The Whistler Health Care Centre has seen more than its share of trauma over the last 20 years, adapting to the changing trends in the resort — the rise of snowboarding, the explosion of mountain biking, and more recently, the growth of summer festivals and events. In the last fiscal year it treated 18,500 patients with an urgent care budget of $1.7 million — not including doctor's salaries. That budget relies on out-of-province patients for roughly 20 per cent of its funds; if those numbers are down, the centre runs at a deficit. Roughly 70 per cent of the activity seen by the doctors and nurses at the Whistler centre is "walking wounded" — semi-urgent or non-urgent patients. The remaining 30 per cent are acute.
As the centre marks 20 years in operations Pique looks back over the years, at a facility that remains incomparably distinct in how it operates, what it deals with, and how it negotiates through the system. There are no other facilities like it in B.C.
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Lying on the side of Whistler Mountain, the wreckage of the Quicksilver Chair around him, Michael Negraeff realized how easy it would be to die, to just fade away forever.
He was alone, and so cold.
And he couldn't feel his legs.
There was a brief moment of clarity, when deep tunnel vision narrowed his focus and blackness threatened on the edge of the light.
He thought: "Oh my God, that's how you die. You just go to sleep and it's over and you don't wake up again.
"I thought I was going to be gone and I just realized how easy it is to just slip off, and that's it."
He did everything he could to stay awake. But it was futile. He drifted in and out as a massive rescue operation unfolded up and down the mountain.
A woman appeared in a blue jacket — help from Whistler Mountain, he wondered. She stayed with him; as the blood filled up his broken body, and that insidious cold crept over him, stealthily stealing his will to live.
He had just fallen from the sky — a fractured face, ribs, a broken back.
High up there, riding that chairlift, the whole world was at his feet, a 25-year-old doctor, intent on eking the most out of Whistler over his Christmas break before buckling down to finish off his third year as an anesthesiology resident.
It felt like five minutes had passed when he heard the steady heartbeat of the helicopter coming for him in the fading light.
Help was coming to take him on the brief ride to the Whistler Health Care Centre, which was dealing with the biggest crisis in its history.
There, says Negraeff simply, they saved his life.
"After they saved my life, stabilized me... I was flown down to Vancouver," he says.
As they do with all urgent care patients, Whistler's doctors and nurses sent him on his way, uncertain what the future would hold for the young doctor who just wanted to ski one more run that day.
As it marks its 20 years in operation this month, that day in 1995 stands apart from all the rest.
Quicksilver: All hands on deck
Head nurse Janet Hamer remembers that day — Dec. 23, 1995; she was working at the centre.
The call came in, that call that every nurse and doctor dreads — mass casualties on the way. It was just after 3 p.m. and the lack of snow that year meant that people were downloading the Quicksilver Chair to the Creekside base.
Rough calculations at the centre, in the absence of knowledge, meant potentially hundreds were on the way.
"Part of the problem was that we didn't know how many people we were going to get," recalls Hamer from the nursing office at the centre. "We just heard that the chairlift fell down."
As the patients streamed in, so too did the people who could help them. The town's doctors and nurses were called in, visiting physicians and emergency personnel showed up en masse to offer their services.
Ten casualties in total, more than the small centre had ever coped with at one time before.
"Basically, every patient had a doctor and a nurse," remembers Hamer. "It was incredible, the way it unfolded."
Negraeff found out later that he flat lined after he was intubated at the centre. An anesthesiologist from Mount Saint Joseph Hospital, Dr. Mark Elliott, who had been skiing that day, was waiting in the wings to offer help. The doctor later told him that he stepped in to help the dying young skier with epinephrine, or adrenaline.
It was all hands on deck.
Then the information began to unfold too.
One chair had started a chain reaction, sliding down the line. Four chairs fell to the ground, around the area above Coaches Corner on the Dave Murray Downhill.
Negraeff's chair fell more than 12 metres, onto trees and rocks, some chairs fell as much as 23 metres.
Despite best efforts Trevor MacDonald, 25, of Vancouver was pronounced dead.
All others were transported out.
By 11:30 p.m. it was all over; the doctors and nurses closed the centre's doors for the night.
