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Jeff Rasley

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Medical Treatment on Top of the World
by Jeff Rasley   
Rated "PG" by the Author.
Last edited: Saturday, August 04, 2012
Posted: Saturday, August 04, 2012

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A memoir of my experience as a patient in the highest medical clinic in the world. I didn't climb her, but I spent time with the Mother Goddess, Mt. Everest.


Fifty-eight years ago, on May 29, 1953, Tenzing Norgay and Edmund Hillary became the first human beings to stand upon the highest point on Earth, the summit of Mt. Everest at 29,035 feet above sea level. In May 2003, I returned to the Khumbu region of Nepal to honor the greatest mountain in the world and the men who climbed her 50 years ago.

I was born in the Spring of 1953, and was intrigued with the prospect of celebrating the golden Jubilee of the first summit of Mt. Everest as my own 50th birthday present to myself. After my last visit to the Khumbu in 1999, I did not expect, or want, ever to return. My reluctance was not due to the Maoist insurrection wracking Nepal or the political instability following the June 2001 slaughter of the royal family, the combination of which put Nepal near the top of the danger list for travel destinations. Nor was it due to travel fears after 9/11 or the outbreak of SARS in Asia in the spring of 2003. It was personal.

On that last trip, I was returning from an unsuccessful climb of Mera Peak when I saw three porters swept away and killed in an avalanche. The members of our team had to run for our lives. Everyone in our group survived with no lasting physical scars, but we had a cold, wet and miserable time of it. On an expedition to Pokalde and Island Peak the year before, I had suffered through a severe case of acute mountain sickness to the point where I had symptoms of cerebral edema. Luckily, I was able to reach the Himalayan Rescue Clinic in Pheriche, the highest regularly staffed medical clinic in the world, for emergency treatment. I was nearing the end of my forties and, after four Himalayan expeditions in five years I was sick and tired of being cold, wet, sick and tired. I'd had enough of mountaineering. It was no longer safe to visit Nepal, anyway.

But May 29, 2003 was the golden Jubilee of the first summit of Mt. Everest, and Nepal once again beckoned. The country needed tourists to return, and the Maoists and government declared a truce. Sir Edmund Hillary and the King of Nepal joined forces to try to lure climbers from all over the world back to Nepal to attend celebrations from Kathmandu to Base Camp on the flank of Mt. Everest. I heeded the call. I would not attempt to climb any mountains, but would trek through the Khumbu to Base Camp and check out the highest parties in the world.

My guide and interpreter, Hari Pudasaini, and I spent the first night on the trail, as most trekkers do, at the village of Phakding. We tent camped on the grounds of The Himalayan Chain Resort, and when we sat down to dinner in the lodge's meal room, seated to my left was June Carlyle (age 86), Ed Hillary's older sister, and around the table were a group of 15, including his nieces, nephews, cousins, friends and in-laws. As part of the 50th anniversary events, they were making a pilgrimage to the Hillary school in Khumjung and the Kunde Hospital, the first medical clinic established by the Hillary family foundation, the Himalayan Trust.

The intrepid octogenarian June reminisced, "When Ed was young, he loved to personally work on laying brick and stone to help build schools and medical clinics in Sherpa villages. He had so much fun!"

Before we left Phakding, we expected to see a helicopter rescue of a porter, who'd had a stroke. In my three previous treks through the Khumbu I had seen only one helicopter rescue, but I learned that several private firms viie for this business, as it pays up to $3,000 per passenger. The partially paralyzed porter was helped onto the grounds of our lodge to await the rescue chopper. He was quite old for a porter, almost 50. But his employer, a trekking/mission group from Northland College, Wisconsin, did not have rescue insurance covering porters. After vainly waiting two hours to see if a chopper came, Hari and I shouldered our packs and headed north.

