) leg with the ski attached to it, keeping most of my weight on the poles, and following with the swing of my uphill leg, trying to make that swing from the hip to minimize the ankle impact. I was carrying my other ski.
Two thirds of the way down I met the two climbers. They were Western students leading a climb of nine people from the Western's Outdoor Center. They helped me make the last — flat — third with the minimal impact on my ankle by supporting me from two sides.
They shared a dinner with me and they boiled a liter of water for me, but they only had two four person tents per nine climbers. They didn't have any extra sleeping bags. Having contemplated sleeping on the tent floor between the sleeping bags, I opted not to, my reasoning being that what I gain in warmth, I might lose in further injuring the ankle, as I would have been the fifth large dude in a four-(small-to-tiny)-person tent. For the same reason, I didn't propose sharing a sleeping bag; plus unfortunately I know that the idea might be hard to fathom to new climbers. I elected to stay in the vestibule until 2 am when the climbing party was supposed to leave for their summit bid, at which point I could sleep in one of their bags.
With all my clothing on me, a hot water bottle (that was slowly cooling down), and wind protection from the vestibule's walls, I spent six long hours keeping myself warm. I still of course was cold most of this time, but my core temperature probably remained above what would be classified as hypothermia. My primary concern was my left ankle: with the snow that I put in the boot after the injury having since melted and refrozen, my ankle was essentially in a thin ice cast. That was great for reducing the pain and the swelling, but not as great for keeping the toes from freezing. I kept patiently wiggling my toes for all six hours, but mentally, it was the hardest struggle: do I attempt to take the boot off and warm my foot with my hands and the water bottle? Will I be able to get the foot back in once I warm it up? Wouldn't I make things worse if I get stuck with the foot out of the boot? Finally, how the hell do I get the foot out of the boot if, when I start pulling the leg, the foot doesn't follow?
It was a clear night in the meantime. When I got out of the tent's vestibule to relieve myself at around midnight, I could see the entire Vancouver metro area glowing at the bottom. It was surreal: me battling for survival here and a Saturday night city with civilization, hospitals, food, pharmacies, water and warmth so clearly visible, yet absolutely unreachable.
The climbers starting their summit bid at 2 for some reason didn't mean what "starting at 2" means for us: there were no alarm clocks going off at 1, or 1:30, or even 2. They started moving at around 2:45, and it took them another 45 minutes to get out of the tents. By then, one of the trip leaders gave me a couple cups of hot tea, which warmed my core up a degree or two. When I got to the tent, I was able to get my liners out of the boots (with feet staying in the liners) — fortunately, this turned out to be reasonably easy, perhaps because my ankle was by then almost frozen and wasn't overly sensitive. So, I went into a warm sleeping bag, and as I was falling asleep, Bellingham Mountain Rescue guys showed up. The time was 4 am — about 11 hours after the accident.
They looked at my ankle, determined that there was not much swelling (well, yeah, I paid attention at MOFA) and so diagnosed it as a sprain. I was told to sleep until dawn, so that we could then attempt to walk out.
I slept for two hours, then got up, and tried to get the liners back into my boots. That took a few seconds with the right boot, and about 15 minutes with the left boot. That I walked out of the tent with both boots on prompted the rescuers to upgrade their diagnosis from "sprain" to "not a bad sprain at all". While I knew they were believing what was convenient for them to believe, there was no point in trying to prove them wrong — the helicopter was not coming because the helicopter was not coming, and so my options were to walk down or ski down.
And so I started skiing, so to speak, in the sense that I was losing elevation while having both skis on. We dropped probably a good thousand vertical feet this way when we hit the trees, and at that point, I had to take the skis off and bootpack it. Chris and Juya, who spent the night in the cold as well — at the back of the Search and Rescue truck — helped the rescuers carry the sled up. They were waiting for us at the tree line. We didn't use the sled to transport me. Chris, Juya and Mountain Rescue people divided all my gear between them to reduce the weight on my ankle, and we proceeded hiking out on the icy trail in ski boots — however many miles the Heliotrope Ridge Trail is.
I came home Sunday night, compiled the list of orthopedic surgeons covered by my insurance, and Monday at 8 am the fun began. I first called the Harborview Hospital. They told me that they wouldn't take me that day, and that if I had never been there (which I haven't), I had to come through the Emergency Room. Alright. I thanked them, and called Swedish. They told me roughly this: "well, we don't have any slots in the schedule any time soon, but call us back at 9 when the doctors come in, and maybe, well, maybe, we will be able to accommodate you". My ankle was by then ridiculously swollen, colored in more colors than I could look at, close to twice the original size and constantly hurting, so I was yet again wondering how the hell this world can function if none of this is enough to get an orthopedic appointment without hopping through hoops first — on a work day 40+ hours after the onset of the injury. Is there any wording about minimum IQ requirements for a healthcare worker in that new law that people for some reason thought was worth caring about?
I eventually found a promising looking department at Virginia Mason: Orthopedics and Sports Medicine. I called them up, and they for some bizarre reason actually immediately completely understood my message: "I injured my ankle while skiing on Saturday", followed by the jaw-dropping punch line: "Can I see a doctor TODAY for a diagnosis?" I guess they might actually engage in that weird practice of interviewing their receptionists before hiring them (or — who knows — they might even train them once they hire them). They scheduled me for a 9:45 appointment without much further ado. When I showed up, they immediately took me to the X-ray machine, and five minutes later the doctor came to greet me with his eyes wide open: "You have quite a fracture; you will need a surgery; we can do it this Wednesday." He then gave me crutches, a plastic boot, and told me to never put any weight on that foot again until they tell me to, which he warned was at least a couple months away. He then walked me through the picture: fibula is broken, talus partially dislocated, and based on that there is probably at least one torn ligament.
So, on Wednesday they did an open reduction and internal fixation (cut the leg open, moved the bones where they belong and screwed a plate to hold them together) of my left ankle. They kept me in the hospital overnight, which was very convenient, as the painkiller was just one button push away.
Thursday the surgeon came to visit me in the morning and he told me that he didn't find anything he didn't expect in my ankle, and that everything went according to the plan, and that my bones are very strong and that he had a hard time screwing screws in them, so it was a strong force acting on the bone, not a weak bone. Awesome. In the end I asked him how many ligaments were torn. He hesitated, and said "just two".
I am supposed to start walking on my own around August.