Climbing Mount Everest just got less dangerous
One by one, three climbers with severe frostbite crawled into advanced base camp after their summit bid. They’d been missing for five days. I was a 25-year-old medical student from the Bronx serving as the doctor for a small team of four elite climbers from the US, UK, Canada, and New Zealand. They were purists, using no oxygen or sherpa support as they attempted to set a new route up the unforgiving eastern face of Mount Everest in Tibet. It was 1988, and only one team before us had successfully ascended the world’s tallest peak from this side. We’d been isolated on a glacier for months having seen no other foreign climbers and only a few locals. We knew there was no chance for emergency rescue on this remote side of the mountain.
Our home on the Kangshung glacier felt like living inside an amphitheater with a soundtrack of thundering avalanches. Ice, wind, and bitter cold tested our limits. Our expedition leader chose the East Face because, unlike in Nepal, he could obtain a permit quickly, without waiting years.
No one else was applying to climb the East Face.
To this day, only 13 people have summited from this approach, out of more than 11,000 climbers who have stood atop Everest. When the famous British explorer George Mallory saw the steep, avalanche-prone East Face on a reconnaissance expedition in 1921 he remarked, “Other men, less wise, might attempt this way if they would, but, emphatically, it was not for us.”
When I was invited to join the team as medical officer, I said yes quickly, drawn to return to the majesty of the Himalayas, which I’d first experienced during a solo hike in Nepal at 22. There, I met climbers who later invited me on this expedition. Soon after accepting, I became plagued with self-doubt about taking on such a big role while still a medical student.
Most of the ailments I’d treated up to that point were routine — respiratory infections and mild injuries — but on the mountain I faced bigger challenges: the risk of high-altitude edema, hypothermia, and, of course, frostbite.
I had first learned about severe frostbite from “Annapurna,” by Maurice Herzog, a book about the first successful climb of a mountain above 8,000 meters (about 26,000 feet) in 1950. He and a teammate had reached the summit but suffered from severe frostbite resulting in field amputations of several digits, including a “black and mouldy little finger.” When I read that book, I never expected to join an expedition myself, let alone as the sole medical provider.
My job on the mountain was to treat climbers who pushed themselves to extremes, but I was also at my limits in my role as doctor — and subject to the limits of what medicine could offer as treatment for the crippling frostbite that afflicted the climbers in my care.
Frostbite is an injury resulting from exposure to extreme cold long enough for ice crystals to form in the affected tissue. In its most severe forms, the tissue dies and cannot be restored. For decades, high-altitude climbers have lost toes and fingers — and even noses, feet, and hands — to frostbite. It is one of the most common health hazards a mountaineer faces, and yet until now, there have been no treatments approved by the Food and Drug Administration for this condition.
That changed in February, when the FDA approved its first-ever treatment for severe frostbite — iloprost, a vasodilator marketed as Aurlumyn. If delivered intravenously within three days of a frostbite injury, it increases blood flow to affected tissues and prevents tissue death, ultimately reducing the risk of amputation.
In short, it saves fingers and toes.
A small trial of high-altitude mountaineers with severe frostbite found that iloprost prevented amputation in every patient who received it, compared with a 60 percent risk of amputation for those who did not receive the drug.
And it’s not just high-altitude mountaineers who experience frostbite. Frostbite can happen anywhere people are exposed to extreme cold, including cities. For example, people working outdoors on industrial sites or in the military. One study examining frostbite in the United States found that people experiencing homelessness were at higher risk of limb amputations as the result of frostbite, and that Black Americans who got frostbite were also more likely to have an amputation.
Unlike Herzog’s physician on Annapurna, I didn’t need to do field amputations. But several of our team members lost toes and one lost finger tips to the effects of frostbite. They were all able to return to climbing, but the availability of iloprost could have spared them immense physical and emotional pain.
I never went on another mountaineering expedition, and I’ve treated frostbite only rarely in my medical career since. But as a physician I applaud the arrival of a treatment that will make mountaineering that much safer. Climbers exposed to harsh and extreme conditions now have a much better chance of keeping all their fingers and toes.