Of all the exams that Annika Piccaro ever faced, her most daunting test occurred outside the classroom when a devastating snowmobile accident pushed her to work harder than she ever had so she could receive her Colorado College diploma in front of family and friends.

“When I was lying in that hospital bed, I thought a lot about graduation. I promised myself I was going to walk across that stage. I didn’t care if it was assisted, with a walker or with a cane, but that was my big goal. It ended up that I didn’t need a walker or crutches – I just walked by myself. It felt so good.”

Her college campus in Colorado Springs is a long way from the snowy backcountry in the small town of Rico, 30 miles south of Telluride, where Annika suffered a terrible accident on Jan. 1, 2024, that plunged her into a year’s worth of operations, recovery and rehab.

“It’s taken me a long time to return to normal. My body felt so foreign to me. But I’m comfortable in it again. I have this vessel, and it’s so strong, and I can trust it fully again.”

Looking back, she had no idea that when she set off for a fun day with old high school friends, her life would change forever.

Back for winter break at her home in Durango with her family, Annika, then 21, was having fun with some high school friends. They were “skijoring,” a Norwegian word for ski driving, an activity that began in Scandinavia as a transportation mode during harsh and snowy winters. It originally entailed skiers being pulled by horses and dogs and has since evolved to using other modes of transportation such as cars, motorcycles and snowmobiles.

“I was with all my hometown best friends that day. It was clear skies and a beautiful day, a bluebird day, gorgeous and warm and we were wearing T-shirts. It was about 1 pm.”

With the San Juan mountains towering in the background, Annika was at the wheel of the snowmobile with a friend sitting behind her as they pulled a group of friends. Unfortunately, the snowmobile was not responding well to her steering in the conditions. One of the last things she recalls before the accident was trying to turn a corner, but the machine wasn’t having it.

Heading toward a drop-off, she steered left to avoid it, but the snowmobile didn’t respond and lurched 10 or 15 feet into the air. Her friend managed to jump off, but the snowmobile went sailing with Annika still on board.

“I heard the screams of my friends, and I remember that my brain just froze. I didn’t even have any thoughts or negative reactions. I blacked out for a second, and I woke up with this machine against my side. I started screaming, ‘Get it off me.’ I couldn’t see or move. I was stuck and being crushed by it.”

The snowmobile had landed on top of Annika, crushing the right side of her body.

A friend quickly popped off his skis, scrambled down the hill and was able to pull the snowmobile off of Annika. The first thing she did was wiggle her toes to make sure she wasn’t paralyzed.

Pumped up with lots of adrenaline (“it’s crazy how much of a pain killer that is,”) she hoped she’d just dislocated her hips and would be fine. But then she tried to move the rest of her body.

Her friends, though scared, remained calm. They did not try to move her and held her hand and talked to her. She credited them for helping save her life by doing all the right things during a traumatic situation in the backcountry.

“I wasn’t crying or screaming; I think by then, I was in shock. I was concussed a little and had to keep reminding myself every 30 seconds where I was. But I always thought I was going to be fine. I had such an overwhelming sense of trust in the universe, and I just knew that deep down that I was going to be OK. Some part of me told myself to calm down.”

She then turned to her friends and told them to call 911 …. and her dad.

‘I’m not afraid of anything’

Annika was always on the go growing up, and movement played a huge part in her life as a ‘mountain kid.’ She did competitive dancing and spent a lot of time with her family outdoors, camping and backpacking amid the beauty of southwestern Colorado.

“I’m not afraid of anything,” she said. “I definitely grew up adventurous and very much a free spirit.”

She chose Colorado College for the variety of its extracurricular activities as much as its academics, and she studied computer science while she also taught and choreographed dance.

During her winter break, a day of skijoring with friends was right in Annika’s wheelhouse.

The town of Rico is about an hour northeast of Cortez, the closest city with a hospital. But the area where the accident occurred was further away, on a remote back road, not easily accessible.

A stroke of luck after a crushing snowmobile accident

But in a stroke of luck – or divine presence, according to Annika – the group happened to be on the property of the head of the local volunteer search and rescue unit.

“I basically crashed into his backyard,” she said. “There were volunteers out there in 15 minutes, which was lifesaving. Otherwise, I probably would have bled out if I would have had to wait for an ambulance to arrive from Cortez.”

Volunteers loaded her into a truck and started driving her to Cortez as feathers from her down jacket filled the cab and stuck to the blood in her hair. Halfway there, a hospital ambulance met them to take over the transport to the ER, where Annika’s dad, John, a rural primary care physician, was waiting.

Having seen his share of emergency accidents, he was immediately alarmed when he saw the angle of her feet and the extent of her injuries.

“We were terrified,” he said. “Being a doctor, there were times that I felt like I knew too much about what could have happened and might have gone wrong. But she is so strong, so powerful.”

Annika was critically injured with a pelvis that had been crushed and nearly obliterated by the weight of the snowmobile.

