A Tumble in the Cuillin Hills of Scotland

I have always thought that I was careful while rock climbing, compulsively testing every hand and foothold before giving it my weight.  Stephan and Jon (Brit friends of mine) and I were on our way down from the summit of Sgurr Alasdair in the Cuillin Hills, a series of 3000-foot craggy peaks in northwestern Scotland on the Island of Skye, when the rock I was holding onto suddenly broke away from the rock face.

I arrived in England in early July 1999 for a summer holiday where I had planned to spend a week with Stephan and Jon hiking through the Highlands of northern Scotland before crossing the Channel to explore Normandy and Brittany in France on my own.  Upon arrival in London on Saturday, July 3, 1999, I took the train to Telford in Shropshire.  Stephan, a friend of eleven years, met me at the train station and drove me to his mother’s home.  He introduced me to his mother and a friend of his, Jon.  We had dinner and chatted awhile before piling into Stephan’s car for the long drive up to Scotland.  We stopped once along the way for a bathroom break and to fortify ourselves with tea.  

We drove long into the night until at 2:30 the next morning when we pulled off a narrow lane to the house we would occupy for the next week.  It was a spartan, but neatly furnished house just outside the little village of Attadale near Loch Carron.  

The house, although small, was big enough for each of us to have his own room.  After unloading the car, we went straight to bed.  After a few hours of sleep, I got up and I went outside to check out the neighborhood.  Nearby were the picturesque lochs so characteristic of Scotland.  Our semi-detached (duplex) house was in a valley surrounded by mist-covered hills of heather and thistle.  Sheep lazily roamed the hills and paddocks nibbling at the lush green grass.  It was refreshingly devoid of city noises.  It was as peaceful a setting as there is.  

We spent the first day hiking through a light drizzle searching for a World War II American bomber that supposedly crashed in the hills.  For most of the morning and early afternoon we walked up and down gently rolling hills along a path looking for the wreckage.  Little yellow and white wildflowers dotted the hillsides.  We crossed a rickety wooden bridge and continued as far as a little loch.  All around us hills of the Highlands stretched to the horizon, but no sign of the crash site.  Determined to find it we left the path and struck out across the damp fields and headed up a marshy hill.  There was hardly anyplace to walk that was not soggy.  With nearly every step my boots sank into the muck until they were soaked.  It was not long before I no longer tried to avoid wet spots.  It did not make any difference.  We climbed to the tops of several rocky hills searching in vain for the wreckage.  We never did find it.  I was not disappointed, though.  I was simply enjoying the time hiking and talking with Stephan and Jon in companionable fellowship.  It was my first good opportunity to talk with and to get know Jon since I slept most of the preceding evening during the drive up to Scotland.  I liked Jon from the beginning as we kept up lively conversation covering many topics along the way.  

During the second day the weather was a bit better so that the beautiful Scottish countryside was more apparent as we drove around Loch Carron.  Not a ripple disturbed its surface so that the hills on the other side were perfectly mirrored.  We drove on to the little town of Dornie on Loch Duich where we went on a walking tour of Eilean Donan castle.

During the evenings we built a fire in a little fireplace in the living room.  We quickly used up the little pail of firewood provided so that we had to chop more from a supply in a shed next to the house.  After the first day when we got so wet, we used the fireplace to dry our boots and socks. 

Jon was once a chef in a pub in Ireland, so we did not lack for good cooking.  He and Stephan took turns preparing dinner while I, grossly lacking in culinary skills, merely lent a hand chopping onions and stirring.  After dinner we spent time to ourselves reading then played word games together and whiled away the rest of the evening in pleasant conversation covering a vide range of topics including American and British politics and cultural differences.  Both Stephan and Jon are well traveled so we compared our various adventures around the world.  I looked forward to an entire week of more of the same: hiking, relaxing, and enjoying the amity of two good friends.  During the second evening Stephan and Jon suggested we spend the next day on the Island of Skye.  There was a mountain there in the Cuillin Hills that might be fun to climb.  It was only 3000 feet high, a mere hill compared to Kilimanjaro, Rainier, and Whitney I had climbed before, so it should be easy, right?  

The next day we drove across the Skye bridge from Kyle of Lochalsh to the Isle of Skye, a large island between the northwestern coast of Scotland and the Western Isles of the Outer Hebrides, famous for Harris Tweed woolens.  The sun was shining through scattered clouds and the temperature was comfortably cool as we pulled into a car park near a tent campground.  The summit, however, was obscured by low lying clouds.  We set out along a gentle sloping path up into the hills.  For the first hour the climbing was not at all difficult, but once when we above 1000 feet we ran into increasingly loose rock and the incline grew progressively steeper.  We passed several other hikers and two rock climbers assembling their gear to assault the face of a high cliff.  These guys really are nuts, I thought.

We got strung out as I stopped periodically to take photos.  Soon the climbing became hand-over-hand rock scrambling through a steep boulder field.  For the first time I became worried.  These boulders were very loose, and I was concerned about rocks rolling down on me.  I took note of Stephan above me (who was making surprising speed up the mountain) and was careful to stay well to the side of his ascent route.  Jon was a little below me and off to the other side.  Several times my foot slipped back on some loose rock.  I was very cautious here and was conscious of the possibility of rocks falling from the cliffs directly above us.  I was eager to get to the summit and have this part behind us but was not looking forward to the descent through these loose rocks.  This was more than any of us had anticipated, but I was enjoying the challenge of it.

Stephan reached the top of the boulder field and sat down for a rest.  Jon and I reached him a few minutes later.  Stephan took his shirt off even though it was a little chilly.  We were sweating profusely.  He consulted the map to see if he could locate our position on the mountain relative to the summit to give us an idea where we had to go.  From here to the top there was no marked path to follow.  We took time to eat some cookies and to take a generous drink of water.  After a brief rest we set out for the push to the summit.  We had made it this far and would not be denied the prize.  The worst part was surely over, right?

