People generally have great fear of the moribund and would probably hesitate to apply mouth-to-mouth resuscitation to persons who were cyanotic, vomiting, etc.
(Eisenberg, 1997, p. 277)
The Baltoro glacier is a 62 km long river of ice. It flows down from K2, the world’s second highest mountain. The trek to base camp at 18,000 feet is ten days in and ten days out, all of it above tree line, most of it on the glacier itself. It is devoid of trees, animals and insects; the only sounds the wind and the creak of the ice. It is a world of thin clear air, hard blue sky, and sheer, ice-capped granite towers. It is magnificently sterile. We were on our way out, about four days down from base camp. The night previous there had been a three inch snowfall, but that morning the sky had cleared and the sun on the snow was near blinding. I, and the friend who had invited me on the trek, were trudging along the path tramped through the snow by the long line of porters. In front of us, we saw a small group of three porters moving very slowly. In a short time, we had drawn near to them. One of them, apparently sick or injured, was being helped by his two friends. When we caught up, we stopped them. The affected porter was probably in his mid-twenties, and, though he didn’t look particularly ill, was having some trouble breathing. I wasn’t the trip doctor, he was miles ahead with the medical kit, probably already in the next camp, nevertheless, I had a look. The disabled porter told us his name was Iftikar. His colour was good. His respiratory rate, about 20, and pulse, about 80, were a little fast. We stripped off layers of clothing so I could examine his chest. None of us had been out of our clothes for about two weeks. But that morning, in the sun, in spite of being surrounded by snow and ice, the air was warm. There was no evidence of injury. He had good movement to both sides of the chest. You could see his ribs beneath his skin, but he was well muscled and looked generally healthy. I had no stethoscope, so I put my ear against his back and listened to his lungs — on the right, on the left. I could feel his skin hot against my cheek, perhaps a low-grade fever. When I listened to the front of his chest he had good heart sounds with no murmurs or evidence of failure. On the right, low down, at the back, there were a few rattles present on deep inspiration. My buddy, who was also a doctor, then examined him. We decided he probably had the beginnings of a small pneumonia. Though I didn’t have my medical kit, I had a film canister with a small selection of pills in my day pack. I dug out a couple of Keflex, perhaps not the ideal antibiotic, but it would do for now, and a couple of aspirin. I had him take these. We indicated that we would continue with him to camp and there examine him in more detail. But he waved us on with a smile. His friends said they would continue down slowly, stopping and resting as necessary. OK, fine, there really wasn’t much more to be done, so we made arrangements to see him as soon as he got to camp, and went on. We arrived in camp at about four in the afternoon. We had something to eat with the rest of the group; then went and lay in the sun, dozing on some large boulders at the edge of the glacier. Six o’clock, no sign of the sick porter and his friends. Eight and they still weren’t there. We began to worry. Myself, the trek leader, and four porters set off back up the glacier to find them. Nine o’clock and it began to get dark. Still no sign of them. Because of the new snowfall and the possibility of stumbling into a crevasse, we decided it would be unwise to continue. We turned around and headed back to camp. We hoped they’d taken another route and would be waiting for us when we got down. It was pitch black when we got back. They weren’t there. I didn’t sleep much. At daybreak, we started back up the glacier. At about ten in the morning, we found them. They’d not had a tent, but had bedded down in sleeping bags. The sick porter was now wrapped in all three sleeping bags, and the other two porters were brewing tea on a small stove. We went over to the man in the sleeping bag. I felt my stomach drop. This could hardly be the same man we had left behind yesterday. He was awake, breathing very hard. His lips were blue, his skin cold. His chest now, through the stethoscope, sounded like a pot of boiling water, like a spring bubbling up through the ground, like the last of a milkshake being sucked though a straw. In a hospital, back home, with oxygen and 24 hours of antibiotics, he’d be out of danger. Here in the middle of glacier, at least five days from even a stone hut with dung fire, he was a dead man. I started an IV on him and began to run in IV Kefzol. We sent one of the porters back to camp to bring up a tent, food, fuel, whatever we would need to set up camp here. There was nothing to do but sit beside him and keep watch. It was another magnificent day. The sun moved across the valley, firing the snow. When it reached us, it was so warm we stripped him naked and rub him with snow to bring down his fever. I gave another dose of antibiotic at two. At about four, he began to perk up. His breathing was a little easier, his colour had improved and he asked for some water. We sat him up and gave him a few sips. Then he began to cough. The first paroxysms brought up a little phlegm. Then he took a deep breath, coughed, and a fountain of blood erupted from his mouth and nose. As he turned his head away, blood sprayed out over me, over the porters supporting him, and out in a semicircle to the distance of what must have been ten feet. Blood lay beaded and streaked on the snow, bright red in the sun. I won’t say that I’ve never seen so much blood, because I have, coming from lacerated femoral arteries and oesophageal varices and postpartum haemorrhages, but I had never seen so much blood come from someone’s lungs. I was still looking at the blood shining on the snow, when he just fell over dead. That was it, no movement of his chest, no pulse, no heart beat. He was, incredibly, dead. Still looking at the blood and snow, I tore the knitted hat from my head, wiped his face, and blew air into is mouth. But my breath went nowhere. It came back to me in a mouthful of blood. I spat it out and tried again. There was no point. There was but blood where air should be. There was nothing to be done. Nothing even to say. The porters fetched water from the stream that ran along the edge of the glacier; I took a couple of dirty T-shirts from my pack, and the porters used them to wipe the blood, as best they could, from his body, then they wrapped him in the blood stained sleeping bag. The porters and I went over to the little stream, stripped down and washed the blood off ourselves. All glacial melt-water carries large amounts of dust, ‘rock flour’, milled out of the stone over which the glacier has been grinding for centuries. Here in the Baltoro, the underlying rock contains large quantities of mica, and thus the water is not the usual dirty grey, but shining silver. Beautiful, like sparkling metallic paint. As we stood in the sun, using aluminium cooking pots to pour the water over ourselves, little specks of mica caught in our hair and the fine lines of our skin. Even when we dried off, it remained. When you turned your hand this way and that, it sparkled like sun on snow.