We stayed in lodges in the Sherpa villages of Khumjung and Namche Bazaar and tent camped at Tengboche Monastery 12,000 feet altitude, where we took tea with the Incarnate Lama, Rimpoche Nawag Tenzing. The monastery grounds were to be the site of a party to be co-hosted by the Rimpoche and Peter Hillary, Sir Edmund's son. The next day we hiked through the rhododendron forest beyond Tengboche, crossed over the glacier-fed rapids of the Imja Khola River, passed intricately carved mani stones (stone slates with Tibetan prayers carved on them), and then by a series of chortens (stone conical memorials with a spire) high above the river gorge, always keeping to the left as is customary when passing sacred places, and finally onto the windswept plateau of Pheriche at 14,000 feet altitude.

Hari's 20 year-old nephew, Bhuwan, was working for the Himalayan Rescue Association (HRA) medical clinic in Pheriche as a physician's assistant. The clinic is the highest regularly staffed medical clinic in the world. Volunteer medical doctors from developed countries staff the clinic in the spring and fall during the climbing seasons.

In 1998, when I was a patient at the clinic, my team had hiked to Everest Base Camp, stopping only once for a rest day, and as the only member who lived at sea level, I could not acclimatize at that rate of altitude gain. I foolishly ignored the early symptoms and pushed myself to maintain pace with the others. By the time we reached Base Camp, I was beginning to show symptoms of cerebral edema and didn't have the strength to get out of my sleeping bag. In that condition I had to make the twelve-hour hike back to the HRA clinic in Pheriche. The young American physician staffing the clinic prescribed diamox, monitored the O2 saturation of my blood and other vitals for two days, and made sure I drank lots of water. After remaining at the lower altitude for two days my red blood cells were able to oxygenate adequately, and I was able to climb Pokalde, a beautiful little 19,000-foot peak. So I have a fondness for the clinic.

When we arrived at the clinic, a gaggle of porters were standing inside the door waiting to see a doctor for minor problems. In the treatment room a 60ish German woman was being given oxygen. She was in Rheinhold Messner's trekking party, and had gotten altitude sickness on the way to Base Camp. Messner, another legendary climber, was doing a Jubilee trek as it was also the 25th anniversary of Messner and Peter Habler's first ascent of Everest without O2.

After we stowed our packs at the neighboring Panorama Lodge and had some bracing black tea, Hari and I hung around the grounds of the clinic, waiting to interview the volunteer doctors when they finished with their patients. Bhuwan took a break from his duties to tell us the latest news, which was that 32 climbers had summited Everest the day before (May 22nd), including an Indian team, Nepalese Army team and a Japanese team. Two weeks of bad weather had prevented any summit attempts prior to this, and there was worry throughout the Khumbu that there might be no summits during the Jubilee. I had secretly cheered for the mountain, but had to admit to myself that I, like the locals, got an emotional lift on hearing the news of summit successes. People in the Khumbu react to news of activity on Everest much like fans of local sports teams in the West. Word-of-mouth and the one radio station that is sometimes received at night are the means of transmission of information up and down the Base Camp trail. The only news being transmitted on the trail in May 2003 was about activity on Mt. Everest and the Jubilee celebrations.

In 2002, a monument to climbers who have died on Mt. Everest was erected on the grounds of the Pheriche clinic. Hari counted 178 names, which is consistent with the oft-cited statistic that for every ten climbers who summit Everest there is one death on the mountain. (1,659 had summitted by the end of 2002.) There were spaces for many more names.

The clinic offers a lecture twice each day to trekkers about Acute Mountain Sickness (AMS) and other health problems encountered in hiking the high altitudes of the Khumbu. Hari and I attended the 3:00 pm lecture presented by Bhuwan and Dr. Kirsten Moller, a slight, athletic-looking Danish internist. She told us that ignorance and carelessness were the causes of many trekkers and climbers getting sick. About 35,000 people hike through the Khumbu each year, but only 1,500 stop at the clinic to hear the lecture on AMS. "Ninety percent of our patients wouldn't need treatment, if they just stayed on a schedule of three hundred meters maximum altitude gain per night. But not enough people get this information. And too many think they are strong climbers and can ignore it." (I raised my hand, and offered my own testimony as an example of one of the ignorant and careless ones.)

