Mount Everest's Doctor.

- DATE December 7, 2000 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Dr. Kenneth Kalmer talks about his experiences as an
expedition doctor on Mt. Everest
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

During the disastrous snowstorm on Mt. Everest in 1996, my guest, Dr.
Kenneth Kamler, was on the mountain, taking care of survivors. That was one
of several climbs he's made as an expedition doctor on Everest. He's
treated
extreme frostbite, snow blindness and altitude sickness and has risked his
life to save others. He's conducted research on Everest in conjunction with
National Geographic and NASA. Dr. Kamler is also a hand surgeon. He
directs
the Hand Treatment Center in New Hyde Park, New York. He's written a new
memoir called "Doctor on Everest: Emergency Medicine at the Top of the
World." I asked him how good a climber you have to be in order to work as an
expedition doctor.

Dr. KENNETH KAMLER (Author, "Doctor on Everest: Emergency Medicine at the
Top of the World"): Well, of course, that depends on what mountain you're
climbing.

GROSS: Good point.

Dr. KAMLER: Yeah, on a mountain like Everest, you have to be, I would say,
a
very accomplished climber to even get started on the mountain. It's a very
technically difficult mountain and many of the difficulties come right at
the
beginning so if you want to be an effective doctor, you have to be up where
the problems are which are high up, for the most part. And you can't even
get
there if you're not able to get past the first barriers which come lower
down.

GROSS: And the problems are high up because that's where the oxygen thins
and
the air pressure changes.

Dr. KAMLER: Yeah, if you think about it, the summit of Everest is 29,035
feet. That's about the same height as the cruising altitude of a
trans-Atlantic jet. So there's only about a third as much oxygen as there
is
at sea level and your body can't burn fuel efficiently at that height. So
your metabolism is sort of like smoldering instead of burning and you can't
give yourself enough energy. So it's easy to get into trouble at that
altitude.

GROSS: What are some of the medicines you pack with you when you're working
as an expedition doctor?

Dr. KAMLER: That's a difficult problem. Like Everest itself, the challenge
of packing medicine is daunting, if you don't take it one step at a time.
So
I try to think of every injury I might encounter and every problem I might
run
into, then I list every supply I would need for it, form cardiac stimulants,
to adhesive tape. Because if I don't bring it, I don't have it and I have
no
chance of getting it. But even more subtly, you have to consider the
quantities which I have to bring because, in climbing, weight is critical
and
I have to limit my supplies, recognizing that I might run short in a major
disaster. And as you go up the mountain, you can take less and less. I
start
at base camp with about four yack loads of supplies, but by Camp 2, which is
4,000 feet higher, I'm reduced to just a fishing tackle box worth of
equipment. And then higher than that, I just take what I can put in a
plastic
bag and keep inside my pocket. Medications freeze; if I don't carry them
right against my chest, they'll be frozen and for the most part, unusable.

GROSS: What are some of the main differences in how the body works high on
a
mountain compared to how the body works at ground level?

Dr. KAMLER: Yeah, the biggest problem is with the lack of air. There's
only
one-third the air pressure as there is at sea level and since metabolism
depends on burning oxygen, you don't have that ability. And it's, as I've
seen before, a smoldering fire. So your metabolism is very low. Plus, at
that altitude, temperatures can run 40 degrees below zero or even colder and
you can have winds there that can be up to 40 miles an hour or more. You're
so high up that you're actually exposed to the jet stream. So you're
dealing
with wind chill factors that you'd only find on the surface of Mars, maybe.
And added to that, at the summit, after several days of relentless climbing,
you've probably had very little to eat or drink, you've had maybe half a
bowl
of warm water on summit day, when you start out, and you'll be out for 16 to
20 hours that day. It's a very, very long day. And you'll be burning
12,000
to 15,000 calories, which is about 10 times your normal amount. So you're
really on the edge of survival there.

And to just give you an idea of just how thin the margin of survival is, I
remember on one of my own summit attempts, I was carrying a water bottle
inside my down jacket, against my chest and as I was coming back from the
attempt, I wanted to take a drink of water and I reached inside my jacket
and
my water bottle was frozen. So you really see how thin your margin of
survival is there.

GROSS: Gee, remind me to climb a mountain on my next vacation.

Dr. KAMLER: I wonder myself what I'm doing there sometimes.

GROSS: What's breathing like that high up?

Dr. KAMLER: Well, as you get higher, it gets harder to breath. At that
height, it's essentially taking one step and then several breaths and then
one
more step and then several breaths. It becomes extremely laborious to
breath.
Breathing requires muscle power and you get to the point where the muscle
power required to breath uses up more oxygen than what you're taking in. So
it becomes a law of diminishing returns. In fact, the summit of Everest is
physiologically just about man's limit as to where they can breathe.

GROSS: Because the body is under such stress at these high altitudes, it
must
be very difficult for you, as a doctor, to figure out what's, say, a normal
headache caused by the high altitude and when is that headache a symptom of
a
very serious, life-threatening problem?

