The crackling message over the 911 scanner is delivered with cold precision: The female patient in the ambulance is dazed and concussed, clinging to consciousness.
Natasha Richardson lay on a stretcher inside the speeding vehicle, her mind confused, her breathing aided by oxygen. A fall taken on a ski hill earlier was already, silently, killing her.
"I'm arriving with a female in her 40s … [she's]disoriented …" the medic radioed to hospital staff. "It's following … a ski fall that happened at noon. Soon afterward she presents signs of confusion, a concussion."
Radio exchanges between ambulance medics and a 911 dispatch centre obtained by The Globe and Mail reveal that as she was being rushed to a Laurentians hospital in the afternoon, Ms. Richardson's health had deteriorated but her condition was still eminently treatable. By the time she reached a Montreal trauma centre at the approach of sunset, her state was dire, the damage to her brain probably irreversible.
The medic read her vital signs on the way to hospital in the afternoon, all reassuring: Blood pressure 124 over 86. Pulse 70 beats per minute. Breathing "100 per cent" with the help of oxygen.
"We'll be there in about eight minutes," he said.
Ms. Richardson, 45-year-old scion of a theatrical dynasty, was suffering from a blunt head trauma, blood forming a clot inside her skull that ended up fatally pressing on her brain.
Two days later, the award-winning actress was removed from life support.
Ms. Richardson struck her head during a beginner's ski lesson at Quebec's Mont Tremblant in a banal spill, the kind seen any day on Canadian slopes.
Yet this fall set off a sequence of events that, in a conflation of tragic choices and lost time, doomed her.
BUNNY HILL RUN
The Nansen run at Mont Tremblant is a bunny hill, a gently sloping run favoured by ski instructors coaching novices and parents with young children.
Ms. Richardson had signed up for a lesson on Monday, March 16, a day that promised a skiers' paradise of abundant sunshine and near-windless conditions. The temperature reached several degrees above zero, but before lunchtime, the snow was still firm enough to give someone a good knock on the head if they fell, according to a resort veteran who'd skied it that morning.
Ms. Richardson was on an area known as the flats when she tumbled within sight of her instructor. No one knows exactly what caused the spill, but the blow and after-effects were worrisome enough for the resort's ski patrol to call an ambulance.
The call was routed to the 911 dispatch centre near Mirabel, Que.
"Priority 3, Tremblant resort … female, 42 years old, 17-Bravo-1," the dispatcher says.
Despite the mix-up about Ms. Richardson's age, the message underscores the severity of what had just occurred: 17-B-1 is paramedic jargon for a fall, possibly dangerous.
Priority 3 meant medics have to get to the hill immediately and use their siren if necessary. They are told to go to the Nansen Bridge, a narrow overpass spanning the ski run.
They arrive 17 minutes later.
But no one is there.
"10-17," the medic says at 1 p.m., meaning he has arrived. "Uhh, we're still waiting for the patient."
Ms. Richardson makes a fateful decision. In a response not uncommon among head-trauma victims, she feels fine and refuses medical help. Her minders tell the waiting medics.
"There's a [ski]patroller who just went by, who tells me it's a 10-3," the medic reports to dispatch at 1:11 p.m.
10-3: In ambulance code, it means the job is cancelled.
Rising on the shore of Lake Tremblant, the Hotel Quintessence is a refined getaway with fireplaces in each room and a celebrity clientele. Ms. Richardson had booked in with one of her young sons while her husband, actor Liam Neeson, was shooting a film in Toronto.
Ms. Richardson decided to retreat to her suite after her fall, accompanied by the ski instructor. The actress, sloughing off concerns over her condition, is said to have walked there under her own steam.
Under ski patrol rules, she would have been asked to sign a waiver saying she declined medical help.
A private medical clinic with a physician is steps from the hotel. But the owner said Ms. Richardson didn't seek treatment.
As mid-afternoon approached, she began to experience severe headaches. The hotel decided to call 911.
Ambulances have different levels of priorities when they're answering calls, and this one got the most serious: Priority 1, requiring the ambulance to race to the scene with sirens on.
"Priority 1, Mont Tremblant," the dispatcher says at 2:59 p.m. "This will be at the Hotel Quintessence, Suite No. 11. For a female, 41 years old. 17-Delta-1."
This designation means that the injury is now classified as "dangerous."
Within 45 minutes, the medics load Ms. Richardson into the ambulance and head to the Centre Hospitalier Laurentien in Sainte-Agathe, a local hospital serving 60,000 people in the Laurentians and injured or ill skiers.
