Day 4: The Hubris of Himalayan Mountain Itineraries, #MM4MM

Today was the day we were going to the mountain.

The itinerary was clear: fly from Kathmandu to Lukla and then hike 3 miles downhill to Phakding.

It didn’t work out quite that way.

We woke up at 4:45 for a 5:00 AM breakfast followed by a group picture and a bus ride to the airport.

The Kathmandu International Airport is chaos personified. Noise. Cars. Monkeys.

We got in something that resembled a line and then we went through something that resembled security while people were pushing from all sides. Security was a decidedly informal affair. You did not need to take your shoes off. Liquids were fine. My metal detector flashed red from my phone in the pocket, I was waved though. After we got through security we moved to another room where we checked the luggage.

It was here that we saw that the flights to Lukla were delayed due to wind. We waited in that room for about 2 hours before the sign gets taken down and Lukla is open for business. We then go through another round of security. This one is much more fastidious with a few of our team having pocket knives confiscated and all of us getting an uncomfortably personal pat down. This put us in the gate area. More waiting.

While waiting, the first flight to Lukla, the one that had already taken off, returned with all of its passengers. The plane flew the 40 minutes to Lukla and couldn’t land. Lukla has one of the world’s shortest runways. It is so short that it pitches up 20 degrees to assist in slowing airplanes down for landing, and accelerating them for take off. To make things even more treacherous the end of the landing strip is a cliff so airplanes can’t easily abort a landing and try again. A landing a Lukla requires total commitment. So the plane made it to Lukla circled around a bit and didn’t attempt a landing due to visibility, or wind, or something, so they returned to Kathmandu.

https://youtu.be/jhvpwDuh3C4

Seeing those people return to the gate took the energy out of the team. We sat around the gate until noon. And they called our number, actually they called half of our numbers, our group is too big to fit on one airplane. Our group left the gate, boarded the bus and drove to the airplane, drunk with excitement.

We arrived at the airplane and the mood deflated. There was a crew of ten maintenance men & women wandering around the plane with the cowling off the left engine. We waited on the bus for about 15 minutes and then turned around and headed back to the terminal. Despite the maintenance crew it was a weather problem. The looks on the team that was waiting for the second airplane when we strolled back in was utter disappointment. It was mirror of our own emotions. The word was they would try to fly again at 2 PM. This was for a 9:00 AM flight.

2 PM approached it became clear that no one was flying to Lukla. But while we were eating moo moos and chow mein, Jim and Bishnu were burning the phones working alternatives. They gathered everybody and told us to leave the gate because we were going by helicopter!

Ooooh Exciting! The helicopter offered the opportunity of skipping past Lukla and landing in the lower, and hence less windy, Phakding. We divided into groups of 6 that weighed less than 540 kg. Nope change that to 520 kg because they wanted a full load of fuel. I tried not to be concerned that the helicopter company was called Fishtail Airlines.

Our group was Ellen, Anne Marie, JP, Stan, Ryan, and myself. We went back through security, including the overly handsy pat down, loaded into a van, and drove out to another part of the airport and…waited. But this time outside. Our helicopter landed, and was refueled. By gravity.

Then we were told it was too windy and if we couldn’t leave by three, we would be grounded until four because the whole airspace was being shut down so the prime minister of Pakistan could land (He coming for a two-day state visit). Right before the airspace shut down one helicopter with 6 of our group took off. We, on the other hand remained at our pleasant picnic table eating crackers. We could see another 6 of our group across the runway hanging by their equally grounded helicopter. Then we piled into the van and headed back to the terminal.

There, we figured we would head back to the hotel and take another run at this tomorrow, sans wind and Pakistani prime ministers. But no, Bishnu was not defeated yet. He bullied and cajoled another helicopter crew to take us. These guys were either less safety conscious or more desperate for the dough, but they agreed to take us. We weighed in, this time we were going with 5 people. Ryan was out. Then back through security. Back past the gentle molestation with a smile and out into, not a bus, not a van, but a luggage vehicle. Women in the cab, men with the cargo.

