1998

Course in wilderness medicine ends with a strong dose of reality

Dr. William A. Houghton remembers with aching clarity the instant the cliff's vertical sandstone face broke away beneath his feet. He remembers his foot slipping, the sudden sense of lightness when his body became airborne, and how he groped at his lifeline as he began to fall.

He still can almost feel the faint jerk as the line tightened, then went limp as the piton that held it to the rock popped out of the wall. And he remembers the stabbing, bone-shattering whack as his body slammed into the rocky talus 30 feet below, then the carnival-ride centrifugal heaviness as he flopped feet over head down the steep pile of sandstone rubble.

Houghton slid to a stop on his side, his face on the rocks and sand. Boulders and pebbles kicked loose by his fall rattled around him and bounced down the steep slope to the canyon floor 500 feet below. Through a haze of pain and dizziness he could hear his companions, most of them fourth-year students at the University of Massachusetts Medical School in Worcester, scrambling and stumbling toward him over the loose and clattering rocks.

He was 44 years old. He listened to the anxiety and fright in his companions' voices, wondering how badly he was hurt and whether he was dying.

Houghton, an assistant professor of family and community medicine at UMass, and his seven students were just finishing the second week of a three-week field course on wilderness medicine that Houghton was leading in northeastern Utah. It was the last course most of the students needed to graduate. They had spent the first week in the Wasatch Mountains, learning how to improvise rescue equipment and practice emergency medicine in high-altitude snowfields.

The group also included two co-instructors, Drs. Thomas E. Jager and Natacha Barber-Jager; two assistants, Jennifer Klockars and Aaron Sodickson; and Mary Beth Pomeranz, the wife of one of the students. These helpers created rescue scenarios and acted as victims for the course training drills.

The students and their companions had started that week on a 100mile rafting trip that would take them through Desolation Canyon in the Green River Wilderness Area. The Green is Utah's major river, and as it cuts down from Wyoming through the Uinta Mountains and flows south toward its confluence with the Colorado, it passes through canyons and gorges with names as colorful as the pastel blues of the desert landscape - Whirlpool Canyon, Split Mountain Canyon, Flaming Gorge. The deepest of these channels is Desolation Canyon. At the canyon's Rock Creek, the Green River lies more than 5,000 feet below the rim. Houghton and his students were about halfway through the canyon when he fell from the cliff on the morning of May 16. He had scheduled that Saturday as a day off from rescue drills. The members of the group were on their own to explore, go fishing, or just hang out.

Two people had gone for a hike. One bunch had ventured into a side canyon where a thousand years ago, the Anasazi - the "ancient ones, " as the Hopi call them - had lived, and where you can still see their painted scenes of battles and chiseled petroglyphs of the hunt, of the spirit realm, of the dream time, on sandstone walls in the cool shade beneath other rock overhangs. Houghton and five others had trudged up the mountain to practice what he believed would be a little easy rock climbing. The cliff face jutted from the top of the 500-foothigh rubble pile and rose about 60 vertical feet before leveling off on a mesa. It was the first in a series of ever higher cliff bands and steep scree fields that rose like some Brobdingnagian staircase to the arid plateau nearly a mile above the canyon floor.

Houghton was one of only two experienced rock climbers on the trip. The other, Dr. Peter M. Loescher, had climbed the scree, but had wandered over to another rock face to work on his own free-climbing techniques before going up with Houghton and the rest of the group.

Loescher, now an intern at the Dartmouth Family Practice Residencv Program at Concord Hospital in New Hampshire said he was hanging on to the side of a rock wall when Houghton fell.

"Will was lead climbing up the first pitch to set up some belay lines on the top," Loescher said. "He'd gotten about 30 feet up. I actually was around the corner doing a little free climbing. I heard the fall and I climbed down and came around the corner to find him lying in a heap at the base."

All the way

The rubble was so steep, Loescher said, that if you dropped a rock, it would roll and bounce all the way to the bottom of the slope.

"We had to go on all fours and scramble just to get up it," he said. "The rock and sand would give way underneath your feet and it was very steep. The rock cliff was very crumbly and loose. It was a kind of soft sandstone with a lot of fracture lines."

