Toby Briant-Evans goes skiing, improves his language skills, and stitches scalps back together

Having failed miserably to find something suitably challenging, appealing to my sense of adventure, and sufficiently different from the planned mass exodus of our year to developing countries for their electives, I was very fortunate to end up working in Chamonix Hospital, at the foot of Mont Blanc in the heart of the French Alps. This fitted perfectly with my plans for the elective; an opportunity to do something totally different from medicine back home and chances to pursue my interests in skiing and climbing. Furthermore, it would enable me to develop my French language skills, something that I had always enjoyed but felt had suffered during my medical studies.

Skiing celebrities

The hospital in Chamonix needs to be able to cope with the demands of numerous dangerous mountain activities that attract the best sportsmen in their fields from all over the world, who on the road to fame and fortune have unfortunately found it necessary to lose any sense of self preservation that they may once have had. Thus a visit to the local accident and emergency department is part of an honest day's work, and those treating them soon learn to not bother asking them quite why they decided to throw themselves off that particular cliff that morning, although the occasional presence of a camera crew might explain it. Indeed, my career as an international TV doctor got off to a flying start as I was filmed puzzling over a chest x ray film belonging to a grizzly, hardened French extreme skiing champion with a few cracked ribs who--I was rather surprised to see--had arrived in accident and emergency complete with film crew after a worse than normal tumble down a higher than normal cliff face. My appearance on national television a few weeks later was a great source of amusement to my colleagues in the mess.

Some skiing casualties are reachable only by helecopter

Europe's only specialised centre for mountain medicine

The flagship department of the new hospital is the department of mountain medicine and trauma, the only specialised centre for mountain medicine in Europe. The service is staffed by accident and emergency doctors who share their time between accident and emergency at the hospital and the D"Z," the drop zone where the rescue helicopters are based. The idea is that if someone is stranded half way up a mountain face, or down a crevasse up on one of the glaciers, the medic can be winched down to the casualty from the helicopter and stabilise him or her, ready for the helicopter journey down to the hospital in the valley. Strong winds and poor visibility can, however, hamper the helicopter and the duty medic at the DZ may be called upon to lead a search and rescue team to go up on to the Mont Blanc massif on foot to reach the casualty. Thus all have to be particularly competent mountaineers and skiers themselves. The department is also in the forefront of research into mountain medicine; it is ideally situated to study the complexities of altitude sickness, hypothermia, and frostbite.

A disaster struck area

The 1998/99 winter season in Chamonix will be remembered as being particularly ill fated. A host of disasters hit the resort, including the avalanche in Le Tour which killed 12 people, a fire in the main square, the deaths of two mountain guides, and the sad incident of two British climbers who were marooned on the Droites for six days--one died of hypothermia and the other lost his hands and feet due to frostbite. My arrival in Chamonix coincided with the next, and probably most serious, disaster; that of the fire in the Mont Blanc tunnel. A lorry containing flour and margarine caught fire half way through the 10 km tunnel. The ensuing inferno was to last for three days, reach 900°C, and claim the lives of 42 people, including one of the firemen. My first few days were spent mainly seeing the local firefighters who were suffering from carbon monoxide poisoning and from smoke intoxication. Indeed, on the day of my arrival I was told that the anaesthetist himself had been admitted as he had passed out in the tunnel while trying to rescue the firefighters who had gone in to fight the fire in the early stages and had taken inadequate supplies of oxygen. This was a serious problem, as the hospital could not function without an anaesthetist, and the other one had left that morning for a few days of ski mountaineering somewhere up on the Mont Blanc massif. The only solution was to send one of the rescue helicopters up to try to find him and bring him back to work.

Atmospheric view of Chamonix

Everyday life at the hospital...

After this baptism by fire I was to spend the next six weeks working in accident and emergency, and my expectations of what Chamonix would offer were not disappointed. The type of patients seen were predominantly skiers and snowboarders as these form the majority of the population at that time of year. There were also a lot of locals with work related injuries; the occasional child who had fallen over in the playground; and the odd elderly person with angina. I was given a lot of freedom, and by the end of my attachment, by which time I was more comfortable working in French, I would be seeing patients, ordering x ray films, writing out prescriptions, and discharging the patients myself. Injuries included a lot of knees; cruciates, collaterals or "unhappy triads" that I became an expert at diagnosing, and many broken bones and dislocations; you would be very unlucky not to have had some sort of x radiography before being sent away from the accident and emergency department at Chamonix. My other specialty became suturing as any laceration would be passed my way. A surprisingly common skiing injury occurs in big falls: when bindings pop, skis become airborne and strike the unfortunate casualty on the head. Much of my time was therefore spent sewing back bits of people's scalp that had been lopped off in such an accident.

...is interspersed with more dramatic injuries

Among the excitement would be the distant thudding of an approaching helicopter. Everything would be dropped, and we would rush out on to the helipad with a trolley to collect the latest casualty, fresh from the mountain, still covered in snow. These tended to be the more dramatic injuries. Many were the classic "tib-fib" fractures at the top of the ski boot; an instant diagnosis could always be made when the foot was at 90° to the knee when the splint was removed, or when a grating bone on bone feeling was accompanied by a host of French expletives when attempting to remove the ski boot. Occasionally we would receive people who had fallen down crevasses. As I was the only English speaking person present at the time I spent an afternoon with a petrified New Zealand snowboarder who had spent two hours wedged at the bottom of a 17 metre crevasse and whose core temperature read 29°C on admission. Textbooks will tell you that people should be in a coma or fibrillating uncontrollably at such temperatures, but he was still able to give me his name and address, while the nurses calmly put a duvet over him and ran an extension of his drip line through a basin of hot water to warm him up.

Not only the language skills benefited

It can be deduced from the above accounts that my time in Chamonix fulfilled all of my expectations: it was something completely different and a unique opportunity to pursue a whole host of interests. I was extremely fortunate to be offered the place and am indebted to everyone out there who helped to make it such a fabulous experience, in particular the head of the mountain medicine and trauma service, Bernard Marsigny, and the accident and emergency doctors Manu Cauchy, Guy Duperreux, and Francois Lecoq. I have come away with a fantastic experience of hands-on orthopaedics, emergency medicine, and practising medicine in a foreign language. My French certainly improved, as, dare I say it, did my skiing and healthy complexion.