In this article
- Recruitment as team doctor and impressions of the mountain
- How Dr. Semple prepared to be a team doctor on Everest
- Common health problems in high altitude climbing and treatments
- Challenges for Dr. Semple’s team on Everest and outcomes
- Studying Everest - from mortality patterns to global warming
Mount Everest holds enduring appeal. The tallest mountain in the world, it draws hundreds of climbers a year. Not all make it to the summit; not all make it home. The conditions are extreme and the toll on the human body is acute.
In 2003, climbing enthusiast and surgeon, John L. Semple, MD, FRCSC, was offered the opportunity to serve as a team doctor for a British Everest Expedition.
He took it.
Fast-forward two years to 2005 and Dr. Semple — who had previously summited peaks in South America, Western Canada, East Africa and Asia — made his first trip to Everest; trekking up the North side of the mountain as far as the North Col (about 23,000 feet) with a team of eight climbers, four Sherpas and a cook.
But forget the sublime vision you have of pristine wilderness. While undoubtedly beautiful, even 12 years ago, Everest was crowded.
“Everest is a circus,” he said, quoting estimates of about 400 climbers on the North side in 2005 (the route his team took via Tibet) and 600 more attempting the summit from the South side (via Nepal).
“It’s a very exotic place to go to. It’s a great trek up to Base Camp. It’s quite high but you have a lot of communication equipment up there now and there are clinics run by volunteers; gosh, they even have bakeries at Base Camp on the South side now, so there are a lot of people.”
Team doctor: preparing for Everest
Dr. Semple, an alumnus of the Ontario College of Art and Design and a former medical illustrator, studied medicine at McMaster University and surgery at the University of Toronto. He is currently head of the Division of Plastic Surgery at Women’s College Hospital and a professor in the Department of Surgery at the University of Toronto. He also recently received an adjunct appointment at the Massachusetts General Hospital in Boston in Wilderness Medicine Program. As a hobby, he climbs mountains. He also studies them — an interest he developed at the height of the SARS crisis (more on this below).
In preparing for his role as team doctor for the 2005 British Expedition, he sought advice from physicians who’d previously held this role.
“I took a lot of stuff with me. I took a lot of antibiotics, because I figured there’d be lots of infections and things like that. I thought I was pretty well-equipped but when I got there I realized that you’re essentially looking after everybody not just your own team,” he said with a laugh. “I basically used up a lot of my meds in the first couple of weeks because it’s hard to deny anybody who’s got problems.”
Dr. Semple quickly realized that by collaborating with other team doctors, they’d all have a greater chance of ensuring the safety and wellbeing of their climbers. He helped organize a system to make sure they weren’t duplicating services up and down the mountain and they agreed to look after each other’s’ patients when one of them was at base camp vs. advance base camp.
The main treatment for high altitude health problems is descent
Climbers can get ill for a variety of reasons. For some, it’s because they ascend too quickly and don’t acclimatize properly; for others, it’s a matter of their physiology just not being well-suited for the task.
Common health problems on Everest
- Frostbite, hypothermia
- Moderate or acute mountain sickness (e.g. dizziness, vomiting, persistent cough)
- Cerebral or pulmonary edema
- Eye problems (e.g. retinal hemorrhages)
- Hypoxia (i.e. oxygen deprivation).
“As a general rule of thumb, if there was the potential of something getting worse as they went up and potentially threatening their limbs, their eyes or their life; I’d recommend that they go back down to a lower altitude,” said Dr. Semple.
Of course, it is up to the climbers to listen. He recalls one couple in particular.
“There was this couple from Ireland who wanted to be married at the top of the mountain, but the groom-to-be had a major retinal hemorrhage so I had to send him back down. I don’t think he was very happy about it. I ended up meeting the couple about two years later again on the South side going up. They’d gotten married back in Ireland and looked to be in good health.”
Challenges for his team on Everest
One of the greatest threats to a high-altitude climber is climbing late in the day, running them the risk of using up all their oxygen before they get back down.
“You have to imagine that they’ve been climbing for sometimes over 24 hours without much nutrition, without much opportunity to hydrate themselves properly. I’ve been up above 7000 meters (23,000 ft) myself — the fatigue that you experience is extreme. It takes a tremendous amount of stamina, strength and experience to get down. But, if you run out of oxygen, it’s sort of game over for most people.”
