Bad Ending to Great Backcountry

Bad Ending to Great Backcountry 

by Liz Dunham

Pictured are Ben and Liz Dunham on the day of the big injury.

The day started out wonderfully.  Tumwater canyon was gorgeous under the cloudy sky; recent avalanche paths were visible between the evergreen forests and bare winter larches.  After a stretch of especially freezing single digit temperatures and firm conditions we had a warmup and some fresh snow.  My husband and I decided to finally get back out there and do some low angle ski touring at Yodelin trees, a popular area near Stevens Pass.  The area first opened in 1969 as Yodelin Ski Resort.  As the resort’s popularity grew, they developed houses and ski cabins across the highway.  Tragically, an avalanche in 1971 took out two cabins in its path, causing four fatalities and proving the housing development to be unsafe.  Subsequent litigation and legal fees led to Yodelin Ski area closing by 1974.  The chairlifts were sold and the former ski area is now popular with backcountry and cross-country skiers.  

The terrain is just a few miles east of Stevens Pass and receives similar snowfall.  We arrived late morning and skinned up the track already set by others enjoying the warmer temps and fresh layer of powder.  Light snow fell as we followed the track through the trees, traversing the old ski runs.  As we attained our goal above the ‘Yodelin trees’ the view opened up, and we enjoyed looking out at the valley below.  After transitioning our skis we descended cautiously, knowing the “Christmas ice” layer was under the top layer of fairly fresh powder.  I started to find some smooth untracked turns under the thin trees. About halfway down the slope I heard my phone ringing and was surprised to have service; I took a FaceTime call from my brother and exalted in the beautiful day and conditions.  I used the cell service opportunity to call my mom and ask her to pick up our daughter from school since we would be running late.  As sunset encroached we traversed into another patch of woods, searching for a clear way down.  We hit some more lovely turns through trees and were relieved to discover our skin track, confirming we were almost back to the car.   

We decided to descend the last half mile on the skin track back to the car.  As we rounded a switchback a lovely but steep pitch opened up to our right, a shortcut meeting the skin track a bit lower.  My husband pointed out the variable conditions and our fatigue from our day, and suggested staying on the skin track; I announced I was feeling good and my last three months of gym workouts had really paid off.  I was going for it!  He cautiously sideslipped onto the slope.  I followed, but felt the snow was skiing well and quickly went into a few turns.  As the slope steepened I hit an aggressive turn left and suddenly my ski stopped dead in the deeper, hard layer.  Everything happened in the blink of an eye – my right ski stopped, my body kept twisting with full momentum, and I heard two clear snaps.  I looked down and saw my right ski boot and ski twisted at a very unnatural angle to my knee and leg and knew immediately I had broken both lower leg bones, the tibia and fibula.  This was a classic “boot top fracture”.  Now I was stuck with an unstable leg, my lower leg no longer connected by bone to my upper leg.  In the instant of injury the brain can’t quite keep up with what is happening – I initially felt no pain.  I looked down and knew that in just a few moments my brain would catch up and I would feel the injury.  I tried to wrap my head around the sudden change of my fate, knowing immediately my next three months would be very different from what I had planned.   

X-ray of the spiral fracture of tibia and fibula bones.

I reached down to release my binding so I could try to reduce my fracture before pain worsened and swelling set in.  As a physician with extensive experience in the wilderness I began thinking through the best-and worst-case scenarios.  My mom brain sighed with relief that I had already made arrangements for our daughter, and my next thought was to wonder if we still had cell phone reception. Another potential complication loomed large in my mind; I am a type 1 diabetic.  I am often proud of all I have accomplished while managing type 1 diabetes, but in this type of situation trying to manage insulin and blood sugars could be very difficult.  My doctor brain started imagining hypothermia, hypoglycemia, and complications from a leg fracture.  With all my ski layers on I had no idea if this was an open fracture, with bone poking out through skin.  This fracture type is also high risk for compartment syndrome, where the swelling cuts off the blood flow to the limb and you risk losing the limb if you don’t perform an emergency procedure to cut the injury open and relieve the pressure.  I risked frostbite if I removed layers to assess the injury further.  The light continued to fade as I yelled for my husband to come help, screaming “I broke my leg!!! Tib-fib!!!”  He was about 20 feet away and had seen me stop.  He had heard the two snaps but thought they had been branches in my path, not realizing they had been my bones.  My leg started to hurt in a very unnatural type of severe pain. 