Dr. KAMLER: Yeah, that is a very difficult problem because everybody gets
headaches for various reasons. It could be something you ate or didn't eat
and it could be due to just tension, nerves, exhaustion, there's all kinds
of
reasons to have a headache. And, virtually, everybody does get a headache
but
that same headache can be a forerunner of very serious conditions, such as,
pulmonary edema or cerebral edema and it's only with a lot of experience, I
think, that you can really get a good feel for who has a critical condition
and who doesn't. I can't send everybody back down the mountain who has a
headache or no one would ever climb. So a lot of it is just sort of by feel
and by experience.

GROSS: Yeah, you write about a situation on, I think, it was your first
climb
as an expedition doctor, where someone had a headache, you gave them a
couple
of aspirin. There seemed to be more serious problems to treat at the moment
but it turned out, this person did have pulmonary edema. How could you tell
that it had progressed to something very serious?

Dr. KAMLER: Yeah, I think that in that case, it was probably my own
inexperience. It was my first expedition, I was dealing with a lot of
climbers who did have headaches and one of our Sherpas complained just, sort
of, along with the others that he also had a headache. And at the time, I
took it to just--I had the idea that he just sort of wanted to feel like
part
of the group and almost said he had a headache just because he wanted to
belong, in a sense. And I didn't take him as seriously as I should have. I
did give him some aspirin and he seemed thankful for that but I didn't
really
examine him. And had I examined him, I might have seen some clinical signs
which would have tripped me of. But I just gave him some aspirin and that
next morning I was awakened by other Sherpas because they could not awaken
him
and he, in fact, had gone into pulmonary edema and even some cerebral edema.

GROSS: What is that and how did you treat it?

Dr. KAMLER: Yeah, that's a condition where fluid in the body comes outside
its normal area where it's held. And it begins--it comes out of the blood,
it
starts to swell in other tissues. A good way to visualize it is that the
air
pressure that we normally live under, holds fluids in our lungs and as the
air
pressure decreases, that fluid is no longer held back and it's like breaking
a
dike. The fluid leaks out, it gets into the system where--in the lungs it
can
essentially cause drowning. You're developing fluid in areas that shouldn't
have anything but air in them. And in a similar way, the fluid leaks out of
the brain. Since the brain is enclosed in a hard skull, there's no room for
extra fluid, so that fluid causes pressure buildup, which can lead to
unconsciousness and can lead to death. So this Sherpa had developed that
condition and had I examined him, maybe I would have picked it up earlier.
But sometimes you can't tell even on the most careful examination.

GROSS: What were you able to do for him once you did diagnose it?

Dr. KAMLER: Well, then, what we had to do was--I tried to give him fluids.
We had to start an intravenous line, which even that is not as easy as you
might think, since everything is frozen at that altitude. We had to thaw
out
the IV bags of fluid and start giving him some fluid, which would reduce the
pressure in his brain. You give him steroid-type medications, which will
sort
of act like wringing out a sponge and decreases pressure. It's a temporary
measure but it can be life-saving until he can be evacuated.

GROSS: And what was the outcome?

Dr. KAMLER: The outcome was good. We were lucky, in a sense. We were able
to stabilize him long enough to get him evacuated. The weather conditions
were terrible. We couldn't get a helicopter in because of the weather. But
we were able to load him up on a stretcher and carry him out, and he
actually
did quite well, to the point where--the expedition lasted about two months,
and toward the end of the expedition he actually came back and rejoined us.

GROSS: If you're just joining us, my guest is Dr. Kenneth Kamler. He's a
hand surgeon but he's also a mountain-climbing expedition doctor and his new
memoir is called "Doctor on Everest." He was there, by the way, during the
storm in 1996.

What's the impact on your ability to think clearly and to remember things
when
you have so little oxygen getting to your brain because the air is so thin?
Does it make it difficult for you to function well as a doctor?

Dr. KAMLER: Yes, it does. I'm called upon to make some critical medical
decisions which are complicated enough in a modern hospital intensive care
unit, and I'm often in a situation where I'm not getting enough oxygen
myself
and it's very cold and the cold is sort of debilitating as well. So you
often
have a situation where it's hard to think clearly, and sometimes it's
literally confusing to figure out how to tie your shoes--that becomes a
problem--much less making difficult medical decisions. But I find that I'm
aware that I'm thinking slowly. It's not like I'm hallucinating. I'm very
aware of the situation. I'm aware I'm thinking slowly and, therefore, I can
just sort of concentrate and focus and I find I can get the job done, even
though it's a little harder than it would be at sea level.

GROSS: So what happens if you need a doctor?

Dr. KAMLER: Yeah, that's what people often say to me up on the mountain.
The people I climb with are very experienced and they very often do climb
without doctors on other expeditions. So many of them do have a good deal
of
medical experience. Some of them are emergency medical technicians and
they've had a lot of first-hand experience. So I think that they would be
able to take care of me in an emergency situation.

GROSS: My guest is Dr. Kenneth Kamler, author of "Doctor on Everest." We'll
talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Dr. Kenneth Kamler. His new book "Doctor on Everest" is
about his work as an expedition doctor.

