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Everest Base Camp–Helicopter Rescue

October 29, 2009

in Nepal

As a trekking guide, when the day first comes that a client needs a helicopter evacuation, you can only hope that you’re ready…..and you had better be, because the decisions in those moments can be life or death.

I’ve seen plenty of sick people in the mountains of Nepal. I know the nuances, and I can often tell how they’re going to feel 6 hours from now, before they know themselves. I’ve dealt with virulent intestinal ailments, chest infections, altitude sickness, and more, yet I’ve never had to send a client out on a helicopter. I try to catch illness early and treat it wisely. Even so, the unexpected can happen.

——–
“Mike” is an older man who was tired and weakened from diarrhea all night (unfortunately common in Nepal). I was evacuating him on a horse to the next town, which seemed to be going fine. He was resting on a stone bench when he complained of dizziness and nausea–and then lost consciousness. I caught him before he fell.

He’s making gurgling noises. Choking? I check his airway. He’s breathing and it’s clear. Good. I call his name loudly. My mind is racing. Stroke? Heart attack? What the hell is going on?? Serious altitude complications? Merely low blood sugar? Passing out at nearly 12,000 feet is not a minor issue. I send a runner for Pemba, our senior Nepali staff and an expert climber. Mike is breathing–good. My number one thought: Get him conscious if possible. I slap his face, calling his name.

He comes around after about 15 seconds, but he’s disoriented. When I ask his name, he hesitates before he’s able to tell me. When I ask where he is, the best he can offer is “the Himalayas”. A few seconds later, he’s more present. He infers from my questions that he passed out. Okay, give him some time.

I talk to Mike, smile at him. Reassurance goes a long way in reducing the tension of medical emergencies. Then I shift gears: clarify his medical history, take his pulse and oxygen saturation, and check my log to see what medications he’s been taking the last few days. The question is: now what? …and how long do I have to decide?

——–
In these situations, the best thing you can do is to be calm and clear. I pause. I think. Immediate emergency like a heart attack? No. We’ve got some time. Pemba and Kami show up. Dawa shows up. “Elisa” (Mike’s wife) shows up. She counts as an additional patient in my mind. I check in with her, explain what’s happened. I want her calm, and she is, thank goodness. She’s a seasoned hiker, and she keeps her cool.

First water and sugar. Then another set of vitals. He’s more oriented now and keeping the liquids down. That’s all good. He’s still a little spacey though. Drifting. Breathing is shallow. Can he walk?

In Nepali someone says, “I think we should call a helicopter, yes Deana-sister? I pause, look at him. He looks wobbly just sitting there. They press, “Yes, Deana-sister?” I hesitate a moment longer. I don’t know what’s wrong with him. The signs aren’t typical, I’m sure of that much. I think: he’s been sick all night, he’s over 60, and most importantly he’s lost consciousness. I’m clear. Yes, call the helicopter. Even if he can walk, I don’t want to push it.
——–
Our Nepali guide calls Kathmandu. (Fortunately we’re on the second-to-last day of the trek and within cell range.) A helicopter will be on standby shortly. We’re going to need to get him to a helipad (which in this case is simply a small rectangle of flat terraced field). That’s within sight–fortunately. It’s only about 10 min walk at a normal pace, but it’s going to be plenty far in this situation.

Mike is not looking great. He’s pale and still sort of spacey. We suggest that a porter will carry him on his back. He doesn’t balk. When a grown man who has spent years hiking and skiing in the backcountry is totally amenable to being carried out on someone’s back, you know you have a problem. Helicopter? Right decision.

The trail is too steep for the horse. Pemba, Kami, and the horseman each take turns carrying Mike down, and UP, the trail for nearly an hour. Outside of Kathmandu, Nepal is never flat. I’m carrying one of the staff packs, plus my own. Even that little bit of extra weight is enough to remind me just how hard it is to carry a full grown 180-pound man. They are incredibly strong. Pemba is a 6-time summitter and has rescued people on more than one mountain. Kami summited Everest for the first time this spring and has run the Everest marathon three times (no small feat–and he’s one of my favorite sherpas both for his humility and his humor). The horseman is an everyday Nepali guy–and still plenty strong enough to carry Mike. These mountains breed tough men.

Each time they set Mike down to switch off, Kami holds onto to him, wrapping his arms around him to not only hold him upright but also to make him feel secure. Kami has no awkwardness in his touch–it is solid and easy, without any undertone of macho distancing or awkwardness.
——–

It has been a rough trip–people more sick than I’ve seen in a while. My staff and I have all risen to the occasion, taking care of people constantly–whether at 3am or 3pm–but it is a few of the village-raised boys (at 26, men actually) who melt my heart with their care. They take their responsibility very seriously, but they also have a sweetness about them which is impossible to convey.