I was unable to interview the doctors until late the following morning. They worked late into the evening on a Russian climber, who arrived during the lecture having been helped down from Base Camp with symptoms of pulmonary edema. In the morning they were occupied with treating a Sherpa climbing guide with appendicitis. He was evacuated by the same Army helicopter which rescued Dr. Beck Wethers, Jon Krakauer's Into Thin Air climbing mate who lost his nose and part of his hands to frostbite, according to Dr. Martin Wilcox.

Dr. Wilcox is a tall, hearty white-haired retired U.S. Navy general surgeon. He has lived a full and active life, but called his three months at the HRA clinic "the most rewarding of my life." He related that he was able to practice medicine using rudimentary equipment and no lab, but "focused simply on helping people get better." He was, however, quite upset about corruption of the government and the HRA board. For example, the clinic was required to use a particular helicopter rescue-company when calling in a rescue for a private-paying patient, such as the German woman in Messner's party. Dr. Wilcox was sure there were kickbacks involved with the helicopter company and the HRA board, because the patient had to pay $3,000, which is a huge sum in Nepal. Dr. Wilcox pointed out that his patient had been waiting over 24 hours for a helicopter to evacuate her. He was also upset that the clinic had taken in over $30,000 in private pay fees, yet, because of inadequate equipment, the clinic had fifteen power failures and twice run out of oxygen.

Dr. Wilcox passionately described to me how a porter had needlessly died, "because no one knew what to do for first aid. They just brought him here, but it was too late." A major problem in the Khumbu, in Dr. Wilcox's view, is that there is virtually no means of communication other than messages carried on foot. He intends to present a proposal to Motorola to develop a communications system among the villages, so that first-responders could communicate with physicians at the HRA or Kunde Hospital.

Dr. Moller joined us in "the sun room" (a square structure of glass and plexiglass roof, which gets unbearably hot during the day, but offers a respite from the small, cramped windowless clinic) for Cokes from Dr. Wilcox's private stash. Shading our eyes from the sun glinting off majestic white-caps, we talked about the changes in health and living standards for the Sherpa people of the Khumbu. Dr. Moller described how the Sherpas used to have many lung problems, because they cooked over open fires and were exposed to so much smoke from their cooking fires. Now, they all have iron stoves with smoke stacks. Yet the primary fuel for the stoves is still yak dung and gathered wood. It is a Sherpa belief that it is a bad omen for a child to be born outside of the home, but the doctors at the clinic have been urging Sherpa mothers to go to the Kunde hospital to give birth. Dr Moller worried that there may be a cultural downside to the improvements brought to the Khumbu and wondered when the "tipping point" will be reached so that Sherpa culture has compromised so much it is no longer Sherpa.

Dr. Moller described Sherpas "as the most helpful, thoughtful, friendly people I've ever known." She was glad the world has come to recognize the Sherpas for their climbing achievements, but did foresee that, at some time in the future, the adaptations of Sherpa culture to Western ways would push it over the tipping point. "But so many changes improve the quality of life, how can we criticize?"

The volunteer doctors' three-month stint was up at the end of May, so Dr. Moller was hoping to fly to Kathmandu by helicopter when her last patient was evacuated. Dr. Wilcox would make the trek back to the airstrip at Lukla village with Bhuwan, and they would fly standby from there to Kathmandu. Both doctors had to pay their own travel expenses and were paid no stipend for their service. They were on their own to get home.

