Surviving the Extremes: A Doctor's Journey to the Limits of Human Endurance (37 page)

My human-scale ministrations paled into insignificance. Nonetheless, I had two critically ill patients to keep stabilized through a night in a freezing tent. Our propane heater was kept constantly aimed at Beck and Makalu, and being highly directional, it did nothing to warm either the rest of us or the IV bags hanging from the ceiling. If the bags were allowed to cool, the fluid would drip our patients back into hypothermia. We alternated the exposed bags with others that we kept soaking in tubs of hot water. To prolong hang time, we wrapped chemical hand-warmers around them while they were in the air. I passed the night in the bitter cold of the tent watching the dripping of the IV bags, the flowing of the oxygen regulators, and the breathing of my patients. My feet were freezing, though I had put mittens over my socks and then wrapped them in a down jacket. To stay warm I tried to work as much as possible without getting out of my sleeping bag.

An hour before dawn we got a radio message that the helicopter we had hoped for couldn’t come. It was still too windy. With no idea when it was going to let up, I had a hard choice to make: keep Beck and Makalu there for another day or try to get them down now. Carrying them down would put them at risk of further injury. Even more, it would mean risking the lives of the rescuers, who I knew were ready to carry out my decision without question. We could try to wait out the wind but at this altitude even simple cuts don’t heal; Beck and Makalu, with the injuries they had, would deteriorate rapidly. The need to get them out was compelling. I opted to bring them down the hard way: a combination of walking, sledding, and carrying them over the crevasses and down through the icefall to base camp. Rescue teams were organized. We started off, Beck walking with assistance
and Makalu being dragged and carried, since he couldn’t put any weight on his frostbitten feet.

So intensely focused were my thoughts on how we would get through the icefall, and then how I would manage my patients at base camp, that I didn’t notice the wind had died down. I was startled by the noise, and then the appearance, of a helicopter overhead. The pilot was trying to take advantage of the lull in the wind to scoop up two passengers. He touched down lightly on the ice, keeping the rotors going at full speed. The helicopter, and the pilot himself, were both well above their altitude limit. The air was too thin to provide much lift for the rotors or much oxygen for the pilot. If the helicopter couldn’t lift off, it could be as fatal for the pilot as a crash. Totally unacclimatized, he would be unlikely to survive more than a few hours.

At this altitude only one passenger could be lifted out at a time. Since he couldn’t walk, Makalu was loaded first. The pilot ferried him to base camp, then came back and picked up Beck. He reloaded Makalu in the relatively thicker air at base camp and flew them both off the mountain, pulling off the highest helicopter rescue in history. Beck and Makalu were in a clinic in Katmandu before the rest of us made it back to base camp.

Though left with devastating injuries, Beck and Makalu both survived. Beck lost his entire right hand and most of his left, while Makalu lost large portions of both hands and parts of his feet. Both had to have their noses reconstructed. Their recoveries are stunning examples of the body’s incredible ability to endure in one of the harshest environments on earth. Beck’s survival, however, transcends the laws of medicine. Beck descended into profound hypothermia—and then, somehow, climbed back out.

IMAGINE LEAVING HOME AND FAMILY
to get inside a camper with five other people. You have worked closely with them for years; some you genuinely like, others you merely manage to get along with. Eating, sleeping, washing, showering, and using the bathroom—everything will be done inside this vehicle. Although you have a privacy curtain, you’re never more than a few feet from everyone else’s sight, sound, and smell, or they from yours. You can’t open the windows. You can look outside, but all you will find is black sky, unchanging except for the stars. There is no fresh air, no outside sounds, no natural light, no daily rhythm of light and darkness, no weather, and no change of seasons. You can’t go outside except for an occasional short walk around the vehicle. There are no visitors, no chance for conversations except with the other five inside—and very few of those will be private. There isn’t much to do, and yet if you allow your mind to idle, your thoughts will most likely focus on fears of death. Nonetheless, you hope your self-imposed state of isolation will last the full three years that have been planned; anything less would mean sudden death. You’re on a voyage to Mars—with no guarantee that it will be a round-trip.

Mounted on a rocket, your camper is a spacecraft. Though roughly the size of a jet airliner, most of the space is filled with machinery, fuel, and supplies. When Mars and Earth are at their closest proximity, the outbound journey takes nine months, the return trip nine more.
Optimal orbital alignment of the planets will be lost two weeks after arrival, not to return for another year and a half. Since a two-week visit would hardly be worth the trip, you have to be prepared for the longer stay. At times, you will be 250 million miles from home.

Astronauts don’t have to leave the planet to experience at least some of the physical and mental stresses of living with a small group in a claustrophobic capsule from which there is no easy escape. A training facility that in many ways mimics life on a trip to Mars exists on a coral reef off the coast of Florida. Just ten miles from the animated and popular boating resort of Key Largo, the undersea habitat Aquarius sits silently in 63 feet of water. Placed on the seafloor in 1996 and run by the University of North Carolina, it doubles as a research facility for the National Oceanographic and Atmospheric Administration (NOAA) and as a space analog for NASA. Astronauts are submerged there for weeks at a time to live in group isolation and carry out experiments and training exercises in a program called NEEMO—NASA Extreme Environment Mission Operations.

The astronauts scuba dive down to the facility and, once inside the dry chamber, breathe pressurized air for their entire stay. This means that their bodies become fully loaded with nitrogen, as any other saturation diver’s would be, and they are unable to return safely to the surface without first decompressing for over sixteen hours. Their saturated state does, however, allow them to spend as many as nine hours per day underwater outside their habitat. Since scuba diving makes them essentially weightless, the astronauts have the opportunity to master the skills and perfect the techniques they will need on space walks. Isolation underwater also trains them to focus on complex tasks while maintaining a cautious awareness of the hostile environment surrounding them.

