Lucas Parker is doped up on morphine, trying to remember three simple words. He can't.
His mother Janice sits beside him, still in her light blue ski jacket, willing her youngest son to remember the words the doctor is asking him and the series of events that led up to his accident.
"I was in the terrain park and I went off a jump and I can't really remember the rest," says Lucas slowly, lying flat on his back in the clinic, his head immobilized, his right arm splinted. His eyes, however, tell a story — pained, dazed, confused. He is just 14 years old; flying through the air one minute, strapped down in a hospital bed the next.
Lucas has a concussion, just how serious it is remains to be seen. The doctor also suspects he's broken his humerus — the long arm bone that runs from the shoulder to the elbow — a heart-breaking reality for this young competitive badminton player who has provincials on the near horizon. The doctor has told him to rest his mind, sleep if he needs to. X-rays will tell the tale.
He is the quintessential Whistler patient — young, injured while skiing or snowboarding...with broken bone.
Lucas and his mom wait quietly; the curtain falls back around them, isolating them in their temporary cocoon, as the daily medical melodrama at the unassuming centre unfolds in earnest around them.
• • •
Of the total 18,643 ER visits in 2011 at the Whistler Health Care Centre, a staggering 43 per cent (or 8,199) were orthopaedic injuries, like Lucas's. Compare that to the 18 per cent seen at Lions Gate Hospital in roughly the same time period.
It's easy to see why the centre's work in orthopaedics — that business of broken bones, dislocated joints and torn ligaments — has become its tour de force of sorts.
"Because we treat a population that's involved in high energy sport injuries, we tend to see these things perhaps with greater frequency than do other emergency departments," says Dr. Bruce Mohr, president of the medical staff at the centre. "There's a lot of high energy young population trauma going on here.
Set against the backdrop of North America's busiest ski resort, one that caters to more than two million skiers and riders annually, the centre is a hive of calm, business-like activity on a Sunday afternoon at the height of the ski season, the quiet punctuated by the rhythmic click-claquing of plastic ski boots on the polished linoleum floors.
Lined up in single file against the season-worn walls, the weary walking wounded wait, ski jackets unzipped, boots propped up to ease the pain of hurt legs, arms held tenderly.
They rest their heads on the back of their chairs, gazes turned heavenward as if in search of answers. Quiet prevails. They replay over and over the chain of events that led them from winter's playground to this hard new reality.
What went wrong up there?
And then the next thought, with a sinking heart: is this the end of my season?
In 2011, more than 3,600 skiers and riders wondered the same thing — that's how many come to the ER for injuries from skiing or snowboarding — 20 per cent of all ER visits in Whistler. A further 1,351 injuries were from biking in 2011, including the bike park — roughly seven per cent.
Those walking wounded don't know it yet but they're the lucky ones — they got here on their own steam. Others were not so fortunate, wheeled from ambulances at the back door into the centre on the steady stream of stretchers that bypass reception, straight to the beds at the back.
While the orthopaedics and other big traumas may punctuate the oft-mundane regular business of health care, Whistler's centre is also the main stage for urgent and emergency care for the resort.
The crying babies with fevers and ear infections, the panicked women looking for the morning-after pill, the sous chefs with lacerations on their hands, kids who have been throwing up all night with the stomach flu, allergic reactions, the fallout from drunken fights, a tourist who left his blood pressure medication at home. They all come here for help.
But it's the sheer volume of high energy sports injuries in a little rural ER that make this place unique, a place where budding doctors training at UBC want to come to learn.
"We see everything," says Mohr. "Every bone that you could possibly break or dislocate, we see. It just depends on the day. You'll see certain injuries more frequently with certain weather condition and snow conditions."
Sunny, fast, hard snow conditions bring in more head injuries, spinal injuries, broken femurs and upper extremity injuries like broken collar bones and wrist fractures in snowboarders.
A grey overcast day with powder and poor visibility will bring in those slow, twisting fall injuries that rupture knee ligaments, dislocate shoulders and fracture ankles.
Today it's a mixed bag. No fresh powder to speak of, no bluebird skies above.
