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reed magazine logoSeptember 2010

Life and Death in the Valley of the Moon continued

We infused him with liters of warm saline and put him on oxygen. Avoiding respiratory depression, which would be fatal, was in the forefront of my mind as I treated his hypothermia, wounds, cerebral swelling, muscle spasms, and pain. We cleansed the scalp as best we could, cutting away the matted hair and debriding the shredded scalp tissue before stapling the long, dog-eared gashes.

My outstanding medical assistants, Gobinda and Tshering Sherpa, were my second and third sets of hands and eyes. They labored tire­lessly through the night with me trying to save this poor man’s life, but our work was just beginning.

An hour after the porter arrived, another patient was brought in on a Sherpa’s back. He was in severe respiratory dis­tress, blue from depleted blood oxygen, with florid swelling in the lungs, a cough, and high fever. I treated him for HAPE (high-altitude pulmonary edema) and pneumonia with oxygen and IV antibiotic. Thus we had two patients on supplemental oxygen, as well as an entourage of ex­hausted Nepalese and Sherpas who had brought these two patients to the clinic, and who sat up most of the night keeping a vigilant watch over their friends.

At dawn, the porter’s rigors finally ceased. He opened his mouth, peered out of his right eye, and reached out purposefully for a blanket. We felt such a thrill of delight at these signs of progress, but our hopes were quickly dashed by the news that his employer was still refusing to pay for a helicopter. With just a few more doses of IV anti­biotics, sedatives, and narcotics left in our pharmacy, we didn’t think we could keep him alive much longer.

By now, the HAPE patient was on his feet and able to trek with a friend down to the clinic in Kunde for further care. We tried to solicit donations from several passing groups of trekkers to evacuate the porter, but to no avail.

Another hour passed, and a large Indonesian trekking group arrived at the post carrying one of their members on a crude stretcher, suffering from acute altitude sickness: severe confusion, unable to walk, vomiting, bluish pallor, delusions, and severely depleted oxygen levels. He had HACE (high-altitude cerebral edema), the most deadly form of altitude sickness. There was no doubt he would require a helicopter to Kathmandu.

Ironically, this life-threatening situation for the Indonesian represented a lifeline for the porter. After consulting with his company in Indonesia by satellite phone, the group leader generously offered to let the porter ride in the helicopter’s second seat. This meant the Indonesian, who was nearly unconscious, would be unaccompanied and would have to rely on the HRA to take care of him in Kathmandu. Their one condition was that I examine the remaining members of the group to be sure nobody else was in need of evacuation. Once the Indonesians were medically cleared, and the porter’s evacuation assured, the HRA arranged to meet the porter at the airport and stepped up the pressure on his employer.

With bad weather fast approaching, we had a full and stressful morning before both the porter and the Indonesian trekker were stabilized and ready for transport. We were afraid the wind and clouds would ground the flight. What a relief, hearing those helicopter blades! The whole village came out to watch as the porter and the Indonesian man were loaded into the helicopter and flown down the valley towards safety. By the time the helicopter arrived in Kathmandu, the porter’s employer had succumbed to the HRA’s pressure and agreed to take him to Teaching University Hospital and pay for his medical care.

I never saw the porter again, but the following month, back in the U.S., I heard that he had made a full recovery. All I can say is that helping to save that young man’s life has been one of the greatest rewards of my medical career.

Madeleine Martindale ’84 completed her MD in Rochester, New York, and an internal medicine residency in Seattle, Washington. She has volunteered for two seasons at the high-altitude clinic in Pheriche, Nepal, and spent a year working at CIWEC Medical Center in Kathmandu. She resides in Portland, Maine, and is currently stationed in Antarctica, wintering over at the U.S. Antarctic Program’s McMurdo Station. Her email is drmartindale@yahoo.com.

reed magazine logoSeptember 2010