Knife Edge: Life as a Special Forces Surgeon

by Villar, Richard

  It was Chen who came to our rescue. A master of arbitration, by the day’s end a modified yak load had been agreed. This was approximately fifteen per cent lighter than we had anticipated, so more animals would be required. With loads lighter, and secret money changing hands, the yak herd performed miraculously. Thereafter we had no problems - beyond their fleas of course.

  It is often said that doctors on climbing expeditions do not need to know much medicine. Your patients are either fit, in which case they pose no trouble, or dead, in which case they can be left where they lie. Complex injuries and diseases that need detailed treatment are supposedly rare. At the Rongbuk I had a constant flow of minor ailments: laryngitis, bronchitis, burns, blisters and boils. There was even one case of housemaid’s knee, and a broken dental filling, even though in your mind are assorted horrors such as broken bones, fractured skulls and the need to perform gut surgery in a tent. A doctor friend - a remarkable man - had to open a belly on Everest once. I do not envy him the experience. Nevertheless, despite the simplicity of most conditions seen on the mountains, there is an inexplicable fascination with all things medical at altitude. It is not unknown for expeditions to visit the mountain purely for the purpose of scientific research. There was certainly an American team on Everest 500 metres from our Roadhead Camp, comprising a large number of doctors, well-equipped and undertaking advanced scientific experiments at altitude.

  A persistent memory of Everest is the intensity of the friendships created. Our team was strongly bonded before we ever arrived, by virtue of being SAS. Once on the mountain, and living in the confines of small tents, confidences exchanged can be deeply personal. I developed a soft spot for everyone and count myself lucky to have known them. They all had hidden strengths and, to a lesser extent, hidden weaknesses. I got to know Tony particularly well. He was an excellent climber. The two of us would carry loads together, go yeti hunting (we were, surprisingly, always unsuccessful), and discuss any aspect of life one might care to imagine. Frequently he would tell me how he missed his family at home, and how worried he was about climbing, even though he realized he was skilled at it. ‘I want to be sure I get back alive for them,’ he said to me quietly, one sunny Everest morning.

  Peter was also a good friend, particularly after his valiant attempts to teach me Prussiking on McKinley. A strong man, he had persistently vomited and felt unwell when we first arrived at the Rongbuk. So bad was it that I asked that he be evacuated to a lower altitude for a few days. Tony, having developed persistent headaches and intolerance to bright lights, accompanied him. This is ‘photophobia’, a feature of mild brain swelling that may occur at altitude. It can turn into more serious things if prompt action is not taken. Dropping altitude was the required treatment. After three days at a lower height, Peter and Tony returned, fully recovered.

  By early April the team was moving confidently. Equipment and climbers had gone forward from Roadhead to Base Camp, and from there to Advance Base. All was going well, with the lead climbers already at nearly 7000 metres - less than 2,000 metres to go. The Regiment was set for a record ascent of Everest. All around were climbers from other teams struggling to cope. The SAS was clearly ahead.

  It was at dawn that chaos happened. It had been a terrible night. High winds battered the sides of our tents, snow being whipped horizontally at colossal speeds. I thought nothing of it at the time but realize now it was the winds that probably loosened the massive ice serac on the North Col. A serac is a huge, overhanging ledge of ice, frequently found at altitude. At the Advance Base Camp one of the lead climbers, Merv, was standing outside his tent preparing for the day’s climb. It was he who first witnessed the 400 metre length of serac break loose and fall freely to the bottom of the North Face, setting off a major avalanche as it did so. Brummie, in his book Soldiers and Sherpas describes the event admirably:

  ‘ … I heard Merv scream a warning, but it came too late. A chunk of ice whistled through the tent in front of my face and the whole world went crazy. The tent, with me inside it, was picked up and thrown down the mountainside by what I took at the time to be a big wind. I felt myself being lifted from the ground and rolled around the small blue capsule [his tent] as it was flung down the hill, all my kit tossing and tangling around me as we went. I was screaming with panic, convinced I was going to die without seeing anyone ever again. ’

  I escaped the avalanche, being one camp down the mountain from the scene, but was fully involved in the casualties it created. Tony had been killed instantly, only forty-eight hours after he had said how desperately he wished to return alive to his family. Brummie had strong evidence of a broken neck with pins and needles in his left hand, which implied injury was perilously close to his spinal cord. Full paralysis could be only millimetres away.

