Unrelenting in winter, frostbite poses a life-changing threat to homeless Alaskans

Earlier this month, Michael Baker fell asleep in an Anchorage snowstorm.

At the time, the 63-year-old was living in his Subaru. He thought he was prepared for the third of three major storms that hit the city in December: He’d bundled up in his warmest winter gear. He was wearing boots and socks.

Falling snow quietly buried his station wagon, parked near downtown. The battery went dead. The car grew cold. At some point, Baker drifted to sleep.

When he awoke, his boot liners were frozen. His feet felt numb and deadened, as if they belonged to someone else.

He’d had frostbite before and knew he urgently needed help. Somehow, Baker struggled through the foot of fresh snow to a nearby fire station.

The firefighters “took one look at my feet and took me to the hospital,” said Baker, a former logger originally from Idaho.

In Anchorage’s long, frigid winters, frostbite poses an unrelenting threat to the homeless.

People with cold injuries show up in emergency rooms regularly.

“This time of year, we get somebody almost every day,” said Dr. Tim Ballard, the chief medical officer at Alaska Regional Hospital.

Most have mild frostbite. But the most severe cold injuries can have devastating, life-altering consequences that include losing fingers, toes, hands, feet and skin to amputation.

Losing a part of your body to frostbite is a life-changing injury, and one that makes the already grueling routines of living without consistent shelter that much harder, said Raeshawndra Jett, who manages the medical respite clinic at Brother Francis Shelter. The clinic aims to give unhoused people leaving the hospital a safe place to recover from hospitalization.

She remembers one young man who lost every finger and toe on both hands to frostbite. Still in his 20s, he ended up in an assisted living home because he needed help with everyday tasks, Jett said.

“There were so many things that he just wasn’t able to do,” she said.

‘Changes your life’

Over the past five years, in at least 262 cases Alaskans were discharged from medical facilities after undergoing amputation surgery related to frostbite, according to data from the Alaska Division of Public Health’s health facilities data reporting program. That’s an average of 52 per year.

Data suggests frostbite disproportionately impacts unhoused people: At least half of the inpatient cases included the diagnosis code “related to housing and economic circumstances,” indicating homelessness.

Dr. James O’Malley has been practicing as a surgeon in Anchorage for over 30 years and has performed many frostbite-related surgeries, including amputations.

He estimates that roughly two-thirds of his frostbite patients over the years have been homeless, with the balance being outdoor misadventures during mountain climbing or other winter recreation. Last winter, he completed 12 operations for frostbite.

Talk to people who have lived on the streets of Anchorage and they’ll tell you: Getting frostbite “changes your life,” as Brian Vaughan put it. Vaughan is homeless and camps year-round outdoors.

[Anchorage Assembly raises capacity at Sullivan Arena shelter amid surging demand during cold snap]

Avoiding frostbite during days and weeks when the temperature falls below zero takes vigilance and creativity.

People who’ve lived winters without regular shelter in Anchorage know the hidden ways of finding warmth from the city, he said.

Some of them: Double up on gloves. Know where every heated sidewalk in the city is located. Memorize which buildings vent warm air into alleyways. Linger in grocery store lobbies and library corners. When walking long distances, wrap your boots in plastic bags. The cold is always waiting.

Lucky

Baker, a compact man with a soothing voice, said he felt like he came away from that cold night in his Subaru lucky: His frostbite only affected the bottom of his toe, where a spot of flesh has turned black.

He was in the hospital for a day or two. When he was discharged, he went straight to the Sullivan Arena shelter.

It wasn’t his first experience with frostbite in Anchorage.

Baker, who says he is disabled from years of hard physical work in logging camps in Idaho and Montana, lived in a shelter at the outset of the pandemic. One day he ended up on Tudor Road in the snow, in nothing more than sneakers.

He had to have part of the bottom of his foot removed. The area still gives him trouble years later.

“Yeah, when it gets cold, it hurts,” he said. “It’s most susceptible to the cold.”

He’s been sober and clean for years and had wanted to avoid shelters because of disruptive people, he said. But healing from frostbite, “inside is where I need to be.”

He said he planned to remain at Sullivan Arena until he could figure out how to get his station wagon working again.

It’s simple: When there’s nowhere to get out of the cold, more people end up with frostbite, said David Rittenberg, the manager of the Brother Francis Shelter.

