Sunday, October 20, 2013

Climbing Mt. Kilimanjaro


"Only those who will risk going too far can possibly find out how far they can go."- T.S. Eliot


 

We are now down from climbing Mt. Kilimanjaro, Africa’s tallest peak, and I’m only starting to digest all that this trip has entailed.  It is really difficult to put this whole experience into words… but I will do so for the sake of chronicling what has definitely been the biggest challenge of my life thus far (and for blog-readers or friends of blog-readers who may also want to go someday!). This post may be too lengthy for some people to read in its entirety (so feel free to just look through the pictures!). I also wrote it rather quickly, so please pardon any minor errors or typos!

Why did we climb Mt. Kilimanjaro?  Well... I think some time at the end of last year or early 2013 we received some CME (continuing medical education) brochures about wilderness CME in Tanzania (a country I’ve always wanted to visit!), which included some lectures in altitude medicine amidst some “fun” activities like hiking/wildlife safari-going.  We contemplated doing a program like this; however, neither Kelvin nor I are particularly interested in wilderness medicine, and the cost was a bit too high (you end up paying the way of the CME lecturers). We then decided to look into doing a hike/safari combo on our own.  My good friend Mindy had climbed Mt. Kilimanjaro a few years ago and, while she is in unbelievable shape, we thought it was a challenge that was realistic for us, too (we’re never going to be crazy Everest-climbers, or Seven Summit-seekers or anything!). We enjoyed a trekking trip to Peru in 2009 (actually before we were officially dating!) and like the combination of outdoors activities with relaxation on vacation. We also wanted to do a safari (my South African safari experience with John, Wendi, Ajit, and Kelsey in 2007 was unbelievable!). So, after talking Apurva, Kelvin’s college roommate, into joining us, we had a big trip planned!

We left San Francisco on Friday and then flew to Toronto, meeting up with Apurva, then to Addis Ababa, Ethiopia (with a re-fueling stop in Rome), and then finally to Kilimanjaro Airport, which is partway between the towns of Arusha and Moshi. 

 

We were escorted to the Springlands Hotel where we had our trekking briefing by Zara Tours, where we were immediately instructed to STOP Malarone (an antimalarial drug) if we had started it, as it would only decrease our hiking stamina and “if we saw a mosquito on the mountain, take a picture! Start it on your way back.” [mosquitoes are only found and low elevations].

We had a nice dinner and a good night’s rest (despite the 10-hour time difference) before our trip.
Here is our day-to-day journey!

Day 1
Hours hiking: 6
Peak elevation: 3000m (9800 ft)
We met our other group members and our guides at the hotel.  In addition to Kelvin, me and Apurva, our other group members included two American women, Sara and Alicia, Louise, a young Danish woman studying in the Navy, and Ansa, a Swedish woman living in Brussels. It looked like a great group of 7!  We also got to know more about our tour guides, Eddie and Joseph. Joseph, who is 56, has probably climbed Kilimanjaro a thousand times; the first time was when he was 11 years old, and he has been a professional guide for almost 40 years (he even accompanied ex-president Jimmy Carter to the top!)! Florian and Nicky also joined us as guides a bit later.

Apurva, K and me, ready to get started!



We left our hotel by Minivan around 0900 (after Ansa FINALLY got her delayed luggage from the airport... she was so thankful it made it! We, paranoid as usual, were wearing and had carried on a lot of our hiking gear... just in case) to head to the base of the mountain, which is an (extinct/) dormant volcano with the last volcanic activity something like 350 million years ago. We arrived at the Machame Gate to start the trek via the Machame route, one of many routes up the mountain, which vary by elevation change and length. Other routes included the Marangu (a straighter shot to the top), Rongai, or even the strenuous 3-day Mweka trail (straight up and down) but the Machame is supposed to be one of the most scenic routes and we had the option of an added day of acclimation by doing a 7, rather than a 6-day hike which allowed us to descend a bit to sleep on two of the nights so as to let our bodies adjust more to the altitude (a must for all of us coming from sea level!).

