High-Altitude Doctor Read online

  Juliet dropped to her knees beside him, noticing that the man’s skin was clammy and pale.

  ‘He’s showing all the signs of HAPE.’ High-altitude pulmonary oedema was a potentially fatal illness in which the lungs filled with fluid. Invariably it was brought on by climbing too high, too fast, and the only real cure was a rapid descent. ‘Can we get him to the medical tent?’

  ‘Only if we carry him, and I’d rather not lay him flat. Better to bring everything to him if we can.’

  Several climbers and Sherpas hovered expectantly in the entrance of the tent, waiting for them to do something and share the responsibility.

  Suddenly she was glad that Finn was here, too. The knowledge that she wasn’t alone in this situation helped her think more clearly.

  ‘What do you want us to do?’ Billy stood calmly in the entrance of the tent, awaiting instructions, and Finn didn’t hesitate.

  ‘What we really need to do is get him down to a lower altitude, but given that we can’t do that until tomorrow morning at the earliest I need dexamathasone, nifedipine and oxygen to start with.’ Finn gave instructions as to where they could all be found and Billy listened carefully.

  ‘Do you want to use the gammow bag?’

  The gammow bag was a double-skinned, inflatable plastic chamber which, when pressurised, had the effect of lowering the apparent altitude by several thousand metres.

  ‘At the moment I don’t want to risk laying him flat,’ Finn said calmly, ‘but some more layers would be useful. The cold raises pulmonary artery pressure and we’re in enough trouble here as it is.’

  Billy went off to do as requested, without wasting time asking further questions, and Juliet reflected on just how good teamwork was on the mountain. Although everyone had their individual goals, no one hesitated to put aside their own dreams when someone else was in need of assistance.

  Someone brought a propane heater into the tent and covered Carlos with several sleeping bags. Juliet continued to check his oxygen saturation.

  ‘It’s thirty-four.’ She looked at Finn, trying not to let her expression show her anxiety. The level of oxygen in Carlos’s blood was dangerously low, even given the high altitude. As a Sherpa arrived with an oxygen cylinder, she took it from him and slipped the mask over Carlos’s face then checked the reading again. ‘His sats have gone up to sixty-five already.’

  She struggled to stop Carlos from removing the mask and Finn nodded.

  ‘That’s good. We’ll give him a dose of dex. straight into the muscle and then I’ll try and get a line in. All the IV fluid is frozen so there’s no point in waiting for that. Someone needs to go and start defrosting it.’ He looked up as Billy lumbered into the tent, holding boxes of drugs. ‘Any luck?’

  Billy nodded. ‘I found all of it, I think. You’d better double-check the boxes.’

  Juliet grabbed them from him. ‘I’ll give him the dex.’ She agreed with Finn’s decision to give dexamethasone—a steroid would help draw fluid out of the tissues and relieve symptoms. She ripped open the syringe and gave one of the boxes back to Billy. ‘Open that, will you? He needs to have 10 milligrams of sublingual nifedipine straight away. Push it under his tongue.’ She was talking as she worked, preparing to give Carlos an injection which would hopefully help save his life.

  Finn glanced up. ‘We’ll give him another 20 milligrams of slow-release four times a day until we get him out of here, and also acetazolomide.’

  Juliet gave the injection quickly, hoping that it would have some effect. ‘We need to get him down to Kathmandu.’

  ‘Then let’s hope for good weather tomorrow,’ Finn said, his gaze concentrated on the sick climber’s arm. He found a vein, sited an IV and taped it firmly in place. ‘Has anyone defrosted any fluid for me yet?’

  ‘It’s in the kitchen tent, being defrosted over the gas as we speak.’ Billy was hovering, prepared to be a runner for anything and everything they needed. ‘Jack’s been talking to the rescue guys. They’re going to try and land a helicopter here at dawn tomorrow. So let’s pray for good weather. One helicopter crash in a season is more than enough.’

  Juliet looked at the patient. They were more than seventeen thousand feet above sea level and darkness was falling. There was no chance of a helicopter evacuation until early morning, which meant that Carlos had a long night ahead of him. And so did they.

