Medical vignettes 5: the Nepali ambulance

sandyscott01In 1988, a small group of us split from a large trek descending from Everest to climb over a high altitude pass to view the beautiful turquoise lakes of Gokyo. From there we descended a steep and little-used trail to the valley floor. Here, after dropping some several thousand feet, we arrived in the late afternoon at a small village at a point where the two great rivers of the Khumbu region meet. All around were high peaks and the only way out and back to civilisation involved a 3000 foot climb in any direction.

We settled down to spend the night at one of the many teahouses that dot the trails. Entering the dark communal sleeping area of the lodge and believing that we were alone, I was startled to hear a gurgling noise emanating from the corner of the room. Further inspection revealed the presence of a very large, deeply unconscious body of what appeared to be a lone trekker.

The story that unfolded as told by the innkeeper was a not uncommon one, though not usually so extreme. The man, one of a group of German trekkers who because of bad weather had missed their flight into the mountain airstrip, had been delayed by two days but had tried to catch up with their trekking schedule by ascending much faster than would be deemed safe. Arriving at Gokyo, he had been taken ill with severe symptoms of Altitude Sickness, a potentially rapidly fatal condition affecting both brain and lungs. With no medical facilities available the maxim in such cases is that the victim should descend as far and as fast as possible. In his case he had been helped down by two porters in his group and then simply left to fend for himself while they hastened back to their party. At this time he lapsed into what would have been terminal unconsciousness.

Here, therefore, we found ourselves in a Catch-22 situation: unconscious, he was going nowhere and even if conscious he would have had to ascend a further 3000 foot to get out of the valley which obviously he could not do.

Fortunately as the expedition doctor, I always carried a comprehensive medical kit and so together we started to treat him. With constant observation and regular medication, the night passed with little sign of improvement until at dawn we were delighted to hear two words uttered: “Pee pee”. This at least indicated that his kidneys were starting to work and to get rid of the fluid from his lungs. Also, the pressure on his brain was reducing and he started to regain consciousness.

Though still seriously ill, the immediate emergency had passed, but he was still unable to stand, let alone climb out of the valley to safety.

Enquiries in the village produced a farmer with a pony who agreed, for a fee, to ferry our patient up to the ridge. His pony, though, could not ferry a sixteen stone man down the series of deep steps cut into the cliff that led to lower levels.

sandyscott02Accepting that half way was better than no way, and with the urgency of the situation, we agreed and later in the morning when he was sufficiently conscious to co-operate, we loaded his bulk onto the poor pony and with two outriders holding him on its back, began the ascent. Three hours later and after much resting, we breasted the hill, the pony’s work well done.

Unfortunately his condition remained serious and he was still totally incapacitated.
Without any discussion or bidding, the pony man, a painfully thin 5ft 4in and weighing no more than 8 stone, fashioned a sling for his head band and settled this under the expansive posterior of our patient. Placing the band on his forehead he leant forward lifting him, his feet dangling just a few inches off the ground and liable to catch on any protruding rock and began the descent. With a 1000 foot drop to the left, and with steps sometimes more than a foot deep, the procession moved slowly down the precipice with us supporting on either side to steady this abnormal load.

Stopping every fifty yards we made our way at snails’ pace eventually arriving at the small mountain hospital, built by Sir Edmund Hillary, in the early afternoon.

Our patient was admitted, oxygen administered and he began to recover.

Then came the issue of payment to our diminutive hero. We had negotiated a fee of $50, a king’s ransom at that time in Nepal, to take him up but had not expected him to undertake the superhuman feat on the other side. The patient, now conscious, claimed that as he had not been party to this agreement he refused to pay a penny piece towards his life-saving rescue!

Our expedition leader, an ex-commander of the Arctic Warfare section of the Royal Marines, did not take kindly to this boorish behaviour and promptly relieved our complaining patient of his money belt which when opened revealed a very large amount of currency. He extracted $250 and gave it to our man.

I can still hear two sets of squeals at the same time, one from the German who claimed he was being robbed and the other, one of sheer delight.

Three hours later as we exhaustedly resumed our trek to the nearest village to rejoin our party, we heard the whirr of a helicopter, summoned at great expense to evacuate our somewhat aggrieved and ungrateful patient to the safety of Kathmandu.

I would like to think that as he had been largely unaware of all our concerted efforts to save his life and that the balance of his mind had been affected by his condition, that this caused his totally unacceptable behaviour but I am not sure. At Pheriche, a small high-altitude hospital with which I am involved (as are so many in the Wychwoods who have contributed to the project), the doctors often report that similar events take place where patients refuse point-blank to pay for their life-saving treatment. What a sad reflection on humanity.

Dr. Sandy Scott

February – March 2020