Beyond NJ 9842

by Nitin A Gokhale

  As I sat there with my silent companion wondering when the headache would recede, and if I would be able to sleep at all at night, along came an angel. He sat down by my side and gave me sweet (over sweet) tea and spoke to me at length of this and that, of the ongoing cricket series, political happenings in Delhi, everything and anything, but the situation at hand. Another hour must have passed when feeling better now (for the headache had receded somewhat) I agreed to walk along with him, and stopping every few steps we made it to the next camp just as the sun set.

  The warmth of the camp, the litres of tea, bowls of ‘Thukpa’ and a few Brufen tablets had me feeling healthy again within a few hours and I spent the next day playing ‘Sweep’ with the soldiers even as we all laughed at how I had been the day before. Was it dehydration and fatigue or was it AMS (Acute Mountain Sickness)?

  I still do not know. But, at that time it did not matter. All that mattered was that I had learnt that such things could happen to people as they ascend in trying conditions, and I had also learnt how to treat them. I was learning medicine from experience and the experienced and not books!

  Illness on the Glacier

  A soldier leads a busy life on the glacier. A day’s routine work involves link duties (carrying rations and other material from a halfway point at which the lower staging camp people leave them, and doing the same for soldiers at higher camps), helipad maintenance, telephone line maintenance and camp maintenance, all of which involve a fair amount of labour. Work usually proceeds at a slow pace, for at extreme altitudes on the glacier, mild to moderate amount of labour such a shovelling snow or walking up a gentle incline carrying a weight makes one breathless. Yet, or maybe because of it, most of our soldiers are healthy at high and extreme altitudes.

  The “routine” ailments of everyday life in a peace station are rarely seen here. Few if any soldiers develop viral infections, gastroenteritis, fevers, common cold and the host of illnesses and injuries that are the bread and butter of a Regimental Medical Officer (RMO)’s practice in the plains. The reasons are probably two-fold. First, that except for some infections carried by ascending soldiers, there are few pathogens (disease causing viruses and bacteria) in the sparsely populated extreme cold environment here. The second reason would of course be that every CO ensures that only the fittest of soldiers are allowed to ascend to the glacier.

  Nima Norbu after his recovery

  What does a doctor do then? The day’s routine would begin for me with a leisurely breakfast in bed at around 8 AM. After this, while the soldiers completed their morning chores, the company commander and I would practice skiing under the tutelage of a long haired youngster. Ski classes done, we would catch up with the soldiers who having completed the days’ tasks would be taking a break enjoying tea and “pakoda”. The balance of the day would be spent playing games of cards, chess or noughts and crosses, telling tales (rather tall ones at times!) to regale the company and talking of home and family. We lived as a family. Usually, all the soldiers assembled in and around one hut during the day, and as they chatted and joked I assigned to myself the role of a listener, except when alone with the company commander. Another good pastime was to ring up all the satellite and staging posts, and chat to anyone who picked up the phone. While this kept me busy, it also allowed me to catch on early when somebody was feeling unwell. I think my most important role there was to listen to the soldiers to reassure them when they came to me for advice, and keep a stock of jokes and puns ready to make them laugh once in a while.

  For a doctor, the critical period is when a new group of soldiers are “inducted” on the glacier. Most altitude related ailments are reported in the first week, as the body tries to compensate for the decreased air pressure and consequent fall in pressure of oxygen. As compensation is completed in a week or two, the risk of altitude related ailments rapidly decreases. Thus, it came as little surprise when a new battalion started being inducting to my post, and a number of them developed AMS en-route, or on arrival at the post. Thankfully, this ailment is self-limiting and the patient recovers with rest and/or simple medication, over a day or two. I do not recall the need for supplemental oxygen or Acetazolamide (a drug used specifically for treating moderate to severe AMS) having arisen in any individual. We preferred to save oxygen, which was available in limited amounts, for cases of HAPO and HACO, two potentially fatal and dreaded conditions amongst fresh inductees to such altitudes.