It is, however, the Sunday of U.S. President's Day weekend.
The staff at the centre is steeled for a busy day.
• • •
It's noon. Whistler Blackcomb has been open for just a few hours. Truck 70 is parked at the front doors of the centre. Patroller Corey Brealey is behind the wheel, in his red vest with the white cross.
This isn't his first trip to the centre today and it certainly won't be his last.
He will cart a steady stream of the injured from the different mountain bases, monitor them with questions while they're in his truck, help them to the centre, carry their skis or board to the ski-rack, settle them into a wheelchair. Reassure them that they're in good hands.
Today Brealey is a glorified concierge of sorts. He's injured himself, and so is unable to patrol on the mountain. Truck 70 is a courtesy truck provided by Whistler Blackcomb — slope-to-centre service for those not-so serious injuries.
It's busiest between 11:30 a.m. and 3 p.m., generally when skiers or riders get tired before lunch or tired after lunch and at the end of day.
Brealey pulls up to the Blackcomb Day Lodge.
"Hey, buddy, how's it going?" asks Brealey, against the near never-ending crackle of his radio. "What did you do?"
A young skier in obvious pain gingerly lowers himself into the front seat of Truck 70.
The patroller who has helped him down the mountain debriefs Brealey from the side of the truck: James was skiing in the park when he crashed. He fell on his side but it's his ankles and shins that are the problem. The pain won't go away. Shin splints? Possibly.
With a "good luck and take care," the on-mountain patroller hands over her patient to Brealey and heads back up the slopes.
"Better safe than sorry," Brealey says to his temporary charge, keeping a flow of conversation going with his patient in part to gather information but also to keep the suffering skier's mind off the pain.
Less than five minutes later they're at the centre, the big red hand on the sliding door both welcoming and a caution to sanitize before entering.
Brealey carries the skis to the almost full ski rack at the front doors.
He gets James settled and heads back out again, the sliding door wooshing closed behind him.
The centre's door will woosh open and close all day long, heralding patients past the line of skis and boards to the triage nurse and receptionists stationed behind the new glass walls.
The questions begin — a mantra of sorts:
"Hi there, a ski patroller just brought you in — what did you hurt?"
How many times will that be asked today? Some days more than 90 patients are seen.
Truck 70 is just one example of the cooperative relationship between Whistler Blackcomb and the centre, where the first responders stabilize the patients in order to get them down the mountains safely, and the nitty-gritty work of diagnosing and fixing gets done later.
That's how 48-year-old Lynn Spark got here three weeks ago, via Truck 70, she says. She's sitting up in her bed, her right knee puffy and swollen and obviously causing some pain.
Spark recalls the series of events starting at the end of January that has her sitting at the centre once again.
She was on Blackcomb Mountain, turned in heavy snow, felt a little pop, then pain, and she couldn't put any weight on her right leg. At the time there was no definite diagnosis. She limped for days. And when the pain got better she began rehab, doing squats, going to physio.
Yesterday, she says, was her first day back on skis.
"It was sore all day but I kept on going — right or wrong," shrugs Lynn.
She was in the trees at Franz's Creek going along a narrow track. One leg slipped down.
"And because it was weak, I couldn't grab an edge."
She ended up hitting a tree, twisting her leg, sliding down three metres of a steep embankment on her stomach, screaming in pain.
She skied out on one leg, went home, iced it, popped some Tylenol 3s.
And here she is now, at the centre again, less than 24 hours after the fall, looking for some answers.
Lynn has the knees of a seasoned skier. This right knee has already seen an ACL tear, her left knee the meniscus.
"I'm mad at the situation, that I've actually injured myself again — the knees again," she says.
"I think that I'm going to move to Vancouver," she laughs. "If I can't ski anymore, I'm leaving."
It's a common question — one that's on many minds here: am I done for the season?
For now, however, Spark waits for the answers that will come from the x-rays.
• • •
Waiting for his x-rays, Lucas still can't remember.
So his mom remembers for him.
She knows exactly what happened, saw it all unfold before her.