You were an expedition doctor in 1996 during the storm on Everest in which
so
much has been written and filmed about. Where were you during the storm?

Dr. KAMLER: Yeah. When that storm hit, I was at 24,000 feet, which is what
we call Camp 3. And the climbers who got in trouble were 2,000 feet above
me
at Camp 4. They had just gone for the summit that day. And we were in our
camp below them listening on the radio as to what had happened to them. And
we had heard that they had summited just in the afternoon. But even though
there was some celebration on their part, it made us all very nervous
because
they had summited very late in the afternoon. It's a good rule to make sure
you have enough daylight to get back, you know, with plenty to spare. And
they had summited at about 2:30 in the afternoon, which is a very late time
to be coming down. They only had a few hours of daylight left and no margin
for error.

And, at that point, we were just sort of hoping they'd get back down. But a
storm came up and, unexpectedly, the mountain was just engulfed by the
worst,
most intense storm I've ever seen. And we knew that they were still out
high
above their camp, which would have been their shelter. So we were quite
nervous about them. And it got dark and we still had no word that they were
back. And, in fact, they did not get back. They were stuck out in that
storm, and they were unable to get back to their tents. So I was at Camp 3
at
that point, which was a place where I could--I would be unable to even treat
anybody. We were 2,000 feet below them. They were almost inaccessible to
us.
But our strongest climbers risked their lives to go up and try and rescue
them. And two of our climbers did make it up to the area where most of the
climbers were and started doing what they could for first aid.

Where I was, I could radio advice, but we realized we'd have to get the
survivors back down, if I was going to treat them at all. There was no way
that I could get up to that height. And there would be nothing I could do
for
them at that height anyway. So...

GROSS: What did you do to prepare in the hopes the climbers would come
down,
knowing that if they did come down they would need help?

Dr. KAMLER: Well, I was in a place where--I was on a 45-degree icy slope.
It's just a notch cut into the mountain. The camp is really--it's just
enough
room for a tent. And you can't even stand up without roping yourself in.
It's bitter cold. Everything freezes. I had very little equipment with me.
I just had that plastic bag worth of supplies. My supplies were 2,000 feet
lower down. So we felt that if we could get the survivors down to the next
lower camp, Camp 2, we'd have a much better chance of treating them and
keeping them alive. So we worked out a plan where the climbers would have
to
stay overnight at Camp 4, which was already a dangerous place to stay, but
there was just no way we could bring them down that late in the day.

So we waited overnight. The climbers did survive overnight. And as they
were
being brought down by the rescuers, I, myself, down-climbed 2,000 feet to
that
lower camp. So what I did was I took the New Zealand camp's mess tent,
which
was the largest tent in the area, and turned that, essentially, into a
little
field hospital. I laid out foam mats on the ice and sleeping bags on top of
those. We collected sets of dry clothes because I anticipated that the
climbers would be soaked and they would have to get out of their freezing
clothes. I hooked up IV bags from the tent, which had to be defrosted first
in warm water. And we had oxygen tanks. I opened them up; got them ready;
put out my bandages; my medications. And I had the Sherpas boil up as much
water as we could because I anticipated some severe frostbite. I knew I'd
have to warm their body parts.

GROSS: How many people made it down who you ended up treating?

Dr. KAMLER: There were two critical climbers who came down. Beck Weathers,
the American climber who got a lot of publicity in the United States, and a
Taiwanese climber named Makalu Gao who was in a very similar condition. His
back--they both had severe frostbite and hypothermia.

GROSS: Well, how did you treat Beck Weathers? Many Americans saw photos of
his extreme frostbite...

Dr. KAMLER: Yeah.

GROSS: ...when he came down from the mountaintop. He wasn't expected to
live. I mean--I think--yeah, go ahead.

Dr. KAMLER: He was not expected to live. In fact, when we first heard
about
Beck, we heard that he was dead. That was our first report. He had been
found in the snow at Camp 4 and pronounced dead. And our rescuers were
tending to the other ones who were still alive when Beck just suddenly
appeared out of the white-out, out of a swirling fog and he just staggered
into base camp. And I remember getting the radio report from one of the
rescuers. He said: `Beck is alive but I don't know for how long.' We really
weren't sure he'd even survive the night. But he did survive the night and
he
was brought back down to us.

When I caught up with him at Camp 2, I expected an incoherent,
half-conscience
phantom, but he walked into the tent and he said, `Hi, Ken, were should I
sit?' He was really very well-oriented, much better than I expected. So we
laid him down on the mat and on the sleeping bag and we started an IV. And
I
started to examine him. He had the worst frostbite I've ever seen and I've
seen quite a bit of frostbite. His right hand and wrist were purple and
frozen, all the way to a third the way up his forearm. His left hand was
also
frozen. His nose was just a brittle, black crust; it looked as if he would
sneeze, he would just blow it away. So the first thing to do was to make
sure
that he wouldn't die of hypothermia so we started the intravenous line, but
that in itself was a problem because the fluids are so cold at that
altitude.
They have to first be defrosted and then you have to make sure they're warm
because the last thing you want to do is put cold fluid into someone who is
already cold. So we used hand warmers, the kind of chemical hand warmers
that
skiers might use and wrapped them around the IV bags to try to keep them
warm.