I have always believed the best rescue is self-rescue.  I also believe in ‘loading the boat’ when appropriate, however, and given the worst-case scenarios piling up in my head I realized this was definitely an appropriate emergency to activate emergency response.  I had no idea how long it would take me to move myself out of this situation, and the combination of freezing temperatures, darkness, and diabetes did not inspire confidence.  It was about 4:30 pm and the sun was setting.  I pulled out my cell phone and dialed 911.  Amazingly I still had good cell phone service and was able to tell the dispatcher what had happened and roughly where we were.  My husband took the phone and calmly asked if they could find our gps coordinates from my phone data and activate local search and rescue, explaining that we were not at a resort and that we would most likely need help to carry me out of difficult, technical snow conditions.  The 911 operator assured us they would call us back with updates and hung up to begin activating appropriate agencies. 

Anyone who knows my husband knows he could probably carry me out of most wilderness situations.  He is strong, spending hundreds of hours every year outdoors digging and maintaining wilderness trails.  At 6 feet tall he is my go to heavy lifter, and can easily pick me up.  He had always assumed he could pick me up and carry me out of the woods if I were injured. (In fact, he actually did carry me out of Hungate hiking trail 2 years ago with a broken foot.)  He arrived by my side and unclipped his skis to assess the situation.  He immediately was thigh deep in snow, and it became obvious he would not be able to boot pack down off this steep hill with me on his back.   I decided I would slide down on my butt, bracing myself with my left ski boot and trying to move my right boot and leg as little as possible.  He tried to stabilize me and help as best he could, worried I would slip and careen head over heels down the hill, fracturing more bones.  Since we were married I vocally informed him to simultaneously be ready to catch me, spot me, help me, and stay the heck away from me.  

Dog Cocoa following Liz and Ben. She enjoys chasing sticks.

We made it down to the skin track and worked on setting up a splint for my right leg.  We estimated we were 1/3 of a mile from the car, a quick 5-10 minute ski assuming two working legs.  I used my ski and ski pole to try to splint my right leg, securing the whole setup with some first aid tape.  Unfortunately my ski boot kept sliding left, twisting my leg at the fracture site and eliciting severe pain.  The skin track was narrow, and I had to frequently stop, adjust my splint, and try to straighten my ski boot which in turn would hurt a lot and feel better all at the same time.  Outside the narrow skin track was deep, chunky snow.  After about an hour I had gone 40 feet.  By this point it was dark.  I try to always carry a headlamp even if I’m sure I won’t need it, but this time both my husband and I had left ours behind.  Ever prepared, however, he remembered he had a headlamp in the glovebox of the car a short distance away.  I also had an ankle length heavy down coat and insisted he leave me and go to the car to get light and layers.  He hesitated, worried I would go into shock or pass out, but I pointed out that we weren’t moving and it was only getting colder.  A light source and a thick coat could be lifesaving.  We had been alerted that ski patrol from Stevens Pass was currently busy with other injuries but that a Search and Rescue team was trying to get to us; however you never knew how long these things could take.  It was not unheard of for injured skiers and hikers to have to spend a night out before they can be evacuated.   

Once alone in the dark I realized my most immediate risks were hypothermia and shock.  I had emergency food and water in my backpack.  My blood sugars were stable, and in fact elevated from the stress and pain.  I decided to keep myself busy by reinforcing my splint and seeing if I could slowly slide a little further on the skin track towards the parking lot at Yodelin.  This helped distract me from the pain and kept me moving and warm.  I took down the splint and replaced everything, wrapping my fleece gaitor around my boot and ski pole to stabilize below the fracture and used medical tape to stabilize above the fracture.  With a better splint I was able to slide down the skin track until the next turn, where I was stopped abruptly by a large snow drift.  About that time I saw some lights in the distance and heard approaching people.   

I was thrilled to meet members of Lake Wenatchee Fire and Rescue.  My husband had encountered them in the parking lot, putting on snowshoes to come find us.  They arrived with hot tea, heat packs, and warm blankets.  They brought a “sked” as well as an air splint; the air splint stabilized my fracture and I was immediately more comfortable. After warming me up with heat packs and placing a heavy wool blanket under and around me I enjoyed some tea.  At that point it was about 7:30 pm; I had been sitting in the snow for 3 hours.  A sked is a combination stretcher, wrap, and sled, and would be slow going with the snow conditions and a team on snowshoes.  We received word that Stevens Pass Ski Patrol was now available and heading our way; the search and rescue volunteers recommended waiting for skiers and a toboggan given the technical terrain.  Even if it took another hour for ski patrol to arrive the rescue would ultimately be faster and safer.   

Ski patrol soon arrived on touring skis and worked quickly and efficiently.  They assessed my injury, cutting my ski pants just enough to confirm there was not an open fracture.  Then their voices got low and serious.  “We usually recommend removing the ski boot so we can assess the distal limb for pulses and prevent constriction as things swell.”  I knew by their tone that this would probably hurt.  A lot.  My husband suggested waiting until we got to the ambulance, but if anything went wrong it could potentially take some time to get there.  I told them to just do it, and make it quick.  About three volunteers pried my boot open as much as possible, a fourth did their best to stabilize my fracture, and the boot came off.  I screamed a few curse words and then breathed deeply as the pain subsided and they re-splinted my leg.  I had good pulses in my foot, which was another excellent sign that I did not have a limb threatening injury.  The next step was to get packaged into the toboggan.  

