HAPE and the Titanic

Tonight we have two very sick patients who both have High Altitude Pulmonary Edema (HAPE). They each arrived by donkey late in the afternoon with low blood oxygen saturations and having trouble breathing. HAPE is a kind of altitude illness that involves swelling and water in the lungs which makes it hard to get what little oxygen is available here. It is a true emergency and the leading cause of altitude-related death.

If someone came in to the Emergency Department at home with an O2 saturation of 46%, they would be intubated, put on a ventilator, and headed for the ICU in about 90 seconds. Here there is no ventilator. No ICU. No intensivists or critical care team.

These two men needed oxygen and prompt evacuation, but poor weather and darkness precluded helicopters from reaching us. These men could not walk and were each larger than any of us. It takes 6-8 people to carry a stretcher for one mile on level ground in the best conditions. It was dark and below freezing. The route down is treacherous in the light. Evacuating them further would be extremely difficult without a helicopter or a full team of people and would place all of us in danger of hypothermia if nothing else. We had no choice but to start up the oxygen concentrator and try to get them through the night, hoping for clear skies in the morning.

Our solar and wind power has been charging the batteries daily, but the readout of the percentage of full power has been wildly fluctuating and difficult to determine the real amount of power left. Truly off-the-grid, there is no back-up. The oxygen concentrators are the biggest draw on the system. At 4pm, the battery read 85%. At midnight and it read "LO". At some point, an alarm will sound and then the power will stop. It feels like we are on the Titanic waiting for the boat to sink.

It is now 3:30 am. I am fully dressed except my boots in my sleeping bag next to my patients with oxygen saturations in the 70s, barely holding on for the helicopter that might arrive at dawn. For now, the oxygen concentrator continues to run. And I lie here listening to their scary periodic breathing and coughing fits, waiting for the battery alarm to sound...

Hill

March 19