Houghton was saved from plunging all the way down the 500-foot slope by a single belaying line tended by Klockars, a high school student and family friend who had volunteered to go along to help with the training.

Dr. David Feinbloom, now an intern at Boston's Beth Israel Hospital, stood in the rubble at the base of the cliff and watched as Houghton inched his way up the rock wall. Klockars stood a little to one side holding the belaying line that was attached to Houghton's climbing belt.

"It was pretty incredible and frightening," Feinbloom said. "I guess for me it was the most dramatic thing I've seen. I've seen a lot of trauma, but you usually see it after it's happened. This is the first time I've ever witnessed it. I was standing right there."

Houghton had put a piton into the rock, attached a protective line to it, then continued his crab crawl up the wall. Feinbloom saw Houghton's foot slip out, then saw him tilting backward into the air.

"His protection ripped right out of the rock," Feinbloom said.

Houghton's body was rotating backward as he fell, and it looked to the horrified students as if he would land on his head. But just before he hit, his body slammed through a dried juniper tree that was growing out of the rock. The impact shattered the tree branches, but righted him enough so that instead of landing on his head, he took the full force of the impact on his left hip. When he hit the rubble, his body bounced and started to roll down the slope. Klockars strained to hold the line as Houghton tumbled. As the line stretched taught, Houghton slowed and then skidded to a stop. He came to rest on a small rock shelf about a foot wide. He lay on his side, his face in the dirt, his body curled almost into a fetal position. His shattered hip was raised in the air and his leg stuck out at an odd angle. He bled from gashes on his head and back. His hands were a mass of cuts.

Intense pain

The muscles of his leg and hip, no longer supported by a stable bone structure, quivered in violent spasms. As the muscles contracted, the jagged pieces of pelvic bone cut into the interior of his hip. The pain, he said, was phenomenal. Houghton remembers lying in the rubble and trying to assess whether he was alive or dead.

"I could feel all my body parts," he said during an interview from his home in Ashburnbam, where he still is convalescing with his wife, Gay, and their 2-year-old daughter, Kate. "I felt that was a good sign."

He knew from the fear he could hear in his companions' voices -- and in the fact that his leg would not move -- that he was seriously injured. The likelihood that he could bleed to death internally, or that he could die of shock, was high. He also knew that even if his students could get him off the mountain without killing him, his prospects for rescue were limited.

The group had spent four days navigating the easiest part of the canyon, the first 50 miles in three 16 foot rubber rafts. But the most dangerous part of the trip remained ahead of them. The spring snowmelt and early season rains had swollen the down-river stretch of the Green into a rolling series of long Class IV rapids -- waters so violent and treacherous that they should only be run by, or under the supervision of, an expert in white-water rafting.

Houghton not only was one of only two rock climbing experts on the expedition, but was one of only two people on the trip with white-water rafting experience. Loescher, who had worked as a ski patrol officer in Aspen and as a professional river guide in Colorado and Utah before attending medical school, was the other. For the inexperienced students to attempt the rapids without an experienced crew member to guide them through the white-water obstacles, hydraulics, currents and waves was to court death.

Houghton knew that his only hope of rescue was by helicopter. And the nearest telephone was in the little town of Green River, 46 miles downstream.

"Initially, what was important to me was to kind of monitor what they were doing," he said. "My role as a leader is to make sure no one gets hurt. I tried to make sure they were setting up a correct belay system from my standpoint of lying on the ground there. I said to them to tell me what you're planning to do."

For Houghton's students, the sudden role reversal was unsettling.

"It was awkward," Feinbloom said. "He had been in charge, and now it was very clear he wasn't. I think he felt responsible. He was trying his best to still be in charge."

Loescher said his first thought when he came around the corner and saw Houghton on the rocks was that this was another rescue scenario, like the drills that had already taken place during the trip.

"I thought, 'Here we go again,' " he said. "But when I saw the blood and his clothes all torn and his hands all torn apart, I said, 'This is for real.' It very quickly became clear this was no exercise."

