Theme of the Week: Heli-evac

Monday April 11, 2011

7:05PM

The theme as of late has been heli-evacuation. We’ve had at least two per day over the last 3 or 4 days, and I have to say, they have all been legitimate. Not that we would call or approve a helicopter transport for someone who didn’t deserve it, but most of these people have been pretty sick. Even the ones who didn’t look all that bad at first glance turned out to have horrible vital signs.

The streak started with the woman I previously mentioned with the bizarre sudden vision loss and since then there have been two Brazilian men with HAPE, a man from the Czech Republic with HACE and HAPE, a nervous camerman with a heart condition, and, at least, a few others that I can’t currently recall the specifics. There would have been two others, but they chose not to heed our advice and walked down. 

The first of these two was a middle-aged man from the US who while working hard to get up a steep hill began to feel heart palpitations and subsequently passed out. In the medical world, red flags go up over a situation such as this, but despite our warnings he decided to walk down. The second of the two refusals was even more dramatic. A young woman, again American, happened to notice her very rapid heart rate while resting in her room. As it turned out, she has likely had a thyroid condition for years, which is being treated back in NY by her “Oriental Healer” with ginger and some other herbal supplement. Judging by the goiter in her neck, the twigs and berries haven’t been working. We don’t have the ability here to prove the thyroid as the cause and there were several other more serious diagnoses in consideration so we recommended that she fly down to Kathmandu for a more formal evaluation. The trouble came when she refused to go and insisted that she continue up to base camp with her group. After multiple meetings with her and her guides she was ultimately escorted down to Lukkla and onto a plane by one the group’s guides who missed out on his first opportunity to guide a Himalayan ascent on Lobuche.

Tonight we have an Aussie woman with some mild AMS who really just needs someone to hold her hand for a little while. Too bad we’re all going next door to the Panorama Lodge for a night on the town. Five minutes after she arrived her companions asked whether the “heli” would arrive tonight or tomorrow morning. Fortunately, Alun was feeling kind hearted and provided both the TLC as well as the well thought explanation of why she would likely be heading down-valley under her own power tomorrow after spending the night in her own lodge tonight. One of the benefits of eating out is siting around the lodge’s wood stove, so it’s going to take a really sick patient to keep us away from that.


I'm now off for another backpacking trip, and I'm really looking forward to some time away. The plan is to head up to Zhungla today and over the Cho La Pass from the east to Gokyo tomorrow. From there we'll head up to Cho Oyu base camp before crossing another high pass, the Rhenjo La, to Thame. Then it's a long two days of walking down to Namche and back to Pheriche. I should be sufficiently tired by the time I get back. Hopefully, I'll have some new adventures to report in a week or so. Pictures, as I'm sure you can tell, haven't been loading into the blog well on the slow connection, so I'll try to put something new on Facebook when I get back.

Increasing Business, Decreasing Temperature

Thursday April 7, 2011

4:23PM

In the past week business has started to pick up, especially in the last 2 or 3 days. The large climbing expeditions have started to roll through town, which, for the most time, make the village seem a little more alive. I expect the expedition traffic to continue for another 1 to 2 weeks before tapering back down to trekker traffic, which has also increased.

With the large expeditions comes a lot of “personalities”. I’ll leave it there as I don’t want to pass judgement. Just to give you an idea, the questions during our altitude lecture have transitioned from curiosity regarding side effects of altitude medications to wanting to know how many liters of oxygen a face mask should be delivering above 8000 meters in order to achieve adequate oxygen saturations for summit success. Hmmmm....... not sure anyone has that one worked out quite yet. My thought was give yourself enough to stay awake and give the rest to your Sherpa, so he has plenty of energy to carry you to the top. Not all have been quite so aggressive, and it has been nice talking to the guides as well as many of the climbers. I’m looking forward to going up to basecamp where I can get to know them a little better.

