PellucidWombat wrote:

MoapaPk wrote:OK, I said I'd shut up, but one last comment:
http://www.high-altitude-medicine.com/A ... .html#HACE
"I have not yet seen a case of HACE in which the patient didn't ascend with AMS symptoms."
(Not my words.)

Personally I saw just one case where the person was supposedly diagnosed with HACE. I always heard that HACE was the endpoint of AMS, and the person usually presents with the familiar symptoms of AMS beforehand. In the case I saw, the person had been vomiting and had a severe headache, and eventually was totally unable to walk; but the other symptoms had been going on for at least 2 hours.

One thing that frustrates me and has me wondering what happened is thinking about AMS symptoms. Not only had Tom been at or above 10-14,000 ft several times this winter with no problems, but on Shasta he was showing signs of good acclimatization all the way to the summit. He and I were both stronger and felt better ascending the Whitney Glacier Saturday than we had Friday when we climbed the Bolam Glacier to ca. 14,000 ft. Tom was urinating clear and frequently over Friday and Saturday, and when climbing technical ice in the icefall, he had plenty of energy and coordination.

As I think back, I can only recall symptoms of improving acclimatization, rather than any signs of AMS.

That lends credibility to the 'sudden event' theory, which doesn't mean that you immediately keel over, bur rather that your symptoms rapidly deteriorate. Hopefully the autopsy results will give you the peace and answers that you seek.

Frankly, when the first (probably inaccurate) reports came down, I thought it was HACE. What I've really been trying to convey is this: with all the possibilities suggested, PellucidWombat did as much as he could have to save his friend's life, and more than most would do.

When my mother died, I agonized over what I might have done differently; every day was fraught with a few moments of "if only I had..." But the truth is, I could have done nothing. I ended up writing two articles on CNS fluid circulation, and that was a little cathartic.

PellucidWombat wrote:One thing that frustrates me and has me wondering what happened is thinking about AMS symptoms. Not only had Tom been at or above 10-14,000 ft several times this winter with no problems, but on Shasta he was showing signs of good acclimatization all the way to the summit. He and I were both stronger and felt better ascending the Whitney Glacier Saturday than we had Friday when we climbed the Bolam Glacier to ca. 14,000 ft. Tom was urinating clear and frequently over Friday and Saturday, and when climbing technical ice in the icefall, he had plenty of energy and coordination.

As I think back, I can only recall symptoms of improving acclimatization, rather than any signs of AMS.

Hi Mark.

Again I'd like to say how sorry I am to hear of Thomas' passing and my thoughts go out to all of you. It's nice to see all the support from your fellow SP members, the climbing community and others. I lost a climbing partner about a year ago and can sympathize, to some extent, with what you're going through. Like many have stated I think you did all you could to help him but only you can come to terms with that over time. I won't speculate on what happened physically to Thomas but I hope the following information helps you work through this and perhaps it may be a benefit to others as well. Below is a link to the Lake Louise AMS worksheet developed by Thomas E. Dietz, MD, Emergency & Wilderness Medicine.

http://www.high-altitude-medicine.com/A ... sheet.html

Using this if a climber scores 1-3 (mild) the recommendation is to drink fluids, take painkillers and rest. A score of 4-6 (moderate) it's recommended that the climber drink fluids, take painkillers and postpone any further ascent until better. A score of 7+ (severe) calls for immediate descent. From your post it doesn't sound like Thomas was having problems acclimatizing.

For anyone interested more information is available here:

http://www.high-altitude-medicine.com/

Symptoms:

1.Headache:
No headache 0 _0___
Mild headache 1 ____
Moderate headache 2 ____
Severe, incapacitating 3 ____

2.GI:
No GI symptoms 0 _0___ (actually, when we were willing ourselves out of our packs, he was snacking on food while I just didn't feel like eating)
Poor appetite or nausea 1 ____
Moderate nausea or vomiting 2 ____
Severe N&V, incapacitating 3 ____ _

3.Fatigue/weak:
Not tired or weak 0 __0__ We both reported feeling better on the second day. On our ascent he went out of his way to climb up and down the seracs for fun at the icefalls at 11,000 ft and 11,600 ft.
Mild fatigue/weakness 1 ____
Moderate fatigue/weakness 2 ____
Severe F/W, incapacitating 3 ____

4.Dizzy/lightheaded:
Not dizzy 0 __0__ On our ascent he went out of his way to climb up and down the seracs for fun at the icefalls at 11,000 ft and 11,600 ft.
Mild dizziness 1 ____
Moderate dizziness 2 ____
Severe, incapacitating 3 ____

