番茄社区

Welcome to "Medical Mavericks," a series from 番茄社区 featuring interviews with healthcare professionals working in unconventional fields of health and medicine.

We spoke with Deirdre McCormack, MBBCh-BAO, a fellow of the Royal Australian College of General Practitioners and a remote medicine-trained physician, about her experience volunteering at Mount Everest Base Camp.

McCormack completed her initial schooling and training at University College Galway in Ireland, but she always had a deep interest in traveling. Shortly after finishing her "post-registration" (internship) in Ireland, she headed straight to Australia where she got her first real exposure to remote rural medicine at Mount Isa, as well as in two remote Aboriginal communities. These experiences sent her further down the pathway of remote medicine.

Before volunteering at Everest, she spent time training and working in the U.K., remote Canada, the Falkland Islands, and with the Royal Flying Doctor Service of Australia.

This interview has been edited for brevity and clarity.

How did you get involved with the Himalayan Rescue Association [a voluntary nonprofit organization that aims to reduce casualties in the Nepal Himalayas]?

McCormack: By this stage in my career, I had done a lot of remote stuff, and I've always had an interest in travel. So, in 2011, I did an expedition mountain medicine course in Nepal. As we were making our way up to Everest Base Camp, we passed a clinic in a place called Pheriche, which is 4,370 meters in altitude.

I remember thinking to myself, I would love to get a chance to work in a place like this. But, you know, you're always full of self-doubt and are you good enough and are you able to contribute in any way?

After that, I applied and went back to Nepal to work for a spring season in Manang, on the Annapurna Circuit, for 3 months in 2016. Our clinic was 3,500 meters in altitude. We gave lectures on altitude to trekkers traveling through to go across Thorong La pass, and did home visits for people in the village. It was a wonderful immersion into Nepali culture, and my first exposure to managing acute mountain sickness and all that goes with that.

But I really wanted to go higher in altitude. I went through the process of doing the diploma in mountain medicine in 2017. The practical component was 4 weeks in Nepal, so I was lucky enough to get back for a third time.

After that, I was very interested in working at [the tent-based medical clinic at the Everest Base Camp founded in 2003 by Luanne Freer, MD, in cooperation with the Himalayan Rescue Association]. As it turned out, the doctor I volunteered with in Manang was also a climber, and he and a good friend were planning on trying to climb Mount Everest.

And he said, "Come on, try and apply, it would be lovely if you were at Everest ER when I was climbing Mount Everest." So, I guess doing the diploma and knowing that he was going up there gave me the encouragement I needed to feel I was going to play a part.

I applied and was lucky enough to get the chance to be part of the Everest ER team in spring 2019.

Did you have to pass any type of physical test?

McCormack: Most of the doctors who are at Everest ER are keen to be in the great outdoors. So, it tends to attract a type of person who's comfortable in that environment and physically fit.

But physical fitness doesn't necessarily mean you won't be affected by altitude sickness. As with any trekker, we had to go the slow, gradual ascent. We flew from Kathmandu to Lukla, and then it's about a 10-day trek from Lukla before you reach Everest Base Camp.

Because we were at Base Camp for 8 to 10 weeks, we were lucky enough to acclimatize, and become a lot more comfortable. That's why the climbers who plan on attempting summits of Everest will spend on average of about 6 weeks at Everest Base Camp acclimatizing.

What did the day-to-day look like at Base Camp?

McCormack: Our logistics were looked after by a company called Happy Feet, and we shared that camp with two climbers who were attempting to climb Everest and Lhotse. We had an individual tent each for sleeping -- there was enough space for a mattress, sleeping bag, a little camping table, and a little camping chair. There was a large mess tent where we all gathered together for our meals. We had a poo tent, a pee tent, and a shower tent.

The Everest ER was quite a large tent. It took a few days because it's set up on a glacial base. So, stones have to be cleared, flattened, and then a wooden floor gets put down on the ground and they have to level it. Then a large tent is put up -- enough for two stretcher patients, two desks, and for our equipment and our medications. It's not a huge tent, but it's big enough to stand up in. It wasn't insulated, so it was pretty cold once the sun went down, but we had a little gas heater that we would use if we needed to. We took turns being on call overnight. But we were all there for each other if something catastrophic happened; we would all pitch in.