With increased traffic comes increased patients and we’ve had a few more in the recent days. We flew out two patients today, one of whom had strange vision loss in her left eye along with AMS, so I suspect that it was mainly due to the elevation and perhaps some variant of cerebral edema. She didn’t really cooperate with examination and there wasn’t a lot we could do for her anyway, so the answer was to fly her down. I gave my card to her guide so he could send information back to us when her condition had been treated. The other was a trekker with mild pulmonary edema who could have been treated here, but I think he had had enough of the Nepal highlands. Otherwise, I feel sure that I have now seen every person in the villages of Dingboche and Pheriche and several have been seen twice. At one point today, I thought about hanging a box of tylenol and cough drops out front next to a sign with the definition of a cold that instructs the local population to take each of the medications for at least three days before coming to the doctor. I have seen one patient three times in the last 2 days: once because he wanted his blood pressure checked, once because his left ear felt full and again today because his ear still feels full a whopping 18 hours after I told him it would get better with some time. 

The nice thing about having patients, even when they aren’t really all that sick, is that it breaks up the day. We’ve started taking them out to the “sunroom” to be seen as you can’t see more than two in a row in the clinic before your hands don’t function from the cold, not to mention that I feel terrible asking people to take off their 4 layers of clothes for an examination when it’s 25 degrees INSIDE.

In regards to the temperature, I’m tired of being cold but at the same time I've grown pretty used to it. My hands and feet stay cold most of the day with the exception of the morning in my nice warm sleeping bag. The hot water has also now gone from broken to fixed to broken to fixed and, we believe, now permanently broken. It’s a painful experience coming back from a run in the snow to bathe inside a freezer with a small pitcher of hot water. Actually, it’s even more painful if there is no preceding exercise as you start off even colder. Thus far, I’m the only one to attempt bathing since the water broke and I’m pretty sure my blue lips and intense shivering deterred the others. Eventually, though, they’ll break down too.

I might be tired of being cold, but Lauren is on a completely different level. We have a gas heater that, if one sits a few inches away from its front, can warm you reasonably well. Last night it ran out and we have to conserve our remaining gas for cooking. That must have been the final straw, because a short time later she came in the kitchen and very sternly asked, “Is there a solution?”. Her question received the silent response of confused looks from our Nepali counterparts, but Alun and I both knew what she was thinking. She continued with “If we can’t get wood or dung for the stove heater, gas for the other heater, or working hot water, I’m going on holiday to Namche until something gets done.” Obviously, nothing got fixed today and Lauren has yet to emerge from her sleeping bag.

In the next few days. I’m going to head out again to reattempt the Cho La Pass. The husband of one of the basecamp team is spending the next few weeks wandering Nepal after his expedition insurance lapsed thus canceling his plans to climb Ama Dablam. I think both of us are happy to have some companionship while trekking through the mountains. The plan this time is to go over directly from this side and then to spend a couple of days hiking up Gokyo Ri and to Cho Oyu basecamp before coming back across the pass. Things will surely go better this time, and I’ll definitely carry a little more gear to assure staying warm and dry.

Unfortunately, I’ll have to stop this entry here. I have more to say, but my fingers aren’t working too well and I can’t feel my toes, so it’s time to add a few more layers.

First Month Done

Friday April 1, 2011

4:23PM

After the adventure earlier this week, there hasn’t been much exciting to report. The HRA Basecamp team, led by Luanne Freer, has been in town for the last 2 days and it has been nice to have some new faces with whom to socialize. Luanne has been running the basecamp operation for the past 7 or 8 years since she first worked in Pheriche back in 2002. This year there will be 3 doctors there as well, excluding herself, but she plans on staying only long enough to get things up and running smoothly. I’ll be trading for a couple of weeks with the Nepali doctor and suspect that Alun and Lauren will also go up for a few days of something different.

Two nights ago the two teams and the duo of Sandy Scott and John Knowles from the Everest Memorial Trust sat down to a tasty dinner and a few drinks at the Himalayan Lodge. It’s amazing how well one sleeps after 1 glass of red wine - far and away my best night yet. I think I could make it a nightly habit, but red wine, even the cheap stuff, runs about $35 per bottle. 

