Sunday, July 02, 2006


This afternoon, as we were banging away on our keyboards, there was a knock on the cabin door. I recognized the woman on the porch from the retreat site office. She knew I was a doctor, and as soon as I saw her face I thought, "Uh, oh. Injury." Sure enough. They had gotten word at the office that someone had taken a bad fall on a mountain bike up the valley. WEnt off the edge of the road. He was unconscious, might have a broken leg...Rescue had been called, but if I wanted to go up ahead of them and see what I could do....

Of course I went. Threw my shoes on, stuffed a pack with what little I had with me, and jumped in the car. Sheila came with me. While I was getting ready, we saw and heard a police SUV go by up the dirt road, sirens echoing in the usually quiet valley. No ambulance yet. The ambulance would have to come from town, 8 miles from us, and 15 miles from the crash site.

I threw the Pathfinder into low and put pedal to the medal. Ten minutes later I was there, at "the bench", a familiar landmark almost all the way to the pass. The road, steep along a rocky ravine, takes a curve and a dive right there. I left it to Sheila to park the car out of the way, and walked down the road heading for the huddled group I could see on the slope below. Just then the ambulance arrived, so I offered my help as a "Family Physician from down there" - vague southward wave. "If you can use an extra pair of hands, I'm glad to help. Just tell me what to do." They accepted, and we trekked down. (I know better than to try to take over a scene from paramedics. They are the experts.)

Turns out it was a 14 year old kid. Tomorrow he turns 15. He had been riding downhill on the dirt mountain road - get this- without his helmet. He missed the turn there at the bench and went right over the edge, where there happens to be about a ten foot cliff. Best I can tell, he endo-ed and landed smack on the crown of his head. Depressed skull fracture as big as your fist. (So I heard - someone had a fat gauze and pressure on it the whole time so I didn't actually lay eyes on it). He rolled down from his impact point at the base of the cliff and lay there unconscious while watchers scrambled to help. I guess his dad was riding with him, and Mom was waiting at the car right nearby. One bystander happened to be a nurse, and had gotten to him, put pressure on the wound, and covered him with a blanket.

When we got down there, he was unconscious, very pale and grey, but breathing. All lung fields clear. Heart steady at a pulse of 80 (surprisingly low). Belly soft. Legs, arms abraded but apparently intact (possibly an ankle fracture, hard to tell). Distal pulses good. Not responsive to voice or painful stimulus. Blood and vomit all around.

When the head paramedic saw his head injury, she got on the radio for a helicopter. The rest of us acted as human splints, holding him in place on his side (how they found him I guess), and then holding him still for O2 and
an IV when he started to come around and get combative (which was reassuring as he moved both arms and both legs). Mom was standing nearby wringing her hands. Dad was helping. The kid came to enough at one point to say a few words ("It hurts!") which I conveyed to Mom as good news. Dad was right next to me. I kept giving him jobs to do - "hold this, Dad." knowing how guys like to be active and figuring it was keeping him sane. I also held the kid's arms away from the oxygen mask and IV needle and spoke to him (more like a mom than a doc) - "I know, sweetheart, I know it hurts. We're going to take care of you." stuff like that.

The EMT or paramedic or whoever who was trying to get an IV line in failed twice. The oxygen mask was somewhere near the kid's mouth. We were working on a rocky slope. I was kneeling on some thick branches, and my back was up against the stump that probably stopped his tumble.

Meanwhile, the weather, which had been cloudy and dark, was getting steadily and rapidly worse. Lightning flashed. Raindrops started to spatter. The helicopter pilots radioed that they wouldn't be able to make it up there in
this weather, so Boss Paramedic said, "Let's get him outta here." My sentiments exactly. So we did the one-two-three heave and lifted him up, slid their inflatable stretcher underneath him, set him down, strapped him in ("tighten that strap, Dad") and did another one-two-three heave to lift him (four handles on each side) and then carried him carefully up the side of the steep and rocky ravine as the drops changed to a downpour. Just as we got to the ambulance, the downpour changed to hail. Jeezus. I gave Mom a hug, (which I don't think she even felt) helped load the stuff up, then went back down the hill with another guy to clean up the garbage and mess we'd left, wrapping bloody gauze, needle caps, alcohol wipe wrappers and trash in a portion of the kid's Tshirt we had cut off him.

