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I told him in no uncertain terms that he should not attempt the summit later that night. It would put both himself and the mission at risk. He said he wanted to see how he felt a few hours later, and that he was determined to make the climb no matter what. I consulted with the leader of the medical team, and we agreed that we would forbid him to make the climb if his pulse and blood pressure did not decrease substantially after taking nifedipine and atenolol. But although his pulse had dropped to 90 by the time we were to climb, Tim’s BP was now 146/102. Meanwhile, the expedition leader had already left for the 4,000-foot summit attempt with the group of climbers who had been anticipated to be slower than the others.

All the other members of the medical team were gone — except one, an unassertive chiropractor who was clearly hostile to conventional medicine. (I wish I could do something about this common mutual hostility between MDs and DCs.) He questioned the accuracy of my readings, though did none of his own, and said that Tim was “a big boy” who could make his own decisions. By the time Tim reached the summit, he was hallucinating. He had to be carried down by two team members. And he wasn’t alone.

Two others did not make it to the summit because of altitude sickness. The PAF team of four had made it to the top in good shape, but by the time we arrived back at Kibo, 11 of the other 19 needed acute medical attention, mostly for dehydration and exhaustion. Three of them had not voided in more than eight hours, had thready pulses, and could not tolerate fluids because of cramps.

The army medic and I went into “MASH” mode. Despite our own exhaustion, we assessed, conferred, and reassessed among the tents for more than two hours, often running to the shouts that rang through the cold wind. Eventually, with the help of Gatorade powder and one-to-one assignments with the three most critical climbers, everyone was stabilized.

All except the chiropractor who had allowed Tim to climb. He developed pulmonary edema, and was evacuated from the mountain.

Climbing Mt. Kilimanjaro proved to be more than just a physical challenge for me. It tested not only the limits of my endurance, but also the limits of my assessment and organizational skills as a nurse.

Jan Zlotnick is a registered nurse who teaches psychiatric nursing at City College of San Francisco and is a staff nurse at San Francisco General Hospital. He also volunteers for the Prostate Awareness Foundation.