One advantage of medical examinations, for whichever qualification, is that they demand instant recollection of long factual lists. How many of the 234 causes of bloody diarrhoea do you know? Tell me the forty-six ways appendicitis can kill? I applied this acquired skill to climbing. I went on courses, talked to instructors and read every book written on the subject since time began. Within two years I was theoretically sound, though practically very inexperienced.
The first stop was not Everest, but McKinley. Our visit there was to sort the wheat from the chaff. Climbing is not everyone’s forte. Masquerading as a military exercise, Exercise ‘Top Slap’, it was to be my first experience of high-altitude snow and ice climbing. McKinley was well known to be one of the world’s fiercest peaks, especially when the weather turned sour. Twenty-nine of us went to Alaska. The subsequent Everest attempt only required fourteen.
By the time we left for McKinley, my climbing knowledge was well-ordered, but my personal life in chaos. Being in love does that to you. Louise and I had decided to live together before we were married, though we had set the wedding date for soon after my return from Alaska. This was a difficult situation for the RAMC, which did not know how to handle two officers, in the same Mess, falling in love. Even the Queen’s Regulations - Queen’s Regs - had no advice to offer. The Army is run on the Queen’s Regs. If you perform an act that lies outside the text in those massive tomes, all manner of disciplinary horrors can befall you. It has opinions on homosexuality, rape and other assorted deeds, but nothing covered Louise and me co-habiting in Farnham. It was to our advantage. We simply did it and in no time it became accepted as normal.
Alaska is a long way from Hereford and Hercules aircraft very slow. The first stop after leaving the UK was a Royal Air Force base in Newfoundland. It must be the loneliest place on earth. I felt desperately sorry for the RAF ground crew stationed there. There was nothing to do. Nothing except fantasize about life elsewhere in an attempt to enjoy one’s own company. My memories of the base are now limited, but I do remember lots of snow, miles of forestry and an endless supply of pornographic videos. For most of our twenty-four-hour stay we saw nothing of our hosts. They remained locked away in a darkened room looking at assorted views of the same act of procreation.
Staging through Vancouver, we arrived eventually in Anchorage and were transported from the airfield to the US Army base of Fort Richardson. It was an interesting introduction to the eating habits of our American partners. I cannot recall seeing so much high-fat food being squeezed on to a plate before. Having queued, you would eventually be confronted by a massive, overweight chef, frying pan in each hand, furiously cooking omelettes. Not one- or two-egg omelettes, but six- or seven-egg ones. He was surrounded by rows of stainless steel pots and containers filled to the brim with dietary extras: hash browns, syrup, waffles, cream. The temptation was too great. I was in Fort Richardson for two meals and put on half a stone. I knew then I would have to climb to great heights, simply to expend the calories I had gained.
My impression of Alaska was like something from the great Wild West. The area surrounding McKinley, the Denali National Park, is home to many wild, fully bearded trappers. Moose are their favoured prey. ‘One that got away’ stories abound and bars really do have chest-high saloon doors. Town names, and local behaviour, are wonderfully traditional, as shown by the near shoot-out in Moose Creek. One night, almost at closing time and before we had gone anywhere near the mountain, I was sat at a small round table in a bar being interviewed by a journalist for a climbing magazine. He was becoming quite intense, quizzing me in minute detail on the various tablets available to deter mountain sickness. Scattered around were similar tables of SAS climbers, each deep in discussion. The atmosphere seemed friendly. Suddenly I heard a female voice shout, ‘Get the hell out of here or you’ll regret it!’ It was the bartender.
‘I’m going for my gun!’ came the swift reply from a well-oiled trapper. Two men, both trappers, had been arguing furiously, in subdued tones, for some time. I had not realized: it seemed the only solution, if you were Alaskan, was a shoot-out.
At the mention of the word ‘gun’ the bar emptied instantly. People dashed everywhere. Being somewhat slow about these things it took me a while to realize why the journalist was now under the table. By the time I had thought to join him, one trapper had already charged from the bar into the street outside to get his gun.
From beyond the saloon doors I heard a whispered voice, as I cowered, trembling, beneath the table, hugging the journalist for extra security.
