Knife Edge: Life as a Special Forces Surgeon (31 page)

In remote regions, mild toothache can become a raging abscess, a grumbling stomach can turn into appendicitis and so on. Louise and I were rigorous with the Everest medicals. Every lump was removed, every tooth cavity filled, every ache investigated. One climber mentioned occasional headaches. Nothing worrying, but an unusual story from a tough man who would normally claim fitness in every respect. As the pain was in the forehead, and behind his eyes, I sent him for an opinion from an eye specialist. Normally I would never have gone so far, but it paid to be safe. The eye man declared him normal. I also sought specialist opinions on a climber with mild asthma, a man with piles and another with varicose veins. All were dealt with, so that by 27 February, our day of departure, everyone was as fit as could be.

It does not matter where or how high you climb in the world, Everest is in a league of its own. Everest doctors began to appear from everywhere, each with an emotional tale to tell. I talked to young and old alike, gathering what information I could, soon realizing I was being gradually welcomed into a form of medical secret society. I was shortly to become an ‘Everester’. That does not make me unique, but there are still not large numbers of us, however routine the media may make the mountain appear.

Civilian life is less sympathetic to strange habits such as climbing than the military. By now I had moved my orthopaedic practice from Aldershot to Southampton, a civilian job, though still with part-time connections to the SAS. I had also become a ‘Mister’. It is a strange habit of UK surgeons. They work for years to call themselves ‘Doctor’ and then work even harder to relinquish the title. Surgeons in other parts of the world think it is very odd. Odd or not, Mr Villar was now my name. The Army will frequently provide fully paid leave for its soldiers to take part in so-called ‘adventure training’. It is seen as an essential part of the job. The National Health Service is not always so supportive. Permanently strapped for cash, allowing its key players to disappear without trace, however honourable the intent, is not something it easily permits. To climb Everest I had to resign from orthopaedic surgery and turn my back on the profession I knew. There was no guarantee I would be employed again when, or if, I returned.

Much of the time the role of an expedition doctor is a mundane one. You are dealing with a largely fit group of individuals who are unlikely to let minor ailments stand in their way. Mostly you will not be told if a climber is ill. They are terrified you will stop them from climbing. There is intense, unspoken competition on these trips to be the first to the top. Final decisions as to who will form the summiteers are often left until late in the expedition. He who appears strongest at the time is normally selected. There is rarely an opportunity for many to make the top. Windows in the weather are few, so an expedition will put in a great deal of work, simply to place one or two climbers on the summit. Everest’s casualty list, a Who’s Who of mountaineering, speaks for itself. Not everyone makes it up and fewer make it down. The North Face is a particularly difficult choice.

All climbing arrangements in China had to be handled through the Chinese Mountaineering Association, the CMA. This formed a significant part of expedition expense, but at least ensured we were in the hands of local people. It was the CMA who negotiated such things as yaks, sherpas and the transit of stores. So it was that the 1984 SAS Everest expedition, Exercise Pilgrims Return, landed with a thump at Peking airport. Chinese Airways had sent a dilapidated Boeing 707 to collect us from our transit stop in Hong Kong. It was barely able to taxi, let alone fly. Probably the aircraft posed a far greater threat to expedition safety than Everest ever could.

It was in Peking we met our CMA companions, attached to the expedition for its duration. There were three, with wonderful Chinese names: Mr Chen, Mr Chow and Mr Lin. Lin was our interpreter and Chow a so-called ‘life manager’. I never did establish what this was. All three were excellent company, though it was Chen who was the climber, or so it appeared. Much of his face was missing, his ears and nose being grossly scarred due to earlier frostbite. Stories flew round the expedition like wildfire as to how this had happened, though no one dared ask the man himself. Whatever the truth, he made Everest appear terrifying.

Food is a vital part of any expedition. Proper selection, and reasonable diversity, will do much to raise people’s flagging spirits. In the middle of nowhere, miles from the nearest shop, fresh food is an impracticality. Everything must therefore be taken with you, in vast quantities. We had trialled a high-altitude ration on McKinley, but had made it so comprehensive it was physically impossible to eat everything. The only way of finishing a daily ration pack, whose contents were based on scientific calculations of energy expenditure, was to stay in your tent, cooking and eating all day. The rations were trimmed down for Everest, providing approximately 4000 calories per man per day. Even so, the quantities required were enormous: 1728 pepperoni sausages, 5184 tea bags, 6912 sachets of milk powder. Jim our ration man, and Larry his assistant, had done well.