Got back up to the car, soaked to the skin
and stinking of vomit, and just sat there breathing for a few minutes until a wave of aftershock hit. Just feel it Peg, it'll pass quicker. So, a few minutes and a few tears later, we were driving slowly down the hill in hail that was literally piling up on the road, a visible quarter mile behind the flashing and creeping ambulance. The plan was for them to get somewhere the copter could land (probably back in town) so the kid could be airlifted to the nearest trauma hospital, over the mountains from here.

I'm hoping his youth and health will get him through and that the damage to his brain isn't too bad, and that they can fix it. I'm thinking of all the positives, to the point of absurdity (well, he's less likely to herniate his brainstem cuz his skull is open and the swelling of his brain can go OUT). I'm hurting for his parents, Jehova's witnesses by the way, who must be kicking themselves over the helmet issue, to put it mildly, and frightened to the core.

I'll probably never know what happens. Maybe the mountain grapevine will get news back to us eventually, maybe not. Maybe not 'til after I'm gone next week.

Sheila and I drove somberly back to the cabin, where I showered and put on dry clothes, and then we opened a bottle of wine. Sounds cold, perhaps, but it was a tough day, and we wanted it. We toasted a prayer for the young man's life.

I keep seeing that kid's pale young face, a kid on the cusp of manhood, so terribly injured. I hope he makes it.
Hold him in the light, as the Quakers say. Pray he sees his 15th birthday.


TheTundraPA said...

Oh, Peg, how incredibly sad... A helmet wouldn't have saved him breaking lots of bones (which will heal), but it might have saved his brain (which may not). I hate to see cyclists of any age riding neighborhood streets without a helmet, much less in the kind of terrain you are in. I hope you do learn of the outcome, and will let us know; in the meantime I will hold space for him in the light.

shrimplate said...

He will probably become our President some day.

connery said...

Wow!!! What a gripping story, Peg. That was an extremely gripping and phenomenally-written Mountain Doc emergency chapter. I literally felt like I was in your pocket. (MAN!!! That vomit stunk!!!)

You are right; the situation probably IS much better that the swelling can go externally. The kid sounds lucky he didn't break his neck and suffer (from what you describe) any spinal cord damage. I've seen patients in the hospital who've had craniotomies and survived after head traumas, so, if they got him to a trauma and neurosurgery center soon then I"m sure he'll have a great chance to come back from this, thanks to the heroic efforts of you and the EMT team.

Cracking open some wine doesn't sound "cold" at all; it sounds like a much-needed anesthetic after a traumatic, shocking and upsetting caregiver's day. I'd have done the same thing, if I'd encountered this on MY vacation.

Thanks for sharing this saga. It was very vivid to read, as I told you. I'm sure it was extreeeeeemely vivid to live.

I hope the kid's alright, too. I hope someone relays word to you. I'd imagine it might make the local newspapers, perhaps, no?

BIG lesson on helmet-wearing, for sure. You should post flyers or something on the campgrounds about the vital importance of helmets for life-saving and injury-prevention.

dr peg said...

tundrapa - it was incredibly sad. I can't even imagine what his parents feel like.

shrimplate - thanks for visiting! I'm guessing your opinion of our erstwhile president's cerebral function isn't terribly high.

connery - thanks for reading and commenting. And especially for your hopeful comments about craniotomy pts. There was an article in the local weekly paper but they didn't have any more details. See today's post re update.

My son had the helmet lesson reinforced by this episode (not that I ever let him ride anywhere without it anyhow!)

Judy said...

The first time my son crushed a bicycle helmet I was angry -- for just a few seconds. Then I realized that it could have been his head. This boys' parents must be feeling terrible, no matter how this ends.

Thanks for sharing this story.

woolywoman said...

Well, hell. Good of you to do what you could do.

Kim said...

Moving all extremities, verbalizing "It hurts" - I'm saying a prayer for him right now. They say kids are resilient...

He'll live.... and learn.

dr peg said...

Thanks to the 3 nurses for weighing in. I bet you've each had off duty experiences like this, in addition to your many on-duty tales. It's wild, isn't it?

Gordon said...

You did the best you could, Doc.

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