  If they couldn’t stabilise him, they were going to be in trouble.

  Finn looked at her. ‘We need to keep an eye on his blood pressure after that nifedipine.’

  She nodded, knowing that the drug could lower the blood pressure to a dangerously low level, and at the same time she marvelled at how calm Finn appeared to be. Although she was careful not to display any evidence of tension, inside she didn’t feel calm at all.

  She’d worked in accident and emergency departments all over the country in England, but all that experience counted for nothing up here. Up here in this frozen, barren, airless wasteland there was no fancy machinery to call on, no second opinions. There was just her and Finn.

  And it was medicine in the raw, a true test of a doctor’s skills. Up here, her knowledge truly made a difference. Ever since the effects of altitude on human physiology had been recognised, doctors had been trying to find ways of spotting those at risk and reducing fatalities.

  It was all about avoiding needless deaths.

  Like her brother’s.

  Is this what had happened to him?

  High up in the Death Zone, had he succumbed to pulmonary or cerebral oedema with no one to help get him down?

  Dark thoughts bubbled up inside her and for a moment she stilled, her mind distracted.

  ‘We might end up using the gammow bag if he doesn’t improve soon,’ Finn muttered, and then broke off, a frown on his face as he looked at her. ‘Juliet?’

  Juliet didn’t hear him. She was still locked in a frightening, terrifying world of swirling dark memories.

  ‘Jules!’ This time Finn’s voice was sharp and penetrated her mental fog.

  ‘Sorry?’ She gave a jump. What had she missed? ‘Did you say something?’

  Finn’s eyes were sharp on her face. ‘I was saying that I don’t want to use the gammow bag now because I want to keep him upright. What do you think?’

  Juliet swallowed. ‘I—I agree,’ she said, her voice slightly croaky. ‘His condition is more stable now and his sats have improved. If he gets worse or if the helicopter can’t land in the morning, maybe we’ll review the situation. I think we should try Salmeterol. I know it’s an asthma medication but it also can hasten the body’s ability to re-absorb oedema fluid that clogs up the airways in HAPE.’

  ‘Right. Let’s do it.’ Finn’s eyes didn’t leave her face. ‘Are you all right?’

  Conscious that they had an audience of climbers and Sherpas, she gave a brisk nod. ‘Fine. Absolutely fine.’

  He hesitated and then gave a sigh. ‘Liar. But this isn’t the time or place, as we both know.’

  He saw too much.

  He knew everything about her, and always had.

  As a child she’d loved the fact that he’d always seemed to know what she’d been thinking and feeling.

  Billy stepped forward, shining the torch in their direction so that they could see everything they needed to see in the dark confines of the tent. ‘Do you guys want anything else?’

  Finn gave a wry smile. ‘A decent meal and a warm bed wouldn’t go amiss, but I don’t suppose that’s on offer.’

  Billy gave an apologetic smile. ‘The honeymoon suite is all booked out but we do have some incredible rooms with mountain views. Any takers?’

  ‘Not tonight,’ Juliet said quietly as she checked Carlos’s blood pressure and sats again. ‘We won’t be going anywhere until that helicopter arrives.’

  Finn stifled a yawn. ‘It’s going to be a long night.’

  CHAPTER EIGHT

  THE helicopter arrived before dawn, making the most of the higher air pressure to gain
maximum lift for the rotors.

  In order to be able to fly at that altitude, the pilot had stripped the helicopter down to make it as light as possible but still only had enough fuel to stay on the ground for three minutes.

  Every time a helicopter landed there was a risk. This time there was no crash. No drama. No disaster.

  He landed on the new ‘landing pad’ that had been hacked out of the rough terrain by a team of Sherpas and climbers.

  The deadly whip of the long blades caused a storm of snow and ice and the sound echoed around the valley.

  Carlos had been strapped onto a stretcher, sitting upright to aid his breathing, and the climbers loaded him into the helicopter, guided by Finn who was talking to the pilot via a radio.

  As soon as the patient was loaded the pilot took off and the lumbering aircraft swooped down the valley and out of sight.

