The Price of Success

If everything goes well on summit day then tagging the worlds loftiest mountain is a huge deal, no matter what you hear otherwise. It comes with immense satisfaction, an emotional rollercoaster ride, and the realization that with enough desire anything is possible. And yes, dropping the ‘E’ bomb does work, or at least it did back in 2005! Away from the mountain there were, and still are periods of being lost, questioning myself why and what happened – now this could be related to my specific circumstances but does tend to materialize after life-changing experiences.

Four months on and my frostbitten fingers and toes are still some way off from looking anything like normal, a full recovery not being 100% guaranteed. The longer the recovery process takes the more frustrated I become and the more I look back and ask myself the question; was it really worth it? Choosing not to use the electronic foot warmers, or being too hypoxic to care, I now realise had cost me dearly, very much like not taking the time to execute what one of the CTSS guides, Casey Grom, had said about not zipping our down suits up fully – fighting with frozen zippers with ungloved hands will lead to frostbite on a cold and windy morning at 29,000 ft! I was now learning the hard way that high altitude mistakes are easy to make, even easier to prevent.

Waking up the day after summiting with slight discoloration in two fingers of the left hand was no surprise; I had already seen that coming after returning to the South Col, whereas I had no idea how the feet would turn out. Both feet had sensations I had never experienced before pretty much the entire summit day. Unfortunately, sock removal revealed toes the same shade of purple as the fingers! At that moment I had absolutely no concerns, nor any idea of what lay ahead.

Fast forward 1 days and visually things look a whole lot worse! I now get to admire a pinky finger that is black with dry gangrene from the bed of the fingernail to the tip, the second finger with a tingling sensation and missing a nail, a big toe that is now only half a big toe, the raw and exposed end showing the inner workings of an amputated limb, and the two toes alongside both having nails in some state of attachment. I couldn’t be any prouder of my new post-Everest body!

In between then and now a whole lot of other ‘healing’ events have taken place, almost all making the frostbite look worse instead of better.

After receiving approval from Ripcord expedition insurance I had arrived at the Ciwec hospital in Kathmandu, not unlike many other frostbite patients over the years. These guys were experts when treating mountaineering incidents such as mine and wasted no time in getting me into intensive care. The treatment of choice was 5 days of Iloprost,¹ each day consisting of 5 hours hooked up to a drip with the drug attempting to do its thing with my extremities. The caveat with this treatment is timing, typically of little use if not administered within 24-36 hours of frostbite occurence.

The 5 miserable days were soon over and other than intense discomfort when the docs didn’t bother adding significant pain killers to the ‘drip-mix’ it was uneventful. Not sure I’ll ever know to this day if it improved my situation in the slightest! The medical treatment cart was already sitting at a pretty $6903, a figure that would have been multiplied a few times over had treatment been carried out in the US. More to follow on this!

Ripcord expedition insurance footed that bill and delivered nicely on a business class upgrade from Kathmandu back to Lexington, Kentucky. The cost to me so far… some discomfort, missing out on a succession of drunken nights out in Kathmandu with my climbing partners, and zero cost.

As well as Iloprost the other medical procedure that I had heard may assist with the recovery of tissue damage was Hyperbaric Oxygen Therapy; pretty much the delivery of 100% pure oxygen whilst cocooned in a pressurized chamber. The wound clinic at Lexington’s St Joseph Hospital provided this exact service. Days after arriving back in the US I paid them a visit, excited about the possibility of saving ever worsening fingers and toes. I should have known better as the wound doctor; let’s call him Dr Misery-Guts, dove straight in to remove the mushroom shaped blisters and toenail – what happened to advice on hyperbaric treatment?

Whilst the toe was significantly smaller it resembled something from a zombie movie!

What made matters worse was the doctors concern with my second finger, his medical terminology and explanation boggling me. Not sure if he was trying to scare the crap out of me or not but within an hour I was sitting in front of a specialist about to be jabbed with a needle full of local anesthetic. An incision either side of my finger to relieve pressure would hopefully be the final time my body was abused on what started out as an exciting day. This guy was far more friendly, bombarding me with an array of questions surrounding the Everest climb – so interested in fact that I couldn’t resist asking for the minor surgery to be on the house! You don’t get what you don’t ask for and to this day I never received anything more than a small, at least by US standards, consultation fee.

The finger was probably going to survive but Dr Misery-Guts had raised alarm bells inside my head about how serious the big toe could become. There was a high risk of infection and if wet gangrene set in then the toe wouldn’t be the only limb I could be living without! The only concern I had was how he felt about the flight to France and me spending a couple months out of the country. It would soon become obvious that overseas travel would turn out to be the best thing, both medically and financially.

