I am currently sitting at Black Canyon Coffee at the Chiang Mai airport waiting for my flight back to California. In a few days, I hope to be getting surgery to remove an alien growing on my mesentery. This is a good thing.
It took me 4 scans, 2 biopsies, 8 shots in the ass, and more trips to Bangkok Hospital than I can remember, to get to this point. Finally after ruling out prostate cancer, and getting a diagnostic confirmation from the Cleveland Clinic, it all comes down to this one 2.5×1.5 cm tumor. The consensus is get it out if at all possible.
I talked with two surgeons affiliated with Bangkok Hospital. One was willing to do the traditional slice and dice procedure, and the other one was an expert in laparoscopic (minimally invasive aka. key-hole) surgery. Neither had any experience excising neuroendocrine tumors. I had to wonder if they would even know what one looked like. So I went on the internet. It turns out there are only a handful of facilities in the USA that have a specialization in Neuroendocrine Tumors (NETs). It boiled down to choosing between Dana-Farber Cancer Institute in Boston, The James Cancer Center in Columbus Ohio, City of Hope in Duarte, California, and Cedars-Sinai Medical Center in Los Angeles. One didn’t take my insurance, and one didn’t follow-up after 3-4 emails. In the end, I chose the Carcinoid and Neuroendocrine Tumor Program at Cedars-Sinai. In about 48 hours, I have an appointment with a surgeon who specializes in NET tumors. Not to disparage my doctors in Chiang Mai, all of whom gave me excellent care, but this feels like moving up to the big leagues.
My prospective surgeon, Dr. Kosari, has reviewed my scans and believes the tumor is resectable (Doc speak for “yea, we can cut it out”) and likely can be done minimally invasively using a robotic assist. As the above picture shows, the robot looks a little scary. Sean Connery would agree.
I want to emphasize that my disease has not worsened or progressed. Surgery, if possible, is a good thing (my new mantra). My disease will still be there, will still be incurable (BUT NOT TERMINAL). If successful this will be a step towards my ultimate goal – high life-quality while waiting for something else to kill me. Stay tuned.
I am now 7 months into my battle with Nueroenocrine cancer. I have had way more contact with the medical community here in Chiang Mai than I ever wished for. I always figured that most people died in a hospital bed, so better to stay away. However, I now feel somewhat qualified to make some observations about health care in Thailand that might prove useful to anyone thinking about retiring or traveling here for medical care.
But first, a very brief update of my current status. I have now been on monthly injections of Sandostatin LAR for 5 months. These injections are not a cure, but intended to stop or slow the tumor growth, and stop or limit the proliferation of tumors. They do come with some unpleasant, but mostly bearable, digestive side-effects. Suffice it to say that if I had one of the more common side effects then, I would have been a cult hero in my fifth grade class. Last month, I traveled to Bangkok for another Gallium 68 PET scan. The scan showed no growth of my one known tumor, but continued to “light up” my prostate, suggesting something might be there too. Last week, I had a biopsy done on my prostate where my urologist turned it into a pin cushion by removing 24 small cores. Fortunately, I was in Lala Land at the time. Early this week I got the results: nothing at all going on there (except BPH which I have known about for years). Good news!
I will be meeting with my oncologists next week to discuss our next move (surgery or more Sandostatin injections are the two most likely). Unfortunately, the one known tumor is in my mesentery, and is very unlikely to be the primary. Where the hell is my primary? Most likely it is 1. too small to see, 2. gone already due to immune response, or 3. hidden away somewhere, most likely in the curlicues of my small intestine. Neuroendocrine tumors (NETs in the lingo) are sneaky nefarious bastards. Once they have metastasized they are nearly impossible to 100% expunge from your system via surgery or medicine. This will make the decision to cut or not to cut a difficult one….So that’s where I stand at the moment. In the meantime, digestive issues not-with-standing, I feel great and life goes on mostly as normal.
Medicine in Thailand
According to the World Health Organization, Thailand ranks #47 amongst 190 countries in terms of the quality of their healthcare system. For perspective, the U.S. ranks #37. Thailand, except for the tiny states of Brunei and Singapore, ranks number one in south-east Asia. Thailand ranks 65 spots above India that magnet for medical tourism. So by WHO standards, health care is pretty good here. My own experience corroborates this conclusion. But it is only good if you have money (or good insurance).