From the rest stop to the top the climbing was relatively easy and within twenty minutes we reached the summit.  We sat down to rest for about 45 minutes, taking pictures, eating, and admiring the stark scenery.  The clouds that had previously obscured the summit from our view below now and again drifted away to give us fleeting views of the surrounding peaks, the camp and car park below, and some of the nearby islands in the Minch between Skye and the Hebrides.  Several climbers were barely visible ascending two other peaks in the distance.  Some were so far away that the only way to see them was through the telephoto lens of our cameras.  

Another peak not far from the summit challenged me.  I climbed down a short way then scrambled to the top.  I stood on the edge and looked down the other side.  It was a sheer drop straight down.  It was a good thing Mom did not know I was doing this.  She hates it when I do this sort of thing.  I threw a couple of rocks down and listened to them bounce off the sides of the cliff before crashing at the bottom with a resounding echo.  One large rock started a little rockslide.  It was a little easier climbing back to Stephan and Jon.

Before setting out for the climb back down we consulted the map to ascertain the simplest and easiest route.  We wanted to avoid the steep boulder field we had to climb through on our way up.  We set out down another side, which was not the most direct route back, but one that would be different than the one we came up.  Very shortly we came to a section that provided more than one way down.  I chose to take a different way down than the route Stephan and Jon were taking, a way that presented a sheer rock face not more than about twelve feet high.   The only way to descend was to go down facing the rock face.  The first few feet presented no difficulty as I placed my feet into two sure footholds and looked for a secure handhold.  Holding onto a crack with my left hand I reached for what looked like a good handhold for my right hand.  I took hold of it and gave it a slight tug to test its integrity.  It felt secure so I gave it all my weight before proceeding to the next foothold.  

I like this kind of climbing, relishing the challenge as long as it is relatively safe.  I have never been drawn to the more demanding and dangerous form of rock climbing that requires ropes and special equipment needed to secure oneself to the face.  I like a challenge, but I draw the line at this sport as a little too extreme.  It belongs in the same category as bungi jumping, hang gliding, and like sports for the athletically insane.  Of course, any form of rock climbing is inherently dangerous, but I have learned what my limitations are and have gained the confidence needed from previous climbs to do a little rock scrambling.  Climbing in the Cuillins was a bit more than rock scrambling, but I was sure I could handle it.  I was not afraid and besides, this was fun.

As soon as I gave the rock my weight it immediately broke away from the face and it and I fell backwards into space.  My immediate thought was “This is going to be a bad fall and it’s going to hurt – a lot”.  I was aware of tumbling backwards but time seemed to come to a standstill.  The vertical drop was only about five feet, but I felt an excruciating pain, the source of which I was not yet aware.  I cried out as I hit the ground, bounced hard, and continued to role like a limp rag doll.  When I finally came to rest, I was on my back looking up toward the face from where I had just fallen.  I cried out in pain again as I looked down in horror at the source of the pain.  There was an ugly, bloody abrasion over the middle of my left forearm and a gross deformity midway between the elbow and the wrist.  It was clear that I had fractured both the ulna and the radius.  When I tried to move my forearm, the fracture angulated more grotesquely.   Next, I looked down at my left thigh.  It, too, was very painful.  My foot was wedged up against a big rock.  When I tried to move it, a searing bolt of pain shot up my leg, and I watched with morbid fascination as a lump moved beneath my jeans as if it were trying to find a way out.  There was no question that I had fractured my femur, too, and the lump was one of the broken ends poking into my thigh as I moved my leg.

It was a surreal scene.  This could not be happening, I thought.  My leg and arm could not be broken.  I have never broken a bone before.  I am too healthy and fit.  No, this was not happening.  It must be a dream.  This only happens to the other guy, not me.  There was one thing, though, that I could not deny.  The pain was very real, and I was reminded of it every time I tried to move.  

It had happened so fast that I was not aware of the precise moment that my bones snapped.  There was no perceivable moment when there was pain when a moment before there was not.  I did not know that I had broken anything until I saw the deformities.  That is when I became frightened.  

Much later, I tried to reconstruct in my mind the events of the fall and the mechanism of the fractures.  The abrasion on my left forearm and the nature of the fractures indicated a blow from a heavy object, most likely the rock that broke away from the face and fell with me.  The lack of any external signs of trauma on my thigh, such as abrasions and lacerations, and the fact that my jeans were not dirty or torn indicated that the rock had not hit my leg (as I first suspected), at least not hard enough to snap in two the largest bone in the body.  Much later when I got back home, I inspected my left climbing boot and found a deep gouge in the leather on the heel.  Given these particulars, a likely explanation for the femur fracture is my left foot momentarily got snagged by the heel on a rock as I started to fall backwards resulting in catastrophic stress to the mid-shaft.  This would account for the transverse orientation of the fracture later revealed by the x-ray.  I think my initial pain was the femur fracturing and my forearm fractured after I hit the ground and was struck by the rock.

As soon as I saw my deformed forearm and thigh, I became very frightened and with undisguised terror in my voice I cried out to Stephan and Jon, “I’ve broken my arm; I’ve broken my leg”.  I tired to lessen the pain by straightening my forearm but it only hurt more.  Using my right hand, I gently maneuvered it onto my stomach to a position that hurt less.  I could not move my leg to reduce the pain because my foot was wedged against the rock.  It was not a matter of getting comfortable but trying to find a position that was least uncomfortable.  I yelled for Stephan and Jon again.  

