By Robert McGarvey
More than five miles above sea level — that’s Mount Everest, with a highest point around 29,000 feet. Snow and ice abound. Winds are ferocious, and the climbing season lasts but weeks because the conditions are too terrible most of the year. But still they come — hundreds of climbers who show up every year with the single-minded intent to scale Mount Everest. Some make it: roughly 2,000 individuals have successfully summited — some numerous times. Others die. And many more are injured in hard falls or simply because their bodies fail to cope with the thinning oxygen supply at this highest spot on the planet. Breathing, in itself, is a challenge, which is why many climbers use supplementary oxygen tanks, but miscalculating the amount of air in a tank can be life-threatening.
Mount Everest is nowhere to be ill. For 50 years following Sir Edmund Hillary’s historic 1953 ascent, there was very little available medical care on the mountain. And evacuation to lower altitudes was itself often dangerous simply because getting anywhere on the side of Mount Everest demands deliberate, cautious action. Some climbing expeditions bring their own physicians, but many climbers simply have to hope they stay healthy because the alternative is grim.
Little by little, however, conditions are improving, mainly because of one woman who set out to bring medical care to Mount Everest — Dr. Luanne Freer, an emergency physician who brings critical medical care to both the climbers and their Sherpa helpers (Sherpas are the indigenous people who live at very high altitudes in Nepal, and some of them earn their living helping climbers make it to the top of the world). “What we’re doing benefits both the climbers and the Sherpas,” says Dr. Freer. “They needed expert health care, and they did not have it until we set up our clinic.”
At an altitude of 18,000 feet, Dr. Freer’s Everest Base Camp Medical Clinic consists of a 12- x 20-foot tent. The base camp is where climbers start and return and stage their climbs. There are four higher elevation camps above the base camp, but those aren’t equipped for medical emergencies. It is also where they return for help, sometimes because they desperately need urgent medical attention. “This is medicine without a safety net, and no patient has died in our clinic,” says Dr. Freer with both pride and relief. She has operated the base camp clinic since 2003, and certainly people have died on Mount Everest in those years. “Usually they die higher up the mountain, in horrible falls,” she says. But when a sick or injured climber or Sherpa makes it to Dr. Freer’s clinic, odds are high that she and her team of volunteer assistants will somehow find a way to stabilize the patient. “That is what wilderness medicine comes down to: thinking very outside the box,” Dr. Freer adds. “Our aim is to give the best care we can, even though we’re practicing emergency medicine in a very unusual setting.”
It isn’t always easy. Dr. Freer never knows what a day at the clinic will bring. She has pulled infected teeth (she’s no dentist, but she improvised to help a Sherpa in terrible pain), set broken arms, treated severe frostbite, and dealt with the range of altitude-related disorders such as HAPE (high-altitude pulmonary edema), a life-threatening sickness that hits 
some climbers very hard when their bodies react badly to the thin mountain air.
The real challenge, though, is the equipment. Medicine freezes solid, tubing snaps in the icy winds, batteries die — nothing is exactly predictable at the base camp clinic. “There is no rule book that says, ‘when you’re at 18,000 feet and this happens, do x.’” Dr. Freer remembers having a patient’s friend sit on the patient’s bed while she ran IV tubing down the sleeve of the friend’s down jacket to try to keep the line from freezing. “And it worked! That’s what we often must do: we have to be creative in providing safe alternatives to what would be considered traditional care in a traditional setting,” says Dr. Freer, whose day job is at Medcor, Inc., and as a medical director for both Yellowstone National Park and Midway Atoll national wildlife refuge.
Come mid-March, however, Dr. Freer is in Nepal, getting ready for the climbing season. By the first week of April, the clinic is open, and Dr. Freer stays on the mountain until climbing is finished, or May 31, whichever comes first. “It’s all weather dependent,” she says.
Just how did Dr. Freer get involved in delivering emergency medicine on Mount Everest? Serendipity, really — just plain luck. In 1999, she gave a speech at a meeting of the Wilderness Medical Society. Afterward, a fellow came up to her and told her he was organizing a trip to Nepal that left in 19 days. He asked if she wanted to come. “When this opportunity presented itself, I felt destiny was staring me in the face. I had always wanted to go to Nepal, to the region around Mount Everest,” she recalls.
Dr. Freer fell in love with what she saw: the austerely gorgeous landscapes and the stoic nobility of the Sherpas. When she got home from that trip, she immediately resolved to go again and, in 2002, she volunteered at a medical post for the Himalayan Rescue Association. This time it was to spend three and a half months living in a Sherpa village at 14,000 feet. “That’s when I came up with the idea of putting a clinic at base camp,” she says. “The need for a physician with experience in wilderness medicine was compelling.”
Many Sherpas would literally have to travel for days from their homes to get medical care. Maladies such as broken arms, pneumonia, and worse go untreated. Dr. Freer instantly saw where she could help, and setting up the clinic gave her a high profile that helps her attract support. “The real mission of the clinic is to subsidize health care for the Sherpas,” says Dr. Freer. “They have hardly anything available to them.”
Dr. Freer, however, is not there to personally climb Mount Everest. She had not gone higher than around 20,000 feet when she became sick with HAPE. And she has no real interest in making it to Everest’s top. “The reality is that I am there for the Sherpa people. It has nothing to do with climbing the mountain.
“I consider myself very lucky. I get to be out in nature where I want to be, practicing medicine in a very personal way like the television character Marcus Welby did. I’m helping people out of their pain, doing what’s best for them. And maybe at night I’m sleeping in a tent on a block of ice, but it is work that is very satisfying.”