Once I was sure Beck was warm enough, we started the process of trying to
thaw
out his hands and feet. So we had buckets of warm water and I put his hands
and feet in there. It was very difficult to keep the water warm because of
the outside temperature being below zero and because of the fact that his
hands and feet were essentially blocks of ice and they would cool the water
very rapidly. So we had to keep reheating the water and adding it and
measuring the temperature. It was a difficult, very time-consuming job but
the Sherpas, most of whom had never used a thermometer before in their
lives,
very quickly got the hang of how to do it and sort of took over monitoring
the
temperature while I could look into their medical condition a little more.

GROSS: Are there any dangers when you're defrosting somebody's body parts
that have frostbite? Are there any dangers in having the temperature being
too warm or in trying to defrost them too rapidly?

Dr. KAMLER: Yeah, that's a very interesting point that people don't realize
very often. I'm dealing with a frozen body part and when I try to rewarm
that, if I do it too quickly, of course, they might get burns and since
their
hands are not able to feel pain, they wouldn't even be able to tell me. So
you have to be very careful about the temperature. And, of course if it's
too
low, you're not going to be effective. But an even more difficult problem
is
that if their bodies are not warm, their hearts will be a little bit cool
and
cooled heart muscle is very sensitive and it can react by going into what we
call an arrhythmia, a pattern of beating which would not allow blood to flow
and can be fatal. So I had to be careful that their body temperature was
high
enough where their heart was functioning properly because, if I suddenly
rewarmed their hands, that wave of cold blood, which would come out of their
hands and into their body, would be a shock which could kill them.

GROSS: So how did he survive your treatment?

Dr. KAMLER: Well, he did amazingly well. He did survive as did Makalu.
They lived through the night. I stayed up all night taking care of them,
just
making sure their IVs were working, making sure they were breathing. It was
freezing cold. We had one propane heater which we kept aimed on my two
patients. To keep myself warm, I tried to do as much as I could without
getting out of my sleeping bag and we did manage to get through the night.

In the morning, we were hoping that a helicopter would be able to come to
evacuate the two climbers but the wind was still blowing so hard that there
was just no way the helicopter pilot said he could land. So at that point,
I
had to make a decision as to whether or not I should try to keep them at
21,000 feet a second day or whether we should try to evacuate them over the
ice. Over-the-ice evacuation is quite dangerous, you have to go through a
lot
of crevasses, it's technically difficult and it would not be me who would be
risking his life to evacuate these people since we would be using our
strongest climbers. So I would be asking our strongest climbers to risk
their
lives to bring down these two sick climbers. But the alternative was to
leave
them another day at 21,000 feet and I didn't feel they could survive another
day at that altitude. Twenty-one thousand feet is an altitude where cuts
won't even heal. And I had two climbers who were so critically ill
that--I've
seen healthier-looking patients die in an intensive care unit.

GROSS: Why won't cuts heal at that altitude?

Dr. KAMLER: There's just not enough oxygen. The body is functioning at its
bare limit. The body does what it has to do to keep itself alive but it has
no extra energy, so to speak, to bring about healing. It's the last place
you want to have a critical person.

GROSS: So what did you decide to do?

Dr. KAMLER: Well, I knew my decision would be taken without question so--it
was a difficult decision, but I felt that we had to get these two climbers
out
and I felt we should evacuate them over the ice, even knowing that it would
be
risking other climbers, so we prepared to do that. The climbers organized
themselves into rescue teams. I packed up the two climbers as best I could,
keeping them as warm as I possibly could. And we started out with that in
mind, going down the ice fall. We were at 21,000 feet and we had a stretch
to
go of 2,000 feet, after which we would enter the ice fall, which is the most
dangerous area filled with crevasses. And as we were going down the route,
I
was trailing behind the rescuers, and I remember thinking how I'm going to
manage these climbers when I get down to base camp. And, you know, what are
the problems I might encounter as we went through the ice fall.

I didn't realize, as we were going, that the wind had died down and, all of
a
sudden, I was startled to hear a noise and look up and see a helicopter. So
the pilot had been monitoring the weather conditions; he'd noticed the lull
in
the wind immediately and made a very daring rescue. He came in in that lull
in the wind and landed in a crevasse field and was able to lift out the two
climbers, one by one actually. And he was flying his helicopter above the
limit that was considered safe for that helicopter. He was at 19,000 feet;
the limit of the helicopter was 17,000 feet. But he risked his life to go
higher and bring these climbers out. And, in fact, he did get them both
out.
He helicoptered them out to Kathmandu, where they were in a hospital before
we
even got back to base camp.

GROSS: Dr. Kenneth Kamler, his new memoir is called "Doctor on Everest."
He's also a hand surgeon and directs the Hand Treatment Center in New Hyde
Park, New York. He'll be back in the second half of the show. I'm Terry
Gross and this is FRESH AIR.

(Announcements)

GROSS: This is FRESH AIR.