I receive most of my healthcare at Bangkok Hospital, Chiang Mai (BHCM). Bangkok hospital is a country-wide system of hospitals that was started by a Thai doctor in 1972 as the first private hospital in Thailand. Prasert Prasarttong-Osoth parlayed his medical degree into a $3.2 billion fortune that includes Bangkok Airways and 3 regional airports. BHCM is in my view the best hospital in Chiang Mai. From its welcoming lobby that exudes the ambiance of a 5 star hotel, replete with live music from grand piano, to its immaculately attired english speaking staff, to its state-of-the art equipment and spotlessly clean ORs and examining rooms, anyone will feel confidence in the care they are about to receive. But the quality of that care comes with some significant caveats.
In the course of my diagnosis and treatment, I have seen more than a dozen doctors. They all impressed me with their caring attitudes, and general intelligence. However they collectively are the product of an insular system of in-breading. Virtually every doctor in Chiang Mai obtained their medical degree from Chiang Mai University Medical School. Many are listed as faculty members there in addition to their hospital posts. Thai culture’s pronounced stratification, makes questioning one’s supervisors/seniors/elders difficulty at best. This just has to stifle innovation and the adaptation of new or alternative treatments.
I normally meet with two oncologists, one is an elderly woman listed as a professor emeritus at Chiang Mai medical school, the other is a youngish male with an MD degree from there. When I meet with them, she does 95% of the talking, while he mostly stares at his computer. She will suggest something, and he will do his best imitation of a MLB bobblehead doll. On the rare occasion when I meet with him alone, he becomes talkative, and full of ideas and intelligence. I would consider asking to be seen by just him, but I am afraid that it would make an irreparable rent in their cultural universe.
Another caveat is the lack of accountability. Malpractice lawsuits are nearly unheard of in Thailand outside of a few high-profile nose-jobs-gone-wrong that splash across the headlines. When a doctor makes even an egregious mistake, about the strongest reaction is “oops”. Doctor’s are looked up to in Thailand to a much greater extent than are western doctors. Thai patients seldom question their care, and confidently swallow unmarked pills given to them in completely unlabelled baggies with instructions of when and how many to take. There is a clear advantage for patients if doctors have a paranoid fear of being sued. I cannot say how much this accountability issue effects health care, but it will weigh heavily on me if I have to decide on invasive surgery.
The bottom line for now is that my health care has, in my view, been very good. My doctors’ decisions have been verified to the extent possible by Dr. Google and his myriad colleagues. I also received a “virtual” second opinion from an oncologist at the Cleveland Clinic, who, after reviewing all my records, scans, and even my original tissue biopsy samples, concluded that the care I have been receiving is spot on. But my disease is uncommon, complicated, and varies from case to case. Experience here is lacking so I may have to consider returning at some point in the future for evaluation at one of the handful of “NET Centers” in the USA.
I intend this blog to be a recounting of my adventures in retirement, and random observations about my universe that others might find interesting. I don’t want it to become a recounting of my medical travails – I get enough of that sitting around beers at O’Malley’s Irish pub with my like-wise retired friends. But, I do feel it desirable to share with my blog readers my current condition, since it will probably alter my life significantly going forward. Besides, I am too lazy to recount the story to each and everyone of my friends and acquaintances when the subject inevitably arises – so hopefully most of them will read this. I will be giving you the Reader’s Digest addition. I am happy to recount the gritty details to anyone interested, but you might have to show up to O’Malley’s for that.
Upon my return from Nepal, having fully recovered from my bout with altitude sickness in Nepal, I awoke up one morning with moderate to severe stomach pain. I endured it for the entire day before giving in and driving myself to the hospital. I spent the late
night and early morning hours undergoing a battery of blood tests and scans. A CT scan revealed a soft-tissue mass on my mesentery. In case you didn’t know, the mesentery is the connective tissue that keeps your intestines from falling into a tangled pile around your ass hole. I was given two rounds of morphine, which resolved the pain. A needle biopsy was scheduled, then delayed then scheduled again and finally happened on April 30. The final results took another 2 weeks, but it was confirmed that the tumor was a neuroendocrine tumor, which on the realm of good news/bad news is closer to the good news end.
