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Separation anxiety

Tourniquets and the art of tyin’ one on

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“I think I need a tourniquet.”

I heard my mouth issue the unlikely phrase calmly, like asking for a glass of water. I’d been climbing, and just fallen a dozen feet. A boulder the size of a refrigerator fell with me. It stopped moving right between my knees. I was dazed, sore, and I couldn’t move my neck, but mostly I was grimly aware that my right hand was no longer on the end of my arm.

Montana Headwall. Outdoor adventure under the Big Sky.

The hand was still attached, but just barely. It dangled near my elbow. Between it and me was an exposed mess of shattered bones, grated skin and severed sinew. The open end of an artery was pumping wildly, painting arm and granite in a warm red. The bright ivory bone fragments and mangled innards looked like a deer leg that had been blown apart by a bullet. The wound had an inoffensive, almost coppery odor, like damp meat or blood. I imagined my deer-butchering days might be over.

My partner, Kara McMahon, appeared from behind me, frightened but poised to help. It took only seconds to agree the hand was lost. It required no imagination to see my arm now ending in a stub. We turned our focus to saving the rest of me. As far as we could figure that meant stopping the bleeding.

Kara pulled the climbing rack from my pack, unclipped a 24-inch sling of webbing, and doubled it up. To get the loops around my wrist I grabbed the limp hand with my good one and lifted it. Bone shards caught and clicked in the joint, but the pain felt distant. The joint was in the wrong place and the hand, heavy and stiff, did not feel like mine, or even alive.

The sling positioned, Kara stepped across and straddled me. She removed her cotton T-shirt to use as a bandage. The morning sun shone on her skin, backlighting her like an angel. I quipped that the real tragedy was that she didn’t rip her shirt off while straddling me more often.

Montana Headwall
  • Chad Harder
  • Spire Rock near Butte

Two friends—John Adams and Jesse Froehling—arrived horrified, and offered to do whatever they could. John got through to 911 immediately. An ambulance would be at the trailhead in an hour or so, but that seemed a long ways off. We had much to do before then, not the least of which was getting me—the biggest guy in the group—to the road.

This would be a first tourniquet for all of us. Kara hardened herself, grabbed a stick, inserted the lever through the loops of webbing and twisted. The strap snugged against my forearm about two inches upstream of the wound. I breathed deeply, realizing that we were choosing the terminus of my new arm.

“Ready?” Kara’s face was inches from mine. She was about to finish off my hand with a tourniquet, a thing neither of us had ever considered. I nodded, slowed my breathing, and positioned my hand back where it had always been. The wrist gurgled and clicked. I looked directly through a void that had recently been my wrist.

The tourniquet dug into my forearm. Kara repositioned for leverage, then twisted until the spurting stopped. She went a few turns more, then pressed the stick against my forearm and tied it tightly in place.

Sitting there, propped against my pack, I wanted to help, but I was at a loss. Most pressing now was the walk out. The idea of getting to the rig with this now-extraneous appendage flopping at the end of my arm was freaking me out enough that I considered yanking it off entirely, removing it like a bracelet. I thought I might just pull it off, slip it in my pocket, and carry it out. Why not? What was the better option?

I forced myself to inspect the wound more closely. All the back-of-hand tendons were severed. So was at least one artery. The nerve situation was unknown but I couldn’t feel anything past the pinch point. No bones or connective tissues seemed to bridge the gap. The skin of my wrist looked like perforated tissue paper. The hand might release with a reasonable yank. One bundle of abraded tendons remained intact on the inside of my wrist. The “flexors,” I’d learn later. Having butchered dozens of deer and elk, I have some understanding of tendon strength. Without a knife, the effort would be heroic, if not futile. I was vaguely aware that a series of aggressive but unsuccessful tugs would be hard to erase from my memory.

But walking out with a dangling hand was equally unappealing. Jesse found a nearby juniper branch and I used my left hand to press the fingers of the unfeeling right hand into a fist around it. The pale fingers stayed where I put them. Jesse wrapped it with Kara’s T-shirt and held it snug with webbing. The whole mess would be held rigidly in place and not flop about.

Montana Headwall
  • Kara McMahon

This took maybe 10 minutes, and I hadn’t moved an inch from where I’d landed. Kara insisted that I sit tight until she’d checked out my spine and palpated me for less obvious injuries. She’ll say anything to get a piece of me.

* * *

Kara pinched my toes and poked every inch of my body. All seemed fine until, probing near my knee, her thumb pressed into something she called “squishy.” That hidden 3-inch gash would eventually take several layers of stitches to close, but I hadn’t noticed it. Kara was now even more suspicious about my ability to assess my own spine, and she suggested we wait for the medics.