Over the coming weeks the bills started to come in – I had been to see both the wound guy and the hand specialist three times, where the latter had billed a total of $244 after insurance, Dr Misery-Guts and his team of robbing bastards had come up with me owing $1219 out of pocket. The second two visits were purely wound checkups and no work was carried out. This is why I love the US healthcare system – Greed!!!

…and so off we went to housesit in Chamonix, France.

Within a few days of arriving I’d been to see a local doctor as an introduction and a point of contact in case of complications. In sharp contrast to a recent experience the doctor was super friendly and billed me a whopping 50 Euros; the second visit coming in at 30 Euro! The service was second to none and here I was paying top prices due to having no reciprocity or EU healthcare connections – I had already made my mind up to have the toe amputated in France.

By now it was 5 weeks since the frostbite and each day Andrea and I had the pleasure of working on an ugly black mess, the new dressings keeping the shriveled toe clean and infection free. Slowly the digit beyond the knuckle had turned black and solidified into a rock hard nugget. The distinction between live and dead tissue was slowly becoming obvious, eventually allowing a surgeon to clearly see where amputation would be necessary. I needed this to hurry up and happen as I knew the cost in the States would be higher than our barely touched $8000 deductible! A French surgeon had already advised me that I would be paying substantially less if I had it done there.

 Receiving the “let me talk to the local frostbite specialist as it looks ready to be amputated” statement from the second Chamonix doctor kind of made me excited. Hearing that made the realization sudden that I could soon be an amputee, one of those people that get stared at as something is not quite right. It didn’t take long for a quick about turn, the fact that this occurred whilst summiting the worlds tallest mountain and not from some messed up flesh eating bacteria making my mind accept the inevitable.

The appointment with an English speaking surgeon at a larger hospital close to Geneva went well, the initial confirmation that he might not be able to save much of the toe not coming as too much of a surprise – the flap of skin that would need to be folded over the end had to come from somewhere, or so I thought! He could do it within the next few days and thought it might cost 4-5000 Euros. This is fortunately where things were a little lost in translation; the emailed estimate coming in at 1050 Euros, assuming no general anesthetic and no overnight stay – I had told them I didn’t plan on either! If Maurice Herzog, the first person to stand atop an 8000 meter peak, could have his fingers amputated whilst hiking down from Annapurna then there was absolutely no reason that I needed to be put to sleep!

August 9th wasted no time in arriving. Hungry, nervous and horizontal; first came a leg block for the surgery and post-pain, quickly followed by theatre – did I want to watch the procedure or not? The screen that went up made that decision for me. Almost immediately I was aware of cutting or something equally as intrusive as it hurt like hell, the leg block although numbing everything below the knee had barely prevented pain! A couple of needles and 20 minutes later it was over, my new partial toe heavily bandaged and pain free. The surgeon must have thought I was some sicko and declined when I asked for the amputated piece!

Moving on 4 days and a little later than instructed it was time for a dressing change – I was in no rush to have the existing one removed, sure that it would be stuck solid. It was great to have a thoughtful nurse that didn’t feel the need to inflict pain on this foreign patient. Seeing the new toe for the first time was when the shock set in; the stub appeared to have been created by a swift blow from a machete, the raw and exposed end resembling a slice of pepperoni pizza!

Dressings aside the French healthcare system had charged me the equivalent of $1720, an amount that although could have been prevented, wasn’t too shabby. Daily nurse fees would have pushed this amount upwards so Andrea and I decided that so long as we could prevent infection this would be done in-house. Regular Facebook postings ensured that the doctors in our life were kept informed and would comment if they suspected anything amiss – the other 99% of our friends would just have to put up with the gory newsfeed entry!

Almost seven weeks has now passed since the surgery and as well as everything going smoothly the stub has some curvature, the raw opening becoming smaller by the day. Initially hearing a couple of weeks as the healing time it’s going to be well over 2 months. The saving grace being that as long as it’s not cold or wet out then hiking in Chacos is a daily occurrence, often taking us beyond 10 miles with big ups and downs. Traveling by plane, bus or sitting down for too long still causes uncomfortable swelling and the digit nerves sporadically hit me with stabbing pain, tingling and itching sensations.

So would I go through this all over again if it meant standing on top of the world and putting an end to the 7 summits quest?

When I’m staring at an overwhelmingly appealing Mediterranean Sea on a hot day and can’t dive right on in due to the infection risk then I wish things had gone differently, but otherwise there aren’t too many things that are being missed out on right now. For the most part, hell Yes the summit was worth every miserable second!