In his last dispatch, dated Monday, climber Brian Smith said he was recovering after nearly suffocating to death from high-altitude pulmonary edema at 23,200 feet.

Brian Smith, a 1988 South Medford High School graduate, is sending periodic e-mail dispatches to the Mail Tribune from Mount Everest, where he hopes to reach the summit by the end of this month. The son of Larry and Linda Smith of Jacksonville, Brian Smith began his treacherous adventure when he arrived in Kathmandu March 28.
In his last dispatch, dated Monday, Smith said he was recovering after nearly suffocating to death from high-altitude pulmonary edema at 23,200 feet.

May 8

Since a lot of people wonder what it is like to have high-altitude pulmonary edema, I will describe my experience.

HAPE kills more people than any other altitude-related sickness. Up to 15 percent of HAPE victims die within the first few hours.

HAPE is basically caused by the lungs straining so hard to pull oxygen out of the thin air that the blood vessels in the lung walls begin to leak plasma into the lungs. Once the lungs are filled with blood plasma, the HAPE victim goes into cardiovascular collapse and dies. The person essentially drowns in his own blood plasma.

At Camp III at 23,200 feet, I was breathing 41 percent of the oxygen breathed at sea level. Back at Camp II, I was at 21,200 feet and still breathing less then 50 percent oxygen.

Drowning has to be one of the worst ways to die. Slowly drowning in your own blood plasma is far worse than drowning in water as the suffering lasts for hours rather than minutes. At one point, I was begging God to either take my life or heal my lungs. I could not stand the suffering from suffocation, violent coughing spasms and constantly vomiting huge amounts of sputum out of my lungs any longer. It was at that point that I was able to get my boots and down puffy jacket on and stumble out of the tent in search of an oxygen bottle.

I am not sure what kicked off my HAPE, but I was tired from a long day climbing and rappelling the Lhotse Face as well as dehydrated. I had been coughing for almost a month.

I could not get to sleep and continued coughing pretty violently until about 11 p.m., when I was suddenly totally suffocating. I sat up with a start and could then breathe in shallow breaths. I am guessing that I was gasping with 60-70 breaths per minute. I was panting like a dog on a hot day. My coughing turned into violent vomiting.

Then the crackling rails started. Every time any air went in or out of my lungs, it sounded like Rice Crispies were going to boil out of my throat. As the rails intensified, I knew that I had a bad case of HAPE going and was going to die within a few hours if I did not do something about it.

I began to yell, "Undi, Tindi, Myla. Are there any Mountain Madness Sherpas here to help me? This is Brian. I have HAPE, can't breathe and need help!"

The Sherpas must be deep sleepers. Nobody stirred in camp. I started to pass out and each time I fell over I would waken with a start with more violent coughing and suffocating. I was so tired. I tried leaning against the tent wall but I just slid down the side and fell over once again and stopped breathing.

I sat up in just a light and heavy weight poly pro shirt with the temperature reading -10 F inside the tent. My down puffy was somewhere behind me but I could not find the energy to get it on. I didn't care if I died from hypothermia or HAPE at that point, please just stop the suffering!

It was now reading 1 a.m. on my watch. I felt like I had been choking for 10 years. The night had turned endless. I then knew that to survive I had to get up and find oxygen.

There are three ways to stop HAPE. The first is descent of a couple thousand feet. I was in a bad place. Camp II is almost 4,000 feet above base camp. It was the middle of the night with the treacherous Khumbu Ice fall between my descent and me.

The next option is the Gammow bag, a hyperbaric chamber that tricks the body into thinking that it has descended a couple thousand feet. Since I could not lie down, the thought of crawling into a small inflatable tube and lying on my back sent waves of panic through me.

The last option is to breathe oxygen gas. I had seen a dozen or so oxygen bottles sitting in the mess tent.

I spent about 15 minutes struggling to get my boots on. My hands were totally numb. Where are those gloves? I gave up on finding them as I struggled to get my down parka on and crawl out of the tent. Once standing I stuffed my hands in my pockets and stumbled through camp in search of my Sherpas.

After banging on a couple of tents yelling for Undi, I finally found his tent. He poked his head out to see what was up. Undi does not speak a lot of English. I told him I had HAPE. He just stared back. I was not sure if he was just tired or didn't understand, so I said, "My lungs are full of water, Undi. I can't breathe! I need oxygen now!" I then stood there panting into the frozen night air as another violent coughing wave overtook me and I doubled over.

Finally Undi said, "oxygen yes but no mask." All of our masks and regulators were either at Camp III or base. I re-emphasized that I needed oxygen one way or another right away. Undi told me to wait while he went to get Tindi up. I saw them disappear into the other camps so I knew they were hunting for a mask.

Finally they came back and took me into the mess tent, where they fitted an old mask they had come up with and a bottle and then I drug myself back into my tent. They put the mask on me, turned it up to about 1 liter per minute and got me into my bag.

Suddenly the oxygen took effect and I could breathe! Oh, sweet oxygen, God's gift. My coughing stopped almost instantly, the blood plasma drained back into my system from my lungs, and I could lie down on my back. Tindi slid a couple of hot water bottles into my bag. All of this was so great that I passed out almost immediately into a deep sleep. It was about 2 a.m. at this point.

In the morning I got up around 8 a.m. to talk to Willie (the team leader) on the radio and give him an update. He wanted me to head down immediately.

I got off oxygen for a few minutes to eat some breakfast and drink some tea. My system had nothing in it and I was badly dehydrated. Tindi helped me pack up my gear. I knew my trip was probably over.

We made good time down to Camp I in an hour and 14 minutes. Oxygen gave me tons of energy. In all it took me about five hours to reach base from Camp II. Not bad for a guy who was dying only eight hours before that.

After a couple days of treatment at base camp, I had recovered well enough to descend to Namche, where I currently reside awaiting my hopeful hike back to base camp and bid for the summit.

I hope that I never experience HAPE again. It had to have been the worst night of my life.

To be continued