Some of the big mountaineering companies at Base Camp had their own doctor who they employed, and we also got to know them. It was nothing but heartening to see doctors from so many different parts of the world. We all communicated and worked really well together. Also, a lot of us knew each other or had mutual friends because of the small family of doctors who enjoy expedition and wilderness medicine. So, there's a real sense of community.

We were welcomed by the climbing community there too, and we were invited to what they called Puja ceremonies. Once all the camps are set up, each climbing company has a celebration or a blessing for everybody on the trip and support staff for a safe trip up and down the mountain. It was a real privilege.

What types of climbers or patients were you seeing? What were the common conditions?

McCormack: It was two kinds of separate groups. So, any of the paying climbers, they or the company they were climbing with would register with Everest ER at the start of the season for 100 U.S. dollars. That allowed them unlimited visits to see the doctor at Everest ER; that money was used to buy equipment and medication so the clinic could continue. And that way, when a Sherpa community member or expedition member presented, they would either get free medical care, or would be charged a very small amount. So that's how it was funded.

The paying climbers were a mixture of professional climbers and recreational climbers. Some may not have had many trips to altitude that high [Base Camp is 5,364 meters]. People often start suffering from acute mountain sickness at much lower altitudes [2,000-2,500 meters]. Symptoms like a headache, nausea, and dizziness, and feeling pretty unwell. We used to describe it as just feeling a little bit hungover, and so we saw quite a bit of that.

At the other end of the spectrum of acute mountain sickness would be an acute cerebral edema -- swelling in the brain. It's a complicated process, and potentially life threatening. So, a big part -- particularly lower down in altitude -- is to educate people on symptoms they may experience.

For the cerebral edema, you're looking at a more severe headache, more significant vomiting, and often staggering around -- like a really badly intoxicated person.

The other condition was acute pulmonary edema. And again, people can potentially die from that -- it's when the lungs fill with fluid. So, very significant conditions that are specific to altitude.

How are you approaching treatment in such a limited resource setting?

McCormack: That's why so much emphasis is put on prevention and education. A slow ascent will reduce your risk of any of these happening. And also, early recognition that people think they've just got a headache and ignore it, but it could be early signs of swelling in the brain.

With regards to treatment, the treatment is descending. Descent, descent, descent. But you might be left in a position where the weather is bad, there's no helicopter coming, so in that particular case, we have oxygen to help, medication called dexamethasone, and a portable altitude chamber. If the clinical situation was safe, we could put somebody in that -- basically, it'll simulate a 1,000- to 2,000-meter descent. But ultimately, the treatment is descent, descent, descent.

I'll briefly mention some other common conditions. Common diarrheal illnesses from traveling overseas, and up in the mountains, you have to think of trauma, falls, avalanches, frostbite, frostnip, sunburn, hypothermia. So, these are common, but they're unusual compared to everything you see in normal day-to-day practice.

Did you handle any unusual patients or situations?

McCormack: We did come across somebody with a more uncommon condition. It was a Sherpa climbing guide that we knew from our diploma. He was one of our trainers. He came down to Everest ER complaining of shoulder pain. He thought he just hurt his shoulder, but we have to always be suspicious, and we did an ECG. And that ECG showed us that he was having a massive heart attack.

We were able to put a cannula in and give medication and fluids through that. But we had no other medication. We were at the mercy of the weather: if the weather was bad, we would not be able to get helicopters up or down; the only way to get down would be by foot, by horse, or by yak. There are no vehicles that can access Everest ER or Everest Base Camp.

Luckily, the weather was on our side and with the help of our logistics person at Everest ER, we were able to get a helicopter and evacuate this wonderful gentleman down to Kathmandu, where he was able to get definitive care for his evolving heart attack.

So, that was unusual and unexpected in the environment we were in.

What was your favorite part of volunteering at Base Camp?

McCormack: It was the sense of community. Also, without a doubt, the natural beauty of being surrounded by the most amazing mountains and scenery, and always being mindful of what had happened there a few years prior, with the earthquake, and the Khumbu Icefall disaster. And just being mindful of the people I met that never made it back down the mountain.

That's [the] reality of life in the mountains. Not everybody makes it home.

Nepal is such a special place, and the people are very, very welcoming. I'd recommend the experience to anybody.

It's the reason why I'm here in Antarctica now. To me, it felt like the mountain environment with the cold injuries I saw there, the next natural step was to see about working in Antarctica.

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