“Trust is the glue of life. It's the most essential ingredient in effective communication. It's the foundational principle that holds all relationships.”
Steven Covey
As I peered out the front window of the helicopter, I could see the bank of clouds powering up the valley right towards us with the look of a massive oceanic wave. A wall of thick, white whip cream that contained enough energy to drop a helicopter out of the sky. The weather in the Himalaya was notoriously fickle. Within minutes I have seen it go from perfect blue bird, T-shirt weather to batten down the hatches, put on every stitch of clothing you have and hang on weather. What I saw coming towards us sure had the look of a game changer.
Our position at Everest Basecamp (17,200ft) was precarious at best… but absolutely necessary. The young Sherpa climber in the back of the helicopter next to me was waxing in and out of consciousness. He would come to, clutch at his chest, flail about for a minute, and then collapse back into unconsciousness. I was fairly certain that he was suffering from a condition called Prinzmetal Angina. This condition is when the coronary arteries spasm from stress, exertion or other factors. It’s technically not a heart attack, but it sure feels like it to the patient and looks like it to the bystanders.
As I was crouching in the back of the helicopter caring for the young Sherpa, his friends, brothers and cousins all anxiously spectated from just outside the machine, each with deep looks of concern stretched across their sunburnt faces. I’m sure they were confused as to why their otherwise healthy colleague was apparently dying right in front of them. They also seemed to understand the urgent nature of the situation and the need to get him down to a lower altitude promptly and how challenging that seemed due to the imposing weather barreling down on us.
The weather was shutting down quickly and the patient was deteriorating just as quickly.
The chaos wheel was spinning pretty fast at this moment and I had a sense that things were going to get worse before they got better.
*
Six months prior, I received one of those “friend of a friend” calls. My buddy explained to me that an acquaintance of his was part of a consortium of folks trying to put together the first ever Search and Rescue team to operate on and around the flanks of Mt Everest. They had the budget. They had the Sherpas. They had the helicopters. Only thing they needed was a medic. This medic would have a fairly specific skill set of experiences… great familiarity with Everest and it’s flanks, well versed in altitude medicine and a strong relationship with Nepal and the Nepali people. Oh, and also, this medic would need to be OK with flying around in a helicopter in the largest and most daunting mountain range in the world in ever changing weather conditions all the while working on critically ill and injured patients.
Check. Check. Check. Check.
What could go wrong?
I’m in.
It’s become a fairly typical routine for me over the years… get an invite for some random, daunting project… deeply consider the consequences for a total of perhaps 2 minutes and then sign up. I’m not sure whether that’s admirable or reckless. Either way, it’s this approach that regularly slaps me down right in the middle of some fairly sticky situations. Perhaps one of the strategies I have incidentally stumbled upon is that if I quickly sign on to a challenging objective, I will then be absolutely forced to immediately take the deep dive into the preparation phase prior to putting feet on the ground. Agree to go… then worry about all the training and prep after the plane tickets are bought.
Now I had spent over a dozen seasons climbing and trekking in the Himalayas… and I had spent several seasons working Search and Rescue on Denali in Alaska… but flying around plucking sick and dying people from precarious positions throughout the biggest mountain range in the world… that makes for a spicy recipe.
I spent the better part of three months prior to departure honing the skills and knowledge base that I would have to pull from during the rescue season operating in the back of a helicopter.
I went to my Emergency Department and practiced intubating and starting IVs on a mannequin straddled on a stretcher while a friend shook the stretcher back and forth to duplicate the feel of a bumpy helicopter ride. That scene garnered some laughs from colleagues as they passed by the training room.
I poured over maps and reached out to many of the guide services that would be guiding clients on Everest that season, inquiring about their climbing schedules and guides. I established relationships with the hospitals in Lukla and Kathmandu where we would be transferring critical patients. I did as much on my end as I possibly could so that when the shit hit the fan, I would be the best version of me as possible.
All of that being said… there would be plenty of elements that would be completely out of my control.
It’s fairly common knowledge that helicopters are an effective method of transportation, especially in the ‘runway limited’ Khumbu Valley of the Everest region. It’s also fairly common knowledge that helicopters occasionally fall out of the sky. Especially with the fickle and powerfully changing wind and weather patterns of the Valley. Storms come out of nowhere and when they hit, they are ferocious, slapping everything around with complete disregard.
