“Expedition medicine is a specialty in and of itself. Few doctors have the skills and background to be a good expedition doctor without a pretty substantial investment in self-learning,” she says. “Unfortunately, many just try to wing it.”
Freer was also struck by what she perceived as a discrepancy between the care some doctors were providing the paying clients versus the local staff—in many cases making the Nepalese walk (or be carried) down to the HRA’s clinic at Periche or, for more serious cases, the Sir Edmund Hillary Foundation’s hospital located in Kunde, an additional day away. “I saw a way to continue using the mission of the HRA by treating Westerners and using the fees to subsidize care for the Sherpa,” explains Freer.
Each spring for the past nine years Freer has made the ten-day trek up to Everest Base Camp, often staying for the entire two-and-a-half-month season, and walking with her is like traveling through a well-loved local’s neighborhood, not someone who is halfway around the world from home. At each teahouse and frequently along the trail, Sherpa—grateful patients or friends and relatives of patients from years past—quietly approach Freer with a soft “Lulu Didi.” (Didi is the customary term for “older sister.”)
“It makes me squirm when people call this work, what I do—‘selfless,’” says Freer. “What I do feels very selfish, because I get back so much more than I give. It turns out that’s the magic of it all.”
Freer and the rest of the Everest ER doctors have been in camp for less than 48 hours and already they have dealt with a deceased body from a few seasons past, inadvertently unearthed in the moraine by Sherpa constructing camps, and have seen close to a dozen patients in their bright yellow dining tent as they wait for the clinic’s Weatherport structure to be erected. One Sherpa complains of back pain after a week’s worth of moving 100-plus pound boulders—part of preparing flat tent platforms for incoming clients. Another man can hardly walk because of a collection of boils festering in a sensitive region. A Rai cook who has worked at Everest Base Camp for multiple seasons is experiencing extreme fatigue and a cough, which the doctors diagnose as the onset of High Altitude Pulmonary Edema.
With the exception of the cook, who must descend, all the patients are able to remain at base camp, with follow-up visits scheduled for subsequent days. Each man I ask explains that without Everest ER’s help, they would either have to wait for their expedition to arrive with the hopes that their team leader would be able to treat them, or descend to see a doctor. The ability to stay at Everest Base Camp is not only logistically easier but also means the men do not risk losing their daily wage or, in the case of some lower-tier companies, their job.
The ER’s locale might be glamorous, but the work is often not. Headaches, diarrhea, upper respiratory infections, anxiety and ego-related issues disguised as physical ailments are the clinic’s daily bread and butter. And although the clinic’s resources have expanded dramatically over the past nine years, there is no escaping the fact that this is a seasonal clinic housed in a canvas tent located at 17,590 feet. When serious incidents do occur, Freer and her colleagues must problem solve with a severely limited toolbox. Often the handiest implement is duct tape.
“There is no rule book that says, ‘When you’re at 18,000 feet and this happens, do x.’ Medicine freezes solid, tubing snaps in the icy winds, batteries die—nothing is predictable,” says Freer. But it’s that challenge that keeps Freer and many of her colleagues coming back. This back-to-basics paradigm also engenders a more old-fashioned doctor-patient relationship that Freer misses when practicing in the States.
“Working at Everest ER takes me back to what took me to medical school in the first place—helping people and having time to actually spend with them,” she says. “I’m just doing what I think is best for the patient—not what the insurance company will reimburse.”
While Everest ER is now a well-established part of the Everest climbing scene, there have certainly been bumps in the trail, particularly that first year in 2003. While the HRA backed the idea of the clinic, Freer had to find financial support elsewhere. Critical pieces of equipment never arrived, and one day while treating a patient, the generator malfunctioned, rendering radios and batteries needed for oxygen concentrators useless; the foot pedal to the hyperbaric chamber broke; IV fluids were freezing en route to a patient’s veins; and all the injectable medications had frozen solid. As if that weren’t enough, the floor was covered in water as the glacial ice melted from below.