Headed for trouble: a cautionary tale
December 20, 2006
Aspen, CO ColoradoASPEN I’m sliding into a CAT scan machine and my mind is racing.There is sharp pain in my neck and back. My head is throbbing. I’ve been immobilized on a backboard for more than an hour and I’m wearing a stiff neck restraint. I can wiggle my toes – which is good – and I’m coming out of the fog from the accident, but I’m scared. The doctor says they won’t know what, if anything, is wrong with me until the film comes back.I’m praying.I’m mulling scenarios: What if it’s bad? What if I have brain damage? What if my neck is broken?
I’m angry: How did this happen? Couldn’t I just have a “do-over” of the morning? What will I tell Mom?I remember hurtling down the Dallas Freeway, a wide intermediate trail on the Big Burn at Snowmass. It was only my second time down that run, and I was just laying my skis over and making Mach 10, super-G turns on the freshly groomed corduroy. Maybe trying to impress my friends. Hardly a soul was on the hill, and it was a bright, sunny Sunday.Then it happened.I rounded the top of a knoll, my skis went out from under me, I flew through the air, and landed like a cracking whip: hip, back, neck and head in one snapping motion and I went out cold. Everything after that is fuzzy.I remember my friends collecting my things for me. The fanny pack with my lunch was torn to bits – the food scattered about. I put on my skis and made it to the bottom of the run, my lunch in my hand, and my friend said I skied just fine all the way down. But it was all like a dream sequence in soft focus.I even started skiing toward the lift to take another run, but my friend called me over to the Ullrhof Lodge. Sitting down inside, I said, “I don’t feel so good,” before my eyes rolled back in my head. They told me later that I started to convulse.The first patroller to arrive stabilized my neck, put me on the floor and talked to me. But it’s all fuzzy. The oxygen helped, but I was still completely out of it.More ski patrollers seemed to appear out of the woodwork.”What day is it?” they asked.No clue.”What did you have for breakfast?”What a nasty quiz! I have no idea.”We’re taking you down in the sled,” they said.
The first question everyone asks, of course: “Were you wearing a helmet?”The Dec. 31, 1997, death of Michael Kennedy on the slopes of Aspen marked the beginning of a shift in thinking about helmets on the slopes, said Dr. Bill Rodman, head of the trauma department at Aspen Valley Hospital. Before then, most skiers put nothing but a knit cap between their heads and the open air.Kennedy, nephew of former President John F. Kennedy, died when he hit a tree while playing a game of football on skis. And just a few days later, Jan. 5, 1998, entertainer and politician Sonny Bono died in a similar accident at Heavenly Valley, a resort in California and Nevada.I’ve been skiing since the age of 4. And while I don’t huck cliffs or catch much air, I do shred. Steeps, trees, whatever. I know all the kids wear helmets these days, but helmets are just that – for kids, right? And for people who do ridiculous things. I can just “be aware and ski with care,” I thought.
“Would you drop your laptop from 6 feet up?” Rodman asked. That’s what it’s like having a fall without a helmet. “And the brain is more important than a laptop.””Get a helmet that fits and wear it properly,” Rodman said. He’s seen firsthand the effects of many ski accidents in the valley and said that, while helmets do not prevent brain injury, they do decrease the severity.The brain is like a head of cauliflower covered in Saran Wrap inside a paper bag in a cardboard box, Rodman said. And when you hurl that box against something hard those fragile layers give way and the damage spells the future for a head-injury patient. A helmet softens impact and diffuses force, Rodman said.”We’re seeing fewer injuries in the last couple of years because people are wearing helmets,” Rodman said. There were 269 head-injury visits to the AVH emergency room in 2004, and 252 in 2005. There were two skiing deaths in those years – both skiers were not wearing helmets.”Most of your other organs you injure can recover well,” said Sandra Morris, trauma director at AVH. “But once you seriously injure your brain, it never recovers 100 percent.”Morris leads the Roaring Fork Valley school-safety program, a cooperative effort between Aspen Skiing Company, Sunlight Mountain Resort, Aspen Valley Ski & Snowboard Club and Aspen Valley Hospital to inform young people about safety awareness and etiquette on the slopes.She visited 15 area schools this fall and handed out helmets for skiing and cycling from Aspen to Rifle.The safty program’s slogan is “Preride, Reride and Freeride” and teaches riders and skiers to weigh all options before attempting dangerous tricks. “Preriding” is about going down a terrain park or ski run to scope out the situation. “Reriding” is going back through a second time to figure out your tricks. And “Freeriding” is just going out and doing it. In the future, some terrain parks might require a special pass to prove that skiers and boarders have passed a rudimentary training before they enter, she said.”Wear a helmet. Ski in control. And don’t ski beyond your ability without instruction,” Morris warned.But Morris said that most local kids do wear helmets. It’s the skiers and boarders between 20 to 50 who won’t give up their knit caps.In a study of records since last January at AVH, Morris found that all of the student-aged skiers and snowboarders admitted to the hospital were wearing helmets at the time of their accidents. Only the older folks – like me – left their brain uncovered.”The best skiers think it can’t happen to them, but it’s just a matter of catching an edge or landing a jump wrong,” she said, and many skiers and snowboarders don’t consider variable snow conditions.”Everybody thinks it can’t happen to them,” she said.
