"Mountains My Lab" Part 10

Posted by Jeremy Windsor on Mar 13, 2020

Jim Milledge has been one of the UK's leading figures in mountain medicine for many years. In 2018 he completed a long awaited memoir - "Mountains My Lab". Although Jim's intention was not to publish the book widely he has granted us permission to reproduce extracts on our blog. Over the course of the next year we'll bring you images and text that describe Jim's extraordinary life. 

Part 1 includes an overview of Jim's life. Part 2Part 3Part 4Part 5Part 6Part 7Part 8 and Part 9 can be found in earlier posts.

In Part 10 Jim leaves the Silver Hut and heads off to climb the 8000m peak Makalu. Alongside the challenges of his research, Jim has to treat life threatening illnesses in a number of his colleagues...

On a fine, clear, sunny morning John West and I left the Silver Hut for the Barun valley and Mt. Makalu. Makalu is 8,485 metres high, the fifth highest mountain in the world. It was first climbed by the French in 1954 and we planned to climb it by the same route. We donned crampons for the climb up to our col using the fixed rope as a handrail. At the top we met Ed and some Sherpas who took our crampons while we put skis on. We had a good run down the gentle slopes of the Hongu Glacier to about 200 yards short of the transit camp set up by climbers and Sherpas in the last few days. Though quite high at 5,300m, it was a pleasant site in the centre of the huge Hongu basin, just off the snow, with a mossy bank and a small stream nearby. We reached camp at midday and had a lazy afternoon. 

Map of the Khumbu showing our journey east to Makalu

After a rest day at the Hongu camp, we set off for a long day to reach Base Camp in the Barun Valley. We went with Ed Hillary, Tom Nevison and about twenty Sherpas for the first stage. We climbed up about 500m to the Barun Col West, which we reached with a short rock scramble. There were fine views looking back to Ama Dablam, Puma Dablam and “our” Col. 

Now we were on the Barun Plateau at about 6,000m. John and I put our skis on, (which had been carried for us by Sherpas), and skied across the plateau using skins for the pull up to the East Col. Here we had fine views of Makalu across the Barun Valley. It looked so close in the clear air. 

We had to carry our skis down on the far side: this was quite tricky as we were in our clumsy ski boots, carrying our skis and were now on our own. We put our skis back on when we reached snow below the rock. We had to be careful as we were on very steep snow. From here we had the best skiing of the day down towards our Base Camp. The snow ran out above the camp so we had a tedious moraine trudge, carrying our skis, for the last hour. 

I think this was possibly the first time that skis had been used in the Nepal Himalayas to get from A to B. Mostly the terrain does not lend itself to ski touring and we might have thought better of it, had we not the luxury of having Sherpas to carry our skis and other equipment for us.  

Base Camp (5,200m) was not a pleasant site. It was set in the moraine above the Barun Glacier and was extremely dusty. When any wind got up, as it frequently did, the dust was whipped into everything: hair, eyes, nose, clothes and food. 

Ed realised that those of us who had spent longest in the Silver Hut, though we were very well acclimatised, had also suffered from some degree of altitude deterioration. This is a poorly understood condition, which affects climbers who remain at extreme altitude for any length of time. Above 8000m, for instance, climbers are seriously affected in a few days. The symptoms of altitude deterioration include general fatigue, loss of drive, poor appetite and weight loss. At less extreme altitude the same deterioration can occur, but it takes longer and it seemed that the altitude of the Silver Hut was high enough for us to have been affected. 

So Ed suggested that, before we went up onto Makalu, the four of us scientists, namely John West, the two Mikes (Ward and Gill) and I, should go down the valley to a small yak pasture, Shershone, and have four days rest and recuperation at a lower altitude, about 4,500m, which we did.

Whilst there, and since we were all very tired of our preserved food, we tried, unsuccessfully, to trap some grouse-like birds. They were called Chukor partridges, on account of their call, chuck-chuck-chuck-kor. We talked a lot, read, lazed, slept and made plans for the physiology research we hoped to do on Makalu.

At the end of our “leave”, the four of us made our way back up the Barun Valley, across the rock-covered glacier and up an icefall in a sort of ice corridor. This opened onto the mountain proper and to a rock knoll where Camp II had been placed. The next day we all went up an easy glacier to our Advanced Base Camp III at 6,300m. The camp commanded a wonderful view back to the way we had come from the Silver Hut, with the long summit ridge of Chamlang dominating the panorama. Looking the other way was Makalu summit with our route going to Makalu Col.


Advanced Base Camp III looking back at our route from the Silver Hut. The peak with the long summit ridge is Chamlang (7319m). Baron Plateau Col East is just to the right of Chamlang. The Barun valley is in deep shadow beyond the tents.

