I truly missed being back in the thick of the fire
By Ronald D. Ballard
Growing up in Omaha, Nebraska, is as good as it gets for a young man born in Anaheim, California. My foster parents afforded me every opportunity for success in life: a solid religious exposure, good education, great health care, exposure to culture, and the ability to make friends in an environment of nonjudgment or prejudice. My education included Catholic elementary school followed by public junior and senior high school, with undergraduate studies at Iowa Western Community College, the University of Nebraska at Omaha, and Creighton University.
I also included military service in my young adult life–six years in the Air Force (four years active duty and two years inactive reserve), which included a 97-day temporary duty to Viet Nam and a Purple Heart. After serving in the Air Force, 55th Strategic Reconnaissance Wing as a flight engineer, I thought it would be a good idea to keep my time-in-service years up, so I joined the Army (active reserve), 82nd Field Hospital as a field medic/clinical specialist, where I learned a number of new skills, one of which was rappelling. I furthered my military service with two years in the Arizona Air National Guard, 162nd Tactical Fighter Wing, as a clinical specialist.
At 26 years old, I was working for Creighton University in Omaha as a computer dysrhythmia monitoring technician at St. Joseph Hospital. St. Joe’s is a 900-bed Level-I Trauma Center associated with Creighton University. The training program for this position was top notch and, as a young EMT, my skills in cardiac rhythm interpretation and emergency cardiac care were improving exponentially. Only an EMT-Basic and already I was certified as an advanced cardiac life support provider and as a basic cardiac life support instructor. I loved being exposed to as much as possible in the medical field, and it had always been a long-term dream of mine to become a doctor.
I was at the time living in a two-story house divided into three apartments. My apartment was the entire main floor, a male nurse (mentioned later in this article) and two interior design students lived in the second-floor apartment. A recently discharged female Army veteran lived in the basement, and we all became close friends. One evening when my upstairs neighbors had some acquaintances over for a small get-together, my life changed in a big way. One of their guests was a young lady by the name of Michaela who later became my roommate, girlfriend, fiancé, and wife (in that order).
While engaged, Michaela and I decided to take a road trip to the West Coast and look for potential areas for me to ply my trade as a nurse/paramedic, as my career path was headed toward becoming a nurse/paramedic with an Air Rescue Service somewhere. We thought it might be a good idea to also look at the Pacific Northwest area, since Michaela had an aunt and uncle in Portland, Oregon, so we started off in that direction.
An Introduction to Mount Hood
It was a brisk fall day in Portland when Michaela’s aunt and uncle drove both of us to Timberline Lodge on Mount Hood. I was eager to try out a rope that I had found in Michaela’s uncle’s basement. When we arrived at the Lodge, located on the Salmon River Canyon, I was amazed at how clear and beautiful the area was. I soon found a tree to use as an anchor, tied off my rope, and threw it over the rim of the Canyon. Let me say this before going any further: Knowing now what I didn’t know then, I bit off more than I could chew. I was in an area unfamiliar to me, using equipment substandard for that area, with no climbing partner, etc. I thought I knew a lot about ropes and whatnot … but boy, was I wrong! I should have never attempted that rappel. Michaela was busy taking pictures of the entire area, and after I hooked onto the rope and was backing down toward the rim of the canyon, she hollered at me, “Hey, slow down, I need to take your picture.” That was the last thing I remember until three days later. Michaela told me later that my rope had slid across a sharp rock and it had been severed cleanly in two as if cut by a knife.
The next thing I remember was seeing ceiling tiles moving over my head. I was flat on my back and unable to move. I knew there were people walking around me, but I didn’t know where I was. The last thing I remembered was preparing to step over the rim of Salmon River Canyon. So I hollered out, “What the hell’s going on here?” It felt as if someone was holding me down. A female voice who was walking somewhere up around my left shoulder leaned down and whispered to me, “Mr. Ballard, you’ve broken your neck.” It was probably the 10th time I’d been told this over the past three days, but I simply didn’t remember. I laid there and felt my entire body rock back and forth and I thought to myself, “I must’ve really screwed up.” I’ll go to my grave remembering exactly that.
You don’t need to be a physician to understand the implications of a broken neck, so I just laid there and kept quiet. I found out that they were pushing my bed from the CAT scan back to my room. Three days had been completely erased; however, I was told that over the course of those three days I talked on the phone, I was able to tell them where I hurt and when I was hungry, etc., but again, I don’t remember any of it. Michaela told me that I had been flown by Life Flight from Mount Hood to St. Joseph’s Hospital, a Level-I Trauma Center in Portland.
