Knife Edge: Life as a Special Forces Surgeon (30 page)

Up to 2500 metres above sea level, given enough time, it is possible to acclimatize almost fully. Upwards of forty million people worldwide live at or above this height. Once over 3500 metres full acclimatization is impossible. You may not feel too bad, but the body is not fully efficient. Over 5500 metres deterioration is significant. Slowly the body’s cells become damaged by reduced pressure of oxygen, however gradually one chooses to climb. If you stay there long enough you can quite possibly die. McKinley’s summit was 6200 metres above sea level and high-altitude problems were assured.

From the air a glacier looks very innocent. On the ground the situation is different. It can be full of crevasses - small, big, enormous. Crevasses really can be covered with snow bridges that give way when you least expect it. The cause of death, should you fall through one, is very rarely the impact on striking the bottom, as crevasses can be quite shallow. It is more likely to be the effects of cold - hypothermia - in a climber who is unable to gain purchase on the crevasse’s slippery walls and thereby escape. The body’s functions are gradually slowed until the heart stops, at which time you are almost dead. I say
almost
because resuscitation is sometimes possible even then. By immersing itself in one of Nature’s deep freezers, the body is maintained, for a few minutes at least, in a form of suspended animation. This particularly applies to children. It is always worthwhile resuscitating a patient with hypothermia, however dead they look.

Having reluctantly accepted my fears of being avalanched, dying from brain oedema, or hypothermia, I now had to cope with the worry of crevasses. The experienced climbers would play havoc with my imagination by regaling me with stories of past accidents, near misses and tortuous deaths. ‘You do know how to Prussik, don’t you?’ asked Peter, a wicked schoolboy smile on his face. Peter was a leading light in climbing circles and virtually assured a place on Everest the following year.

‘Prussik? Prussik? What the hell’s Prussik mean?’

Peter laughed, knowing he had me at his mercy. I had no idea what he was talking about. Certainly the low-key rock-climbing course I had attended in the UK had not even mentioned the word. So Peter set about teaching me to Prussik, a means of climbing out of a crevasse should you have the misfortune to fall into one. Despite his teasing he looked after me well and before long I could Prussik in and out of anything.

To reduce the chances of falling into a crevasse you need something on your feet to spread the weight. The choice is either skis or snowshoes. I hated snowshoes. They are incredibly hard work. Skis were simpler for me and I was pleased to find many others on the mountain felt the same. To go up major slopes on skis requires skins, now often synthetic, to be attached to their bases. If applied correctly, the skin hairs act as tightly gripping barbs on the way up but allow gliding on the way down. Skis and skins attached, and provision sledge behind me, I set off up the Kahiltna glacier.

There is plenty of time to think, as you trudge up a glacier’s gentle incline. McKinley was being kind with her weather, so mostly gave us clear blue skies. I thought of home a lot, terrified what arrangements for our wedding were being made in my absence. Already Louise’s plans to have a simple, quiet, cheap ceremony had turned into something costing a fortune. At current rates I would have to lock myself in the operating theatre, and not come out for a decade, to pay the bills. My wife does have one minuscule fault, however. She hates writing letters. All around me sat fellow climbers reading their missives from home. Some were Dear Johns, others full of emotion, still others torrid pornography. I received nothing. I understand the situation now, but it was unfamiliar then. Had she changed her mind? My colleagues detected my worries immediately. Expecting sympathy was a forlorn hope.

‘Forget her,’ encouraged Tim.

‘She’s got another bloke,’ added Peter. ‘Go and find someone else.’ The banter of all-male SAS life was predictable. How I wished a letter, just one, would arrive.

My job, and inclination, was to hold well back in order to pick up casualties that might occur. Mark’s knee was an example. By the time you have dealt with stragglers, the lead climbers have already gained the top and are coming down with their own injuries. It is therefore easy to miss out on reaching the summit altogether.