The hike from Pheriche to Lobuche is only four hours, but the gain in altitude is 2,000 feet. At the top of the 16,000 foot-high Lobuche pass, prayer flags whip in the wind and chortens, cairns, and stacks of mani stones stand in testament to climbers killed on Everest. Hari and I drank water and rested by the memorials and watched shaggy yaks trudge by. Their Tibetan bells tinkled and their herders "shooed" and threw stones at the yak's hulking backsides. Above and beyond the pass stand the massive white and gray Chomolungma and her giant maidens, Lhotse at 28,000 feet, Nuptse 26,000 feet, and Pumori 23,000 feet

For the first time on the trek the weight of my pack was really bothering me. I felt utterly exhausted by the time we carefully crossed the last plank bridge over a creek and picked our way across the rocky moraine to the Eco Lodge at Lobuche. To avoid altitude sickness the HRA recommends that trekkers not gain more than 1,000 feet per day, and to take a rest day if any headache or dizziness is experienced. Drs. Wilcox and Moller both reminded me before we left Pheriche that they recommend trekkers not hike to Lobuche in one day, because of the excessive altitude gain. I just winked at them, and, of course, had a headache and felt dizzy by the time we arrived at Lobuche. We would have to take a rest day to allow me to acclimatize.

At Lobuche we encountered the first groups of Everest climbers coming down from Base Camp. The first was a Swiss team, who summitted one Swiss with three Sherpas. The second was the Tokyo Agricultural University team with two injured members (severe frost bite), who were to be helicoptered out. All members of both teams had a raccoon pattern of sunburned faces from wearing oxygen masks. They moved very stiffly. Several of the Japanese looked mildly ataxic.

On the final stage of the trek to Base Camp, we dodged yaks hauling gear from completed Everest expeditions on their way back to Lukla. The trail skirts the gigantic Khumbu glacier, which is pock marked with little lakes, vast moraines and rock falls. Base Camp is a crazy quilt city of multi-colored tents strewn all over a ridiculously rocky moraine below the forbidding Khumbu Icefall.

Hari and I searched out the Nepal Mountain Madness campsite, because one of the climbing Sherpas with that expedition, Lhakpa Tsering, is a friend and was the lead guide on my ill-fated expedition to Mera Peak in 1999. We found the campsite, but learned that Lhakpa was still descending from the summit with an American client. Serendipitously, Lhakpa Gelu Sherpa, another member of the Mountain Madness team, had broken the record for the quickest ascent and return from the summit just before we arrived.

Lhakpa Gelu climbed from Base Camp to the summit by "the standard route," pioneered by Hillary and Norgay, in ten hours and 56 minutes, and completed the descent to Base Camp in a total time of 18 hours and 20 minutes. I don't know what to compare this with in terms of amazing physical feats. Assuming no delays for bad weather or acclimatization problems, it takes most climbers at least seven days to summit and return to Base Camp. Lhakpa Gelu completed in 18 hours what is one of the most difficult feats performed by any human being, and had been performed by less than 1,700 in the history of the world, but which took most of the others at least a week to do.

Lhakpa is 35 and summitted Everest the first time in 1993. He told me he didn't do anything special to train for his record attempt. "Just climb mountains." I asked him what the record meant to him and why it was important.

"Record is important because set on Golden Jubilee. I wanted to set record for several years, and wanted to do it this year. It is important that Sherpa set record. Sherpa are strong."

When asked how he was feeling, he said his upper legs and throat hurt a little.

The golden Jubilee festivities were complete. I was standing in line to check in for my departure flight from Nepal at Tribhuvan International Airport just outside of Kathmandu. I spotted Dr. Wilcox leaning up against the ticket counter for Thai Airways, the major carrier for international flights from Kathmandu. He had a tired but patient look on his tanned face. He told me he was flying standby and his prospects were not good. With the festivities over, many people were leaving the country. When my flight was called, I felt guilty boarding, and glanced back at Dr. Wilcox as I entered the curtained area to go through security. He gave me a wane smile and waved goodbye.


Web Site: Jeff Rasley, Author, Himalayan Trek Organizer, and Basa Foundation president

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