But this hell was starting to get to me, and I was ready to get off the rock and to the hospital. My neck was stiff but didn’t seem broken, so with my friends’ help I struggled to my feet, only to find my knees and feet too banged-up to stand, let alone walk. The terrain didn’t permit a side-by-side carry, so I started scooting downhill in one-handed crab-style. The truck was just a quarter-mile away, but that seemed terribly far.

I don’t recall hearing ATVs, but John tracked down a rider (I didn’t catch your name, but I still owe you a beer!) who came over immediately and gave me a ride to the road. We pulled in just as the ambulance arrived—an ambulance carrying no pain meds. Too much risk of getting them stolen they explained as I finally let myself lose it, writhing and complaining on the gurney but thankful to be hospital-bound.

Less than an hour later, nurses at the St. James Hospital’s emergency room in Butte injected me with some forget-about-it cocktail. A kindly doc chatted me up while unwrapping the mess.

“What are we looking at here?” he asked, maybe of Kara, maybe of me.

“Well, my hand was sorta pinched off by a falling boulder. It’s pretty ugly.”

Montana Headwall
  • Kara McMahon

“Oh yeah? What do you think is going to happen?”

He carefully deconstructed our makeshift splint, revealing my wrong-colored and disjointed hand from the dirty, crusty mess.

The purplish-yellow color was difficult to swallow. “I think it’s done for,” I said.

“Done for?” The doc leaned close to my face.

“We don’t do amputations,” he said.

His matter-of-factness was so confident I believed him. But I knew that the tourniquet had been constricting bloodflow for an hour. And with my hand and wrist resting on blue surgical pads, I could clearly see more space than wrist separating the two. But it was the right thing to say, an invigorating and empowering last thing to hear before passing out.

* * *

I woke dazed. Doctors were talking to Kara. I was wearing nothing but a gown. A bandage extended from above my elbow to well beyond where my fingers should have been. A clue my hand was still in there? It was all held in place by a bright- yellow foam brace full of holes. It looked like what a Cheesehead might put on his head for a Packers game. The ER staff said they’d heard that before, and let me know I would soon be flying.

An ambulance zipped me to a Life Flight airplane for an immediate flight to the hospital at Utah State University. The plane was refueling when we got there and the ambulance had other broken people to go deal with. They pulled me out and collapsed my gurney directly on the hot black tarmac. The ambulance sped away and even though I was left just inches off the ground I recall good views of the Berkeley Pit and Our Lady of the Rockies. Flight nurses stood nearby, dressed like Top Gun pilots and chatting, exuding calm confidence as they waited for the plane. A slight wind licked at my gown, and I might have felt sexy if it hadn’t been for that Cheesehead thing on my arm. I asked for more pain meds and wondered what things might look like under this bandage, and what would happen next.

Montana Headwall
  • Kara McMahon
* * *

A lot had occurred since we’d arrived to climb at Spire Rock just a few hours before. Spire is one of countless piles of giant granite boulders rising out of the high desert of Homestake Pass, the route by which Interstate 90 crosses the Continental Divide a dozen miles southeast of Butte. The rounded formations are part of the Boulder Batholith, an unmistakeable granite formation visible from the highway. The hard, clean, quartz monzonite has long served as a magnet for rock climbers.

But while dozens of established climbing routes make it a prominent cragging destination, it’s the uncom-monly dry and warm microclimate that draws the masses during the shoulder seasons of spring and fall. When Missoula is wet, or still coming out of winter hibernation, the crags at Spire Rock are frequently dry, sun-baked and inviting.

After a quick and greasy breakfast at Butte’s M&M Bar, we’d arrived racked and ready, angling for mid-level sport routes up the west face. There’s no single approach trail, just incipient paths weaving through sagebrush, juniper and boulder piles before converging at the saddle separating Spire Rock’s two prominent towers, The Queen and The King. We spread out and took our own routes up, choosing whatever level of challenge we wanted as we went. I found myself farther left than the others and confronted with a choice of scrambling through spiny vegetation to the right or a balancey boulder problem to the left. I chose left. It was short, just a delicate, gently overhung step-across that required an under-cling to accomplish eight feet of traverse. I was feeling strong and eager and got right to it.

Montana Headwall
  • Kara McMahon

I pounded the rock with my palm a few times to determine its soundness. It rang a bit hollow, but felt rigid, so I called it good. I reached beneath, found a solid grip and, swinging my left foot toward the next step, pulled my body into the rocky bulge.

That’s when the rock shifted and collapsed, the coarse granite pressing against my face while its thin lower edge drove toward the rock below. Its weight pushed what had just been an excellent handhold right through my wrist as if it wasn’t even there.