The first day’s hike was very pleasant. From Machame Gate at 1800 m (5900 ft), we climbed about 1200 m over 5-6 hours through the rainforest to arrive at Machame Camp at 3000 m. We took frequent breaks and went, as the Tanzanians say it, “pole, pole” which means something like “slow and steady” and seems to be the motto of the mountain.  We passed many other hikers and porters with the greeting "Jambo!" We ate a pre-packed lunch. Our tents were already pitched by the time we reached camp, the porters (despite carrying way more gear than we were, often on their heads!) beating us up the mountain to set up camp.  We enjoyed tea and popcorn, followed by a cozy dinner in the dining tent, including fish and fresh fruit.  It was amazing to see the night sky from where we were—stars were so bright, as was the moon (not that I ever sleep well when camping, but I had to put a mask on because the bright moonlight made it hard to sleep!).  Before the trip, we had decided to splurge for a “portable toilet,”(which was basically a portable bucket, with seat, in a nearby toilet tent) rather than using the public squat toilets (and was definitely well worth it for the frequent nighttime bathroom trips).


(these are definitely APPROXIMATE times!)

(how the Europeans prepare for a trek at altitude!)

Group photo to start it all off! (courtesy of AC)

 



 (a little Sudoku, which I never had energy for again!)
 

end of day 1

Day 2
Hours hiking: 5
Peak elevation: 3900m (12,800 ft)
We awoke early (it was light around 6 a.m.) to receive our “warm water for wash,” as Eddie called it, and our typical breakfast which was (per person) toast, a fried egg, a sausage, some fruit, and tea/coffee/Milo. We had more great views of the mountain as we walked.
We started hiking around 830 AM and after a very dusty ascent, made it up to about 3900 m before descending slightly to 3700m at Shira Camp, arriving around 1:40 pm. It was pretty relaxed hiking with nothing too strenuous. We again had a packed lunch including a boiled egg, fruit, some biscuits and juice.  We viewed the Shira Caves, where campers/porters were allowed to sleep until about 8 years ago when it became dangerous due to falling rocks.

Day 2 Group Photo (a tradition)- with very poor lighting!

Summit views



We also had great views of Mt. Meru, another climbable peak and the second highest in Tanzania (4565m, 14,977 ft)




goofy shot on a break, including Joseph and us in "natural" poses :)


Trekking, porter style!

with our very talkative guide, Eddie


Ansa, ascending
Shira Camp

Group at Shira Cave


Gorgeous Sunset!!!




Day 3
Hours hiking:  8
Peak elevation: 4650m (15,255 ft)
Day 3 was perhaps the hardest day of the trip for me (with the exception of summit day/night/day, of course). It was uphill for about 5 hours. Many times during the day, I asked myself, "Why am I doing this? This is supposed to be vacation!!!". In any case, we left camp around 815 am and walked up from our camp at 3700m to the Lava Towers at 4650 m, arriving somewhere around 1:30 pm (eating our packed lunch), and then walking DOWN another 3 hours to get to Barranco Camp at 3900m or 12,800 ft. We hiked part of way in the sun, but then it got windy, making appropriate layering tricky. Louise, one of our group members, began to get a moderate-to-severe headache, one of the first signs of altitude sickness (of note, five of us were already taking Diamox, or acetazolamide, a mild diuretic that may help reduce the signs of altitude sickness, but Louise then started it).  I had began to manifest more signs of a mild cough that started on day 2, which I wasn’t sure whether was due to dust or a true URI, and was quite short of breath on the ascent.  The 3-hour descent, over rocky steps and slippery sand, was mentally very challenging, and was met with quite a few spills.  What was (per the initial sign) a "6-hour" hike was, for us with breaks, 8 hours due to our struggles.  Luckily, no one got hurt and we made it to camp safely albeit exhausted.  Having figured out the secret to layers in my rented sleeping bag (plus handwarmers in my wool socks, my second sock layer) plus the above exhaustion, I slept much better, "lala salama".

Day 3 Group Photo
 

Joseph and the flag of his country!

Florian

Porters (how do they do it???)



Chugging on a break (courtesy of Louise)

Mt Meru again (a pretty mountain, isn't it?