In order to determine if the cancer has spread, I went to Bangkok and was injected with radioactive gallium 68 and had a fancy PET/CT scan. The injection arrived in a huge lead box, and the hypodermic was shielded by a large lead cylinder. Yikes! The scan showed a possible small tumor in a lymph node near my neck and my prostate lit up on the scan suggesting either a tumor there or prostatitis. This means that the tumor had metastasized.
A bit about this kind of rare tumor. They normally grow very slowly as mine is (good) but metastasize easily (bad). The location of the tumor on my mesentery is almost 100% likely to be a metastatic tumor, not the original tumor. In many cases (like mine), the original tumor is never found. For now, the treatment I have been prescribed is designed to control the growth and spread of the cancer (although there is a 10% chance the treatment will shrink the tumor. If completely removing the cancer by resection is not possible, then there is quite simply no cure, only control. Fortunately, several lines of treatment are now available to control these tumors, and many patients live a long time. So I apparently have incurable but NOT terminal cancer. The goal is to control it so well that something else gets me first.
On July 5, I had my first injection of sandostatin LAR, a synthetic hormone that attaches itself to neuroendocrine tumors and inhibits their tendency to grow and metastasize. These injections are not chemotherapy (chemo only works on fast growing cancer). The side effects are not fun, but nowhere near as bad as having chemo. I will have 2 more injections 28 days apart followed by another radioactive PET scan in Bangkok. I am also in the process of obtaining an online second opinion through the MyConsult program at the Cleveland Clinic.
So that’s where I stand for now. Other then the side-effect of digestive problems, I feel pretty good. As soon as I can wander farther that 50 m from a toilet, I will resume my jogging program – I am even thinking of trying another marathon down the road. So life goes on, but my perspectives are evolving rapidly.
I woke up on Friday April 5 in my tiny twin-cotted room with a large pomelo attached to my knee. When I moved to get out of my sleeping bag, that pomelo screamed “don’t move me!” Apparently that sharp pain I felt during yesterday’s descent was not trivial. It really is a good thing I didn’t have to hike anymore. The day dawned bright blue and green. I was ready to go by 6 am. I spotted my pilot once again talking earnestly on a borrowed cell phone – his had run out of battery.
It amazes me how ill prepared my pilot appear to be given that he was flying in the worlds highest mountain range, with questionable weather that might cause him to land and even spend a night in almost any environment imaginable. Really, there aren’t regulations about this? He literally had only the clothes on his back. I ask him about this and he said he never brings anything. No suitcase, no cell phone charger, no clothing other than his leather flight jacket, no toothbrush , no nothing. Really?! I noticed the other pilots had small backpacks with them, so maybe he is an exception.
I limped out to the helicopter and asked him when we would go. Not so fast, the bad luck was still with us. Now that it was clear in the mountains, Kathmandu was closed by smog/smoke/haze causing low visibility. One by one the other choppers lifted of to fly to Lukla – their original destination. Only the two of us were left to await the weather in the Kathmandu Valley.
I hobbled around the landing pad, really just a small terrace that lay above the valley floor near the confluence of two drainages. It was perfectly suited as a helipad, with sufficient space around it to allow for take offs and landings. It looked pretty full with 4 choppers parked there, but the owner said he could squeeze in 12! His record was just 10 though. He charged landing fees from the airlines and also earned on food and lodging from their pilots and passengers, He prayed for fog I guess.
About 11:30 am, with the clouds starting to build around the peaks, my pilot final said let’s go! Kathmandu was just at the weather minimum and he said we would divert to another lowland airport if we couldn’t make it into Kathmandu. Earlier that morning, the pilot told me that he had house guests staying with him in Kathmandu, so he needed to get back home. Nothing like having a super motivated ill-prepared pilot flying you down to safety! The previous day I googled “Dynasty Air” to look up their safety record. Big Mistake.
We were soon in the air twisting and turning down the valleys to avoid the higher ridges. Once near the Kathmandu Valley we were forced to hug the ground to avoid the smoggy clouds. Visibility appeared to be just at the 1000 m minimum. We landed next to several other choppers at the communal heliport at Kathmandu Airport and I resisted the urge to hop out and kiss the ground.