I spent a week at Camp III mostly doing physiology. This included ECGs (elector-cardiograms) on most expedition members and exercise tests on our main subjects, using our faithful stationary bike and alveolar gas samples. 

On one day I went up to Camp IV, just ahead of a party of Sherpas, to re-cut the steps in the couloir just below the camp. I had to use about four swipes of the ice axe for each step and had to keep going so as not to hold up the laden Sherpas. I have never felt so breathless. The altitude was about 7,000m, the highest I had ever been. Ed, directing operations from Camp III, was also suffering, in his case, from bad headaches. 

By May 7th we had almost completed our planned physiology work and the route had been pushed through to Makalu Col. The “heavy lift” of supplies for the summit bids, using all available Sherpas and led by Peter Mulgrew, (a New Zealand Naval Officer a climber close friend of Ed’s) and Leigh Ortenburger (an American Climber, went off to stock Camp V on the Col. The other climbers and Ed went down to Camp II leaving John West and me to finish some final bits of work at Camp III. 

By midday we were ready to leave for Camp II when I was called to see a Sherpa who was sick. Aila, one of our older Sherpas was complaining of a headache and feeling ill. I listened to his chest and found he had crackles at his lung bases. I thought he might have high altitude pulmonary edema (HAPE). This is a condition first described by Charles Houston was, an American physician, and mountaineer, in a paper in the New England Journal of Medicine, published in August 1960. He described the condition in a single patient. Although it was published just as Betty and I left for Nepal. Somehow I had got a reprint of this short paper and so was on the look out for this condition. It is a potentially fatal form of acute mountain sickness. Sherpas are much less susceptible to the condition but Aila seemed to be an exception. The treatment is to get the patient to lower altitude as soon as possible. Oxygen is also very good but all the oxygen at Camp III had just gone higher up the mountain. So I told him to get his personal gear together and get ready to come, with John West and me down to Camp II. 

Looking to Makalu summit from Camp 3

The route down was quite easy but it was over a crevassed glacier so we roped up. I led and John brought up the rear. We had gone only about 50 yards, when Aila collapsed. So we took his rucksack and John nobly added it to the top of his pack. The weather was not good. It was misty with snow flurries as we cautiously made our way down the glacier, with me probing, with my ice axe, any irregularities that might indicate a hidden crevasse. Every 100 yards or so we had to stop, because Aila was coughing so much. At first he was spitting out frothy white sputum but later the sputum became blood-tinged, obvious on the white snow. Clearly he was suffering from HAPE. About two thirds of the way down to Camp II we got off the glacier so we could unrope.    

I left Aila with John while I ran down to the camp and got oxygen and a couple of Sherpas and returned to Aila. Whilst a Sherpa carried the oxygen set for him, Aila breathed the oxygen and with its help could walk without stopping down to the camp. Once there, I kept him on oxygen for about three hours by which time he declared he was OK without it.

The weather got worse later in the day and the camp was not a very comfortable one on its rocky hillock. Ed was still suffering with headaches and stayed in his tent while the rest of us were in the mess tent. We were about to start supper when we heard a sort of strangled cry from Ed’s tent. Mike Ward went to see what was happening and called me. We found Ed unable to speak and with what was clearly a left facial and left-sided weakness. It was obvious that he had had a stroke. We were naturally shocked. There was little we could do except to give him oxygen (which probably was of questionable value) and then wait and see how things progressed. Mike and I took turns to stay up with him for the night. 

By the next morning Ed was considerably improved and was able to talk, with slurred speech, and to stand up. We felt that altitude hypoxia was likely to have played a part in his condition and that therefore he should get down as soon as possible and not come back up to any significant altitude again. 

Mike was appointed leader and it fell to me to accompany Ed down. So about mid-morning we set off taking also the much-recovered Aila and a small group of Sherpas led by our Sirdar, Dawa Tensing, who was keen to stay with Ed. We made our way down to the Barun Glacier and across it to Base Camp. Ed was able to walk slowly with some support from a Sherpa. 

In the years since 1961 there have been a number of cases of mountaineers having strokes at high altitude. They occur after some time at altitude, usually later in the expedition, so not associated with acute mountain sickness. They usually recover quickly with no residual problems. But in at least one case, the patient had a second stroke whilst still at high altitude. 

The initial plan was to go on to the 1954 French Base Camp further down the valley and call for a helicopter to take Ed back to Kathmandu. But as Ed recovered further, he was very much against this and if he couldn’t go back up Makalu, he wanted to get back to Solu Khumbu and supervise the building of a school in the village of Kumjung-Kundi, 

Route from Camp 3 to summit

He had wanted to do something to express his thanks to the Sherpas, who he recognised had been vital to the success of the 1953 Everest Expedition which had propelled him into his world celebrity status. As he and the yeti hunting party had come over the Tesi Lapcha Pass he had asked the Sirdar of his party, Urkein, “What will happen to you all in the future?” Urkein thought for a moment, and then replied, “In the mountains we are as strong as you – maybe stronger, but our children lack education. Our children have eyes but cannot read. What we need more than anything is a school in Kumjung village”. (Hillary View from the Summit p194).