From Peking we flew to Lhasa, a city 3700 metres above sea level. Consequently, on arrival by airplane, you experience instant high-altitude sickness. You notice it the moment the aircraft doors are opened, a feeling you have consumed a whole bottle of gin. Having suffered so badly on McKinley, I was accustomed to the problem and did not worry. Acclimatization cannot be hurried. You simply wait until Nature does the job for you. Occasionally, drugs can be used to help the body adjust. One called acetazolamide is particularly common. Various local remedies are also said to exist, but there is no better substitute than gradual, steady ascent.

It was fascinating to see the climbers’ reactions to altitude sickness. It was fair game for me to tell everyone how awful I felt. No one expects the doctor to be a summiteer, and feeling sympathetic to you often makes them feel better themselves. Every man was experiencing the effects of altitude. Sleepiness, breathlessness, reduced appetite and so on. No one would admit to it, as if this was a sign of weakness. I could see the same again as we drove by coach from Lhasa towards Everest. Travelling through the smaller towns of Xgazi and Xgur, the road ascends mountain passes as high as 5300 metres. As we went up so the volume of conversation by all present reduced. As we descended so the volume resumed.

Everest’s northern roadhead, from where it is impossible to drive further, is traditionally positioned by the Rongbuk Monastery, named after the valley in which it lies. Once a thriving institution, it was where famous names such as Mallory or Irvine, in the 1920s, would stop to be blessed before moving onwards to climb extraordinary heights. Those were days when protective clothing amounted to a tweed jacket and smoking was considered a good way of avoiding altitude sickness. The Rongbuk is now a dilapidated place, with a few local Tibetans, but little else to its name.

The noise in the Rongbuk Valley, and our adjacent Roadhead Camp, was incredible. Wind was continuous — a distant, persistent, low rumble overhead. I dictated a diary during our Everest attempt. Throughout it you can hear a fearsome, overpowering noise. The Everest range is continually battered by astonishing winds. It is no wonder that rock, ice and snow blocks can be occasionally shaken loose.

That day we did not arrive at the Rongbuk until late. Exhausted, and feeling weak due to altitude, the team went to sleep, paired in tiny mountain tents. For the first time in my career, an SAS team closed its eyes without posting a guard against enemy attack. Our enemy on this occasion was Mount Everest, unarmed, but more vicious than any terrorist or foreign power could ever be.

Sleeping at altitude is not easy, however exhausted you may feel. Insomnia is a classic feature of high-level climbing. Consequently many of the team took tablets, temazepam, to help them snooze. They appeared to have a remarkable side effect, one you can happily enjoy - the erotic dream. I have never seen it reported in the medical literature. The combination of Everest and temazepam allowed us to pass the night away smiling from ear to ear. Lie awake at night and you could hear satisfied grunting from tents all around.

Unfortunately, you will also hear Cheyne-Stokes breathing. Classically seen by hospitals in patients suffering from severe head injuries, the low pressure of oxygen at altitude can cause the same effect. It is an irregularity of breathing where the climber gradually breathes faster and deeper over a period of about a minute. Then, suddenly, he stops altogether. He stops, and stops, and stops. It can appear he will never start again. Just as you feel you should do something to help the climber breathe, he begins spontaneously once more. The number of times I reached for the emergency oxygen to resuscitate my tent companion was countless. No sooner had I turned on the cylinder, resuscitation mask firmly in hand, than he would begin to breathe under his own steam.

Panic attacks, attacks of breathlessness at night, are also common at altitude. You scrabble furiously to escape your sleeping bag and tent, desperate for air. In fact they represent the very end of the breathholding phase of Cheyne-Stokes breathing. You get used to them eventually. A double dose of temazepam, with a supererotic dream, is a perfect cure.

‘Please sir, how do you go to the toilet?’ is the commonest question I am asked whenever I lecture to schoolchildren about Everest. The answer is ‘With difficulty, and with pain.’ I did not realize this until one morning, after breakfast. The air was pierced by an agonizing scream.

