Into Thinner Air

Igor Gamow is explaining how his legendary astrophysicist father, George Gamow, helped hatch the big-bang theory of the universe. Truth be known, my oxygen-deprived brain is in no condition to process anything this pointy-headed. At the moment, Im piloting a rental car up a canyon of red granite and ponderosa pines, en route to Estes Park, Colorado. This famous gateway to Rocky Mountain National Park is poised some 7,550 feet high in the clouds. As we make our ascent, the thin air turns redolent with smoke from unseen wildfires. Slurry bombers laden with chemical retardants drone faintly in the distance.

In the backseat, Gamows lovely East German wife, Elfriede, 67, cradles testing apparatusesa pulse oximeter, an altimeter, and the Gamow Bag, which my host, a former chemical engineering professor at the University of Colorado, invented in the late 1980s.

With any luck at all, Ill soon be dragging my nauseated carcass into Gamows body bag in the hopes of curing a severe case of acute mountain sickness (AMS). Indeed, my goal in flying from sea level to Colorado this morning is to get violently ill with as many types of altitude sickness as I can induce, then report back to my fellow travelers on how best to treat and/or prevent such miseries in the first place.

The types of sickness from which I seek to suffer, at least a little, include: the common, nasty, but usually benign AMS; the potentially fatal high-altitude pulmonary edema, or HAPE, in which pinkish liquid accumulates in the lungs, eventually drowning 44 percent of untreated victims; the similarly lethal high-altitude cerebral edema, or HACE, during which fluid leaks into the brain, triggering poor decision-making, hallucinations, stroke-like symptoms, and possible death; and, lastly, the non-lethal-but-nevertheless-disconcerting-to-all- in-range high-altitude flatulence expulsion, or HAFE, in which digestive system gases seek frenzied exit from the squeezed intestinal tract.

Getting sick, I must confess, has always come naturally to me. Still, I dont want to leave anything to chance. In addition to todays inaugural field test here at Estes Park, my itinerary over the upcoming week will include a bivouac in Gamows hypoxia chamber back at his lab, followed by a second field test at a United States military research lab high atop 14,110-foot Pikes Peak.

To further up my odds of becoming symptomatic, I have interviewed a number of authorities in the field of high-altitude medicine, gleaning an assortment of boneheaded training maneuvers likely to hasten the telltale splitting headache, nausea, hangover-like malaise, and various ancillary symptoms disgustingly familiar to anyone whos suffered from AMSthe poison of the pass.

Their expert recommendations: Fly to Colorado from sea level and immediately ascend as high as possible, allowing no time to adjust; imbibe plenty of alcohol and very little water; wolf down greasy food with gluttonous abandon; and finally, upon arrival at terminal altitude, exercise vigorously.

Do these things, experts assured me, and your chances of getting sick are great. For lifetime lowlanders like me, its not even necessary to go incredibly high. In one study of 3,158 visitors to the Colorado Rockies, 25 percent developed AMS at heights as modest as 6,300 feet. By 14,000 feetnearly the same height as Pikes Peakfully three-quarters of visitors who stay at least four hours become ill, some violently.

At 9,500 feet the combination of zero habituation time, several Fat Tire ales, and vast quantities of Mexican food are beginning to take some effect. At least I think they are. When I monitor myself closely, I notice that I feel a wee bit queasy, light-headed, and dazed. The driving process in particularswooping back and forth through roller-coaster passes while trying to stay more or less between the appropriate linesfeels like a video game set on a level slightly beyond my skills.

Elfriede asks her husband to hush and let me concentrate on driving lest we suffer an altogether different big-bang experience. Gamow shrugs. The 70-year-old sports a cowboy hat, a diamond ear stud, and a ring shaped like his favorite comic book character, the Phantom, aka the Ghost Who Walks, an item of jewelry crafted for him from a silver ingot by an artisan in Kathmandu, Nepal.

I swerve to avoid hitting a marmot, then ask the professor how he came to invent his ingenious namesake device, which uses air pressure from a foot pump, not supplemental oxygen, to simulate descent in those who become too sick up high to descend for real.

Gamows brainchild, he tells me, was born of serendipitythe result of his research in the opposite direction. In the early 1980s he was experimenting with a personal hyperbaric bedchamber that would allow elite endurance athletes to sleep at a simulated high altitude and in the process boost their bloods oxygen-carrying capacity. He was just starting to build a prototype in his lab in Boulder, Colorado, when a former student proposed an alternative concept. The student, a mountain climber and physician named Gary Ruggera, had buried a friend the previous year after the man succumbed to HAPE while climbing Nepals 27,765-foot Makalu peak. Instead of simulating ascent for an athlete to increase performance, Ruggera suggested that Gamow look into a portable means of simulating descent to treat mountain sickness.