Janice Parker is calm. Reality is sinking in and the thoughts of what could have been are kept at bay, for now at least.
It happened at 11 a.m. The first run of the day, the last day of their long weekend in Whistler. The Calgary family — mom, dad and two sons — make this four-day trip every year. Today they were planning on skiing and then hitting the road for home.
"We were all together and we had just gotten to the top of the gondola, went down to the beginning of the terrain park and the first jump that he took he did a wipe out," says Janice calmly.
"He wiped out on his head and back."
Within minutes of Lucas falling off the jump, a medic, who had seen the crash from the chairlift, was on scene.
An orthopaedic surgeon and doctor were also quick to respond.
Lucas was tobogganed down the hill, put into an ambulance and taken to the health centre all within an hour.
"Lucas was in very good hands," says Janice.
It's confirmed now. Lucas's right arm is broken. He will need to go for surgery in the city to knit it back together.
"It's always hard... seeing your child in pain and knowing..." his mom pauses, takes a breath.
"He's a competitive badminton player, so he's going to be out of commission for a while no matter what, so that's kind of sad. Provincials are coming up.
"I'm just happy that it's not more than what it is. They say he's lucky there doesn't seem to be nerve damage in the hand from where the break is."
Lucas also has a concussion.
If orthopaedic injuries are just part of the game of high-speed sport, then head injuries can be the more serious ramifications of being on the team.
Even with the growing use of helmets, head injuries, says Dr. Mohr, aren't going away.
Last year 843 cases in the Whistler ER were neurological.
"Any sport where you have high speed collisions with other skiers or riders or trees or just the ground, in spite of helmets, you're going to have head injuries," says Mohr.
While he doesn't have the stats to say definitely if head injuries are on the rise, the head doctor's gut tells him there are still just as many horrific spinal and head injuries coming through the clinic. Helmets, while they help protect the head, do not prevent head injuries, says Mohr.
"The whole (terrain) park phenomenon has increased the height of these jumps and a lot of the head injuries do come from the park," says Mohr. "That is one thing that has changed... Head injuries don't seem to be going away. They're still really common... and severe."
Severe, he explains, are the cases where people are unconscious after the accident, or can't remember anything, symptomatic with headache and vomiting.
"We see a lot of those kinds of concussions," says Mohr. "I would call all of those serious. We have to watch them, make sure there's no evidence of bleeding and they're not going to die imminently. And there's a certain per cent that will have to be sent down for neuro-surgical intervention because they are bleeding, but they're rare."
The bulk of cases, however, require intense observation. Or a CT scan to produce diagnostic images of the body.
New to Whistler in recent years is the CT scanner, a donation from the GE Corporation with additional funds provided by the Whistler Health Care Foundation.
It used to be Whistler patients would need to travel to Vancouver for that procedure to see if there was potentially something sinister brewing in the brain — delayed swelling or bleeding. Now they can have it done on hand.
Today the CT machine is not operating — it operates just four days a week. Anyone needing a CT will be going to the city.
A few hours later Lucas is wheeled out on a stretcher to a waiting ambulance, his mom trailing behind him.
They are going to Vancouver. His story in Whistler has ended, the next chapter to be written at another hospital.
It's often the case. Hundreds are transferred out of the centre to a higher level of care.
While it's true Whistler doesn't have all the equipment or the expertise to do all the procedures the city emergency departments do, the procedures it does do, it does very well.
Perfecting the art of fixing a broken wrist for example.
• • •
That's why Dr. Adam Bretholz is here. Not to get his wrist fixed but to see how it's done. Bretholz is a doctor at the Montreal Children's Hospital, observing the experts at the Whistler centre for two weeks.
"Whistler has a unique way of doing fracture reductions within North America," said Dr. Bretholz. "The way that they provide analgesia (or painkillers) for broken bones that they are trying to reset, it has a lot of benefits compared to the standard of care at a lot of emergency departments."
Barbara Martinho is going to reap those benefits.