I instinctively shoved away from the tumbling boulders and, aware that Kara was somewhere behind me, screamed “ROCK!” With the sharp, unmistakable smell of broken stone dusting the air, I became aware that a Massive, Important Thing was happening. A split second later I came to a rest, utterly limp-wristed, and not yet understanding the gravity of the situation.

* * *

The “partial” part of a partial amputation is weird. It may be better than full amputation, but it’s also more difficult to comprehend, and way more hassle to deal with. If your finger or leg is completely detached, there’s not much to do other than decide whether to carry it out or leave it for the birds. Partial amputations leave wiggle room and invite questions like, “Is the appendage salvageable?”

Aron Ralston has considered these things. His hand was trapped under a boulder while hiking in Utah, and he famously chose to cut it off. Others have done the same when their arms have been trapped by winches, combines, front-end loaders and fallen logs. They had to get out.

My boulder didn’t trap me. It let me and my mangled hand go. Repairs were complex enough that one surgeon told me it was the most significant reconstruction his team had ever attempted. One titanium plate, four surgeries and lots of rehab later my hand is back on my arm and functioning remarkably well. I still have flexibility issues, because tendons adhere to bone when they’re immobilized and don’t ever return completely to normal. Nerve regrowth was incomplete, so I don’t feel the back of my hand, except in one hyper-sensitive, on-fire spot, a “neuroma.” Doctors combined salvaged bone fragments with a chunk of my hip to create a bone that extends from knuckle to elbow. Today that knuckle is calloused and often bleeding, because I bang it on everything. It’s inconvenient, and it can be awkward, but it’s so much better than a handless stub. Some circulation and chronic pain issues remain, but I’m not complaining. I had written off the hand, and I’ve still got it. I can grip a camera, plant a ski pole and boy can I hold a beer. I call that a smashing success.

Montana Headwall
  • Kara McMahon

As beneficial as it was, therapy was terribly painful, more persistent than the injury itself, and a real psychological challenge. It also introduced me to remarkable people with equally difficult or worse conditions who helped me appreciate my luck.

One had fallen into a well and, among other serious injuries, had “de-gloved,” essentially ripping the skin entirely off his hand. His therapy involved having his hand surgically inserted into his abdomen, where conditions are conducive to regrowing skin.

Another was in therapy after having his ulna and radius shattered by a .50 caliber bullet, fighting in Afghanistan. He too had needed a tourniquet. The military uses them regularly to stop severe bleeding when medical help is nearby but not immediately on the scene. Their reasoning is that cutting off blood flow to an appendage is appropriate only when an injury is thought to be life-threatening.

And ending that threat to life was exactly what we were trying to do at the time. We didn’t know it, but two separate arteries feed oxygenated blood to the hand. The tourniquet we applied worked by stopping the leaky one—the radial. Doctors speculate that it didn’t stop the other, the ulnar. Though compromised by the tourniquet, the ulnar continued pumping blood, keeping my hand alive enough to salvage.

* * *

I didn’t return to the accident site for years, but last summer I went back to get a more levelheaded sense of the scene. I arrived emotional—a bit nervous, a bit sad. Kara and I walked up the hill in silence, retracing our steps of three years prior.

Montana Headwall
  • Kara McMahon
  • The rock

When we neared the area, we split up to look. Kara found it immediately, an obvious void where the rock once rested, its unmoved neighbors precarious in its absence. The rock that had crushed my arm was obvious, still clean and pale from its recent tumble. The granite slab beneath it was still white, chipped by the falling boulder, not yet covered in lichen or duff and gleaming exposed in the sun. There was no blood visible. I remembered the broken-rock smell.

Warm from the uphill approach and the afternoon sun, we shed a layer and sat down on the offending stone. We burned some dried sage that Kara had brought and I smoked a bowl. Sizing up the boulder, I was glad to be alive. We agreed that I had been incredibly lucky, that the rock was plenty large enough to have done more damage than it did. I exhaled into the clean, crisp air and felt fortunate to be here again, and still.

It was a visceral, potent reminder of human frailty, impermanence, of my place in this world. Perhaps more than anything else, that falling rock defined my last three years, altering my work and my play and the lives of many deeply caring friends and family members.

But that’s just the “me” part. On that quiet afternoon, looking out across the grand landscape, I couldn’t help but be overwhelmed by the utter irrelevance of that one small rockslide to the part of the universe that isn’t me. Millions of similar granite boulders emerge from the surrounding forest, every one of them under the constant assault of wind, rain and gravity. That one of them fell and smashed my wrist was a nearly unnoticeable shift in the landscape’s endless erosion. I felt a strong sense of place, and of peace. We walked quietly back to the truck, turning around to watch a climbing party top out on The King, laughing and shouting their joy to be alive.

Montana Headwall
  • Kara McMahon

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