As we went higher, so injuries and altitude sickness became more common. Wind and sun, in particular, took their toll. Steve, fiercely committed to the idea of Everest, spoiled his chances by sustaining full thickness sunburn of his lips. Full thickness means what it says. The skin covering is burnt away, exposing the raw flesh beneath. It is incredibly painful, making eating and drinking almost impossible. The thick white glacier cream worn by climbers, and seen so often in mountain-adventure photographs, is vital. Snow being highly reflective, it is possible to be burned under the chin, behind the ears and, worse still, up your nose. It pays to take care. In Steve’s case, his sunburn meant he would be unable to demonstrate his true skills on this Everest preparatory expedition.

At 4400 metres, and at the top of the Kahiltna glacier, was the Headwall, the crux of the climb, the part that separates men from boys. At the bottom of the Headwall the Americans had placed a research station for high-altitude medicine, doctors watching in bemused interest as climbers went past in either direction and in various stages of disrepair. By the time I reached the Headwall I had dealt with Mark’s knee, the sunburnt lips, a number of more minor injuries, plus a case of life-threatening lung swelling - pulmonary oedema. The lead climbers had already returned from the summit, some with their own injuries, leaving me little time to make an attempt myself. Competition was fierce. Everyone knew that barely half those climbing McKinley would be selected for Everest the following year.

I set off up the Headwall early one morning, accompanied by Steve and his sunburnt lips. All credit to him. Despite awful cosmetic injuries, and barely able to speak, let alone eat, he wanted to try. SAS determination, I suppose. He was glad to have me around, and I him, as he was a technically excellent climber. I do not think even he realized the depth of my inexperience. Three-quarters of the way up McKinley you do not expect to find someone who has never donned crampons before. We decided to climb unroped. Should you fall, you would only injure yourself, not your climbing partner. Behind us, only fifty feet below, came an American team.

Up I went. Ice hammer in, crampon in, ice hammer in, crampon in, slowly working my way up the Headwall. I was petrified and did not dare look down. I must have been doing a reasonable job as an American below me shouted up, ‘Hey! You’re looking good! Where did you learn to climb? I thought you Brits didn’t have any big mountains back home.’

I shouted back, staring directly at the Headwall to my front. ‘Thanks very much. It’s my first climb actually. I’m ****ing scared if it’s any consolation.’

‘Your first time? Jesus Christ!’ came up from below.

Tentatively I looked down to see the disbelieving, open mouth of my unknown American companion. The entire American team, seven in all, were moving sideways across the Headwall rather than upwards behind me. I knew why. If I fell unroped, anyone directly beneath would be pushed off the face. They were moving out of the way to allow me a clear solo descent should I fall. I’ll show the bastards, I thought.

After much muttering, blaspheming and cajoling from others, I made it to the top of the Headwall. Steve was a major asset. ‘Come on, Doc, you can do it!’ he would shout, whenever I showed signs of flagging. From the Headwall it was an easy climb, barely more than a stroll, to the base of the final summit ascent, an area called the Igloopex. By this stage I was beginning to feel unwell. I was out of breath and disorientated. Steve was still supporting me well, confidently saying it was entirely normal to feel like death at altitude and I should not worry about it. Given time, it would settle. I did not believe him, but was damned if I was going back down the Headwall again without having a shot at the summit. It had taken every ounce of courage I possessed to get up it.

My night in a tent at the Igloopex was a lesson in high-altitude sickness. I had lectured about it, read about it, knew about it, but never experienced it. Every movement was in slow motion. Even unzipping my duvet jacket made me breathless and exhausted, while my head throbbed so hard I thought it would burst. When I tried to cook a high-altitude meal, my trembling hands spilled the entire contents of the container on to the tent’s floor. So cold was the temperature outside, below minus 50 degrees Celsius, that the lumpy liquid set solid the moment it hit the groundsheet. I did not have the energy to clear it up. Instead, I lay there all night, half asleep and half awake. I was feeling terrible - completely helpless. If I had seen one of my patients looking as bad I would have evacuated him instantly, combined with a hefty dose of diuretics to help him pee off the excess fluid. The nature of high altitude sickness, however, is that it makes you feel listless and acceptant of anything fate throws at you. I could not have cared less at the time whether I was alive or dead.