There was never a moment that I was not fully aware of what was going on.  I understood my predicament and knew I was in serious trouble.  Knowing how serious my injuries were and how remote and isolated I was on the mountain frightened me most.  I knew that there was no way I was going to be able to get off the mountain without a significant rescue effort and I became acutely aware of the continued danger I was in.  I was not going to be moved anytime soon until some definitive help arrived and as I looked up to the rock face, I began to worry about rocks tumbling down on top of me.  There was not a thing I could do to protect myself.  I never felt so helpless and vulnerable in my life.  I was defenseless, completely exposed to the continued danger.  I could not do anything to help myself and was wholly dependent on others to protect and succor me.  This sense of utter helplessness was a completely foreign experience for me and was very unsettling.

Within seconds of my cries Stephan and Jon climbed down around the side of the face from where I had fallen and were at my side.  They quickly realized what had happened and could immediately see what had to be done. The decision was quickly made without any discussion that Jon would be the one to go for help.  Later, he told me that the decision as to who would go was an obvious one since speed was now critical and he was the more experienced climber.  Stephan knew me better and so might be of more comfort to me while we waited.  Jon looked at me with a grave expression and simply said, “You know, it’s going to be a good hour and a half.” meaning that it would take that long just to get back down the mountain to get to a phone to call for help.  I nodded understanding and he took off with the keys to Stephan’s car.  A minute after he left, Stephan remembered something and trotted down the hill and shouted the code to make the cell phone work.  I hoped he would not forget it by the time he got to the car.  I had gotten to know Jon well enough in the past three days that I had every confidence in him, although it did not occur to me at the time that in his haste to get down, he, too, might fall and get hurt.  

When Stephan got back to me, he began to look me over to see if there were any other less obvious injuries.  He checked my left side pants leg to see if there were any other blood stains that might indicate there was active bleeding from any open wounds.  The possibly of an open fracture with active bleeding occurred to me, too.  The though of bleeding to death from an arterial laceration momentarily crept into my mind.  It seemed clear that there was no active bleeding from my thigh, but there was some blood on the front of my jeans, most likely from my bloody forearm abrasion.  There was no pain from my head or neck, and I could move through all neck motions, so I was pretty sure I had no cervical spine injury.  I could wiggle my toes and move my legs and had no back pain, so I was not concerned about a lumbar spine injury.  I could breathe easily without any discomfort, so I did not think I’d broken any ribs.  Indeed, all my discomfort and all other indications were that my injuries were confined to the fractured forearm and femur.

As long as I did not move my forearm and let it rest, the pain was tolerable.  The main source of my discomfort was the fractured femur, primarily because I could not straighten it out.  It felt as if my thigh were bowed downward at the fracture site.  When I tried to straighten it out it sent another bolt of pain through my leg.  My kneecap was externally rotated a little so I thought I might have two fractures, one in the middle and another one just above the knee.  The thought occurred to me that I might not ever run again; silly when I should have been more concerned with getting off the mountain alive.

I could not move my foot off the rock so I resolved that I would just have to put up with the pain until somebody could move it.  I asked Stephan to try, but when he did it only sent another searing bolt of pain through me.  After a couple of attempts I told him to forget it.  

I had come to rest on my backpack.  My glasses had fallen off (but I did not realize it until I was later moved) and my watch had been torn from my wrist (Stephan found it later).  He tried to pack some flat rocks under my leg to keep it from bowing downward, but it did not make much difference.  He covered me with his rain jacket because I started to chill (I was only wearing a t-shirt).  The jacket helped a little, but I started to shake and my teeth to chatter.  I asked Stephan to sit next to me to warm me.  It was a great relief and very reassuring to feel his body warmth and to have him close by.   Occasionally he got up to see if he could somehow make me more comfortable by rearranging things under my leg and my head.  Despite all his efforts nothing seemed to make any difference and I only started chilling again.  I told him to just sit next to me to keep me warm.  

I don’t specifically remember what we talked about while we waited for some form of rescue, but he kept me engaged in conversation and occasionally got me to laugh.  We heard an RAF fighter flying close by but did not see it. There is an air base nearby and they train up here.  I did not know how I was to be evacuated off the mountain but was worried that whenever help did arrive that I would have to somehow be carried down the mountain.  The prospect of that was disconcerting because unless I received something for the pain, it would be a very uncomfortable ride down.  

After lying on the mountain for about three hours we heard the characteristic rotor sound of an approaching helicopter.  Within in a minute a big red and white helicopter appeared overhead and swung around and circled as if it were searching for us.  Stephan stood and began waving.  The helicopter flew out of sight, but I could still hear it circling.  One of my first thoughts was that I would soon get something for the pain and would not have to be carried down the mountain; I was going to be flown off.  This was a tremendous relief.  I tried to follow the sound of the helicopter as it flew out of sight.  Later, I learned from Jon that it landed down at the car park where it picked up the mountain rescue squad before returning to locate us.  It came back and circled again.  Stephan waved at it again and it must have seen him because he ran back and told me there were several people climbing toward us (they had to repel from the helicopter since there was no place for it to land).  

Oddly, as I waited the pain seemed to intensify and I willed them to hurry.  Stephan went back to direct the rescue squad to me, returned and told me one guy was just over the ridge.  Within a minute a guy wearing a climbing helmet reached me and began to assess my injuries.  He introduced himself and said more help was on the way.  A few minutes later five other people were at my side.  They quickly unloaded their gear and went to work.  Four of them were from Mountain Rescue and two were other climbers who came to help.  One guy knelt at my head and placed an oxygen mask over my face.  It was a demand breather, so I only had to inhale to trigger a whiff of oxygen.  They kept telling me to breathe deeply, that this would help the pain.  They did not have any morphine to give me.  I would have to do without it for now but that there might be some on the helicopter.

