There were an awful lot of things in Nepal I thought might kill me. Just landing at the Kathmandu airport was a bit hair-raising. Then I did some white-water rafting. I rode an old Royal Enfield through the mountains, careening around hairpin turns and sputtering down steep dirt paths. I went paragliding. I took more than one brain-scrambling bus ride along a dirt road hugging the edge of a cliff. Rappelling down a waterfall, my feet slipped on the wet rocks and I ended up with a bloodied-up hand. And the comically slow wi-fi speeds and constant power outages could very well have driven me to death by defenestration.
None of these thing even came close to being as fatal is it felt. The thing that did—well, I barely even noticed it was happening.
Let’s go see some mountains!
I met up with a friend in Nepal, planning to do a bit of exploring and then head out on an independent seven-day trekking tour in the Langtang valley. It looked pretty, a bit less well-trodden than the Annapurna circuit, and we’d get to see glimpses of Tibetan culture without getting China angry. We spent a couple of weeks in Pokhara and then headed back to Kathmandu to get started on our trek.
I genuinely thought the bus ride from Kathmandu to Syabrubesi would kill me. It takes somewhere around nine hours to travel a mere 150km, most of which takes place on dirt roads that cling to the side of steep mountains. The buses have all the suspension and grace of a go-cart, and they’re often overloaded with extra people, packages, and goats—both on top of the bus and inside it. The roads redefine “potholed” and are subject to landslides and washouts, depending on the season. The roads aren’t wide enough for two cars at once, so people hang off the side of the vehicle and use a system of knocks to communicate with the driver. On a particularly sharp corner, we saw a bus carcass lying far below in the gorge.
I’ve been on a great many uncomfortable and terrifying bus rides in my travels, but this one by far took the cake. Not just took the cake, but devoured it, smeared icing all over its face, and laughed maniacally in my face.
So as we started heading up to higher ground, I was more worried about the inevitable ride back than I was about anything those mountains might throw at me. We spent our first night at 1800m in Barabal, an absolutely tiny place with no other trekkers, and the second in Bamboo (2100m).
When it all started to go pear-shaped…
Before we left Bamboo that morning, I threw up a few times. I took that as a sign to take some Diamox and start drinking more water. I felt mostly fine, so we headed off for another six hours hiking uphill, stopping for the night when we reached Ghora Tabela (2900m). The next morning, I felt nauseated, but I didn’t have a headache, so I figured the Diamox was doing its magic and I was acclimatizing alright.
Once you leave Ghora Tabela, the forest gives way to wide, “flat” (don’t believe anyone when they tell you a path is “flat” in Nepal; “flat” is just code for “not vertical”) panoramas surrounded by huge snow-capped peaks. It was gorgeous, and after three days of forest, I was happy for a change of scenery. I was still nauseated and I had the trails of a headache coming on, but I felt okay to keep going, so we started out.
We’d nearly reached Langtang (3500m) when I started slurring my words. We stopped for a rest, and I realized I was having a lot of troubles taking things in and out of my backpack. I chalked this up to exhaustion, but I think my trek-mate was concerned. Once I stopped being capable of walking in a straight line, he decided something wasn’t quite right, turned me around, and we started heading back downhill.
It was like I had all the shitty parts of being drunk and being hungover, without the deliciousness of wine: I couldn’t focus; I couldn’t walk straight, or speak without slurring; I had a headache kept throwing up; I couldn’t function quite right. But I felt great: energetic and chatty and just a tiny bit stumbly.
About an hour later, we ran into a man who worked as some kind of EMT in the US park ranger service. He took one look at me, asked “Does she normally talk like this?” and then got an extremely concerned look on his face. He asked me to close my eyes and touch my nose with my finger. I was pretty sure I’d passed this test, which I guess meant I was fine and I should stop being such a weakling and get my butt back up the mountain.
I later learned that I apparently completed this task with all the grace and agility of a newborn puppy on LSD. When I opened my eyes, the stranger was giving my friend some highly-illegal dexamethasone, along with strict instructions that, were I to pass out, he was to put one under my tongue and it would buy us another four hours of me-be-conscious in order to keep hiking. He told us to just keep walking down, and not to stop until I quit acting like a crazy drunkard, even if it got dark, which would have been pretty treacherous in and of itself. He told me I had all the classic signs of a cerebral edema.
My friend was a lifesaver. He refused to let me carry my own backpack, and refused to let me stop for anything. We kept on trudging down for a few more hours, and by 2500m, I was walking in a straight line again. The term “come down” has never felt quite as literal as it did then.
Once my head was on straight again, we stopped for the night, and suddenly it hit me how badly that whole thing could have gone. If I hadn’t had someone with me, I might never have turned around, and while technically there are a couple of army helicopter landing pads in some of the bigger settlements, the logistics of getting me back down once I’d passed out would have been pretty nightmarish, if not downright impossible.
Let’s talk about altitude sickness
HACE (high-altitude cerebral edema, where your brain swells) is a rare condition, especially at the altitudes I was at. HAPE (high-altitude pulmonary edema, where your lungs fill with fluid) is the more common progression of AMS (acute mountain sickness, sucky but not life-threatening). Both conditions will kill you like it’s their job and they’re in line for a big promotion. In the case of HACE, which is what I had, most people die within twenty-four hours, and they fall into a coma before that. Basically, you have a few hours to descend before things start getting catastrophic.
Mountain sickness doesn’t discriminate based on age, fitness levels, or overall health: there’s no real way of telling who will get it and who won’t, and having it once doesn’t mean you’ll get it again (or vice-versa.) Diamox will help your body acclimatize more rapidly, but the only cure for HACE or HAPE is to get back down to somewhere where the air has more oxygen—something that’s often a challenge when you’re up in the mountains, with limited access to basically anything.
If you’re planning to trek in Nepal, or generally hang out anywhere above 1500m: read this article. Twice. Make sure to drink lots of water. Bring some Diamox. Hold off on the booze. Pay attention to how much you ascend each night. If you start experiencing symptoms of AMS, drink a litre of water and stop ascending until you feel better. (If your headache goes away after the water, you’re just dehydrated. Drink more water!) If you start experiencing symptoms of HACE (slurred speech, confusion, loopy walking, general drunk-acting) or HAPE (rattling breath, wet or bloody cough, breathlessness, fast breathing or heart rate not caused by exercise), head for lower ground immediately. Do not stop, do not pass Go, just keep walking until you’re not sick anymore.
I count myself extremely lucky. Had I not had people with me who recognized I was sick and helped me out, my story may have ended on a very different note. I’d read up on altitude sickness time and time over again, and I was doing everything right to prevent it, it still hit me, and I didn’t even realize what was happening when it did.
I’d like to go back up into the mountains, and this experience hasn’t scared me off of them. But for now: I think I’ll be sticking at sea level for a while.