This time was different because we actually got into the aircraft! We took off and flew to Phakding. Except the helicopter wasn’t going to Phakding, it was going to Lukla, something we didn’t realize until we were on the ground bewildered that we were in the wrong place. The helicopter ride was pretty bumpy, pretty scary. We went through clouds with zero visibility. It was a white knuckler to the wrong place.

We texted upon landing we texted our leaders (thank god I bought that local SIM card, because I didn’t have the leaders numbers but Stan did, so he logged onto my hotspot and was able to establish communication) and it turns out another helicopter that landed a few moments ahead of us, also went to Lukla. They had secured rooms at a local tea house, the Namaste Inn. We humped it to the tea house had some masala tea and dinner (fried rice, chips, and vegetarian spring roll). There we learned the what had become of our group. The first helicopter group that left before three, indeed made it to Lukla and did the hike to Phakding. They had to use headlamps to make the final kilometer, as they were hiking in the dark. Two helicopters full of people were in Lukla for the night and would hike to Phakding at first light. Six people didn’t get out of Kathmandu and were back at our previous hotel. They were going to fly to Phakding at 7 and land by 8 the next day. Fingers crossed.

Travel in the Himalayas is not routine and does not follow your itinerary. To think you can schedule when and where you fly is just hubris.

Day 3 of the #MM4MM Trek to Everest Basecamp, a day in Kathmandu

Today was the last day before we begin trekking. As usual I woke up early, though it is getting later and later as my biological time zone catches up to my geographic time zone. I had a decent breakfast with most of the team. After breakfast I needed to replace the toiletries that I left on the bed in Huntington Woods on Thursday.

Ben used the wonders of google maps to find a drug store that turned out to be more of grocery store. I was able to get my deodorant and tooth brush (I had already replace the toothpaste), but Ellen needed a pharmacy so off we went. First north, then south. Past the crazy wedding car. Past the French embassy. And finally, after getting no closer to our goal, and realizing the futility of Google Maps in the twisted streets and back alleys of Kathmandu, we encountered a friendly Sherpa who guided us to a pharmacy. On the way back I bought a local SIM card with 10 gb of data for $22.

Then we had a morning meeting where we went over our equipment and weight limits. The guides and sherpas on our trip are surprisingly hostile to prophylactic acetazolamide while simultaneously extolling the ability of a positive attitude, a swallow of water, and mushroom soup to stave off altitude illness. A number of them support the use of symptomatic acetazolamide. At one point, one of the guides said acetazolamide only treats altitude illness and does not prevent it. I could hold my tongue no longer and blurted out the reference I covered on PBFluids months ago. In this study a randomized, blinded trial was done on the very route we were hiking. It showed that acetazolamide (Diamox) prevented the development of acute mountain sickness, both mild and severe.

The discussion on acetazolamide continued. The discussion on equipment continued. And then we broke up and did final packing. We had lunch and I had my first course of dahl bat. This delicacy of rice and lentils is a mountain staple and will be what fuels the team up to Everest Basecamp.

I loved it. I’m going to be just fine with Nepalese mountain food.

After lunch we gathered to board a bus to go visit the Monkey Temple and Boudhanath Stupa. We were all waiting in the lobby when I realized I had forgotten my sunglasses so I ran up to the room, borrowed the key from the cleaning staff, grabbed my sunglasses, ran back down to the lobby. Empty. Everyone was gone. I figured they must have just left so I walked out of the hotel grounds. Still no peeps. So Plan B: get a passport picture (I needed one for entry to the park and had used my last one getting the SIM card). I figured I’d get the picture then hail a cab and hook up with the group at the Monkey Temple. So I walked to the main drag (I had seen a photo place on our wanderings, looking for a pharmacy that morning) where I bumped into English Paul. Paul had to run out to do some last minute errands but he told me where to catch the crew. So I hustled back to the Radisson parking lot and hopped the bus.

Big mistake. I was at the back of the bus, on a bumpy road, with a belly full of dahl bat. It was hot stuffy and I could barely understand the tour guide. Traffic was terrible and it took an hour to reach Boudhanath Stupa.