Racing toward the hospital just before 4 p.m., the medic gives a crucial index of the actress's state: She has a Glasgow score of 12 out of 15. The Glasgow coma scale measures degrees of consciousness. A rating of 12 is worrisome, but a doctor would consider the patient very much treatable. (A fully alert person would receive a score of 15.) The medic says the patient is "verbal," meaning she responds when spoken to, but otherwise drifts off.
She is losing touch, however. Her orientation rating is 0, meaning that she doesn't know where she is, what day it is, or what happened to her.
The hospital whisks Ms. Richardson into one of its two emergency rooms, Crash Room 2. Staff work to stabilize the actress and prepare her for transfer to Hôpital du Sacré-Coeur, the closest of two Montreal trauma centres.
A dispatcher summons an ambulance.
"Priority 2 Sainte-Agathe … Crash room 2, destination Sacré-Coeur," says the call at 5:15 p.m. "With oxygen, 10-48 [an escort]and a [heart]monitor."
The ambulance arrives in five minutes. Ms. Richardson is loaded in with a nurse and respiratory technologist.
They set off at 5:55 p.m.
AMBULANCE TO MONTREAL
The trip from Sainte-Agathe to Montreal's Sacré-Coeur hospital is 88 kilometres.
On a typical weekday evening, commuters are heading home out of Montreal. And the ambulance ferrying Ms. Richardson was flying down Hwy. 15, commonly known as the Laurentian Autoroute, at up to 138 km/hour.
It reached Sacré-Coeur in less than 45 minutes, at 6:38 p.m.
According to a medical insider, a neurologist there was overheard saying that Ms. Richardson's pupils were unresponsive, a sign of advanced brain damage.
From the time the ambulance was dispatched to her hotel room and her arrival at the specialized hospital, nearly four hours elapsed. Some have said a medical helicopter, which can make the trip from Mont Tremblant to Sacré-Coeur in less than 30 minutes, might have saved Ms. Richardson.
By lunchtime the next day, she was airlifted to New York and taken to Lenox Hill Hospital, a community medical centre on East 77th Street.
The brevity of her stay at Sacré-Coeur suggests she was already brain dead and beyond help.
Among those who notice such things, the fact that Ms. Richardson was taken to Lenox Hill was a quiet admission that she was likely beyond hope. The respected institution has handled head trauma, but does not specialize in complicated neurosurgery. She was placed on life support.
"If you're brain dead already, the rest of your body isn't far behind," explained Marc S. Arginteanu, an attending neurosurgeon at Lenox Hill who was not involved in Ms. Richardson's care. "You have to support their lung functions, their respiratory rate, but you'll also have to support their cardiovascular function, so a lot of times there'll be drips of medication to keep their blood pressure high enough to allow their heart to beat. The other thing that happens is the hormones that control fluid balance stop being produced, so you have to artificially allow that to be dripped into the patient's veins too.
"Despite everything you could possibly want to do, once somebody is brain dead, it's really just a matter of time before the body goes."
Ms. Richardson wasn't the first celebrity to use Lenox Hill as death's waiting room. Others who have died there include the novelist Olivia Goldsmith ( The First Wives Club ), Katie Couric's husband, Jay Monahan, Ed Sullivan, and the alleged spy Alger Hiss.
After years on the public stage, the final moments of Ms. Richardson's life unfolded in a forum that was not entirely private. On the seventh and eighth floors, the cream-coloured walls of Lenox Hill's intensive care units are brightened up by posters from the Metropolitan Museum and the Brooklyn Museums. As in most hospitals, the units are open, the beds enclosed on three sides by glass walls with a curtain.
Family members, including Ms. Richardson's two sons, and her mother, actress Vanessa Redgrave, gathered at her bedside to say goodbye.
Removing someone from life support, said Dr. Arginteanu, is "usually very emotional for the family. The patient themselves, you have to understand they really are dead before you're doing anything else. If they're brain dead, it's the same as being dead in general, it's just that there are machines are keeping the heart beating. So you have to have people say their last goodbyes, they don't necessarily want to be there at the last moment when everything is totally stopped."
At about 8 p.m. on Wednesday, Mr. Neeson's publicist delivered the news. Family members had decided to remove the actress from life support. Natasha Richardson, who had gone skiing on a sunny day, had died.
With a report from Simon Houpt in New York