‘Doc! Come over here. We need you.’ I looked around me and tiptoed out through the doors. The only person left standing in the bar was the other trapper, lounging against the counter in an astonished, alcoholic way. Outside, I was greeted by a number of smiling SAS faces. Fifty metres away I could see the trapper in his four-wheel drive wagon, scrabbling through assorted bags to find his weapon. I was immediately grasped by a dozen hands and pushed to the front of the group. ‘Go on, you walk first. We’ll follow behind,’ I was urged. Our accommodation was the far side of the intoxicated trapper in his vehicle. Despite the distance, I could see the satisfied smile on his face as a large Magnum revolver appeared from the depths of a light brown holdall. So much for not getting shot on the mountains, I thought.
‘What’s this about?’ I asked. ‘You’re the professionals. You’ve done this sort of thing before.’
‘That’s the point,’ one SAS operative replied. ‘He knows you’re a doctor. He won’t shoot you. With one of us out in front he’s bound to have a go.’
So I was frogmarched past the trapper, as a form of friendly hostage. The gun-toting drunk barely spared me, or my SAS colleagues, a second glance. For the first, and perhaps only time of my life, I could claim to have saved the SAS.
There are many routes to McKinley’s summit. Our chosen one, the West Buttress, is perhaps the simplest of them all. A long, winding glacier, the Kahiltna, finishes at the base of an almost vertical ice Headwall. Once up the Headwall it is a long, dangerous trudge to the top. We flew in to our base camp on the Kahiltna glacier, a paltry 2150 metres above sea level. Bumping through the sky in a tiny, single-engined Cessna we negotiated the fearsome One Shot Pass, whose name speaks for itself, before landing smoothly on skis.
My first feeling was wonder. Clear blue sky, perfectly white snow and the overpowering image of the summit, miles away, leaning over us. My second feeling was terror. Avalanches. Fresh snowfalls had covered all slopes with a thick layer of unstable snow. By midday, our time of arrival, the sun had warmed the area and the snow began to slide. Avalanches were everywhere. Wherever I looked I could see another one - dozens of them. From a distance an avalanche is a beautiful thing. Nearby, the impression is different. It starts as a feeling of the mountainside moving. Then comes a high-pitched rattle as the smaller ice blocks and snow particles begin to move. The rattle is followed by a rumble, becoming louder and louder as, quite possibly, a whole mountainface gives way. As the avalanche picks up speed it can push before it a great wave of air, well able to pick up a man and throw him down again. Then follow the larger ice blocks and mass of snow, covering everything in their path. After I counted twelve avalanches in the first hour, I realized what a dangerous game high-altitude climbing was. The advance climbing party, highly experienced in such things, had sited our base camp well out of harm’s way. With luck the experts would see me through.
Snow and ice are not the only hazards of altitude climbing. The environment is a major problem - a medical nightmare. As you ascend, so the pressure of oxygen in the air gets less. At the top of Mont Blanc (4807 metres) the pressure of oxygen is half that found at sea level. On the summit of Everest (8848 metres) it reduces to a third. It is this reduced oxygen pressure that causes so many of the problems climbers can suffer. Red blood cells, responsible for carrying oxygen around the body, simply do not have enough of it available to do their job properly. Brain and lungs swell, the so-called high-altitud
e oedema, blood thickens in the legs and clots, while blood vessels in the eyes can burst. The process of acclimatization is therefore vital. This long word describes the body’s adjustment to the strange high-altitude environment. In principle, the more rapidly a climber ascends, the more likely it is that medical disaster will follow. It is worthwhile climbing slowly at altitude.
Up to 2500 metres above sea level, given enough time, it is possible to acclimatize almost fully. Upwards of forty million people worldwide live at or above this height. Once over 3500 metres full acclimatization is impossible. You may not feel too bad, but the body is not fully efficient. Over 5500 metres deterioration is significant. Slowly the body’s cells become damaged by reduced pressure of oxygen, however gradually one chooses to climb. If you stay there long enough you can quite possibly die. McKinley’s summit was 6200 metres above sea level and high-altitude problems were assured.
