Memento Mori

Why do people climb mountains? It would seem, at a first glance, that there isn't any obvious tangible gain. It's risky. It's hard. It's cold. There are some who criticize the entire activity for reasons of class, sex or race. There are those who criticize it on the basis of solipsistic egoism. And yet still, every day, countless people set out into the high country for no other reason than to climb a mountain. Certainly, the experience is often set in some of the most beautiful and awesome natural places that exist. Who can not stare up at the soft alpenglow just before sunrise as it illuminates a jagged vista of snowy peaks and not reflect upon the wonder of this beautiful planet?

Then there are the tremendous exertions that must be made. Some days it's just climbing uphill, all day, with crampons and heavy packs strapped on. Sometimes I count my steps as a way to pass the time and gauge the distance covered. "I'll look up after five hundred steps," I tell myself because if I look up after only fifty or a hundred the distance covered doesn't appear to be much at all. That's a real heart-sink. And then, I look down at my boots and count to five hundred. By the time we get to camp, many thousands of mostly uphill steps later, I'm usually exhausted. My day job doesn't prepare me quite as much as I'd like for the average climb but it's mostly a pleasant kind of pain. It is the tender ache of achievement well earned.

Earlier this month my brother and I had the privilege of climbing in the Northern Italian Alps and by the end of five days I had muscles I forgot existed throbbing. My shins were starting to look like I had a serious vitamin C deficiency and every step down in my (unfortunately poorly fitting) boots was agony. "How's the pain cave?" Tom would ask me as he tended to his own raw blisters. Sounds fun, right?

And yet, it is. It's a brief amount of voluntary privation, an escape from the comfort of an otherwise blessed life, that reminds me of my own mortality and physical limits. The hours spent climbing in solitude or resting in one's tent or (in the Alps anyway) hut gives one time to simply think, long and deep and in a way that is difficult to do when we return to the chaos of our busy lives-filled as it is with so many modern distractions. This too, this time to reflect, is for me anyway, a major draw of mountaineering. One of the topics I would often ponder about, as my raw and bloodied shins reminded me, was death.

On the face of it, this sounds quite morbid. But there's a hidden wisdom gained in the effort. Allow me to expand the thought. As an emergency physician, it's not an unusual occurrence that I am witness to death-both natural and violent-and one might consider that this exposure provides me with more time to reflect upon the fragility of our species. And it does. But often in the hectic pell-mell of the emergency department, I don't have the time to unpack what I have just seen or been a part of because the next patient, one who is still very much alive, needs something done urgently and so you move to the next task. This privilege though, of being a part of somebody's life, even if it's the last few minutes only, is a hidden honor that I don't think most people consider when they think about working in the ER. It's a glimpse into another's soul that reminds you of our common and interconnected mortality. It teaches humility and demands honesty. And yet, sometimes in a busy shift we fail to take the time to think upon it. An example from just the other day...

I was taking care of an older woman who had passed out at her place of employment. She was in a hallway stretcher because of how busy we were and was in the process of telling me how she suddenly felt lightheaded when one of our seasoned nurses came up to me, tapped me on the shoulder and with a certain strain in his voice said "Dr. Ross. We need you now."

I looked up and saw a young man coming down the hallway on a stretcher, being pushed quickly by the anxious medics. He was covered in blood and clutching his face, moans of agony gurgling out of him in small, crimson paroxysms of pain. They rolled him into the trauma bay past the poor, little old lady in the hallway whose mouth was now agape in shock.

"What happened?" I asked as I followed them in.

"Shot himself just down the road. A handgun. Small caliber, I think. We got the call, picked him up and came straight on in," came the tense reply.

I looked at the young man clutching at his face. There was an entrance wound below the chin. Blood was pouring out of his mouth as he groaned. Tears were pouring from his eyes.

"Did you shoot yourself?" I asked. He shook his head yes and sobbed, spraying blood and anguished tears into the air in a fine, scarlet mist.

"Open your mouth as wide as you can."

Nurses were establishing IV's. Respiratory therapists were preparing for what would likely be a very difficult airway. I was peering into his mouth where I saw a hole through the back of his tongue and another that went up into the roof of his mouth. On his forehead, above his right eye, there was an object lodged under the skin. I gently touched it. It was hard-likely a ballistics fragment. Somehow, miraculously, the man's eye had been spared.

"Have we got the cric kit ready?"

"We won't need it."

I looked up and saw the trauma surgery team. They had just arrived. Normally this would be their case from nose to toes but there hadn't been time to call them as he'd arrived so suddenly and unexpectedly. But they were here now and they assumed care. One benefit of working in a level one trauma center is that there are teams of experts available and this crew is an incredibly talented group of pros. I smiled, relieved to have them with me at the bedside, but a little disappointed that we hadn't intubated yet. I love a challenge.

Medication was pushed and the patient was sedated and paralyzed. The surgery resident couldn't visualize the vocal cords and time was running out as the patient's oxygen saturation started to drop.

"Give me a scalpel. I'll cric him," I heard the trauma attending say.

She deftly cut his neck and put an endotracheal tube directly into the trachea through the man's throat. We could now breathe for him through it and they prepared to take him to the OR upstairs for more definitive management.

I quietly slipped out the door and washed some of his blood off my forearms before returning to the poor woman in the hallway. I was gone for maybe ten minutes.

"So you were feeling lightheaded at work?" I heard myself say. It was back to business as usual with little time to reflect. It was only much later, at home, that I thought about the case again. We have these reminders of mortality on every shift but quite often we don't have the opportunity to reflect upon them in real time-to organize them coherently and make sense of it all.

At the end of our climb, Tom and I are exhausted and wounded. We have summited 6 peaks. We are supposed to climb Monte Rosa and make it to the top of Dufourspitze, the tallest mountain in Switzerland but we are physically spent and the conditions are icier than we'd prefer. Two days prior a man fell to his death on Dufourspitze. He was alone. He climbed in bad weather. We tell ourselves these rationalizations but we decide this isn't a climb we can probably tackle safely. Luckily, our fantastic guide Alan senses this too. He makes the call for us-we don't have to capitulate (though we would have). I thought of that man, falling for so long and landing somewhere far, far away, on the 16 km hike down the glacier and back to Zermatt. The mountain brings our own mortality home and parks it right in front of you. That reminder teaches you how to live with more urgency and with more wisdom into what really imparts value into our lives and, perhaps just as importantly, what doesn't. In the ER, I see it all the time but haven't the opportunity to really digest it. In the mountains, it is a constant presence and I have all day, step after step after step, to mentally unwind.

Nowadays, most people don't have that opportunity. In the past, most people died at home, surrounded by their families. Today we die in hospitals, surrounded by machines. When we become old, we are packed away into homes for the elderly. We become open secrets and the young do not experience the old in the same type of way they might have in the past. We lose our vital connections to the dying generations that preceded us and we don't know how to prepare for our own inevitable demise. Climbing mountains is thus, in a sense, a memento mori. I'm reminded of my own mortality and fragility but also, ironically, of grit-of the incredible resiliency of the human spirit. Climbing is hard. Dying is harder. We're all going to die one day. We don't all climb but if you have the opportunity, I highly recommend it.

On a happier note, I've decided to publish my new novel, entitled The Meteorite, using the wonderful folks at Palmetto Publishing in Charleston again. It's in the hands of an editor now and I am mulling over cover art but I hope to get the book out soon! Stay tuned!