Soon after Anne and I arrived in Seattle, we became hooked on alpine climbing.
Three of our favorite climbs were:
The Inspiration Glacier Route on El Dorado
The Kautz Glacier Route on Mt. Rainier
and
The West Ridge of Mt. Stuart
It occured to me that alpine climbing was similar to surgery in many ways: it is rewarding, it is technical, and it turns out well most of the time.
Also, like climbers, surgeons often do not learn from past failures.
My friend, Colton Bramson, loaned me a book last night called Accidents in North American Climbing 2023. What stuck me as I paged through this book was that a substantial number of fatalities occurred during rappelling. For the non-climbers among you, rappelling is a standard method of descending from a climb in which the climber slides down a rope that is fixed to an anchor.
In contrast to climbing up (where the climber is supported by his/her hands and feet), in rappelling the climber is completely dependent on (1) the anchor fixed to the rock or snow, (2) the link between the anchor and the rope (usually a combination of a carabiner and webbing or cord sling), (3) the rope (passed through the anchor system so that the ends are of equal length with large knots at the end of each one), (4) the climber's harness, and (5) the link between the harness and the rope (such as a jumar). The technique of getting it right is shown in this link.
As can easily be seen (as is the case in surgery) there are many points of potential failure: anchor, carabiner, sling, harness, jumar and the rope (e.g. sliding off the end of the rope).
Causes of fatal rappel falls have been well documented:
2004 Devils Tower — Fatal rappel error - no knots at the end of the rope
2006: Sinks Canyon — Fatal fall while rappelling - no knots at the end of the rope
2016: Indian Creek — Uneven rope ends, no knots at the end of the rope
2017: Shelf Road — Fatal rappel error - improper set up of rappel system
2020: 6 rappel-anchor failures, 3 of them fatal
2022: Joshua Tree (broken sling) - fatality
Tahquitz (broken sling) - fatality
Mt. Evans (fell while pulling rope after rappel) - fatality
In spite of these examples of fatal errors from which climbers could learn, there were 8 known rappelling fatalities in 2023.
Accidents in North American Climbing sought to determine the cause of each failure, even when complete information was not available, and to suggest what could have been done to prevent the failure
45 yo female, Auburn Quarry-only one end of the rope passed through her belay device=>make sure both ends of the rappel rope are passed through the device
51 yo female, Joshua Tree-failure of old anchor and weathered sling=>avoid using anchor systems placed by prior climbers unless they are solid and in mint condition, take time to place new anchor system
22 yo female, Mt. Evans-fall while retrieving rappel rope=>make sure footing is secure and/or that the retrieving climber is anchored so that the act of rope retrieval does not cause a fall
58 yo female, El Dorado Canyon-one end of rope pulled through anchor=>tie knots in the end of each rope strand
two 67 yo males, Glacier National Park-hastily placed anchor pulled from rock=>take time to assure that anchor is solid and redundant
44 yo male, Leavenworth-poor anchor placement leading to anchor failure=>take time to assure that anchor is solid and redundant
33 yo female, Tahquitz Rock-failure of old anchor and weathered sling=>avoid using anchor systems placed by prior climbers unless they are solid and in mint condition, take time to place new anchor system
It is apparent that the American Alpine Club provides a great example of causal modeling. In each case, they sought to determine the counterfactual - what could have been done differently to prevent the rappelling accident - even in cases where complete information was not available. In addition to the analyses of individual fatalities, they publish their results in their annual publication, Accidents in North American Climbing, so that all climbers have access to the results.
This a perfect example of learning from a relative small number of failures in a space - like orthopaedic surgery - where the great majority of cases are successful (see this link)
For more learning from failure in the mountains, see When Everest Climbers Die Because of Poor Decisions.
Surgery, like climbing, is usually wonderful,
but past failures contain lessons for preventing future failures
Mt. Rainier
August 2025
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link)
The total shoulder arthroplasty (see this link)
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).