On Dec. 23, 2003 life changed for then 17-year-old Bobby Layman of Silt. An outdoorsman, varsity soccer player and extreme skier, Bobby did a 360-degree trick off a 25-foot tabletop at Snowmass on the last run of the day and crashed. He suffered a traumatic brain injury. After he was resuscitated at Aspen Valley Hospital, he spent six months in hospitals across the state.”A helmet saved my life,” Bobby said. “Let it do the same for you.”He had to relearn how to do everything – how to eat, walk and talk. His speech is slower today, and he has a hitch in his gait, he said, but Bobby was back on the slopes just 11 months after his accident, and still rips it up with members of Challenge Aspen. He skied Highland Bowl last year and plans to do it again this year. Bobby does a lot of the activities he used to, just in a different way – he rides horses and a recumbent bicycle, rock-climbs and plays soccer with members of the disabled Olympic soccer team members. But one of Bobby’s main missions is getting the word out about head injuries.”You can have fun and go big. You’ve just got to know how to do it,” he said. “Take the time and research it.”He travels to schools with Morris and shares his experience.”I hope to just get the word out on my whole experience, just to help educate people before they try something stupid,” Bobby said on the third anniversary of his crash. “I just thank God and my parents and family and friends for being there for me.”
The ceiling of Aspen Valley hospital is hung with cheap, plastic garland and shiny Christmas ornaments. It seems an absurd joke, and what with being strapped down so tight, I can’t look away – can’t change the channel.The hospital staff is friendly, but it’s the same question over and over: “No helmet, eh?”I ask over and over what’s going on or if they know anything. A nurse offers me an Adavan for anxiety – no thanks, I just want to know what’s going on. There is nothing to do but sit still and wait for the results.Dr. Rodman said in a later interview that there are a number of scenarios for head-injury patients. Depending on which layer is damaged, there can be internal bleeding inside the skull but above the gray matter of the brain that applies pressure and forces the brain to squeeze out the base of the skull. This requires immediate attention – within 6 hours – and relief comes in the form of a surgery to remove the trapped blood and control the bleeding.In other types of injuries, a shunt may be used to remove some of the cerebral spinal fluid to decrease the pressure.And injuries to the deeper layers of the brain can worsen over time and cause problems weeks later and require invasive surgery.
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Standard concussions are essentially a bruise to the brain, often both front and back and with varying degrees of severity – requiring ongoing observation.Rodman pointed out areas on the brain that handle motor skills and speech. They don’t stand out as special organs, just areas on the edge of the brain where, if hit, you lose capacity.And brain injuries are “additive,” Rodman said. The more you have, the worse they get, and the same trauma can cause worse problems with successive events.”The head is a big ball on top of a short stick,” Rodman reminded me, adding that at least 15 percent of head injuries are associated with neck injuries. Damage to the C-spine, or upper vertebrae where the head swivels, can cause major limitations.But I know none of this as I lie rigid in a hospital bed and stare at the ridiculous decorations. I only know that I don’t know.Until word comes. The nurse says the CAT scan is good. No bleeding in the head. No injury to my upper vertebrae.They have to redo one of the back X-rays, but that just means a few more minutes of waiting, a few more checks from the docs, before they release me from the neck brace and backboard. I sit up in bed, sore and shaky, but OK.Next I’m standing, signing paperwork and walking into the waiting room in my ski boots to meet my three patient friends. We’ll be all smiles and stories on the ride home, but it’s surreal nonetheless.I’m so glad to be alive – grateful to be whole, with just a concussion and whiplash. A week of headache and a sore back are a small price to pay for my lapse in judgment, a lapse that has cost others so much.I’m back on the slopes today, but I wear a helmet, and I take it slow.
Sunny, one of the friendly volunteers at the hospital saw me stand up and leave that day. She said it didn’t look so good when I came in, and that many in my condition don’t come away as well as I did.”You go home and count your lucky stars today,” she said.I am.Charles Agar’s e-mail address is firstname.lastname@example.org.