Peak Experience

By Jan Zlotnick
January 17, 2005

The eight of us on the medical team met to determine how to respond to problems our 25 climbers might have on our attempt to reach the summit of Mt. Kilimanjaro in Tanzania. Our team consisted of six chiropractors, an army medic, and me — the lone registered nurse.

We were at base camp, 15,600 feet up, and had lost only one of the men and women who had started the climb, a 75-year-old man with high blood pressure and a penchant for cigarettes. He was now safe in a hotel in Moshi, having needed oxygen within a quarter mile of the trailhead. Our goal was to get everyone else to the top of Africa’s tallest mountain.

We agreed that anyone with an abnormally high resting pulse or high blood pressure at the start of our summit attempt should be forbidden to climb. Anyone who developed ataxia or a dangerous cognitive impairment would be sent back with one of the guides. And such decisions needed to be made by the medical team, not the affected individual. Every reliable source about mountain climbing that any of us had read was clear about this. High altitude can impair reasoning.

Climbing the world’s tallest mountains had never appealed to me. I’d always loved hiking, but the travails of altitude sickness had never seemed worth the risk. And forget about technical climbing with ropes and picks. But the year 2003 greeted me with a unique challenge.

A group was preparing to climb Mt. Kilimanjaro to raise funds for prostate cancer and to increase public awareness about it. At 51, I was in my 10th year of having this disease. As with many other men, surgery and radiation had failed to cure me. Intermittent androgen deprivation therapy, a mixture of three drugs, was keeping me alive. But for how long?

Here was a chance to make a “difference,” a lasting contribution toward defeating the most common cancer in men. It was also a chance to promote the Prostate Awareness Foundation (PAF), a nonprofit support group I had joined that helps men make informed treatment decisions.

At the start of the climb, I had been responsible for the health of the four PAF climbers. Everyone else was climbing under the auspices of another prostate cancer organization, which had recruited interested chiropractors from all over the world. One of them seemed knowledgeable about acute mountain sickness (AMS), and was the overall leader of both the medical team and the climbing expedition.

But during the four days that it took to reach base camp at Kibo Hut, I found myself increasingly beseeched for answers to medical problems. Climbers developed diarrhea, headaches, sleeplessness, indigestion, and dietary concerns, among other things. My reading about AMS had forewarned me about what medications to bring, and despite being a psychiatric nurse, my assessment skills as an RN quickly identified me as the person to seek out about most health issues.

After arriving at Kibo Hut, a primitive concrete outpost, the leader of the climb asked me to assess “Tim,” a 50-year-old man with a high resting pulse. I discovered that his pulse was not just high, it was racing along at 170. It is normal for one’s resting pulse to elevate significantly in response to the lower oxygen at high altitude. At 15,600 feet, oxygen is about half that at sea level. My own resting pulse, normally in the high 50s, had risen to 80.

But this man was already at his calculated maximum heart rate (220 minus age), and he had been sitting for at least an hour. His blood pressure was 162/94.

I asked him about his medical history. He reported having been diagnosed with borderline high blood pressure at least two years earlier. He had been given prescription meds to take, “But I didn’t like taking them,” he said.

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.