I was met by an ambulance that whisked me off to Swacon Hospital. As it turns out, anyone who is rescued by helicopter must be evaluated and spend one night in a hospital if they want their insurance to pay. This makes some kind of sense, otherwise any tired trekker could just pant a little and request rescuing, and the insurance would cover the cost of their laziness. However the system is also rigged to pay maximum benefits to the hospital. I was given a physical exam, blood tests, X-Rays (ostensibly to screen for pulmonary edema) and made to stay overnight, my hospital room for the night was really just a cramped hotel room, complete with a set of toiletries in the private bathroom, and room service (food wasn’t bad). The only sign that it was a hospital room was a bare IV rack shoved into the corner.
The rest of my story is anticlimactic. I was released the following afternoon after I spent all the day fulfilling the insurance companies paperwork needs. I was picked up by one of the Nepal Hiking Team’s drivers, and deposited back at the Dom Himalaya Hotel. The next day was spent dealing with flight changes and more insurance hassles. After two nights at the hotel, I endured the uneventful flight back to my home in a Chiang Mai.
The great news is that my erstwhile partner, Tom Prouty, successfully reached Everest Basecamp and safely returned to Lukla using his own two feet. I have to admit a little chagrin that the older, cigarette-puffing, beer swilling dude was able to do what I could not.
Ironically, I am now lying in a hospital bed in Chiang Mai. The morning after I arrived back home, I was stricken with severe stomach pains. I endured the pain until evening, then drove myself to the hospital. It turns out my kidney stones were on the move and the likely cause of the pain, but a CT scan used to verify that also showed a dreaded “soft tissue mass” clinging to a hard-to-reach part of my small intestine. I see biopsies and potential surgery in my future. This incomplete story must await a future blog, but perhaps I am really lucky to have not been stricken while high in the mountains. Hard to feel lucky now, though.
Sitting around in the lodge, opposite the Lukla airport, watching the thick fog roll in, I mentally prepared myself for an overnight stay here. Lukla is not a bad place to hang out. It is fairly low, so after the thin air, I could actually breathe pretty well here. The food is pretty good because many of the ingredients are flown in fresh. Its pretty clean here too, with a nice “main street” paved with schist and lined with shops and even a few bars. Not a bad place to get stranded.
As I was sitting reading the news on my phone and enjoying the fast 4g internet here, I noticed my porter, who speaks only a few words of English, in a conversation with the lodge owner (ok that is an assumption, be he seamed like he was the boss). Suddenly, the boss-man walked over and said “you walk down to Surke.” Huh? What? Where? “They have helipad there, no fog.” Oh! “How far is it?” I asked. “Walk one hour” was the reply. Well, that didn’t sound too bad. Then I remembered that the Nepali sense of time for walking involved using worm holes and warp drives. “Now?” I asked. “Yes! Go!” was the reply.
My poor porter, who thought he was already done with me, looked chagrined. We walked back down to the helipad where my duffle bag was waiting in hopes of the fog clearing. There stood my pilot next to his impotent helicopter looking a bit agitated, talking on his phone and still in his flight jacket and street shoes. He clicked off the phone, said a few words to my porter, then looked at me and said “Lets go! I go to Surke with you.” Off he went down the paved rock stairs that paralleled the steeply-sloping runway. “Follow me!” he called over his shoulder. I looked at my porter; he was already rigging the tump line to my duffle bag.
Down we plunged into the mist. Most of the trail was nicely paved with stone stairs. Steep stairs. Some of the stairs involved a 3 ft drop, maybe more. We plunged down, only leveling off to bypass stone dwellings or to cross the steep ravine on steel bridges. Down, down, down. I had to hurry to keep up with this pilot dude walking in street shoes and his flight jacket (no bag of any kind). To add to the sense of adventure, the pilot stopped at almost every house and asked for directions. It was quite obvious he had never been down this path, nor had my porter. After walking about 20 minutes, the pilot called over his shoulder “only 30 minutes more!”. Not.
