Thursday March 24, 2011
2:43PM
Although there are many hours left in this day I’m going to, perhaps prematurely, deem it the best to date here in Pheriche. Although nothing all that extraordinary has occurred since my last entry, there have definitely been a few more things to smile about and life is beginning to have more of a rhythm again.
I had initially planned to go for a run yesterday afternoon with the added benefit of returning to a tank full of hot shower water, but plans were quickly laid aside for more important matters. Just prior to closing time yesterday afternoon, as I was squeezing in one last page of my book, a faint jingling sound seemed to take presence in the back of my head. It was definitely getting louder so likely wasn’t some altitude produced auditory hallucination. I peered over the edge of the sunroom windows and was both surprised and disappointed by what I saw. Regardless, I knew that two men unloading a third from the back of small horse whose saddle and bridle was covered in no less than 50 small bells, very similar to those found on Christmas trees, meant that my afternoon run was shot. After spending the day couped up in the clinic and seeing a total of 2 patients, it was almost demoralizing to see this group pull up just as about to go inside and strap on my shoes. Being the only doctor within 2 days hike, I reminded myself of what I had signed up for, put a smile on, and headed for the inside. It was a good thing that I hadn’t left sooner, because this kid was sick.
Like many other people in the region who depend on the trekking season for income, this teenager drives his yak train up and down the mountains carrying gear and supplies for expeditions and trekking groups. Even though he spends 6 months or so a year tromping up and down the mountains behind his yaks he lives at low elevation and this happened to be his first trip of the year, so he wasn’t yet acclimatized. In an effort to get one quick trip in to Everest Basecamp he had ascended something like 7 or 8 thousand feet in 24 hours. That may sound like a lot of vertical ascent, and it is, but what is deceptive about the trails here is that the elevation gain occurs over a relatively short distance, one that is easily accomplishable in 2 full days.
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| My Accommodations |
Needless to say, the outcome of such rapid ascent was poor and resulted in the development of both Acute Mountain Sickness and, worse yet, High Altitude Pulmonary Edema, which is the most lethal form of altitude illness. He happened to stumble across a group of Iranian medical students and one intern who assessed him and correctly diagnosed him with AMS but failed to merge his low O2 sats, tachycardia, rapid breathing, pulmonary crackles and breathlessness into the much more serious diagnosis of HAPE. They gave him some lasix, which is unlikely to help much, but, fortunately, they did recognize the need to have him evacuated and being in Nepal a horse is as good as an ambulance.
Upon my initial evaluation he was falling asleep in the chair in the front office where his rescuers had dropped him but fortunately remained responsive. His heart rate was quite elevated in 130’s and his O2 sats were fairly dismal at 68% (normal here is 85-90). The treatment is pretty simple and involves a few anti-hypertensives for the HAPE, steroids and diuretics for the AMS and oxygen for all of the above. With a little extra oxygen his sats bounced up and I felt relieved but an hour later his lungs sounded worse, his sats dropped slightly and I started to think of how to get this guy further down the hill. Unfortunately, darkness was rapidly approaching, the clouds were thick and this kid was highly unlikely to have the funds to support any dramatic evacuation. Luck and likely youth were on our side, however and a few more meds, a quick prayer and another hour later he started to turn the corner and I knew we were in the clear. Govi and I took turns waking up to check on him and we made up the bed next to him for his friends to sleep in. At 7AM this morning we packed him back on the same bell-laden horse and sent him down to the next medical post in Kunde, probably a 10+ hour walk.
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| The Panorama keeps me connected |
Following a little more confident after my first successful HAPE diagnosis and treatment the remainder of the day has been gravy. It was definitely a great way to start the day skyping with Charlotte and then there was the added treat of a skype call from the good Dr. Samuelson who was enjoying a night out with the Cochrans and the Moore/Walls. I was sorry that my first meeting of the youngest Cochran occurred via skype but I’ll take what I can get. I think I would already be suffering from major homesickness without, at least, email, but I think that skype is likely what will get me through 3 months up here with the majority of my sanity intact.
To make things a little better I got out for my second run of the week at lunch time and felt some improvement over my last venture, which was hampered by the sensation of a bowling ball bouncing around in my stomach. I managed to make it a little further up the valley, but the minute the hill went from slightly up to slightly more up I was left completely breathless. I haven’t had problems with my asthma in years, but today returned thinking that I need to start taking a few puffs off the inhaler before my next run. I don’t know why I’m surprised. It’s not like I’ve ever tried to run at 14,000 feet before.
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| The Aforementioned "Sunroom" |
On a final note for the day - the book total is now 5. This one I particularly enjoyed. Growing a Farmer: How I Learned to Live Off the Land by Kurt Timmermeister details a man’s transition from successful restauranteur to small-time local farmer who raises vegetables, beef, pork, lamb, milk and predominantly cheese for both personal and local consumption. I kept envisioning this as being the way many places back home, like Smiling Hill, may have started.
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