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At His Peak

Dr. Carlo Canepa Spent an Everest Climbing Season Practicing Emergency Medicine at One of the World’s Highest Clinics

 

Climbing—and for an intrepid few, summiting—Mount Everest has an iconic place in the human imagination. But each year, a much larger number of people set a more modest but still lofty goal: hiking up to Everest Base Camp. “It’s at 17,500 feet, so just getting to Base Camp is like climbing a mountain anywhere else in the world,” says emergency medicine specialist Dr. Carlo Canepa MD’12. “A large portion of people don’t make it all the way up.”

Last climbing season, it was Dr. Canepa’s job to safeguard the health of some of those who attempted the trek. As part of the yearlong Massachusetts General Hospital Wilderness Medicine Fellowship, Dr. Canepa spent two months—mid-March to mid-May—as one of three volunteer physicians in a tiny nonprofit clinic in Pheriche, a village in eastern Nepal that’s 14,340 feet above sea level. “It’s one of highest-altitude clinics in the world,” he says. “So you get a lot of exposure to high-altitude medicine and physiology, and you see things that you normally wouldn’t see anywhere else in the world, at least in those numbers.”

Located about three-quarters of the way up to Base Camp, Pheriche is a stop on a decades-old trekking route; Sir Edmund Hillary and Tenzing Norgay spent the night there during their historic Everest ascent in 1953. Hikers—some 10,000 per month in peak season—generally start the trek in Lukla, a town about 9,400 feet above sea level. (Dr. Canepa himself flew into Lukla and hiked up to the clinic, which is run by the Himalayan Rescue Association and has no road access.) On the 40-mile trip to Base Camp, trekkers sleep in rustic lodgings known as teahouses, breaking up their journey as they hike ever higher, generally walking for five or six hours per day. “You can’t gain much altitude every day or you’ll get sick,” Dr. Canepa explains, “so people trek, then they sleep at that altitude, then trek to the next teahouse.”

Trekkers commonly suffer headaches as the altitude increases, but sometimes that progresses to acute mountain sickness, which is a headache plus other symptoms such as lightheadedness, dizziness, fatigue, weakness, nausea and vomiting. Dr. Canepa notes that while everyone feels short of breath to some extent at altitude—and a drop in blood oxygen levels is normal—some trekkers go on to develop a dangerous condition called high-altitude pulmonary edema (HAPE), in which fluid accumulates in the lungs. Perhaps the most perilous type of altitude illness is high-altitude cerebral edema (HACE), a life-threatening condition in which the brain swells; patients suffering from it begin to lose coordination, then can no longer walk, and can even become unresponsive. “People die of high altitude illness on the trek to Base Camp every year,” Dr. Canepa says. “No one died in our clinic, but we heard of at least four or five trekkers who passed away in teahouses in the surrounding areas or on nearby peaks. So people die every season there who are not even on Mount Everest.” While the clinic had little in the way of medical equipment—its most advanced devices were two portable ultrasounds, one of which Dr. Canepa had brought for a research project on detecting HAPE in hikers who had no overt symptoms—it had medications to treat the various types of altitude-related illness, as well as an oxygen concentrator. Patients diagnosed with HACE, of which Dr. Canepa saw about 10 cases during his stay, were usually evacuated by helicopter; those with HAPE often had to be carried down the mountain, while people with acute mountain sickness or very mild presentations of HAPE might improve by walking to a lower altitude. Dr. Canepa notes that although some people fall ill because they ignore initial symptoms or push themselves too hard, even those who take the proper precautions—including veteran trekkers who’ve been fine on previous trips to high peaks—sometimes suffer from altitude-related sickness, for reasons not yet fully understood.

Dr. Canepa participating in a marathon that starts from Base Camp.

Of the roughly 550 patients the clinic treated during the season, about 30 percent were foreign trekkers. The rest were Nepalese, often working as porters or staffing the teahouses; while they can also suffer from altitude-related illness, Dr. Canepa says he most commonly treated them for conditions ranging from lacerations and twisted ankles to primary care issues like high blood pressure, kidney stones and upper respiratory infections. “We had no blood tests, no lab. There’s nobody else up there—you can’t talk to the cardiologist or the neurologist,” Dr. Canepa says. “You had the history and the physical exam; you basically had to handle everything on your own, and you had limited supplies to work with. It was great, and it was something I’ll always carry with me.”

Born in Peru, Dr. Canepa is no stranger to life at altitude: his mother comes from the Andes region, and he’s a longtime mountaineer who has climbed peaks in such far-flung locales as Ecuador, New Zealand, Tanzania and Washington State. After the Pheriche clinic closed for the season, Dr. Canepa’s high-altitude fitness was put to the test when he ran the Tenzing Hillary Everest Marathon, which begins at Base Camp and follows a punishing route downhill over uneven terrain. A veteran of five previous marathons, he finished with a time of 6:48—nearly two hours longer than his usual performance closer to sea level, but still good enough to put him fourth among the foreign runners.

Before leaving for Pheriche, Dr. Canepa spent several weeks in Kathmandu, where he navigated the process of obtaining a license to practice medicine in Nepal. While there, he got some happy news: his wife, psychiatrist Dr. Dorothy Chyung, was expecting their first child. Although the internet at the clinic wasn’t particularly robust, he managed to FaceTime with her during her first-trimester ultrasound appointments. After Dr. Canepa completed his fellowship in June, the couple—who met at their White Coat Ceremony, began dating soon after, and did the Everest Base Camp trek as fourth-year medical students—went off on their next adventure. They’re now practicing medicine on Saipan, a U.S. commonwealth island in the western Pacific, 120 miles north of Guam.

 — Beth Saulnier

This story first appeared in Weill Cornell Medicine, Fall 2018

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