"It wasn't that long, but it felt like it was about 2,000 hours," says Hamer.
For the first time the centre's disaster plan had been put into effect.
"Although we had quite a good disaster plan, it could be better and we paid attention to what happened that day and I think we're pretty prepared for what can happen," says Hamer.
They learned that people need to be in designated roles more so than they were; someone has to screen volunteers, someone has to deal with the reporters.
The disaster plan has not been activated since.
Frontier medicine goes state of the art
A snapshot of Whistler's health history, painstakingly complied in two large scrapbooks in the nursing office, shed some light on the glue that has kept visitors and locals intact these years.
While the facilities have played their role — first the rudimentary trailers, then the basement of municipal hall, then finally the Whistler Health Care Centre as it stands today — it's the people who have really made the difference, fixing weary travellers who have ruined their holidays, helping local families get well.
Since 2007 the centre has maintained very high ratings in the patient satisfaction scores.
"They're always rating it between very good to excellent care," says Laurie Leith operations director coastal for Vancouver Coastal Health (VCH), the province's largest health authority of which Whistler is a part.
Overall, she says VCH has very good results.
"But I think the amount of years that Whistler has sustained those kinds of results is probably unique to them," she adds.
It goes to show that the little centre punches above its weight time and again.
Tucked within those old scrapbooks, holding tight to Whistler's past, there is a name that appears time and again, in pretty handwritten thank-you notes, in typed foolscap letters, the lines laced in sincerity and gratitude.
Over and over they begin: "Dear Dr. Burgess, Thank you for..."
He seems almost surprised about that as he leans back in his chair at the Whistler Medical Clinic, above the emergency department.
It used to be that Dr. Rob Burgess was the only game in town; now, he's one of many.
He came in 1978 to be the on-mountain doctor on Whistler, sidetracked from a trip to Nepal with the promise of powder.
"Well, if I take this job, will I get to ski a lot?" asked the young doctor, just a few years out of med school, in his job interview.
Roger McCarthy, now Whistler councillor, then Whistler manager of safety and lift operations, told him: "Only the steepest and the deepest."
Sold.
"So, I came for one season and I never left," shrugs Burgess.
The more he thinks back on his early days as the town doctor, the more the stories of the past begin to surface — delivering a baby in the back of an ambulance at Black Tusk 28 years ago, responding to a murder scene before the police had arrived, treating a certain Prime Minister's son in his doctor's trailer.
Whistler's James Herriot — the life of a small town ski doctor.
He remembers a desperate call for help on the top of the mountain one afternoon; there was no on-mountain doctor available, so a helicopter came to his office and whisked him to the peak to deal with a woman stuck in the trees with two broken legs.
Burgess soon found himself in waist-deep powder... in his office shoes and slacks.
He waded through the snow to his patient, administered some morphine, loaded her onto the stretcher and began carrying her out.
"Then the helicopter almost crashed... but that's another story," he tempts, the promise of tales to come hanging in the air.
Those were the halcyon early days — days when nobody gave a second thought that the new on-mountain doctor was skiing around with avalanche bombs in his coat pocket en route to blow up slopes.
Days when it seemed only natural that the doctor himself would come out of his trailer to steer people clear of a landing helicopter.
Against that backdrop, however, Whistler was getting more and more sophisticated.
From the four-metre trailer in 1982, the health centre then moved to the 372-sqaure metre space at the basement of municipal hall.
A newspaper clipping in the scrapbook from April 1993, tells the story of a small facility bursting at the seams, seeing some 13,000 people a year.
"Because of the lack of space and beds, people are often required to wait on mattresses laid on the floors or be treated as they sit in chairs," wrote Don Anderson for The Question.
"The rest of the building is made up of a mishmash of small, crowded offices and hallways. Staff are often doubled up in offices and the lunch room has been transformed into a meeting room, medical records and supply room, coat closet and quiet area for bereaving relatives and friends."
It was time for a new home. In 1994, at a cost of $5.5 million, the new Whistler Health Care Centre was coming just in time.
"It was wonderful to finally get a facility that was permanent and state of the art... at that time," said Burgess.
Just in time for a disaster on the mountain.
