48. High Altitude Cerebral Edema

High Altitude Cerebral Edema

Even youths shall faint and be weary, and young men fall exhausted…

Isaiah 40:30

Our training schedule for the next six months included either the best or worst of both worlds, depending on how you look at it. We trained at altitude in the winter months and in the desert during the summer. In February 2011, we journeyed to the Marine Corps Mountain Warfare Training Center in Bridgeport, California. The base camp, sitting 6500 ft above sea level, required a few days of acclimation to the relatively scant oxygen in the air compared to San Mateo. Simply walking up the steps to the gym felt like a mild jog. 

Evergreens salted many of the surrounding jagged peaks, adding a serrated outline to an already sharp, towering horizon. These immutable mountains, with their lofty presence, snowy luster, arduous formations and cozy tree line provoked a sense of tantalizing dread. Their inviting yet ominous display filled me with wonder and intrigue as the full force of Nature’s call to adventure gripped me for the first time. She leaned in, whispering her seductive invitation into my cold ear: “Come enjoy the ecstasy of my bosom… if you dare.”

To prep us for our stay in the chilling bed of our seductive mistress, the instructors issued us cold weather and camping gear and taught classes on how to not die and/or freeze our balls off while sleeping with her.

“Listen up, this shit is serious so keep an eye out for each other.” The instructor said, standing beside the projection in front of the classroom. “We’re gonna bivouac between eight and nine-thousand feet, so it’s not just the cold we have to worry about. There’s AMS, HAPE and HACE,” he continued, pointing to each acronym on the slideshow. “This is why we’re spending a week at base camp, because going up too fast without acclimating is the biggest risk of Altitude Mountain Sickness. Be on the lookout for headache, extreme fatigue and dizziness. 

“AMS can progress to HAPE and/or HACE. I’ll break it down simple stupid for you crayon eaters. AMS equals bad. HAPE and HACE equals very bad. High Altitude Pulmonary Edema is when the lungs swell up, causing extreme shortness of breath. High Altitude Cerebral Edema means brain swelling. Symptoms include confusion, abnormal behavior, fever and loss of consciousness. Extreme physical activity combined with high altitude increases the risk. The likelihood of seeing HAPE or HACE is basically none though, because it’s rarely seen below ten-thousand feet.”

Something about his dismissive comment didn’t sit well with me. That devil Murphy, and his conniving law, disrupts not only our most intricate preparations but also exploits our willful or ignorant attempts to write off even the most unlikely scenario. I frequently think about the Titanic, and that however correct the engineers and passengers were of the infinitesimally small chance of the ship sinking, to proclaim it unsinkable with such arrogance, all but guaranteed it’s destruction as Murphy heard their boastful claim and said, “Hold my beer.” Perhaps my intuition or subconscious superstition understood that speaking such blasphemies out loud could welcome Murphy to do his dirty work.

The temperature in Bridgeport wasn’t as cold as I anticipated. Daytime ran between a sunny 32 degrees while night time temps dropped to high single or low double-digits. I don’t think it ever plunged below zero. For me however, though I did embrace this cold, I ironically sat in the conflux of the frigid air and withering heat.

Somehow I won the lottery without buying a ticket. The company selected me to be one of the handful of drivers chosen to operate the SUSV. This Small Unit Support Vehicle is a light personnel carrier with widened treads designed to navigate snowy climates. Consisting of two compartments connected by an articulating hitch, it is capable of transporting about six Marines comfortably on the rear pod’s inboard-facing seats in addition to four passengers in the front. To help equalize the center of gravity and enable tighter turns, rather than having the engine stored in front of the vehicle, the designers placed it where the center console should be, shrouded by a thin, removable cover.

Small Unit Support Vehicle. (Image pulled from Wikipedia)

These old, 1980’s diesel engines, though workhorses in their own right, were pushed to their limits daily when encumbered by a full loadout of Marines and trudging through steep switchbacks. I reunited with my long lost inner hillbilly plowing through those powdery hills. Many years prior, around ten years of age, I awakened this recluse while bumping around dirt paths on quads with my friend Daniel. Now, as my confidence with this new machine grew, I sped through shaky mounds on winding paths which at some bottlenecks, were a dozen feet removed from a plummeting tree line. During even short expeditions, the obnoxious clacking engines frequently overheated. To mitigate the risk of burnout, the engine cover almost never was fully sealed or removed all together. Hot air blasted from the vehicle as I swerved it up and down the mountain. While other Marines were trudging through the frostbitten snow with many layers to keep warm, I roared to and fro in the rattling, sweaty sauna in short sleeves as the surrounding frigid air succumbed to the impenetrable furnace.

