When I woke up Thursday morning, about halfway along our Wind River traverse, I knew my forehead was burning and that I had started to cough during the night. I asked Booty-Less to check and she confirmed. I had a fever. I had to get down. Staying at 10,000-12,000 feet for an additional 30 miles was no sort of option.
At this point, however, it wasn’t clear exactly what I was sick with. Booty-Less started grousing about flu and complaining about sharing her whisky bottle with me. The Look had been preaching the wonders of hydration. We all talked about altitude. It just wasn’t clear.
What was clear to me was that my physical abilities were diminishing extremely quickly. On Tuesday, I had led the group over Knapsack Col—a day that will certainly be among my best this year. From roughly 9,000 feet to over 12,000 feet, we climbed this fairly intimidating pass. Much of it off trail, I picked our route up and over, reading the terrain, crossing the snowfields, then finding our way down the talus on the other side, crossing the glacier. I felt fully engaged, entirely alive, and just generally having a great time. Maybe my heart beat a little faster than at sea level, but I was slowing the group to account for that (I had watched my Nepalese guides over my trips there and tried to emulate them). Later in the day, as we passed through Titcomb Basin, I was tired, but naturally so. It had just felt like a good day in the mountains.
Wednesday morning, the weather hung low over the mountains, and I made the decision that route-finding on the eastern side of the divide would probably not be a good idea. I can’t say if my physical condition played into this decision. It may have. But it was a very fortunate decision as it turned out. On the more isolated side of the divide, my subsequent deterioration would have been even more serious.
We set out for our day, planning to use the CDT to head down the range towards the Cirque of the Towers—less of a “high” route but still a very challenging traverse of the range. The next time we turned uphill, however, it felt like I was wearing shoes make of 20 pounds of concrete. Later, this description would prompt the doctors to look for a blood clot. Even very gentle short grades left me gasping for breath.
I pulled off from the lead to let others pass me a few times. I remember Shamrock looking at me like maybe I was pulling her leg. Throughout Wednesday, however, I managed. We walked something in the neighborhood of 16-17 miles, climbing over two alpine passes, walking through a hailstorm. I was struggling on the climbs, but wasn’t too far off the back. On the last climb to camp, I was miserably slow, stopping to gasp every few feet. UPS noticed that I was stumbling.
Camping was a relief. At this point, I still believed I’d pull through and be able to continue the trip. I set about recovering very deliberately. I forced myself to eat a lot, though my appetite was waning, and indeed I did feel better. I hung out around the fire a little. I drank a lot of water.
But when I woke up Thursday morning even worse, I got serious about getting down. I wasn’t that upset about it. I’ve spent the last couple of years singing the praises of people who bow out in ways that aid the group. I figured it was my turn, and I was determined to do it correctly. UPS asked if I wanted the whole group to go down. I definitely did not.
Praise goes to the rest of the crew. The Look and Booty-Less accepted battlefield promotions. UPS got evicted from her tent so that I could have a solo shelter (she got to join the “sorority”). The SPOT beacon stayed with the group, but it was decided that Heavy D would descend with me. He was concerned that I might have pneumonia, as my cough was kicking in. We stood around in the rain, feeling forlorn. I assured everyone that we’d meet in the hotel on Saturday.
As Heavy D and I descended the trails from the CDT near Baldy Lake, I knew we were in for a slow day. In retrospect, I had miscalculated. In the rush of the morning, I had picked the quickest route to a trailhead … when I should have been looking for the quickest way to lose a few thousand feet—actually rather tough in the Winds. The Look and I had calculated the mileage to the trailhead to be about 14 or 15 miles. Any other day, I could have been there by 1pm or so. I knew it would be very slow.
Over the next 9 miles, Heavy D displayed a truly saint-like patience as my abilities trailed off. I was getting out of breath on flats, any climbing at all exhausted me, my moderate pack felt like a ton of lead, and I was breaking every few minutes. My mood darkened as the slowness of our progress was measured. I started to know, in my bones, that we wouldn’t make it today. Heavy D said that didn’t matter. In a sense, he was right … but I needed to get lower and needed a doctor, not another night in the tent. Perversely, we spent the whole afternoon climbing. I tried to do it gamely enough, but by the time we reached Elklund Lake (well above 10,000 feet), I was completely spent. It was maybe 3:30pm.
