Marcus Stevens / Critical Care International / Mali
Everest ER: Tent City’s Medical Marvel
Marcus is a former president of the Oxford Wilderness Medicine Society, now working in Southern Mali. In April 2018, he successfully ascended to Everest’s North Col (7050m) as part of a charitable expedition to raise money for Community Action Nepal. Here’s how he found himself eating a Michelin-starred meal perched on top of the world.
The wind rattled my jacket as I stared up at the near-vertical final section of ice wall to Everest’s North Col. The exhaustion was unquenchable and, as I fought the desire to curl in the snow and sleep, my groggy, hypoxic brain reminded me again just what a shockingly bad idea it thought this was.
I was at 7000m, struggling for breath and coughing till I gagged, for a charitable endeavour (though in a professional capacity). A few months previously I had been asked to join Neil Laughton’s Highest Dinner Party expedition as team doctor. The plan (simple really) was to climb to Everest’s North Col before donning black tie and sitting down to enjoy a three-course, two Michelin Star meal washed down with champagne, Scotch and port. The highest black tie dinner party ever. All in aid of Community Action Nepal, Doug Scott’s powerhouse charity that’s been working to help Nepal’s mountain communities since 1991.
Kathmandu
Getting to Kathmandu (from Mali, where I currently work) involved 30 hours in the air, four airports, 80kg of medical and climbing kit and hours of arguments with Delhi Airport’s transfers’ desk to get it all safely onto my flight to Kathmandu. Arrival saw us crawling through Kathmandu’s glacial traffic before a quick shower and an eight-hour drinking session at the hotel bar as we all got to know each other.
The group, fifteen in total, was as diverse as it was interesting; a seven-summiting explorer; an adventuring architect; a Manhattanite future business titan; a globetrotting travel writer; a spearfishing city lawyer; and an Aston Martin-racing, space-visiting online entrepreneur and his sporting sons, an international bobsledder and an Aston Martin-crashing champion triathlete. An evening of stories washed down with beers, Black Russians and whisky set the stage for the next month, even if that stage were to change dramatically over the coming weeks.
Kathmandu was considerably more ramshackle and tumbledown than I expected, the whole city choking under the weight of enough cables and wires to encircle the world multiple times. Some telegraph poles were laden feet deep in what must have been decades of cabling detritus. Surely it couldn’t all be in use, I thought. It looked like a city-wide modern art project gone terribly wrong.
I used the few days in Kathmandu to source the majority of the medications I’d need for the trip and the last few pieces of equipment I hadn’t been able to buy in the U.K. Deciding what to take and what to leave at home had been difficult: it was crucial I had enough to manage the conditions I was likely to see but equally important that my equipment was compact enough to accompany me up the mountain. I sought advice from colleagues who’d climbed Everest, as well as the wealth of expedition medicine literature now available on the internet.
Kathmandu was also home to a good friend from university who had been in Nepal for the past year working with Partnership for Sustainable Development Nepal. It was great to escape Thamel, the tourist epicentre with its gap yah students and dreadlocked hippies. Over beers in a little bar overlooking Buddha Stupa we caught up on his work, and his trekking, ski mountaineering and mountain biking adventures over the past twelve months.
From Lhasa to Everest
We would be tackling Everest from the northern, Tibetan side so after a couple more nights out exploring Kathmandu we boarded a flight to the Tibetan capital Lhasa and were treated to our first glimpse of Everest and the high Himalaya.
Tibet’s most unexpected offering was its food. The jewel of Lhasa isn’t one of the ancient monasteries or other cultural attractions but a small, steep staircased restaurant, the Tibetan Family Kitchen. On the sharing table, a rather liberal approach to ordering offered up a wonderfully glutinous and varied selection. If you happen to find yourself in Lhasa, and if you’re able to locate the restaurant tucked away down an alleyway, try the Yak Momo. Delightful.
Restaurant reviewing aside, we also visited a number of the valley’s monasteries, including the expansive Potala Palace. Dating back to 1645, the palace was the home of the Dalai Lama until 1959 when he fled to India in the Tibetan uprising. Comprised of a thousand rooms it stands regal overlooking the Lhasa Valley. It was a fascinating glimpse into Tibetan culture and the role of Buddhism in shaping the region.
Being at 3650 m, we also got our first taste of Acute Mountain Sickness (AMS). I was mindful of Gonggalanzi et al.’s 2016 paper which showed an AMS incidence of 36% amongst tourists visiting Lhasa from lower elevations. A few of the group suffered mild symptoms, included headaches, sleep disturbance and nausea, otherwise we all adjusted very well. Many had been to altitude before but, as many hadn’t, we made sure to advise on ways to avoid and minimise symptoms.