As astronauts venture out along the seafloor, they reel out safety lines from their habitat, which they can follow back if they get disoriented, or lost at night. Small plastic triangles are affixed to the line at regular intervals so that an astronaut can feel the triangle’s point and know which way is home. Much like cave divers, they can’t surface
if they run low on air. Over their heads is an invisible barrier that they can’t penetrate without getting the bends because of their saturated state. The safety lines are then cross-connected to form a spiderweb lying over the reef—a grid that can be used to measure rock formations and to determine the precise locations of plant and animal specimens. The oceanographic work is valuable in its own right since it adds enormously to our understanding of coral reefs, but it is doubly beneficial to astronauts, who will use the techniques they learn here to map the surface of other planets.

Along with their surveying work around Aquarius, astronauts build elaborate lattice frames under the sea, using the weightless environment to further develop the procedures currently being used to construct the International Space Station (ISS). Sections of the station, sent into orbit in compact form, are opened and assembled like an Erector set. During a mock procedure on NEEMO 5 one day in the summer of 2003, astronaut Clay Anderson was trying to enlarge a hole in a plastic pipe so that he could pass a bolt through it. His knife slipped, cutting into the side of his thumb. Realizing, as he said later, that “it was probably not a good thing to be bleeding in shark-infested waters,” he and his “space walk” partner, scientist Emma Hwang, headed quickly back to the habitat. To complicate matters further, the team was scheduled to hold a live videocast that same afternoon with schoolchildren across the United States. The two other astronauts had to handle the videocast, since bleeding in front of a TV camera might have been a bit distracting for the young students. And as if that weren’t enough, in the middle of the videocast Aquarius suffered a power failure. Though the reserve battery kicked in immediately, the station was now functioning on reduced power. Anderson and Hwang called topside to the Navy doctor on standby, Jay Sourbeer. Dr. Sourbeer happened to be on a support boat almost directly above the habitat, having just completed two dives with the NEEMO project director, Bill Todd, the science manager, Otto Rutten, and a visiting diver who had been invited by NASA to observe the NEEMO project because of his interest in extreme medicine. The visiting diver was me. Jay and I conferred by radio with Clay and Emma. From their description, we decided the wound would need stitching. NEEMO
protocol called for maintaining as much isolation as possible within the habitat; there aren’t going to be any guests on a space station. But this was an emergency, and I was a hand surgeon only about 60 feet away. Jay asked me if I wanted to make a house call.

We had already done two dives each, during which I had swum around the habitat—a steel cylinder propped above the seafloor on four stubby legs. The cylinder is about the size and color of a large school bus, with a box-shaped entry port at one end. Several large portholes allowed me to peer inside as the astronauts ate lunch and did the dishes. I had also swum around the reef, observing the grids and markers, the latticework construction, and the “gazebos”—air chambers strategically placed around the site. The divers can enter them to refill their tanks or use them as a safe haven if they have to abandon Aquarius in an emergency. Because of our previous dives, Jay and I were close to the maximum amount of nitrogen we could tolerate without having to decompress. We hadn’t planned for a third dive, so while we waited for a shore boat to arrive with some additional medical supplies, Otto calculated how much time we could safely spend below. We would have fifty-three minutes.

Jay, Otto, and I dove back down toward Aquarius, descending past the vibrant reef on which it stands, surrounded by plants and fish of every color and stripe. I was swimming in an aquarium. Otto directed me to swim up under the entry-port box at the end of the habitat. Suddenly I was out of the aquarium. My head had popped up above a pool of water inside a metal-encased air bubble. A smiling man in a dry T-shirt and shorts was leaning over a railing. He reached out to take my dive gear from me and hung it on the wall—as if we were in a locker room. I stepped up on a metal gate, then onto the deck. “Welcome to Aquarius,” he said. I felt as if I had stepped through a space warp.

We were in the “wet-porch”—the transition zone from sea to inner space. The air within Aquarius exerts enough pressure to prevent seawater from rising up from below, in the same way that air pressure prevents water from spilling out of an inverted glass covered with a piece of cardboard. The result is the “moon pool,” its surface always at deck level, providing open access to the sea. Aquarius needs a floor
not to keep the water out but to support the legs of air-breathing mammals. There were four of us on the wet-porch now. James Talacek, my official greeter, maintained the generators, compressors, and heaters that kept Aquarius humming. He instructed me to use the hot shower in the corner to rinse off the salt water. Then he threw me a big fluffy towel and told me to dry myself thoroughly so that I would carry as little moisture as possible into the already too humid air within the habitat. Jay did the same. We wrapped ourselves in dry towels. Otto stayed on the porch to wait for us and count the minutes.

James pulled a hydraulic lever in the ceiling, opening the hermetically sealed hatchway in front of us, and we stepped into a small entry chamber. There were a sink and counter on one side; on the other were gauges, valves, computers, and tangles of wire. I was thrust, nearly naked, into the twenty-first century. Standing before me was Clay, our wounded astronaut. He was resting his arm on the counter, his thumb over the sink, where Emma was conscientiously irrigating it with fresh water. Emma stepped aside and I took a look. The lighting was a little dim due to the power failure. James found a flashlight and held it overhead.

For the second time in my life, I was operating by flashlight. I thought of Hermanigildo, the little boy who had sliced open his hand trying to clear weeds from under his father’s dugout canoe in the Amazon. Now I was with an astronaut constructing a prototype space station underwater. The two exist at the very opposite extremes of life on our planet, yet their injuries were poignant reminders of how alike and vulnerable we all are.