A Yak In The Fridge

Posted by Jeremy Windsor on Jun 19, 2020

News of the death of Dr John Dickinson has recently reached us. Well respected by many, John spent a number of years in Nepal where he gained a reputation for successfully treating those with high altitude illnesses. In 1975, John together with Dr Charles Houston, published one of the first studies of High Altitude Cerebral Edema (HACE)*. Now almost half a century later, many of his observations still hold true...

Recommended management is rapid descent to low altitude at earliest indication of cerebral or pulmonary oedema, intravenous dexamethasone or betamethasone in large doses, hydration ... Prognosis is good if descent and treatment are started early, but permanent damage may be anticipated if the patient in unconscious for any prolonged period before descent.

A version of an obituary written by his daughter Dr Mary Harding is reproduced here...

Dr John Dickinson

Dr John Dickinson had an unusual and interesting medical career: from missionary doctor to Army doctor and back again, from London to the North Yorkshire Dales via Kathmandu and the Gulf War, and with special interests ranging from TB and altitude sickness to HIV and heat stroke.

He was born John Graham Blow, the son of Stanley John Blow and Esther Blow née Babb, but shortly after his birth the family changed their surname to Dickinson, the name of some paternal relatives. Brought up in London, he was apparently a handful – his mother used to tell stories of stopping him just in time as he tried to see if he could fly from an upstairs window using an umbrella. He was the first in his family to go to university when he gained a place at Oxford to study medicine. He met his wife Angela (née Clarke) there, who shared his strong Christian faith, and after his early junior jobs in London, they moved with their young family (at that time aged 1 and 3) to Kathmandu in Nepal, where he was a missionary doctor from 1969 to 1986.

He worked a near-continuous rota as a consultant physician in Shanta Bhawan Hospital, a converted palace, mixing this in the early days with language study. He had many funny stories about his Nepali language errors. He became expert in common infectious diseases such as TB and typhoid, but his love of the beautiful Himalayas and being the doctor on the spot treating patients returning with altitude sickness combined to make this his particular specialty and he became one of the early experts.

He attended and lectured at a number of conferences (including the Advanced Medicine Conference at the Royal College of Physicians in 1989) and had a number of publications on the topic and it was the subject of his dissertation for his doctorate in 1982. He was fascinated by the physiology of it, going to the lengths of acquiring a yak heart and lungs, storing it in the fridge at home and sending it abroad for analysis to help understand the adaptations which allow these animals to live at altitude without ill effect.

John treating a patient in Shanta Bhawan Hospital

He was involved in the early development of the Himalayan Rescue Association (HRA), which built health posts at high altitude to educate climbers and trekkers about acclimatisation and to help those suffering from the effects of altitude. The ‘about us’ page on the Association website says: ‘He was the first doctor to have handled most of the cases concerning Acute Mountain Sickness (AMS) not only in Nepal but perhaps in the whole world. Any doctor who wanted to know anything about AMS consulted Dr Dickinson. He wrote the first brochure on AMS for the HRA and no other brochures that have followed will ever match it.’ He gave regular lectures to new missionaries on ‘Staying Healthy In Nepal’; sessions which were cancelled more than once because he was ill himself! 

He wrote and updated a chapter of early editions of the book Traveller's Health: How To Stay Healthy Abroad (Oxford, Oxford University Press). He was involved in setting up the first medical school in Nepal (Institute of Medicine, Tribhuvan University) and became the first professor of physiology there. He also became the first medical director of the new and purpose-built Patan Hospital in Kathmandu when it replaced Shanta Bhawan in 1983. In Kathmandu for many years it seemed everybody knew of him and he couldn’t go anywhere without meeting someone who had reason to be grateful to him for his treatment of some relative or friend.

Trekking in Nepal in 1994

Moving back to the UK in 1986, he joined the Royal Army Medical Corps, passing out of Sandhurst at the grand old age of 46, his ex-Army father bursting with pride. With the RAMC he worked in Woolwich, Catterick Garrison, Akrotiri (Cyprus), Gosport and (again) Kathmandu, as well as serving in a field hospital in the Gulf War, from which he returned injured, albeit minor and not from a war wound. 

He developed an interest in exertional heat stroke, drawing on his physiology background, and published papers on this topic. In 2000, he retired as a colonel and returned to Nepal as a medical missionary once more. This time his work was with HIV; he was the medical director of the Sakriya Unit, which had been set up to help manage the HIV/AIDS epidemic in Nepal.

Retiring (again) in 2005, he and Angela settled in Richmond, North Yorkshire (in a house chosen for its proximity to the moor and the tennis club), but he continued teaching, on a regular basis in Hull, York and Leeds medical schools (the latter until shortly before his death), and through occasional trips back to Nepal to teach in one of the medical schools there.

John placing a string of prayer beads (mala) above a medical post whilst trekking in Nepal

He was very keen on sport, both watching it and participating in it. He was particularly keen on rugby, running, tennis, swimming and trekking, and got grumpy if he could not do some form of exercise each day. He was less successful at kayaking (which he mainly did upside-down) and climbing (he had to abandon an ascent of Island Peak near Everest when he lost a crampon, and in later life had to be winched down from a high ropes course when out with his grandchildren).

He approached his pancreatic cancer with typical physiological curiosity, discussing the basis for each symptom and treatment in detail, which must have been challenging for those treating him. He did his best to carry on regardless and had preached at a local church 2 weeks before his death and won a tennis match within 6 days of it!

He is dearly missed by his wife of 56 years, Angela, his son, daughter, 3 grandchildren, as well as numerous friends, ex-colleagues and patients to whom he made a real difference, literally saving many a life over a long and illustrious career.

In 2016, John and his family wrote a memoir entitled, "A Yak in the Fridge". It is highly recommended! Dr Buddha Basnyat, Consultant in Internal Medicine at Patan Hospital, has kindly allowed us to reproduce the introduction to it...

A Yak in the Fridge

This book entitled, "A Yak in the Fridge" was great fun (and nostalgic) for me to read because, when I was an intern in Shanta Bhawan, Dr John Dickinson so strongly communicated his abiding interest in high altitude medicine and the treatment of typhoid fever that it left an indelible mark in me. In fact years later when I returned to Nepal from North America and wanted to do some useful and interesting research, studying these 2 diseases (altitude illness and typhoid fever, poles apart though they may be) came naturally to me. 

For me the attractive title of the book conjured up images of yaks roaming around at high altitude in the cold Himalayas until I stopped to think, what exactly was the yak doing in the fridge? This intriguing question actually inspired me to read the book as soon as I got a hold of it. The answer, when I found out, was just as fascinating as the question. The book is filled with hilarious stories where his close-knit family members (his wife Angela, daughter Mary and son Jamie) heartily join in writing chapters to give us an entertaining and often insightful perspective of Nepal especially from the late 1970's and 80's which for me made riveting reading. Indeed the contributions from them add very strongly to the appeal of this book. 

I too have many fond memories in the outpatient clinic of friendly banter between John insisting on speaking in Nepali with his Nepali patient and the patient unfazed, trying out his English on John. It was wildly entertaining for this lowly intern as it broke up the seriousness of learning from the Guru of high altitude medicine.

Thanks to all those who have contributed to this post.

Our condolences go out to John's family and friends.

* Houston CS, Dickinson J. Cerebral form of high altitude illness. New Engl J Med 1975;758-761.

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