Intrigued, Gamow and a tentmaker in Boulder spent the next two years experimenting with a multitude of potential bag fabrics, glues, airtight zippers, pressure gauges, and foot pumps. The net result was a 14.5-pound sleeping-bag-like device constructed from polyurethane-coated nylon, with plasticized viewing windows to inhibit claustrophobia. Once a victim has been zipped inside, a fellow climber on the outside uses the foot pump to inflate the bag to an atmosphere above the ambient air pressure. This translates to only about two pounds of pressure per square inch (psi). When you consider that steel-belted radials are typically inflated to 30 psi and racing bike tires to 100 psi, two pounds of pressure may not seem like much. But for victims of high-altitude syndromes, the effect can be dramatic.

If a person were to get in the bag at the summit of Mount Everest, Gamow explains, it would simulate a descent of about 9,000 feet. The first time I was in Nepal, I saw climbers carried into camp unconscious and in very bad shape, placed in the bag, and within five minutes, their eyes opened and they could respond to questions. Except in extreme cases, people see their symptoms disappear within two hours.

Though statistics are hard to come by, Gamow believes that as many as several thousand climbers have directly benefited since he sold the technology to DuPont, in 1990 (which in turn sold it to Portable Hyperbarics, of Ilion, New York. Today the device is priced at around $1,800).

The notion that a Gamow could actually come up with a bona fide useful product still strikes Gamow as amusing. The better you are as an astrophysicist, he says, the worse you are at doing anything practical. Father was the absolute epitome of this phenomenonhe couldnt even change a tire. When I first heard the name Gamow Bag, it seemed as funny to me as an Einstein Pencil Sharpener.

After another ten minutes on the winding roads, we pull into the parking lot at the Alpine Visitors Center in Rocky Mountain National Park. I immediately strap on the Gamow Bag backpack and begin jogging up a footpath that winds steeply to a 12,005-foot-high viewing area. The panorama here is as breathtaking as the altitude itself: the Never Summer Mountains, the Medicine Bow Mountains, the distant headwaters of the Colorado River. On the Atlantic Ocean side of the Continental Divide, the sky is blue and dappled with fair-weather cumulus clouds. On the Pacific side, the first monsoon of the season is rolling in and I can hear thunder though not yet see the bolts.

My legs burn, my lungs burn, and my labored respiration exhibits what scientists call increased hypoxic ventilatory response, i.e., massive huffing followed by massive puffing. At 12,000 feet there are nearly 60 percent fewer oxygen molecules per breath than at sea level, so its no wonder the body seeks to compensate by breathing more deeply, more often. When I finally reach the crest, I lie panting on a granite boulder sparkling with fools gold. Gamow and Elfriede arrive ten minutes later, having ascended at a saner pace.

Gamow quickly takes initial measurements with the pulse oximeter, a device that lightly clamps onto the index finger to calculate oxygen saturation levels. For healthy people at sea level, this is usually in the ballpark of 98 percent. Mine up here measures 81 percenteasily low enough, says Gamow, to cause heavy-duty AMS if my constitution proves susceptible (nearly one-quarter of all individuals experience no symptoms) and I remain at this altitude long enough for such side effects to kick in (typically four to eight hours).

On the plus side, I probably dont need to worry about HAPE or HACE, both of which usually take several days to develop. But the humiliation of HAFE, I am acutely aware, could strike at any time.

The classic symptoms of AMS include at least two of the following: headache, dizziness, loss of appetite, excessive fatigue, difficulty sleeping, and sometimes nausea and vomiting. With the exception of vomiting and difficulty sleeping, I am experiencing all these things now, at least dimly. Unfortunately, I have all these things back home in Pittsburgh, too, at least much of the time.

Following Gamows instructions, I unpack the bright red bag, roll it out on a level patch of rocky turf, and climb in. Elfriede attaches a foot bellows to a port, zips me snugly inside, and begins pumping in air. Within a minute, the bag has fully expanded. With each foot pump thereafter, the altitude inside drops another 300 feet on the altimeter I am monitoring.

On the fast slide down, my ears pop as if Im riding a high-speed elevator to Death Valley. The pulse oximeter registers the richening of my blood: 11,000 feet, 86 percent saturation; 9,000 feet, 91 percent; and finally, the bag levels off at 6,500 feet, 93 percent. My pulse, too, has slouched toward its normal state, 57 beats a minute. On a more qualitative level, the general malaise I felt previously has vanished, replaced by the much lower grade cruddiness that is my normal state of health perception.

