Scott Hamilton Monday, May 17 Everest Base Camp, Nepal

A huge avalanche fell again from the Lho La during the middle of the night. Making a sound much like thunder, and driving a huge wind and cloud of snow dust that blasted through our Camp in the wee hours, even though we were some distance from the snow slide itself. The evening of May 15th started off quite slowly, with little activity during the day except for the medical research activities. Late in the day a number of climbers could be seen descending, slowly, through the Khumbu Icefall enroute to Everest Base Camp. High winds and bitter cold high on the mountain had driven many climbing teams into retreat, and many tents at Camp 2 had been destroyed by the hurricane force blasts. As our evening telemedicine rounds with Yale University School of Medicine began we encountered our first survivor of this ordeal. A Welsh climber who had succeeded in climbing to the summit of Everest 2 days earlier had battled his way down to Base Camp. Looking terrible, and unable to breathe he came to our E-3 clinic, barely able to walk the last few steps. Our quiet medical rounds became an instant scene of activity as the entire team went to work providing oxygen, intravenous fluids, and hot water bottles in order to stabilize his condition.

Only a few minutes later he was joined by a Canadian companion, in almost as bad condition, giving the E-3 Base Camp Clinic a second patient in desperate need of medical care. Dr. Ken Kamler auscultated the lungs of both patients, determining that the first patient had consolidations in both lungs rendering him virtually unable to breathe. Both patients were severely dehydrated, so IV's were started. Starting an IV at Mt. Everest is quite a bit more difficult than at sea level. The fluids are stored in the clinic at the ambient air temperature...about 40 degrees f. and must therefore be warmed to body temperature prior to administration. To accomplish this as rapidly as possible the fluid bags are immersed in pots of hot water, and carefully monitored until they achieve the necessary warmth. During the night, with a slow drip IV we run coils of IV tube into a thermos filled with warm water, to bring the fluids to body temperature prior to administration.

The second patient had just succeeded in climbing the South Summit of Everest without supplementary oxygen, a tremendous feat. Also suffering from acute breathing problems Dr. Kamler and Dr. Davila administered inhalable steroids, followed by intravenous fluids and oxygen to treat a partial bronchial constriction. In the meantime a gram stain was completed utilizing our OLYMPUS microscope, confirming Dr. Kamler's earlier suspected diagnosis of bilateral strep pneumonia. With the quick diagnosis made possible by the presence of the OLYMPUS microscope the E-3 team was able to immediately administer appropriate IV antibiotics and thus treat a potentially life threatening condition with amazing rapidity. The second patient recovered sufficiently in several hours to be discharged to his climbing camp. The first patient, still in serious distress was kept in the E-3 clinic overnight, and discharged the following morning. Both climbers have since joined the E-3 team for lunch to express their deep appreciation for the care rendered at such a critical moment in time. They are heading home tomorrow, in much improved health.

The Workings of Kharma: The Khumbu Himal, where Mt. Everest is located is a deeply Bhuddist area. Prayer flags are abundant, and every morning juniper is burned as an offering to the Gods' of the Mountains. One of the primary tenants of Bhuddism is Kharma...The belief that good thoughts and deeds will always beget a similarly good result, although a great deal of time may pass between the original act and the kharmic result. This is known as "kharmic ripening". Five years ago I was a climber on the North Side of Mt. Everest. While crossing the upper section of the East Rongbuk Glacier at 23,000 feet I fell in a crevasse and tore several of my ribs. Our team had no doctor, so when I got down to Base Camp I made my way to the Canadian Camp, because I heard they had a doctor. It took a while, but I found the doctor's tent. Awakening him from a sound sleep I asked him if he would have a look at my ribs. Without hesitation he crawled out of his tent and patched me up. A super guy, and a great doctor, Dennis Brown M.D. Almost exactly five years later, as the patients arrived at our E-3 clinic I knew immediately that I recognized patient number two. The Canadian that had just reached the South Summit of Everest, and survived a most difficult descent was the self-same Dr. Dennis Brown. It was my turn to help him, and with the E-3 clinic, and the consultation of The Yale School of Medicine we were able to do a first class job. It was great to be able to return the care that had been rendered to me five years earlier. Perhaps it was just an amazing coincidence, but perhaps not. Kharma seems to ripen quickly in the mountains.

Scott Hamilton