The scene.
It was a beautiful Spring afternoon at Bowden Doors in northern Northumberland, sunny with a breeze of dry refreshing air; perfect conditions for climbing. The cliffs are of the highest quality sandstone, firm and reliable with excellent frictional properties, and they form an escarpment running along the moor. The normal style of climbing there includes problems that generally finish a short distance from the ground, or longer routes that go right to the top of the crag (on average about 10 metres high). Most people climb unroped, as a fall from the problems would be too short to cause any damage, and the longer routes are attempted only if the grade is well within ones standard. I'd been climbing well, feeling strong, athletic and smooth, well in control even on problems that at other visits I'd found well nigh impossible. I'd also been doing some of the longer routes, but with plenty in reserve. Alan and I had been exploring Scoop 1, a 10-metre 5a climb with the crux at mid-height. Given that I'd been on-sighting 7a+ and climbing up to 7c indoors, a climb of this grade was not an extreme test of my ability (in other words, I had approximately 10 numerical grades in reserve). None-the-less, we both climbed up to the crux a couple of times to find the correct sequence, before committing ourselves to the easier upper section. I climbed to the top, and pulled onto a 1-metre wide horizontal shelf at the top of the crag.
The fall.
Exactly what happened will remain to a certain extent a mystery, but the following is consistent with my memories and various eye witness accounts. Behind the shelf there was a further short wall, perhaps a metre high, and it was clear that the most straightforward way to join the descent route was to walk along the shelf towards a dry-stone wall running down the moor to the cliff edge. I remember a clear view of the moor, the stone wall, the cliff, friends on the path at the foot of the cliff and the outlook over the moor to the right – this is compatible only with me standing on the shelf and moving right along it; indeed, someone saw me doing exactly this. The generous width of the shelf meant that this was genuinely easy ground and anyone could have walked along it. My next memory was of being on my side or chest, desperately fighting to find something to cling onto, then a vivid picture of the ground below and the fact that I was falling face down towards it.
The cause.
The apparent speed with which the situation changed from a gentle stroll to a loosing battle with the cliff top suggests a catastrophic slip. Sandstone is made of tiny grains; very occasionally the grains can be dislodged by the pressure of contact with a foot. Once one grain has been dislodged the additional pressure can dislodge others, thereby starting an exponential process that causes the foot to ride on a surface of ball bearings, precipitating a fall as surely as an icy pavement or banana skin. The victim has no time to react, and in my case momentum must have carried me to the right and the edge of the cliff. The rounded nature of the edge gave me no further chance.
The immediate aftermath.
While luck seems to have deserted me for a vital split second, I am very much aware that from the moment I became airborne I have been very, very lucky indeed. The landing site was flat and grassy, and I did not hit any of the boulders dotted around. I did not damage my head, neck, spine or any vital organs. Mark Garthwaite, a climbing friend who is also a GP was just 30 metres away and was with me in seconds. Another friend, Hazel Allen was also close by with a mobile phone; her 999 call alerted a paramedic helicopter that was already in the air. It arrived within 20 minutes, and took me to a first-rate hospital (Wansbeck General, near Ashington, north of Newcastle). Since all my belongings had been in my rucksack (which Alan collected) and my clothes had been cut off I was essentially completely without possessions or formal identification on arrival, which I gather caused some minor confusion. A short while later a general anaesthetic released me from my discomfort and an excellent surgical team led by Mr Innes began to put me back into as near the correct shape as possible.
A little physics.
One has plenty of time to ponder on things when in hospital, and application of dimly remembered schoolboy physics provided a few pertinent numbers. An estimated 10-metre free fall takes about a second and I would have been travelling at 25-30 miles an hour when I hit the ground. This doesn't sound much, and is equivalent to an Olympic sprinter at full throttle, the average cyclist going full tilt on the flat, or a high street bus between stops. The force of the crash can be imagined by putting an invisible solid brick wall in the path of the sprinter or cyclist, or simply stepping off the pavement into the path of the bus. Collisions of this degree of energy can cause a great deal of damage.
The injuries.
(briefly, starting at the bottom)
A crack in the left-hand side of the pelvic ring (the part of the pelvis you sit on), and another (or a compression injury) on the right-hand side. Extensive bruising and inflammation of the lower abdomen and genital area (the nurses marvelled at the size of my scrotum!). A broken rib. A fairly simple fracture of the right wrist. A double compound fracture of the left wrist. A black eye.
The injuries in more detail.
(skip this bit if you're squeamish).