  Finn breathed out heavily and glanced at Juliet. ‘Good job.’ His voice was soft and she blushed at the praise.

  ‘You, too. We’re a good team.’

  He looked at her for a long moment and the atmosphere tensed and throbbed around them. Then he gave a brief nod and strolled back across Base Camp towards his tent.

  Juliet swallowed.

  Colleagues. That’s what they were now.

  And wasn’t that exactly what she’d wanted?

  CAMP III, 7300 metres above sea level

  They sat together, four of them cramped in a tiny tent that was balanced on a platform hacked from the ice, trying to melt enough ice for drinking. At first the stove had refused to light but eventually it had yielded to their attempts and now it hissed gently.

  Above them lay Camp IV on the South Col, a bleak lonely place, deep in the Death Zone where no living thing could survive for long. And above that the summit of Everest.

  Their dream.

  But they were still a long way from that, Juliet thought wearily as she ripped open a packet of dried food and emptied it into a cup. She wondered why she was bothering. She had no confidence that she’d be able to eat it.

  She was tired and she had no appetite, all consequences of the high altitude. Several of her team were talking about dropping further down the valley to the villages before making the final push for the summit, working on the assumption that breathing in the oxygen-rich air lower down would be beneficial to their acclimatisation programme.

  Juliet was sorely tempted by the prospect of being able to breathe properly, but, at the same time, was slightly concerned about the strong possibility of contracting a stomach bug, which was always a risk in the Sherpa villages.

  Would descending to a lower altitude make her stronger? Give her more energy?

  Billy had said that they needed to make the distance between Camp II and Camp III in seven hours if they had a hope of making the summit.

  She’d taken closer to eight and Neil had finally slumped into the tent ten hours after leaving Camp II.

  He lay now, exhausted and spent, with his eyes closed and Juliet sensed that he had nothing left to give.

  They were too slow. She knew they were both too slow.

  An avalanche of ice and rocks had ripped tents from the camp, leaving only a few standing. Consequently the expeditions currently on the mountain were sharing while Sherpas brought up more supplies from Base Camp.

  Only a climber would understand how totally unromantic it was to be sharing a tent with three bulky men at 24,500 feet, Juliet thought with wry humour.

  Billy and Neil were in the tent with her, along with Finn.

  The rest of his team had turned back to Camp II after finding the going too tough, and Anna had gone down with them.

  Should she have turned back, too? She certainly didn’t feel good. Her cough was worse and she felt as though she’d stretched herself to the very limit.

  Finn had made the climb in six hours and now sat with his eyes closed in the corner of the tent, recovering.

  Juliet longed to wriggle over to him and rest her head on his chest just for a moment. She needed his strength.

  Maybe he felt it, too, because his eyes opened and he looked at her for a long moment, his gaze curiously intense.

  He’d loved her.

  The thought flew into her head and she swallowed hard. Once, this amazing man had loved her.

  And she’d run away from that love.

  She’d chosen to live her life without it. Without him.

  Suddenly her thoughts twisted and tangled and she felt panicky and confused. It was just the altitude, she told herself firmly. Just this place. It made one long for human comfort.

  She reminded herself firmly that she and Finn were colleagues and friends. Nothing more. She wasn’t capable of feeling what he claimed to have felt so it had been right not to marry him. She didn’t want to feel anything for him. Didn’t dare.

  Finn’s eyes held hers and she had a sudden, desperate need to know what he was thinking.

  But with two other people squashed in the tiny tent, there was no chance of finding out.

  It was Neil who broke the contact between them. From being almost comatose, he suddenly stirred, sat up and wriggled his way to the edge of the tent.

  Juliet caught his arm. ‘Neil? What are you doing? Where are you going?’

  This wasn’t a place to go for stroll and enjoy the view. One false step and you were dead.

  For a moment he stared at her blankly, as if he didn’t recognise her. There was no sign of his usual joviality. ‘To the toilet.’

  He didn’t seem himself and Juliet frowned, her hand still firmly on his arm. ‘Crampons, Neil,’ she said urgently. ‘You haven’t put your crampons on.’