Somewhere around the 50 minute mark, I stepped down a high stone riser and felt a stabbing pain in my right knee. That’s the surgically repaired knee that had been sore since our acclimatization hike at Namche several days before. Suddenly feeling quite unstable, I slowed down, but kept going. What choice did I have? My pilot cum guide disappeared down into the mist. I used my trekking poles like crutches, hopping down the steep path on my good left leg. After another half hour of hobbling, we found ourself at a dead end in some terraces where the trail petered out. My guide started calling out to the small dwellings for someone to guide us onto the right path. Finally we found a local working in his garden who pointed down the hill. Down we went for another 15 minutes, when we finally rounded a corner to see 4 helicopters parked in the mist in front of the “Surke Helipad Lodge”. We had descended 550 m vertically in just 1.6 km (nearly 2000 ft in a mile). Perhaps one of the steepest paths I’ve ever seen.
The swirling fog that shrouded the helicopters made it clear that we had wasted our time, energy, and, in my case, meniscus, on this long plunge down into the gloom. If anything, the fog was thicker here. Then it started raining.
We sheltered in the lodge’s small dining room. Three other American’s were huddled in the room looking exhausted, along with 3 other pilots. The Americans comprised a young Mormon couple (the husband was suffering from Nepal-belly) and a talkative middle-aged guy from I-can’t-remember-where (Texas maybe?). They had evacuated via helicopter from Gorak Shep, the town just below Base Camp. They were headed to Lukla to connect with a fixed-wing flight, but got diverted to Surke just before the fog dropped down. We all waited futilely for a couple of hours, then I threw in the towel and got a room. I asked the lodge’s owner for the penthouse – he gave me the room closest to the toilet ( a squatter that was impossible to use given my throbbing knee). It was not a penthouse, but it was dry.
Following a sponge (baby wipe) bath, I shuffled back to the adjacent ding room and joined the 4 pilots, 3 Americans, and the lodge own and his family. He had a daughter of 25, and was raising his 6-year-old niece whose mother had died just 6 months earlier during childbirth, apparently a common occurrence here where medical assistance can be a day or three walk away. The pilots were already into there 3rd or 4th beer. I thought about buying them all a round, then I thought – “hmm, I would rather not have a drunk or hung-over pilot in the morning”. Didn’t slow them down at all though. After drinking a beer, and while I waited for the chef (owners wife) to prepare meals for all these unexpected guests, I ordered up a Tongba.
Tongba is the classic alcoholic drink of eastern Nepal. It is made from fermented millet, which is a hardy cereal grain grown in many developing countries because of its high tolerance for adverse weather conditions such as drought. Ok, look it up on wikipedia, I had to. The grain is fermented into a mush by adding various nasty molds, bacteria and yeast, then stored for up to 6 months in sealed jars. When ready, the mash is added to a special wooden vessel, with an integrated straw. Hot water is poured over the mush, and after a few minutes, the alcoholic, warm “tea” can be slurped up with the straw, which has a built in filter to prevent you from slurping up the mash. When empty, you add more hot water to the vessel and you slurp up a second round. In fact I got four rounds out of it (I think, I wasn’t really in any shape to count after the first two). The taste reminded me of hot sake. Not bad, but won’t replace a good IPA.
By the time I finished the fourth round, the weather had cleared, and the stars were out. The pilots and lodge owner (A guide himself who had climbed to the top of Mount Everest twice) had retreated out to the front yard where several stump-chairs surrounded a wood burning stove. The lodge owner soon brought out a case of Everest Beer and announced that it was on the house. Somehow, later that night, I stumbled back to my room and collapsed onto my cot. Supposedly, I was to be up at 6 am for a crack-of-dawn flight down to Kathmandu. Hopefully.
As I clambered aboard my rescue helicopter, I looked around for the last time at the brown, barren landscape and windswept village of Dingboche. I was pretty sure this would be the last time I would see this scene. I can say that I wasn’t taking away many good memories. After three days and two sleepless nights of gasping for breath and shivering in the sub-freezing cold, I was looking forward to thick air and long sleeps.