I'm Terry Gross back with Dr. Kenneth Kamler. He's a hand specialist who
also works as an expedition doctor for teams climbing Mt. Everest. He's
written a new memoir called "Doctor on Everest: Emergency Medicine at the
Top
of the World." When we left off, we were talking about the disastrous storm
on Everest in 1996. Dr. Kamler was on the mountain treating survivors.

During the storm, did you have to treat a lot of snow blindness?

Dr. KAMLER: Yeah. There were several cases of snow blindness. Snow
blindness
is a condition where the cornea, which is the window of the eye, becomes
burned. It's like a sunburn of that covering, and it results in total
blindness, and it's extremely painful. What's good about it is that it's
generally self limiting and in a few days it clears up. For the few days
that
you have it, it's quite painful and you're totally blind. So if you're in a
hospital you can sort of get by with pain medicine and rest. But if you're
high up on a mountain in freezing conditions, you can see very easily how
that
blindness could be fatal to you. So I did treat some patients--some
climbers
with that condition who managed to get down with the help of others. And
then
it cleared up on its own.

GROSS: What were you able to do to help them through that period?

Dr. KAMLER: Well, I brought along a lot of pain medicine. And what we
could
do is just patch their eyes closed and keep them in a safe place and
actually
guide them down, blind, which is something that some of the rescuers would
do.

GROSS: And what burns the eye? Is it the cold or is it the snow hitting
the
eye?

Dr. KAMLER: Yeah. Well, the most common problem is that when you're high
up
on Everest, you need oxygen. And the oxygen is somewhat warm. And if
you're
wearing a face mask, it causes fogging. So your face mask very quickly gets
fogged out. And there's a very strong tendency for climbers to lift off
their
face mask, at that point, because they can't see. They're on treacherous
slopes and, quite obviously, you have to watch where you're putting your
feet.
So there's a huge temptation to improve your vision by taking your goggles
off. And once you do that, your eyes are exposed to the brilliant sunlight
at
that altitude. There's very little filtering of radiation from the sun at
that altitude, plus the rays of the sun bounce off the ice. So you get an
intensification of the rays of the sun, and it can very quickly burn your
eyes. And since there are no pain sensors in the cornea itself, you don't
realize you're burning your eyes until later on when it really gets very
severe. So climbers will often take their goggles off for the immediate
problem of seeing where to put their feet, but then they pay for it later
because they burn the corneas.

GROSS: So in what conditions are Beck Weathers and Makalu now; the two
people with the extreme frostbite who you treated?

Dr. KAMLER: Well, Beck I'm still very much in contact with. He's a
pathologist. Lucky for him, it's about the only field of medicine you can
practice without hands. Beck, in fact, unfortunately, did lose both his
hands. He has a prosthetic hand on one side and he a kind of a pinching
mechanism on the other side. But he is able to function. He's gone back to
work as a pathologist. And just like he didn't let the mountain stop him,
he
didn't let his disability stop him either.

As for Makalu, he went to Alaska for treatment. He was in hospitals almost
a
year. But as he told me, he knew it was time to get back to Taiwan because
the doctors in Alaska wanted to refashion a nose for him, and he said he
didn't want to have a Caucasian nose. So he headed back to Taiwan, where I
haven't heard from him since.

GROSS: How did the deaths during the storm on Everest and the extreme
injuries affect your attitude about climbing again?

Dr. KAMLER: Well, when you've climbed all over the world and had a lot of
experiences, you always are involved with people who are dying on the
mountain. It's not--unfortunately, it's not that unusual to have climbers
die on the mountain. So it's something that we've all thought about. And
we wouldn't be climbers if we didn't sort of accept that risk and understand
that that can happen.

But having said that, I have to say this was the first time that my friends
died on the mountain. And that puts it in a whole other perspective. The
risk is no longer abstract. It becomes real. And it's--having a
consolation
like saying something like, `they died doing what they loved,' it suddenly
seemed ridiculous. Nobody loves freezing to death. And saying things like
`We go for the thrill of the climb,' it sounds pretty thin compared to the
devastation you see in the families of the people who died up there.

But the risk is inherent in climbing, and it's--actually, I think it's
essential to the sport. It's part of the appeal, but it's not an appeal as
it
would appeal--as a daredevil might enjoy it. Because in climbing you assume
a
risk that makes you responsible for your actions. And your actions have
direct, immediate consequences. It's a kind of refreshing condition that's
often lacking in modern lives where the actions and the effects of what you
do
are dissipated. So the risk is essential to the sport. It's actually, I
think, what elevates climbing above a sport. And someone like me who goes
climbing has to just believe you can control a lot of the risk; keep it
within
an acceptable limit, although, honestly, I'm not sure that taking any risk
is
acceptable.

GROSS: How did your family feel about you climbing again?

Dr. KAMLER: Well, my wife is actually very supportive. She'd certainly
prefer that I had another hobby, but she understands that it's important to
me. And even though she doesn't join me physically on the climbs, she
certainly is with me in spirit to the point where she relates my climbing
stories with so much detail and animation that listeners just assume she was
there with me. And, in turn, I never forget the investment my family has in
me, and I try to climb as cautiously as I possibly can.

