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altitude training

The mounting perils of high altitude training

Although it’s only a few months since I stood on the top of Mt Everest, many of the details from that day have already faded from memory. What remains is a very vivid sense of the fear that accompanied me on the final approaches through the area known as the ‘death zone’ and on to the summit. At an altitude of 8,850m, Everest stands at the very limit of human survival and has claimed the lives of more than 200 climbers since the first attempt on the mountain in 1922.
While the fatality rate on Everest and other 8,000m peaks is falling, the growing numbers of mountaineers climbing peaks such as Everest and Cho Oyu ensures that significant numbers of deaths will continue to occur (see Figures 1 and 2, opposite). Although 1,055 climbers safely reached the summit of Everest in the spring seasons of 2006 and 2007, 19 climbers died (see Table 1, p8). How do these deaths occur, and perhaps more importantly, what can be done to reduce the risk?

While new routes, such as the one that claimed the lives of the two South Koreans, are still being opened up on Everest, nearly all mountaineers ascend by either the South-east or North Ridge routes. Both these long-established routes are technically straightforward, but they involve lengthy journeys through icefalls and along narrow ridge lines before reaching the summit. These arduous approaches not only expose climbers to the risk of falling snow, ice and rock, they also contribute to the fatigue and exhaustion seen in those who spend long periods on the mountain.

Over time, fatigue leads to physical deterioration, with climbers losing their willingness to perform even the simplest of tasks. On Everest this can have fatal consequences. To illustrate this point, I’ve included here a passage from my diary, written shortly after descending from the summit to Camp 4 (7,900m).

‘I was exhausted. Every step down felt like 10 steps up. Struggling, all I could think of was Sundeep’s phrase, “The summit’s only half way”. Over and over I repeated it, trying to block out the fatigue I was feeling. Sometimes it would work but often I’d find myself lacking even the energy to stand upright. Soon, clipping into the fixed rope proved too much and instead I would wrap my left arm around it and trust my grip. This worked well until I reached a point just above the Hillary Step when suddenly I stumbled against a rock. Lurching towards the fragile cornice I fell and found myself staring 2,000m down the Kangshung Face to the valley floor below. It was only at that point that I realised a loose grip on my only lifeline was really not enough…’

Although the details surrounding the falls of Pavel Kalney, Dawa Sherpa and Tomas Olsson will never be fully known, it is likely that simple errors, like the one I made, were responsible for their deaths.
In addition to the distinct physical dangers of the mountain, Everest also possesses a very real ‘invisible’ threat. At 8,850m, the summit of Everest enjoys the lowest barometric pressure on the planet, providing only one third of the oxygen available at sea level. To put this into context, a human plucked from the coast and dropped onto the summit of Everest would lose consciousness and die within a couple of minutes. Thanks to the combination of acclimatisation and supplemental oxygen (by 2000 only 98 out of 1,318 ascents had been completed without the use of oxygen), mountaineers are able to climb into the ‘death zone’ – but only just! Anyone entering this world is faced with a high probability of developing a high altitude illness (HAI). Acute mountain sickness (AMS) is a benign condition that may be an uncomfortable distraction for a couple of days, but fatal complications such as high altitude pulmonary oedema (HAPE) and high altitude cerebral oedema (HACE) become increasingly common on the slopes above Everest Base Camp (5,300m).

This year I was briefly involved in the well publicised case of Usha Bista, a 22-year-old Nepali woman and member of the Democratic Nepal Everest Expedition. On 21 May, Usha was found unconscious near the Balcony, a snowy promontory that marks the beginning of the final ridge to the mountain’s South Summit. Descending from the summit ,David Hahn, leader of the International Mountain Guides (IMG) commercial expedition and nine-times Everest summiteer, recognised that Usha was suffering from HACE and needed urgent treatment if she was going to survive. After administering dexamethasone and supplemental oxygen, Hahn and his team of Sherpas, guides and clients wrapped Usha in sleeping bags and lashed her to a stretcher, before lowering her down the mountain.

Eventually, some 12 hours later, the head torches of Hahn and his team were spotted from our tents at Camp 3. Fortunately we were well prepared with experienced doctors, a comprehensive medical kit and a warm and well lit tent awaiting her arrival. Once safely down and inside the tent, Usha was quickly assessed, fitted with an oxygen mask and given further treatment. By the next morning she had improved so much, she was able to walk down to Base Camp, from where she was air lifted to safety.

Usha was not the first to experience such a close brush with death on Everest. On 25 May 2006, Lincoln Hall had been left for dead at 8,700m after successfully summitting earlier that day. The next morning climbers on the North Ridge were amazed to find Hall still alive after a night without supplemental oxygen. Myles Osborne was one of the first to reach him and wrote:

‘Sitting to our left, about 2f t from a 10,000ft drop, was a man. Not dead, not sleeping, but sitting cross-legged, in the process of changing his shirt. He had his down suit unzipped to the waist, his arms out of the sleeves, was wearing no hat, no gloves, no sunglasses, had no oxygen mask, regulator, ice axe, oxygen, no sleeping bag, no mattress, no food nor water bottle. “I imagine you’re surprised to see me here”, he said.’