Including hovering aircraft.
I was quite aware of these topics when I boarded my international flight for Kathmandu. I squeezed my wife and kid tightly before I left, all of us acutely aware that the unthinkable was a stark reality. One of the helicopter pilots I had flown with in Nepal during the earthquake medical mission had just recently crashed into the side of a mountain killing everyone in the aircraft. My military friends had lost plenty of brothers in helicopter crashes. Turns out, helicopters crash.
I promised them that I would do my job the best I could. I promised them I would be very situationally aware and not take any unmanageable risks. I promised them I would assess every situation and limit the amount of exposure to danger… as best I could.
And therein lies the tricky part.
What might seem like a risk for one person might be a lot more manageable for someone else. My wife and I have slightlydifferent levels of acceptable risk. I made my promise to those I love the most with my optic of risk management as my measure. My wife and I were quite aware that flying in the helicopter would be an integral part of this mission and that this element would be 100% out of my control. We feel better when we are in control, that much is certain. But in order for a team to run at its optimum and most efficient gear, there needs to be a level of trust in the process. An understanding that each of has a particular job and if our rope team is constructed, developed and nurtured with compassion and attention to detail, the ability to give our teammates the breadth to operate objectively will be part of the successful executed process.
*
The young Sherpa sat up straight in the back of the helicopter, clasped at his chest and let out an agonal cry. The benzodiazepine syringe that I was holding in my hand dropped onto the cockpit floor as his arm swung around wildly. I located the syringe and with the help of my Sherpa team, got his jacket sleeve pulled back to expose his deltoid. Only a couple minutes after the jab, the Valium appeared to start to lessen the frequency of his painful attacks. All the while, my pilot Andrew was providing me up to the minute weather reports from the front seat, most of which were bleak as the cloudbank surrounding the bird showed no indication of abating. Our flight path from Basecamp would require us to lift off from the 17,200ft landing pad and make our way down valley in between the gargantuan walls of Nuptse, Pumori, Lobuche and Cholatse. The flying is precise and being able to visually identify the flanks of these beasts was critical. I could hear the slight concern in Andrews voice as he communicated back to me over our headsets. He knew the kid was in grave condition and needed to get down to lower elevations and he knew that our jet-A fuel was dwindling. He was also acutely aware of the ‘rule of the rescuer’… do not put the aircraft or its occupants in undue danger.
Suddenly Andrew called over to me on the headset, “Doc, I see a hole and am going to see if I can get us out of here.”
“We are packaged up back here ready to fly when you are”, I replied.
Ten seconds later I could hear the rotors start to spin with a more furious pace and the turbo began to whine in anticipation of lift off. I reached over and clipped the patient and myself into a couple of the cockpit eyebolts… the only option for security since we always remove the backseat when flying at extreme altitudes to cut down on weight. I felt the helicopter strain to lift up in the thin air and the nose start to point down valley. Although I was facing backwards toward the patient, I took a glance over my shoulder out the front of the helo and saw nothing but dense white. Andrew had made the judgment call and although I could not make sense of how we were going to find our way through the clouds, I was confident in my teammate and his decision making and piloting skills.
After a couple minutes of slow, tense creeping down the valley, Andrew spotted a patch of clear sky and shot right towards it. That clear air took us down to another spot of clear air and another and another until we were down somewhere around the 14,000ft mark with nothing but clear skies out the front window. We made our way to the Lukla hospital and within a few minutes after landing, we had the patient on a bed, hooked up to a monitor with a team of Docs and Nurses working to get him stabilized. He would live to climb another day.
*
When a distress call would statically come over our radios, several dozen variants would come into play immediately. Current weather, forecasted weather, current helicopter position, position of patient, condition of patient, potential landing zone and on and on and on. Although I would contribute to each mission discussion with the pilots, the director of operations and the Sherpas on the ground, my job was to be the medic. Not the pilot (he had his job). Not the Sherpa (he had his job). My job was very specific and had enough of its own critical decision making moments that I could not spend critical bandwidth contemplating the nuances of my colleague’s responsibilities. An effective team relies on the profound trust each member bestows on the others to do their job. Working on high-level teams with many moving parts requires each individual to empower those around you to optimize their performance so that you can effectively focus on your own objective.