The 25-year-old Brazilian broke her wrist snowboarding on Blackcomb Mountain. It's the first day of her holidays with her boyfriend Diogo Almeida, her first time in Whistler.
Whistler's doctors and nurses have a name for this injury — FOOSH: Fall On Outstretched Hands.
They're no strangers to treating it.
Two to five broken wrists are tended to at the clinic each day.
One record-breaking day there were 25 — 13 of those required reduction, which means the bones are out of position and need to be manipulated back in line.
Martinho's wrist needs to be reduced. She is tucked into the back corner of the centre, her left arm mottled, blood flow to her hand essentially cut off by a pneumatic cuff on her bicep.
That's being done on purpose.
Dr. Deanna Tripodi has explained what's coming; she is going to be manipulating the wrist bones back in place.
Martinho isn't in any pain; the effects of a local anesthetic to the arm are starting to kick in. The pneumatic cuff stops the anesthetic from travelling throughout her body. It's called a Bier Block.
No less than four staff members are gathered around her, all in heavy lead aprons. Dr. Tripodi is going to put the bones back in place, Ross Hopper the ortho technician is going to hold the arm steady and Derek Barton, x-ray tech, will take the before and after pictures.
They work in calm concert with each other; this has been done many, many times before.
Dr. Bretholz stands to the side, watching the pros at work. This is why he's travelled all the way from Montreal, to see this procedure in action first-hand.
It's so packed in the little area, curtains cutting off the procedure from the rest of the ER, that Martinho's boyfriend is left to peek through a little makeshift plastic window from the neighbouring bedside.
They look at each other, smile — his reassuring, hers brave.
Effectively, Martinho has no feeling in her arm, but she's awake and alert.
"If this same young leady fell and broke her wrist at Cypress for example she'd end up being sedated fully for her procedure," says Dr. Bretholz.
Watching this is not for the faint of heart, particularly when it's your own broken wrist that's being pulled and moved about.
Martinho turns her head away.
This was not what she imagined her time in Whistler would be like when she saw the pictures of the 2010 Olympics in a magazine and decided she had to visit.
Tripodi has seen the x-rays, knows which way to move the bones. The diminutive doctor knows this isn't about force. It's about placement.
She leans back, holding on to the broken wrist while the ortho tech Hopper holds the arm steady at the elbow. Tripodi crouches down, drawing the broken wrist down. With a deft, upwards motion the broken bones are back in place.
Tripodi turns to the x-ray technician to get another look at the newly aligned bones.
The portable C-arm machine swings towards the bed and the inside of Martinho's wrist is up on the screen within seconds.
It's good; it would pass the muster anywhere. Dr. Tripodi can make it better, just a few degrees more.
She takes the time to do the procedure over again. Another look through the x-ray machine. The doctor is pleased.
Resetting the bones is all done within a matter of minutes.
The total cost, because Martinho is from out of country, for the hours spent at clinic, getting x-rays, waiting for the pain meds to kick in, consulting with the doctor: $1,500.
Martinho nods knowingly, relief written all over her face, when asked if she has traveller's insurance.
Her Visa card is going to take a hit when she checks out of the centre, but she'll get the money back.
Another wrist is fixed, another one to add to the Whistler tally.
The Bier Block is just another thing that makes the centre different from most.
Like getting ski boots off broken legs or injured knees as painlessly as possible. Sounds impossible.
• • •
Dr. Mohr laughs remembering a phone call from another rural centre dealing with an injured backcountry skier with two broken legs. The call was to ask what ski boot removal machine they used in Whistler.
"Of course, we don't have a ski boot removal machine," he says. "But there is a way to do it."
Like taking temperature or blood pressure or doling out pain meds, removing ski boots is just a regular part of the nursing in Whistler.
When asked what the secret is, head nurse Janet Hamer says:
"There is no magic. We're just really, really good at holding the leg and wedging the boot open and getting it off."
By extension that makes them good at dealing with the pain of boot removal.
It's called a procedural sedation.
The patient isn't fully asleep but one of the medications, in addition to dulling the pain, has an amnesic effect so the injured patient isn't conscious, or if they are, they don't remember it.