I tried to go over in my mind what had just happened, trying my hardest to remember the seconds just before I fell, but nothing was there; it was all a blank. Michaela was there with me and filled me in on some of the details, as did the many nurses and technicians. I found out from one of the nurses that I had fractured two cervical vertebra and was a quadriplegic. It was further explained to me that C-5 had a transverse linear fracture, which fractured the vertebral body into two pieces, whereas C-6 was a comminuted (fragmented) fracture and was putting a great deal of pressure on the nerve roots at that level, most likely the cause of my initial paralysis. Add to this that there was a subluxation of C-5 over C-6 and a complete 180° rotation of the C-spine at the C-4/C-5 level. In fact, the first rescuer to reach me said I looked like someone from “The Exorcist” with my head turned around looking backward.
My neurosurgeon had placed me in what was called “Gardner-Wells” tongs to stabilize the fractures. Of course, I couldn’t see this apparatus; however, I was told that it was an aluminum stabilization device drilled into each side of my skull and 25 pounds of cervical traction were added to keep my C-spine in alignment. One of the more innovative uses for these tongs was when the nurses needed to flip me over in bed, they would simply grab the tongs at each temple site and turn my head left or right; of course, my body would closely follow.
As I laid there in my hospital bed, I still couldn’t remember anything before three days prior. It suddenly occurred to me that life as I once knew it would be changed forever. My career plans of being a nurse/paramedic with an Air Rescue Service no longer seemed very practical. It was all too easy for me to be a little down on myself and somewhat depressed.
It was about a week or so into my stay at St. Joe’s that I suddenly was able to move my right pinky finger. I was so excited that I yelled for the nurses to come in and see what I could do. It was at that point in my convalescence that I was convinced I most certainly would walk again. Of course, this newfound movement comes at a price in the form of increased sensations of pain. The pain was extreme from my C-spine across both trapezius muscles, down both forearms (more acute on the left) and settling in each hand–left-hand pain was worse and still is. The C-5/C-6 nerve root damage has also severely affected the extensor muscles in both arms and hands.
One day about two weeks into my stay at St. Joe’s, my neurosurgeon came into my room and explained what a halo brace was and that he was inclined to install one on me. He had a patient in the hospital who already had a halo brace installed come into my room and model it for me. I remember seeing this woman walk in with an aluminum halo around her head affixed at four points by metal attachments to her skull. She smiled at me and as I looked at her all I could think of was, “That’s not for me. I’m gonna walk again!”
Five more days went by, and my neurosurgeon fitted me with a Philadelphia collar and told me it was time for me to go home. Michaela made arrangements for to fly me back to Omaha while she and my sister Donna drove back in Michaela’s car.
I was met at Eppley Airfield in Omaha by my two supervisors from Creighton University’s Cardiac Dysrhythmia Monitoring Unit. They had a wheelchair ready and took me back in a hospital van, where I was admitted into the St. Joe Level-I Trauma Unit. Over the next two weeks, things came back very slowly and gradually. One day I was able to flex my arms up but needed assistance to extend them back down. At the end of a two-week period, I was transferred to Immanuel Medical Center in Omaha, an inpatient long-term rehabilitation facility, where I continued my treatment and convalescence.
Again, various motor functions came back very slowly and gradually; however, I steadily and satisfactorily progressed in my recovery. I was at Immanuel Medical Center approximately 10 days when the physical therapy staff felt I might be able to walk with the aid of a metal walker. Although my left hand was still unable to grasp anything, the staff wrapped an ace bandage around my hand and the handle of the walker so that I could at least pick the walker up as I was moving about. It was quite obvious by now that due to the severity of nerve root damage at the C-5/C-6 level, the entire left side of my body had been weakened. I seriously started to contemplate alternative career choices.
Getting My Life Back to Normal Seemed Almost Impossible
Discharged from Immanuel Hospital, I continued my rehabilitation at home. I still had a lot of pain and a great deal of left-side body weakness. It was also obvious to me that I needed to get a handle on my pain problem immediately or I would end up addicted to narcotic medication. Fortunately, a good friend knew of someone at the University of Nebraska College of Medicine’s Chronic Pain Management program and was able to schedule me for an interview. Once I was in the program, their first step was get me off all narcotic medications; they gave me a list of other options for more appropriate pain management.