*
A week after the Basecamp rescue of the young Sherpa, the morning of May 6th dawned. The heart of the Spring Himalayan climbing season was starting to kick off. Teams were all moving and shaking up their respective mountains in order to be in position for a summit attempt when the jet stream lifted around the end of the month. Knowing this would be a busy time window, our SAR team remained vigilant for the pending distress calls from Everest as well as the proximal climbing peaks in the region. Sometime in the late afternoon we received a call that a Spanish climber was close to death at Camp 2 on an 8,000-meter mountain called Makalu. This beautiful but daunting mountain was a solid hour flight from our HQ over a very high mountain pass. Due to the limited daylight remaining, our options were limited to monitoring the situation and check back in the next morning with the hope that the weather was adequate to fly and make an attempt at retrieving the climber.
I woke on the morning of the 7thand with all of the tension surrounding the pending rescue, forgot that it was my birthday. Our SAR headquarters in Lukla (9,600ft) was socked in with a thick layer of cloud cover and a threat of rain. Our inquiries up the valley where our flight path would take us towards Makalu also came back with patchy clouds and variable wind gusts. Not exactly optimum bird flying weather. The status report we received that morning on the Spaniard was that he was in and out of consciousness and only moderately coherent when he was awake. The folks taking care of him relayed to us that basically he would be dead by days end if not evacuated.
Anyone that has ever worked Search and Rescue would tell you that the first order of business is to never put the rescuer in a compromised position, by doing so, potentially adding to the casualty count. But this is the conundrum of working to save our fellow human beings… by pulling people out of deadly and tenuous situations; the rescuer is by default placing him or herself in potentially harrowing scenarios. What does that risk vs. reward equation look like?
I stood on the heliport in Lukla discussing weather and options with Captain Nischal KC, the helicopter pilot I was working with that week. He was a seasoned and gifted Nepali pilot that had logged thousands of hours flying all over the Himalaya as well as Europe and North America. The week before, in a display of skill and absolute megaballs, he landed his helicopter in the middle of the Everest icefall in order to rescue an injured climber. No pilot had ever even imagined landing a helicopter in one of the most volatile pieces of terrain on the planet. So clearly I trusted Nischal’s decision making with regards to “go” or “no go”.
Our discussion was based on available collected data. Then all of the data was weighted accordingly. We considered all of the pressing variables: the clock was ticking on this guy… another few hours and he’d be dead. The clouds were thick up valley and behind those clouds were very large, immovable mountains. Unlike an airplane that can operate on instruments alone, visibility is paramount with a helicopter.
Our decision to go or not go was very collaborative. We both asked questions of the other. We were transparent and honest in the assessments we provided from a medical and aeronautical perspective. We had to both be all in to make it a go.
After much deliberation, it was decided that we would, at the least, take off and head up valley with the caveat that if we encountered a situation where the soup got too thick, we would bail and return home.
Out of Lukla, the going wasn’t too bad… with the cloud bank hanging high in the valley there was a fairly clear path down deep between the cavernous mountain walls. It was when we crested over the hill into the small village of Chukhung that things got a little spicy. The wind gusts began hitting the aircraft like a rattling Mike Tyson punch, lifting and rolling us back and forth. I could feel my stomach lurch up into my chest like similar to that feeling you get on a super turbulent airplane flight… only by an order of magnitude. The cloud cover thickened to the point where Captain Nischal had to move along at a very pedestrian pace, connecting the dots of clear air.
“It’s just a game of connect the dots” I said.
Nischal replied with a spry, “Yep, connect the sucker holes… with consequences.”
As we continued to fly up the valley gaining altitude, the intermittent flashes of brown terrain below us gave way to snow and then, with a full dramatic entrance, the massive glaciated face of Imja Tse filled the entire window of the cockpit. Fluted ridges dropping thousands of feet from the summit, cresting over massive hanging glaciers… all just a few hundred feet from our helicopter. It almost felt like we could reach out and touch the wall.
Nischal made a deft turn to the left to steer us away from the wall as the sky opened up before us. Just as the bird tilted to the left, Nischal’s GPS iPad that was attached to the front window via suction cup, popped off and clattered onto the cockpit floor and to make matters worse, slid up under his seat.
Now, it’s dangerous enough when this happens while you’re driving down the road in your car; but dropping your handheld device under the seat while you are flying a helicopter at 19,000ft surrounded by Himalayan giants is fairly unsettling. With the collected calm of a seasoned pilot, Nischal worked the yaw peddles and the cyclic stick gently while fishing around under his seat with his right hand… a smile across his face.