Road tripping
The road trip to base camp involved a few more monastery visits, games of toothpaste roulette, questionable roadside food and some intergroup flirting with the Salomon Freeski Team, whom we’d met over dinner in another excellent restaurant. The five-man team, including Cody Townsend, were en route to the 6952m high unskied Colangma peak to attempt a first descent.
In Thingri, a two-day drive from Lhasa, we spent a morning scrambling up some of the surrounding foothills to a collection of prayer flags looking down on the town below. The amateur geologists in the group, of varying levels of self-appointed competence, marvelled at the rocks. Excellent examples of lava balls on show, according to Ralph. The rest of us admired the views.
Like many of the Tibetan towns we passed, Thingri was a structural dichotomy. A falling down, ramshackle high street alongside just-completed lines of whitewashed buildings. However, the new dwellings, rows and rows of them, were always eerily empty, never anyone in sight.
Prior to the trip various people had scoffed when I mentioned that on the northern side it was possible to drive to base camp, avoiding the trek in required on the Nepalese side. I had wondered whether we were to miss a major part of the Himalayan experience. How wrong I was. Top Gear may claim to have found the world’s greatest driving road – the Transfăgărășan Highway – but they clearly haven’t driven the Zhufeng Highway. Miles of achingly perfect blacktop spaghetti wound its way up and over 5000m passes, every hairpin leading us closer to Everest’s iconic North Face.
The tarmac ended just a kilometre from base camp, and we bumped and scraped the last few meters into our new home. Camp offered the best view yet of the mountain and was infinitely more picturesque than I had envisaged. Before the trip I’d read about the rubbish, human waste and mess that littered the mountain but here it was immaculate. Individual tents were laid out neatly under the burning sun with a carpeted mess tent for us all to eat together. Glamping at 5200m.
A place of essential simplicity
We had five days at base camp to allow for acclimatisation. We filled our time with treks on frozen lakes, a practice black tie dinner, sunbathing, reading and the odd team photo. Soon the group would split in half, eight of us would go onwards towards the North Col while the others would travel back to Nepal overland and fly home.
One evening, as I strolled from my tent to dinner I looked up at the face as the last light drained out of the valley. Everest was silhouetted against the blue-black sky. Might just provide the perfect background for a night-time shot, I thought. The following evening I layered up, set my camera on a mini tripod on a tray balanced on top of a camping chair and tried to turn my imagination into reality and shoot an image worthy of the setting.
“All around, the world’s biggest peaks soared into the night, the stars casting blue light upon their cold silhouettes. We were far from home, yet the place felt like home, or at least an extension of where I most wanted to be. It was a place of essential simplicity. There was up and down. There was light and dark.” — Robert Birkby
Beyond base camp the next major goal was advanced base camp (ABC), a two-day trek away. The route took us up the Rongbuk Glacier and onto the Magic Highway, where the track ran alongside the glacier’s towering ice pinnacles. The first day’s six miles ended at Interim camp where we spent a night camped amongst the yaks who’d followed the same trail we had, albeit carrying significantly heavier rucksacks.
By now many of us were riddled with Khumbu cough, our airways irritated and angry thanks to the frigid, dry air. Climbing out of my tent in the morning nearly always guaranteed a coughing fit as the change in air temperature tickled my bronchi. By mid-afternoon, snow had begun to fall, quieting the valley and muffling the coughs rising from our tents. Come morning the valley was transformed, orange tents dotted in snow, like overboard life rafts in a frothy ocean.
We trekked upward for another day, the path always rising and falling, twisting and turning, breathlessly wiggling up the valley. By the time we all arrived at ABC at 6440m the cloud and chill had descended and the snow belted us from behind, necessitating extra layers to keep warm.
Into thin air
Once over 6000m, life became painfully slow. Even the most mundane activities took minutes of puffing to recover from. Getting in a sleeping bag, getting out, standing up for dinner and packing a rucksack all seemed a colossal effort. In fact, in order to minimise activity as far as possible, I set up my bed at the far end of the mess tent, within centimetres of the table. Only the toilet required me to venture outside.
At over 6000m everybody’s health had begun to slowly deteriorate and the task of deciding who was sick became surprisingly difficult. All healthcare professionals pride themselves on an ability – gained from seeing thousands of patients – to instantly judge how unwell someone is. Sat in the mess tent trying to force down Spam and potatoes I realised that my medical judgement was uncalibrated for such an environment. Everyone looked exhausted, no one wanted to eat, we were all breathless, our faces sun burnt and puffy. Who should I be worried about?