Apurva & Louise (from Louise)

Lava Tower (lunch stop)

 I was sooo tired by this point, and really didn't want to be in a photo, so here is the result:


But then I put on my happy face :) 


Sun setting over Barranco Camp





Day 4
Hours hiking: 5
Peak elevation: 4300 m (14,100 ft)
We got to “sleep in” a bit on Day 4, not leaving camp until close to 9 am. We first had to ascend the great “Barranco Wall,” a rock face which has narrow turns that showed quite a bit of traffic and which required a bit of light rock climbing (i.e. trekking poles were not to be used here!)! Apparently (although I’m not sure if it’s true, as Joseph could be very goofy), the Machame Trail got it’s nickname “Whiskey Route” as porters really have to wiggle/sway themselves up this narrow trail.   The weather was sunny at first, but then quickly turned misty and cold, which was the case with most days on the mountain (although, thank God, we were spared rain for the whole trip). The peak elevation was 4300 m at the top of the wall, which was actually a lower altitude than we reached on day 3, which was to help with acclimatization,  although we then descended, and re-ascended another slope (where I had a lot of shortness of breath) to get to Karanga Camp at 4100 m (13,450 feet) around  2pm. My little pesky cough was now a full blown cold, prompting another trekker to pop into our dining tent after hearing my hacking to ensure we were all ok (i.e. didn't have pulmonary edema, a sign of altitude sickness).  Luckily, we all felt pretty well-- while we were tired, short of breath, and dizzy at times (even with a brief walk to the toilet tent!), we had no major headaches, vomiting, or need for transport down the mountain! We enjoyed a hot lunch on this day, which was wonderful, and then napped or read in our tents before dinner, then slept some more...

Day 4 Group Photo

(hikers look like ants in this photo, on the Barranco Wall)


Cacti along the way

Going up the Wall (at least the summit was looking a bit closer!)


Louise & Alicia

Day 5
Hours hiking:  4
Peak elevation: 4600 m (15,100 ft)
We again got to have a late start on this day 5, our “light day” before the great ascent. We slept in until 730 or so, and left camp by 9 am. This day was all uphill, but it wasn’t too bad. We tried to stay well hydrated as well as warm in the dry/dusty but cooler conditions at the altitude.  Remarkably (while we were gasping for breaths), Joseph whistled Christmas carols along the way, as well as talked on his cell phone during one of our breaks (yes, there is apparently phone service from the mountain!) while we chugged water and kept our energy up with clif bars or fruit chews. We arrived at Barafu Hut/Camp or “Kilimanjaro Base Camp” at 15,100 ft around 1 pm, in time for another hearty, hot lunch.  We then had the rest of the day to sleep/rest/(freak out) before the Summit push.


Day 5 Group Photo

"Above the Clouds" 
 



"Papa Joe," as we called him, chattin' from 14,000 ft!
 

Day 6 (but starting on day 5)- The Summit
Hours hiking: 14
Peak elevation: 5895m (19340 feet)
Still on Day 5, we were awakened around 10 pm to have some tea and biscuits in preparation for our push to the summit which we started promptly at 2300. I have NEVER hiked in the dark before, but doing so allows you to get up to the summit and back down to a "safe" altitude during day hours, so night hiking it was for all of us. 
Actually, since we were hiking during the full moon, headlamps (if you can believe it) were not even really required during the "midnight" hike! Following guides Eddie and Florian, we went pole, pole up the mountain.  It was pretty rough. We were all dressed like Michelin Men-- I was wearing five upper layers including a tee, long-sleeved shirt, thick fleece, light down, and then my ski parka, and three layers on the bottom, thick socks with liners, plus handwarmers in my gloves, and, while my core was warm, my hands and feet still felt really cold (so much so that I was worried about frostbite!). We also wore balaclavas, wool hats, etc, to cut the wind. We made stops about every 45 min or so, to drink a bit and eat a bit (luckily no one was vomiting!), but couldn't stop for long for fear of freezing. While Camelbaks had been very useful throughout the whole trip, despite blowing back into the hose as we were instructed, they froze halfway up the summit push, rendering them useless (and the water in them quite heavy!). I had to hold my other Nalgene bottle in my jacket front to keep it from freezing.  There were some guides who were singing and playing music to keep everyone going.  Too out of breath to do much of anything aloud (most of these trip ascents were "wordless walking"), I was singing songs in my head, reciting scriptures and quotes, and thinking of happier places/things to keep focused. The ascent to the summit was HARD. A friend of Kelvin's who did the Kili climb a couple of years ago said that it was much harder than a marathon (not being a marathoner, I can't really comment), but the altitude is a definite butt-kicker, and it is just MENTALLY so difficult to push yourself to keep going.