  Once, two boys of the newly inducting battalion developed HAPO on arrival at the Zulu post. This post was notorious for the occurrence of HAPO, probably because it involved a climb of almost 4,000ft in a day. So a soldier started from approx 15,000ft early in the morning, was at almost 19,000ft by evening! The last part of the ascent is up a steep ice wall, all of 100 feet, on which the camp is located. The two who had developed HAPO were diagnosed by evening on the day after arrival at the post. Both were treated through the night and helicopter evacuation asked for. To everybody’s dismay, however, the morning arrived densely clouded with heavy snow fall. The battalion being replaced were highland natives, and as mentioned earlier, very competent at these altitudes.

  Oxygen reserves being low, it was decided to evacuate the boys to the lower staging post where both would definitely improve. One of the patients was badly off and unable to walk, while the other could walk. The bedridden soldier was put on a stretcher which was lifted by two of the highlander soldiers, as they began the descent down the ice wall on which the camp was located. Barely had they reached the base and begun to walk, to the horror of all straining to watch them in poor visibility conditions (due to the falling snow), the stretcher bearers along with the stretcher disappeared from sight, as if swallowed by the ground. They had walked into a crevasse, one of the many that dotted the valley floor. We lost both the stretcher bearers and the patient.

  “Telemedicine is the invention of the army,” a senior once proclaimed.

  I agree.

  Much before I had heard him speak, or heard of telemedicine at all I had practiced it, as every young doctor in the army does. It was usual for us to ring up our senior in the Base Camp, or specialists in the field hospital for advice on a puzzling case every once in a while. But during a new induction I had a “telemedicine” experience of a different kind. A new group of soldiers had arrived at Zulu the previous evening, when I got a call at 4 am from the officer there. One of the soldiers was unable to sleep, was very breathless and had a severe cough. It sounded like HAPO and I asked to talk to the patient. The moment the patient came on line it sounded like I was standing next to a gurgling stream of water. His lungs were full of water, so full that every inspiration and expiration produced loud bubbling sounds. I could not have got better diagnostic evidence if I had taken an X-ray. That was the only time I asked for a patient to be put in a HAPO bag along with doses of drugs and oxygen. Thankfully, two hours later he was better, and with sunrise he was air evacuated. In the Base Camp, the doctor diagnosed him as a case of severe HAPO.

  Weather was and is the biggest enemy.

  The casualties due to weather were far many more than due to illness, which outstripped casualties due to enemy action, not that enemy fire did not cause damage. We lost our artillery observation post officer, a bright youngster full of enthusiasm and zeal, fresh out of OTA. He died in artillery fire by the enemy, taking splinters through his chest and head. His radio operator too had a splinter through the chest and over the liver. But neither his lungs nor liver were damaged, the splinters had deflected off bone and lay harmlessly in the surrounding muscle. He survived. We (our battalion) also lost three boys in artillery firing on an adjacent post in a separate incident. In the same time duration, we lost three people in a crevasse accident (mentioned earlier) and a post on the northern glacier that sat atop a mountain was blown away in a night of gale force winds. Neither the five soldiers living there, nor any vestige of their camp could ever be traced. News of loss of life and limb in avalanches and blizzards would filter in every
once in a while. The smallest mistake in judgement could be harshly punished. In the summer months, avalanches and new crevasses opening were a constant threat. A crevasse covered by many feet of snow in the winters, would have a progressively thinning layer of ice over its mouth in the summers, waiting to swallow an unsuspecting soldier who walked over it every day, and would be surprised to have the ground crumble under his feet on a given day.

  Dogs are very useful creatures even at these altitudes. Other than company, they also offer invaluable service. We had a little pup, a local mastiff, carried up by one of the ascending soldiers. Named “Stupid” because of his habit of storing leftover pieces of meat in our sleeping bags, it started accompanying “link” patrols as it grew up. And on more occasion than one, it saved our lives. For it would dig in its feet and refuse to move, barking in protest the moment it approached a hidden crevasse! Soon we learnt to respect his judgement and avoided many a hidden crevasse that might otherwise have claimed life or limb.