“When they did the first X-ray of my pelvis, they said I might die. I had lost half of my blood volume during the past two hours. Here I was, thinking I was fine. I thought I had dislocated my hips and would be on crutches.”

Transported by a helicopter, then an air ambulance to get more help

After she was stabilized, Annika was taken by helicopter to a larger hospital in Grand Junction. Her friends lined up on either side as she was wheeled in a gurney to the chopper, but she was in too much pain and nauseous from the pain meds to speak. With a suction tube in her throat so she wouldn’t choke on her vomit, she flew with the pilot and a flight nurse to her next stop.

At Grand Junction, she would receive six units of blood (in addition to the three she’d had in Cortez) and have her pelvis bound to slow its bleeding and immobilize it. She also had a chest tube inserted to help her breathe, as one of her lungs had collapsed.

But Annika’s injuries were so severe she would need the medical skills and expertise of a Level 1 trauma center.  That meant one more leg in her exhausting trip to get her the help she desperately needed.

A few phone calls later, she was on a medical flight to Denver, where an ambulance would transport her to UCHealth University of Colorado Hospital at the Anschutz Medical Campus.

“I knew deep down I would end up in Denver. Unfortunately, rural Colorado does not have the expertise to deal with the kind of injury and trauma I had,” she said. “I was so tired on that flight, but I was worried that if I closed my eyes, I might die, so I stayed awake.”

This was the only time during her ordeal that her thoughts took her to such a dark place.

Kind nurses and the first of many surgeries on the path to an inspiring recovery

That night at Anschutz, it was a blur of lab tests, scans and blood work as her medical care team hurried in and out of her surgical trauma intensive care unit room. She was stable enough to wait for next-day surgery, allowing time for her parents to arrive. During that long first night, she credited the UCHealth care team for staying with her. One nurse gently washed her hair, still strewn with feathers, while a second nurse braided it when it was clean.

“I remember feeling so safe even though I had no family there. It was really comforting. The nurses stayed with me the whole night.”

Her parents were grateful for the important role UCHealth staff played in Annika’s recovery, beginning on her first day.

“Nobody knows how painful and hard it is for these patients to experience what they’re experiencing,” said Michele, Annika’s mom. “To come back from near death and pain of a pelvic fracture, losing half her blood, and going through PT when every movement hurts. I don’t know how you capture it.”

Said her dad: “I kept thinking: ‘What’s next? What is the next hurdle she has to go through? How are we going to help her through this?’ But she trusted and had faith in the team that was taking care of her and let them do their job.”

The next day, 24 hours after her accident, Annika had the first of many surgeries to piece together her smashed pelvis. Her injuries were extensive: more than 60 jagged bone fragments were scattered throughout a complex system of pelvic nerves that caused excruciating pain.

She also had injured her sacrum, the bone that connects the base of the spine to the pelvis, had seven stable vertebral fractures and had broken several ribs. Internal damage also included a partially devascularized right kidney, a severe injury that means the kidney’s blood supply has been disrupted.

Annika was looking at a long rehabilitation process – daunting even for a young, spirited and competitive woman like herself.

“I don’t think it clicked in my brain then what recovery was going to mean.”

Annika faces surgery and rehab, then more surgery and more rehab

The pelvis is the ring of bones located in the middle part of the body that supports our upper weight, providing the stability that allows us to stand, walk, run and move. It also contains a vast system of vascular support, as the arteries there – six in the female pelvis – supply blood to nearby tissues and organs, as well as blood to the lower limbs. Those organs for women include the ovaries, fallopian tubes, uterus, cervix and bladder.

“She had a pelvic ring injury but a very complex one with multiple fractures around the pelvis, along with bones that were broken very significantly and no longer attached,” said Dr. Nicholas Alfonso, Annika’s orthopedic surgeon at UCHealth.

The surgeries she would undergo were complex because the bones had to be stabilized and precisely realigned with plates and screws on the back and front of her pelvis to prevent future pain and ensure her gait would be as normal as possible, said Alfonso, who is also an assistant professor at the University of Colorado School of Medicine. The shards of bones around all the pelvic area nerves had to be cleaned up as well.

“There’s a lot of nerves in that area that can sustain damage in a traumatic injury, and there’s a substantial amount of blood as well.”

After her initial surgery and a few days recuperating, Annika went to the UCHealth rehabilitation unit.

Two days after the surgery, she managed to sit up – a feat so painful she nearly passed out. In the following weeks, she began intensive daily physical and occupational therapies.

She progressed from barely being able to move her legs and lower body to transitioning to a chair with help, and then slowly being able to put weight on her legs. Standing for 10 seconds and then 30 and then being able to walk with the assistance of the parallel bars.

Annika’s therapists encouraged her to work harder than she thought possible.

“Her doctor said she could stand on her own,” recalled Kalina Caudillo, one of Annika’s UCHealth rehab physical therapists.

“She said, ‘Are you sure?’ Then she did it, and it was a game changer. She felt so good and progressed to stepping with a walker,” Caudillo said.

Annika and Caudillo, a former college dance team coach and ballet dancer, bonded over a shared love of dance. Their rapport and trust built each day.