Amazingly, by about 5 am, six hours after we started out, we reached Stella Point, which at 5739m (18,828 ft) is a point at which some defeated climbers (or those who are too sick from altitude) turn around. From there, it was about another hour to the Summit.  As we reached the plateau that is a straight and just slightly uphill grade to the famous "green sign" of the Kilimanjaro Peak, the sun was just starting to rise. It was incredible. As soon as I saw the sign, I started sobbing (prompting one of our assistant guides, Florian, to comfort me, saying "you can do it!" I don't think he quite understood why I was losing it). I don't know how to put into words how I was feeling. It was absolutely overwhelming to be at that point. We were at the highest point on the continent. We viewed the glaciers around us (Arrow Glacier being the major one to our left), knowing that our (potential future) children will never see them as they are melting, quickly.  All seven (100%) of our group members made it to the summit, which was remarkable, and testament to the excellent guidance and pacing of our guides. I thanked God, to whom I have never felt closer. It was truly a miraculous feeling.

After taking our photos and spending about 30 min at the top, we then had to head DOWN the mountain back to base camp, which only took about 2.5 hours and was quite warm in the early morning light.  We were lucky to have summited early, as we passed many (tired-looking) people still ascending when the sun was already up. We rested, we ate, and then we headed straight down for another 4 hours to Mweka Camp at 3100 m (10,170ft), where it was much warmer. We had a hot dinner, and then, about 20 hours after we had awakened the previous evening to start our trek to the summit, slept hard.

Stella Point at 5 am (in darkness)

Stella Point at 7 am (in daylight, descending)

Sunrise over Africa from Uhuru Peak, Mt. Kilimanjaro


Arrow Glacier

(from Louise)

Alicia & Louise

Uhuru Peak, the Summit of Mt. Kilimanjaro, 19,340 ft (5895m) on 10/19/13, 6:05 AM 
The highest point in the continent of Africa
The world's highest freestanding mountain

Group Shot (100% summiting!)


(yes, we're dorks and brought a little pic of Pepper, not a flag, to the top!)


Trio of champions


Alicia took this photo... moon setting and sun rising all at once!

The long way down...

Exhausted on a break (check out Sara's expression!)

Dancing "Papa Joe"! (LDB)
 

Last dinner together :(

Day 7
Hours hiking: 3
Day 7 was a light, easy day. We left camp around 7:00 a.m. to head all the way to the mountain's base, but to Mweka Gate (a different point than we started). We then headed back to the Springlands Hotel via minivan, where we bid farewell to our trusted guides, did the tipping, got our certificates both from the Zara Company and Kilimanjaro National Park, and had MUCH needed showers and even a massage :) 

 Last view of the mountain


(with so much extra oxygen around, we were more motivated to take action shots!)


All done (and, after 7 days, badly in need of a shower!)
But they actually had a flushable toilet at the Mweka Gate "Tourist Toilet"!

with Louise

end-of-trek group shot (credit to AC)

Making it official....(with Eddie)





Showered and hungry! (from Louise)

This trip was amazing. Would I recommend this to others? Yes (if you're in good shape and very stubborn!). When we were planning, I remember Mindy giving us trip advice and suggesting that, if she went back, she'd try a different route to the top. Kelvin and I have already said that there's no way we're going back to do this. Are we glad we did it? Yes. But I don't think we're going to be doing any hiking in a long, long, long time...

Now we get to sit back, relax, and, with hope, see a lot of animals on our safari this next week!

Sunday, October 6, 2013

tiny sweater


I am lucky to have a husband who does more than his fair share of household duties and is very self-sufficient.  He makes the bed. He walks Pepper when I'm stuck at the hospital which is a lot of lunchtimes and evenings and is in charge of bathing her. He shares the dishes responsibility.  He will go grocery shopping with me because I hate it so much. He vacuums. He starts most of the laundry and folds his own clothes! (What do I do, you might ask? :)... I work all the time, cook, walk the dog in mornings, dust, clean the kitchen and bathrooms).

