From Physician to Patient

For Diane Ruschke, an emergency physician at Jordan Valley Hospital in West Jordan, UT, the 4th of July holiday in 2003 started off as an exciting weekend hiking with friends in Little Cottonwood Canyon in Utah. But halfway through the holiday, the doctor who was used to being in charge suddenly became the patient in a freak accident that left her seriously injured on the side of rugged Pfeifferhorn Mountain.

"This is a very popular hike that takes you up past an alpine lake to an area with VW-sized boulders in a really steep climb and a pretty minimal footpath," Ruschke recalls. "I was already coming down, and there were a couple of kids--probably in their teens--going up and, being inexperienced and not knowing what they were doing, they were kicking off a lot of loose rock."

Suddenly, without warning, a rock the size of a bowling ball came bouncing down the hill and landed at Ruschke's feet.

"As it landed, the rock bounced up and hit me in the upper left quadrant, richocheted off my shoulder and kept going," she says. "It didn't even knock me to the ground, but it took my breath away, and I remember thinking, 'I have to sit down; I can't breathe.' The place it happened was steep and irregular, and I had to hike down a couple more feet to some loose rock to sit down. I knew my chest hurt, but other than that, I thought I was fine. My friend saw the rock hit me and instantly dialed 9-1-1, because she was sure from the impact alone there would be something really bad wrong with me. When she reached me, I told her I thought I was fine; I just needed to sit for a few minutes. But after 5 minutes, when I tried to stand, I passed out and couldn't stay conscious. I passed out multiple times in a row, and that's when I decided I wasn't OK and told them I thought I needed a helicopter."

Actually getting a helicopter to respond should have been easier than it turned out to be. Because it was a holiday weekend, the helicopter service had already responded to multiple calls to rescue people out of the canyon, none of whom required transport to the hospital, says Ruschke.

"When we called 9-1-1 and told them I thought I was probably pretty seriously injured and needed a helicopter, they said they would send a rescue team. We made it very clear where we were and how difficult it was to get there, and we were definitely led to believe they were going to send a helicopter. Hours later the helicopter hadn't come. I was starting to get more demanding and telling them how critically I thought I was injured, so they said they would send a ground crew from below to evaluate me first. Unknown to us, because of all the previous calls with no transport, they had made the decision they would no longer dispatch the helicopter until a ground crew reached the person and made an assessment, which significantly complicated things.

"At that point, I wasn't very coherent anymore," Ruschke says, "and I told my girlfriend, 'You need to tell them I'm critically injured. I think I've ruptured my spleen, I have a belly full of blood, and I know my BP isn't over 70. I don't have palpable radial pulses anymore, and if they don't send a helicopter, I'm not going to come off this mountain.'"

The dispatcher's reply was not what they wanted to hear. "Where exactly are you?"

It became apparent, says Ruschke, they had no idea where she was, and they were trying to send a ground crew up.

"We had given them very clear instructions with respect to where we were on the mountain," she says, "but we knew it would take a really good hiker not carrying any kind of equipment at least three hours to reach us and another three to carry me out. At that point, they decided to try to long-line someone down to me, and that's what they ended up doing. I remember when the helicopter finally came around the first time, as he passed over us, I had such an intense feeling of relief that I was really going to get out of there."

Even that turned out to be more difficult than they anticipated. Because of the windy conditions and rough terrain, the paramedic was dropped off at a point that was about a 45-minute hike down the mountain, so some of the bystanders who had gathered to see what was going to happen ran down to help him carry the litter and medical equipment.

"When the paramedic arrived, he started an IV on me and I asked if he had any morphine in his bag," Ruschke says. "I remember him saying, 'Yeah, I have morphine in that bag, but you should know better than anybody that I won't be able to give you any.'

"I was coherent enough to tell him what I thought my injuries were. Then he wanted to c-spine me and I tried to talk him out of it, but he insisted. As soon as he c-spined me, put on the collar and tried to lay me flat on the board, I completely decompensated. I was clearly hypoxic or hypotensive, and I started screaming, thrashing and yelling for him to take off the collar, so I obviously wasn't fully with it. As soon as he took off the collar and let me get my chest up a bit, I was calm again. Then, they decided to wrap me up in a big air splint, but as soon as they inflated it and tried to lift me up, I became agitated again and couldn't breathe, so they let the air out and repositioned me. There was a whole discussion about whether they should try to medevac me in a sitting sling, but at that point, I couldn't even raise my head. Just the exertion of trying to reposition myself made me completely lose consciousness, so I told them I didn't think I could sit upright. They finally repositioned me with my non-crushed side down and my left side up, then re-inflated the splint and manually picked me up, and I told them I could manage that."

Finally, Ruschke was ready to be airlifted out of the canyon and flown to the road below. At that point, her condition had deteriorated to the point where she doesn't remember the helicopter returning, even though it must have made a lot of noise.

"The next thing I remember, I was in the air," she says. "I opened my eyes, and the paramedic said, 'Oh, you're with us again.' I remember this intense euphoria and a really warm feeling. I remember looking at the sky and marveling at how blue it was and how peaceful and quiet, even though I was circling under a helicopter. It doesn't make any sense at all."

Landing on the road in the basket was extremely painful, says Ruschke, but then the helicopter landed and she was loaded in and flown to the University Hospital in Salt Lake City. Ruschke's assessment of her condition was spot on. "I ended up losing my spleen; I avulsed my renal artery, so I lost a kidney; I infarcted the tail of my pancreas, so I had two months of pancreatitis; and I had a bunch of fractured ribs and a broken finger," she says. Pancreatitis kept her in the hospital for 10 days, but she was back at work in the ED by the second week of September.

When asked about the EMS response, she has high praise for her rescuers. "I'm so grateful the paramedics came for me," she says. "There were some things that didn't go the way they should have, but in the end, they came for me. It was very windy, and I know the pilot had to make multiple passes because he couldn't get close enough, so it was a big deal. Bottom line, they came and got me off the side of the mountain, and that's all that matters."

And how about her attitude in the ED? "On the one hand, it made me more empathetic to patients," she says, "but, on the other hand, it also made me a lot more critical. If a patient comes into the emergency room carrying on and there isn't much going on with him, it made me more willing to say, 'Buck up. I am not even remotely sympathetic for you.' It's a mixed bag I guess."