I decided I needed some technological assistance and pulled out a saturations probe. We passed it round the table and I looked on as it muddied the waters. Saturations ranging from 40% to 70% with seemingly no correlation to one’s apparent health. Those with the lowest figures seemed to be the strongest climbers, and those who looked the most broken had the highest numbers. I decided that comparison offered the safest and most reproducible means of patient assessment. Looking around the group I made a subjective judgement of the baseline and then decided who deviated below it. It wasn’t perfect, but in an environment as warped and foreign as the upper reaches of the Himalaya it was the best I had.
Anyone with an interest in high altitude medicine will know about the research expeditions carried out by UCL’s Xtreme Everest group. Their pioneering work has revolutionised our understanding of high-altitude physiology and pathophysiology and the breakthroughs made on the sheer slopes of Everest have laid the groundwork for a deeper understanding of the role of hypoxia in critical care medicine. I had reread many of their papers as I prepared for the expedition, in particular their startling 2009 paper detailing the results of arterial blood samples taken at 8400m after successfully summiting. They showed arterial oxygen saturations as low as 34% to 70%, a staggering variation and a level of hypoxia previously thought incompatible with life.
Thanks to one or two hyper-social members of the group our mess tent became a meeting place for other climbers on the mountain, with tea and Pringles offered at all hours. While there were a number of large expeditions on the mountain there were a surprising number of independent climbers or small teams. We spent three days and nights days at ABC acclimatising further and preparing ourselves for the next part of the ascent, the fixed ropes to the North Col.
Having experienced the weather closing in on previous days, we convened a group discussion and decided to leave at first light, giving us ample time to hike out of base camp to the base of the face before tackling the fixed ropes to the col.
Shocked
During the preceding weeks the route up the fixed ropes to the north col had been described as anything from a ‘snow slope’ to ‘a little steep in places.’ However, as I stood at the base watching the single file row of ants moving up, it looked impossible. Walking on the flat was exhausting, let alone 600m of vertical ascent. I pleaded silently for something that would offer me a way out, a medical emergency that required my assistance perhaps? But the group plodded on and I resigned myself to the fact that the only way was up. I hadn’t come this far to give up at the mere thought of hours of breathless misery.
On the climb the weather alternated between brisk snow filled gusts and periods of skin peeling sun. I was either putting on suncream or a down jacket. Although both were an annoyance they necessitated stopping which gave me an excuse to stand – no, lie – and catch my breath. As the hours wore on, I tried myriad ways to distract myself, including thinking about what I’d write of the trip when I got back.
Through the hypoxic haze a quote from Krakauer’s Into Thin Air came floating back to me.
“Above the comforts of Base Camp, the expedition in fact became an almost Calvinistic undertaking. The ratio of misery to pleasure was greater by an order of magnitude than any mountain I’d been on; I quickly came to understand that climbing Everest was primarily about enduring pain.” — Jon Krakauer
By the time I crawled into the tent I was utterly spent. The fatigue was unlike anything I’d experienced before. At sea-level, after a marathon or a hundred-mile cycle the body is exhausted but knows what it needs to replenish and recover; food, water and sleep. At a touch over 7000m we were higher than every other mountain on earth, except those nestled in the Himalaya, and the exhaustion gnawed away inside me.
It took nearly 30 minutes to work up the energy to find and take the paracetamol and ibuprofen that I hoped would dull my throbbing head. Finding my stethoscope took as much time again. I’m not sure how accurate my subsequent auscultation was but I semi-confidently decided my tent mate wasn’t developing pulmonary oedema, despite his laboured grunting.
At various opportunities I had bored members of the group with my interest in high altitude physiology and I figured there was no better time to consider my deranged internal condition. I thought back to lectures at medical school and the textbooks I’d read.
In medical parlance, shock may be defined as ‘a condition where the tissues in the body don’t receive enough oxygen and nutrients to allow the cells to function.’ Understandably, if not reversed by prompt and appropriate treatment such an insult can lead to cellular death, organ failure and loss of life.
It occurred to me that high altitude mountaineering is the most effective way of pushing an otherwise healthy body into a state of recreational shock. Shock induced not by physiological dysfunction but by our species’ relentless desire for adventure and exploration.