One time I was on Everest, I was only 900 feet below the summit, but I
turned
back because I felt conditions at that point were too dangerous. That's 900
feet on a 29,000-foot mountain. Had I continued on and made the summit, it
would have probably only taken another hour. And this was after a two-month
expedition. But I felt conditions were dangerous, and I turned around.
When
I told my wife that story, I thought she'd be disappointed, but, actually,
she was prouder of me than if I had summited because she felt that I
understood what was most important. And what I had waiting for me at home
was far more important than the top of the mountain.

GROSS: Did you ever make it to the top?

Dr. KAMLER: No, I haven't. I've been on Everest six times. That
particular
time that I just told you about was my third attempt. And, essentially, I
have had no attempts since then because the fourth--my fourth chance was the
time that the disaster occurred. And, of course, at that point we abandoned
any idea of summiting and just took care of the injured people. And then
I've been back two more times since then, but both those times I went with
expeditions sponsored by NASA, and those were research expeditions where we
tested medical equipment to try to develop equipment which could prevent or
at least lessen the risk of the kind of disaster that happened in '96.

GROSS: My guest is Dr. Kenneth Kamler, author of "Doctor on Everest."
We'll
talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is Dr. Kenneth Kamler. He's a
hand surgeon--a hand specialist, but he's also a mountain climbing
expedition
doctor. And his new memoir is called "Doctor on Everest." And one of his
expeditions was in 1996 during that storm on Everest.

You've never made it to the top. And as a doctor, you've often had to tell
people on expeditions that they couldn't continue the climb for health
reasons; that they just weren't healthy enough to go any farther. What's
the
range of reaction you've gotten to telling people, you know, `It's over for
you. You've got to go back down, I mean, instead of going up'?

Dr. KAMLER: It's always a difficult thing to tell somebody that because a
lot of people put a lot of their dreams, a lot of their time, a lot of their
money into climbing Everest. I think it's a little easier for me to
understand what's involved in that because it happened to me. My first
climb
I also had ideas that I would be able to summit. I felt I was in good
condition before I went and I thought that I had a real good shot to make it
also. And when I first realized, as I relate in the book, that I wasn't
going to make it, I was surprised at how much it affected me. I had already
felt like I was a successful doctor. I had a kind of storybook family that
gave me a lot of satisfaction. I didn't think that Everest would be such an
important goal for me. But when I found out that I wasn't going to make it
on that trip, it really hit me hard. And I was surprised at how much I had
wrapped up in Everest. So I really understood how it would affect other
people.

And I try to let them down as gently as I can. Everyone understands it's a
dangerous mountain, and no one questions my decisions on the mountain, which
makes me even more careful in telling somebody they can't climb. But we
always have to remember what's the most important, you know--it's, in fact,
only a mountain. So I think if I let people down gently--what I try to do
is
explain their medical situation to them and let them realize that, for their
own good, they'd better not climb. And I try to sort of evolve their
thinking in a way that they tell me they'd better not go on.

GROSS: Your last couple of expeditions on Everest--you served as a chief
high-altitude physician on research projects sponsored, in part, by NASA.
What were you testing?

Dr. KAMLER: After the '96 disaster, the people at NASA understood that the
climbers that were near the summit of Everest were as out of reach for us as
if they'd been on the moon. And the analogy struck them that this might be
a
way that they could test their own equipment. NASA had been developing
remote-sensing devices to use for astronauts on the moon or in a space
station, because there are a lot of similarities. They're going to have
people out there who will not be able to get medical care--at least not
directly, so they developed these devices which could be worn on the body
which would monitor blood pressure, pulse, respiration, body temperature.
We
developed pills that people could swallow which would give their internal
body temperature by broadcasting a signal--all this high, space-age
technology. But what they wanted to do was see if it worked outside the
lab.
So they thought they could bring this to Everest, put it on climbers and we
would monitor how they did.

And, literally, I got a call from out of the blue because they were looking
for a doctor to go along with them to--first, to take care of their
engineers
and scientists, and, secondly, to actually monitor this equipment and see if
the readings made sense. So we've done two expeditions like that. And, in
fact, the equipment has been developed and it's been working pretty well.

GROSS: What does it accomplish for the climbers and for you, as their
doctor?

Dr. KAMLER: Well, this is groundbreaking stuff because we can now send
people out into dangerous situations such as mountain climbing or wilderness
situations. A backpacker or a hiker or a firefighter in the woods; anyone
can wear this equipment. It's very lightweight. It only weighs a few
pounds. And this can be monitored at a base station. So we can hook this
up
to a global positioning satellite, which the person can also wear, so at any
time we can know where a person is and what kind of condition he's in. So
if
he needs rescuing, we can know that by just measuring his vital signs;
knowing if he's alive or not and knowing within a couple of yards of where
he
is.

If we had had this equipment on Everest, we, perhaps, could have saved some
of
the people who are still lying up there on the mountain. And certainly,
it's
not limited to mountain climbers We could save people lost in the woods and
we
could send out rescuers, if we knew the people were alive, and not risk
rescuers if we knew that the people were not savable.