After recuperating in the heady bag air, I give Elfriede a nod, and she initiates the deflation process. The danger to ones ears is minimal on the way up, and I can feel internal air pressure harmlessly bleat its way out of my ear canals. I ascend back to 12,005 feet in less than five minutes, and my oxygen saturation reacts predictably, dipping back down to the upper 80s.

Hungry? Gamow asks me as I emerge from the deflated bag.

Not really, I say. I feel like I have a very mild hangover again. The temporary relief from the bag has apparently evaporated. Gamow tells me that anorexia, or loss of appetite, is very common at altitude until youve acclimatized.Thats why I suggest we wait till were back down before we have lunch, says Elfriede.

Her recommendation proves prescient. By the time we descend to Boulders puny miles worth of altitude, my oxygen saturation is back to 94 percent and my appetite is fully restored. I order barbecued pork and fries, hoping, in the process, to boost tomorrows prospect of getting so sick I wont question the seriousness of my condition.

Early the next afternoon, I lie in Gamows lab, sealed inside a fiberglass cylinder that resembles a one-man submarine. My head swims slightly from a gin martini consumed with lunch.

This is a prototype of the bed I invented to increase aerobic capacity in endurance athletes, Gamow explains. They simply climb in each night with pee bottle in hand, spend the next six to eight hours sleeping at a simulated 12,000 feet, and emerge the next day with stimulated erythropoietin, which makes red blood cells. We call it holistic blood-doping, says the proud inventor.

Overhead, I spy four pressure valves, safeguards designed to keep my manufactured ascent from proceeding too high. Depending on how many of these are closed off with plastic caps, external air will begin bleeding in at varying degrees. By using only two such caps, Gamow has planned it so that during todays demonstration I should be leveling off at a relatively namby-pamby altitude of only several thousand feet above Estes Park. I have my own plans.

Before we begin, Gamow points out an emergency ball valve I can crack open if for any reason I need more air. Then he asks me for my pretest readings. At the labs altitude of 5,700 feet, my pulse is 60 and oxygen saturation is 96.

Gamow switches on the mechanical pump. By 12,000 feet, my oxygen dips below 90in keeping with yesterdays experience at a similar real height. At 12,500 feet, I reach the highest point any Thornton has been known to venture, and my oxygen dips to 86. Eleven minutes into the ascent, Im up to 14,600 feet, oxygen still at 86, and Gamow signals that its time to halt the experiment.

Let me go just a little higher, I say, stalling until the altimeter reaches 15,100 and my oxygen saturation 82 percent. So far I feel no symptoms whatsoever. At 15,300 I at last dip to 78 percent, a personal record.

Whats the altitude of Everest base camp? I ask. Were not going there, says Gamow. In fact, you really do need to start letting some air in now.

I feign difficulty hearing him and virtually head upward. Just as the altimeter registers 16,000 feet, a pressure valve opens and outside air leaks in, delaying further ascent. My oxygen saturation is 74, a new record, but the complete absence of physical symptoms is dispiriting.

Lacking a cap to plug the valve, I decide to press the flesh of my palm as hard as I can over the bleating airway. Amazingly the leak stops, and we resume climbing.All right, says Gamow, when he notices my scheme. This experiment is halted now! OK, OK, I reply, a tad disingenuously, my palm still choking off the valve. I just dont want to hurt my ears by letting in air too quickly.

As I stall, the ascent continues: 17,000, 17,500, 18,000, 18,300 feet. I glance over at the oximeter: 71 percent oxygen and still no symptoms whatsoever. Id like to hold out a little longer, but the good professor is poised on the brink of churlishness. Finally I ease my hand off and cool air immediately leaks into the cylinder.

Thirteen minutes later, Im safely back down to Boulders altitude, and Gamows good nature has returned. Why is it, I ask him, that when I wanted to go up higher, you insisted I stop? It would have been nice to see what the top of Mount Everest feels like.

Where you went is really high, he says. For athletes I normally go up only to 14,000. I dont know when the bed has ever gone that high in the past four years. You know, my former assistant used to kill rats by putting them at 25,000 feet.

Iits 11 a.m. the day after my symptomless hyperbaric ascent, and Im being chauffeured up 14,110-foot Pikes Peak by Allen Cymerman, Ph.D., a research physiologist in the U.S. Armys Thermal and Mountain Medicine Division.

Cymerman, 64, who from the side looks a little like Robert De Niro, is describing how nearly every summer he travels to the U.S. Armys lab atop Pikes Peak from headquarters in Natick, Massachusetts, and how he develops a nasty case of AMS every time.

