Surviving the Extremes: A Doctor's Journey to the Limits of Human Endurance (2 page)

Millennia ago the earliest explorers, at sea in wooden boats or on foot in deserts and jungles, carried with them the same ancient mysterious device that scuba divers and high-altitude mountaineers use today. It was by far the most complicated yet most reliable piece of
equipment aboard
Apollo 11
when it landed on the moon. In the entire universe, no system more complex has ever been discovered than the human body.

It comes in two standard models, which have spread out over the earth in billions of copies. Though some parts have been modified to work effectively in varying climates and terrain, the basic design has remained relatively unchanged for several eons. Nevertheless, no one would claim to understand how it works, least of all doctors like me who have seen it function in harmony and in chaos.

Human beings are both tough and fragile. They have populated the earth by adapting to its various environments, but thrive only on the land, in temperatures between freezing and 100°F, and mostly at heights below a mile or so. The body’s own physiological constraints confine it to less than one-fifth of the earth’s surface; beyond that, the environment is too extreme for an organism that needs food and water daily, oxygen by the minute, and heat constantly. The few million humans who live in borderline environments don’t thrive, but they do survive at the edge of their own physiology. Like Pasang, they live on the periphery of habitable land in regions such as the Himalayas, the Amazon, the Arctic, or the Sahara—regions that can sustain life, though only barely. The borders of these realms are defined by connecting the points at which their inhabitants’ body defenses can no longer match the insults of the environment.

No animal in its right mind ever intentionally puts itself in danger by going somewhere it doesn’t belong. Human beings, on the other hand, are controlled by brains whose emotional and spiritual imperatives can override the survival instinct. Humans have always had an insatiable drive to explore. Now, with the accumulated wisdom of countless generations, we have developed the technology to cross barriers that had previously contained us for hundreds of thousands of years. The combination of wanderlust and technology has given us the temerity to believe we can take on the most extreme environments on earth and not just survive but adapt to them. Human bodies, however, are far more fragile than we’d like to admit. If our protection breaks down, we die easily.

I am a doctor on many scientific expeditions to the most remote
regions of the world. My patients are the people who live on the edge of survival and beyond. I practice medicine in environments and in situations incompatible with life, often treating conditions I have never seen before, and sometimes never even imagined. The operation of the human body is mysterious enough under normal conditions; when subjected to the full power of an inhospitable environment, it can become completely incomprehensible. It’s not easy to fix something when you don’t even understand how it works, yet on these expeditions it has been my responsibility to try to counter the effects of environmental insults on human physiology. When things go wrong in extreme locations—when a mountaineer develops pulmonary edema, when a diver gets decompression sickness, when a body part is severed in a remote corner of the jungle, and when a man tumbles headfirst into a crevasse—all eyes turn to me. There is no adequate repair manual to consult; my only tools are those I have brought with me. There is often no reasonably safe place to work, or even to think, and the problem has to be fixed immediately. So I have learned to make up some rules as I go along, often aware that I am not just waiting for help to arrive—help isn’t coming. At least not from outside. Sometimes help does appear, arising from within—from a patient’s deep-seated will to survive.

I practice medicine in places where I don’t belong, often where no one belongs, because I never lost the childhood instinct to explore. When I was eight, I spotted a book in my house called
Annapurna.
An odd title, I thought. I couldn’t imagine what it was about, so I climbed up my father’s bookshelf and pulled it down. It turned out to be the classic tale of the ascent of what was, at that time, the highest mountain ever climbed. The book opened up to me a world I never knew existed, impossibly far away from my apartment house in the Bronx. The idea of exploring hidden worlds took hold of me and never let go.

