Mountain Competence

Words and Photos by Ethan Vimont

I have a strange propensity to find myself in situations in which somebody else is in way over their head, and is desperate for competent help.  There was the lost, diabetic mountain biker who had ditched his bike and had started walking with no food in the hopes of finding help. The nearest town was a good 30 miles. Then there was the family who was arrived late in the afternoon at a rappel in a slot canyon without gear, no way to get back up the slippery canyon they had come down, and a fear of heights verging on terror. They were too big to fit into the largest harness our group had, so we had to get creative.

Most recently, while acclimatizing for a climb in the Himalayas I came across a man at one of the teahouses in serious trouble…

I reached the top of the Thorung La for the second time in as many days, and continued down to High Camp at 4,800m.  Around 5 PM I got up to use the restroom.  Light was just starting to fade, and the gentle snow was starting to pick up.  As I walked out of the outhouse, I heard a guy yelling, “Alex! Alex!”  A group of people had clustered around a man lying face down in the mud.  One man rushed over and dumped some icy water on the collapsed man’s head.  “Oh boy,” I thought, and then went over and told them to stop dumping freezing water on the guy in the sub-freezing temperatures.  Another person and I got one of Alex’s arms around our shoulders, dragged him indoors, and sat him up on the floor.  A little Nepali guy, who turned out to be his guide, was saying, “Alex, tu m’entends? Tu m’entends?” (Can you hear me?)

“Oui,” mumbled Alex, though I guess he could have said anything.  It really was more of an “Unh.”  His eyes were not focused, and he was drooling a bit.

By this time, Alex’s French companions had arrived and started babbling French at him.  One young lady elevated his feet.  Very strange, maybe she saw it in a movie.  The guide was cradling Alex’s upper body with shaking hands.  He was clearly getting generous doses of adrenaline, and telling someone to get Alex a Coke.  Someone else said in Nepali, “He needs garlic soup.”

“Hey, hey,” I kept saying repeatedly while tapping the guides arm.  He finally looked at me.

“Tapai usko guide ho?” I ask. (Are you his guide?)

“Hajur,” he replies. (Yes.)

“Ani usko tauko dukhyo?” (And does his head hurt?)  Our conversation continues in Nepali.

“His head hurt this morning down in Yak Kharka (around 4,100m), so he took a horse up to High Camp.  He slept most of the day, and when I went to get him up for dinner this happened.  But only his head hurt, his stomach was fine.”

Obviously, my eyebrows were trying to climb off the top of my head in astonishment.  Every choice in the above statement was the wrong choice, and a guide should have known better. This was almost certainly High Altitude Cerebral Edema (HACE), and this guy was in serious trouble.  The guide started feeding Alex some Coke, and discussing whether he should have tea or soup.

I told the guide, “This is dangerous.  He needs to go down.  Now. Tea and soup will do nothing.  He needs to go down.” Since my Nepali is far better than my French, I told the guide to ask Alex if he is breathing okay.  He was.  I didn’t hear any gurgling in the lungs, so likely there was no pulmonary edema as well.

The guide says, “We have a horse.”

“Well, get your horse,” I say.

At this point, I looked around and saw one of Alex’s friends standing there shaking.  I realized my hands were shaking.  This was scary.  I nodded to the lady holding Alex’s legs up, and motioned to put the legs down.  “It’s okay.”

She complied, and then looked at me as if to ask, “What next?”  

While I was thinking, the horse handler came and said, “It’s snowing too hard.  It’s too slippery for the horse with a heavy load.”

“Okay, what is here that we can carry him,” I asked.  “Are there some pieces of wood and a sheet? Or anything?”

“Oh, we have a stretcher,” someone said.

“Get it!” I said.  “He needs to go down quickly.  He needs oxygen.”

“This place has some little oxygen bottles,” the lodge manager put in.  

My God.  What else do they have that is exactly what Alex needs?  Do they have a hospital stashed in here somewhere?

“Get one,” said the guide.