GROSS: Would you like to go to the moon and test it out there?

Dr. KAMLER: Well, I've done a lot of expeditions. I've been around the
world. It certainly would be tempting to go to the moon and test it out,
but
I also have--I also miss my family and I'm not sure I'd want to take such a
long trip again.

GROSS: You know, one of the problems that keeps creeping up in your book is
the problem of sanitation, both in doing your work as a physician and making
sure that the conditions you're working in are clean and that the equipment
you're using is clean. But your own personal hygiene as well is difficult
to
keep up in the kind of conditions you live in. Can you talk a little bit
about that kind of problem, as a doctor, with personal hygiene and the
conditions around you?

Dr. KAMLER: Yeah, the hygiene is difficult. You don't get to wash very
often, particularly above base camp. We do--we are--were able to set up a
shower system at base camp, which is a real luxury on a mountain climbing
expedition. So at base camp we can wash up. People always ask about going
to
the bathroom. That's something you can do even though it's cold out.
You--you know, we do build ice walls to block the wind, and then, really, no
matter how cold it is, you still manage to go to the bathroom without too
much
trouble. But as you get higher, it gets more difficult.

What people don't understand about climbing very often is that you don't
just
relentlessly move up the mountain. You move up to a higher camp. You set
it
up, and then you go down to base camp. And then you build a higher camp in
a
leap-frog sort of way so that you're constantly returning back down to base
camp every few days. So at base camp we can, sort of, take care of personal
hygiene a little better. Going higher up on the mountain, there really
isn't
much you can do.

GROSS: Excuse me if this is a silly question, but, you know, you talked
about
bathroom facilities. Urine must be among the warmer things in the area. Is
there any way to channel that heat that you temporarily get from it?

Dr. KAMLER: Not that we've ever done in any kind of practical way. You do
lose a lot of heat when you urinate. There really isn't much you could do
about it. I suppose you could, if you wanted to. We all carry what we call
pee bottles in the tent so that you don't have to get out of the tent when
you
feel the need to urinate. And that is warm. And you could put that in your
sleeper. And, in fact, we do put it in our sleeping bags so that that heat
that is within the urine can be sort of be recycled, so to speak, within
your
sleeping bag. But even doing that, often we find overnight that the urine
will freeze inside the bag. But it does give you that second chance to use
the heat.

GROSS: Now in the rest of your life, you're a hand surgeon.

Dr. KAMLER: Yes.

GROSS: You write a little bit about that in your book "Doctor on Everest."
And you say the hand is the part of the body that we feel closest to, after
our face. What's so personal about the hand, do you think?

Dr. KAMLER: People do so much with their hands. Their hand is in front of
them all day. They really can't function without a hand. It's a body part
they're very aware of all the time. So other than the face, I think that's
a
part you identify with. People realize that if they lost their hands, they
would lose a great part of their lifestyle. So people attach a lot of
importance to it, obviously.

GROSS: You must see the results of some pretty bizarre accidents.

Dr. KAMLER: Oh, yeah. Yeah, you do. I treat a lot of athletes who have
injuries. A lot of people who work in factories with machines injure their
hands. And I also take care of a lot of people with rheumatoid arthritis or
a lot of kids who are born with malformed hands. We try to correct them and
turn them into useful tools.

GROSS: As a hand surgeon who needs your hands to perform the surgery, don't
you worry about taking care of your hands when you're on an expedition?

Dr. KAMLER: Yeah, I do. In fact, believe it or not, I take 18 pairs of
gloves with me when I go climbing for all kinds of conditions. I often wear
three pairs of gloves at a time, as do other climbers. We're very aware of
the problems with the hands, but, in fact, my hands are less at risk
climbing
ice, which is what I usually do, as compared to if I was climbing rock.
Because when you climb rock, you actually have to put your hands in
positions
where they get twisted and can get broken. When you climb ice, you climb
with ice tools--with axes and hammers. So all you have to do is grip those,
so your hands are not stressed nearly as much. The real risk is frostbite,
and, you know, we do as much as we can to avoid that. But my hands have
come
through pretty well.

GROSS: Did you ever have frostbite?

Dr. KAMLER: I've had frostbite once on my face, but, interestingly enough,
that was not on Everest or any other major mountain in the world. That
happened in New Hampshire, where conditions can often be very, very cold. I
was near the summit of Mt. Washington in a wind storm and I got frostbite
on my face. And that was the only time I've had it.

GROSS: Oh. So what's next for you in your work as an expedition doctor?

Dr. KAMLER: Well, it's hard to say. I sort of take it as it comes. I
still
haven't summited Everest, and that would be nice to do, but that's just one
goal among many. You know, I've spent a lot of time on Everest. And I
think
the idea of developing this equipment with NASA is very rewarding and,
perhaps, even more rewarding that summiting. So I still have an interest in
doing that. But as I was saying before, it takes a lot of time. It's
something I have to balance with my family life and with my professional
life.

GROSS: Do you worry, as a doctor, about taking risks that could jeopardize
your ability to continue helping your patients?