From the air a glacier looks very innocent. On the ground the situation is different. It can be full of crevasses - small, big, enormous. Crevasses really can be covered with snow bridges that give way when you least expect it. The cause of death, should you fall through one, is very rarely the impact on striking the bottom, as crevasses can be quite shallow. It is more likely to be the effects of cold - hypothermia - in a climber who is unable to gain purchase on the crevasse’s slippery walls and thereby escape. The body’s functions are gradually slowed until the heart stops, at which time you are almost dead. I say almost because resuscitation is sometimes possible even then. By immersing itself in one of Nature’s deep freezers, the body is maintained, for a few minutes at least, in a form of suspended animation. This particularly applies to children. It is always worthwhile resuscitating a patient with hypothermia, however dead they look.
Having reluctantly accepted my fears of being avalanched, dying from brain oedema, or hypothermia, I now had to cope with the worry of crevasses. The experienced climbers would play havoc with my imagination by regaling me with stories of past accidents, near misses and tortuous deaths. ‘You do know how to Prussik, don’t you?’ asked Peter, a wicked schoolboy smile on his face. Peter was a leading light in climbing circles and virtually assured a place on Everest the following year.
‘Prussik? Prussik? What the hell’s Prussik mean?’
Peter laughed, knowing he had me at his mercy. I had no idea what he was talking about. Certainly the low-key rock-climbing course I had attended in the UK had not even mentioned the word. So Peter set about teaching me to Prussik, a means of climbing out of a crevasse should you have the misfortune to fall into one. Despite his teasing he looked after me well and before long I could Prussik in and out of anything.
To reduce the chances of falling into a crevasse you need something on your feet to spread the weight. The choice is either skis or snowshoes. I hated snowshoes. They are incredibly hard work. Skis were simpler for me and I was pleased to find many others on the mountain felt the same. To go up major slopes on skis requires skins, now often synthetic, to be attached to their bases. If applied correctly, the skin hairs act as tightly gripping barbs on the way up but allow gliding on the way down. Skis and skins attached, and provision sledge behind me, I set off up the Kahiltna glacier.
There is plenty of time to think, as you trudge up a glacier’s gentle incline. McKinley was being kind with her weather, so mostly gave us clear blue skies. I thought of home a lot, terrified what arrangements for our wedding were being made in my absence. Already Louise’s plans to have a simple, quiet, cheap ceremony had turned into something costing a fortune. At current rates I would have to lock myself in the operating theatre, and not come out for a decade, to pay the bills. My wife does have one minuscule fault, however. She hates writing letters. All around me sat fellow climbers reading their missives from home. Some were Dear Johns, others full of emotion, still others torrid pornography. I received nothing. I understand the situation now, but it was unfamiliar then. Had she changed her mind? My colleagues detected my worries immediately. Expecting sympathy was a forlorn hope.
‘Forget her,’ encouraged Tim.
‘She’s got another bloke,’ added Peter. ‘Go and find someone else.’ The banter of all-male SAS life was predictable. How I wished a letter, just one, would arrive.
My job, and inclination, was to hold well back in order to pick up casualties that might occur. Mark’s knee was an example. By the time you have dealt with stragglers, the lead climbers have already gained the top and are coming down with their own injuries. It is therefore easy to miss out on reaching the summit altogether.
As we went higher, so injuries and altitude sickness became more common. Wind and sun, in particular, took their toll. Steve, fiercely committed to the idea of Everest, spoiled his chances by sustaining full thickness sunburn of his lips. Full thickness means what it says. The skin covering is burnt away, exposing the raw flesh beneath. It is incredibly painful, making eating and drinking almost impossible. The thick white glacier cream worn by climbers, and seen so often in mountain-adventure photographs, is vital. Snow being highly reflective, it is possible to be burned under the chin, behind the ears and, worse still, up your nose. It pays to take care. In Steve’s case, his sunburn meant he would be unable to demonstrate his true skills on this Everest preparatory expedition.
At 4400 metres, and at the top of the Kahiltna glacier, was the Headwall, the crux of the climb, the part that separates men from boys. At the bottom of the Headwall the Americans had placed a research station for high-altitude medicine, doctors watching in bemused interest as climbers went past in either direction and in various stages of disrepair. By the time I reached the Headwall I had dealt with Mark’s knee, the sunburnt lips, a number of more minor injuries, plus a case of life-threatening lung swelling - pulmonary oedema. The lead climbers had already returned from the summit, some with their own injuries, leaving me little time to make an attempt myself. Competition was fierce. Everyone knew that barely half those climbing McKinley would be selected for Everest the following year.
