The human forearm contains robust bones, a mass of tough muscles, various ligaments, a host of nerve fibres and a lot of blood vessels. As American fans of the television series ER know, it is not always straightforward to sever such a limb: in an episode of the drama in America recently Dr Elizabeth Corday, played by the British actress Alex Kingston, struggled to amputate the diseased arm of her mentor Robert Romano, even when operating in a hospital theatre fully equipped with the wonders of modern medicine. No such equipment was available to Aron Ralston, an American climber, when he set off hiking near the Canyon-lands national park in south-east Utah recently. He had merely some water, two energy bars, climbing ropes, a torch and a multi-purpose tool similar to a Leatherman that included a pen-knife. A 6ft 2in adventurer, who had climbed dozens of the tallest peaks in the Rocky mountains, Ralston was well aware that danger can come from any direction in the wilderness: he was once stalked by a black bear and, earlier this year, was buried in an avalanche, leaving only the top of his head and one arm poking through the snow. But few could have foreseen the bizarre accident that would befall him as he clambered through the narrow and remote Blue John Canyon. As he tried to cross three large boulders wedged in a 3ft-wide gap, one of them rolled over and trapped his hand against the canyon wall. “I was, truth be told, between a rock and very hard place,” he later told his father. He had informed nobody where he was going and nobody was likely to pass by. “I felt very frustrated with myself for not leaving a note about my destination in my car parked at the foot of the canyon, so no one knew where I was,” said Ralston.
He tried to chip away at the boulder and the wall with his cheap knife, and used his climbing ropes to try to rig up a way to lift the boulder. It did not budge at all. After two lonely days and nights, Ralston had run out of water and was starting to hallucinate. “I believed I could see my family and friends around me, which was comforting,” he said. On the third day he took the decision to cut off his trapped hand, but the knife was so dulled from chipping at the rock that He could not easily break his skin. He waited a little longer. On day five, May 1, Ralston decided he would have to break two major bones in his forearm if he was to hack himself free. “I was able to bend back and snap the radius then, within a few minutes, snap the ulna at the wrist,” he said as he recovered in hospital. “I had the knife out and applied a tourniquet to my upper arm, using my biking shorts as the padding, and then I went to task. It was a process that took about an hour. I felt pain and I coped with it.” Only Ralston knows what he really felt when he finally sliced through his arm. Horror? Relief? Disbelief? Bleeding heavily, he had little time to ponder. He bandaged the stump as best as he could and set off crawling down the canyon. Despite his pain and weakness, he managed, almost incredibly, to rig ropes to rappel 60ft down to the base of a cliff, a technique that usually demands two hands. Then he staggered into the desert, hoping to find his car. Finally, his luck turned. After walking six miles he met a Dutch couple who fed him biscuits until a helicopter arrived.
When rescuers went back for his squashed hand, it took three burly volunteers with a mechanical hoist more than an hour to lift the 800lb rock to recover the splintered, severed remains. This single fact has convinced Ralston that he had made the right choice. “That rock was going nowhere, and nor was my hand,” he said. But in the heat of such dilemmas, making the choice, let alone during the act, is far from easy and the reasons why some people can do it and others cannot are complex. At Camp Pendleton in California, where the US military carries out research into pain endurance, the marines take a close interest in why some soldiers buckle under pain and others can carry on, wounded beyond belief. If pain is ultimately in the mind, they reason, there may be many different ways of blocking it. “The fashionable treatment is bio-feedback, where you use other stimuli to drown out the signal coming from your bullet wound,” said a former army psychologist. “They are looking at some science-fiction solutions to battlefield injuries, ranging from bio-feedback speakers in your helmet pumping out white noise, the equivalent of screaming, to super-charging drugs. There are also intelligent field dressings that prompt the release of beta-endorphins, which are more powerful pain killers than morphine.” Some physical factors, say experts, may have helped Ralston. “He would have gone into shock when he started snapping his bones,” said Dr Scott Karlan, a trauma specialist at Cedars-Sinai Medical Centre in Los Angeles. “That could then have induced a state of natural analgesia.” But his outgoing personality was probably the key, according to Frank Farley, a psychologist at Temple University, Philadelphia, who has studied heroes through the ages. “He is a classic T-type personality, or thrill-seeker,” he said. “He’s a confident rule-breaker, and they have a higher than average pain tolerance. They feel it, of course, but can deal with it. “Freud talks about people who relish adventure as having a death wish. In fact they want to survive more than most; it is more accurate to say that Aron Ralston and other T-types have a life wish.”
What do people who have faced choices similar to Ralston’s believe? In 1993 Bill Jeracki was out fishing when he got his leg trapped under a boulder in a river in Colorado. He, too, saw no prospect of rescue. So he used his fishing line as a tourniquet and his bait knife to cut off his leg. “I cut through the knee joint like you separate your chicken,” he said. “It’s all soft tissue. It took maybe 15 to 30 minutes.” Jeracki had not expected to survive a single night and acted swiftly. Last week, he was astounded that Ralston had been able to summon the courage and strength to sever his arm after being trapped for several days. “I no longer find it incredible that someone could sever their own arm or leg,” he said, “but to do it after surviving being trapped for five days? Now that is remarkable.” Donald Wyman, a 37-year-old from Pennsylvania, found himself trapped while working in a forest. Somehow he became pinned to a fallen oak tree by his bulldozer. He shouted for help in vain and decided after only an hour that his only hope was drastic action. He used a three-inch pen-knife to amputate his leg, using a shoelace as a tourniquet. He then drove back to his farm. Others talk of an overwhelming desire to survive for the sake of their families. The British climber Stephen Venables did not have to resort to amputation, but he did find himself in freezing conditions high on a Himalayan mountain with two broken legs after a fall. “I was thinking about my wife and children,” he said last week, “and feeling very guilty that the accident had happened and very anxious that I might not be coming back. I was determined to do everything to react until you are put into that situation.”
Another British climber, Dough Scott, also broke both legs while climbing in Pakistan with Sir Chris Bonington. It took them eight days to descend. “I didn’t consciously think of death; all I could think about was getting back home to my kids and my wife,” he said. “I got out of it by picking a feature and getting to that. To think about the whole thing, getting off that 24,000ft mountain with five miles down to base camp, was too mind-boggling. But by nibbling away at the problem it sort of solved itself.” That ability to focus on the immediate task, rather than worrying about the wider consequences, is what probably saved Ralston, says Dr David Purves, a psychologist at London Metropolitan University who studies trauma. “Most people would just die,” said Purves. “They wouldn’t be able to get themselves in the psychological position to operate on themselves. “You would have to come to the decision that there is no alternative. But even that decision is difficult, because, as they say, `hope springs eternal.’ Some people would have left it too late.” How such decisions are made is not always clear. In extreme stress, said Purves, it is common for people to have “dissociative episodes,” where they may not remember exactly what they are doing or why. Ralston, however, seems to have been fully aware. As Mitch Vetere, who was in the helicopter that finally rescued him, said: “He seemed pretty calm for a guy who had just cut his own arm off.”