Jealous, I quickly relate my past several days of trying to get sick on purpose, adding that my failure to do so makes me increasingly convinced that I probably never will. Cymerman shakes his head. It really takes a little longer than youve given it to start feeling AMS-like symptoms. He points out that I stayed up at Estes Park for only a couple hours, and yesterdays simulated trip to 18,300 feetthough it triggered oxygen saturation low enough to put stress on every organ youve got and qualify me for admission into an intensive care unitwas even shorter.

Pikes Peak gets half a million visitors every year, he says, and theres generally no harm done, because they dont stay long enough. If you go up to 18,000 or even 25,000 feet and take off your oxygen mask for ten seconds, no problem. Do it for a little longer, theres a big problem. Bottom line, he tells me: Dont rule out sickness quite yet. Hope springs anew in my not-yet-gasping breast.

When we reach the mountaintop, Cymerman parks the truck and leads me inside a prefabricated steel building stuffed with bunk beds and arcane testing equipment. Each summer, up to two dozen military and civilian volunteers agree to live here for weeks at a time, having everything from their balance and eyesight to cognition and voice patterns analyzed. Thanks to this unique facility, new insights into the acute and chronic effects of high-altitude exposure are regularly published, benefiting everyone from amateur mountaineers to U.S. troops stationed high in the mountains of Afghanistan.

One of the more promising avenues of investigation includes alterations in the way mountaineers pronounce certain consonants (p, t, and k soften with oxygen deprivation, eventually becoming indistinguishable from b, d, and g, respectively). Cymerman recalls the case of one ill-fated Mount Everest climber. As he was approaching base camp, researchers there had him read a list of words, including bed, cake, good, and coat. They then used a digitizer to quantify the milliseconds it took him to pronounce the consonants.

They could hear he was deteriorating and warned him he was in trouble, he says. A mountain is very unforgiving of mistakes, especially Everest. The climber, alas, ignored the warning and summited, but then fell to his death after forgetting to hook on to his safety line during descent.

Three hours after I arrive at the Army lab, a mild headache sets in. I also notice its becoming difficult to stand for prolonged periods of time and find myself propping against walls to steady myself. Cymerman hands me an AMS scoring questionnaire. As I fill it out, my excitement grows. The symptoms may still be subtle, but this time theres no doubting theyre real. From anorexia and clumsiness in a heel-to-toe test, to lassitude and increasing darkness in my visual field, Im definitely feeling effects.

Outside the building, Cymerman and his fellow researchers have created a makeshift basketball court. He explains that this is used, along with stationary bikes and ancillary gym equipment, to measure changes in exercise tolerance throughout the acclimatization process. He tosses me a ball and suggests I try some layups. Intending to exercise full-bore for the next half hour, I sprint around, dribbling and shooting. A mere five minutes into my wind sprints, I have to stop to catch my breath, head pounding. I cant believe what horrible shape Im in.

Cymerman says not to worry. Upon first arriving at altitude, he explains, virtually everyone sees an immediate 25 percent drop in their maximal aerobic capacity. In fact, this never really gets any better up here, no matter how long you stay.

What does change is submaximal capacity. In two weeks, he says, your ability to exercise at 70 percent of capacity will be almost the same up here as it is at sea level. This sounds good, but I realize I am too stuporous to understand exactly what it means. I think hes saying we humans can never perform our best at altitude, but with acclimatization, we can eventually do basically the same half-assed effort we can at sea level.

When I ask him about this interpretation, he says it pretty much sums it up. In other words, even fully acclimatized, the best anyone can hope for in such an alien environment is mediocrity.

We stay another hour or so, at one point touring the gift shop at the Pikes Peak visitors center, a quarter mile from the lab. This experience is like a disquieting dream. As I bumble about the aisles, fearful of accidentally breaking knickknacks, I feel like Im suffering all of the downsides and none of the pleasures of drunkenness.

A wave of nausea roils through me. Sensing my unease, Cymerman suggests its time we head back down. If you stay much longer, he says, your headache will move into the moderate category, and by tomorrow morning its likely to become really severe. Indeed, all the symptoms on the AMS questionnaire are likely to get much worse before they get better.

My mission accomplished, Im more than happy to descend. But first, I say, I think I left some notes back in the lab.

I spend the next 20 minutes futilely searching the building, only to discover that my notebook has been in my pants pocket the whole time. Cymerman smiles knowingly. We actually print out instructions for every step we take up here, he says, because its so easy to forget things.

As if to punctuate the point, he begins to back the truck out of its parking spot and accidentally knocks over a 50-gallon garbage barrel. Fortunately the rest of the descent proceeds without incident. A half hour later, were safely back at 6,000 feet. The air down here tastes rich as cream, the best antidote of all for the poison of the pass.

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