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Xtreme Everest expedition to Cho Oyu, Tibet 2006

By Chris Imray

I first met Mike Grocott as a fellow ?diplomat? on the UK Diploma in Mountain Medicine in 2003. Mike had a plan which to me had seemed so ambitious as to be verging on the foolhardy. His proposal was a medical research expedition to climb to the summit of Everest. The 2006 Cho Oyu expedition was the second expedition to an 8000m peak undertaken by the CASE group, the aim being to try to prepare for the proposed Everest expedition in 2007, testing both equipment and climbers at extreme altitude. One of the pre-requisites for inclusion in the Everest summit climbing team was an uneventful prior ascent of an 8000m summit.

I had started climbing as a teenager and in the following 30 years had been lucky enough to have climbed all over the world. In 2006 my highest peak (climbed 16 years earlier) was Aconcagua (6959m) the highest mountain in the Southern and Western hemispheres. For me, Cho Oyu would be a quantum leap in altitude, and a challenge which I felt at the time would probably be beyond me, however this would be a once in a lifetime opportunity.

The name Cho Oyu means ?Turqouise Goddess? in Tibetan, and the mountain is the sixth highest in the world at 8,201m. It sits on the Tibetan/Nepalese border about 25 miles to the west of Everest. Cho Oyu was first attempted in 1952 by an expedition led by Eric Shipton, it is reported that technical difficulties at an ice cliff above 6,650m (21,820ft) proved beyond their abilities.

Cho Oyu_CASE Medicine 2006

Cho Oyu was first successfully climbed on October 19, 1954 via the northwest ridge by Herbert Tichy, Joseph J?chler and Sherpa Pasang Dawa Lama of an Austrian expedition. The expedition was remarkable for its time, being a super lightweight expedition without supplementary oxygen on an unclimbed 8000m peak. Cho Oyu was the fifth of the fourteen 8000 metre peaks to be climbed, after Annapurna in June 1950, Mount Everest in May 1953, Nanga Parbat in July 1953 and K2 in July 1954. This route is now seen as one of the more straightforward of the 8000m peaks and is often used as a ?warm up? for Everest.

We left the UK in late August travelling via Kathmandu, Nepal, at the end of the monsoon season. Our base, the Summit Hotel, has wonderful walled gardens which act as a haven of peace from the frantic hustle and bustle of the streets of Kathmandu. We wandered around this enigmatic city, visiting old haunts, finding last bits of equipment and getting to know the rest the climbing group and our sherpa team. I certainly felt a degree of nervousness as we completed our preparations. It was rumoured that there was a steep scree slope leading up to Camp 1, and as a result I ended up buying a second hand climbing helmet from the bazaar in Thamel- hardly the actions of a confident climber who had been in the mountains for 30 years!

Tibet 2006_CASE Medicine

After a few more days, we flew on to Lhasa (3,600m) in Tibet. Here we spent a couple of days acclimatising and exploring the ancient capital of mystical Tibet. The massive contrast with Nepal started with the border guards and extended into almost every aspect of Tibetan life. Although the visit to the imposing but empty Potala Palace was a very special moment, in many ways the visit to the 7th century Jokhang Temple was more atmospheric. Thousands of pilgrims were slowly circumambulating the temple and many of them were prostrating themselves for the entire circuit around the Temple. The dimly lit passageways with shafts of sunlight penetrating the juniper smoke incense, the spinning brass prayer wheels and the chants of endless prayers of devotion could be out of a scene from a thousand years ago.

We travelled overland for four days by jeep to the roadhead at Chinese Base Camp. At 4950m Chinese BC is higher than anywhere in Europe. There were a large number of tents with expeditions from all over the world. Amongst our own expedition, despite the relatively slow ascent profile, there were still a few of us who had mild acute mountain sickness (AMS). Headache, nausea, loss of appetite and shortness of breath are all common symptoms.

However our first serious challenge was a 58 year old Japanese climber and a superfit triathlete who had ascended too quickly. He had developed severe shortness of breath and became ataxic (unable to walk unaided) and was semi-comatose. His friends said he had appeared blank for long periods of time and that he had also been unable to move his left side. Untreated, this situation was likely to deteriorate rapidly. We treated him with oxygen, intravenous steroids and nifedipine. Three hours later he was considerably better; he was able to talk and move all four limbs and was evacuated by jeep to lower altitude later that day. After a night in a Kathmandu hospital he went on to make a full recovery, but clearly it was a sobering lesson about the need for sensible ascent profiles in the high mountains.

On a lighter note, it was at this time I struggled to master the art of the pee bottle. I was sharing a tent with polar explorer Mike Stroud, and I felt too embarrassed to ask him the exact technicalities of how it is done! So in the middle of the night without using a torch so as not to wake Mike, I tried it for the first time. I thought all had gone well as I filled my 1 litre bottle. I carefully sealed the container and placed it between the inner and outer tent. It was only the next morning when I went to empty the pee bottle that I found the pee frozen and that my sunglasses were still in the container!

We spent four weeks acclimatising to the very high altitude and whilst doing so we also undertook a number of medical research projects. In particular we studied the changes to the blood supply to the brain, heart and lungs that occur at extreme altitude with exercise. The research was aimed at improving patient care in intensive care units and preventing strokes, and was the preliminary to the 2007 Caudwell Xtreme Everest expedition. We also spent time practising ascent (jumar clamps) and descent (abseiling) of fixed ropes.