Growing up in New York, it’s not easy to climb mountains, but I discovered that with a microscope, I could explore vast mysterious worlds without ever leaving my room. That started me on the path to explore the ultimate unknown—the human body. I became a doctor, taking a residency in orthopedic surgery and eventually a fellowship
in microsurgery, moving along the prescribed route toward becoming a member of the medical establishment. But I always held on to the dreams of adventure that
Annapurna
had given me. I learned to hike, canoe, sail, and scuba dive so I could reach exotic places on my own terms. Finally, one day I called a climbing school in New Hampshire and signed up for lessons. My instructor was an itinerant ex-Green Beret from North Dakota. I assumed he and I would have nothing in common. He turned out to be an intelligent, sensitive soul who shared my enthusiasm for adventure—though his path in life had given him far more of it than mine had. We hit it off immediately.

Six months later he asked me if I wanted to join his team to climb mountains in Peru. He enjoyed my company, he said, and liked the idea of having a doctor along. I was immediately tempted by this opportunity to combine my medical training with my passion for adventure. I was curious about the challenges that the human body in general—and my body in particular—could meet. For a single guy with no steady job, like my Green Beret friend, pulling up stakes and going to Peru for a month was easy. I, on the other hand, was a surgeon attached to a wife and a hospital. Knowing my lifelong desire to climb, my wife supported me enthusiastically while admitting she would have preferred it if I hadn’t wanted to go. Taking a month off meant rearranging my schedule to ensure that there would be adequate coverage for my patients. As chief resident, I could make all the arrangements, though I didn’t know how my colleagues would react to my disappearance. But I was determined to go climbing, even if it meant the risk of getting fired when I returned. Being a surgeon, I told myself, is what I do, not who I am. I didn’t want to become a prisoner of my profession.

The bigger the mountain, the more planning required to climb it. The mountains our team would attempt in Peru were nearly 20,000 feet high. Preparations were divided among the team members according to their interests and skills; the responsibility for all the “doctor stuff” fell to me. To the other team members, this obviously meant preparing a list of all the medical supplies we might need. Less obvious to them, but striking to me, it meant I’d have to know how to use these supplies, some for conditions I’d never treated or even seen.
Motivated by the fear of being found wanting as a teammate lay dying, I was determined to start at the beginning and not miss a detail. I noted down every problem that might befall a high-altitude climber from head to toe—fractured skull to athlete’s foot, and everything in between. I read about every condition and carefully listed each medicine or supply I would need to treat it. If I didn’t bring it myself, I wouldn’t have it and there would be no way of obtaining it. I even wrote out treatments on small squares of paper that I would keep in my pocket in case my mind went blank in an emergency. In short, I went to Peru thoroughly prepared and somewhat confident but nevertheless hoping for a trauma-free adventure. I didn’t want to be put to the test.

With that thought in the back of my mind, I sat on climbing gear in the back of an open truck and watched the Peruvian countryside roll by. We were riding up a high mountain pass on our way to Taqurahu, the 19,000-foot peak that we intended to climb. Another open truck, even more rickety than ours, was coming from the other direction filled with Indian villagers on their way to market. As we watched in disbelief, the truck teetered on the edge of the road and then toppled over, tossing out people and animals as it tumbled down the slope.

My first test was going to be at a full-blown disaster. It was like a bad dream. I forced myself to keep cool on the outside, because if the doctor looked nervous, everyone would get nervous. The two minutes it took for our truck to reach the accident scene was enough time for me to calm down on the inside by focusing on the likely injuries. I ran through the treatment steps in my head. I remembered the notes in my front pocket.

People, livestock, and baggage were strewn all over the hillside, which sloped down to a ravine where the truck was lying on its side. I paused at the top to let the first frightening impression pass by, then took an analytical look, noting who was groaning, who was only moaning, and who was bleeding. No one seemed to be dying. I reduced the chaotic scene to a series of problems I would handle one by one. Gradually it became clear that although I was high up in the Andes, I was facing injuries not unlike those I would find in any
hospital’s emergency room. I injected a little girl with an anesthetic, then set her fractured forearm. My Green Beret climbing teacher was a resourceful assistant; he splinted the arm with a wooden slat he broke off from the overturned truck. I started an intravenous line on a farmer who looked ready to faint. There was one concussion, one blunt abdominal trauma, and several other more minor injuries. Once I realized there was no patient I would not be able to treat, my confidence, which at first had required some effort to project, started flowing naturally. Though they spoke only Quechua, my patients and I communicated easily in the universal language of patient and doctor. I didn’t once think about the little treatment notes in my pocket, though having them there may have helped me subconsciously. As I finished cleaning and sewing the last laceration, one of my patients came back with a goat, still stunned and bleeding from the neck. Buoyed up by how well things had gone, I sewed up the goat.