I had never been the object of medical care like this, and it was strange to be on the receiving end of so much attention.  I tried to observe their ministrations clinically and with a detached interest but was quickly reminded that I was indeed the patient when another bolt of pain shot through me.  A plastic splint was gingerly placed around my forearm and inflated.  This brought immediate relief from the pain as the fracture was reduced.  Next, they had to move my leg to get another splint around it.  This meant moving my foot, up until now wedged against the rock.  With two guys supporting my leg and another guy pulling me by the shoulders the rock was pulled away.  I knew this had to be done and that it would hurt.  I was told to take several deep drags of the oxygen, then in one effort my leg was pulled free and straightened out, but not without a scream of pain barely muffled by the oxygen mask.  It was over in a second.  The splint was quickly applied and inflated.  This, too, brought immediate relief of the leg pain.  

With my leg and forearm splinted I felt reasonably comfortable for the first time in over three hours.  My legs were strapped together for additional splinting.  I looked up at my rescuers as they worked over me, preparing me for the evacuation.  They were efficient and compassionate.  They kept offering me words of encouragement and I gave them a thumbs up to indicate I was doing okay.  I got a lump in my throat.  Everything they were doing was for my benefit and comfort.  I was not a burden to them, someone who had interrupted their afternoon.  I was simply someone who needed help and they were there to provide it unselfishly.  Never before have I felt so helpless and dependent on somebody else for my safety and wellbeing as I did there on the mountain in Scotland.  I felt comforted to know I was in their hands.  I was touched.  I sensed a very real and unmistakable bond developing between us, unlike anything I had ever experienced before; and I did not even know them by name.  To me, they were simply my rescuers. 

Once I was splinted the next step was to get me to a point where the helicopter could retrieve me.  Up until now the helicopter waited on the ground down by the camp.  According to Jon it had to fly off to refuel, he thought in Kyle of Lochalsh.  I was bodily lifted and placed into a red bag then onto a backboard.  I was told to take several big whiffs of oxygen before I was lifted up again and laboriously carried about 50 yards down the mountain.  I was jostled around a little, but the splints kept me immobile enough so that it was not too uncomfortable.  I dearly hoped they would not stumble and drop me.  It was, after all, very rocky and a turned ankle or a slip…

A seventh guy (I don’t know where he came from) lit a flare to signal the helicopter, which had been circling overhead.  The smoke also gave the helicopter pilot the wind direction so that he could adjust his approach.

The helicopter came in and hovered directly over us making a tremendous noise and buffeting us with the rotor wash.  I looked up at it and was surprised at how motionless it remained as the winch slowly lowered a red clad crewman with a yellow helmet.  He alighted a few feet away and was quickly grabbed and pulled over to us.  Somebody quickly attached the litter to the winch cable.  I was surprised and a little anxious at how thin it appeared.  Both the helicopter crewman and I were quickly attached to the winch cable.  He looked at me with a reassuring smile and I nodded back at him.  I looked at my rescuers one last time knowing I would never see them again, never get a chance to properly thank them for all their efforts on my behalf.  I gave them one last thumbs up as I looked up at them individually through tears of gratitude and appreciation welling up in my eyes.  I nodded to the crewman that I was ready, and he spoke into his helmet microphone, and we began the slow ascent.  

During the ride up I lifted my head to look around.  The backboard spun around on the cable so that I got a good look at the mountains below me.  Since I was no longer in pain and felt relatively comfortable, I actually enjoyed this part.  The ride to the helicopter took only a minute.  The crewman was right next to me all the way to the helicopter. As we neared the open doorway of the helicopter the ascent slowed.  When we pulled even with the bottom of the doorway my left foot struck the housing of the landing gear sending another bolt of pain through my leg.  

A second crewman was in the doorway waiting for us and speaking into his helmet microphone.  When I arrived at the level of the doorway the crewman inside quickly straightened the backboard out and pulled me inside.  The crewman who rode up with me climbed aboard and pulled the door shut.  The second crewman, whom I guessed was a physician, straighten the backboard and clamped it securely to the floor.  He quickly set about assessing my injuries.  I told him the same story I told the mountain rescue people.  I got the impression that the plan was to take me to a military hospital at Stornoway on the Western Hebrides Island of Lewis.  When I told him I was a physician and certain that I had a fractured femur the decision was made to take me instead to Inverness where there was a bigger hospital with a trauma center.  The guy who rode up on the cable with me brought me a headset and placed it over my ears and positioned the microphone over my mouth so that I could listen and talk to the crew.  He said something into his microphone to the pilot then looked down at me and said the ride to Inverness would take about 30 minutes and asked if I would be all right that long.  I nodded and said that I would be okay.   The pilot also spoke to me, and I was able to listen in on his conversation with the helicopter and ground crews throughout the flight to Inverness.

During the flight I was not aware of any forward movement.  It was a surprisingly smooth ride, my first in a helicopter.  I was also not aware of the passage of time.  This was all so unreal; dreamlike.  I thought again: this simply could not be happening.  I was supposed to be enjoying my holiday with Stephan and Jon hiking in the Highlands, not flying in a helicopter to a hospital with two serious fractures, faced with the certain prospect of surgery in a few hours.  I knew all too well what awaited me at the hospital. Surely, I would wake up tomorrow and Stephan and Jon and I would go out for another hike.  We would lounge around another warm fire tonight and stay up late talking and play more word games.  