Heavy D told me that we would camp. We thought, with a little rest, I’d be able to walk out the following morning. It was a smidgen over 5 miles, most of it downhill, but it seemed far, now.
As I tossed through the early hours Friday morning, waiting for the sun to come up so that I could take some action, it occurred to me that I was seriously sick. My heart rate was pounding through my carotid so hard that it was booming and wouldn’t let me sleep (I clocked myself at 120 BPM in the morning, but I believe it was worse during the night). When I got up to go take a piss, I was entirely winded; the hacking cough was much worse and I could feel material moving around in my trachea and lungs (I never reached the coughing blood phase, but I think I was close); when I breathed in deeply, I was starting to feel pain in my ribs. My body was passing beyond my control.
In the morning, we decided that Heavy D would go for help. I wrote out a list of my symptoms along with emergency contact information, etc. We had seen a number of horse trains and hoped we could hitch a ride.
By mid-morning, Heavy D had returned with an FS ranger, Tyler, who was very happy to find me conscious and lucid. I clambered out of the tent and we shot the bull for a while. Tyler was an interesting fellow to talk to, and has seen a lot of the outdoors. We talked about gear, and how awesome tarps are. Then, the radio crackled to life to let us know that a helicopter was inbound. Helicopter? We were waiting for a horse! This caused some consternation. I wasn’t entirely sure that I was sick enough for a copter, and I was concerned about paying for it. Heavy D actually started looking through his pockets for some spare change to help. The dispatcher confirmed that the helicopter ride was free, however, so “Why not?”
I was feeling a bit sheepish, as I was concerned that I wasn’t really that sick. Once they were on the ground, the EMTs seemed to think I looked pretty bad, however. They were all business. My BPM was very high. They gave me oxygen, which reduced my heart rate by 40 BPM in a matter of seconds. They loaded me into the copter, and left poor Heavy D standing there, missing out on his copter ride.
A few minutes later—the EMT people and the doctors at the emergency care facility were great and very efficient—I was in a bed, hooked up to a full range of gear. My oxygenation levels were low; chest x-rays showed acute pulmonary edema; I was checked for a blood clot. The diagnosis was HAPE: “HAPE remains the major cause of death related to high-altitude exposure, with a high mortality rate in the absence of adequate emergency treatment.”
For awhile the doctor wanted to transport me to a lower elevation (Pinedale is still pretty high), but I was intent on meeting the others at the hotel on Saturday, so long as that was medically sane. She put me on a course of dexamethasone, which helped a great deal. I was eventually released and spent the evening in a hotel, watching crime stories on cable. Heavy D passed by on his way to a rodeo.
Some closing thoughts:
• Altitude sickness doesn’t correlate with fitness, as everybody knows, but it’s worth remarking that prior to beginning this trip I was in quite solid shape. I wonder about mental exhaustion, however. Over the last two years, I’ve maintained a hectic pace. In July, I essentially walked and wrote half of my second book; practically every hour of the days were planned out for very long periods; my day job was keeping me occupied too; there was the usual turmoil of my private life. I wonder if the mental strain could have contributed.
• This happened to me at a low elevation, relatively speaking. I have been much higher, as high as 5,416m, with no problems. I’ve climbed Rainier and a few other Colorado peaks, with no particular problems. There have been other high-altitude treks, in Nepal and the west. If you had asked me before this trip, I would have said that I may be slightly susceptible to attitude sickness, based on some symptoms I experienced in Cusco a few years ago. That, however, was much, much less serious than this event.
• What characterizes my successful ascents was their fairly gentle character. I rented a cabin for a week near Rainier, and in Nepal, a hiker benefits from very gradual (non-mechanical) climbs towards the higher elevations. It seems plain that, whether I am somehow genetically predisposed towards this sort of sickness or not, several days of acclimation will have to be built in for me for any future trips. Although going to Vegas to help drive up with Carrie seemed like fun at the time, I probably needed to be at least 6,000 feet on those nights.
• Prior to this trip, I worried some about how DC UL’s style would conflict with altitude. People may remember me talking about this at a HH in June. The members of the group will no doubt recall my slowing people down early in the trip. I also tried to sequence the campsites so that they would not increase in elevation too much too quickly. I will claim some success there, as no one else got sick! But it is plain that some acclimation needs to be built into these trips. We live at sea level, after all.
• Dexamethasone is good stuff, and I’ll be carrying it with me whenever I go to altitude again. I had resisted drugs before … and still believe that gentle acclimation is the best solution, but still.