Dinner is served
An utterly sleepless night was followed by one of the weirdest outfit changes of my life. Layers of thermals, fleece and goose down replaced by a creased shirt, crumpled dinner jacket and bow tie. The table was set and we assembled for dinner, albeit at 8am. Jane and Sadie were in their ball gowns and weren’t the only bare legs on the mountain, Jon endured the three-courses at -25℃ in his kilt. I had forewarned him that a mere kilt was not a suitable outfit for Everest, more specifically that I would not be responsible for treating any subsequent genital frostbite. If he looked down to find a blackened appendage in the coming days, he was to keep it to himself and silently curse his stupidity.
The setting couldn’t have been more different from our practice meal at base camp. The menu may have been the same – a Michelin starred selection of miso soup, lamb tagine and chocolate mousse rehydrated on a small gas camping stove – but the glaring sun and relaxed chatter were noticeably absent. However, despite the buffeting wind, swirling snow and crippling hypoxia the food was thoroughly enjoyed. Once record-breaking gastronomic procedures were complete we enjoyed a glass of champagne (opened by sabre), speeches from the expedition leader and our lead Sherpa and then some final unexpected and unplanned hilarity.
Our chairs were unstable at best, summer picnic furniture designed for a firm base and not the icy snow of the North Col. With almost perfect comedic timing our kilt wearing compatriot found the snow collapsing under his chair legs and slowly tilting backwards, crampons flying through the air as he rolled away from the table, his nether regions exposed to both the table and the icy Himalayan wind.
Guinness World Record suitably broken we prepared to descend back to ABC. Having set ropes up above 8000m the night before the Chinese Sherpas were descending haughtily, barrelling past us, moving achingly quick. Some were using up the remnants of oxygen cylinders they’d started higher up. One such cylinder, broken loose and cascading down the mountain in leaps and bounds narrowly missed Jon, glancing his shoulder before careering on. A nasty reminder of how quickly things can turn, sometimes through no fault of one’s own.
Down and out
With everyone safely back at ABC the relief was overwhelming. We still had a long day of trekking to descend to base camp but the hardest part was done. It was downhill from here, the air getting thicker every step of the way as we dreamed of hot showers, greasy burgers and a clean set of clothes.
By now we were under no illusion as to the superpowers our Sherpas possessed. Many were now close friends and we were in awe not only of their apparent indifference to the altitude but their never-ending compassion and selflessness. Some had been up to the col and back multiple times but their exhaustion rarely showed. It goes without saying that western mountaineering has long stood on the shoulders of the Sherpa community and it was a pleasure to climb alongside (well, behind) them. Some of the team were on their first expedition while others were high altitude veterans such as Phurba, who has stood on the summit an astonishing twelve times.
Twelve hours after arriving back at base camp we were on the road, squeezed into two minibuses en route to Kerung, perched on the Tibet-Nepal border. The road was as breathtaking as on the way in and negotiated at about three times the speed as before. The scenery changed all day, as though we were travelling through countless countries. Views of Everest gave way to wide, farmed, U-shaped valleys and finally steep, pine-lined river courses carved by the thundering power of Himalayan meltwater.
After dinner in Kerung we asked our Chinese minder where we could go for a few drinks. We ended up in a gaudily tiled, red velvet nightclub. The waiters, Bieber-inspired Nepalese boys in their late teens, alternated between serving drinks and competing in increasingly vigorous dance-offs, of which we obviously joined in. A big night was capped with the best street food I’ve ever eaten. Tibetan gastronomy, a true revelation.
At the border we exchanged Tibetan tarmac, efficiency and progress for Nepalese dirt, delays and stagnation. We left a cavernous, echoey, airport-esque border post, crossed the river and were greeted by a row of rusting corrugated iron shacks. The next sixty miles to Kathmandu took over fourteen hours as the rock strewn, mud-hole ribbon of road looped around the mountains and valleys. The views were stunning, as views generally are when you spend hours only meters from a free fall death into the valley below.
Back in Kathmandu and with only a few days before we all began departing for home we enjoyed the rich air and beer gardens. We were honoured to be invited by Doug Scott to a Community Action Nepal banquet on our final night, a celebration of the incredible work they’ve done over the past three years rebuilding after Nepal’s devastating earthquake.
We had spent the previous weeks intensely focused inwards on our goal and ourselves, everyday ensuring we made forward progress. It was fantastic to finally step out of that world, hear stories of selfless devotion and meet those who had dedicated years, or more often decades, to improving the lives of those living in Nepal’s beautiful, breathless and inhospitable mountains.
Pictures and Video: Marcus Stevens (Instagram: @ghystem)