"We do a lot of that at the clinic... We're very good at pain management. It's one of the things we do best: pain management and sedation for relocation or splinting," says Hamer.
This process isn't the norm in most places.
Often, said Dr. Mohr, the patient needs to be procedurally sedated twice — once to get their gear off, and a second time after x-ray and the injury becomes apparent.
"That alone is something that doesn't occur in a lot of other places," said Mohr.
Sarah Ussher had her racing ski boot taken off her broken foot today. It was removed on the mountain.
Now the 13-year-old is wrapped in a warming blanket in bed, the pink stripes of her racing suit visible, her mom Monica and her dad John sit beside her.
It hurts. That much is clear but she's putting on a brave face.
She was racing in the Parsons memorial Super G today. Her dad was a gate judge.
"It's the life of the ski racing parent," says John with a smile and a shrug from the side of the bed. "No more skiing, just watching."
Sarah was flying down Ptarmigan and, says John, when she passed him she was looking great, moving fast.
It all went wrong at the finish line.
She likely hit a rut, crashed and fractured one of her growth plates in her foot.
As nurse Shirley Balzarini wets the plaster for her foot and holds it in place, she reminds Sarah that a "fracture" is indeed a break.
"You're young. You're strong. You'll heal fast," says the nurse, efficiently wrapping up the right foot, holding the splint in place.
Sarah has been skiing for two years. This is her first major injury. She's desperate to get back up on skis. This trip to the ER, this setback to life, as minor as it is in comparison to others, wasn't part of her plan today.
• • •
There will never be a hospital in, and Dr. Mohr knows that; the corridor's hospital is in Squamish.
But if he had his druthers, and an unlimited budget (the centre's operating budget is about $5.8 million annually), he can envision great things for the centre, catering to what it does best.
"The place could be amazing," says the doctor who has worked there for 16 years. "It's pretty darn good the way it is but it could be just an amazing centre of excellence for emergency primary care of sport medicine and orthopaedic care. There's not too many places that see as much orthopaedic trauma as we do and that don't have a hospital and ambulatory care surgery."
He wants to see more orthopaedic capability.
Meanwhile, Montreal's Dr. Bretholz is impressed with what he's seen to date. He's half-way through his two-week observation stint and he's seen half a dozen to a dozen Bier Block procedures.
When asked why other ERs aren't doing the same thing, Bretholz admits it's a complex question.
On the one hand there's all the benefits that come with the Whistler way — not being fully sedated where there's always a risk of airway compromise and other side-effects and the recovery time is longer. On the other hand, there are different ways to skin a cat, says Bretholz, and that's just the way things have been done over the years.
"They (other ERs) don't deal with the same amount of orthopaedic trauma so they don't have a real push to change it to make it the best possible," he says.
He thinks what's happening in Whistler is "the best possible."
And he wants to bring it to the Montreal Children's Hospital. He's pushing to make that happen.
In June, the hospital is flying out Hamer and Dr. Mohr to help Bretholz teach a course. In the meantime, they're just finishing up getting the protocol approved at Montreal Children's and getting the funds for the pneumatic cuff machine — the A.T.S. 3000 — which runs about $20,000.
• • •
Lucas Parker is still at home recovering two weeks after his accident.
"Hopefully he'll be starting to go back to school this week," says Janice in a phone message in early March. "All is well."
Sarah Ussher is still on crutches. She tried racing in Panorama at the two-week mark but it was too early. She could only do one race.
"She's still recovering," says mom Monica.
The crash and break has not dulled her love of the sport. She's keen to get back on her skis... and make the most of what's left of the winter ski season. The broken bone a temporary blip in what she hopes to be a lifelong enjoyment racing down the mountains.
And there's nowhere else Dr. Mohr would work. Sixteen years seeing the same kinds of sports injuries and he says Whistler has all that's unique and interesting about emergency medicine without some of the challenges seen at big city hospitals.
"It's got a really nice case mix of healthy injured people and medicine," says Mohr.
"It's hard to find that anywhere else."