The second crewman occasionally came back to look me over and to ask how I felt.  I was able to talk directly to him through my headset microphone.  In what seemed sooner than 30 minutes he told me we were descending to the hospital landing zone and that as we got lower the ride might get rougher.  I tried to simply relax as we went down.  Soon the helicopter began to shake just a little, but not so much that it bothered me.  Throughout the flight I was quite comfortable, even as the helicopter wheels touched down on the landing pad.  The door was yanked open, and the two crewmen unclamped me from the floor and swung me around so that my head pointed out the door.  As soon as the door was open, I was aware of the roar of the engine and the blast of the rotor wash.  With tightness in my throat, I nodded to the two crewmen and thanked them.  One took off my headset and smiled at me as two ground crewmen pulled me out and onto a stretcher.  One of them wore a blue uniform.  

Two people immediately pulled me over to a waiting ambulance and pushed me inside, headfirst.  The guy with the blue uniform introduced himself as Ian as he secured the stretcher in the ambulance.  The ride to the emergency department did not even take a minute.  As soon as the ambulance stopped under an entranceway the back door was flung open and I was pulled out and wheeled inside.  I was taken down a hallway and into a typical appearing treatment room.  With a groan I was lifted off the stretcher onto a table and the emergency room staff went to work.  A pretty nurse peered down at me and introduced herself as Christine.  She inserted an IV catheter into the back of my right hand and a dose of morphine was injected.  Within a minute I felt the soothing effects of the opiate working its magic.  Since the splints had been applied by the mountain rescue people, I had not experienced much pain, but the relaxing effect of the morphine was welcome.  The splints were gingerly removed, but the morphine made the process tolerable.  Christine and another nurse wrapped my forearm in another temporary splint and a different splint was made ready to be applied to my left leg.  I became worried that they were going to drill a pin through my leg just below the knee for skeletal traction.  I was relieved when a Thomas splint with skin traction was applied instead.  

A guy who appeared to be in his mid-thirties and whom I suspected was an orthopedic resident stood over me and introduced himself as Mr. Banaskiewicz.  Not a very Scottish sounding name, and mister? I wanted to be treated by a doctor.  A few days later I asked one of my nurses about this.  In the UK medical training system when a student graduates from medical school he gets the title, “doctor” but after he specializes, such as in orthopedic surgery, he drops the title “doctor” and takes the title, “mister.”  Apparently “mister” is a title of distinction.  He explained what was going to happen then did a quick exam.  In addition to my obvious injuries, he was careful to thoroughly examine me for less obvious ones.  He gently pushed down and rocked my pelvis.  There was no pain there and it seemed solid.  He asked about neck pain and palpated my cervical spine and gently put it through its range of motion.  He said he would get an x-ray of it just to make sure, though a cervical collar was not applied.  He later changed his mind and decided cervical spines films were unnecessary.   He also performed a neurosensory exam of my fingers.  Some persistent numbness of my entire fifth finger, the ulnar half of the fourth finger, and the ulnar side of my left hand was a disquieting finding.  All the fine motor functions of my fingers were intact indicating that the ulnar nerve had not been transected, but somehow the sensory branch of the ulnar nerve had been traumatized.  There were no sensory deficits in my feet.  I hoped that reducing the forearm fractures would restore the sensory function in my hand.

After this quick exam and securing the splints, Christine wheeled me down to the x-ray department.  Front (AP) and lateral views of my forearm and thigh were obtained.  When the x-ray tech was finished, I asked to see the films.  She first handed me the femur films and I held them up to the light and was immediately relieved to see that it showed a simple transverse fracture through the midshaft.  It was not as bad as I feared when I first realized I had a fracture on the mountain.  There was minimal comminution (fragmentation) and just a little bit of separation between the two fractured ends.  As femur fractures go, this one was not a bad one (classified as a Type 1) and would be relatively easy to fix.  The forearm films, however, were far worse than I suspected.  There was gross angulation of both the ulnar and radial fractures and a slightly compacted radial neck fracture just below the elbow.  This was a bad fracture, worse than the femur fracture.

Christine wheeled me back to the emergency room.  Mr. Kevin Baird, my attending physician, and who would perform the surgery, came to my bedside to discuss the films with me.  The forearm fractures were clearly more serious than the femur fracture and had to be reduced and fixed that night.  The femur fracture could wait.  I would be kept in traction until it could be later reduced and fixed with an intramedullary rod.  

I asked to call home and was wheeled out into the hallway to a wall phone.  The hospital operator made the connection for me.  It was roughly 9:00 in the evening in Scotland, mid-afternoon in Indiana.  Mom answered the phone; Dad had just left for the office.  I told her that I had had an accident, what had happened, and that I was on my way to surgery.  That put her into tears. Later, when I got back home, she told me when I told her I had had an accident she knew immediately it was a climbing accident and not an automobile accident.  I called Dad at the office and told him what had happened.  Before we hung up, he asked me an interesting question: “Are you apprehensive about your doctors?” meaning the care I was going to get.  I told him I was not, but later I thought about the question some.  What if I was apprehensive?  What was I going to do about it?  I had to have the fractures reduced and fixed that night.  I had no choice.  They could not simply pack me up and ship me back to the States.  No, for better or worse I was committed to this hospital and this surgeon.  Truly, I was not apprehensive.  So far, what I had seen and the treatment I had received had been exactly what I would have expected to get in the States.  Had I gotten hurt in some of the Third World countries I have been to recently, such as Russia, China, or Africa, then I would have a justifiable and understandable cause for concern, but this was the U.K., with as modern and up to date medical facilities as any in the States.  No, I was not at all apprehensive.  I had every confidence in my surgeon, Mr. Baird.  I just wished they would call him doctor instead of mister.

After my phone calls, I was wheeled upstairs to theatre (pronounced theeta with a long “e”), the Scottish term for the operating room.  I was taken to a smaller room first where I met the anesthetist (pronounced, aneesthetist with a long “e”).  He asked me the usual preoperative questions then injected my IV with a barbiturate.  Within seconds I was asleep and do not remember anything else until I woke up briefly in the recovery room.