By morning I was worse. Steve was also looking bad, huge purulent scabs appearing round his mouth. Between the two of us we were not a good SAS advertisement. It seemed best that Steve should keep out of the sun as much as possible, so I decided to try for the summit alone. During my approach to it, it was necessary to cross a massive, steep, snow slope that seemed to drop away forever to my left. For an expert climber such things are probably routine. For me they were horrifying. I made my way slowly across the slope. I knew if I fell I would die for sure, particularly as I was unroped. With an ice axe in my uphill hand, I dug its pointed shaft firmly into the snow as I walked, gripping it tightly. The fingers of my right hand felt very warm, despite the desperately low temperatures around me. It was a strange, tingling impression at first, at my very fingertips. What I was feeling was not warmth but the early burning of frostbite. So confused was my high-altitude brain that I did not recognize what was happening. The metal head of my ice axe was frozen. I had failed to insulate it properly with tape before leaving Fort Richardson and even a triple layer of gloves was insufficient to protect me. When I eventually descended the mountain I took off my gloves to view the damage. The middle three fingers of both hands were white throughout their length. They had not yet turned black - that would come later. It was certainly going to cause problems for my operating abilities, though I did know of one surgeon who still operated having lost a finger.

Ill-prepared, I had climbed the mountain and not paid attention to the cardinal signs of altitude sickness. I had gone on alone, leaving my climbing partner to suffer in silence. I had paid the price.

In retrospect it is a worthwhile experience to be on the receiving end occasionally, though I would not recommend frostbite. I was evacuated from McKinley with several other injured climbers and treated by medical staff at Fort Richardson. Thanks to their expertise, antibiotics and a pair of protective gloves, my fingers gradually recovered. The tips eventually turned black, and the nails dropped off, giving me three months away from practical surgery. I am left now with fingers that turn pale at the least hint of chill, but their full length still remains. I was lucky. Fingers have a remarkable ability to recover from quite significant insults. Even if a digit blackens, this does not mean it is destined to fall off. In earlier days, the presence of a black finger would lead to a formal surgical amputation the moment a patient reached established medical care. The situation has now changed, as it is possible for significant recovery to take place. Even if amputation is eventually required it is worth waiting as long as possible, as some length can probably be saved. I could see the bloodthirsty look in my surgical colleagues’ eyes when I returned to the United Kingdom. I made sure I kept my distance. I learned a lot on McKinley, my first high climb - an excellent preparation for Everest.

I was a worried man on my return, having heard nothing from my future wife since I had left. I was certain she would by now be surrounded by dozens of other male admirers. Richard Villar would no longer be her agenda. I was wrong and delighted to be so.

The wedding went well, if one can ever remember much about such events. Mostly they pass you by in a mist. Squeezed into an ill-fitting, sweltering dress uniform and SAS beret, I married Louise in London within days of my arrival from Alaska. Fortunately dress uniform comes with white gloves, so I did not have to explain my black fingertips.

With McKinley conquered it was time now for the SAS to turn its attention eastwards, tackling Everest via its North Face. Logistically this was an enormous task as the Nepal-Tibet border was closed. Those wishing to climb the mountain’s northern routes had to pass through China, and Lhasa, the capital of Tibet. The Chinese are not known for their administrative simplicity, so preparations made by Bronco and Brummie for this attempt were nothing short of miraculous.

For myself, having been caught out by Mark’s knee in Alaska, I was going to make certain the same did not happen again. I resolved that any illness or handicap, however minor, must be completely settled before departure. I arranged to perform detailed, pre-expedition medical examinations, bringing the chosen fourteen climbers, of whom I was one, together one afternoon in Bradbury Lines. Due to their continuous and varied overseas commitments, it is a difficult task accumulating thirteen SAS operatives from different Squadrons in one location simultaneously. Somehow we managed it.

Louise volunteered to help perform the examinations. By then she had left the Army, though was aware of the dangers involved in high-altitude climbing. From my viewpoint, her participation in the expedition workup was both valuable and essential. I was about to abandon my lovely wife for months on end. Not only did she have the required medical skills, but it was important she was involved with events. However strong emotional ties may be, prolonged separations are asking for marital trouble. You must do what you can to avoid them.