• Oxygen is even better stuff.
• I have unfinished business in the Winds.
Well, it was a serious survive story, and I am so happy that you walked out with no obvious complications. Wish you a speedy recovery, and a full pulmonary capacity back. If it is possible, please do deep breathing exercise once/day: 1, Take a normal breath 2, Blow the air out from mouth until all the air completely pushed out of your lungs (Make sure your face turned to purple color..Kidding) 3, Take a full deep breath.
Why do this?? In normal condition, we breath shallowly, and there would be 1/3 of the lungs called "Dead space" never inflated or inflated. We do 2-6 deep breath every hr naturally to manage this problem, but when breathing muscles are tired/weak, this effectiveness of deep breath is limited. OK, U-turn see you on the trail again soon..[:D]
Michael, I'm really glad to hear that it turned out to be a happy ending! Altitude is no joke, as I got harshly introduced to it last year in the Sierrras and punched in face by it this year. I had a lot of the same syptoms as you did minus the fever and coughing and I thank my decision (with of course the help of Mike and Shannon) to get off the trail when I did. Dan, you are one hell of a guy and we all appreciate what you did for Michael. Kudos to all of you guys and look forward to sharing stories soon!
Yes, diamox and gentle ascents make a big difference and, still, ya never know.....I've been there. Glad you're OK. Best,
Aileen
Hmm... this was much more severe than it sounded from a few of your flippant facebook comments. Scary stuff. I have to say that I've never heard for HAPE below 14k feet, but then again, I haven't exactly read up on it in much detail (just the occasional glance through Accidents in North American Mountaineering). Did it occur to you ever that this was altitude related, or that your lungs were filling with fluid, and that your elevated heart rate was trying to compensate for low blood oxygen? That is, did you ever connect your symptoms to HAPE? I didn't know about fevers, but the other reactions sound kind of textbook... then again, I'd not be expecting it in the winds. I'm sure Tyler the ranger and the EMTs have seen it before, though. Will be interested to chat with you this evening at the Corsica party.
"High-altitude pulmonary edema (HAPE) (HAPO spelled oedema in British English) is a life-threatening form of non-cardiogenic pulmonary edema (fluid accumulation in the lungs) that occurs in otherwise healthy mountaineers at altitudes typically above 2,500 meters (8,200 ft).[1] Some cases, however, have been reported also at lower altitudes (between 1,500–2,500 metres or 4,900–8,200 feet in highly vulnerable subjects), although what makes some people susceptible to HAPE is not currently known."
After driving from Vegas, I had us camp at 8k feet the first night, 9.5k the second night, then about 10.5k feet the succeeding nights, as high as 12k during the day. Though this may not seem very conservative, at this juncture, it is more conservative than what many do. And I was thinking about altitude, and somewhat worried about bringing people from sea-level. I wasn't too worried about myself ... obviously, mistakenly.
It appears this started in the range of altitude that's considered "normal," though I too find it rather "low."
When the strange fatigue developed, I was thinking altitude, but then I started to let myself be persuaded that it was dehydration or perhaps flu. The cough and the fluid in the lungs came on so very quickly that I went from having a minor cough Thursday morning (it was more the fever that made me think, "go down!") to a very scary cough Friday morning. Even then, we were thinking pneumonia.
I didn't think HAPE until the doctor said it.
That is a lower onset than I knew. And yeah, your acclimitization schedule sounds totally reasonable, and even more conservative than I likely would have done (I went from sea level to 10k for Rainier last year, and felt good to go to the top the next day, though we spent a day playing on the glacier instead). This sounds like 'one of those things'. Maybe you partied too hard in LV. :)
Every mountain has its own weather, and own pressure systems which influence oxygen content ... when we camp and climb over 12k in the Andes, we go slow because even if you are well acclimated, you still need 2-3 more breaths per normal pace. Try panting all day long... Trying to go fast up there leads to headaches, which lead to dehydration, numbness in the body, and then partial loss of consciousness... after that, God help you cause your buddies may not be able to bring you down or find help in time. I've seen all the signs. Drink extra water, eat foods easily digestable, and keep away from alcohol 48 hrs before and until the trip is over. Not recommended for standard use, but take Ibuprofen to help reduce headaches at night if you must and diamox before the hike. Better is to listen to your body and take extra days to rest. Thank goodness you're back here and nearly recovered!