I have long since lost the acute films of my fractures that were taken in Scotland. The following x-rays were taken at various stages of my convalescence in Indiana while I was under the care of Dr. Jack Gossard, one of my dad’s orthopedic surgeon partners.

In surgery the same evening that I fell, under general anesthesia, Mr. Kevin Baird inserted an intramedullary (IM) rod down through the center of my left femur after first reaming the femoral canal to 15mm to accommodate the 14mm diameter rod. The approach was from the top through an incision in my left buttocks. The rod was pounded across the fracture and locked into place with an interlocking screw both proximally and distally.

As can be seen in the above x-ray there is little evidence of healing at the fracture site. It is also clear that the IM rod is firmly fixed within the femoral canal. Also, the minimal comminution is evident. The main difference between this x-ray and the one above it is the impaction of the fracture. Because of the interlocking screw, the fracture was not allowed to impact. Dr. Gossard removed the distal screw so the fracture would impact and facilitate healing. The gap at the fracture site has been reduced with the removal of one of the interlocking screws.

Both Dr. Gossard and I were not satisfied with the femur fracture healing. It was not progressing as fast as we hoped. To try and speed up the healing process I wore a bone stimulator around my left thigh for three months. Had this not helped, the next step was to preform a bone graft at the fracture site. The bone graft was not necessary as the fracture began to show callus formation indicating healing.

There is clear evidence of fracture healing by the formation of a good callus around the fracture. This would eventually disappear by dynamic bone remodeling or resorption. At this stage, the IM rod is a neutral factor adding nothing to the integrity of the femur. Because of bone formation over the proximal end, it was elected, however, to leave the rod in place permanently. The second interlocking screw was eventually removed.

I vaguely remember waking up in a dimly lit room before falling back into a drug-induced sleep.  When next I woke up, I was in a four-bed ward.  I had a bulky dressing on my forearm and, to my surprise, a dressing on my thigh.  Later, Mr. Baird and his assistant, Mr. Banaskiewicz came to see me.  Mr. Baird explained what he had done.  A compression plate and screws were affixed to each of the ulnar and radial fractures.  During the procedure he decided to go ahead and fix the femur fracture as well.  An intramedullary rod had been inserted through the length of the femur and a screw inserted at each end.  This provided solid fixation of the fracture.  He said the surgery took a total of four hours and that I had tolerated the procedures well.  He also told me that there had been a lot of muscle stripping from my forearm bones, which might cause a delay in the healing so that at a later date I might need a bone graft to get the fracture to heal.  Great news, I thought sarcastically.

I had a morphine pump attached to the IV that allowed me to give myself a metered dose of morphine anytime I wanted it.  It was set up so that it was impossible to inadvertently give myself an overdose.  Throughout the first postoperative day I was in a lot of pain that seemed only minimally alleviated by the morphine.  I kept pushing the little button to deliver another dose but did not seem to give me much relief.  All it did was make me groggy.  

Later in the afternoon Stephan and Jon came to visit me during the posted visiting hours, 3:00 – 5:00.  It was great to see them.  Apparently, I kept nodding off, so they left to get something to eat and returned during the evening visiting hours, 6:00 – 8:00.  When they came back, I was even more dopey.  I remember that we talked, but apparently, I could hardly keep me eyes open and had trouble articulating so they left early to let me rest promising to return the next day.

Stephan and Jon came to visit me everyday during afternoon and evening visiting hours and it was always good to see them.  Stephan gave me copies of all the photos he had taken on the mountain.  I was surprised at how many he had of the rescue operation.  I only remembered one that he took when he asked me to look up at him.  By then I’d been splinted and felt well enough to actually smile, but I do not remember any of the other pictures.

Throughout my nine-day hospitalization I had very little appetite.  Knowing that nourishment was important for heeling, and eager to begin the rehabilitative process, I forced myself to eat to regain my strength.  Still, I rarely finished a meal.  The food was not bad; I simply was not hungry.

From the first day after surgery, I resolved that I would start right away and work hard to get back into shape.  I knew it would be a long, maybe even a painful process.  For the moment I had lost all desire to climb, but I wanted to swim, bike, and run again.  I wanted to do triathlon.  I wanted to race again.  This was my motivation.  There was another motivating factor. Lance Armstrong was winning his first Tour de France (this was before he was suspected of blood doping). We watched the Tour stages from our four-bed ward television. I knew that Lance had survived metastatic testicular cancer and had not only gotten back into shape, but had gotten back into such good shape that he but he had become of the best cyclists in the world. I thought that if he could come back from cancer to be competitive again, I, too, could come back from my injuries and do triathlon again.

My rehabilitation began the second day after surgery.  Two physical therapists came to my bedside with a walker and told me they were going to get me up onto my feet.  I looked at them incredulously.  Surely, they were joking.  I’d just broken my femur and they wanted me to stand?  They weren’t joking.  Very slowly, and with their assistance, I swiveled to a sitting position with my feet dangling over the side.  One kept hold of my left leg and lowered it slowly.  I was anxious that she not drop it, which I knew would be painful.  Using the walker, I gently stepped down onto the floor (I wore nonskid slippers).  The therapists kept a firm hand under my arms.  Forty-eight hours after surgery to repair a fractured femur I stood, bearing all my weight.  A smile replaced my initial look of concern and skepticism, and a spark of confidence replaced my fear.  One told me to take a step with my right leg.  When I did, I became lightheaded.  They immediately set me back down on the edge of the bed and swung my legs back up.  That was enough for the first day, they said.  I readily agreed.  