“With people that don’t have access to shelter, or when there’s not enough shelter available, we see an uptick in it,” he said.

[Anchorage pedestrians navigate a post-snowstorm obstacle course]

Often, people who come to the ER with serious frostbite are in some kind of altered mental state, said Dr. Daniel Safranek, the medical director of the emergency room at Providence Alaska Medical Center.

“They might be intoxicated, or under the influence of drugs, or just may not have the wherewithal to get out of the cold,” he said.

Safranek sees the Anchorage Safety Patrol — a service that picks up people in public and showing signs of impairment and takes them to the city-operated “sleep-off center” — as a crucial tool that likely prevents cases of frostbite every year.

Robin Cope is a physician assistant who works at The Caring Clinic, a Southcentral Foundation-operated clinic at the shelter. She also worked at a health clinic inside Sullivan Arena. Frostbite cases come in waves, she said, and not always during times of severe subzero weather. In warmer winter weather with lots of snow, people tend to get wet and are unable to get dry. That can also lead to frostbite, Cope said.

“I think we need to simply have a better plan for the unhoused,” she said. If there’s anything that’s predictable about living in Alaska, she said, it’s that winter will come.

Recovery

On a recent afternoon, Raeshawndra Jett, the Brother Francis respite manager, was on the phone with a potential guest — a man who was hospitalized with frostbite. But his condition had worsened, and he wouldn’t be leaving the hospital right away after all.

“We’ve been trying to get him in here for a week,” she said.

About one in 10 guests of the respite clinic are there due to frostbite itself, according to data compiled by Catholic Social Services. But about half come to respite care due to infections, lung issues or wound care — injuries potentially linked to cold weather exposure or the aftermath of frostbite, said Molly Cornish, a spokesperson for the organization.

In the 10-bed respite unit, people get wound care, a crucial part of recovering from the blisters and skin damage that cold injury can cause, and they get help making it to follow-up appointments. They also stay out of further cold.

Physicians emphasize that people recovering from cold injuries need to stay warm, or they risk more serious cold injuries. Amputation is necessary only in some circumstances.

Surgeries aim to remove the dead tissue while still keeping as much function as possible for the patient, said O’Malley, the longtime surgeon. Too often, people start with mild frostbite and then get exposed to the cold again. Re-freezing the already cold-damaged tissue makes a more serious consequence, such as amputation, more likely.

[24 people believed to have been homeless died outdoors in Anchorage this year]

“If you put someone who has frozen their feet back on the street, the risk of them having another freezing injury is quite high,” O’Malley said.

Jett, the respite clinic manager, sees the cycle play out: “A lot of times, they get frostbite and they don’t think it’s that bad. So they go back out into the community, they get it again. Now it’s gotten worse,” she said.

Or maybe someone waits to get medical care, thinking it will heal on its own.

“They’re waiting a couple weeks thinking, ‘Oh, it’s going to be OK, I’ll put on another layer of socks.’ And then they go to the hospital and they’re at the stage of amputation.”

A trade-off

On the winter solstice, the sun struggled to rise over the horizon and the air temperature in Mountain View hovered near zero. Down a precisely shoveled trail near Davis Park, Brian Vaughan’s tent was a haven of warmth.

Vaughan and a dozen or so others camp all winter, even when subzero temperatures drive others into shelters. He sees shelters — specifically the people in them — as less safe than his tent. Furthermore, he said, he’d heard about people sleeping on the concrete floor of a so-called “warming area” at the Sullivan. It didn’t sound good to him.

“It’s just gotten kind of crazy up in there,” he said.

He’d taken a kind of trade-off: Live on his own terms, but in a battle with the threat posed by cold.

Inside his tent, packed tight with belongings and visitors, Vaughan used a propane stove to heat some breakfast sausage — something public health officials strenuously warn against due to the risk of carbon monoxide poisoning in an enclosed space or fire. Yes, tent fires are a worry, Vaughan said. But so is freezing. He’d gotten frostbite on a toe three years ago and didn’t intend to experience it again.

“It was just a small spot, he said. “Turnt black and fell off.”

He knew how fast frostbite could set in — exposure leading to a disabling cascade of trouble. A man he knew had lost feet to the cold.

“I’ve gotten lucky, myself,” he said, adjusting the propane flame on the stove.

It usually came down to a momentary lapse. The daily business of living outdoors in a frigid climate is exhausting, he said. One day, you slip up.