“They’re 2,000 rupees each.”

“Doesn’t matter, I’ll pay,” the guide snapped.

We got this strange bottle of oxygen covered in Chinese characters, and figured out a system to time the breathing process to maximize the oxygen usage at regular intervals.

The stretcher arrived, and we laid Alex down.  A few people got their hands under him.  “One, two, three,” I said, and we lifted him onto the stretcher.  “Zip up his jacket.  He needs a blanket,” I said.

“I have an emergency blanket,” said one by-stander.

“So do I,” said the guide, and he barked an order to his porter to get the blanket, his backpack, and Alex’s backpack.

I’ve now realized that I should go with the stretcher, so I lace up my boots.  Other helpful people got Alex wrapped in the space blanket and someone found some straps to tie him to the stretcher.  Good thinking, that.  I hadn’t thought of it, but they were very necessary on the treacherous trail down.  Four local folks got Alex lifted up, and I asked the guide, “Do you want me to come?” I already knew the answer.


“Okay, I need to grab some things, and I’ll meet you.”

I grabbed a shell and some gloves, while managing to forget my headlamp.  I ran to catch up with the group about 20m down the trail.  I took up a spot in the middle of one side of the stretcher.  We were a team of six, four Nepalis and two foreigners, plus the guide and the porter carrying gear.  The trail was narrow, steep, slippery, and had plenty of tricky switchbacks.  I was basically slipping my way down, as we were moving quite fast.

“Slowly, slowly,” I said to the Nepalis.  The other foreigner was opposite my position, and I kept catching his eye as we walked down.

About five minutes in, the Nepalis stopped, and we put the stretcher down.

“Okay.  Let’s discuss how much we’re getting paid.”

I was flabbergasted, but after thinking about it, it does sort of make sense.  These local guys probably see some idiot foreigner sick every month or so, and their lives are hard enough without having to volunteer to carry someone down the pass in the dark.

The guide says, “Money is nothing. How much do you want?”

“15,000 rupees (about $150) each.”


Then we picked up the stretcher and continued on.  Every time someone got tired, we set the stretcher down, and I gave Alex some oxygen.

“Ready?” Deep breath in while releasing oxygen, breath out.  Repeat.  Each time the oxygen was given the effect was instantaneous.  Alex’s eyes cleared up, and he said, in very clear French, something like, “I feel better.”  A minute later, he was back to dull eyes, and barely mumbling “Oui” when someone said “Alex, ça va?” 

A little ways down the pass, I looked at the other foreigner and asked his name.


“Ethan, where are you from?”

“The States, Illinois.”

I had assumed he was one of Alex’s friends from France, but it turned out that none of his friends came along.  Just after this we got some dexamethasone, a powerful steroid, from a helpful lodge owner.

We gave Alex the “dexy” orally, and continued on our way.  As we headed down, various Nepali folks came out of the dark with lights.  Some helped carry for a bit, and others just gave us lights.  Stretches of the trail were very narrow, with precipitous drops into the river on one side.  At these sections we set Alex down very carefully, and only two people would carry the stretcher through the narrow spot.  The Nepalis were so sure footed!

Around 8 pm, after dropping 700m we reached a town.  We decided that we needed something to eat, or as the local guys said, “It’s time for some biscuits and alcohol.”  (The guide talked them out of the latter until they had taken Alex further down). 

Guy and I decided to stay put. Alex was doing better, the guide was convinced to continue to a lower elevation, I had shown him my technique for giving oxygen, and we were exhausted.  I had climbed from 4,100m on the other side of the 5,400m pass, and was now at the elevation from which I had started.

It all worked out as Alex survived, though he might not have if a person competent in mountain travel and medicine had not been there.  He would have never gone through this with some basic research. 

Happily for me, despite the acclimatization delay and after several attempts in previous years, I summited my first Himalayan peak over 20,000 feet, and did it solo.

Check out some of Ethan’s training routes in the States that he did to prep for the Himalayas”


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