Surviving the Extremes: A Doctor's Journey to the Limits of Human Endurance (3 page)

Wherever I was and whatever the circumstances, I was always the doctor, expected to treat whatever injury, or
insult,
a hostile environment might inflict on a fellow traveler—from frostbite to snake bite. If I didn’t know what to do, I would rely on local lore or improvise. I took my expedition work very seriously and after a few years, wasn’t quite sure anymore which of my worlds was the “other” one. Dr. Kamler’s adventure stories always circulated quickly around the medical community, often embroidered with more detail and infused with more drama than my original accounts. Increasingly I felt like an outsider in the traditional, medical world from which I had come. Sometimes my New York practice seemed the more alien environment. However, something very interesting happened. Doctors pinned down by heavy mortgage payments and high overheads sought me out for vicarious relief. They understood why I did what I did. They shared my curiosity about what happens to the human body at the limits of medicine and felt the same longing for adventure in places far from their waiting rooms.

The earth’s harshest and least explored environments—above sea level, at any rate—tend to contain mountains. Many of the expeditions I have found most intriguing involved rugged mountaineering, making climbing proficiency a required skill for a doctor practicing extreme
medicine. I climbed in the Alps, the Andes, and Antarctica, joining the tight community of high-altitude climbers. No matter what hemisphere I was in, I would run into the same people.

Several years ago, by word of mouth, I heard of an expedition being put together, sponsored in part by
National Geographic,
to study the tectonics of Mount Everest and measure its exact height using a laser telescope. The climbing would be difficult, but the research would be valuable, and the challenge of providing medical care would be as enormous as the mountain itself. My phone call to the expedition leader struck him, he later told me, as divine intervention. Though he had a clear scientific objective, adequate funding, and supremely qualified climbers, he had not yet solved the problem of medical supervision. I would be the only team member he hadn’t already climbed with and my climbing resume was a little thin by his standards, but he was still eager to have me. He had been to Everest before and told me how quickly bad things can happen on big mountains, even to experienced people. He was right. Only one day after we arrived in base camp, with most of my supplies still in boxes, Pasang fell into a crevasse. I was yet again treating someone in a hostile, unforgiving environment and discovering—yet again—the body’s enormous capacity for survival.

That discovery forms the core of this book. We are going on a journey into the most remote and dangerous regions of the world, and then continuing on into the bodies and minds of the people who are there, people for whom that environment is very real and very life-threatening. Some of the stories are journeys I have made myself, some are based upon the experiences of others: climbers, divers, sailors, explorers, astronauts, as well as ordinary people who found themselves in extraordinary circumstances. Woven throughout are observations and reflections on the evolutionary biology, physiology, and psychology that combine to give humans the means to prevail, whether it is in an acute response to an attack from a force of nature, or a long-term adaptation to a chronic stress in the environment. We will cross the human threshold to see how the body works under normal
load-bearing
conditions, how it moves into overdrive when subjected to environmental insults, and, finally, what happens when the body breaks
down—overwhelmed by extreme environmental forces it was never designed to withstand.

The tried-and-true method for dealing with extreme environments is to avoid them. Apart from the occasional hapless wanderer, this approach has worked well for the human species over a few hundred thousand years. People who live on the edges of these no-man’s-lands have adapted to their particular environmental stresses through natural selection, but it made no sense to venture any farther inside to a place offering no food or shelter. And there was no good way to get there, in any case. Ocean depths, remote deserts, high seas, dense jungles, tall mountains, and outer space were all safely inaccessible, so the challenge to adapt to more extreme conditions simply did not exist. With gradual exposure over enough generations, humans demonstrate enormous adaptability. Without that exposure, such remote regions are deadly.

With no one willing or able to go there, forbidding environments long remained empty spots on the map. Advancing technology, however, has suddenly made these places accessible. Moreover, the peculiarities of modern civilization have made them alluring to explorers, scientists, and adventurers. In an evolutionary instant the rules have changed, though the game—survival—remains the same. For example, the body “understands” tiger bites; it doesn’t “understand” nitrogen bubbles. It knows the rules for tigers because it has been dealing with them for thousands of years. Through trial and error, natural selection has equipped humans with a complex and precise sequence of physiological responses, refined over countless generations, whose aims are to counteract a tiger’s predation. First, the mind recognizes that the fast-approaching creature is dangerous; then it sends a signal to the body, instructing it to flee. Should the escape mechanism not work, the body prepares to defend itself. And if it gets injured, there is a preset sequence of healing cells and chemicals that can assess the damage and initiate repairs. The effort may prove unsuccessful, but the body understands the threat and has developed the tools that enable it to fight.

What happens to the same meticulously developed defenses when nitrogen bubbles attack the body? Deep-sea diving has only been
around for a few generations, and exposure, when it occurs, is anything but gradual. In the body of a diver, the bends, the onslaught of nitrogen bubbles in the bloodstream, is like an alien invader. Having never seen it before, and with no time to adapt, the body’s response will be as chaotic and misdirected as planet Earth’s reaction would be to an attack from Mars. The body undertakes equally chaotic responses to other unfamiliar enemies: the low air pressure on a Himalayan mountain or the high water pressure under the ocean; the constant daylight of a polar summer or the constant darkness and extreme cold of a polar winter; the relentless heat in an African desert; the weightlessness of outer space. Yet, as we will see, people who live on or near extreme environments—from jungle Indians to Sherpas, from Eskimos to Bedouins to South Sea pearl divers—have each developed specific adaptations to the environmental insults they confront every day. Evolution has molded humans to fit along the various frontiers of survival, but even their special protection breaks down quickly if they push themselves beyond their borders.