The Boudhanath Stupa is a Buddhist religious site. It is a world heritage site. Surrounding the base are prayer wheels. You are supposed to circle the building clockwise and need to circle it only clockwise and an odd number of times. Thankfully 1 is an odd number. We then checked out a Thangka art school. A super knowledgeable proprietor gave an amazing lecture on symbology in the art and the various techniques that the artists use. He showed us how to differentiate a master from a novice. I was able to escape without buying one. (You’re welcome Cathy).

When we got back to the hotel I went for the passport photo. After that I went to the porch where a number of trekkers were hanging out. I brought out my scale, pulse oximeter, and blood pressure cuff and started gathering baseline data on almost everyone in the group for my science experiment. I’m totally going to win the science fair this year. People were really supportive and I got 15 out of 18 of our group to go through baseline data. Really excited for this.

Then we had dinner. And we were all given personalized headbands. I am Detroit Runner.

After dinner I went back to Bablo’s T-shirt emporium and bought a hat.

(That’s not the hat, this is)

I capped off the night by having a drink with an exiled Indian national that now makes his living as an arms dealer, though he preferred the title “defense contractor.” (My favorite part of the encounter was when he answered his phone “Yes General, thanks for calling me back”).

You meet all types at the hotel bar in Kathmandu.

Tomorrow Lukla!

Day 2 of #MM4MM, the trip to Kathmandu

All day I have been trying to think of a funny joke among the line of “What’s an interventional cardiologist’s favorite city? Kathmandu.”

Yeah, yeah, yeah, I know. Keep the day job.

I woke up at 1:00 AM

Went back to bed until 3:00 AM

Got up and started my day.

Figured out to use the origami coffee bags. Very cool.

Went down for breakfast. What a feast. The Korean breakfast at Paradise City was awesome. They had this noodle bar. I filled my cup with some noodles, lettuce, chicken meatballs, and some mushrooms. I took the bowl back toward my table when I was intercepted by the noodle chef who ran that station. Turned out it was a soup bar. Make you own soup. Once you have all the ingredients the chef boils it to cook the veggies and noodles. Total tourist move.

During breakfast we all agree that we have successfully made the leap to local Korean Time and congratulate ourselves on strategic withholding of sleep. (Important post script for this conversation: later That day, at around 2 PM, we all fell dead asleep on the plane. Total time zone hubris)

The Korean dad at the table next to us was wearing a Detroit Tigers hat. I asked him if he was a Tiger fan. Nope never heard of them. In fact there were lots of American sports logos everywhere you looked:  Tiger Woods, New York Yankees, Michael Jordan.

I started my acetazolamide.

We took the bus to the airport and it was amazing that nothing in Inchion looked older than a year. The airport was filled with American and Luxury brands. The Dunkin Donuts, Krispy Kreme and Jamba Juice surprised me.

We flew out on Korean Air Boing 777. John and I were in the middle section, each of us on the aisle without a middle passenger. Score! We flew all the way across China, seven-hours to Kathmandu. Seems like Jets are not allowed to fly over the Himalayas so you need to take a southern approach.

We landed. Snapped some photos. Bought a visa. Collected our luggage. Met Jim from Embark Tours. Took a 15 minute bus ride to the hotel. Met with a lot of the group. I am rooming with Stan. I had sesame chicken and some dumplings. Really good.

After dinner, Stan John and I walked into town and I got a t-shirt and some post cards.

Pretty tame day. Tomorrow we get to really see the city.

Day 1 on the #MM4MM: The flight of the endless sunset

So the trip to Everest Basecamp began yesterday. Cathy took Jeff, Silva and I to the airport Thursday morning.

I dropped my altimeter (gift from Rose and John) going through security. 😢 First casualty of the trip.

We then met John Raithel at the gate and boarded our A350. About this time it started snowing.

Turns out Jeff, Silva, and I were all assigned to row 32.

The the plane went to the pad for de-icing and then got in the cue to take off. We were the next one to depart when the captain decided we needed another round of de-icing and we would need to refuel since we were burning so much on the ground. The captain we needed to add 2 additional tons of jet fuel, which he then explained was not that much😳.

So the whole back to the gate to re-fuel, back to the pad to de-ice and get back in the cue to take off put us 3 hours behind schedule.