John and Sandy have an interesting relationship with the HRA. The HRA has been running this facility since 1973, but sometime in the ‘80’s the EMT began remodeling the post. This has lead to the EMT managing the post from a structural standpoint and the HRA handling the administrative and medical side. I understand that, occasionally, there may be some tension between the two groups on how things should be done, but from my observation it appears that everyone gets along pretty well. Through the years the EMT has installed the running water, solar power, and a glycol heating system, all of which I’m more than happy to use. However, Nepal can be a difficult place for advanced technology to take hold and the heating system has never really worked. It would be nice to be warm at some point during the day, especially inside, but I suppose I can be content with the occasional hot shower. 

That brings up the downside of the last 48 hours. The day Sandy and John left, and the day the plumber was supposed to arrive to fix the pipes, the hot water pump mysteriously quit. Once that news got around to everyone, spirits dipped slightly, to say the least. It didn’t help that the plumber, who was supposed to bring 15 ft of replacement pipe, arrived with 12 in of pipe, no tools, and after taking one look at the system stated that he really didn’t think he could do much. Awesome!

I’m certainly no plumber but it made sense to take a systematic approach to figuring out the issue rather than giving up on account of overall complexity. Coincidentally, or perhaps through some divine intervention, Alun and I both had dreams during the night about fixing the system. Over breakfast this morning we put our heads together and started at the breaker box moving down the line toward the pump. Ultimately, the problem was lack of power to the pump which was easily remedied by splicing a broken wire back into the circuit. Voila! The hot shower was back up and running and spirits recharged. Now the plumber could go back to eating and watching Forest Gump.

Since we now had water again, it was time to get out and work up a little sweat. I put off running yesterday in hopes of getting the water fixed, so I set out on the route I had planned previously. Thinking back to my previous running experiences here, I started out downhill for a few minutes in hopes of getting the system a little warm before trashing myself up a hill. That almost worked, but the hill started a little before I was ideally warm. To be honest, I’m not sure that being ideally warm would have made much of a difference in my ability to get up and over Pheriche Pass. Surprisingly, I managed to get within about 20 ft of the top before I started to get lightheaded from the effort. After coming down the opposite side of the pass I took a hard left at the junction with the trail to Dingboche. There were a few steep sections leading up to the neighboring village that I had to walk and then a couple more when crossing up and over the ridge from Dingboche back to Pheriche. All in all, I had to walk less than I realistically expected but more than I hoped. I guess it really wasn’t bad for 50 minutes and close to 1000 ft of elevation gain. If I manage to run the whole thing before I leave, I’ll be pretty psyched. Of course no recent venture would be complete without running into my Parisian friend, Christine, who made it to Basecamp and was returning down the ridge from Dingboche.

Upon getting back to the post I kicked the plumber out of the bathroom (He had decided to do some work) and took advantage of our efforts from this morning. Since my I had been wearing my last clean shirt and socks for the last 3 days, I also took the opportunity to do some laundry, which reminds me of a question I have been pondering for the past few days. When washing  clothes by hand in a basin of soapy water, do the clothes really get much cleaner, or is the dirt just redistributed? I’m leaning toward the latter. Perhaps the icy, subfreezing fog in which the clothes are now hanging to “dry” will contribute positively to the cleaning effect.

On a final note for the day, if you’re reading this Friday morning in Portland, don’t wimp out because of the forecasted weather. Go to the Boys and Girls Clubs Auction tonight! Anything on which Charlotte works this hard is guaranteed to be good and you can go home with a warm fuzzy feeling inside for supporting a great local organization. Happy April Fools Day!