Pasang should not have survived, but he did. Over the course of the night, his thready pulse strengthened, the swelling in his face receded, and he opened his eyes. With the morning light, the chanting stopped and the spell was broken. Though I felt I had been watching the scene from afar, I was certain I had witnessed a healing force that was beyond medicine. The chanting had released an energy within Pasang, a will to live, and this had reversed his decline. A spiritual force had created a tangible effect, what a religious person would call a miracle. My medical training should have led me to explain his recovery in terms of nerve impulses and chemical reactions, but confronted with such incontrovertible testimony high on a Himalayan mountain, even a faithless man believes. There was no medical reason for Pasang to be alive. I realized then, that practicing extreme medicine would sometimes mean witnessing, and working alongside, phenomena I might never understand.

A rescue helicopter was on its way and we had to get the patient ready to go. I busied myself with the details of an evacuation that,
last night, I was sure wouldn’t be necessary. Conscious now, though still only dimly aware of his surroundings, Pasang began protesting when his arms were tied to the stretcher. It was a good sign—although the words, I was told, were a Tibetan curse.

Every time I returned to Everest, I recalled the power of that event. The research with which I was involved expanded to include global positioning satellite beacons as well as lasers, and took five seasons to complete. With every new expedition, I became more familiar with Everest but never lost my respect for it. Though scientific instruments were placed on the summit, none of us ever felt as if the mountain had been conquered, or that it could be conquered. There were too many reminders of how dangerous a place it is, and how frail in comparison are those who dare to climb it.

In 1995, as I was ascending a steep, overhanging pitch, a Sherpa team member slipped on the slick ice directly above. I watched in horror as he fell past me, plummeting 3,000 feet—more than half a mile—to his death. The following year I was again trying for the summit when a vicious two-day storm took the lives of eight of my climbing friends. I was the only doctor on the mountain and did what I could to help the survivors, but my team was powerless to save those who were lost and freezing in the snow. They were as much beyond help as if they had been lost in space—an analogy that stimulated NASA to try to apply some of their space-age technology to the problem of saving people lost in the wilderness.

In the year following that storm, I got a call from a NASA Commercial Space Center that was funding a program to field-test medical monitoring equipment under the most extreme conditions possible. If their equipment could be made to work on Everest, it would work anywhere on earth—or beyond. They had been looking around for an experienced doctor to serve as their “chief high-altitude physician,” and my name kept coming up. Here again was an offer I could not refuse. Climbing Mount Everest is the ultimate test for a mountain climber, and bringing the world’s most sophisticated medical care to the world’s most remote environment would be the ultimate test for an extreme medicine doctor. I accepted the challenge for myself and for the friends I’ve lost in the mountains.

I returned to Everest, not despite the tragedy of 1996 and the others I’ve experienced, but because of them. I worked with scientists and engineers from the Massachusetts Institute of Technology, Yale University, and the Defense Department to develop computer models and treatment protocols that we tested on Mount Everest. The same wireless body sensors NASA is developing for astronauts on a space station or on Mars were adapted to be worn by mountain climbers, or any other wilderness travelers. Sensors continuously transmitted heart rate, respiration, body temperature, and other vital signs, as well as exact location, to us at base camp. We knew at all times whether and where someone needed rescue.

Once a sick or injured climber was brought to our medical tent, we supplemented the data with heart sounds, breath sounds, EKGs, sonograms, microscope slides, and video images of the patient. The digitized information was sent via satellite through a live-TV hookup to Yale and Walter Reed Hospitals so medical experts there could radio back real-time treatment advice.

We had foreign climbers come to us at base camp asking to be treated for chronic conditions, the level of care we provided on the mountain was so much higher than anything they could receive at home. Had such a telemedicine system been in place during that fateful storm in 1996, we might have been able to save some of the people high up on the mountain who are still lying there.

I’m mindful of how far I’ve come since the days when I kept those little treatment papers in my front pocket. I’ve been to some of the most remote regions on earth, and I’ve had the rare privilege to practice the only form of medicine that mixes modern drugs with herbal cures, satellite signals with ancient chants, and science with spirituality.

THE BLACK, STAR-FILLED LAKE
was such a perfect reflection of the night sky that my paddle made ripples through each constellation. With stars both above me and below, it would have been easy to imagine I was canoeing through space—had it not been for the glassy eyes that broke the water like closely set periscopes glowing jewel-red in the reflection of my flashlight. The eyes remained unblinking, motionless, but my strange light stirred up a hollow grunting sound from just below the surface. Many other pairs of rubies were scattered among the stars in the water. As we passed each of them, the same warning noise arose from below. In the humid silence, the grunts resonated over the lake, intensified by the darkness. I could barely see my companions in the front of the canoe, and no one spoke. Each of us was alone. Hours passed that way, or maybe it was only minutes.

Gradually I grew aware of light coming from above and behind me. Over the jagged horizon appeared an orange disk. I knew it was the moon, but I felt as if I were witnessing sunrise on some other planet. The stars dimmed; the sky and the water turned silver. An irregular black seam appeared around the edge of the lake, its top and bottom edges perfectly symmetrical: the silhouette of the surrounding treetops mirrored in the still water. In this bizarrely lit world filled with unfamiliar noises and inhabited by strange creatures, I was an alien.