The five students mobilized for action. Klockars took off to alert the other members of the group. Feinbloom and Dr. Eric J. Colon, now an intern at Boston Medical Center, bolted down the loose scree to the canyon floor, then ran the mile to the group's base camp by the river. They raced through the camp, grabbing and piling up equipment they thought they would need to get Houghton off the mountain - rope, straps, additional medical supplies and a heavy, plywood-topped, metal framed, 8-foot-long table they intended to use as a litter. The two ran the return mile to the bottom of the mountain with the pile of gear and then struggled to lug the heavy burden up the 500-foot-high pile of shifting sand and rock.

While they were gone, Loescher and Dr. Scott Patch tried to assess Houghton's condition and did what they could to stabilize him.

"I got down close to him to try to talk to him about how badly he thought he was hurt and to first make sure he had no neck injury and to get him immobilized," Loescher said. He and Patch conducted a neurological exam and made sure that Houghton had feeling in his hands and feet.

"He appeared to be neurologically intact and that was reassuring to us," Loescher said. "But he clearly was in a lot of pain and was going into shock. We recognized that this was serious. He was the victim, but also was still our leader. We tried to evaluate him and at the same time ask him for advice on where to go."

Loescher said he wanted to take a raft and head down the river immediately, but Houghton would not agree to that. Loescher, Houghton said, was the only other person who could get the rest of the group through the rapids. Without him, the group was stranded.

Other members of the party arrived and helped care for Houghton. Patch and Dr. Daniel Ngygen completed the medical examination while others searched for appropriate supplies and helped keep Houghton's injured leg in traction. It was nearly an hour before Feinbloom and Colon made it back to the top of the slope with the gear.

"They were really huffing and putting," Loescher said. "They ran as hard as they could, and it was two miles round-trip plus dragging this stuff up the scree slope."

Although most of the students had brought pain medications with them as part of their emergency kits, only Houghton had brought vials of injectable morphine. The students gave him the first shots to help control the pain. But the supply was limited, and it was obvious that the morphine would not last nearly long enough.

'It was grueling'

Feinbloom said that by the time he and Colon made it back, the others had examined Houghton and secured him in a flat space they had dug out of the slope.

"It was really hard to get back," he said. "We had to do a lot of climbing to get back, and it was grueling scrambling back up the hill. It was all covered in broken rock and was very unstable .... When we got up there, they had already moved him and already put morphine into him."

The group, he said, was in a "controlled panic."

"I think we were thinking rationally, but we had to stop a lot and regroup," Feinbloom said. "We had to do a lot of problem solving."

Loescher was perhaps the only one of the rescuers who realized exactly how much problem solving those in the group needed to do.

They fashioned a litter out of the table, using short straps tied around it for handles and longer straps to secure Houghton firmly to the top. Loescher tied the head of the table to the longest ropes and then set up an anchor point on the rock with pitons and anchor straps attached to the wall in cracks. A juniper tree was used as a belaying post. But when the time came to unclip Houghton from his anchor rope and begin the descent, Loescher began to worry.

"I had seen people lose control of rescue sleds in similar steepness and I knew if we lost our grip, he would go tumbling down the slope," Loescher said. "I said to them if we lose control and he goes down this slope on the table, it could kill him."

The group strapped Houghton to the table, then lifted it about a foot off the ground. Loescher slowly played out the line while the others inched down the steep rock pile. The belaying rope was only 150 feet long. When it played out, the rescuers had to stop, tie the litter to bushes and trees to keep it from getting loose and then set up a new anchor point and belay system farther down the slope.

It was nearly three hours from the time Houghton fell from the cliff until the rescuers reached the bottom of the talus. But their journey was not done. They still had to negotiate the rough terrain back to their base camp. The effort took a toll not only on the rescuers, but on Houghton.

"Basically, his pelvis was crushed," Feinbloom said. "All his muscles were contracting from his leg back. He was in exquisite pain."

The hike to camp took two more hours, and by the time the group made it back, it was 3 in the afternoon. An early rescue was becoming ever more unlikely. Several times during the return trip, the rescuers had spotted private airplanes flying over the canyon. A couple of the rescuers had signal mirrors with them and had tried to flash distress signals. But no pilot gave any indication they had been noticed.