  Two climbers had more minor injuries, though one had somehow survived a two-ton ice block ramming into his back. He had also developed frostbite on most of his fingers and one big toe.

  The major issue was Peter. It had taken the survivors some time to remove the snow and ice blocks covering his head once the avalanche had come to rest. When an avalanche stops its slide you have little time with which to play. The snow sets solid, entombing those caught within it. All equipment had been scattered and destroyed, the camp being shifted half a mile down the mountain. Little more than a spoon survived with which to dig out a casualty. The result was the climber had a serious head injury, a broken collar bone, several broken ribs and was disorientated. With such injuries, his chances of survival at that altitude were small. Anything that reduced his ability to breathe, such as broken ribs, could easily tip him over the edge. The moment I saw him, I knew I had problems. Suddenly my quiet, organized existence had turned into uncontrolled medical chaos. The majority of my medical equipment, poised at the bottom of the North Face ready for the final ascent, had been destroyed. This included my mountain-rescue stretcher that I had so lovingly cared for during our journey from Hereford.

  Brummie and the two more minor injured were able to walk down the mountain to Base Camp without assistance, though I knew Brummie ran a risk of paralysing himself. It is part of basic first-aid training that you do not move a patient with a broken neck, except with the utmost caution. A bone fragment has only to shift a few millimetres for full paralysis to be the result. There was little I could do about it, except quietly hope his well-recognized strength would see him through. We decided the best thing would be to place the injured in a tent at lower altitude. For those injured who wished it, I gave an injection of a drug called chlorpromazine. This is a strong sedative, allowing the patient to gather his thoughts and strength. The Americans used it widely in Vietnam for battle stress. It works wonderfully.

  It took most of the day to settle the injured in their tents at Base Camp. It was already beginning to get dark. My major worry was Peter. He had been half-dragged, half-pulled down the mountain to Base Camp and could barely speak. He was in a very bad way. One eye pupil was bigger than the other, implying significant brain damage, and he was Cheyne-Stokes breathing furiously. With the other casualties settled, each being cared for by an uninjured climber, I could concentrate more specifically on him. That first night with Peter is etched on my brain.

  As I lay beside him in the tent, his breathing irregular, I noticed his colour. Instead of pink, it was blue, particularly his lips and fingernails. This is called cyanosis and is a feature of insufficient oxygen reaching the body’s tissues. When he did breathe, I could tell he was struggling for air. Then, without warning, he lapsed into unconsciousness, grunted loudly and stopped breathing altogether. This time it was not Cheyne-Stokes breathing but airway obstruction. Lack of muscle control allows the tongue to flop backwards in the mouth, blocking the air passages. You have about ninety seconds to correct the situation before the patient dies. With trembling hands, I struggled to retrieve an airway tube from my rapidly depleting medical pack, forced open the climber’s clenched mouth and pushed down the tube. The cramped environment di
d not allow me to see where the tube ended up, be it in the food passages or the airways, but immediately the man brightened up. I had been lucky. Putting a breathing tube down the wrong passageway is a sure way of killing a patient. I blew down the tube first, as a form of artificial respiration, before attaching an oxygen cylinder and hand-operated air pump to make him breathe.

  Peter did not breathe independently for several hours. During that time I lay beside him, working the air pump by hand, to keep him going. Thank God he still had a pulse, I remember thinking. I had no wish for him to have a cardiac arrest in addition to his breathing problem. We were still at 5500 metres, well above the Rongbuk Monastery. Somehow Peter had to reach the Roadhead Camp.