Hugh Montgomery_CASE Medicine_Cho Oyu 2006

Whilst we were at Cho Oyu Base Camp (5600m) packing for a further acclimatization climb, a call came over the VHF radio saying a climber from another group had collapsed and could we help. Jon Morgan, Chamonix guide, anaesthetist and old climbing friend and I set off at speed to help. Climbing over the moraine and glacier to 5900m (the same height as the summit of Kilimanjaro) was hard work but we managed it in just less than half the guidebook time. The climber appeared to have had a stroke but High Altitude Cerebral Oedema (HACE) was an alternative diagnosis. After we had stabilized him with oxygen, intravenous steroids and aspirin the Sherpas organized a stretcher evacuation to Base Camp. The speed and efficiency with which they worked was a sight to behold, almost like a steam train as they took it in turns to lift and lower the casualty over the treacherous terrain.

At Base Camp, fellow Xtreme Everest members had already set up a High Dependency Unit in the DRASH science tent. Using a portable power SonoSite doppler machine, which we had with us for the medical experiments, it was possible to assess the main arteries in the brain. Although the middle cerebral artery was normal on the right side, there was minimal flow on the left. Using this ultra-early non-invasive technique (not available in most UK stroke units) it was possible to demonstrate that the blocked artery was almost certainly the cause of the stroke. Under the strict supervision of Sister Kay Mitchell the doctors became nurses and Denny L, Mark W, Mac, Mike G and Jon M took turns in looking after the patient overnight.

It was necessary to evacuate the climber to Nepal, and since ABC is at 5600m we were above the altitude ceiling for helicopter evacuation. We discussed who should accompany the casualty to the border. The next morning with twelve Tibetan porters, I set off with the patient to the road head. It took six hours across difficult terrain to rendezvous with the jeep. From there it was a further five hours to the Tibetan/Nepalese border. Unfortunately the border crossing was closed for the night. After one look at the local hospital, it was clear that with dirty sharps everywhere I would need to set up an ?acute stroke unit? in one of the local hotels. Intravenous fluids were purchased from the market at an exorbitant price, and climbing oxygen normally reserved for summit bids on 8000m peaks maintained adequate oxygen saturations. A satisfactory urine output was achieved via the indwelling catheter. The following morning a helicopter transfer to the Italian hospital in Kathmandu was arranged.

I had lost 7 kg in weight in the 3 weeks since leaving the UK and this is an almost universal phenomenon at altitude. Whilst waiting for the jeep back to Base Camp, I ate for all I was worth in an attempt to regain some of my weight in preparation for the days ahead as I would try to catch the others up who had started climbing already.

At one point the chances of climbing the mountain seemed remote as a snow storm pinned us in our tents at Advanced Base Camp (5600m) for five days. The weather cleared just in time for one last attempt on the mountain before the arrival of the jet steam winds (150mph) and winter. We moved up and spent one night at Camp 1 at 6400m. The following day in high winds and very low temperatures we climbed the ice cliffs on fixed ropes up to Camp 2 (7100m).

Mike Grocott_CASE Medicine_Cho Oyu 2006

The Xtreme Team set off from Camp 3 (7600m) at midnight climbing through the night. We used jumars on the fixed ropes to climb through the Yellow Band Cliffs. Dawn was breaking and a strong wind blowing as we approached the vast summit plateau of Cho Oyu. A triangular shadow was cast for miles across the vast brown Tibetan plateau to the West. After what seemed like forever we were finally able to see Everest to the East meaning that we had no further to climb. We had reached the summit just after dawn, having climbed through the night using supplementary oxygen for the final part of the ascent. Conditions were very tough on the top and one of the climbers developed frostbite in his big toe despite wearing state of the art high altitude boots rated to -60C! A tent was erected on the summit and we undertook arterial blood gas sampling from groin arteries as part of the preparations for our medical research expedition to Everest in the spring of 2007. One of the sherpas, Pasang, carried the blood gas sample back in an outrageously fast time.

CASE Medicine_Cho Oyu summit lab 2006

The successful summit team included 9 climbers (Mike Grocott, Hugh Montgomery, Dan Martin, Sundeep Dhillon, Paul Gunning, Patrick Doyle, Chris Imray, Jon Morgan, and Maryam Khosravi) and 6 sherpas (Sherpa Pema Chiring, Sherpa Nima Gombu, Sherpa Pasang Tenzing, Sherpa Dawa Tenjin, Sherpa Phura Geljen, and Sherpa Thundu). The journey back to Kathmandu was an amazing experience as we descended from the stark barren moraines down into Alpine meadows, the air thickening all the time. The smell of grass, trees, flowers and other more exotic vegetation were experiences we had been denied for six weeks. The bus journey overnight from the roadhead to the border town of Zangmu ended with us pigging out at a Chinese transport caf? at 3.00am, before crashing for a couple of hours. The bureaucratic challenge of first the Chinese and then the Nepalese border control took on a surreal twist with Kay teaching Sundeep how to waltz in the packed immigration hall. Finally, sleep deprived, we cleared all the border controls, and boarded the bus to begin the tortuous descent into the lush valleys of Nepal, riding on a magic carpet of mixed emotions- excitement, disappointment for some, wonder and anticipation. The next step in realising an Xtreme dream had been realised.

Professor Chris Imray

Chris Imray_CASE Medicine

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