Options explored

The group sat down to plan rescue options. Someone suggested lashing Houghton's litter to one of the rafts and taking him down the river. Houghton quickly vetoed that idea.

"There were three issues," Houghton said. "If I were strapped on a boat and it flipped, it would probably be a life-ending event. The next thing is we were probably still two days out by boat and my injury was still an unknown. All they knew was I couldn't move my leg and I couldn't get up. If it was a pelvic injury, it was life-threatening.

"The other issue was pain.... I had woefully miscalculated on morphine injections for multiple days. We were already running very low, and being two days out by boat would have been pretty uncomfortable."

Loescher again argued that he should take a raft and leave immediately. But Houghton vetoed that idea as well. Green River, the nearest town, was all the way through Desolation Canyon and Gray Canyon, a second downriver wilderness area.

"He said it was too late in the day." Loescher recalled. "There were a lot of Class IV rapids and to raft this stretch of river by nightfall would have been potentially lethal."

The group agreed to wait. If no help came along -- either a plane that would notice the party's signals or a ranger with a radio -- then Loescher, Feinbloom and Colon would set out in a raft at first light and try to make it to a phone.

All that day, it had been sunny and calm. But the weather shifted after sundown and turned cold, windy and stormy. Houghton dozed fitfully on his side in a tent as his students and co-leaders took two-hour shifts sitting up with him and monitoring him for signs of decompensation, or serious physical deterioration. The wind picked up and blew sand ever harder against the fabric of their tents.

"It was a very uneasy and restless night," Loescher said. "He was dozing and intermittently crying out for help. He was in a lot of pain. I don't think any of us got much sleep. We were all sort of listening for him."

At first light, Loescher, Feinbloom and Colon set off. The wind blew up through the canyon at gale force. The men paddled in 20-minute shifts and steered for the center of the channel to make the best speed. The three paddled for six hours, finally coming across a group of kayakers who had put in from a jeep road 10 miles upstream from the normal takeout point, where the group had left transportation.

Big'X'

Two of the kayakers offered Loescher a lift into Green River, while the others agreed to notify local authorities. Feinbloom and Colon continued down the river. In the meantime, those who had remained behind with Houghton used stones to create a big "X" to mark off a helicopter landing area and built a wind sock to signal wind direction.

About noon, a member of the group who had gone up to watch for approaching traffic flagged down a party of rangers working down the river on patrol. Not far behind the rangers was someone coming down on a "J-rig" pontoon boat with a stable deck and a small outboard motor.

"The wind in the canyon really started howling." Houghton said. "It can be blowing so strong that you can be rowing down river and it will blow you back up."

The rangers convinced the group that no helicopter would risk flying into the canyon with such dangerous winds. Houghton was looking at the prospect of spending another day stranded at the camp with no pain medication and no certainty of rescue.

The group hailed the pontoon boat. The owner agreed to take Houghton down the river, saying they could be at the takeout point by sundown. Reluctantly, Houghton agreed to allow himself to be tied onto the boat. The group struck camp and set forth in the belief help was not coming.

The cavalcade made good progress until the motor was jarred off the boat in a stretch of rapids. The owner retrieved the motor, reattached it and, after some prodding, got it going again. But in an even rougher section of the river, the motor went overboard a second time The pontoon boat had no oars, and without the motor the boat became a freewheeling, gyrating platform buffeted and whirled along the rolling water like a leaf in a storm drain.

"The second time it happened, we were in the middle of the rapids," Houghton said. "We had no motor: we were adrift with no oars; we were close to the hydraulics…. It was just not at all encouraging."

Downriver, Loescher, riding in the kayakers' pickup truck, was startled to see the sheriff's patrol car and an ambulance, lights and sirens of full, bounce past, headed toward the end of the river road where he had picked up his ride. He realized, he said, that the kayakers back on the river had somehow managed to call for help. He also realized that they had mixed up the message. The sherrif and ambulance were going to the wrong place. The kayakers took Loescher into Green River and dropped him off around 1 that afternoon in front of a pharmacy with a public telephone.

"I called the ranger station, but I got no answer because it was a Sunday," he said. "I called the hospital at Salt Lake City. I called the sheriff. I called the local police."