Thus was born the idea of raising money to build a school. Ed had worked on this project during the winter. He had collected money in the USA and New Zealand and purchased a prefabricated aluminium building, which was flown in by helicopter, in parts, to the site. Ed was naturally keen to be back in Solu Khumbu to supervise this building.

Mike Ward was at first inclined to evacuate Ed by helicopter, but I agreed with Ed that Kathmandu would be hot and he would attract a lot of unwelcome media attention. He would be just as well off convalescing in a nice grassy camp with the Sherpas and me to care for him. Even if he were to have a second stroke, there would be nothing that could be done in Kathmandu except tender loving care, which we could give him just as well. 

The next day Peter Mulgrew came down to Base Camp. He, with Leigh Ortenburger, had led the heavy carry to Makalu Col the previous day in quite bad weather, but on hearing the news of Ed’s stroke had hurried all the way down. Peter and Ed were old friends from Antarctic days and Peter felt he ought to be the one to accompany Ed now. I was very tempted to agree and get back on the mountain, but I knew that Mike Ward and the others would feel that, with five doctors to choose from, it ought to be a medic who stayed with Ed. Not that I could do anything more for Ed than Peter could, should he have another, more massive stroke. 

So, after one rest day at Base Camp, during which Ed and Aila improved, we set off down the valley to the French Base Camp, from where they made the first assent of Makalu in 1954. The weather was not good with mist and some snow flurries, but Ed and Aila went quite well with frequent stops at first. Lower down the going was better and, in gentle snowfall at about five pm, we reached “Hotel Makalu”, the French Base Camp. This was a pleasant grassy site. We considered it would be foolish for Ed to attempt to return to the Khumbu the way we had come, over such high passes. So after six days rest, Ed and I, with half a dozen Sherpas, returned to the Khumbu by a much longer, low-level route, taking two weeks to get back to the Dhud Khosi.

During the 6 days of rest and convalescence and the two-week trek, we had plenty of time for discussion and reminiscence. We were both rather depressed. I, because I had missed the chance to go high on Makalu and Ed, because a stroke at any age is a disaster but at 41 and for such an energetic man it was doubly so. On top of any personal reason to feel depressed, he naturally felt that he had let his team down by having to abandon the expedition just as they were going for the summit. Makalu had been climbed only once before by a French team, using oxygen. We were attempting it without oxygen. 

Me carrying out an ECG on Wally Romanes at base camp

In my absence, John West, Mike Ward and Mike Gill assembled the stationary bike and carried through the physiology we had planned to get done on Makalu Col (7,400m), and carried through exercise tests on each other including VO2max. Their measurements on the Makalu Col remained the highest measurements of this index of performance for the next 46 years, until 2007 when similar measurements were made an the South Col of Everest at 7,906m by the Caldwell Extreme Everest team. 

Mike Gill gathered alveolar gas samples at this altitude and at a camp above, which were added, by Griff, to other data from Everest and Cho Oyu, to give a good account of the change in alveolar pressures of O2 and CO2 with altitude.  

The news we got from the team high on the mountain was not good. The first attempt on the summit was beaten back by bad weather. Then during the second attempt, by Tom Nevison, Peter Mulgrew, and Sherpa Annallu, Peter collapsed, only about 120m below the summit, with severe chest pain and coughing blood. It seems he had had a pulmonary embolus. 

The whole expedition now turned into a rescue mission. It was a long story involving heroic efforts by climbers and Sherpas over 6 days to get Peter down to the Col and a further 4 days to Camp III.   Eventually they got him down alive but badly frost bitten. The full story of this saga can be found in “High in the Thin Cold Air”, the book of the Expedition by Hillary and Doig, in Peter Mulgrew’s personal account in his book, “No Place for Man” and in Mike Gill’s book Mountain Midsummer.  

With hindsight, and bearing in mind that Peter and I had considered swopping places, he to accompany Ed, and me to join the attempt on Makalu, how different things might have been had we decided to do so!

Ed and I were just about able to follow this unfolding saga using the small walky-talky radio we had. We could just make out the transmissions from one camp to another on some occasions, but were never able to transmit a signal ourselves: not that we could do anything about the situation even if we had managed a successful transmission. 

We later heard that they had been able to contact Kathmandu via the Silver Hut and the radio we had there. They were able to arrange for a helicopter to come and pick up Peter in the Barun Valley. Mike Ward, who had had HAPE and HACE on Makalu Col, and Ang Tember Sherpa who had a broken ankle, together with John West, were also helicoptered out. Betty played an important part in answering the radio and arranging all this. She was also involved in looking after Peter in Shanta Bhawan Hospital after he was admitted there with his severe frostbite and a lung abscess.