  Having put a tube down his throat, the process of intubation, I removed it three hours later when he appeared to breathe by himself. By lying him on the uninjured side, and keeping the head well back, his breathing was clear. By morning, having lain awake all night worrying, I was pleased to see my patient was partially recovered. He could remember nothing of the avalanche, nor of my frantic attempts to keep him alive. Beyond a headache and chest pain, Peter felt reasonable. He had improved so much it seemed possible he could walk down the mountain to the Roadhead Camp with little more than simple assistance. I, naturally, would accompany him. The other injured climbers also set off to the Roadhead that morning, Brummie with a primitive surgical collar to ensure his broken neck did not shift further.

  The decision to walk Peter was a mistake, though heavily influenced by the knowledge of what it would take to carry him down. He was a big man, powerful and enormously muscular. Carrying would take at least six of us, and we did not have the men to spare. Having walked with him only 300 metres downhill from the camp, I realized he would not make it, his broad frame buckling at the knees. Any physical effort, however minor, made his lips and fingers turn blue. Cyanosis had returned. I tried carrying him, in a form of fireman’s lift. It seems so easy in the books and films. In real life it is a struggle. On Everest I found it impossible. Furthermore, lying him across my shoulder compressed the injured chest, making it harder for him to breathe. His cyanosis became worse. We could go no further. If the man was to survive I would have to stop and resuscitate him once more. I radioed Bronco, positioned at the Roadhead, and told him of my predicament.

  ‘I’m going to have to stop here for a while,’ I reported. ‘He’s not going to make it otherwise.’

  It was to Bronco’s eternal credit that he complied with everything I said. Never once did he question my decisions. Later, Bronco did say I sounded frantic on the radio. I was convinced I sounded calm, so will have to do a better job of hiding my emotions if the same, God forbid, should happen again.

  Assisted by an uninjured climber I pitched my tent in order to resuscitate Peter further. The moment I laid him horizontal he lapsed again into unconsciousness, though I fortunately did not have to intubate him. By now he was vomiting and incontinent of urine. Dehydration was also setting in.

  Inserting a drip at sea level can be difficult. Inserting one on Everest was almost impossible. I had to skewer Peter more than a dozen times before my needle found his collapsed veins. The more shocked a patient becomes, the more the veins shrink, making them harder to find when you desperately need them. After much searching, I managed to insert the needle into a vein running along his forearm. Over the needle I slid a plastic tube, the cannula, until it was also in the vein. Then I removed the needle, leaving the plastic cannula in position. To the outer end of the cannula I plugged a length of clear, plastic tubing, the giving-set. It was to the giving-set I had to connect the life-saving fluid. There are many types of fluid available, from blood to pure water. All I had was saline, a medical salt solution. Reaching for the plastic saline pack in my rucksack, I found the lifesaving fluid was frozen solid.

  If I was to administer saline at temperatures lower than Nature’s 37 degrees Celsius, I would potentially lower the inner, core temperature of his body, causing hypothermia. Combined with his other injuries, he would be unlikely to survive. The saline was in a plastic container, not a glass one, as the latter would have shattered in the cold. I could not heat the plastic container directly or it would melt. I chose to steam it, like a Christmas pudding. In my rucksack was a large can of orange juice. That, too, was frozen. However, it was in a metal can that I could directly heat, so within minutes I had liquid orange juice, steaming furiously on my portable mountain cooker. I suspended the plastic saline pack from the tent, letting it dangle in the steam. Within twenty minutes that, too, was unfrozen, though I had to judge 37 degrees Celsius by feel. My glass thermometer had shattered long ago.

  Within moments of the saline entering the climber’s body, he began to recover. His eyes opened, his breathing steadied and he became more alert. It was a pleasure to see. Despite this, I realized he was too injured to walk and would have to be carried. Now stranded above the Roadhead, it was vital he descended as low as possible as he was still perilously ill. I was terrified he would develop further breathing problems if he remained too high for too long. Every foot mattered. Often, only a few hundred feet can make the difference between life and death.