One of our porters, Bhanshu, climbed aboard with me, apparently he drew the short straw. As the chopper roared back to life, we slowly rose into the thin air. One other passenger was aboard, a Nepali, who did not appear to be an evacuee. I also noticed that the pilot, a 50ish looking fellow dressed in a flight jacket and wearing a lanyard with an official looking ID, was wearing a nasal cannula supplying him with supplemental oxygen. The US FAA requires oxygen for pilots flying flying above 12,500 ft, so this made sense. The US FAA also requires passengers to be provided with the option of having supplemental oxygen above 14,000 ft. Apparently, the Nepali FAA (assuming they have one) has no such rule, or at least don’t enforce it. I was left to continue breathing the thin air. This was very surprising seeing as I was being rescued for AMS. Fortunately, I was sufficiently distracted by the adrenaline rush of flying in a helicopter, even though we briefly flew above 18,000 ft.
I know that Dip, when he called in to request the helicopter, also requested that they give me a “tour” of base camp before flying me down to Kathmandu. I was dubious that they would do this. Why waste the fuel, and why take a passenger being rescued for AMS to an even higher altitude? It became obvious that I was wrong when the pilot turned and climbed the helicopter up into the Khumbu valley.
What a ride! I may have started dying in the thin air, but with the rush of the scenery in the crystal clean sky, I did not notice. In just 10-15 minutes we flew up the valley, directly over Dhukla, Tengboche, and Gorak Shep, the villages I was scheduled to stay in over the next 3 nights, then onward to Everest Base Camp, marked by a city of hundreds of orange and yellow tents strung out for about a kilometer on the Khumbu glacier’s lateral moraine. As we approached Gorak Shep, with the viewpoint-hill of Kalapathar rising to the left behind the small collection of lodges, the enormous hulk of Nuptse hove into view, and seconds later Everest. Nuptse appeared as a giant icy black pyramid against the pale blue sky with Everest, obviously being blown by a strong wind, lurking behind. “Wow” doesn’t, begin to describe my wonder. This is a scene that will always be with me, burned permanently into my memory.
Once over Base Camp (such an inhospitable-looking campsite), we made a sweeping U-turn and retraced our path back down the Khumbu Valley. It took us only a few minutes to pass by each of the villages that were about a day’s walk apart. Down, down we went, finally pulling to the left of Namche Bazaar, over the evergreen forests we had climbed through several days before, and into Lukla, where we landed on the helipad next to the ski-jump of a runway at the Tenzing-Hillary Airport.
This was a scheduled stop on the way to Kathmandu to drop of my porter and to refuel (and drop of some small cargo items). I was told that it would be 30-45 minutes for the stop, so we climbed some steps up to the same lodge we stopped at after our landing at Lukla several days before. As we ate, I watch the clouds roll up the valley. Not good. After lunch, we rushed back down to the helipad, just in time to watch the last passenger load into our helicopter. Apparently, I had gotten bumped to the next flight, which I was told would be taking off shortly. The chopper roared to life…..but I could see the pilot looking intently down at the clouds rising toward Lukla. Suddenly, the engine powered down. The pilot got out and talked earnestly on his cell phone. He then climbed back into the pilot’s seat and shut down the engine. Apparently, no one was going anywhere soon.
After a wait of about an hour watching the fog swirl around and envelope the airport, we retreated back to the lodge to wait out the weather. It very much looked to me like I was going to spend the night at Lukla instead of Kathmandu. I was wrong though.
I am now back in Kathmandu, having failed once again to reach Everest Basecamp. As I have mentioned before, this blog gets more interesting when things go pear shaped. This year’s flameout was a bit more dramatic than last year’s walking retreat.
On April 2, we arrived in Dingboche at 4,400 m elevation. I wrote a short post that night because I felt very cold and not very energetic. That night, while trying to sleep, the demons from the year before revisited, with a vengeance. Sleep was impossible. As I lie in the the bitter cold, with sleeping bag and blanket piled on top of me, every 30 seconds or so a feeling of suffocation would overwhelm me, and I would gasp for breath. My plan for this eventuality was to pop an Ambien. Unfortunately the Ambien gained me only 2 hours of complete unconsciousness, followed by several hours of gasping and panic.