I probably fell face down, tilted head first, arms outstretched. The first contact was onto my hands, with more force on the left-hand side. The impact snapped the ligament joining the radius to the ulna in the left wrist, then the head of the ulna burst through my lower forearm. Left by itself, the radius concertinaed and shattered into several pieces, one of which formed another small hole in my forearm. The disruption severely damaged (but did not sever) the nerves that serve the hand. Amazingly, I had little pain from this at the time and fortunately I was lying such that it was all hidden from my view. My right wrist was much less badly damaged; the ulna was intact and the radius was broken into far fewer pieces. The major fragment seemed to had swivelled round through about 90 degrees so it looked quite bad on the initial X-rays, but apparently it was relatively straightforward to get things back into the proper alignment. This one I could see, and on regaining consciousness, having established that I could move my feet, I glanced down and thought 'Damn, I've broken my wrist again!' I was really worried about my scaphoid, having broken it before and had it expertly fixed by Mr Crossan with some difficulty. 'He'll be cross', I thought. But amazingly, despite the 'hands outstretched' fall, the bone had obviously healed completely and was not damaged at all this time. The rib and pelvic injuries were essentially trivial, although the pelvis has caused most pain and inconvenience so far. Even at the site of the fall, I realised that although my neck and spine were undamaged (thanks, Garth, for such expert and gentle checking) I was more or less incapable of moving my lower torso because of pains in the pelvic region.
Initial treatment.
I remember a strange dichotomy; I was desperate to receive the anaesthetic as my whole being felt so sore, yet I was also desperate to hold onto someone and to talk; it was as if I was scared to let go. Eventually the anaesthetic was supplied, and I came to a few hours later with both arms suspended above me, and a merciful morphine pump automatically supplying an appropriate dose. My nether regions were extremely sore, especially if any movement was attempted, and crucially while coughing to try to remove a slight build up of fluid in the lungs. I am very grateful that Mr Innes and other members of his team explained carefully and completely to me exactly what had happened, what had been done, and the short and medium term plans for my treatment. Although painful, and perhaps the reason why my haemoglobin count went down to 9 over the first couple of days (equivalent to the loss of about a third of my blood), the pelvic injuries are trivial and will heal by themselves in a few weeks. The rib scarcely bothers me. My right wrist is fixed with three K-wires, skewer-like objects with external hooks that descend into the radius to hold its position. These are conveniently hidden by a light half plaster. The left wrist had to be extensively cleaned and set. Because of the dangers of infection with compound fractures, and because there were many bits of bone, Mr Innes chose to use an external fixation method rather than internal plates and screws. The ligament between radius and ulna was rejoined, then holes were drilled in my hand and the intact upper part of the radius. Pins were fixed into these holes, then a complicated jointed bar was attached to the pins. These allow the length and orientation of the radius to be adjusted, and the aim is that once the pieces have been manipulated into as close to the correct positions as possible, healing will join them back together and remodel the bone structure into roughly the correct shape. I required a further operation to adjust the position of the support, give a final clean to the wound and to seal it. Although it seemed that a skin graft might be necessary due to some tissue loss, a clever elastic arrangement of the sutures seems to have closed the gap.
The short and medium term.
I was able to stand and take my first steps within a week, then continuous improvement in my mobility and general health ensued. After two weeks the swellings had disappeared, I could walk short distances without support (or with crutches designed for people with broken wrists), and finally I could get up and down stairs. Before being transported back to Glasgow, Mr Innes went through all the X-rays with me, explaining exactly what had been done and the likely course of treatment. The K-wires might be removed from my right wrist as early as 4 weeks after the operation, and if I am lucky I might have only a support in their place (rather than a conventional plaster). Even now my finger mobility on my right hand is excellent, and my strength sufficient to lift a half-full kettle (or a pint glass!). The prognosis for this wrist is good, and it should get back completely to normal. The left wrist requires regular monitoring to check alignment and healing. The course of treatment will depend on what happens; the best possible outcome is that 6-8 weeks after the operation the fixation can be removed and a normal plaster applied. However it is also possible that further operations, or even a bone graft, will be required. Whatever happens, it is likely that a satisfactory reassembly of the radius will be achieved eventually. At two weeks, finger mobility and sensitivity remains poor, but it has improved enormously from a very low starting point. The nerve damage will take months to repair fully, but it should be restored and even now I can type with it and do some limited manipulation. I should be able to work fairly normally in the near future.
The long term.
The only long term problems lie in my left wrist. The problem is that all the working surfaces of the wrist were disrupted with considerable force, so in addition to the bones there is extensive soft tissue damage. The tendons and nerves should recover in time, but the great unknown is the state of the cartilage. Put under high impact crush forces, cartilage can shatter. If this happens, it will tend to degenerate rather than repair, causing rapid onset osteoarthritis for which the only cure is to fix the bones together surgically to prevent continuous pain. The probability of this happening is uncertain. Mr Innes said it might be necessary, and it would be preferable to struggling with pain should the worst happen. My first Glasgow consultant was extremely pessimistic, dismissive even, saying he'd seen these before and the prognosis was very poor. I thought this guy might be difficult to deal with, so I requested a transfer. Mr Crossan said he'd make no predictions, as the outcome was extremely variable and one just could not tell at this stage. Two things seem certain: firstly, it will be several months before we can begin to draw any firm conclusions; secondly, the wrist will never recover completely, and the balance of probabilities is that it will eventually be fused.
A look on the bright side.
- I am alive.
- No really major damage was done.
- Any permanent disability is likely to minor.
- My ability to work will be at most marginally affected.
- I will be able to walk, scramble or ski in mountainous areas as before, even with the worst outcome.