The Best Laid Plans of Mice and Men Oft Go Awry

Wednesday March 30, 2011

1:08PM

I arrived back in Pheriche yesterday around lunch time after nearly 4 days on the opposite side of the mountains to the west. The plan was to hike down-valley to where two major rivers converge, set off up that particular drainage and return over a high mountain pass to the east which ultimately leads down to Pheriche. It was the same hike that Alun and Lauren just did and I was optimistic that I would have equally good weather. Plans did not turn out quite as anticipated.

Day 1: Pheriche to Macherma

After a quick Skype session with the wife and parents to let them know my plans I headed southeast into light winds and sunny skies. My plan was to descend through Somare and Pangboche to Phorche before heading up the opposite river valley to Dhole and Macherma, where our friends with IPPG have a medical outpost similar to our own. I had decided, based on my colleagues’ experience, to travel fast and light with waterproof shoes, a few extra layers, snacks, water and sleeping bag. I figured that with this setup I could make better time than they had assuring completion of the trek in the three allotted days. I let the family know my schedule and that I would be in contact when I got back to Pheriche. 

The first few hours of walking were pretty casual and the weather was warm and sunny. The trail gradually descends from Pheriche to Pangboche and allowed me to make good time without working too hard. From Pangboche to Phorche the way changes from a broad thoroughfare to a narrow path carved into a steep hillside. At times there were sections that had obviously washed out in the past and were now rocks and dirt supported by logs on wooden pegs. Not exactly North American construction standards but I figured it must hold up several tons of yak each day so surely it would hold me. Nonetheless, I tended to hug the cliff-line as much as possible where the ground looked a little more solid and a slip wouldn’t result in a tumble to the river channel 1000 feet below.

After reaching Phorche the trail descended sharply to the river where I crossed a bridge and started up the other side toward Dhole. This was harder work by far, but having descended a couple thousand feet thus far, I was well within my acclimatization range and felt surprisingly good going up. The trail on this side was a little more crowded and I passed around 2 dozen other trekkers on their way up. 

Upon reaching Dhole, I decided it was time for a break, as I had been at it for around 5 hours, was out of water and had eaten only a granola bar since breakfast. I refilled my bottles and sat down to a warm bowl of Sherpa stew and a small pot of hot lemon tea. While eating I inquired about the remainder of my journey to Macherma and was informed that it was another 3 hours walk. It felt like I had been walking pretty fast but I was going to have to pick up the pace a little if I was going to avoid finishing my hike in the dark. I resigned myself to the fact that this could no longer be a relaxing lunch break and scarfed down my food. 

The trail immediately ascended around 600 feet up and over a ridgeline to the north of the village. By the time I reached the top, my stomach was in a serious knot due to the exertion and preceding gorging. To make matters worse, it began to snow. Initially there were only small little pellets but this quickly transitioned to large fluffy flakes. The trail remained easily visible but the rate of snow fall and accompanying wind started to concern me a little bit. As I had just turned myself inside out getting up the hill, the idea of turning back didn’t appeal. So I proceeded onward with the thought that I could go back to Dhole if conditions deteriorated. Along the way I passed through another small village consisting of 2 houses and again told myself that I could return to this place if things got worse. A short while later the snow really started coming down and began to fill in the path, but navigation remained relatively easy as there was only two ways to go, forwards and backwards. Just when I thought that I might have to turn around and make for one of the houses I had passed, I pulled over a small rise and looked down into Macherma valley.

It was a relieving site to see the clinic at the top of the valley and I walked through the door just as they were finishing the afternoon altitude-illness lecture. I welcomed a cup of milk tea and visited with Laurie and Helen while warming up by the stove for a few minutes. They recommended the Namgyal Lodge in the village proper, so that is where I decided to call home for the night.

One of the great things about trekking in Nepal is that you don’t have to carry much equipment because you typically go from village to village where there is always a warm stove, bed (not usually warm), and good food waiting. The other nice aspect is that one can travel alone and usually find company with whom to share dinner and a few stories. 