  With the mountain-rescue stretcher destroyed and a fireman’s lift being an impracticality, I had no idea how to carry the man down. It was Bronco’s suggestion to use the caving ladder, a thirty-foot aluminium affair used to cross crevasses and other dangerous drops. It was a brilliant idea. It had taken most of the day to resuscitate Peter once again, so we would have to remain where we were for a further night. Bronco, having buried Tony near the avalanche site, joined me at my impromptu camp for the night, ready to assist with the carry the next day. All night I lay again beside my patient, listening to his screaming and shouting. Though shortly on his way to safety, he was still disorientated.

  A caving ladder makes an excellent stretcher. Once padded with sleeping bags and sleeping mats, a casualty is as secure as can be. It took eight of us six and a half hours to reach the American research camp. We only dropped Peter once, though he was fortunately asleep. I had sedated him for the journey as I had felt anything could happen on the way. In reality, evacuation went smoothly. The moment we arrived, out came the tea, soft drinks and an endless supply of American candy. Meanwhile Peter was taken off my hands, being thoroughly examined and assessed by their resident specialists. Despite his broken bones, head injury and disorientation, I was now happy he would survive.

  I do not envy Bronco the terrible decision he next had to make. Should we now go back up the mountain and try again? Whatever conclusion he reached was bound, in someone’s eyes, to be wrong. Tony was dead. It was obvious that Peter, and Brummie, should not continue. Likewise the climber with frostbite. Brummie’s neck could still paralyse him and Peter could barely speak. They would have to return to more sophisticated medical care. Four men down, from a fourteen-strong team, and significant quantities of equipment destroyed, it was unlikely the SAS would succeed. Failure is not a word that comes easily to the Regiment, but I am sure the decision to abandon Everest was correct. Exercise Pilgrims Return was over.

  Four days after the avalanche, the UK still did not know of our predicament. Satellite communication was only just coming into service and our team did not have it. The Tibetan driver tasked to take us from the Roadhead to Lhasa appeared overcome by events and decided to drive like an ambulance on a blue-light emergency run. Second only to the avalanche, he was unquestionably our greatest hazard. Within minutes of leaving the Roadhead, two casualties and me on board, he ran off the track, half overturning the Land Rover. I can hear my companion’s screams now. We were fortunate not to sustain further injury and wasted no time in telling the driver what we thought of him. SAS operatives are a class apart when it comes to insults. He took the hint at that point, driving sedately thereafter.

  The village of Xgur was our first stop. At first sight the place had little to its name. Dusty, primitive houses, overlooked by the tatty remains of the town’s w
alls, perched erratically on the side of a mountain. Despite this, Brummie found a telephone, so together we tried to ring Hereford. It was not easy, though we eventually made contact with the Orderly Room. This is the one location, in any military barracks, where you can be certain someone can be found at all times. The line was terrible, the only way of passing the message being to spell it out, letter by letter, using the signaller’s phonetic alphabet. A is Alpha, B is Bravo, and so on. It was painfully slow, and enormously expensive, taking four hours to notify the SAS and the Defence Attache in Peking. I also tried telephoning Louise - no answer. The first she heard of the avalanche, I subsequently learned, was when a friend telephoned her to say it had been reported on the news.

  As we travelled through Tibet towards Lhasa, I was relieved to see Peter steadily improve. The lower we went, the better he became. Even so, his behaviour was far from normal. He staggered rather than walked, demonstrating that the head injury was still having a profound effect. As a matter of urgency, I felt it was important he was admitted to the nearest Western-style hospital, probably Hong Kong. The Chinese Mountaineering Association, despite the expense, pulled out all stops to help, taking us through the land at phenomenal speed. Medically this was ideal, but I felt there might be more to their cooperation than simple medical urgency. A telephone conversation I had when we reached Lhasa, with a high-ranking officer in Hong Kong, explained all.