Steve, climbing the first pitch of R&D.
The weather for the weekend looked excellent and we had some plans to do an alpine climb. At the last minute, we worried that the avy danger might be a bit high due to the first really warm temperatures of the season, so we decided instead to do some cragging in Leavenworth. Between the hikes and scrambles during the fall and winter, and climbing in the gym since January, we felt ready to test my ankle out on some real rock. We had only been rock climbing in Leavenworth once before, so we purchased a guidebook to survey our options. The route "R&D" was reputed to be a classic, and at 5.6, it sounded like a good starting route.
We arrived at the start of R&D just after a group of eight from a Mountaineers Intermediate class. Elain didn't want to wait, so we decided to check out some short climbs above R&D called Bob's Cracks. It took us a while to find the place. We played around on the 5.6 and 5.7 cracks before having a nice lunch. Our afternoon plan was to find a place to toprope some climbs and then hit R&D the next morning. However, as we passed by the start of the route, there was no one on the first pitch, so we decided to give it a try. During the first pitch, I got off-route and ended up following a harder diagonal crack to the left. We met back up with the route, but encountered a back-up of parties waiting to climb the next pitch. We thought briefly about just heading back down, but decided to wait it out and ended up waiting about a half hour. The next pitch went fine, although the chimney was wetter than I would have liked. Elain joined me at a nice belay ledge and we took a break as we waited for the party ahead of us to move on. Eventually, I started out on the easy terrain at the beginning of pitch 3. As I was attempting to pull over a large block, my right foot slipped. I bounced and landed on a ledge about 20' below, with my hip taking the impact. I tried to stand up, but the pain in my leg was terrible. I concluded that my femur was fractured. I laid down on the ledge, stunned with disblief and wondering how this had happened.
Two climbers, Jens Klubberud and Kellie McBee, were climbing the "Cocaine Crack" route to the left of R&D, and were on-scene within a few minutes after the fall. Jens and Kellie offered to assist with getting off the route. Because the fracture appeared to be in the proximal femur (in the hip), I wasn't sure if I would be able to hang in my harness, but I was willing to try. They kindly rigged two fixed rope lines (a 70 m and double 50s). I rappelled one line, while Jens rappelled the other in parallel to keep an eye on my progress. I had rigged myself a chest harness which helped keep me upright, and used one arm to support my leg. Looking down the buttress, I saw that a small crowd had gathered to watch us. At the base of the route, participants from the Mountaineers class offered to help me to the car. The trail proved to be the hardest part, and oddly sliding on my behind, with someone holding my leg in front of me, proved the least painful method. Once loaded into the back of the car, Elain drove me to the hospital, and an x-ray revealed a comminuted intertrochanteric fracture of the femur, which is a kind of hip fracture. Each time I had to slide from stretcher to table, it was quite painful. I found it puzzling that even with morphine in my system, my heart was racing at over 100 bpm. The doctor was worried about complications developing (most particularly internal bleeding and compartment syndrome) and wanted me to go to Wenatchee for treatment; I asked to be transferred to Harborview instead. He kindly called Harborview, and they agreed to take my case. Within an hour a LifeLine ambulance and two paramedics arrived from Wenatchee. They kept me as comfortable as possible during the 3-hour ambulance ride to Seattle, providing morphine and reglan a couple of times. I was wheeled into Harborview's ED (emergency department) at about 10 PM. The triage nurse was a bit taken aback when I quoted my Harborview patient ID number from memory (I had long ago memorized it, during my three previous hospitalizations). She directed me to a "resus room", where a doctor asked about the mechanism of injury. When he learned it was a 20' fall, I was put on a backboard and given a spinal collar.
The ED was a beehive of activity, with so many people having injured themselves during this beautiful spring weekend. I was sent to radiology where they took approximately 30 x-rays, and then was sent back for another x-ray when one of them didn't come out. I was then sent to a different room where I was given two CT scans (one of the head/spine and one of the femur). The intravenous contrast dye gave me hot flashes and a metallic taste. Back in the ED, the chief orthopedic resident (I'm not sure if she really was the chief resident, but she seemed to be in charge) caused me considerable distress when she announced that I might have a spinal fracture; it was later determined, by comparison with my 2004 CT scan, to simply be an "anomaly" predating my accident. Next was the focused spinal assessment, which involved four people tilting me onto my side so that the resident could examine my vertebrae; it was a awkward position that placed stress on the femur, and seemed to take forever. I wailed a bit at this point. Once my spine and head were cleared of injury, I was taken off the backboard. The chief resident then explained that they would need to put my leg in skeletal traction. This would involve drilling a small hole transverse through the distal femur, and inserting a pin through it. She explained that it would be done in the ED, under conscious sedation. For the next procedure, the chief resident recruited two residents to assist, which immediately made me nervous. Before I could negotiate a morphine bolus, they were straightening out my leg. It was over quickly, but I began to shiver uncontrollably, causing intense pain. A medical student took pity and brought me a warm blanket. Elain was asked to leave the room and I was sedated (midazolam and fentanyl) for the drilling; when I woke up, my leg had a metal clamp attached to a pin skewering the thigh. A cable ran from the clamp, over a pulley, to a 10-pound weight. Eventually I was sent up to a room for the night; the only room available was in the burn unit. The process of moving me from the gurney to the bed (while under traction) involved about four nurses, and seemed to take forever. Though I couldn't see him beyond the screen, I overhead that my roommate had burned off a portion of his feet in a chemical burn; Elain blanched when she accidently glanced at his feet. I was not allowed any drink or food by mouth ("NPO" orders), because of the impending surgery.
The next day I spent waiting for surgery and dreaming of chugging a cold ginger ale. I was finally wheeled down to the PACU at about 6 PM, to be prepped for surgery. My case had been bumped by several higher-priority cases that day, including one person who had been attacked by a bear. It was very quiet in the PACU and the lights were dim in all patient bays except one. By then, I was extremely thirsty, since I had not had a drink in about 30 hours (just IV fluids). I met one of my surgeons, Dr. Greene. He explained the two possible interventions they might pursue (intramedullary nailing and lateral plate fixation) and discussed the risks and possible complications. I talked briefly with the anesthesiologist and the surgical nurse. I was told that, mercifully, I would be moved from stretcher to table while under sedation. Back in the PACU, Elain told me the surgery had been a success, and that they had been able to use the "less invasive" method of fixation - an intermedullary rod that runs the length of my femur, bisected by two screws at the distal end and a second intramedullary rod (inserted all the way into the femoral neck) at the proximal end. Although the incisions are small enough that the procedure could be described as CRIF (closed reduction and internal fixation), the accident and the operation left the thigh muscles quite sore and stiff. I was kept at Harborview another three nights, and finally discharged on Wednesday. The doctors say it will be 6 weeks on crutches, followed by progressive weight-bearing and physical therapy.
Elain and I are extremely grateful to Jens Klubberud and Kellie McBee for their their kind and expert assistance in descending the route. We are also grateful to the members of the Intermediate Mountaineers climbing course who helped me get from the base of the route to the car. Finally, we are grateful to the medical staff at Cascade Medical Center, LifeLine Ambulance, and Harborview Medical Center.
Steve, climbing the first pitch of R&D.
Femur fractures tend to have quite a bit of internal bleeding, as
can be seen in this large contusion on the posterior of my thigh about
five days after the accident.