The face of a dog, lying on the floor. A woman's foot and leg is right behind the dog

A woman seated behind a DHART helicopter in its hangar

A woman's hands hold a makeup brush and small vanity

A woman walks her dog in a snowy landscape

A woman reaches down from her desk to pet her dog

An older man kisses the forehead of a younger woman outdoors on a sunny but snow-covered Winter's day

“I think that if I didn't get flown to Dartmouth Hitchcock Medical Center immediately, I don't know if I would be here right now.”
- Caroline Alley

Caroline Alley seated next to DHART Helicopter

Guardian Angels: Caroline’s Way Forward

Caroline Alley, 27, is grateful for her life. She loves her career in the beauty industry, lives in Manhattan with her dog Snoopy, and has a close-knit family and friend group.

Unless she told you the story, you would never guess that six of her toes are missing after a weekend getaway went wrong in a way no one predicted. She considers herself lucky that she didn't lose more than that.

Deep freeze

Four friends. A winter ski trip. A hot tub.

The weekend in Stratton, Vermont, had everything that would make perfect memories. But freezing cold temperatures meant the group would forgo the slopes and stay cozy instead, ending their night in the condo community's hot tub.

After hanging out for a bit, one friend stayed behind to pack up, while the others went back to the condo. Caroline trailed behind them but never caught up.

It was dark outside, and all the condos in the ski village community looked the same. Wearing only a bathing suit and towel, she stood at what she thought was their garage door, shivering, waiting for her friends to appear.

That was her last memory of the night.

Caroline Alley kneels down to pet her dog

Wake up

Three days later, Caroline woke up in the intensive care unit at Dartmouth Hitchcock Medical Center. Slowly, she would piece together what happened.

The sudden shift from hot to cold was too much for her body to handle. Caroline had lost consciousness at the neighbor’s garage door, and frostbite—the freezing of the tissues under the skin—set in.

“Your body rapidly tries to preserve life and sacrifice a limb,” said Max Alley, Caroline’s father, who is an orthopaedic surgeon and works in a Level 1 Trauma Center in New York. “You go into what is called “vasoconstriction” to save the blood flow for the brain and the body.”

As Caroline’s body temperature dropped, her friends searched for her, going door to door. A neighbor stepped up and called the police. “She's really the first hero in a line of heroes,” Caroline said.

A search party was assembled, and soon, a firefighter found Caroline unconscious in the snow—just two doors down from the condo she and her friends rented.

She would later learn that her body temperature was only 73 degrees. “She was extremely cold and in serious jeopardy of losing her life,” said Max.

“I'm lucky enough to be Caroline's dad but also a surgeon,” he said. He admitted it was terrifying to know what could happen to his daughter.

Caroline Alley and Flight Transport Nurse standing in front of DHART Helicoper

Rescue by wings

“I truly believe that I have a lot of guardian angels,” Caroline said of that night.

The Dartmouth Hitchcock Advanced Response Team (DHART) helicopter is small. It only fits a couple of people, along with everything needed to stabilize a patient and fly the skies.

“We prioritize immediate life threats,” said Caleb Moffatt, RN, CCRN, CFRN, NREMT, a DHART flight transport nurse who was part of Caroline’s rescue. “When we got to you, you were completely unresponsive,” he told Caroline in person when they met for this story.

When the DHART helicopter swooped down to get Caroline, her vitals were so low that Caleb and Jeremy Patten, NRP, FP-C, Flight Paramedic, were surprised she didn’t go into cardiac arrest.

EMS on the ground at Stratton “did the most important thing,” Caleb said, which was making sure to maintain her airway. From there, the flight nurse and paramedic could do their work.

“I think that if I didn't get flown to Dartmouth Hitchcock Medical Center immediately, I don't know if I would be here right now,” Caroline said. “I truly feel that DHART was an angel, and the rest of my guardian angels brought them to me.”

Caroline’s parents, who were out of town at the time, flew to Albany and drove to New Hampshire to find their daughter intubated. Her skin was rosy; the color was back in her cheeks.

Brian Jones, MD, PhD, the doctor in the ICU told them that she would be physically and mentally okay after all of this. He was just one part of the critical care team of nurses, physicians' assistants, respiratory therapists, and others involved in Caroline’s care.

“It shocked me that he predicted the future when she was intubated,” Max said. “But he was exactly right.”

Recovery

“I had never seen a hyperbaric machine before,” Caroline said, before starting seven days of hyperbaric oxygen therapy at Dartmouth Hitchcock Medical Center.

This kind of therapy uses a high-pressure chamber to bring fresh oxygen to damaged tissue and is commonly used to treat wounds from diabetes, cancer radiation therapy, and frostbite.

Jay C. Buckey Jr., MD, a specialist in hyperbaric medicine, was Caroline’s doctor. “You meet Dr. Buckey, and you're impressed by him immediately,” Caroline said. He and Pamela Hannigan, RN, helped Caroline feel comfortable and explained what she could expect while in the high-pressure chamber.

They also started treatment on the weekend, when the facility was normally closed.

“She would go down to the hyperbaric chamber, and her feet were gray. And she'd come back, and they were pink,” Max said.

“I never wanted to skip a day,” Caroline said, knowing it could mean the difference between saving her feet or losing them entirely.

Caroline Alley standing with an older gentleman in the wintry outdoors

Grateful

Hyperbaric therapy wasn’t the only part of Caroline’s recovery.

Over the course of two years and more, she underwent skin grafts for her feet, extensive wound care, and the amputation of six of her toes.

She remembers days when it was painful to lift her leg. Now, she walks Snoopy, her Golden Retriever, around the city every day. “I've learned a lot about being grateful for what your body can do,” she said.

She still experiences nerve pain, and is working on treatment. But she’s also focused on living her life. One day, she hopes to combine her knowledge in wound care and beauty to help others with skincare and scar treatment.

“Nobody wants anything like this to happen,” she said. “But I think it's important to know in your heart that something good will come out of it.”

For Caroline, the silver lining was the people she met along the way, from her DHART crew, to the hyperbaric team, and so many others, she said.

“If I'm going to remember anything from this experience, it's going to be the people that I met at Dartmouth Health who helped me get through this, and who kept a smile on my face while I did.”