On top of all this, the weather was bad most of the time Ed and I were trekking, with rain and mist almost every day. The country we were now travelling through should have been wonderful but the weather reduced the visibility to a few hundred yards and the tracks became slippery and muddy. Perhaps, because I am by nature optimistic and I seem to have a memory that tends to filter out less happy events, I have difficulty remembering this time in any detail. 

Aila Sherpa back at Thyangboche

However, Ed was by now recovered physically, which was good, and I was very fit after many months in the mountains. In fact one diary entry records the fact that I had, that day, descended below the 4000 m contour for the first time in eight months! 

I do recall one memorable evening when we arrived at the first real village, Shedoa, and were able to buy fresh food for the first time. We had both lost weight at high altitude but now at lower altitude, our appetite had returned in full and we had a fantastic meal wonderfully prepared by Penuri, our Sherpa cook, of local potatoes, small and delicious, with greens and a whole chicken each. 

My diary records so much bad weather. One entry, May 24th reads, “A wet morning, off at 6.00am just above the mist briefly. They certainly look like monsoon clouds to me. A glimpse of the snows, then into the mist for the whole day. It must be a wonderful walk in fine weather”.

By the time we reached the Khumbu, Ed was fully recovered and “raring to go” in the building of the school house in Kumjung. Ed sent me up to the Silver Hut site to dismantle it with the help of three Sherpas including Mingma Tsering who was Ed’s personal Sherpa and later became the head of the aid programme (now known as the Himalayan Trust), which developed out of the school house project.    

I was now so fit and acclimatised that I was able to go from Changmitang up to the Silver Hut in one day arriving about 3.00pm, a trip that usually took two or three days. We began dismantling the hut the same day.

John West and Mike Ward assemble the exercise bike on the Makalu Col (7400m)

The weather had been quite warm and the sun was now high in the sky, so that the snow had melted around the hut to such an extent that it stood, somewhat precariously, on an ice and snow plinth about eight feet high! It was quite a climb to get to the hut door. 

Over the next three days, with the help of Mingma and two other Sherpas, we dismantled the hut and its fittings. During this time climbers and Sherpas were coming over the Col and passing near the Hut, on their way back from Makalu. I was reminded of Napoleon’s army retreat from Moscow: they had had such a tough time on Makalu and were disappointed by their defeat. Some, like Mike Gill, had superficial frostbite and all were exhausted. 

On the last evening, after the Hut had been successfully dismantled, I happened to look out of my tent up at the Col walls just in time to see a Sherpa fall from almost the top. He came rolling and bouncing down, his load preceding him. The load bounced over the bergschrund at the bottom of the icy walls, then he disappeared into it with a flurry of snow. I leapt up, calling for Mingma, then thought, “Why the hurry? He’s clearly done for.” So I took the time to put on boots, crampons, gloves, snow goggles and find my ice axe. Then we trudged up towards the ice cliffs. As we approached the bergschrund, a snowy figured emerged over the lower lip and staggered towards us! I was amazed and delighted. In the bergschrund there was soft snow and he was uninjured except for a deep bruise on his buttock.

On June 2nd we were ready to leave, having stacked the Hut parts to be collected by Tensing Norkay later. Ed had given the Hut to the Mountaineering Institute at Darjeeling where Tensing was Chief Instructor. We set off with heavy loads for our rented house in Changmitang. There we were reunited with many members of the expedition and had a party. 

Two days later I set off to trek back to Kathmandu with four other members. Others had either gone earlier or stayed to help with the school building. We were all in a hurry to get out and with a strong Sherpa crew, did double marches most of the way. Betty and my father trekked 2 days out from Kathmandu and met me at Dolighart. It was wonderful to see her and Dad again and to get to the Kathmandu valley and be greeted by my mother and many other friends. 

Winter and spring in the Silver Hut

So ended my first major expedition. Looking back, 56 years later, it is still not easy to sum it up.  I cannot do better than to quote the closing paragraph of an article I wrote for John West’s scientific journal, High Altitude Medicine & Biology (Summer issue 2010):

 “The Silver Hut Expedition was a very happy and, scientifically, a successful one. Many of the findings were not repeated for many years and none have been refuted. On the mountaineering side we were unsuccessful on Makalu due to a combination of weather and illness, but the ascent of Ama Dablam was considerable compensation. For many of us, the experience of being members of this unique expedition turned out to be career changing in a most positive way.”   

Betty and I retuned to England by P&O liner taking in Cairo, the Pyramids, and the Sphinx on the way, as the ship went slowly through the Suez Canal.

My Mother, Father, me and Betty on my return from the Silver Hut Expedition

Part 11 can be found here.

Have something to say? Comment on this post