C-spine icing, exercises, whirlpool therapy, appropriate pain meditation, physical therapy, acupressure, meditation, biofeedback, and occupational therapy as well as one-on-one counseling were just a portion of my daily activities. his program was a six-week inpatient “shotgun” approach to numerous techniques for pain management, and it did me a world of good. I was fortunate to get off narcotic medications as they were easy for me to come by, being in the medical field at the time. The only thing I didn’t give up completely was smoking marijuana. It seemed to relax me and helped me cope with the pain.
Other aspects of home life were also very difficult. Simple tasks such as dressing, bathing, answering the telephone, buttering a piece of toast, writing, using the computer, and so on were nearly impossible for me to complete without help. I was enrolled in physical and occupational therapy each three times a week, and it was one of these therapists that introduced me to aids to daily living (ADL). They are a conglomeration of various tools and apparatus that made everyday tasks for me a lot easier. I used most of these ADLs for the next year or so, making my daily life go by so much smoother. Since I was not able to drive, I subscribed to a handicapped van service sponsored by the Omaha Metropolitan Area Transit System. This service got me to and from all of my scheduled appointments as well as any other locations I requested.
After about a year of hard convalescence, I found myself once again working in the Cardiac Dysrhythmia Monitoring Unit at St. Joseph’s Hospital. It wasn’t too long before I realized it was extremely difficult for me to sit still in a chair for eight hours without increasing my pain levels. I transferred to the Intermediate Cardiac Care Unit as a patient care technician, where I could be more physically active. Although this transfer didn’t completely alleviate my pain level, staying active certainly seemed to help.
While working at St. Joe’s one day, I was talking to a nurse friend (remember my upstairs neighbor?) at Methodist Hospital. As I was going over the Mt. Hood rescue, my friend stopped me and said, “I think I know the person who first came to your rescue, and he’s presently working at St Joseph Hospital.” Of course, I was completely shocked and needed to know more. I found out that his name was Ray, a surgical nurse who was working that very same day at St. Joe’s. After filling my supervisor in on this discovery, I ran down to the Surgery Department and waited for Ray to complete the surgery he was currently involved with. Keep in mind, up until this point I didn’t know anything about the person who first came to rescue me and I certainly (at least to my knowledge) had never met him.
The nurses in the Surgery Department had given me at least a brief description of Ray, so I had a rough idea of who to look for. When he came out of the surgical suite, we immediately locked eyes, walked up to each other, and hugged. We then sat down and talked about the rescue. Ray happened to be on Mount Hood that day showing a fellow nurse friend from Omaha (a friend of my upstairs neighbor) the sites. It was his Omaha nurse friend who was the catalyst for bringing Ray and me together.
He said that when he first came upon me on Mount Hood, he knew my neck was broken. My head was turned completely around, and I had what was known as a “Cheyne-Stokes” respiratory pattern indicative of central nervous system trauma, characterized by a progressively faster and faster respiratory “panting,” followed by periods of breathlessness (apnea). Ray said there was little doubt in his mind that I had sustained a severe cervical spine trauma. I found out that ever since that day, Ray had gone through various aspects of post-traumatic stress disorder regarding his involvement, as he truly didn’t know whether or not I would live or die or if his efforts made any difference.
Ray told me that I had fallen the complete distance of 400 feet (approximately 40 stories) and impacted on solid granite that was situated at an approximate 60° incline. This caused me to roll violently about 30 feet into the Salmon River. While the Salmon River at that altitude is a fast-running, shallow, mountainous river with very cold water (about 33°), because of this low water temperature I didn’t immediately go into shock (reference “Mammalian Diving Reflex”).
When Ray first got to me, he said my chest was in the water and that the lower half of my body was still on shore, with my head turned completely around looking over my shoulders. He said that my face was not in the water; however, river current was apparently splashing up onto my face so he fashioned a rock dam on the upstream side of my head to prevent me from drowning. With the aid of some bystanders, Ray lifted me up out of the water. Ray stated that he then put gentle in-line traction on my cervical spine and rotated my head back around to a forward-facing position. During those periods of apnea, which could last from a few seconds up to a few minutes, Ray had to interpose respirations for me. This meant he was literally lying on his back to do mouth-to-mouth resuscitation.