With a rescue team of 12 Sherpas and an assortment of Western climbers, Hall was eventually stretchered down the mountain and, despite extensive frostbite, survived his ordeal. Unfortunately the British climber David Sharp was not so lucky. Just 10 days before Hall’s remarkable rescue, Sharp had been spotted in a small cave at an altitude of 8,400m. Although the events that surround Sharp’s final hours are uncertain, it’s believed that a number of climbers were aware of his predicament and passed him on the way to the summit. Sharp was strong enough to stand independently and answer questions when he was first met, but by the time those returning from the summit reached him 12 hours later, he was unconscious and badly frostbitten. Despite the efforts of a few to administer oxygen, the lack of a full-scale rescue effort meant that Sharp would die alone, a mere 100 vertical metres above high camp.

What can be done? Implementing change on Everest is far from easy. The mountain is an important source of income, not only for the governments of China and Nepal, but also for many thousands of porters, guides and lodge-owners who work in the region. Anything that threatens this income, such as the imposition of a limit on the number of visitors or ‘closing’ parts of the mountain, will be strongly resisted and almost impossible to introduce. Change, as they say, must come from within. While the inherent dangers of mountaineering will always lead to a certain number of deaths on Everest, it is possible for individuals to ensure that this risk is kept to a minimum. In part this can be done by considering three questions.

Q1: Am I prepared? Anyone stepping above Everest Base Camp must be prepared. This may sound obvious, but many of those attempting to climb the mountain lack adequate mountaineering experience. Remarkably, there are many who attempt Everest who have never used an ice axe or worn crampons before stepping on to the treacherous Khumbu Ice Fall. I stood open-mouthed this spring, watching a Sherpa teach his client how to secure himself to a rope, minutes before crossing a crevasse at 5,400m. The New Zealand guide and Everest summiteer Peter Hillary has spoken at length about the importance of serving an ‘apprenticeship’ before earning the right to climb Everest. Time in the ‘death zone’ fosters independence and self-sufficiency in an extreme environment, as well as helping individuals to prevent and treat specific problems, such as high altitude illness. Experience on 7,000m or other 8,000m mountains prepares climbers for the extremes of altitude; and time spent at lower altitudes helps climbers to develop high levels of fitness and, crucially, to hone techniques that can prove life saving on bigger mountains. Without skills and fitness, the ‘death zone’ becomes just that.

Q2: Do I have the infrastructure to support me? Although commercial operators have provided logistics and guided ascents on Mt Everest for more than 20 years, more recently a host of companies has emerged that allow recreational mountaineers to climb the mountain ‘on the cheap’. Instead of the comprehensive services offered by the major established commercial operators, these outfits simply transport their clients to Base Camp and provide space on a climbing permit. But that’s all. Food, shelter, weather forecasting, communications, supplemental oxygen and medical care are all ‘extras’. While it may be possible to survive alone comfortably at Base Camp, most of us would struggle to climb much higher without the support of team mates and Sherpa guides. But going it alone has attractions for many mountaineers, who believe that being self-sufficient is a ‘purer’ way to climb mountains. This approach inevitably leads to a much higher level of risk. In a similar vein, some, such as the deceased Brazilian Vitor Negrete, prefer to climb Everest without supplemental oxygen in order to achieve a more ‘ethical’ summit. Before climbing alone, or without supplemental oxygen, climbers must make an honest assessment of their ability and should bear in mind that most western mountaineers are just not up to it. Infrastructure comes at a price, and it is one that climbers should be prepared to acknowledge more fully than is currently the case. Sherpas can erect tents, transport bottled oxygen and prepare food and drinks for tired climbers high on the mountain. On summit day their experience and innate high altitude ability can ensure that even some of the sickest mountaineers can return from the highest altitudes unharmed. However, to do this Sherpas put their own lives at enormous risk. It is therefore vital that we, as fellow mountaineers, ensure that they are treated well – that they have evacuation and health insurance, and, in the event of serious injury or death, that they and their families are provided for. When a Sherpa sacrifices his highly prized summit ‘bonus’ in order to complete a rescue, a similar fee must be provided instead.

Q3: Will I help? As the cases of Usha Bista and Lincoln Hall demonstrate, the human body has an incredible capacity for recovery. Given appropriate treatment and rapid descent, conditions such as HAPE and HACE can be successfully treated. As a famous American guide recently wrote: ‘No one’s dead until their down and dead.’ Therefore the decision to abandon a stricken mountaineer should only be made if the situation is hopeless or the rescuer’s own life is being placed at risk. Even when a rescue attempt is impossible, mountaineers can still help. On hearing of the death of David Sharp, the veteran American climber Ed Viesters commented that those who passed by could have done more and tried to provide ‘a little comfort’ in those final hours, by staying with Sharp for longer. For me, the decision to help a sick climber was an easy one. As a doctor and researcher, I am fascinated by diseases found in the mountains and eager to help those in distress. As a proud member of a large medical research expedition, I was also keen to put to good use the enormous infrastructure that surrounded me. For most of our time, we had enough equipment and staff at Base Camp (5,300m) to run an intensive care unit comparable with any in the UK. But perhaps most importantly I wasn’t ‘gripped’ by the mountain. This wasn’t my third, fourth or fifth trip to Everest. I hadn’t remortgaged my house or quit my job like so many do. Instead I was grateful just to be there – to conduct research that fascinates me and climb on a beautiful mountain that had captured my imagination since childhood. What if things were different? I’d hope that, as a mountaineer I’d still recognise my responsibility to care for myself and those around me. When we embark upon these adventures we must be prepared to deal with whatever we encounter. A summit bid can’t be put ahead of a human life. As the American guide Dan Mazur said after the rescue of Lincoln Hall, ‘The summit is still there and we can go back. Lincoln only has one life.’

altitude training