Later that day a blood test revealed my hemoglobin (a measure of blood volume) was 11.6 g/dl, way down from my usual 16+.  Medical people get nervous when the hemoglobin dips below 10.  Later the next day it was down further yet to 8.7. That evening I was transfused two units of packed red blood cells.  A third unit was not needed but held in reserve.  I had never had a transfusion before and was, quite naturally, concerned about blood-borne diseases.  I was not so much concerned about HIV and Hepatitis B as I was about Hepatitis C.  I had gotten the Hepatitis B vaccine 10 years ago and had had a booster in 1996 before going to China.  I was just as concerned about Hepatitis C as I would have been if I were to get the blood in the States.  I was fairly certain that the UK blood supply was as good as it was in the States, yet it was still a little unnerving to watch the column of blood slowly run down the tube and into my arm.  The first unit took much longer to run in than the four hours I was promised it would take.  When the nurses were not looking, I turned up the drip rate on the second unit to get it in faster.  I wanted that needle out of my arm.  My normal, pre-fall resting heart rate usually ran in the low to mid 60s.  During my hospitalization my pulse rate was nearly always above 100, a clear indication that my blood volume was low.  No doubt I had lost some blood during surgery, and it was obvious where most of it had gone.  My left leg was grossly swollen.  There had been a lot of muscle bleeding around the fracture site. 

The following day the therapists were back to get me up again.  This time it was a little easier and I felt better.  There is nothing like a little extra oxygen carrying capacity and a full tank.  With the aid of the walker, my two therapists, and the encouragement of my roommates I walked in a small circle around the room.  There was no associated pain and with each step I gained more confidence.  The next day I walked out into the hall and down to the nursing station.  I was still anxious about falling so I was always sure to stay clear of other people in the hallway.  Soon, I was walking with only a right-hand crutch.  At first, I needed help to get out of bed, but within a few days I was able to get out myself.  

Dad flew over from the States four days after I fell to help me get back home.  He spoke with Mr. Baird and looked at my pre- and post-operative x-rays.  In general, he was quite pleased with the surgical fixation and the care I was receiving.  On the day he was to arrive I made sure I was not lying in bed but sitting in a chair so that he would see that I was making good progress.  He came to visit me twice each day and walked with me in the hallway.  Usually, we walked down to a sunroom for a change of scenery.  From the sunroom I got a good look at the hills of the Highlands surrounding Loch Ness.  Raigmore hospital had no air conditioning so that early in the day when the sunshine came directly into my room it got uncomfortably warm.  It was nice to go to the sunroom where I could open the windows and get a nice breeze.  Dad and I went there every day.

Sandy was one of my roommates.  He was a man in his 60s or 70s who had a fractured hip repaired the same day I had my surgery.  Sandy provided some interesting entertainment during my stay.  During the first two nights Sandy got a little confused and disoriented.  He tried to get himself out of bed on several occasions.  He would grab a hold of his overhead trapeze and pull himself up and try to swing his legs over the side.  Had he succeeded in getting out of bed he would have surely fallen.  I had trouble sleeping anyway and Sandy’s grunting and groaning did not help.  Each time he tried to get up I rang for the nurses who came in and found him half out of bed and each time they scolded him and put him back.  He would argue with them, but finally relented and let them put him back to bed.  I thought they might have to resort to physically restraining him.  After the first two nights Sandy’s mind started working again and he stayed in bed.  He was one of my roommates who, when he was lucid, encouraged me when I got up on my walker for the first time.  When he recovered from his post-operative confusion and was not so wacky, we had some nice chats.  He liked to flirt with the nurses and got away saying some things to them that, had I said them, would have gotten me slapped.

Another of my roommates was a climber who had fallen on Skye the same day I had fallen.  Geoff had recently graduated from university in Sterling and was hiking with his girlfriend.  He was on the other side of the ridge from where I had fallen and fell at about the same time.  He had fallen about 25 feet and fractured his pelvis.  After I had been evacuated, my rescue squad and Stephan went to help Geoff.  He was flown off in an RAF helicopter two hours after I was.  His fracture was not serious and did not require any intervention except bedrest.  He was up on his feet with a walker in two days and walking with a cane a few days later.  Geoff was just getting into mountain climbing and planned to climb in the French Alps near Chamonix a few weeks later.  Even after his fall he clung to the hope of going to France to climb.  Everyday his girlfriend and several of his “mates” came to visit him.  He had a chess set and asked me to play one day.  I really did not want to, not having played in a long time, but gave in.  I won.  Checkmate.

Even though I was a long way from home I got many visitors.  Three different clergy came to visit me, nearly one each day.  The first day after surgery the hospital chaplain came to visit me.  He probably visits everybody who has a “P” on his hospital admission forms.  Sam Logan, president of Westminster Theological Seminary (Philadelphia), who happened to be leading a tour in Scotland at the time, gave me a call the same day.  The next day a pastor on sabbatical from Virginia came to visit me.  Sam had arranged it through the Seminary after several telephone calls.  He also arranged for the pastor of the local Church of Scotland, an avuncular gentleman with a delightful, thick Scottish brogue named Aonghas Ian MacDonald to visit me.  He came to talk with me the second day after surgery and again while Dad was with me.  He arranged for somebody to pick Dad up for Church on Sunday.  

I received several phone calls from the States.  Everyday I got a least one call.  The nurses had to bring me the cordless phone since all the calls came into the nursing station.  In one day, I received nine calls from the States.  Mom and David (brother) called several times; Steve from work called twice; Charlene called twice; Mary Jo, Janet, and Karen each called; Roger called me every day; and Tara called.  Tara (my travel agent in Baton Rouge) made all of Dad’s travel arrangements to come over to help me get back home and arranged for my departure to be moved up one day.  The travel insurance company made several calls both from Chicago and London to arrange for me to return home.  Originally, the insurance policy called for a nurse to accompany me home, both in first class, but I was able to talk them into letting Dad (an orthopedic surgeon) accompany me instead.  Tara made all the travel arrangements.