Jeff found it odd that we would need to refuel before taking off, but it turns out that Detroit to Seoul (DTW-ICN) is one of the longest non-stops that Delta flies.

Note the route we are taking because this the source of the post’s title. A few hours into the flight, I looked outside of the window and caught the last glimpse of the sun setting.

Then a few hours later I opened up the shade expecting to see darkness, but I got…

We had gone far enough north that we were able to keep up with the rotation of the earth so we were trapped in a perpetual moment after sunset. Eventually the sun must have set and night passed but I never saw it. A few hours later I looked out and it was getting lighter with Friday’s dawn.

We landed at 7 PM at Inchion International Airtport. We went through a shockingly relaxed customs and immigration and took a bus to Paradise City, a new, and very nice hotel.

We need to put markers on our bags since everyone on #MM4MM has the same bag. I’m going all #NephJC.

Today’s adventure: Kathmandu!

How to follow my trek to Everest Basecamp

I have been told that the tea houses where we will be staying offer WiFi. I will try to post updates here. However the MM4MM group will be posting frequently to the Moving Mountains 4 Multiple Myeloma Facebook page. You can find that here.

Just a few more days, in the meantime the Himalayan Mountain Hair is coming in nicely, though a bit whiter than the last time.

Trying out this gallery plug-in for Everest

In September 2017, the Aggressive Deer Hiking Club went to Mount Robson Provincial Park. This is the highest mountain in the Canadian Rockies. The terrain is dominated by glaciers, rivers, waterfalls, and canyons. It is among the amazing place I have ever hiked.

Everest. Myeloma. And the centrality of hope.

 

John Raithel and Jeffrey Zonder are on the Moving Mountains for Multiple Myeloma team going to Everest Base Camp. John’s story is incredible. Check out the video. (Despite the hosts claims, we are not climbing Everest next week. We are merely hiking up 18,000 to Everest Basecamp.)

Dig deep and give something. None of the money goes to buying my Ramen. All of it goes to the MMRF a 4-star charity that is delivering new treatments with amazing efficiency.

 

 

When Joel met Edgar. How we got to #NephSecrets.

In late 2002, I was a second year nephrology fellow spending as much time as possible at The John Crerar Medical Library writing chapters for medical textbooks. It was an awesome year. During that time I got an e-mail from another nephrology fellow, who was also in Chicago. He was writing to say what a fan he was of the Fluid, Electrolyte and Acid-Base Companion. He also said he wanted to help write the next edition of the book. (Any day now I’ll get started on that second edition. Any day now.) That e-mail came from Edgar Lerma. Nothing ever came of that collaboration but we became Facebook friends and continued on our parallel journeys. We both went to academic university fellowships but then pursued private practice. But despite  going into private practice, we both kept our toes in medical education. Me through this blog and social media, him by writing book after book after book.

Over the past fifteen years, Edgar has repeatedly provided me with some of the most interesting opportunities of my career. Edgar is a mentor disguised as a peer. In 2013, he invited me to write about KDIGO for ASN KidneyNews. This was my first national exposure, and that article has lead to subsequent opportunities.

He helped get me on the KDIGO App Workgroup.

But the biggest opportunity was a few years ago when he invited me to help him edit Nephrology Secrets. When he asked, I said, “yes” without hesitation. I said yes without thinking of the avalanche of work I just unleashed. The book is 656 pages long. I have read every one of those page 4 or 5 times. At times, my Secrets-to-do list stretched over the horizon. It was hard, exhausting, and for awhile, never ending. But it was also rewarding.

Thank-you Edgar.

It has been an honor to know you and delightful to work with you and Matt on Nephrology Secrets.

And speaking of Nephrology Secrets, the fourth edition is now available on Kindle with the dead-tree version available (fingers crossed) at the end of March. If you have Nephrology Secrets third edition, understand this is a complete rewrite with many new authors.  It reflects a decade of nephrology advances. As we prepared for editing the fourth edition we reviewed every chapter in the third edition. Nothing reinforces how far nephrology has come quite like reviewing a decade old textbook.  From the introduction:

So take a look at the sample pages on Amazon and if inclined buy the book I don’t think you will be disappointed.