Only a few nights ago, Kami had also sat up all night giving an ailing client oxygen periodically until he could be evac’d in the morning by horse. (The client was sick from inhaling some kind of acrid fumes near a stove).  Kami simply smiled the next day at how he had to constantly keep himself from dozing off. He wasn’t irritated or cranky, just happy the client was well again. With Mike, I watch Kami act with a comforting tenderness that reminds me how much I love the genuineness and affection of rural people in Nepal. For those of us raised in a more individualistic and isolated culture, witnessing the gentleness of these men is heart-warming.
——–

Working our way down the trail, we finally reach the lodge, carry Mike in, and lay him on a carpeted bench. He’s getting cold, and I don’t want him going into shock. We put him in a down jacket, cover him with blankets, and add two hot water bottles. Check vitals. He’s scared, upset–as anyone would be. Elisa is, too, now that we have arrived. I give them some time together while I start writing up notes on everything that has happened, recording vitals and meds and everything I can think of before it’s faded from memory.

Pemba and I talk for a moment, because it’s clear one of us is going to go on the helicopter. He suggests that I go because Western doctors are going to want some detailed information. I’m hesitant to leave the group (although there are only 1.5 days of hiking left), but I realize that Pemba can care for them more easily and I can care for our distressed evac clients more easily. Looks like I’m about to fly–which makes me immediately nervous.

My nine other clients are eating lunch and probably wondering what exactly is going on. They know he passed out, they saw him carried inside. I haven’t forgotten them, but I also haven’t had a chance to talk to them. It’s time to meet and let them know what’s going on. I gather round their table and explain we are waiting for a helicopter, that I am going to take Mike back to KTM. I’m planning to meet them in Kathmandu, so I brief them on everything they’ll need for the next day or so, from trail conditions to staff tips, and then return to Mike. His fingers are tingling–weird since he’s off Diamox. He’s cold, and he’s drifting in and out of consciousness. How long until that helicopter is here?? It has taken off from Kathmandu, which is an hour away. In the realm of uncertainty, an hour is a long time.

——–
Waiting. And waiting. Check vitals. Think ahead. Both Elisa and I  are going to need to eat something before we get on a helicopter for an hour. Especially since I’m sure we won’t be eating right after that. I arrange food, but neither of us can eat much. I’m running over my Wilderness First Responder training in my head. Have I missed anything? Am I ready to brief a doctor?

Finally, we hear the helicopter en route. Pemba hauls Mike up a steep embankment to the helipad, with two of us pushing from behind. We lay him on a thin mattress in a corner of the field. The helicopter is coming in. Pemba is standing in the middle of the field guiding it while I help shield Mike from the rotor wind. It’s landed. We ferry him over and lift him in. Then Elisa boards, then I squeeze in the middle. I hand the regulator and mask back out to Pemba, who assembles it onto the new oxygen canister which has arrived in the copter. He hands it all back in to me, and I secure the mask over Mike’s face. My 9 other clients are hiking on to their evening destination as we lift off for Kathmandu. If ever I had a maternal instinct, it’s now, watching all these people who are my responsibility walk off into the world without me.
——–

An hour flight means waiting, waiting. I check Mike’s pulse each time he falls into unconsciousness, even as I’m holding his wife’s hand. 50 minutes to go. 40. 20. 10. We land, and there’s an ambulance waiting–plus the familiar face of one of our Kathmandu staff. Meeting his eyes through the helicopter windshield puts me more at ease. I know we’ll have excellent support here.

The ambulance pulls up. An hour of free-flowing oxygen has given Mike some energy. Getting him onto the stretcher is simple, and then we are careening through the streets of Kathmandu, driving towards oncoming traffic, around cows and vegetable carts, with the incessant blaring of the siren in our heads. Nausea arises from the swerving and noise; the last thing I need is to be sick. We pull in to the small Western clinic in the heart of Kathmandu and get Mike into an exam room. I introduce myself as the group leader and say I have a SOAP note (medical condition and history) ready if they want it. The doctor gives me the go-ahead, so I concisely detail what’s happened since 11 am (these four hours are suddenly rich with information!) and what I know about his medications and medical history. Then the doctor starts asking Mike questions. He hesitates on, “Do you know what day it is?” His wife and l look at each other–neither of us know what day of the week it is either. That’s trekking for you.

One EKG, one chest x-ray, one blood work-up, and a multitude of questions later, the doctor concludes it was very mild high-altitude pulmonary edema (HAPE)–which will fade quickly here in Kathmandu–plus weakness from the night-long diarrhea. Between the oxygen and the lower altitude, Mike has improved substantially in the few hours since we left the mountains. Getting him out was the right decision. Even mild HAPE is serious business. They are running tests, giving him some rest. I realize they are probably not going to keep him overnight, so I’m not done yet. I zip through the streets on the back of a motorcycle to check us into the hotel, ensuring that we have a room and that it will be ready for him without wait, then I buy us some toothbrushes (because nearly all of our belongings are still on yaks in the mountains), and I return to the clinic in time to escort them home.