During the week after surgery I made steady progress in getting around on my crutch.  It was not long before I was able to get out of bed at will and walk up and down the halls as much as I wanted.  On Thursday, nine days after my fall I was discharged.  Before leaving I went around to say goodbye to some of the other patients I had met and gotten to know.  It was difficult to say goodbye to some of them.  

I was wheeled out in a wheelchair to a waiting taxi.  Dad had arranged for us to stay one night in a hotel across the street from the hospital.  The next morning another taxi was waiting to take us to the airport just outside Inverness.  There were no first-class seats on the first plane, so I was given two coach seats.  The first leg of my journey home was a short flight to Glasgow.  I took my time climbing down the steps for fear of falling.  For the next few months I was quite anxious about steps, especially going down.  Another wheelchair attendant waited for me at the bottom.  This was first-class treatment indeed.  I was taken up to a comfortable lounge and later to the first-class lounge.  This was all part of the service that the insurance company had arranged for me.  During the four-hour wait I intermittently watched the British Open, which happened to be in Scotland.  Several of the other patients on my hospital floor had watched some of the earlier rounds.  

Just before boarding was called, I was wheeled to the gate where Dad and I were allowed to get on ahead of everybody else.  Our seats were in the first row.  Even in the larger, more comfortable seats of first class I was never comfortable.  I took a pain pill (some oral narcotic), but it did not help much.  It was, however, much better than if I had had to sit in the little seats in coach with even less room. A TV screen swiveled out from the armrest and I could choose from a number of movies to what on our way across the Atlantic. I chose my favorite comedy, Blazing Saddles.

When we arrived in Chicago another wheelchair and an attendant were waiting for me at the door.  I was pushed ahead of everybody and allowed to go through immigration in a special line for the handicapped.  An American Airlines representative was waiting for us at baggage claim to make sure I got my bags and passed through customs without any hassles.  With our bags in tow on a cart I was wheeled out to the curb where a stretch limo was waiting for us.  It was a long car with a Hispanic driver named Joe.  These cars are impressive to look at but fall short in terms of comfort during a long drive, especially with a bum leg.  It was difficult and painful for me to bend down to get into a car and once inside it was even more difficult to get settled into a comfortable position.  I was not able to flex my knee (because of the residual swelling in my thigh) and it was difficult to stretch out.  There was not enough headroom to get up and move around to find a more comfortable position so that I was constantly squirming and shifting pillows.  I finally resolved that I would just have to put up with it until I got home.  Unfortunately, we ran into a lot of traffic going around Chicago, which slowed us to a crawl.  We finally were able to get up to the speed limit south of Chicago.  

Joe stopped in Merrillville, Indiana so I could get out and walk around.  He made up for some of the lost time speeding down I-65 and pulled into Mom and Dad’s driveway about four hours after leaving O’Hare.  Mom, David, and Susie came out to greet us and to help me get my bags inside.  Heinz was thrilled to see me too and ran around in his characteristic excited style.  Draped above the TV was a sign Susie had made which read, “Welcome Home John.”  That about said it all.

When there was complete healing of both the ulnar and radial fractures, an attempt was made to removed the AO plate and screws by an orthopedic surgeon in Terre Haute, Indiana where I worked. The ulnar plate and screws were successfully removed, but when the radial plate screws were removed, one of the screw threads was stripped necessitating putting them and the plate back. I still have the hardware on my left radius.

Neither the IM rod nor the radial plate and screws give me any problem. I am not at all aware that they are even still there. Occasionally I set the airport security magnetometer off but the scar on my left forearm is enough of an explanation and I am waved through.

One other complication I had after the aborted attempt to remove the plate and screw from the radius was persistent pain over my dorsal left hand in the distribution of my radial nerve. This was quite bothersome but after a few months, it gradually resolved and I no longer have any hand pain. I speculate that this likely was the result of some radial nerve trauma during the attempt to remove the plate.

The only residual effect from my forearm fractures is a persistent ulnar nerve paresthesia in the sensory distribution of the left ulnar nerve. It is best described as a strange feeling in my left little finger and the ulnar half of my left ring finger. I only notice it when I touch these fingers or the ulnar side of my hand. It is not at all bothersome.

Within a few weeks of returning to Indiana I began my rehabilitation in earnest. I first got back in the pool and began swimming laps. As soon as the swelling in my thigh went down I began pedelling on my bike on a wind trainer. It took a year before I could walking without a limp but as soon as I could, I began to run again. Less than two years after my fall my brother, Dave, and I successfully hike to Mount Everest Base Camp. A year and a half later I completed the first of two Ironman Triathlons, which fully validated my recovering and rehabilitation. In essence, I have had a 100% functional recovery.

In retrospect, it is clear to me that God was with me throughout this entire experience, from the time I fell, as I lay helpless on the mountain waiting for the rescue team, through the surgery and convalescence, and my recovering and rehabilitation. There is no other explanation. I was comforted by God’s promise to the Israelites in Deuteronomy 31:6 where it says: “Be strong and courageous. Do not be afraid or terrified because of them, for the Lord your God goes with you; he will never leave you nor forsake you.”

Along the way I made a new friend, my surgeon Kevin Baird.

I was blessed to be under the care of two excellent orthopedic surgeons. In large part, I owe Mr. Kevin Baird and Dr. Jack Gossard a debt of gratitude. Without their surgical skill and expertise, and compassionate care I would not have recovered to the degree that I did. Thank you Kevin and Jack.

Special thanks to Dr. Paul Timperman, interventional radiologist and fellow cyclist, for helping me photograph my post-op x-rays.