5.Difficulty sleeping:
Slept well as usual 0 __0__ Slept as well as I did in that exposure - about a half-hour at a time. He slept well the night before at the 9,800 ft camp too.
Did not sleep as well as usual 1 ____
Woke many times, poor night's sleep 2 ____
Could not sleep at all 3 ____

Symptom Score:
__0__

Clinical Assessment:

6.Change in mental status:
No change 0 _before 8am___
Lethargy/lassitude 1 _8-9am?___
Disoriented/confused 2 _10 am___
Stupor/semiconsciousness 3 __12-1pm__ (unconsciousness by 3pm)

7.Ataxia(heel to toe walking):
No ataxia 0 __before 8am__
Maneuvers to maintain balance 1 _X___
Steps off line 2 __X__
Falls down 3 _8-9am?___
Can't stand 4 __10am__

8.Peripheral edema:
No edema 0 __0__ I saw now signs of swelling or fluid retention at any time.
One location 1 ____
Two or more locations 2 ____

Clinical Assessment Score:
____ ____ ____ ____ ____
Total Score:
____ ____ ____ ____ ____

P Wombat

While none of us really know what you are going through, I think I understand your desire to dissect the situation and to possibly figure out where it went wrong. It appears that with every fact that becomes revealed, the situation becomes more a case of something that went bad that was completley out of your control versus the usual tale of somebody ignoring warning signs. To help bring the eventual closure of the situation for yourself and for my/our curiosity I do hope that the ultimate cause of this tragedy is revealed, but to reiterate what has been said many times already, it appears you acted responsibly in every way. Godspeed in your emotional healing.

PellucidWombat wrote:also, as far as speculation as to what happened to Tom. I hope the autopsy leaves us all with a straightforward answer, but if it does not, I really want to know what happened for my own peace of mind. Many of the symptoms were those of HACE (he showed just about every symptom I've seen listed, and then some), but there were some inconsistencies and a lot of the circumstantial details that make me suspect it wasn't just HACE acting alone in a typical way.

I would really appreciate it if someone could refer me to or connect me with a knowledgeable doctor or researcher on the subject of high altitude ailments, neural ailments, etc. with whom I can go over in detail all of the symptoms and their rough timelines between the sudden appearance of symptoms in Tom and his death.

P. Wombat

My deepest condolences.

You can try to contact the wilderness medical society. Many of the most current docs and researchers in the field of high altitude medicine are affiliated with the group and they could probably get you in touch with some of them.

http://wms.org/

One thing is perfectly clear, Mark, and that is that you are not going through this alone. Many, many of us agonized, hoped, prayed for a different outcome. Sadly, that didn't happen, and there's nothing for it but to forge on ahead through life. You'll never forget, but the immediacy will, over time, become less searing. Keep at it, that's what Tom would wish you to do! My personal feeling is that Tom was blessed with a great climbing partner and friend, and I'm willing to bet that realization was one of his last thoughts, one providing him with great comfort. Someone else has already said this, but I'm going to repeat it: I'd be honored to climb with you. Any time.

Mark,
It's been a while since we have seen each other. My condolences to you and your friend's family. I certainly think you did everything correctly for your friend and then for yourself, when it became apparent, that you couldn't do anything more for him. What a horrible situation to be in, and how much soul searching you must have done, before taking the action you did!

I will be very interested to hear the true cause of death - doesn't really seem like it was altitude sickness. I have a cousin (aged 50) and the son of a friend (aged 20) who both died suddenly of a cerebral embolism - not out of the question in this case..

Moni

Mark,
I can't imagine what it would be like to see someone deteriorate so quickly in front of my eyes. With such a quick onset I don't think anything could have saved Tom. Under the difficult circumstances you were faced with, I feel you took the best course of action.

-Josh

I am so sorry to hear this.

"When an accident occurs, something may emerge of lasting value, for the human spirit may rise to its greatest heights."
Sir John Hunt, leader of the '53 Everest expedition

My thoughts are with you Mark, and Tom's family as well.

This is indeed very sad. It is hard to find words. Condolences to Tom's family and Mark I hope you feel better.

Sorry to hear you lost your friend, Mark. Hope you are doing well.

Unfortunately, the autopsy was not able to determine the cause of death. They are waiting for the lab tests to be done, which could take 6 weeks.

Source.

They would need to do an MRI of the lower skull for unambiguous signs of a brain-stem stroke, perhaps a good spiral CT. Not clear if they have done those tests. An MRA is probably not useful on a dead person, as the blood is not moving.