According to our map, a
clinica
was a day’s ride away, so we unloaded our truck and laid in all the villagers for the long trip. One of my teammates came with me; the others just set up camp where we were and waited for us to return. We fully expected to drop off our patients and make a quick U-turn to the mountain. The
clinica,
however, turned out to be a cinder-block room with no medical supplies, run by a doctor who seemed capable only of handing out birth-control pills. Although the patients were stabilized, he begged me not to leave until medical transportation arrived from Lima. With the still vivid memory of the fear that can be provoked in a doctor faced with a medical challenge, I had empathy for my colleague and stayed the night.

The rescue was publicized in Peruvian newspapers and on the radio, making me something of a local hero. We eventually did get back to climb Taqurahu, but reaching the top wasn’t nearly as exhilarating to me as treating the accident victims had been. I had risen to both challenges, and yet, in my heart, taking care of the villagers had pleased me more. I was interested in the earth’s extremes, but succeeding at extreme medicine had been the higher summit.

When I returned to New York, I was relieved to find that my hospital supervisors, though they couldn’t admit it officially, seemed
to admire what I had done. Only a token punishment was imposed for my absence. Even had the consequences been more severe, however, I knew beyond question that I had made the right decision. I was determined to open even wider the door to that other world.

My exploits in Peru came to the attention of The Explorers Club in New York, and not long after my return I was invited to join that venerable group of seasoned world explorers. For my first meeting I was asked to come with one good idea. Knowing that its membership must possess a unique and wide-ranging collection of medical experiences, I suggested that someone first collect and then synthesize the information, to create a fund of knowledge on medicine in extreme environments. The idea met with approval and, as often happens to someone with an idea at a meeting, I was unanimously assigned the task of bringing it about.

At first it seemed presumptuous that a specialist in microsurgery such as myself should aspire to become an expert on extreme medicine. I felt like an outsider looking in. As I delved into medical journals, however, I found that there were few articles to read; fewer still were worth clipping and underlining. What little information existed was often vague, impractical, or contradictory. No doctor, I realized, could truly master such a disparate and random collection of far-flung maladies, but, within the Club, I was very quickly perceived as the repository and the source for information.

My Explorers Club comrades were eager to share their experiences with me, and I soon had a collection of practical advice on treating medical problems in places and settings I never could have imagined. Perhaps I really did have a unique position from which to practice extreme medicine. Explorers heading for every part of the globe routinely began coming to me for advice, often coupled with invitations to join their expeditions. For someone who a year earlier didn’t even personally know a “real” explorer, every offer seemed too good to refuse but by this time I had left the hospital and was in solo private practice. No doctor I knew of crossed routinely between the worlds of exploration and medicine, and there are good reasons why. Setting up a practice involves risk and investment. I was proposing to be away for long periods of time. That would mean a loss of continuity for
my referring doctors, not to mention a loss of income. The effect on my practice would be unpredictable, but taking risks and facing the unknown are what explorers are supposed to do. The experiences would be worth far more than any acquisitions.

So I became a medical explorer, stepping out into the most extreme environments in the world eager to confront unexpected challenges. I paddled through the Amazon in a dugout canoe. Crossing the Arctic tundra, I tried to remember exactly how I was to record the migration route of a polar bear that was just then banging its lethal paw against the steel-reinforced window of my buggy. I had to stop taking notes for a fish survey while scuba diving in the Galapagos Islands when a shoal of hammerhead sharks passing above me obscured my light. On the Antarctic plateau, in a whiteout so severe I couldn’t see my feet, I made my way back to my snowmobile only by managing to follow voice cues from the driver.