I set off up the Headwall early one morning, accompanied by Steve and his sunburnt lips. All credit to him. Despite awful cosmetic injuries, and barely able to speak, let alone eat, he wanted to try. SAS determination, I suppose. He was glad to have me around, and I him, as he was a technically excellent climber. I do not think even he realized the depth of my inexperience. Three-quarters of the way up McKinley you do not expect to find someone who has never donned crampons before. We decided to climb unroped. Should you fall, you would only injure yourself, not your climbing partner. Behind us, only fifty feet below, came an American team.
Up I went. Ice hammer in, crampon in, ice hammer in, crampon in, slowly working my way up the Headwall. I was petrified and did not dare look down. I must have been doing a reasonable job as an American below me shouted up, ‘Hey! You’re looking good! Where did you learn to climb? I thought you Brits didn’t have any big mountains back home.’
I shouted back, staring directly at the Headwall to my front. ‘Thanks very much. It’s my first climb actually. I’m ****ing scared if it’s any consolation.’
‘Your first time? Jesus Christ!’ came up from below.
Tentatively I looked down to see the disbelieving, open mouth of my unknown American companion. The entire American team, seven in all, were moving sideways across the Headwall rather than upwards behind me. I knew why. If I fell unroped, anyone directly beneath would be pushed off the face. They were moving out of the way to allow me a clear solo descent should I fall. I’ll show the bastards, I thought.
After much muttering, blaspheming and cajoling from others, I made it to the top of the Headwall. Steve was a major asset. ‘Come on, Doc, you can do it!’ he would shout, whenever I showed signs of flagging. From the Headwall it was an easy climb, barely more than a stroll, to the base of the final summit ascent, an area called the Igloopex. By this stage I was beginning to feel unwell. I was out of breath and disorientated. Steve was still supporting me well, confidently
saying it was entirely normal to feel like death at altitude and I should not worry about it. Given time, it would settle. I did not believe him, but was damned if I was going back down the Headwall again without having a shot at the summit. It had taken every ounce of courage I possessed to get up it.
My night in a tent at the Igloopex was a lesson in high-altitude sickness. I had lectured about it, read about it, knew about it, but never experienced it. Every movement was in slow motion. Even unzipping my duvet jacket made me breathless and exhausted, while my head throbbed so hard I thought it would burst. When I tried to cook a high-altitude meal, my trembling hands spilled the entire contents of the container on to the tent’s floor. So cold was the temperature outside, below minus 50 degrees Celsius, that the lumpy liquid set solid the moment it hit the groundsheet. I did not have the energy to clear it up. Instead, I lay there all night, half asleep and half awake. I was feeling terrible - completely helpless. If I had seen one of my patients looking as bad I would have evacuated him instantly, combined with a hefty dose of diuretics to help him pee off the excess fluid. The nature of high altitude sickness, however, is that it makes you feel listless and acceptant of anything fate throws at you. I could not have cared less at the time whether I was alive or dead.
By morning I was worse. Steve was also looking bad, huge purulent scabs appearing round his mouth. Between the two of us we were not a good SAS advertisement. It seemed best that Steve should keep out of the sun as much as possible, so I decided to try for the summit alone. During my approach to it, it was necessary to cross a massive, steep, snow slope that seemed to drop away forever to my left. For an expert climber such things are probably routine. For me they were horrifying. I made my way slowly across the slope. I knew if I fell I would die for sure, particularly as I was unroped. With an ice axe in my uphill hand, I dug its pointed shaft firmly into the snow as I walked, gripping it tightly. The fingers of my right hand felt very warm, despite the desperately low temperatures around me. It was a strange, tingling impression at first, at my very fingertips. What I was feeling was not warmth but the early burning of frostbite. So confused was my high-altitude brain that I did not recognize what was happening. The metal head of my ice axe was frozen. I had failed to insulate it properly with tape before leaving Fort Richardson and even a triple layer of gloves was insufficient to protect me. When I eventually descended the mountain I took off my gloves to view the damage. The middle three fingers of both hands were white throughout their length. They had not yet turned black - that would come later. It was certainly going to cause problems for my operating abilities, though I did know of one surgeon who still operated having lost a finger.
Knife Edge: Life as a Special Forces Surgeon Page 23