For the most part, Dr. Semple’s team was without major incidence.
“We did have one of our climbers collapse and lose vision in one eye,” he said.
Thankfully, he’d equipped the team with emergency kits.
He explained, “I taught them how to give themselves injections, which this fellow actually did. With the help of a Sherpa, he managed to get some dexamethasone into him and make it all the way back down. He had some frostbite and I managed to get an MRI and a couple of ophthalmology consults in Kathmandu in less than 24 hours once we got back, which was pretty amazing since it’s hard to get that in Toronto on demand.”
All told, three members of his expedition summited – albeit later than planned.
“We ended up being stuck at high altitude - over 21,000 feet - for 17 days in a row because of the weather. They couldn’t lay the ropes and nobody actually starting summiting until late in May, which is very, very late.”
Dr. Semple ended up losing over 45 pounds, making him almost unrecognizable to colleagues when he returned to Canada. In fact, he lost so much weight that he had to buy new clothes in Kathmandu for the trip home!
“I tell people that all I do now is social climbing, but it has the same side effects: nausea, headaches… nah, I’m just kidding,” said Dr. Semple with a laugh. “I do still climb. I did ice climbing recently and I’ve done trips to different mountains in Nepal, but not any of the extreme altitude stuff. Climbing Everest has very low attraction to me.”
Dr. Semple shared that the enduring appeal of climbing is the aesthetics of it, the break from stress, the countries you visit, the people you meet and the climbing community: “you all have to work together to get where you want to go.” For those looking to get into this hobby, he recommends starting with a mountain like Mount Athabasca in Western Canada. There are many, quality climbing groups who can serve as guides.
Studying Everest - from mortality patterns to global warming
How does a surgeon in Toronto start studying Everest?
Dr. Semple explained, “During SARS, they cancelled a lot of the inpatient stuff in Toronto, but because I was a Division head, I had to stick around the hospital. I got to reading articles about hurricanes and how much the barometric pressure drops in the middle of the hurricane out at sea. It struck me that if there were storms of that magnitude at high altitude, it would change the oxygen levels so much that you would actually go from being hypoxic to anoxic. I contacted Environment Canada and even went and presented to them about storms at high altitude. Environment Canada doesn’t measure weather on the tops of mountains because there are no people that live there. They were, nevertheless, interested and they wanted to support me. They put me in touch with a guy in atmospheric physics at the University of Toronto, Dr. Kent Moore. He and I have probably one of the more unique, collaborative research relationships. We started looking at how weather can affect people at high altitude, particularly the high-impact storms.”
Dr. Semple and Dr. Moore have published together on about 15 papers.
- They mapped out mortality patterns on Mount Everest over an 86-year period [British Medical Journal, 2008].
- They found evidence to suggest that global warming is increasing the barometric pressure near the summit, over time making Mount Everest easier to climb [High Altitude Medicine & Biology, 2009].
- They provided insights into what may have contributed to the disappearance of famed climbers Mallory and Irvine in 1924 [Weather, 2010].
- They provided the first quantitative account of the risk of cold injury on Mount Everest and a method to characterize this risk and to devise mitigation strategies [High Altitude Medicine & Biology, 2011].
- They provided the first in situ description of the risk of hypoxia and hypothermia on Mount Everest on various timescales [Extreme Physiology & Medicine, 2012].
- They identified that there’s as much ozone on the upper slopes of Mount Everest as there is in industrial cities [High Altitude Medicine & Biology, 2016].
“The key to a lot of this research is that we were able to validate an aviation data stream that went all the way back to 1928. Like forensic meteorology, we could go back and recreate storms — look at the wind speed, the barometric pressure and the temperature; so, for example, we could actually see what the weather was like when Hillary and Tensing summited Everest the first time,” he said.
Dr. Semple hopes to do more detailed investigation into the effects of ozone on climbers (who have acute exposure) versus Sherpas and porters (who have chronic exposure) and try to isolate factors that may contribute to the incidence of Chronic Obstructive Pulmonary Disease among Himalayan guides.