The next morning, April 3rd, I felt tired and woozy. Following a mostly uneaten breakfast, we saddle-up for an acclimatization hike up the steep mountain behind our lodge. I was very slow, constantly gasping for breathe. For most of the 250 m vertical climb, I took 3 breathes for every step, and stopped to pant every 100 steps. The day was crystal clear, but I have almost no recollection of the magnificent views of the high Himalaya. Upon our return to the lodge, I ordered a half-eaten lunch, then retreated to my room armed with two hot water bottles to snuggle with under my pile of insulation. In spite of my preparation, I shivered uncontrollably for 1 hour before my body temperature returned. But sleep eluded me. Instead, the gasping periodic breathing returned accompanied by suffocating panic.
The feeling of not getting enough air is the most scary of my life. At that moment, I wanted nothing more than to go down to where there was more oxygen. When I finally gave up trying to nap and went down to the common room to await dinner and the lighting of the stove, I had already made my decision to bail. I called a meeting with Tom and our guide Dip. After a discussion of the options, I elected to call in a chopper, provided my insurance agreed to cover the cost. To the great credit of Dip, and the owner of Nepal Hiking Team, Ganga, it was all arranged within 2 hours, including a scheduled helicopter for early the next morning, and approval from my insurance company (World Nomads). I now only needed to endure another night.
My symptoms that night included headache, lack of appetite, shivering, periodic breathing, and gasping panic. These are common symptoms of Acute Mountain Sickness (ALS). I managed about 4 hours of Ambien-induced sleep and about 5 hours of tossing and turning and trying to breathe. I finally gave up trying to sleep, packed up and went down to the dining room to await the dawn and my evacuation. I knew that I really needed evacuation when Tom called me a wimp and I agreed with him 100%.
My chopper finally arrived at about 10 am on April 4th after various delays. Little did I know that my evacuation adventure was just beginning. To be continued….
This is a short post today because I am COLD. Today we hiked up to Dengboche sitting at 4,400 m (14,436 ft) in a broad windswept valley. We are now in the alpine tundra zone where most of the vegetation is no higher than your knee. The temperature from the start of our hike was well below freezing, judging from all the ice on the trail. The day began clear, but as is par for the course, clouds began building by noon, and an icy wind brought a few swirling snow flakes.
Upon arrival, I was chilled to the bone. I got myself organized, had a cup of hot lemon tee in the dining room, and went up to my cubical of a room and crawled into my sleeping bag with all my warm cloths on and I even threw the woolen blanket on top for good measure. I almost dozed off, but the cold awakened me, I just could not get the chill out. This is a likely side effect of the thin air. I went down to the common room, which is marginally warmer due to body heat, had a hot chocolate and plate of popcorn, and now I feel much better.
Today’s hike was not difficult, but the thin air kicked my butt. Last night I did not sleep well, so I am hoping tonight will be better. I have Ambien waiting, but don’t really want to use it, at least not yet.
Today started under bright blue skies and crisp cool air and finished under gray skies, cold wind and swirling snowflakes. We are now safely ensconced at the Tashi Delek Lodge just 50 m from the famous Tengboche Monastery. I had a chance to go into the monastery today (last year it was closed to visitors when I passed by). The main room with a huge Buddha in the back was the most colorful temple I have ever been in – and I have been in many. The walls were adorned with intricate full-color drawings from floor to ceiling. A lone middle-aged monk sat in the middle of the room, wrapped in dark saffron robes to ward off the 0 C chill, solemnly chanting from an ancient-looking book. Sorry, no pictures were allowed, but it was a magical scene.
Today’s hike was both pleasant and brutal. The first half of the hike was mostly down hill under sunny skies; the second half was a brutal trudge up the hill into the thin air to the high ridge where the monastery guards the entry to he Everest region. We both took it really slow, but still arrived by 3 pm. We are now sitting in the large dining room of the lodge next to a wood-fired stove, sipping various hot drinks. I still feel chilled to the bone, and it’s only going to get colder.
Tom and I were chatting the previous night and he mentioned that the trails here were not what he expected. He expected trails like Americans encounter in our national parks, well graded, switch backed to avoid steep sections, and, except for the most popular, largely devoid of hikers.
