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Separation anxiety

Tourniquets and the art of tyin’ one on



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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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