Ever tried to keep an IV flowing in sub-zero temperatures? This is just one of the daily challenges faced by Dr. Luanne Freer, the emergency physician who directs operations at the Everest Base Camp Medical Clinic, the world’s highest medical facility.
“We tried several IV warming devices – nearly all had some sort of problem at our clinic,” says Freer, who completed her EM residency at Georgetown University. “In the end, for one patient we ended up having his climbing partner keep the IV bag in his armpit. We ran the IV tubing inside his down jacket to the patient’s down jacket sleeve and back up his arm. This kept the IV flowing, the fluid warmed to body temp, and kept his friend engaged and feeling useful. And it gave us 24-hour monitoring at the bedside. A win-win situation.”
Difficult IVs are only the tip of the iceberg in this challenging environment, explains Freer. When she’s not being jarred from sleep by the thunderous roar of avalanches she’s feeling the constant “air hunger” induced by the lack of oxygen at such a high altitude.
Since 2003, every climbing season – April through May – the Everest Base Camp Medical Clinic has come to life, providing emergency medical treatment for a host of critical situations. The high altitude alone generates an extensive case load of Acute Mountain Sickness (AMS), but patients present with a gamut of diagnostic challenges, from severe exhaustion to hypothermia to life-threatening gastrointestinal infections. This past season, Freer’s medical team faced a case of methanol poisoning from home-brewed whiskey and managed a rare case of steroid psychosis. One of the climber’s personal physicians had prescribed high-dose steroids for AMS prophylaxis weeks before his summit attempt. Corticosteroids have caused many people severe psychotic reactions, which at high-altitude are far more likely.
One of the refreshing things about working at Everest Base Camp, explains Freer, is that it opens your eyes to what is taken for granted in the western world: “Things like simple immunizations,” she says. “I saw my first case of tetanus in Kathmandu. The patient went to her local blacksmith complaining of a locked jaw. Seriously!” The practice environment also allows for care to be given in a less inhibited atmosphere. “In Nepal I am appreciative of practicing medicine the way I had always fantasized that it would be – kind of a Marcus Welby approach – doing what I think is best for the patient independent of legal, economic, business concerns – and there are no insurance forms to fill out!”
So how did this Marcus Welby found the planet’s most extreme medical facility? “I followed my passion for the mountains,” she explains. “My first job out of residency was in Yellowstone Park – I was hooked forever after realizing there was a way to combine my profession with my passion. I got really interested in the fact that 25% of my patients in Yellowstone had altitude sickness – a fact that few people appreciated. I wanted to find out more, and as it were, just kept climbing higher.”
In 1999 Freer found herself in the Khumbu Valley – home to the world’s tallest peaks – and by 2003 she was back, this time with a mission that would forever change the Everest landscape. “We have now served over 1,600 patients within our clinic,” says Freer, whose operation is managed through the Himalayan Rescue Association (HRA).
Jim Barr has been a travel and adventure writer for over seven years and in addition is president of Track & Trail Adventures, a provider of CME retreats. Go to www.TandTadventures.com for more information.