The “trails” in Nepal are their roads. They form anastomosing networks of pathways that connect every inhabited village in the rugged terrain that characterizes the vast majority of Nepal’s area. The paths that connect more densely populated areas and/or popular trekking areas, particularly here in Sagamartha National Park, have sections of trail that are dirt paths through pine and fir forests, but many sections are paved in stone. The steeper sections of trail consist of long stretches of stone stairs, engineered to withstand the hordes of boots and hooves. Everywhere, human and beast pack the trail.
The route to Everest Base Camp is akin to an American Interstate Highway. As I marched along today, it reminded me of the section of interstate 15 that connects the LA megalopolis and Las Vegas. Like that section of highway, a variety of transport plies our trail. The Yaks are the 18 wheelers of the Khumbu, carrying the vital supplies to feed and otherwise support the hordes of trekkers. The porters are Nepal’s pick up trucks. Just like in the USA they come in a variety of forms ranging from overloaded Ford 350s lumbering up the trail (porters can carry up to 100 kg – more than twice their weight), to trekking-company porters analogous to lowered Toyota pick-ups, complete with boom boxes blasting out the latest Nepali hits. Then there are the flat-bellied climbers and guides, the Ferraris of the Khumbu, flying by with crampons and ice axes dangling from their $400 back packs.
While I was a grad student, I took a term off, sold everything I owned, and went to Alaska and climbed Denali. When I returned, I was flat out broke. I bought a 1963 Ford Galaxy off a downtrodden used car lot in Missoula, Montana. It was 17 years old when I bought it for $200 cash. The seats barely kept your ass from scrapping the pavement and it’s muffler was partially intact and partially swinging in the breeze. But it ran…kind of. It blew blue smoke, and steered like a drunken party boat on Lake Mead. Every 100 miles or so I pulled into a service station and filled up the oil and checked the gas. Today, as I slogged up the trail, huffing and puffing in the thin air, I felt like that 1963 Ford, leaking oil and sucking air, amid the late model transport blasting by me. But I got here.
Last night, following dinner and blogging, I headed back to my room about 8:00 pm with more than a little trepidation. Last year, my first night here at Namche was miserable. I struggled the entire night with a phenomenon called periodic breathing, which happens at high altitude when your body gets confused about your blood’s CO2 and oxygen content. This year, I came armed with an inhaler that I use to prevent exercise-induced asthma. It seems to have helped, I slept quite well and awoke very rested. I am still at relatively low altitude (3440 m/11,286 ft), but it is a very hopeful sign!
Today we will spend a second night at The Nest, our lodge in Namche Bazaar. Like almost all the lodges in the Everest area, It consist of very basic rooms, bare but for a cot or two, and a table with no heat. The common room is where everyone congregates for evening meals, conversation, and just hanging out in a space made warm by the many bodies. As I write, the Nepali guides and porters are engaged in a raucous card game that I am pretty sure involves gambling. Most of the time spent on a trek is in common rooms such as this. With 8 hours of sleep, and 6-7 hours of walking, that leaves 9-10 hours to kill lounging around these rooms. As you hike to higher elevations, where the air is bitter cold, yak-shit-burning stoves replace body heat as the main source of heat. It is the interactions in these rooms with your fellow trekkers that make trekking more of a social rather than wilderness experience.
We are lucky because we have upgraded rooms in The Nest, that include en suite bathrooms AND (a first for me while trekking) hot showers! Life in Namche is pretty luxurious. There are fancy climbing gear stores, coffee shops, and even an Irish Pub. The luxury ends tomorrow as we head up towards base camp.
Today, to facilitate acclimatization, we took a day hike up the mountain behind Namche to see views of Everest and the high Himalaya. Last year, following a sleepless night, I struggled mightily with exhaustion. This year was night-and-day better. The hike, while still strenuous, was 100 times easier than last year. Tom did quite well, but, because of his high-center of gravity (he’s 6’3/188 cm tall), he goes down hill gingerly, to put it kindly. We were both back enjoying a relaxing lunch by 1 pm.
Tonight I am hoping for another restful night, then tomorrow on to Tengboche, site of a famous Buddhist monastery. Note however that unless internet connectivity has vastly improved during the last year, my blogs may be posted well after the fact, and perhaps not at all for several days at a time.