At the Namgyal, I enjoyed my nightly dahl-baat with Christine, a retired elementary school teacher from Paris, and Karen, a high school physics teacher on a 6 month sabbatical from her job in Montreal. Our discussion mainly revolved around cultural differences between our respective countries. After the effort from the day, I retired early, but agreed to walk up to Gokyo the next day with my new companions.

Day 2: Macherma to Dragnac

Again the weather was warm and sunny, and in fact, was so nice that after breakfast at the lodge I enjoyed a cup of tea at the IPPG post wearing a T-shirt. After a slow morning, I hit the trail and quickly caught up with my companions from the previous night who had made friends with 4 French climbers from Chamonix. Our group of 3 had become 7 and the company was welcome, but the climbers’ English was about as good as my French so Karen was stuck translating as she was the only one of us fluent in both languages.

The hike was initially pretty easy but then reached steeper terrain along the margin of a large glacier. The trail ultimately flattened out and traversed the banks of a chain of 3 glacial lakes. Surprisingly we were greeted by the calls of creme colored ducks with bright orange heads swimming in the few partially melted areas of the lakes.

As usual the weather began to turn gray as we reached Gokyo and my hopes of climbing Gokyo Ri on the banks of the upper lake were dashed. Instead I decided to enjoy a last lunch with my new friends before doubling back and crossing the glacier to Dragnac. Unfortunately, the service was slow but my meal of vegetable egg fried potatoes topped with copious amounts of ketchup was worth the wait. 

Outside the weather was looking more ominous, so I wrapped things up and made way for the village on the opposite side of the glacier at the base of the next day’s effort, the Cho La Pass. Vincent, one of the climbers, had made the same trek 2 years ago and was kind enough to show me the way to the start of the path. Glaciers, however, are a very dynamic land form and the route that Vincent had taken 2 years ago, which was the route on my map, was no longer passable. It really barely existed. I spent 2 exhausting hours trudging through glacial till and hopping over unstable rocks trying to find my way across the barren landscape. Meanwhile the weather was not improving, so I decided that if I could not see my way to Dragnac by 4 PM I would return to Gokyo. 

I finally found what I thought was the right path, and it most likely was a few years ago, but I was turned around by a wide glacial stream that had washed away the trail. There was no choice but to return the way I came, which proved to be no easy task as cairns marking numerous paths went in almost every direction. Thoughts of spending the night on the glacier crossed my mind and I actually scoped out a few sheltered areas amongst the rocks that would make the night survivable, though highly uncomfortable. Once again, like the day before, a little good luck was on my side, because just as thick clouds rolled in reducing visibility to about 50 feet, I arrived at the large cairn marking the main trail to Gokyo. My friends were surprised to see me emerge from the developing snow storm, exhausted and a little frazzled. Over dinner, I discussed my route-finding difficulties with two guys from England who had come over from the other direction. They had been informed by a guide that the old route really no longer exists and that the new route has not appeared on maps as of yet. That would have been good to know.

Day 3: Gokyo to Dragnac or ?

I woke up in the middle of the night debating with myself on whether or not I should go to Dragnac the next day and then do the Cho La Pass the day after that or whether I should try to get over the pass to Zhungla or even all the way back to Pheriche. The latter, however, would be an enormously long day. Ultimately, I decided on trying to email the HRA and family back home to let them know that I would be delayed an extra day and then climbing Gokyo Ri before proceeding to Dragnac and on to the Cho La.

Again, all of my plans were forced to change as I woke up to 3 inches of fresh snow. Gokyo Ri was out of the question and the likelihood of getting over the Cho La in the next 2 days was unlikely, especially given my lightweight gear and lack of familiarity with the route. The only choice was to go back the way I came. I waited a couple of hours to let other groups pack down the path a little so that the snow wouldn’t continually spill over my low-top shoes.  I enjoyed a breakfast of pancakes smothered in honey along with some milk tea before hiking back down to Macherma in yet another driving snow storm. 