However, yesterday was one day I wish I had done the laundry myself :).  A normal-sized sweater above got run in the dryer and now is a baby-sweater (somehow, though, with preserved arm-length.... is this normal?). Anyone need a sweater with these dimensions? :)

Wednesday, October 2, 2013

Not a Nurse

I recently read a good article, originally on KevinMD.com, by Megan Lemay, an internal medicine resident at Yale.

I love nurses. Most of my medical training (at least on obstetrics) was by far more competent nurses (than I was a resident). They make our jobs easier. They make patients feel at ease. However, here is a good article that highlights the differences in our job responsibilities.

Thanks for the Compliment, But I'm Not a Nurse.  - by Megan S. Lemay

Let’s get one thing clear from the start: I love nurses. My grandmother was a nurse’s aide. My aunt is a nurse. My mother is a nurse. Nurses have been by my side for the most frightening and important experiences in my life (in the hospital and out). But, I’m a doctor. So, please, don’t call me “nurse.”

Here’s why:
1. Please don’t call me “nurse,” because I feel like it undoes the work of thousands of female physicians before me.
Recently, I was on service with one of the most accomplished female physicians at my institution. To greet my patients every morning, I knocked, entered wearing a white coat and an “MD” badge, and introduced myself as Dr. Lemay. Our first patient welcomed us into his room with this: “Can I call you back? The nurses want to talk to me about something.”

One hundred and fifty-four years ago, he would have certainly been correct. However, in 1849, Elizabeth Blackwell became the first woman to receive a medical degree in the U.S. Hundreds of thousands of female medical school graduates later, women are now poised to outnumber their male colleagues by 2017. Still, I can’t say I feel secure in my place as a female physician. We are still underpaid and under-promoted compared to our male colleagues. To me, it feels like we’ve just splintered the shell of this previously male-dominated field. Being called “nurse” reminds me of the enormous gender gap I have yet to cross. Overpowering gender stereotypes will take more than outnumbering the men in our field.

2. Please don’t call me “nurse,” because nurses, also, have reason not to like it.
If you’ve ever seen a doctor struggle to administer a medication, boost a patient in a bed, or try to organize the minute-to-minute care of a hospitalized patient, you can probably understand why. Nursing school has provided them with a different set of skills, approaches, and goals for patients. While my medical school classmates and I studied the M.D. perspective on chemistry and physiology, the nursing students studied the process of patient-centeredness. The last thing a busy nurse needs is a resident who assumes she could do a nurse’s job. It would be insulting for me to accept the title.

3. Please don’t call me “nurse,” because it further separates me from my male colleagues.
When I discuss this topic with my female co-residents, there is an implicit understanding. When I discussed this with a male colleague, he replied, “Why would someone call you nurse?”
I laughed, but with a trace of jealousy. Wouldn’t it be nice to have the first assumption about my career be the right one—to not even understand why someone might think otherwise? I caught myself glaring at him and imagining a caduceus-handled silver spoon in his mouth.
“Why shouldn’t you have to defend your job to patients like I do? Would they think I was a better doctor if I had your short, graying hair and wore your tacky neckties?” I heard myself blurt out.
That was a long night.

4. Please don’t call me “nurse,” because it sets up expectations for my relationship with a patient that I will not be able to fill.
I cannot get you the medication that alleviates your pain or quiets your cough. I will be your advocate, but often after your nurse has called to my attention what I should advocate for. Your nurse will dress your wounds, clean you when you are not able, and tell you that your family called. I will be the one who wakes you at 5:30 a.m. and orders the medication that gives you diarrhea and tastes like dirt. Don’t call me “nurse,” because I cannot be a nurse to you.

It’s not that doctors’ and nurses’ roles don’t overlap. They certainly do. Nevertheless, we are different providers with different skills. It is in this very difference that there is the greatest potential for learning and growth.

I can’t explain all of this every time someone calls me nurse. So, for now, I’ll stick to my go-to line for this circumstance:

“Thank you for the compliment, but I’m not your nurse. I’m your doctor.”