Dr. KAMLER: Yeah. Yeah, I do. I do worry about that some, but I also
don't
want to feel like I'm a prisoner of my profession. My wife and I have
spoken
about this many times. And if I were to just not go at all, I would really
feel like I lost out on something in life. So I'd rather try to balance the
two and do what I can. I'm still a doctor. Even if I lose the ability to
do fine surgery, I could still do other work. And I think I could still be
constructive and have a functional, positive career, even if, somehow, I did
lose the ability to operate.

GROSS: Well, Dr. Kamler, I want to thank you very much for talking with us.

Dr. KAMLER: Thank you.

GROSS: Dr. Kenneth Kamler is the author of the new memoir "Doctor on
Everest." He also directs the Hand Treatment Center in New Hyde Park, New
York.

Coming up, Lloyd Schwartz reviews a new recording of Handel's opera
"Alcina,"
starring Renee Fleming. This is FRESH AIR.

(Soundbite of music)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: Chicago Lyric Opera's version of the Handel opera "Alcina"
TERRY GROSS, host:

Last year, the Chicago Lyric Opera imported a Parisian production of
Handel's
opera about passion and magic, "Alcina." Our classical music critic, Lloyd
Schwartz, thought it was one of the best opera productions he'd ever seen.
A
live recording of the original Paris performance with most of the stellar
case
Lloyd heard in Chicago has now been released by Erato. Here's Lloyd's
review.

(Soundbite of music from "Alcina")

LLOYD SCHWARTZ reporting:

In opera, so many factors have to go absolutely right; singing, conducting,
stage direction; scenery. It's almost, by definition, doomed to failure.
So
when an inspired production comes along, you have to be especially grateful.
That was the case with Canadian director Robert Carsen's version of Handel's
"Alcina" that I was lucky to catch in Chicago last year. Alcina is a
sorceress; a latter day Cerce(ph) who enchants men and transforms them into
animals. The twist in Handel's opera is that Alcina falls in love with one
of
her victims, the knight Ruggiero. But Ruggiero has a fiancee, Bradamante,
who doesn't give up. She follows him, disguised as a man, to Alcina's Bower
of Bliss(ph), where Morgana, Alcina's attendant, falls in love with her at
first sight, thinking she's a man.

In one of director Carsen's most inspired scenes, Morgana sings a love song
to Bradamante's jacket, which is hanging on a chair. Morgana knees on the
chair and wraps the empty sleeves of the jacket around her. She even slaps
a
sleeve when it tries to touch her improperly. The phenomenal French soprano
Natalie Dessay sings Morgana.

(Soundbite from "Alcina")

Ms. NATALIE DESSAY (Morgana): (Singing in foreign language)

SCHWARTZ: Handel operas disappeared for more than a century and a half
after
their first successes. The 19th century, with its insistence on realism,
couldn't handle Handel's plots about magic and sorcery. But the
post-Freudian 20th century found in these implausible stories, as in
mythology itself, profound patterns of all-too-human behavior. The winding
corridors of Alcina's palace, like the woods in Shakespeare's "A
Midsummer Night's Dream," are like the interior of the human heart. Though
Alcina's sacrifice of her power over others when she falls in love is darker
and more painful than Shakespeare's comic transformations.

At the beginning of the production, soprano Renee Fleming, as Alcina, rules
every inch of her domain. When she loses her magic power, the elegant, but
blank, white walls of Tobias Hoheisel's haunting set, close slowly and
relentlessly in on her, and in perfect time to the music. Handel's aching
sympathy clearly went not to the virtuous lovers, but to the defeated
sorceress.

(Soundbite from "Alcina")

Ms. RENEE FLEMING (Alcina): (Singing in foreign language)

SCHWARTZ: The 19th century didn't know what to make of the music, either.
In Handel's long, formal, three-part arias, singers have to repeat the
entire
opening section. Audiences used to find this repetition merely repetitious,
but as the young director Peter Sellers demonstrated in his memorable Handel
productions, the repetitions can actually reveal the deepest insights.
In the aria we just heard, for example, the repeated music underlines the
increasing futility of Alcina's desperate incantations.

Of course, no recording can capture the full range of a complete production.
But early-music conductor William Christie, his period orchestra, Les Arts
Florissants, and the magnificent, all-star cast, perform this ravishing
music as if it were actually about something powerful, urgent and
mysterious.
And now you don't have to go to Paris or Chicago to hear that.

GROSS: Lloyd Schwartz is classical music editor of the Boston Phoenix. He
reviewed a new recording of Handel's opera, "Alcina," with Renee Fleming and
Natalie Dessay on the Erato label.

FRESH AIR's interviews and reviews are produced by Amy Salit, Phyllis Myers,
Monique Nazareth and Joan Toohey-Westman, with Ann Marie Baldonado, Meagan
Howell, and Patty Leswing. Our reseacher is Jessica Chiu. Sue Spolan(ph)
directed the show. I'm Terry Gross.

(Soundbite from "Alcina" aria)

Ms. FLEMING: (Singing in foreign language)

(Soundbite of applause)
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.