Immediately my mind went into overdrive. Where was the emergency kit? Airways? Drips? Shell dressings? Good - I had everything ready. Then from behind our latrine boulder, a short distance away, staggered one of our climbers looking much the worse for wear. I went over to him. ‘Jesus, Doc,’ he said. ‘That was ****ing painful. I don’t want to go through that again. It’s got to be worse than delivering a baby.’ I knew immediately what he was describing. Fissure-in-ano, one of the commonest climbing problems you can find.

Low-fibre rations, due to lack of fresh food, make a climber’s motions hard and solid. The human tail end, however floppy it may be, simply cannot stretch enough to let the stuff out. As with childbirth, if it won’t stretch, it splits. When it splits, it bleeds. I can promise you it is genuine agony. It makes you terrified to open your bowels, so your motions get even larger and more solid, until you have a veritable explosion with which to deal. Local anaesthetic ointment for the tail end is a vital part of any expedition doctor’s kit. On one occasion I had to use it on a yak. Fresh food, or liquid paraffin laxative, are alternatives.

As to how you do it? That is easy. The ‘crap flap’ reveals all. This is a form of Velcro-fastened rear fly that can be ripped open in desperation. It is largely impractical, and often unwise, to remove your trousers altogether at altitude. Your most precious parts can freeze solid if you do. I changed neither underwear nor trousers for the entire duration of our Everest stay, more than two months. When you all smell as badly as each other, nobody notices.

Each evening, when at the Roadhead Camp, the team would meet to discuss its various problems and difficulties of the day. It was great for keeping up morale. A vital part of this meeting was the rum. Military rum, fresh from Jamaica - what wonderful nectar. Each man was issued his ration, faithfully placing it in a white, screwtop plastic container. Glass bottles would have shattered due to cold. Unfortunately, white screwtop plastic containers were also used at night as urine bottles, to avoid the hazard of urinating outdoors in temperatures of thirty or forty below. Rum can be brown, so is concentrated urine. I made the mistake only once. At medical school I had been taught how Hippocrates had tasted a patient’s urine in order to make the diagnosis of sugar diabetes. I had never thought I would use the same technique myself. I found urine-tasting foul.

Keeping the locals on our side was important. With the twenty yaks came an assortment of handlers. They, with Chen, Chow and Lin, would join us in the communal tent. In keeping with tradition, when a soldier made a mug of tea he would take a sip himself and then pass it round all others present. I could cope with my colleagues, even if this tradition of ‘sippers’ was an excellent way of transmitting disease. When the man next to you is a partially-toothed Tibetan yakhandler, who has just coughed a large dollop of green, blood-stained phlegm on the ground, accepting a sipper from him requires immense self-discipline. I felt it was taking hearts and minds slightly too far. How I avoided tuberculosis, and other assorted Tibetan lurgies, I shall never know.

Yakhandlers can be temperamental. It was my management of them one day that nearly caused a general strike and risked bringing the expedition to a halt. The principle of any large climb such as Everest is to move stores and provisions forwards, a step at a time, camp by camp. Roadhead Camp to Base Camp, Base Camp to Advance Base Camp, Advance Base to Camp 1, and so on. You might require five or six camps to reach the top. At the lower levels the carrying is largely undertaken by yaks. Higher, over about 5500 metres, yaks do not perform well and all carrying is by man, be it sherpa or climber. I had not realized a standard yak load had been negotiated by the Chinese. Thinking the yakhandlers would be as enthusiastic as me to see the expedition succeed, I squeezed in an extra kilo of provisions here or there when asked to prepare loads for carriage, completely unaware of the festering sore I was creating. One morning, I heard loud voices babbling furiously near the yak-loading area. The handlers were discontented. Lin translated.

‘Men not happy,’ he said, throwing up his arms in Oriental exasperation.

‘I can see that,’ I replied. ‘Why not?’

‘Loads too heavy. Money not good. Problem.’ As he spoke, the entire yak herd wandered off, driven by their apparently irate handlers. A yak can carry approximately three times as much as a climber. Without animals the expedition would most likely fail. I tried hard to grab the lead yak and prevent it from leaving, but it was a futile task. Yaks may be hairy, flea-ridden animals, but they are immensely powerful. I was simply dragged along in its wake. The first all-out industrial yak action, for all I know the only one in history, was in progress.