By evening Mike and his wife have retired to a room, and I’m certain they won’t emerge again. I am ready for a shower and some food. I haven’t really eaten since a 7am breakfast. Full and clean, I drop off to sleep, but the work is far from over. At 5 am, I arise to hitch a ride on another evac helicopter back into the mountains. I won’t be able to hike with my group today, but I want to be there to wrap up their trek, facilitate the final party, and be sure that their experience hasn’t been tainted by the loss of 2 groups members and a guide.
——–

It turns out to be a good day, from the helicopter ride (far more enjoyable this time!) to the morning in the mountains as I write up a draft of events, and on to the afternoon when I hike out 30-40 minutes to meet the group. As it turns out, I meet my guide Dawa first, who has come ahead to see his family. I hike down the “hill” with him about 15 minutes to his home where his wife feeds us tea and potato pancakes with spicy chile sauce. Back up to the main trail, then straight up the hill 40 minutes again, but the group still isn’t in Lukla yet. I’m worn out from the last few days: 4 client evac’s by horse, loads of stomach ailments, and a few other maladies. I sit in the late afternoon sun–again waiting, and waiting. The group finally turns up behind a long line of yaks, and I am deeply happy to see them. It was a good idea to return to them, and I feel satisfied with my work these last two days. Relieved, in fact, that I’ve executed myself well under pressure.

We drink and eat and celebrate the end of the trek. We play pool and dance and drink with our Nepali staff before flying out in the morning, sad to part from the smiling staff we’ve grown so familiar with. We return to Kathmandu to eat and eat and shop and eat. Everyone has lost weight, and our bodies are craving the calories. Mike has been resting and recovering and is looking more himself again. By the final night, we are all a bit healthier and in good spirits. Our group is reunited for a final Nepali meal–Pemba, me, Mike, Elisa, and the whole rest of the gang which has become like a family over the last few weeks, personalities we now know all too well.

I will be relieved to see the trip end in the morning, but also sad. The people in this group have been great, and I am always getting attached just in time to say goodbye. The recent few days have been emotionally and physically exhausting but also full of learning. In these mountains you can never tell when the moments of life and death will arise. The situation can change quickly. I feel stronger, more capable, and better prepared for whatever the future may bring. Plus I learned how to signal a helicopter for landing–but I hope I won’t need to do that anytime soon.

with best wishes to Mike & Elisa for their continuing good health

{ 7 comments }

ch October 29, 2009 at 1:09 pm

Incredible story, Deana! Nothing like a good medical emergency to test your inner calm. I’m proud of you for being such a pro, as always.

The chopper was definitely the right call. “Mild” pulmonary edema is a pretty nice contradiction in terms. From what I’m reading, HAPE sounds a bit like an inverse of the pulmonary edema divers sometimes suffer. I wonder if the same people have problems in both contexts, or whether it’s isolated to one range of the spectrum or the other. Both are fairly uncommon, though.

I’m happy to hear that you’re alive and well, and having some pretty crazy adventures.

We’ll be thinking of you at Halloween! Take care.

John M October 29, 2009 at 4:22 pm

Mike was lucky to have you as his guide (as well as the rest of the trekking party!) What clear thinking you have!

julie reber October 29, 2009 at 8:19 pm

Wow. I was just glued to every word. It’s crazy to think of where you are right now. I feel like it was just yesterday we were running through the redwoods of Mendicino and now you’re across the world saving lives! You’re simply amazing!
I can’t wait to share this with my parents.
Love to you!!
J,J,J&J!!

erin (aj) October 30, 2009 at 7:18 am

What an amazing and emotional adventure – I echo the comment that your group was so blessed to have your insight, leadership and care guiding them. Amazing Deana. We miss you here, aj

rae October 31, 2009 at 5:17 pm

Wow. What an amazing story. Great work Deana. Miss you!

sue November 2, 2009 at 5:07 pm

what an amazing story! as always, you’re impressing all of us with your inner calm and ability to think on your toes. so glad it worked out in the end. thanks for sharing your adventures with those of us living decidedly less exciting lives over here.
love you!

molly morizon November 18, 2009 at 10:15 pm

Greetings, Deana

My husband, Alain, and I met you at Rita Thapa’s just a few days ago. We were with Maggie Shah. Amazing reading your account of Mike’s helicopter evacuation. Must say that I am not surprised at your competence.At the moment I am in Singapore with my daughter (birthday surprise) but will be back in France next week. I very much enjoyed meeting you and would love to have more specifics about your trekking company. I do want to go back to Nepal…so..who knows? Stay well, Molly

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