It took the Hoodland Volunteer Fire Department Technical Rescue Team approximately four hours to manhandle me out of the canyon for the one-hour Life Flight helicopter transport to a Level-I Trauma Center in Portland. Ray was a surgical nurse working in a hospital across the river from Portland and kept close tabs on my progress until I returned to Omaha, after which he lost track of me until I had a chance conversation more than a year later with a nurse friend of mine.
As soon as I could, I stopped into the St. Joe’s Public Affairs Office and asked, “Did you know you have a hero working here?” Of course, they wanted to know more, so I filled them in on the details of this amazing rescue. One of their photojournalists made arrangements to get Ray and me off work for an entire day and took us to the tallest building in downtown Omaha. He took pictures of us both looking down from the 40th floor to the ground and from the ground looking back up 40 stories. He then wrote a truly spectacular article in the St. Joseph Hospital newspaper outlining the rescue and subsequent meeting of my rescuer.
While working at St. Joseph Hospital, I heard of an open position at Methodist Hospital Emergency Department. I applied and was accepted as a full-time Emergency Department technician. Although the left side of my body was still very weak and my left hand was difficult to open or close (and the use of fine motor manipulative techniques was almost nonexistent), I found different and innovative ways of overcoming these handicaps. Unfortunately, though, pain levels were still very high, mostly in both hands.
While working in the Emergency Department, I made friends with Dave, a respiratory therapy technician. He and I had a lot in common and soon became close friends. In fact, Dave and I decided to enroll in Creighton University’s paramedic training program together. It was now 1982, and we were both looking at working full time as well as going to school full time for the next two years. We couldn’t wait!
The academics of the paramedic program didn’t appear hard for me at all, but some of the physical aspects of my training were very difficult indeed—CPR, for example. While performing CPR one day on a mannequin, an instructor asked, “Ron, did you know that you shift the entire weight of your body over your right arm when you do compressions?” Certainly, I wasn’t aware that I did this, so the next time I performed CPR I paid closer attention. Sure enough, that’s exactly what happened: I shifted all my weight over my right arm. It was very effective CPR, however, and a prime example of how the human body has a tendency to compensate for its weaknesses without us even knowing.
Another difficulty I had was endotracheal intubation. Because my left tricep was so weak, it was difficult for me to insert the laryngoscope blade and hold enough pressure to the retro pharynx to visualize the vocal cords and insert the tube. Seeing my difficulties, one of my instructors suggested inserting the laryngoscope and pulling the entire head up off the floor, which naturally and anatomically exposed the vocal cords. This appeared to be more difficult but it only took a few seconds for me to visualize the cords and insert an endotracheal tube, thus making the whole procedure a lot easier and faster for me.
All my coworkers in the Emergency Department at Methodist Hospital were extremely supportive during my paramedic course. The doctors all made sure I was by their side when any special techniques or procedures were discussed or performed. If it was an unusual or difficult case, everyone made sure I was there. I couldn’t have asked for a better preparation to the field of advanced life support prehospital care than this working environment, as it continued to serve me well throughout my fire service/EMS career.
After graduation from Creighton University, Dave and I both joined the Boys Town (NE) Volunteer Fire Department as their very first two paramedics. Neither of us got to go on many calls or see much action. Dave soon accepted a position in Tucson, Arizona, with the Rural Metro Fire Department, and I kept busy with additional shifts at Methodist Hospital ED. It was shortly after Dave left that I found I couldn’t work in the cold environment of Omaha with my handicaps. The winter weather there caused my muscles to stiffen and become almost useless. I called Dave in Tucson and asked him what was going on in EMS. He said the fire departments were hiring paramedics like they were going out of style and that I should move to Tucson as soon as possible. And so, the great adventure continued.
My Fire Service Career Takes Off
Dave and I first applied with and were hired by the Golder Ranch Fire Department in Catalina, Arizona, which is a suburb of Tucson. Neither of us knew anything about fire suppression, but the department was willing to teach us and we were more than willing to bring their EMS services up to advanced life support/paramedic standards. The Golder Ranch Fire District was a total immersion for two newly graduated paramedics into high-speed highway trauma, agricultural accidents, swift water rescues, and rural medical and cardiac emergencies–all with an extended ground transport time to the nearest hospital, which was a Level-II Tertiary Care facility. The experiences Golder Ranch afforded us were invaluable and certainly laid the groundwork for the rest of our fire service/paramedic careers.
