Head in the Clouds
There’s never been a good test for how altitude affects a mountain climber’s mental acuity. But recently one of our students took steps to improve things.
Sometimes waiting is the hardest part. For five days last spring, Katherine Rizzolo, A09, M16, sat on a boulder in Nepal along the main climbing trail to Mount Everest. As heavily laden trekkers passed, she would ask them one by one if by any chance they were involved in a study she was participating in that looked at how altitude affects the cognition of mountain climbers. Rizzolo and other members of her team were presenting climbers with a 10-minute quiz to be taken at different altitudes.
Getting the hikers to take the quiz at lower altitude had been somewhat straightforward, but as Rizzolo was learning as she waited on the boulder, getting them to take it the second time could be difficult. The results were patchy at best. Climbers who had taken the 10-minute quiz at 10,000 feet might, at higher altitudes, have wandered off the trail, fallen ill, gotten injured, or simply quit and gone home. Not everyone was in the mood to name the president or count backward from a given number. Plus, Rizzolo might have blinked and missed them as they passed.
It was while doing a rotation at Tufts-affiliated Christian Medical College in southern India—an opportunity funded in part by the Dr. Te-Wen Chang Difficile Scholarship—that Rizzolo figured she might as well visit Nepal for a few weeks and pitch in on an effort to develop a new and better screening tool for Acute Mountain Sickness (AMS), an ailment brought on by reduced air pressure and low oxygen levels at altitudes above 8,000 feet. Severe cases may be marked by grayish skin, confusion and the inability to walk in a straight line. The latter two symptoms represent potentially fatal side effects for a climber.
“Right now there’s no good measure of cognition at altitude.”
The best available tool right now for assessing AMS is something called the Lake Louise Score, a rudimentary six-part quiz from the 1980s that Rizzolo calls “outdated and subjective.” It asks a climber such questions as: Do you have a headache? A stomachache? Do you feel nauseous? “If someone is suffering mountain sickness, they may answer the questions wrong and say, ‘Oh, I feel fine,’ ” Rizzolo points out. “Right now there’s no good measure of cognition at altitude.”
To devise something better, her five-member team in Nepal, working under the auspices of MGH/Harvard Medical School and the Himalayan Rescue Association, drew inspiration from the model of the mental-status assessment exam commonly given by hospitals to new patients. For the exam, patients are typically asked to remember and repeat a series of words, cite the year, month and day of the week, and/or retell a story that they heard moments earlier.
Rizzolo’s test group involved 60 or 70 climbers who were each evaluated at 10,000, 11,500 and 18,000 feet (Everest base camp). “It was not a goal of mine to go to Everest base camp, but it just sort of happened,” says Rizzolo, who describes herself as a hiker, not a climber, though she has summited all 48 of the peaks in New Hampshire.
Even ruggedness like that doesn’t prepare you for keeping track of people on a mountainside. Not only did the tentative subjects of the Nepal test fail to follow any fixed plan, but the five testers themselves, strung across the flanks of an immense mountain range, were also hard to pin down. Lacking phone service of any kind, they could not readily stay in touch. “We would leave notes for each other at the lodges,” Rizzolo relates.
Rizzolo isn’t on the mountain these days, having recently begun her internship in internal medicine at Maine Medical Center in Portland, but she says the group’s study of AMS is ongoing as time and resources permit.
Rizzolo suggests that her work on Mount Everest reflects the same interest in global health and underserved populations that led her to India in the first place. “I like medicine, and I like mountains,” she says. “That’s a niche area, for sure, but it’s also part of the much larger field of working to create medical solutions in places where people don’t have access to regular medicine.”
That sort of quest can land you anywhere. With her supervisor’s approval, Rizzolo says, her next challenge may include time spent amid the homeless population of Portland, Maine.