- I will be able climb a little even with a fused wrist. In fact, there are a number of climbers about with severely depleted wrist mobility; if I choose and with a bit of luck, I may be able to climb quite well despite an immobile wrist.
More thoughts on climbing.
Perhaps strangely, it is extremely important to me that this was not really a climbing accident. If I had willingly tried a climb too hard, or made a wrong decision while attempting a route and fallen from an actual climb I would be far more upset – it would have been me who had done this to myself. As it is, the accident has been variously been described as 'freak', 'inexplicable' or 'bizarre'.
Climbing has been a major part of my life for almost 35 years. It has taken me to places of incomparable grandeur all over the world, and during the recent years of high standard rock climbing (high, that is, for a 48-year old) I have enjoyed the intense pleasure of harnessing strength and stamina to move smoothly and surely over very steep rock on very small holds. The way that slight adjustments of foot and body position could turn the impossible into the elegant held great fascination for me, and when this worked well it was a beautiful feeling – a synthesis of coherent bodily motion joined to concentrated analytical thought. At the time of my accident all this was working as well as ever before, and a great season was in prospect. So if this really is the end of all that, I've had a very good innings by anyone's standards, and I've gone out at my peak with good memories to the fore. For better or worse, climbing has made me the person I am, and any success in other walks of life can not be divorced from the benefits gained from climbing experience.
In fact, there are other issues to consider. I'd been having pain in my hips, particularly the left one, for a couple of years and the X-rays taken after this accident showed significant arthritis. I already had an orthopaedic appointment to examine my right knee, which had been giving all the signs of debilitating cartilage problems. All those years of high level activity had clearly been taking their toll; sooner or later I would have had to face the fact that I couldn't climb as well as the youngsters anymore anyway. If the worst really does happen, the silver lining is that I can retire with dignity, and not after a painful decline. There are plenty of other things to do: as Maurice Hertzog said after the first ascent of a Himalayan giant during which he lost all his fingers and toes - 'there are other Annapurnas in the lives of men'.
Thanks.
From the instant of my hitting the ground, I have been lucky to receive the very best of treatment for both mind and body. I am extremely grateful to:
- The staff of Wansbeck General Hospital, particularly the trauma team of Mr Innes, Mr Sher and colleagues, and the nursing staff of Ward 6. I felt safe and secure in their care and greatly value the time spent to explain everything to me. The nurses were superb, giving reassuring care when needed at all times of day and night, encouragement when appropriate, and never loosing patience even during my worst periods.
- The day care staff at the Western Infirmary, Glasgow, for their encouragement and understanding, and the speed with which they changed me from a hospital case to an outpatient.
- Mr Crossan, for taking me on again. Let's hope that between us we can replicate at least some of the success of our previous collaboration!
- All my climbing friends who were at Bowden Doors, particularly Garth and Hazel and others who took an active role in my immediate care, and especially to Alan who cared for me, collected my belongings and, unknown to me, chased the helicopter to Wansbeck so that he could get accurate news of my progress and organise the distribution of bad news as gently as possible. His concern and care afterwards have been a great source of support – thanks for simply being a good mate!
- To all my climbing friends, work colleagues and relatives who bombarded the hospital with enquiring phone calls, and have covered my mantelpiece with get well cards. These things are just so important, and I hope to be able to see all of you soon.
- And overwhelmingly to Dee. It could not have been easy to hear of my injuries, but she set to work and came down to stay with me at Wansbeck for the whole duration, supplementing my nursing care, organising everything, arranging phone contacts and most importantly by just being there when most needed. The next months will be as hard for her as they might be for me, as I will be of limited help around the house and frequently a nuisance. I'll try to make it up sometime, honestly!
Roger Everett
Bowden Doors, 19th March 2000, about 3pm.
Typed with both hands, 31st March - 1st April, 2000.
Time moves on. It's now six weeks after the accident; time to take stock. I returned to work four days after getting out of hospital, which did marvels for morale. The wires and plaster were removed from my right wrist only four and a half weeks after the accident, and progress has been excellent. Already mobility is at least half of maximum, and by exercising as much as possible, it's now getting back some strength. In fact, today is a red letter day as I've just managed to deadhang my whole weight (which is sadly increasing in quantity and flabbiness) from a large hold for a good 10 seconds on the one hand. (I also moved the lawn.) My walking has improved to a distance of about 2 miles, not bad considering I was still part time in a wheel chair only 2 and a half weeks ago, but the pelvis and rib still cause problems and I wonder when I'll be able to move about without discomfort again. My left wrist is "progressing far better than one could reasonably expect" but it is still "hollow looking" according to Mr Crossan. But finger sensitivity and dexterity is definitely returning, I can play a bit with the exercise putty, and today I even used my left hand to cut the nails on my right (progress is measured in small doses!). We still don't know the extent of the long term damage, but the arrangement is to have the fixator removed in 10 days time, the earliest time possible from previous projections. The aim is to see how the left wrist gets on with no more than a light removable support. So far so good – with luck and a bit of application, you might even see me back on the crags later this year (I'll be the lopsided one with the very strong right hand and the very weak and stiff left one).
R.E. 29th April 2000
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