  I moved after three months from “Chandan” to “Darshak” a post a little higher in elevation and much more in the eye of enemy action. Here we lived in a fibreglass hut inside an ice cave, for this was where enemy artillery fire had claimed the lives of three as they slept in their huts “protected” by a ridge of ice. This had prompted the soldiers to dig a cave into the ice and move into it. No artillery fire can penetrate more than one foot of ice they say.

  The post sat on a ridge approximately 1,800 ft above the valley floor. We climbed the steep mountainside to the post, using ropes secured by pitons to the ice covered mountainside. Every so often, one of us would survive a slip on the ice-wall. It would be a sobering thought for all of us when we considered what would have happened if the person had gone all the way down. Certain death! But nature can be a merciful teacher too. A young Naik, part of the battalion training team in the Siachen Battle School, got too sure of himself one day and undid his securing rope at the top of the ice wall. Such was his fate that within a few steps he slipped and went all the way down to the valley in an area observed by the enemy. The enemy helped us search for him. We contacted them on radio, told them of what had happened and informed them that we would be searching for our man. There was no response on the radio, but that day they did not fire on us, as 10 of our boys spread out searching for the “fallen” soldier amongst the crevasses in the ice wall and on the valley floor. Where we expected the worst, late in the evening, as the sun set along with our hopes, one of our search parties heard groaning sounds coming from a crevasse at the bottom of the mountainside. The relief was palpable. He was pulled out of the crevasse, and from his examination I could find nothing but maybe a few fractured ribs! We bundled him off down to Base Camp. Next day we heard that “our man” was hale and hearty with not a wound, except maybe a wounded ego!

  No one can make out Nima has three artificial limbs

  Were we scared? Did we think of death and danger often? No.

  I did not, and I know the others with me did not either. Such thoughts eat away at your spirit. I think we all learnt to consciously put such thoughts aside. When the enemy got our people we seethed, till we got some of theirs in turn. When nature took our people, we held their memories to our hearts and learnt to respect caution over bravado. The boys carried on and worked with greater zeal and caution, their spirits never flagging, making sure to maintain a cheerful face, taking greater care of each other. The spirit of our soldier is indeed insurmountable.

  WINNING AGANST ALL ODDS

  Capt Rajesh Mehta, of the 10 Dogra Regiment would never have thought that posting to Siachen would alter his life so drastically. When he ascended to 18,000 feet after proper acclimatisation, he led his men to the northern glacier in early 2005. Before going to the glacier, he was active in a counter-insurgency area, and also did a commando course, earning the coveted instructor grading. In February 2005, days after settling down at his post, Capt Rajesh developed clots in the veins of his brain, hands and legs. Doctors advised immediate evacuation, but a severe snow storm for 10 days however prevented any helicopter flying. His condition deteriorated. When flying resumed, he was first airlifted to Partapur, then flown to Chandigarh, before being admitted to the Research and Referral (R&R) hospital in Delhi.

  The clotting was so severe that doctors had no option but to amputate his right leg from his hip, and the left leg from the knee, and the left arm from his elbow. Any lesser person and any other organisation would have given up. But, army doctors with their skills and care and Capt Rajesh with his indomitable spirit, helped on by his equally courageous wife, proved everyone wrong.

  The army provided singular support to Rajesh by way of intensive medical care, and suitable employment in the army to rehabilitate him. Four years of treatment enabled Rajesh to recover. Artificial limbs were provided once his medical condition stabilised. Nearly nine years after he was evacuated from the glacier in a near-dead situation, Rajesh was promoted to the rank of Lieutenant Colonel, and is now posted in Pune.