I arrived back at the IPPG post cold and with soaked feet. I think they must have felt sorry for me, because I was treated to one of the best lunches I have had in Nepal - grilled vegetable and cheese sandwiches. 

The snow continued to fall outside and was now blowing horizontally, so I was far from inspired to venture further down the trail. About the time I had conceded to staying in Macherma for another night, Christine, my Parisian friend, came through the door looking for a quick check of her oxygen saturations. She was going to continue on with her guide to Dhole, so I decided to go along. 

The trail was surprisingly easy to follow due to the deep ruts cut by Yak trains. A few areas were difficult where the ground was smooth and exposed to wind but still manageable. The pace of Christine’s group was frustratingly slow so I forged ahead with the thought of possibly continuing on to Phorche or Phorche Thanga. I stopped briefly at a lodge in Dhole to call the HRA so that they would know where I was and so that someone could email the family my whereabouts, but the cloud-cover prevented a decent signal. My plans of going on to Phorche came to a screeching halt when I rounded the first bend and started the descent out of Dhole where the snow had stopped but the trail was icy and the visibility minimal. 

I returned the long 20 feet to Dhole and stopped at the lodge belonging to a woman who I recognized from my flight to Lukkla several weeks ago. The lodge was a little on the cold side but still better than the post in Pheriche and the company was good. After an excellent dinner of tomato egg drop soup and fried potato momo’s, I spent the remainder of the evening playing strange Nepali card games with the lodge owners and a group of trekkers from Lithuania, Germany, and Argentina. 

Day 4: Dhole to Pheriche

Waking up and putting on damp, dirty clothes is never fun, but after a couple of days of gradually increasing sogginess it was tolerable. I said goodbye to the previous evening’s company and set out for the post. I had the thought of getting back in time for lunch, which was doable, but I also was feeling a bit beat down from the previous days so I wasn’t really interested in trying to go too quickly. I also hadn’t taken many pictures of the surrounding country in the previous days due to the horrendous weather so I definitely had to do a little photo-documentation along the way. 

Shortly after arriving in Phorche, the desire for a hot meal, hot shower, and a clean change of clothes took over and I turned up the pace significantly. I also noticed that I was going to be racing the weather yet again as the clouds were starting to build in the lower valley. 5 hours of nonstop hiking later, I pulled into the post just as the group was finishing lunch, but not too late to get my shower and 3 peanut butter on chipati sandwiches.

The previous days didn’t go nearly according to plan but they did have a few semi-epic moments and I’m happy to be back relatively intact. My feet are suffering from the numerous miles in soaking wet shoes and socks, but they should recover within a day or two. I’m not sure that the Himalayas are the place for fast and light, especially when you don’t have access to a weather report. Sometime next month I’ll have to make the trek across the Cho La but suspect I’ll just go directly up from here and then back rather than down and around the whole valley. 

Gone Hiking

After 3 days of, essentially, sitting around it's finally time to stretch the legs a little bit. Alun and Lauren got back from their hike over the Cho La Pass yesterday afternoon and were very enthusiastic about the route. After some Skype chat with the fam, a little milk tea and just a little time to let the sun warm things up above 20F outside I'll set off for Macherma. That should take me most of the day today and from there it will be up to Gokyo with a side venture up the Gokyo Ri tomorrow and from there back across the pass to Pheriche. Monday morning, east coast time, I should be back in communication with updates on the hike, some good pictures and, hopefully, a spirit ridded of cabin fever.

A Good Day

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. 

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.

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. 

The Aforementioned "Sunroom"

 It’s now a little after 3PM and no one showed up for the afternoon altitude sickness lecture. Maybe that’s because it’s cloudy or foggy, super cold, super windy and now snowing. In fact it’s snowing into the sunroom, which means I’m packing it in and retreating to the kitchen where the structure is a little more solid.

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. 

Back on My Feet

Wednesday March 23, 2011

8:32AM

This morning has started far better than most of the previous days. Health-wise, things seem to be functioning normally, which is uplifting from both a physical and emotional standpoint. Now it’s time to get out and explore the country a little more before the thick of the trekking season arrives and the clinic gets really busy. 