“Patients like Annika want to succeed for themselves, their family and also for you, and it becomes a beautiful relationship,” Caudillo said. “She was so motivated she was going to succeed no matter who saw her, but when you have that human connection, that makes it so much more special. When she walked on her own, oh my gosh, I was in tears, and we were hugging. It was so awesome. “

The feeling that her therapists had for Annika was mutual.

“I loved them,” she said. “They were trying to get me back to normal. The beautiful thing about Anschutz is I generally enjoyed my time there because I was surrounded by fantastic providers. I had such trust in the system, the plan and what all my caregivers were telling me.”

After leaving the hospital, Annika returned for another surgery as she raced to heal in time for graduation

Fifteen days after the accident on Jan. 16, Annika rang the bell on the rehab unit floor, heralding the end of her stay there, and she was able to go home. With a bag full of stuffed animals, armfuls of flowers and surrounded by family and friends, she left, albeit 30 pounds lighter, but determined to get back to her previous life.

Home in Durango, with a new front door ramp that friends had built while she was recovering, a future filled with what seemed like endless rehab was daunting. She was required to stay in a wheelchair for two months to allow her bones to start healing.

“My friends were back at school, and while I knew how lucky I was. Still, it was the hardest thing I’ve ever been through. I’m tough and dedicated, but without the support system I had, it would have been really dark.”

Unfortunately, after a few days, she noticed she was losing function in her left leg. She returned to Anschutz and underwent a laminectomy, a spinal surgery that entailed the removal of part of the spinal bone to help relieve her back and nerve pain.

Annika left the hospital but soon returned when she developed a hematoma (a pool of clotted blood) at the site of the spinal incision. Finally, by mid-February, she was ready to head home again.

Back home again, but itching to get back to campus life and walk across the stage to get her diploma

Back in Durango, Annika dedicated herself to unrelenting physical and occupational therapy. She also began walking outside on her own with trekking poles. Soon, she was driving again, which restored her sense of independence, but she wanted more. She missed college life, especially all the fun that comes with senior year.

Her professors at Colorado College were very supportive during her convalescence: She had enough credits to graduate, and they told her not to worry and to focus on healing.

“I love my parents, but a lot of my autonomy had been taken away so quickly. I wanted to go back to Colorado Springs so I could be with all my best friends. No classes, just PT and hanging out with them.”

She soon returned to a bustling off-campus house. There were festivals, music events, a prom and parties (along with PT and lots of naps) – all forcing Annika to build stamina and grow stronger to keep up with her peers.

When her May 19 commencement arrived, she was more than ready. In front of family and friends, she practically sailed across the stage and accepted her diploma.

“She never wavered in her goal to heal as best she could,” her dad said. “We would say, ‘Be limitless within your limits, and the limits will continue to expand.’”

Annika’s mom thinks the accident has matured their daughter beyond her years.

“She has always worked hard and seized moments to enjoy life, and this was no different. Miraculously, she will live almost the life she had before. One little wrong turn and her outcome could have been very different.”

On the road to recovery: A job, volunteering and perhaps a new direction in life

A year after her accident, Annika, now 22, isn’t pulling anyone on skis. She’s got them on herself as she is back on the slopes with confidence, courage and no pain.

“When he first saw me, Dr. Alfonso said: ‘In a year, we are going to get you skiing.’ I thought to myself, ‘You’re crazy!’ But when you go through something so traumatic, there was no other option for me but to trust him and everyone who helped me and believed in the work they were doing.”

She had another surgery in December to remove the hardware from her pelvis and then had to spend a night in the hospital to remove another hematoma. This one developed in her abdomen. Now, she is hopeful that she’s done with surgeries and hospital stays.

“Once everything is healed, the plates and screws are no longer needed as the body is healing itself and is much more durable than anything I could ever do,” Alfonso said. “Annika went through so much, but she is on her way to living her life and doing all the things she loves to do.”

She is still a regular at Anschutz, but for a different reason now: along with her software engineer job, she volunteers in the same surgical trauma ICU unit where she was a patient and is pondering a career in medicine.

“I love Anschutz so much. I want to help people and give back to the institution and to the people who healed me. I’d like to be there for others going through traumatic accidents who might not have the support that I did. It can be isolating, and I want them to know they are not alone.”

She is diligent, disciplined about PT and continues to get stronger while her family wants her to take the time to enjoy life.

“We want her to get some of that innocence and joy of youth back because this past year took a lot out of her,” her dad said. “She had a battle, a lot of loss, and she will continue to face some challenges going forward.’’

For Annika, she just wants to be a “normal” 22-year-old.

“I have a second chance at life. I am so grateful to hug my family and feel sunshine on my face. I survived because I was an active mountain kid, and I want to run and ski and bike and dance because I can. But just as importantly, my fiercely positive attitude saved me and helped me heal so thoroughly. Last year was far from normal, but I have such gratitude, happiness and joy in the mundane because I get to experience the gift of being alive.”