Most of the balance of our careers was made up of service with the Drexel Heights Fire District, another suburb of Tucson. I was alternately assigned to an engine company and paramedic ambulance, while Dave rose to the rank of battalion chief and EMS coordinator. Halfway through my career, I accepted a position as training officer for the Pascua Pueblo Fire Department on the Pascua Yaqui Indian Nation, southwest of Tucson. As the department grew, I quickly made lieutenant and took on more administrative responsibilities. After about three years, I was promoted to chief.
Early in my fire service career, I realized that with my handicaps and pain level, it was unrealistic for me to think that I could be pulling hose around, throwing ladders, dragging people out of buildings, chopping holes in roofs, or any of a myriad of physically challenging tasks required of a firefighter, so I set specific careers goals and moved up in the profession. I took every fire service supervision training program made available by the International Fire Service Training Association as well as Executive Fire Officer training at the National Fire Academy. Additionally, I successfully graduated from the Tucson Fire Department Chief Officer training program. All this advanced education and experience more than prepared me for a position as chief. At this point in my life, it was hard for anyone to even recognize my physical handicaps; however, I was acutely aware of all of them, and chronic pain was ever constant.
Over the course of my career, it’s nearly impossible for me to know exactly how many fires I participated in the suppression of, motor vehicle accident extrications I’ve been involved with, sick people and heart attacks that I’ve attended, high angle/swift water technical rescues I’ve participated in, or emergency incidents I’ve commanded. All in all, though, I’m at peace with the knowledge that I made a difference in my community, “handicaps be damned.”
Life After the Fire Service and Subsequent Recovery
Leaving the fraternity and brotherhood of the fire service was a very difficult one for me indeed. I attempted several management-level positions after retirement, most notably safety/EMS manager for the Desert Diamond Casinos, risk/safety manager for Harrah’s Ak-Chin Casino in Phoenix, director of public safety for the Saguaro Ranch Development Corporation/Saguaro Ranch Estates, and public information officer/community education specialist for the Drexel Heights Fire Department. None of these positions seemed to last much more than about three years, as my heart just didn’t appear to be in it. I truly missed being back in the thick of the fire service/EMS action, and it showed in my professional capabilities.
After about three years from retirement, I started to drink a little bit, which was unusual since I rarely drank while in the fire service. At first, it was just a beer or two a day, which progressed to about a six-pack a day, until I was drinking a half pint of vodka per day. The shame of being mentally and physically unavailable to my family, as well as my inability to walk or even perform simple tasks, was all more than I could bear, so I enrolled in Alcoholics Anonymous. I’m happy to report that as of the writing of this article, I’ve been clean and sober for more than five years. That’s not to say I’m still not plagued with my physical disabilities and elevated pain level, as these are with me all the time. I have simply come to the conclusion that alcohol would not give me back what I lost on Mount Hood or retired from in the fire/EMS service.
Over the years of living with extreme pain, I’ve developed an innovative and a unique way of dealing with it without medication. I made pain a friend. That’s right, a friend–something I can count on all the time to be there and never go away no matter what. I know it’s an unusual way to think about pain, but pain is absolutely something in my life that I can always count on being with me, so I embraced it. Now that’s not to say that I won’t take medication for acute pain such as when I fractured my left tibia. However, because of my knowledge and experiences with pain management, I can appropriately regulate my intake of pain medication and step back from these medications when required.
I’m 65 years old now, retired from the fire service with a beautiful wife (#3) of 22 years. Andrea and I have two daughters, a freshman studying forensic science at the University of Arizona and another just starting her fourth year of veterinary college in Melbourne, Australia. We also have two sons–one is a sergeant with the Plainview (TX) Police Department and the other is a University of Arizona graduate working with an internationally focused radiologist and PhD accreditation service here in Tucson.
Over I’d say the past 12 years or so, I continue to be haunted occasionally by Mt. Hood. I still struggle with chronic pain as well as steadily decreasing physical functions such as balance, coordination, chronic ED, fine motor hand manipulative function, and overall body weakness. Yes, all of this bothers me a great deal. However, it’s so gratifying for me to look back on all my personal and professional accomplishments, civic contributions, and personal growth while still looking in the face of what Mt. Hood threw at me 39 years ago and saying, “You haven’t beaten me.”
For anyone reading this article who is dealing with the crippling effects of chronic pain, please feel free to contact me anytime. I would be more than happy to talk with you about the many ways of dealing appropriately with pain without medication. I can be reached at firstname.lastname@example.org.
Ronald D. Ballard, BA, CEFO, AZ. FF-II, NREMT-P, is chief/paramedic (ret.) in Tucson, Arizona.