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Struck by a Heart Attack on a Mountain

Jon Carlton, then 38, survived a massive heart attack while backcountry snowboarding on 12,400-foot Esha Peak near Mammoth Lakes, California, in April 2016.

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I’d been under the weather all week, but that morning I felt good. I’d dismissed my fatigue as just a cold, but in hindsight, maybe it was an early warning sign. Either way, it was tough to feel too bad the morning of April 4: I had my splitboard, four good friends, and a bluebird day ahead of us.

Our objective was to skin up and ride down 12,400-foot Esha Peak, a stunner with steep, north-facing couloirs. I’d done it in the past, but, after years of drought, we finally had enough snow to go back and tag it again.

Our group—all experienced backcountry riders—set off on the 3.5-mile, 4,700-foot summit route around 8 a.m. The snow was firm, but ski crampons made uphill travel easy. At our first break, I noticed I was feeling sluggish. My legs, particularly my left, kept cramping up, so I compensated by taking slower strides and fell farther and farther behind.

After a few hours of touring, we met up at the base of the headwall. By now the cramping had spread to my back. I downed some water while clicking out of my boards and strapping them to my pack, certain I was just dehydrated.

As we kicked steps on our way to the summit, the cramping grew worse. Every time I looked up, the gap between myself and my friends had stretched. I could usually hold my own, no problem-—I couldn’t figure out what was wrong.

One of my friends, Monica, held up to wait for me, and assuming I was just bonking, handed me a Snickers. Even with the sugar in my system I was too exhausted and in pain to pick up the pace, but I’d been dreaming of this descent for so long. I kept pushing. When I reached the top, the rest of the crew had been waiting on me for more than half an hour.

Every time I’ve stood on a peak, I’ve been stoked. But that day, I could barely muster a smile as my friends welcomed me to the summit. What the heck is wrong with me? I thought. I sat down and drank the rest of my water and immediately puked it up. I couldn’t eat anything. I felt dizzy, like my skull was full of rolling fog. But I shook off my friends’ concern as I prepared for the descent, hoping the cold wind on my face would snap me out of it.

We split into two groups. I decided to go down the main couloir, the bootpack line, because I knew what the snow conditions were like there and didn’t feel up to the quick thinking I’d need to figure out any new terrain. Two of my friends hiked down the ridge to do a line off the west shoulder. Monica and another buddy stayed with me.

As I was walking down to the top of the couloir, the worst cramp I’d ever had hit me between my shoulder blades. I gasped, unable to breathe. Frantic, I took off all my gear—helmet, goggles, gloves, and jacket—and started to roll my back in the rocks trying to relieve the cramping. My buddy got me to sit down and breathe while Monica tried to call our other two friends—one, Kevin, was a paramedic, but his phone went to voicemail and then her battery died.

The edges of my vision began to dim. I feel like I’m dying, I thought. My fingers and toes went numb, and I felt my chest constricting, forcing fast, shallow breaths.

“We need to get down,” Monica said. She said I might have altitude sickness, and a simple drop in elevation would help, but I could hear the forced calm in her voice.

“I can’t get down. I can’t get down.” It was all I could say. The pain was so intense I felt locked in place.

The constrictions came in waves. Whatever was happening, I felt sure there was no time to call for a rescue. If I don’t get myself off the mountain, I’m not going to make it. The thought seemed to occur as if it belonged to someone else. I felt detached, unafraid, robotic. Managing the pain left me with little room to think about anything else.

The entry to the couloir was fairly steep and narrow— about 45 degrees and 10 feet wide—and peppered with rocks. I sideslipped for the first 30 or 40 yards while Monica rode in front, pointing out obstacles. I had to make a hop turn to get around a boulder, then another to turn back onto my heel edge. The familiar feeling seemed to settle me, and despite the mounting pain, I suddenly felt more in
control. Okay, I thought, I can do this.

Then the chute opened up wide, and muscle memory took over. For a few moments, my mind was calm, occupied only with the turns. Over my shoulder, I could hear my friends hooting and hollering as they descended toward us.

Then, at the bottom of the headwall, the adrenaline drained away. Without it, I felt weak and dizzy. I collapsed.

Kevin immediately took over. He said it could be a pulmonary embolism or a heart attack. A heart attack. Lying in the snow, struggling to breathe, I barely heard the words.

“I watched him ride that line; he looked fine,” Kevin said. “If he can get down on his own we are going to get help quicker.” He sounded distant. “A helicopter could take hours.”

There was no cell service, so one of my friends took off down the hill, planning to drive to the fire department to get help. The others pulled me to my feet, took my pack, and handed me a pair of ski poles for balance. I could still snowboard better than I could walk, but Kevin stayed right by my side just in case. We were quiet on the descent—me, fighting through waves of pain, and the others, focused on getting me down.

Near the bottom of the slope, there was a quarter-mile bushwhack. Off my board, I stumbled through it between lurches of pain and dizziness. I could hear Kevin telling me to stop, to take a break, but I couldn’t—when I stopped, all the pain and confusion came crashing down on me in an overwhelming wave. It was better to keep going. At the creek crossing, I slogged straight through the water rather than risk stopping to find the log bridge. We were 20 feet from the parking lot when I saw the fire truck blazing toward us. Thank God.

Later, I found out I had a 100 percent blockage in my left main artery, which I learned was the result of a genetic condition that makes me prone to clots. It’s the heart attack doctors refer to as the widow-maker. Most people don’t survive.

Over a week later, I woke up from a drug-induced coma, on a breathing machine in a hospital in Sacramento. I had a stent put in, then an implantable defibrillator, and I spent a full month in the hospital. Sometimes I think it’s all a big nightmare—until I try to go for a walk. Everything is harder now, and will be for years to come, but I’m alive. 

How to Field-Treat a Heart Attack

1. Know the symptoms.
Chest pain radiating into the left arm or jaw, clammy skin, nausea, vomiting, and dizziness are all classic signs of a serious blockage. “But some people have atypical symptoms,” warns Tod Schimelpfenig, an EMT and the NOLS wilderness medicine curriculum director. Look out for back pain or tightness, a fast or irregular heartrate, and fainting.

2. Administer aspirin.
Aspirin inhibits blood clots and can delay the onset of a heart attack. Schimelpfenig recommends administering 300 mg as soon as you notice symptoms of heart trouble, as well as prescription nitroglycerin if the victim has it.

3. Give it a rest.
“The biggest thing you can do is to limit exertion,” Schimelpfenig says. Get the victim to rest in a seated position to facilitate breathing and reduce the body’s demand for oxygen.

4. Get help.
Call 911 immediately. Hiking out is only recommended if you’re minutes from the trailhead and certain that rescue by road will be faster than by air, Schimelpfenig says.

Learn more skills with AIM Adventure U’s Wilderness First Aid Basics online course.

—Corey Buhay

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