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Deep Breaths

When a Pulmonologist Developed a Lung Condition While Mountaineering on Everest, it Deepened his Connection to Patients

At Altitude: Scenes from the expedition to the North Col of Mount Everest that Dr. Ronald Crystal attempted last April. Photos provided

I’ve been interested in mountain climbing since I was a teenager, when I read a book about Annapurna, the first 8,000-meter peak ever climbed. I was captivated by the challenge of a team working together to accomplish a difficult goal. Reading about mountaineering became a lifelong interest, but it was not until age 60 that I actually started climbing. Since then, mountaineering has become a passion, and I have climbed peaks in China, Japan, New Zealand, Mexico, the United States, Canada and Europe. In the winter, I climb frozen waterfalls.

But of course, Mount Everest is the classic, and I finally planned an expedition there in April 2018, a trip that coincided with my 77th birthday. I was not interested in summiting, which struck me as irrational at my age. But I’ve always been fascinated by Everest’s history, and my goal was to go where the British reached when they attempted to climb the mountain in 1921: a glacier-carved pass called the North Col, 23,000 feet (7,000 meters) above sea level. So I made arrangements two guides from a company in France—one a well-known alpine climber, the other a wilderness rescue physician who’s also an excellent mountaineer. As a pulmonologist, I know you can’t train your lungs—but you can train your muscles, heart and mind. I exercise every morning on a spinning bike at home and work out with a trainer three times each week. I live on the 34th floor of an apartment building, and as I get closer to a climb, I walk up and down the stairs several times a week, carrying a pack and for wearing my climbing boots. Ultimately, though, the important thing is acclimatization—getting used to the high altitude. After spending three days in Kathmandu, Nepal, we flew to Lhasa, Tibet, which is at about 11,200 feet. As we slowly moved toward Everest’s North Side, we went on some hill hikes to get used to the altitude. Eventually we reached the North Base Camp, which is at 17,200 feet.

At Altitude: Scenes from the expedition to the North Col of Mount Everest that Dr. Ronald Crystal attempted last April. Photos provided

From the time we arrived in Tibet I had been tracking my oxygen saturation level, which indicates what percentage of your red blood cells are filled with oxygen. At rest it should be 98 or 99 percent; as you go to higher altitude it decreases. I was fine at first, tracking along with the oxygen saturation of my guides, but after being at base camp for a while and gradually going higher, I started to feel really tired. My oxygen saturation dropped to about 78, my pulse rate was 95, up from my usual resting 63, and I felt short of breath when I lay down. I realized I was developing high-altitude pulmonary edema (HAPE), a potentially fatal disorder associated with a leak of fluid in the lung alveoli, where oxygen is transferred from air to blood.

I discussed my diagnosis with my guide doctor, and he concurred it was early HAPE. We then called the medical consultation and evacuation service I’d hired in advance of the trip. We all decided that the best thing was to go to a lower altitude, and we descended to a small village about 3,000 feet lower. The next day I wasn’t feeling terrific, although I was much better. We decided that it would be too risky for me to continue the climb. We eventually drove across the Tibetan plateau to a small border village and crossed the China-Nepal border, where a helicopter took us to Kathmandu. By the time I was evaluated at a local clinic, I was back to normal. Canceling the North Col climb was frustrating. When you’re on a high peak, despite having symptoms and objective evidence of lung dysfunction, there is an incredible drive to continue. You’ve put in a huge amount of effort, taken all this time, spent the money and you want to reach your goal. But I knew I was in trouble, even before I told anybody else; I struggled with the truth, because denying it was easier, at least for a time. When I finally accepted reality and put the rescue in motion, I was impressed by how helpful and professional the Chinese base commander, the guides and the evacuation service were in getting me to safety.

Since I got home, I’ve been asked more than once whether I see any irony in being a lung expert and developing HAPE. I had even written an article with one of my colleagues outlining our theory of why the condition occurs. Prior to the trip, I was worried about the usual hazards, including inclement weather, ice and rock fall, crevasses, and ice climbing at high altitude, but getting HAPE was not on my worry list.

Having gone through this, I probably bond with my patients a little more. I think I better understand what they go through, particularly the uncomfortable sensation of breathlessness associated with lung disease. It has also made me think even harder about how I can convince patients to exercise, because no matter your age or how disabled you might be, there’s always something you can do. As I tell the first-year medical students, you cannot choose your parents, and thus cannot choose your genes. But you can maintain a reasonable diet and weight, drink in moderation, avoid recreational drugs, and exercise. We need to convince people not to give up—that working at good health may or may not extend your life, but it will definitely make it more enjoyable.

Looking back on the Everest trip, I see it as a positive experience, not a negative one. There’s obviously disappointment, but to me the most important thing is having a goal and moving toward it. As you get older, you begin to realize that you’re not going to live forever, and many people limit themselves. Your goal does not have to be trying to climb part of Mount Everest; it could be walking ten blocks. In September, I returned from another climbing trip—though I’m not going to try the North Col again.

Dr. Ronald Crystal

This story first appeared in Weill Cornell Medicine, Fall 2018

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