Acute trauma up
Broken bones and orthopedic work continue to be the bulk of Whistler's business — more than 40 per cent.
Trauma cases, however, are now more frequent and more severe than they were 20 years ago. The stats are hard to come by, but anecdotally, the doctors and nurses see the changes on the ground.
"The other big change that's happened here is we see things of a higher acuity," says Hamer. "We don't have the little things to balance us out as much."
Hamer points to two snowboarders that came in a couple of weeks ago — one with a splenic injury, one with a renal tear. In other words, one laceration to the spleen, the other a tear in the kidney.
"These people are really sick," says Hamer.
Nothing can be done for them in Whistler — they're stabilized, given blood, some analgesia, and then they wait to get transferred out likely heading into surgery in the city.
"They're all reasonably young," says Hamer of those with injuries like the torn kidney, "which is why they live."
That particular day, both snowboarders were taken to Vancouver via ambulance because a snowstorm kept helicopters grounded.
"So then we lose a nurse because a nurse has to go with them to administer the blood and the medications," says Hamer.
It's another factor to add to the complication of the never-ending stream of patients going up and down the highway, leaving Whistler not only without a nurse in some cases, but also without an extra ambulance.
As for those snowboarders — Whistler usually calls down to the city to follow up on their patients — at least one went into surgery.
The nurses and doctors have seen it all before — they were quickly diagnosed with the portable ultrasound machine and prepped for transfer.
"We're so much better at what we do now," adds Hamer. "We are so much better with managing specific injuries — femur fractures, tib/fib fractures, better drugs, better procedures."
WHCC — Still a Square Peg in a Round Hole
While the building itself may be showing some signs of its age on it's 20th anniversary, inside, the facility has adapted adeptly with the fast-moving times, arguably still state of the art in the health-care delivery that Whistler specializes in.
Dr. Bruce Mohr first arrived in 1996; he's seen the changes first hand. Additions like the trauma stretcher, the portable x-ray machine, the CT scanner, the Bier Block — all making Whistler better in its particular brand of health care. Those things, and a host of others, have been paid for by the Whistler Blackcomb Foundation, the American Friends of Whistler, and the Whistler Health Care Foundation — the community opening up its hands and its wallets.
"I think we provide a great level of service and we're well-equipped to deal with the things that we have to see," he says.
In the background, however, away from patient eyes, some of the biggest changes to Whistler's health care system came with regionalization in 2001 when the province was streamlined from 52 health authorities into five regional health authorities. Whistler went from a small Sea to Sky community health council to part of Vancouver Coastal Health (VCH), an organization serving 25 per cent of B.C.'s population, some one million people including residents in Vancouver, Richmond and the North Shore.
That authority deals with more than 356,000 people in emergency departments; Whistler accounted for about 18,500 of those last year.
"We went from being a middle cog in a slightly bigger wheel, to a small cog in a very big wheel with a huge budget, and lots of costs and considerations and yet we're still a round peg that doesn't fit in a square hole," says Mohr. "We're just a rural facility that has a bigger impact than its size would indicate on the care needs of Vancouver Coastal Health.
"There's no other town in B.C. the size of 10,000 that would see as much trauma as we do."
Growing pressures on Whistler health care
Like all Whistlerites, the emergency room doctors and nurses at the resort's only urgent-care facility, brace for the busy weeks — the Christmas holidays, March break, long weekends over the summer.
Staffing levels ebb and flow according to the time of year, the way things have always been done in Whistler.
But times are changing, never more so than they have in about the last year.
There is a renewed resort focus on attracting major festivals and events to town, and last summer was testament to that with its back-to-back non-stop action, kicking off with Tough Mudder, then followed by the Vancouver Symphony Orchestra, Wanderlust, Ironman, Crankworx, and GranFondo, to name some highlights. And all against the backdrop of non-stop sunshine.
Whistler was heaving, basking in the summer of all summers — as it turned out, one for the record books. Business was booming, hotels were hopping, visitors were feeling the vibe — something was always happening in Whistler.
The Whistler Health Care Centre, however, was struggling to cope (see related story on page 12.)
"We've always had triathlons here, but now we've taken it to another level (the Ironman)," says Hamer. We've always had bike races, but now we have GranFondo.