  As another retired officer describes: “Despite the physical and mental challenges he faced, Rajesh Mehta has continued doing his work devotedly and always with a helpful attitude to find solutions to the problems of soldiers. In such adverse physical conditions many would give up hope, but not this young man, a trained commando and an inspirational leader of troops who lives up to the motto “Mushkil waqt commando sakth (When the going gets tough the commando gets going).”

  Rajesh Mehta before he lost his limbs

  As Rajesh says: “I am especially grateful to my wife, her courage, fortitude and support during our ups and downs. My young son too is a spirited and wonderful company for me. I feel great pride in being part of such a wonderful organisation, the Indian Army’ and its humane approach to employment management, and thank them for taking care of me and my family in every way.”

  Lt Col Rajesh Mehta with his artificial limbs

  “I wish to share with you what helps me cope with my disabilities of triple amputation and CVA (Cerebral Vascular Accident)? As per medical prescriptions, I was bound to be on lifelong medication. During the post amputation period, when my entire time was spent on a hospital bed with hardly any scope of exercise except being picked up on a wheelchair and taken around. Fortunately for me, it was my doctor who suggested that I could follow the Yoga/Pranayama being telecast live on TV in the early mornings. Initially it was difficult for me to pick up the technique of Anuloma pranayama) that is breathing through alternate nostrils.

  But after a period of one month, my body got used to deep slow inhaling and absorbing oxygen in abundance. I continued with medication till mid 2009 and also kept doing Pranayamas. I had to tolerate the strong side effects of the medications. But, in January 2010, my neuro-physician after detailed assessment of my progress felt I could taper down my medication.

  And by the end of 2010, not only was I rid of my medication, but could also do 50 sit-ups on the bed. I continued with the same routine, and as on date I am able to do 200 sit-ups every day followed by an hour of Pranayama. Finally, I would advise all friends to allot some time every day to breathing exercises or Pranayama, and continue a medicine free healthy life.”

  The story of Nima Norbu, a porter from Warshi village, very close to the Siachen Base Camp is equally inspiring. A pleasant young man started carrying loads up the glacier like all his friends and family from the area when he was barely 20.

  In December 2012, he was accompanying a platoon of soldiers and a group of fellow porters when he slipped into a crevasse all of a sudden. The crevasse was barely two feet in diameter, but was deep enough to swallow him. Initial efforts to pull him out failed and as night fell, rescue attempts had to be abandoned. Early next morning the search for Norbu began again. Through the day, soldiers and porters looked for him. Incredibly, as day light started fading again, Norbu was located nearly 25 hours after he fell in. Brought out unconscious, he was immediately flown to Partapur hospital and the next day to Chandigarh, an
d then to Delhi’s RR hospital. Prolonged exposure to cold forced the doctors to amputate—much like Rajesh—three limbs.

  From then on, life looked futile, but the army’s fantastic support system came into play again. Voluntary personal donations, funds from the army welfare fund and world class medical attention allowed Norbu to rebuild his life. When I spoke to him in his village, at first glance, Norbu looked absolutely normal. Three artificial limbs now allow him to move about on his own. Family and friends have rallied around him. With a corpus of about Rs 11 lakh has given Norbu, a base to begin life anew.

  “I cannot be my old self again, but such generous help from the Army has given me renewed hope. I am going to educate my child so that he does not have to become a porter,” Norbu tells me.

  What about his fellow porters? Do they fear going to the glacier?

  Norbu says: “We never fear the mountains or glaciers. They are our natural abodes. My friends continue to go up. And they will continue to help the Army. After all, the Army is here to protect us Ladakhis,” he tells me proudly.

  This then is the story of Rajesh and Norbu, two different personalities, victims of two different circumstances, but both displaying an indomitable spirit.

  A doctor at Norther Glacier

  Dr. Sagarika Patiyal, Commandant of Leh’s Army Hospital in Oct 2013

  A medical post at Khardung La

  A civilian being given oxygen at Khardung La

  Doctors at Leh Army Hospital with the author