The view from inside the ambulance. Photo by Liz Dunham.

Xray post-surgery. New hardware to put things back together.

The ski patrollers had significant experience and expertise, and in no time had me packaged like a burrito with my helmet and ski goggles on for safety.  The snow conditions were chunky and variable, and I did my best to stabilize myself in the toboggan with my arms and core, now really appreciating the time I had invested in strength training these past few months.  As we headed down the trail a voice from behind me asked if I’d ever been rafting before; “Have I been rafting?!” I gleefully replied, explaining that we love whitewater sports and frequently raft and kayak the Wenatchee River.  He suggested I use the “high-side” rafting technique – if your boat is about to flip in a large wave or obstacle everybody jumps onto the “high side” of the boat to stabilize it.  I utilized this technique to stabilize the toboggan on the way down and to help keep me upright and in the track.  The last pitch was fairly steep and irregular.  One patroller held a line behind to apply the ‘brakes’ while the patroller in front expertly navigated a complicated backcountry slope in the dark, made more technical by my dog, Cocoa, trying to help.  We safely descended the last pitch, me gripping the sides of the toboggan and gazing down at the heated ambulance as if it were Valhalla.  I looked forward to a warm bed, but more importantly, I knew they had morphine.  I had not had anything for pain, and search and rescue volunteers are not necessarily certified to carry and administer pain medications.  My stash of ibuprofen I always carry had run empty and not been refilled.  It had taken about four hours from the time of injury to the parking lot, a distance of roughly 1/3 mile.  I had a new respect for how hard it can be to move an injured adult out of the wilderness, even if you are near a highway.  I also realized that if we had been out a week earlier in single digit temperatures the dangers of hypothermia would have been much higher.  If we had not had cell service or had been several miles further back the situation could have been much worse. 

They loaded me into the warm ambulance, started an IV, and administered strong pain medication.  They apologized for the icy bumps on Steven’s Pass that night but after my 4 hour adventure on the skin track and snow it felt like a cloud pillow (the morphine helped too).  I was transported to Central Washington Hospital where spiral fractures of my tibia and fibula were confirmed, and I underwent surgery the next day to fix my leg.  Recovery is slow, with six to eight weeks of non-weight bearing followed by at least that long in partial weight bearing and physical therapy.  Hopefully by the end of summer I can consider trail running again.  I will see how I feel about skiing next season but plan to at least resume cross-country and downhill resort skiing.  Stay tuned! 

Things to know: 

1. What to carry when backcountry in snow:  sled/tarp, shovel, avalanche probe and beacon, headlamp, hot fluids if possible, fluids, food, first aid kit with splint, extra layers, way to contact rescue (in reach, spot, cell phone, etc.).  Check this gear before every adventure, no matter how seemingly conservative the plan! 
2. How to splint a limb:  secure something rigid to both sides of the limb, making sure the splint includes the joint above and below the injury.  Check for a pulse distal (further away from the heart, like at the wrist or ankle) to the fracture.  You can use what you have, such as ski poles, sticks, skis, backpacking frames, etc.   
3. Essentials for a wilderness first aid kit:  ibuprofen, aspirin, splint, ace wrap, band-aids, gauze, tape.
4. What to tell emergency rescuers:  location, injury, pre-existing health problems, medications.
5. Search and Rescue teams are often volunteers working hard to help you out.  Be kind and appreciative.  These people are wonderful, putting themselves at risk to help the rest of us fools. 
6. The best rescue is self-rescue.  Don’t be afraid to call for help but know it can take some serious time and manpower to get to you. 
7. It’s hard to think clearly when the unexpected happens, especially if you are in serious pain or are with a loved one you desperately want to help.  Try to stay calm and take one step at a time.   
8. Know your gear.  In hindsight my binding non-release was possibly due to a release setting that was too high for me.  I will be replacing these bindings with a set with a lower range of release settings and strongly encourage petite women especially to take a look at their release settings on their skis and consider dialing them down.  Current binding release settings are not gender specific, and women have a higher incidence of binding non-release in ski injuries.  For backcountry touring you want a binding that has a range with your release setting in the middle, not at the extreme end.  Posch, Markus, Gerhard Ruedl, Katja Recklenburg, and Martin Burtscher.  Sports Med Open. 2022 Dec; 8:21.  Published online 2022 Feb 5.  Might Gendering Ski Binding Settings be Helpful for the Prevention of ACL Injuries Among Female Recreational Skiers?