“Ah ha!” he blurted as his right arm came up from below with the wayward iPad in hand.
I gave out a weak and ever so slightly concerned, “Oh good.”
“Doc, can you hold this for me so I can see where to go?”
As I held the GPS for the Captain to peer over at intermittently, I could see that up ahead another cloudbank blocked what looked to be our intended path. Nischal clearly took note as well as I felt the bird tilt to the left again. We began climbing even higher now, attempting to find a clear route over the pass and over to the Makalu valley. I could see on the GPS that we had just crested over 21,000ft, tinkering close to the high altitude range of this powerful Astar B3 machine. The thwap of the rotors took on that familiar deep sound as they tried hard to dig into the anemic air.
Then Everest came into view, commanding the skyline… her beauty and majesty belying her ferocity and deadliness. Nischal leaned the copter in her direction and then it appeared; a low cut in the ridgeline with clear air. The Captain aimed the bird over in that direction and I felt myself take in a breath and hold it as we crested over the 21,200ft ridge and quickly dropped down into the clear valley below.
The flanks of Makalu came into view as we rounded a corner and then, up in the foreground, what I assumed was Camp 2. As we approached we could see dozens of individuals on the ground frantically waving their arms in our direction. Looks like we found our guy.
Nischal gently set the helicopter down on the rocky landing zone and I quickly hopped out to assess the patient. His name was Jesus… yep, Jesus… and he was, as advertised, barely conscious. With the help of a dozen Sherpas, we loaded Jesus into the back of the seatless helicopter cabin and I buckled us both in for what I anticipated to be a fun reverse of the trip in.
Jesus perked up a bit when I started speaking to him in Spanish. He was coherent enough to understand me as I detailed what was about to happen. The flight path, the medicines I was about to administer, the hospital that we would reach in Lukla. He voiced understanding as we continued to gain elevation towards the daunting ridge ahead.
Nischal again repeated the flight path and dropped us down the other side, connecting the dots along the way eventually dropping us down at the Lukla hospital landing zone. Jesus perked up quickly with the sudden drop in elevation and began conversing with me in Spanish, telling me about his family and how this near death event would surely be the end of his climbing career. He was effusive with his gratitude for us and the effort we made to come retrieve him. He was keenly aware of the precarious nature of his condition and subsequent rescue.
I still hear from Jesus on a regular basis as he sends me seasonal photos of him back in Spain with his parents and siblings.
*
Over the course of my two-month search and rescue stint, every single day was filled with dozens of fluctuating variables, any one of which could be the singular reason a life was lost. It seemed that every day provided a new rescue scenario that carried with it a myriad of mind numbing, mutating factors. Current weather, forecasted weather, current position of ground team, current position of helicopter, current position of the patient, jet A refuel options… and those were just the basics. Then the nuanced dynamics came into play… operational altitude, potential weight of helicopter with pilot/patient/medic, air density changes, snow conditions at landing zone, communications, etc, etc., in addition to patient diagnosis and treatment. Enough to make your head spin.
It’s easy for any of us to become overwhelmed with how so many variables can coalesce and conspire against our best intentions. At times it appears as if each speed bump on our path builds on the previous one until you have what feels like an insurmountable hill of dirt problems.
In each of our rescue maneuvers that season, I had to calmly but efficiently work through an operational algorithm in my own head… focusing on the decisions that I was directly responsible for, communicating efficiently and effectively with my teammates, and then trusting them to manage their responsibilities; all the while understanding that some of the factors where simply out of our direct control. It was and always will be a matter of applying my bandwidth into the issues that are mine to manage and believing in my teammates that they will perform their tasks effectively.
Rarely a day passes that I don’t reflect on our rescue season in the Himalayas. I think of the patients we rescued: the matriarch grandmother of a small village that broke her back falling 20ft out of a tree. The young Tamang boy that we air lifted from a small village that had an undiagnosed bowel obstruction. The Indian woman that our Sherpas evacuated by sled down from 26,000ft. And of course, Jesus. But mostly I think fondly about my team of Sherpas and pilots who all were dedicated to their jobs and specific skill sets. Two months filled with close to forty rescues, filled with quick decisions, collaborative teamwork, complete with plenty of tense and awe inspiring adventures.
