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Wilderness medicine

There is no ambulance service at 17,000 feet. That's part of the allure of a place like Mount McKinley, of course: the extremeness of it, the way it sits above the boundaries of comfort and safety.

There is no ambulance service and the air is thin. A climber who has ascended too fast may begin to walk like a man who has had too much to drink. His brain may begin to swell and eventually he will not be able to stand up at all, and then, when his brain has pushed itself into the space where his spinal cord should be, he will die.Practicing medicine at 17,000 feet is not like medicine where the air is rich and the emergency rooms stocked with life-saving devices. There's a certain danger and improvisation involved. And the scenery is spectacular.

On Mount McKinley it can take 12 hours for a doctor and the rescue team just to carry a sick climber from 17,000 feet to the medical camp at 14,000 feet. It may be snowing too hard for a helicopter to land. Medical care will have to be administered in a tent.

Colin Grissom, a pulmonary and critical care physician at LDS Hospital, travels each spring to Mount McKinley to practice a branch of health care that has a made-for-TV name: wilderness medicine.

It's not an actual medical speciality, but wilderness medicine has attracted more and more doctors since the founding of the Wilderness Medical Society in 1985. There are now 3,000 members worldwide.

Most of its members practice standard health care during the tamer parts of their lives, but they also share a desire to travel - and to practice medicine - in the Earth's wilder places: really tall mountains, remote jungles and deserts, caves, space.

The Wilderness Medical Society is holding its winter meeting Feb. 14-20 at Snowbird.

Because it's the group's winter meeting, and because it's being held in the mountains, the focus of workshops will be on the kinds of things that can go wrong amid snow and ice and too much height.

LDS Hospital's Grissom, who will present a mountain rescue workshop, has become an expert on high-altitude sickness. In addition to providing medical care to climbers on Mount McKinley each spring, he conducts research on high-altitude pulmonary edema - swelling of the lungs.

Climbers can develop pulmonary edema by traveling from lower to higher elevations too quickly. But some can get the condition even if they ascend more slowly. Doctors don't yet know why, says Grissom.

It's not just a question of their lungs being more susceptible, he says. "It's more complicated than that. It's the way their brain reacts (to altitude)."

Even people flying, say from Los Angeles to Salt Lake, and then driving immediately to Alta can get a form of high-altitude sickness called acute mountain sickness. Symptoms are headache, lassitude, nausea, poor appetite and disturbed sleep.

There is evidence, he says, that acute mountain sickness is a form of brain swelling, also known as cerebral edema. At higher altitudes, climbers can develop a more severe brain swelling that can be fatal.

Insufficient oxygen, even without edema, can cause what Seattle physician Robert B. Schoene calls "brain rot."

In 1981, Schoene conducted psychometric tests of climbers on Mount Everest and discovered that they exhibited problems with word recall, calculations and the ability to reproduce a simple figure drawing. Although these problems resolved themselves, another - the ability to pass a finger tapping test - lingered on in some of the older climbers even a year after the climb.

Doctors don't know why some climbers develop brain swelling, a condition in which the brain fills with fluid. "It's a complicated biochemistry," says Schoene, professor of medicine at the University of Washington.

LDS's Grissom, who was a climber and an Outward Bound instructor before he went to medical school, found out firsthand what it feels like to have high altitude pulmonary edema (HAPE) on a climbing trip in 1985. Later, he wrote about it:

I awoke from a restless night's sleep in our well-sheltered camp . . .at 13,000 feet on the West Buttress of Denali. I felt weak and tired, as if I had the flu. As we packed up camp, I was breathing a lot harder than usual. . . . As we moved higher, I had to stop more frequently because of coughing episodes and to allow myself to gasp for more air. It was 1985, I was young and fit, and I had HAPE. . . .

Death may occur within hours if HAPE is left untreated.

"I've done lots of body recoveries," says Grissom about his work on Mount McKinley. "Mostly they were people who should have turned around sooner, or didn't exercise good judgment."

The Wilderness Medical Society is open to physicians, nurses, EMTs and others in the health care professions, and to scientists and others who have an interest in wilderness medicine. For registration information, call 1-800-967-7494. For information about the society, call 1-317-631-1745. Featured speakers at the meeting will include Sylvia Earle, chairwoman and CEO of Deep Ocean Exploration and Research; and Scott Parazynski, NASA astronaut, former U.S. Luge Team member and emergency physician.