The University Hospital AirMed helicopter ambulance service agreed to fly to Green River from Salt Lake, nearly 150 miles away, pick Loescher up, and then return upriver to rescue Houghton.

The sheriff

Shortly after Loescher made the call, the sheriff who had passed him with the ambulance drove back into town, found him and confronted him about the mixup.

When told that a helicopter was on the way from Salt Lake City, the sheriff snapped back: "No helicopter takes off unless I give the OK." The sheriff called the AirMed service and canceled the call.

After a while he called another helicopter service, based at Grand Junction, Colo. The Grand Junction crew agreed to pick up Houghton, but refused to stop in Green River to pick up Loescher.

"I told him, 'You really screwed things up,' " Loescher said. "Now I've got 10 students up river who don't know anything about rafting. I have to get back up the river."

"About 10 minutes later, the dispatcher calls back," Loescher said. "He doesn't know what's happening and said Salt Lake City was coming."

At that point, the dispatcher canceled the Grand Junction flight. Less than an hour later, the white and blue Bell 222 AirMed copter landed in a parking lot in the middle of Green River, picked up Loescher and took off for Desolation Canyon.

Flight nurse Sherri Stringham and paramedic Thomas Roberson helped Loescher get settled while pilot John E. Wilson turned the helicopter north. Wilson, a retired helicopter pilot who flew military missions from the Vietnam era to the Gulf War, seemed eager to fly into the canyon.

"The winds were kind of ugly that day," Wilson said. "the winds were high, and that's one of the reasons they (Grand Junction) refused to fly. The other reason was their configuration. They refused to take the guide who had flowed down the river back up the river to where they were. Heck, I said, sure, I'd be more than happy to take you."

Loescher directed Wilson to the camp where he had left his companions that morning, only to find it deserted. "I was absolutely astounded they weren't there," Loeschier said. "We found no people at the landing, no rafts, no tents. I had no idea where they were. The only thing I could think of was that he decompensated and they took him out."

Wilson headed down into the can yon to begin a low-level search.

Like a movie

"He got right down on the canyon and pulled a U turn," Loescher said. "He pulled absolutely on a dime. I looke out the window and the water was right there. Then he got right down on the water and started down the canyon, banking the turns. It was like 'Apocalypse Now.'"

The winds churning off the rocks buffeted and rocked the helicopter as Wilson flew above the river channel between the canyon walls.

"The ride was really rough," Loescher said. "You would come around a corner and get hit with the winds and the helicopter would be like a little mosquito blowing in the breeze."

Wilson admitted the flight was rough. But it wasn't the most difficult flying he had done, he said.

"Obviously, we fly with safety first in mind," he said. "That's what everything is based around." Sometimes, he said, it becomes necessary to make a "phenomenal effort due to conditions."

"To me, it wasn't a risk," he said. "Maybe to the passengers it was a pretty wild ride."

Wilson found the raft about six miles down river. He flew low over it, then picked what he believed was an accessible beach area and set the helicopter down. The raft hove to and landed, and the AirMed crew transferred Houghton to the helicopter for the ride to Salt Lake City.

Wilson said it was just one, of many rescues he has made from the canyon. "You just have to have experience flying in it," he said.

"You have to know what's going to take place. Basically, you are flying 30 seconds ahead of the helicopter with anticipation."

Houghton underwent seven hours of orthopedic surgery at University Hospital in Salt Lake city. His hip sustained more than 20 major fractures. Since the accident, he has been on leave from his partnership with the James A. Faust M.D. Inc. group practice in Gardner. He now gets around with the aid of crutches and is working on building enough strength to begin using his leg again.

Houghton's wilderness medicine course is the only one of its kind in the country, and he wants to be well enough to lead another group next spring. Whether he will be able to do that remains an open question.

After the UMass Medical School graduation in June, the river party had a reunion at Houghton's home.

"We showed all our slides and had a chance to talk and touch base with each other," Houghton said. Later, member of the group scattered to their new jobs as interns or residents.

Houghton calls his companions heroes, saying he was grateful for every moment of their personal concern and gentle handling. The experience, he said, was more than just a study course for the students.

"They had truly become real doctors now," he said. "Ones I will never forget."