"Whereas before we could flux with the events, now we can't. We don't have the budget; I don't have the budget."
She even tried to reduce a shift this winter, leaving her with an extra shift for the coming summer.
"It lasted three days and then I had to put the shift back on," she says, giving a rueful smile. "We didn't have the tolerance for it."
Typically the centre slows down in January for a quiet period after Christmas.
"It didn't happen this year," she adds. "We barrelled right through January with super high numbers."
This building pressure has the full attention of health administrators in Vancouver Coastal Health (VCH).
Managing the health fallout from these events has become a top priority this year.
The problem is, there are no models to copy, no footsteps to follow, says Leith, at VCH. This is new territory, unique in many respects to the Sea to Sky corridor where small rural facilities are dealing with mass events, often sporting events, and in Whistler's case, mass events that come over and over again. There is no time to catch a breath.
The goal for 2014, set from above at VCH, is to improve communication with event producers, review medical plans with the corridor's plan, see how they jive, and if they don't, go back to the drawing board, all with a focus on dealing with what's called "surge capacity."
"That's where our focus is this year, just knowing the enormity of the events that are coming," says Leith. "That's kind of our priority."
Framing all these discussions is the elephant in the room: who's going to pick up the tab for these increased costs in health care?
The Next 20 Years?
Amid the politics of local health, the balancing of ever-stretching budgets, the moments of crisis, there are the simple small-town concerns of the ER, peppering daily care.
The ear infections, the cuts from kitchen knives, the scraps and sprains, the little miracles that come once or twice a year when the babies arrive faster than planned.
And then there are those miracles in which the Whistler Health Care Centre sets the stage and the drama plays out in Vancouver.
Negraeff almost lost his life in Whistler after the Quicksilver accident, and his life was saved here too.
When he woke up at Vancouver General Hospital days later he was paralyzed.
He went on to finish his training as an anesthesiologist, he married his girlfriend, had two kids.
He is now a pain medicine specialist at Vancouver General Hospital, taking care of acute and chronic pain in people with spinal cord injuries. He is also chair of the board of Pain BC (see sidebar page 49).
Meanwhile, the little centre in the heart of B.C.'s biggest resort quietly goes about its business of treating patients, and sometimes saving lives.
Whistler's Mayor knows that all too well; the small health centre saved her daughter's life.
In June 2012 Sarah Morden, who was working in Vancouver, developed excruciating back pain. She was twice dismissed from hospital in the city on a Friday, given pain meds and sent on her way.
By Sunday evening, she was delirious with pain.
Wilhelm-Morden remembers saying to her husband:
"'Ted, we've got to bring her up here to be seen by doctors at the clinic because they know her, they know us and we know them.' We were confident that they would get to the bottom of it here in Whistler," recalls the mayor.
Sarah was in the WHCC as soon as the clinic was open on Monday morning and spent three days being monitored and tested here.
By noon on Thursday she was in emergency surgery in Vancouver for what was believed to be a herniated disc.
What they found, however, was a staph infection that had gone into her spine and had attacked her L5/S1 vertebrae and disc.
The infectious disease doctor later said that Sarah had "precious few minutes."
The mayor says: "There's no question in my mind the clinic saved her life." n
Pain BC
Dr. Michael Negraeff is chair of the board of directors for Pain BC Society, a relatively new charity in the province with a mission to move the dial forward to support those suffering from chronic pain.
He knows about that first-hand.
After his accident in Whistler, Negraeff dealt with ongoing pain, travelling to doctors in Seattle in the years after to find ways to manage.
"That's when I got the fire in my belly to change things," he says. "It's still not done by any means, there's still lots to do."
But now there's Pain BC.
One in five British Columbians — 20 per cent of the population in the province — lives with ongoing pain. That number is expected to grow as the population ages.
Chronic pain is not just a biological problem, says Negraeff; it's not just a matter of finding the broken part in the body and fixing it or medicating it, as so often prescribed in western medicine.
"(Pain) is an experience that is modified by your thoughts about it, your beliefs about it, your emotions about it, your social realm that you're in, what do other people think about pain, what are your cultural thoughts about pain," says Negraeff. "It's much more than just a biological problem."
