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High Altitude House Calls
November
1999
by Bruce Fellman
Medical
rounds started routinely enough at Yale-New
Haven Hospital on the morning of May 14 as
Richard Satava, professor of surgery at the School of Medicine,
and his colleagues gathered to discuss the day's cases. But in short
order, there was pandemonium.
"It was
a scene straight out of ER," recalls Satava. "We got word
that they'd brought someone in who was suffering from severe respiratory
distress, and we had to go to work immediately."
Of course,
physicians are often called upon to handle emergencies, but this
situation was unlike any most doctors have experienced. For the
patient was half a world away -- in Nepal, high up the slopes of
Mount Everest -- and he'd been carried by Sherpa guides down the
mountain after running into trouble at Camp 4, the 26,000-foot-high
spot from which climbers make their final push to the summit.
Fortunately
for the mountaineer, there were doctors on the slope, four of whom
were on call at the time in a tent at 17,500 feet that doubled as
medical clinic and the research site of the Everest Extreme Expedition,
a project sponsored by Yale, NASA, and a number of other government,
private, and corporate organizations. E3, as the million-dollar
endeavor is known, was designed to test the limits of telemedicine,
a futuristic kind of health care that can bridge gaps between doctor
and patient.
"If
we can do this on Everest, we can do it anywhere,"
says Satava, who headed a medical team based at Yale that was linked
almost instantly via satellite to the E3 group on the world's tallest
mountain. Not only could the doctors talk to one another, but, because
of technology the teams were testing, they could also exchange sophisticated
information about their patient. With a digital stethoscope, physicians
on Everest and in New Haven listened to telltale heart and breathing
sounds. The results of blood work could be analyzed at the hospital
almost immediately. A Doppler 3-D ultrasound scanner sent back images
of the lungs, and a digital microscope en-abled the doctors to share
views of the bacteria that had been isolated from the climber.
The diagnosis
was pneumonia, and after a course of antibiotics, the patient made
a complete recovery. "An experienced physician probably could have
reached the same conclusion on intuition alone, but the kind of
information we received took the guesswork out," says Satava.
The E3
doctors were able to treat other lung ailments, as well as cases
of snowblindness, with these digital diagnostic tools, which also
enabled the investigators to study the way the human body adapts
to the stress of life at high altitudes.
"The
techniques we've developed on Everest will increase the access patients
have to skilled physicians." says Satava. "We'll soon be able to
make electronic housecalls."
The ability
to monitor vital signs constantly also helped ease Satava's own
anxiety about a particularly perilous part of the E3 mission: a
climb to Camp 2 that required a traverse of the Khombu icefall at
around 21,000 feet. As the physician examined the information coming
in from the climbers, who were wearing monitors no bigger than cigarette
packs, he breathed a sigh of relief. Base camp manager and medical
technician Richard Satava Jr., his son, was just fine. 
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