Yesterday, I got up early and made for the top of the ridge between Dengboche and Pheriche. On the way up I felt reasonably good and found myself approaching the summit after only about 2 hours of climbing. A little acclimatization must have occurred since my last jaunt up the hill, because I didn’t lose the rhythm of climbing and breathing at 16,000 ft as I did the other day. Instead, I maintained the 2 steps for each breath beyond my previous high-point. It occurred to me that my normal breathing rate while maintaining a good running pace at home is 4 steps per breath. The ratio has been gradually declining as we have gone higher, and at some point in the near future, I suspect will actually invert so that there are more breaths than steps. 

As I approached the boulder strewn summit, I anticipated a fantastic view down into the Kong Ma La pass below but instead was greeted by yet more ground to cover. Where I was standing was a false summit at ~16,700ft. The apex of the ridge I was ascending tapered down to a rock path about 3 feet wide that lead around a vertical walled cirque toward the summit of Pokalde. I briefly contemplated going onward, as my goal had been to reach the top, but seeing the thousand foot vertical drop on either side of the off-camber “sidewalk” quickly changed my mind. Had I actually spent some time looking at my topographic map I would have clearly seen the futility of my route choice.

Hiking back down, I passed ~40 people coming up the hill. Of course, they were all staying in Dengboche, but nonetheless I did some advertising for the HRA and our daily altitude illness lecture. Unfortunately, the most recent edition of the Lonely Planet Guide to Trekking in Nepal describes Pheriche as “a cold, windy, inhospitable place”, and apparently this is diverting many groups to the other side of the hill. My hope is that as more groups pass through either the lodges in Dengboche will fill up forcing people to come here or as the weather warms up people may ignore the guidebooks recommendation. I say I hope, because I passed more people on my hike yesterday than I have seen in Pheriche all week. Govi and the lodge owners don’t seem very concerned, so I’ll defer to experience. 

When I arrived back at the aid post one of “my” patients was waiting for me. I say she is mine because I don’t think anyone else wants to deal with her injury. She’s a 15 yo local who burned her right index and middle finger in a stove fire 3 days ago. She waited 24 hours to come see us and by that time the skin was bubbling and peeling. I was able to remove much of the damaged skin and fortunately found good tissue underneath indicating an injury that will likely heal with significant time and care. (For the medical folks - 2nd degree partial thickness). Now we’re on a schedule where she comes back every 48 hours for a dressing change and usually removal of a little more dead skin. I think the thick calluses on her hands saved the underlying tissue. This will be labor intensive on my part in a clinic with few supplies so it’s no wonder the others don’t seem too interested in dealing with it. The most difficult part of it all is getting her to stop working and to keep the dressings clean. These people are tough to say the least and not much short of death prevents them from attending to their daily labors. Deep inside I wish there was somewhere else to send her, maybe the tertiary burn center, since dealing with the long term care of significant burns isn’t really at the top of my skill set. The problem is that I am the burn center here, so I should probably look at my discomfort as a good motivator to learn.

Today Lauren and Alun are heading out to hike to Mocherma and around the Cho La Pass. It will take about three or four days and is supposed to be an excellent route with fantastic views of the high mountains. We have a group similar to our own working for the International Porter Protection Group in Mocherma, so we’ll be paying them a visit soon. After my colleagues return I’ll be setting off to do the same route and should get back just in time for the “Everest ER” team to arrive in Pheriche. I hear we throw down for a couple of nights with them before they proceed up-valley, but I can’t imagine getting too rowdy up here. 

Finally, my daily observation of Ang Rita: He appears to enjoy the bluegrass mixes I play on the computer while blogging or typing emails. He seems to particularly enjoy Dolly Parton which has him dancing around the kitchen, humming the tune 4 seconds behind the actual song all while eating soup from the pot in which he cooked it.