All too often, however, it's treated as such.
"We (humans) are way too complicated, based on what we know so far, to be able to fix pain in that way," he says. "As a result, most people aren't cured of their chronic pain and they bounce around the system... until they finally figure out how to live life with it. There's reason to be optimistic for both better biological treatments for pain relief combined with integrated supports for people trying to live with pain."
Pain BC has three strategies for change:
• educating, promoting skill development, and building hope and confidence among people in pain and their families;
• providing health care providers with the education, tools and skills they need to improve the lives of people in pain;
• facilitating the development and implementation of innovation and improvements in the health care system.
To learn more go to www.painbc.ca.
Whistler's Heli-pad woes continue
Whistler has come a long way from Dr. Rob Burgess' flagging down a helicopter in the heart of the village, and keeping pedestrians at bay, but problems persist.
Twenty years ago, as Whistler readied for the new Whistler Health Care Centre, the community raised the funds for the helipad tucked to the north side of that building.
It went above and beyond, raising more than $1 million for the critical infrastructure. The leftover funds were the genesis for the Whistler Health Care Foundation, which has gone on to raise funds and provide much-needed equipment for the centre for two decades.
For years the helipad went about its business, the essential wheel in the business of moving injured people off the mountains.
Then, a Transport Canada inspection in 2009 revealed a number of changes were needed and the federal agency demanded upgrades to the pad, including mandatory road closures at Blackcomb Way and Lorimer Road while helicopters are landing and taking off.
During the upgrades, the helipad was closed and patients were flown to the municipal helipad 11 minutes north, on a good day, during that time.
Despite the new million-dollar upgrades, single-engine helicopters are no longer allowed to land there, a situation that doesn't sit well with Whistler Search and Rescue, and with the doctors at the centre.
Any delays in getting critical patients to the centre can be life threatening.
During the upgrades, says Dr. Bruce Mohr, he treated two patients with heart attacks on separate occasions.
"The heart attack was more severe than it would have been if they had gotten here quicker," he says.
Lobbying efforts continue.
According to recent VCH statistics, an average of one patient per week has to be transported from the municipal helipad to the Whistler Health Care Centre by ambulance. The centre averages two medical evacuations to hospitals in the Lower Mainland every week using B.C.'s air ambulance service.
Quicksilver fallout
The coroner's report into the Quicksilver accident determined that design problems combined with inadequate checks and balances on the part of the lift manufacturer, the provincial inspection branch, and Whistler Mountain led to the tragedy.
Trevor McDonald was not the only fatality; Vancouver lawyer, James Roche, 50, was airlifted from Whistler to Vancouver and remained in hospital for 12 days recovering from fractured vertebrae and ribs. He was released and collapsed the following day. The autopsy showed he died of a blood clot brought on by the accident.
All lawsuits with the province, the lift manufacturer and Whistler Mountain, were settled out of court and the details were never made public.
Dr. Michael Negraeff was angry, for a while.
"Not enough that it derailed my life," he says.
He travelled to New Zealand to meet that lady in the blue jacket. Her name is Ingrid, an interior designer. That day she was just a tourist skiing down to Creekside; she never left his side while he lay fighting for life on the mountain.
"If there's anything that I really miss or regret about this whole thing... it is being able to get up high in the mountains," he says, adding though that he still comes to Whistler often.
"There's nothing more that I would love to do with my kids and my wife. It was a big thing that drew us together, our love for that."
But, he doesn't dwell on the randomness of the accident that left him paralyzed.
"Things happen. I accepted that right from the beginning. I was in the wrong place at the wrong time."
Still, he remembers meeting his friends at the bottom of the Red Chair that afternoon.
"Let's do one more, c'mon one more," he said to them.
Nobody wanted to go; all of them got on the chairlift and downloaded to Dusty's.
"I went back up Red Chair for one more run and did it by myself... And then I got on the Quicksilver."
The Quicksilver was replaced with the $6.2 million Creekside Gondola for the 1996/97-ski season.
The Quicksilver chair, was only five years old at the time of the accident, named to commemorate Whistler Mountain's 25th year of operation. The entire lift was destroyed after all the investigations were closed.
