Too High, Too Fast on the Pacific Crest Trail

On Tuesday May 19, 2015, after waiting out weather for 4 days in Lone Pine California (elevation 3700'), our host drove three of us up to Onion Valley 9,200' from which I hiked with energy to Matlock Lake 10,000' where we camped--my resting heart rate was 90-100 and snow fell for 30 minutes--water in our bottles didn't freeze overnight. My HR is usually in the 50's. The spreader bars on my bridge hammock poked holes in my polycro tarp--after repairs I decided to ground camp for the remainder of this leg of the trip. Wednesday we hiked over Kearsarge Pass 11,200'.  After Glen Pass 12,100', the trail brought us to camp at 9,500'.  I trailed the other two by at least an hour. Thursday we hiked down to the Paradise Valley Trail junction at 8,500. I tired easily as I worked my way toward Pinchot Pass 12,100'. I'd rest after 10-20 steps.  Hiker Patriot, passed me and at a rest stop, he pulled out a bronchodilator and inhaled, then hoisted his pack and soon disappeared on the trail toward Pinchot--because I had a history of asthma, I thought, "maybe I need a bronchodilator."  A mile before the pass, hiker Kinetic, who had started a day later, caught up with me and said that Michael, a mutual friend, had stayed in town to recover from the "flu".  After Pinchot Pass, it took a great effort and much time to hike down a snow covered trail to camp Friday at 10,062 next to the Kings River.  I began to cough that evening. I thought I, too, had the "flu", or bronchitis.  The next morning, someone asked if I had nausea or vomiting like Michael did.  I didn't--that along with seeing my red, orange color sputum made me less confident of my having the flu or bronchitis. Yet, because my sputum wasn't foamy as I'd thought pulmonary edema would look, I didn't yet suspect High Altitude Pulmonary Edema HAPE.  Friday May 22, I stayed in camp for two hours after the rest of the party had left.  I eventually packed my gear, made my way across the Kings River and walked two miles, ascending 600' and stopped, too fatigued to continue.  I entertained returning to the last night's camp, but hadn't the energy to do that.  I made camp on a site with a small amount of moisture in the soil. Two inches of snow fell that night.  I noticed more shortness of breath and a percolating sound while both inhaling and exhaling when I laid down--I coughed and spit more than when sitting up. I sat up and closed my eyes for much of the night.  I thought about hiking the next day to Mather Pass (12,100') and down to 8,000' which would be at least 10 miles. 
I awoke, if I slept.  I filled a water bottle from the stream twenty yards away, returning exhausted. Hikers came by. I said I had bronchitis and/or HAPE.  Hiker Sage offered to walk me out, but cancelled when he saw my poor condition. Both or us knew I'd never get out on my own power. He took my information to relay to Search and Rescue when he got to Bishop. Hiker Stop&Go took my information to relay when he got to Vermilion Valley Resort. I made camp again at the same site. That night Saturday May 23, 4" of snow fell, accumulating on the sides of my shelter, pressing in on the peak and on the walls.  Enough snow melted that water pooled on the ground around me, wetting all but my sleeping bag--only my 2.5" air mattress kept me dry and warm.  In the morning, I wiggled out of the tunnel that my shelter had become and watched as the sun pulled into a clear blue sky, blasting at the snow that had almost sealed the land.  I cleared snow off some rocks in preparation for drying my gear, again exhausting myself. 

A very wet campsite.

Hikers Indie and Breathless arrived, answering my question, "do you have a satellite phone."  Indie had a Delorme inReach, which permitted texting to an intermediary--after some communication about my condition, a National Park helicopter arrived in about 3 hours. My heart rate improved somewhat to 70/ minute, but my respiratory rate stayed at 35/minute (normal is 20).
The helicopter took me to the Park helipad on the west side of the Sierra.  I was fully alert and enjoyed the scenery.  An ambulance took me to Kaweah Delta Healthcare District hospital in Visalia, CA. The paramedic started a saline lock. At the hospital at much lower elevation, I felt much better.  Techs attacked me with blood draws, ECG and doctors listened to my chest.  I told my story and said I had HAPE. One doctor said I had an abnormal ECG and elevated cardiac tropinin.  I had no chest pain through the entire event and said so. The doctors still put me on schedule for an echocardiogram and a thallium stress test.  A doctor wrote an order, "npo, nothing by mouth," sending me to the cardiac unit.  They shot me up with Bumex and Lasix (diuretics) and gave me a shot of Lovenox (anti coagulant, like heparin, to prevent blood clots) but I refused to take Lipitor, a stool softener and a second dose of aspirin. Monday, I had the echocardiogram and waited for the thallium stress test.  I felt thirsty and hungry and by 10 a.m. I demanded either an intravenous solution or to be allowed to go to breakfast. They ordered a meal tray from food service, which didn't arrive in five minutes, so I went down to the cafeteria and bought my breakfast. I had cereal, fruits, potato patties, sausage, eggs and milk. I bought a chicken Caesar's salad for later.
Following my return, Dr. Harry Lively (his real name!), the cardiologist, cancelled the stress test, saying that my having hiked 813 miles was a successful stress test.  Minutes later, he changed his mind citing the ECG and cardiac troponin levels, saying that I now needed a cardiac catheterization. Confused and frightened, I signed the consent. At 3 p.m. I had the procedure, in which the doctor poked a hole in my right femoral artery, passing a tube through that hole up my aorta to my heart, injecting contrast to view my coronary arteries. You could drive a truck through my clean coronary arteries.  Now I had to lie flat for six hours to let the hole in my femoral artery seal off.  
My wife arrived from Washington with for a vanilla shake and a lengua (beef tongue) burrito, per my request. I ate while on my back, spilling very little, but taking two hours to finish it. A nurse began to re-apply Nitroglycerin paste to my shoulder. I refused it, saying, "I'm not a cardiac patient." I refused another shot of Lovenox, Bumex and all the medications I had refused before.  Curious about the effect of HAPE on one's ECG and cardiac troponin. I googled that on my phone and what I saw told me that I didn't have a very well informed health care team. The ECG will be abnormal and troponin isn't very specific for heart damage. I felt bad for the nurses as they actually had more interest in getting things right for their patients. Those doctors had violated several rules in medicine: The history and physical tells the diagnosis more than any laboratory result or ECG; Don't subject patients to risky procedures; and you'd better have a damn good reason to give a patient more than one diagnosis.
My advice for anyone evacuated for HAPE with more than two working neurons: When you get down to a lower elevation, either demand a teaching hospital like UC Davis or a hospital that treats HAPE frequently. Failing that, just go to the Best Western Motel and enjoy the hell out of life, because you will live long.  If you see Kaweah Delta Healthcare District hospital, PLEASE run away!