  Below them was the infamous Lohtse face, five thousand feet of sheer blue ice, ready to tempt the careless climber to his death.

  They all knew the rules. No one left the tent without the crampons that would give them a grip on the ice. People had died from making that very mistake.

  Neil stared at his feet, as though he hadn’t realised they were his responsibility.

  ‘I’ll be careful.’ He was slurring his words and he stood up and staggered.

  Juliet looked at Finn in consternation.

  His eyes were sharp now, watchful as he studied Neil, and she knew exactly what he was thinking because she was thinking the same thing.

  HACE.

  High-altitude cerebral oedema, a severe form of acute mountain sickness in which the brain swelled and ceased to function properly. Loss of co-ordination and an inability to think straight were both possible signs of HACE.

  And Juliet knew just how urgent the situation was.

  If Neil had cerebral oedema, they had to get him down. Fast.

  Even as she was trying to think her way through the next course of action, Neil dropped to his knees and vomited weakly outside the tent.

  Finn picked up the radio and Juliet heard him talking to the team at Base Camp, discussing who was already on the mountain and who could come up from the lower camps to help.

  She glanced across at him. ‘It’s pitch dark.’ And the deadly ice face lay between them and the lower camps. If they left now, they could die.

  But if they stayed…

  Finn was still holding the radio. ‘You know the treatment as well as I do, Jules.’ His voice was rough and his eyes were on Neil, who was still retching outside the tent. ‘We have to get him to a lower altitude. And we have to do it fast.’

  She knew what he was saying. If they spent the night up here, Neil would be dead in the morning.

  ‘He’s too exhausted to walk.’

  Finn was already trying to gather his equipment. ‘I’ll rope him to me. Ken and Alan are climbing up from Camp I. They’ll meet us. Billy?’

  Billy nodded, his expression worried. ‘No problem.’

  But Juliet knew it was a big problem. They were all exhausted from the long climb up to Camp III. It had taken nearly everything out of them. To descend in darkness over a treacherous ice face was asking a lot.


  Billy looked at Finn. ‘She’ll have to come, too.’

  Finn nodded, his expression grim. ‘I know that.’ He looked at Juliet and something flickered in his dark gaze. ‘She can do it.’

  Juliet was touched by his faith in her but had a sinking feeling of dread deep in her stomach. Could she do it? She’d climbed for eight hours. She was exhausted. Drained. The thought of going out in the freezing darkness and making her way down the nearly vertical equivalent of a skating rink didn’t hold any appeal. Finn was still watching her and she gave a wan smile. ‘No problem.’

  Having made the decision to descend, they turned their attention to Neil who was becoming irritable and belligerent, all signs of HACE.

  ‘We’ll give him 8 milligrams of dexamethasone immediately and 4 milligrams in another six hours,’ Finn said. ‘And start him on oxygen.’

  ‘I’m all right,’ Neil mumbled, but Juliet was already reaching for one of the small cylinders that were stashed at Camp III. Above this height everyone in her team would be using oxygen and the Sherpas had already left a supply in the tents.

  Finn took the mask and tried to fit it to Neil’s face.

  Immediately he knocked it aside with his hand, a fierce look in his eyes. ‘Are you trying to suffocate me?’

  Juliet put a hand on Finn’s arm. ‘Let me,’ she said quietly, and she moved forward so that she was next to Neil. ‘Look at me, Neil. It’s me, Juliet. Stubborn doctor who’s afraid of flying. Remember me?’

  He stared at her blankly and then something flickered in the depths of his gaze. ‘You won’t marry me.’

  ‘That’s right.’ She grinned, ignoring Finn’s astonished look. ‘I’m not planning on marrying anyone, but do you know what?’ She took the mask from Finn. ‘If you put this mask on your face and get yourself safely down this mountain, I’ll seriously consider it. You just might get lucky.’

  Neil swayed slightly and took the mask. His hand was shaking. He put it over his mouth and nose and immediately dropped it. ‘It’s suffocating me.’