My fortunate warmth wasn’t restricted to the SUSV’s. For Christmas of 2010, Lee gave me the two best gifts I never asked for. The first was a Camp Bed 2.0. This plush surface, though heavier than our shoddy green foam mats, was worth every extra ounce. It featured a smooth, breathable lining filled with memory foam that self-inflated once the seal was opened as the squished foam reformed to its original volume. When guys noticed this novel sleeping surface on my pack, I immediately provoked their envy as I boasted about the portable luxury. By the time our desert training rolled around, at least dozen Marines brought Camp Beds, some with the thicker 3.0 version. Looking back, I regret not requesting a kickback or free merch from REI for the many referrals I gave leading to sales.

The second item Lee gifted me was an average-looking pair of brown leather gloves. Though the interior felt like the result of an adulterous union between an alpaca and a kitten, I wasn’t convinced they would be useful once they inevitably succumbed to the melted snow. 

“Thanks, Lee,” I said unenthusiastically after opening the gift. “These are really comfortable.”

“Great! But I’m not done yet.”

“What do you mean?”

“I’ll show you how to make them even better.”

I watched as he cracked open a tin of black shoe polish, lit a candle and began rubbing the goop onto a section of the glove. Once the spot turned completely black, he held it several inches above the flame.

“See? You just rub the polish in real good and the flame seals it in.”

“Huh,” I said, still unconvinced this would do much if anything. After about an hour, maybe more, both gloves were now a shiny, jet black.

He handed me the gloves. “Here you go. They’re all done. With these on, your hands will feel great,” he said with a confident smile. I thanked him, mirroring his expression to hide my doubts.

One morning we were introduced to snowshoeing and cross country skiing. Once the afternoon rolled around, I gathered with several other Marines awaiting our next training evolution. Most of the dudes removed their bright red hands from their damp gloves to heat them up with their breath. 

“Damn, my hands are freezing!” Ward complained.

“Yeah, mine too,” another chimed in, “My gloves have been soaked for hours.”

“Really?” I asked, “My hands are doing great.”

“What kind of gloves do you have?” Ward asked.

“I don’t know, my stepdad got ‘em for me for Christmas then put shoe polish all over ‘em.”

“Son of a bitch,” he said as I pulled one off and gave it to him. “Better gloves and a Camp Bed? I fuckin’ hate you Decoupcrank.”

I had no idea my hands had it so good. 

The good didn’t stop with warm hands and a nice bed. Everything was good for me in the SUSV. Rather than being forced to spend hours carving out a crater in the snow that would later become an icy tomb where one would theoretically, but not actually sleep, I transported Marines up and down the mountain. When the time came to sleep, my buddy driver and I sat in the open rear compartment, set up our racks on the benches and used a camp stove to turn our ice box to a comfortable seventy-five degrees. The base of vehicle had an intentionally designed hole for reasons I can’t explain, but it sufficed to prevent suffocation without letting in too much cold. When guys opened the rear door to relay information to us, a rush of heat smacked their jealous faces. Waking up once per night to run the engine for thirty minutes to prevent a dead battery was a small price to pay for such luxuries.

As if the perks of being a driver weren’t great enough, we also avoided the bone-chilling, back-breaking, snow-shuffling hikes. Humps in the hills of Pendleton are bad enough with the amount of weight we carried, but adding over a mile of elevation, mounds of snow and snowshoes attached to heavy, awkwardly shaped Mickey Mouse boots rucking at Bridgeport was cruel and unusual punishment. 

Mickey Mouse boots are obnoxiously large white, extra-insulated, rubber boots used by the military in extreme cold weather climates.

One such hike began in the open plateau surrounded by towering mountains several hundred feet high. I remember looking in the distance to an arduous slope thinking if ever we were told to march atop, we’d soon be informed the absurd order was a sick joke. When they told us to climb it, we waited for the punchline. It never came.

A sense of guilt overcame me as I imagined the frozen hell my buddies would soon endure. At least I could justify my absence because earlier that day, some Marines injured themselves and needed to return to base camp. One scored a grade two concussion after face planting into the snow when he lost control of his skis and the other sustained a lower extremity injury. Even though I was given an important task, I couldn’t help but hurt for the guys I left trudging uphill.

I brought the wounded into the infirmary. There I met the attending physician’s assistant, a Navy lieutenant who’s name has long since departed from my memory. He asked that I drive him up the mountain to to give routine assessments to anyone who may need them. His request came not a moment too soon. About half-way up, I heard some frantic chatter over the radio.

“We need a doctor up here, now!”

“I got the doc with me. What’s the situation?” I said

“He’s going crazy, not making any sense and now he’s stripping off his cammies! We’re near the top of the western peak.”

“Roger, Oscar Mike,” I said.

I smashed the gas pedal as I peeled left at a fork leading to the top of the ridge. My confidence with the SUSV shone with each sliding turn and snow-splashing dip. When the narrow path widened to an open hilltop beyond a few spotted trees, I cranked right. 

With my boot still smashing the gas pedal, our speed declined as the SUSV splashed into the fresh powder. The vehicle waded through the snow towards the scattered Marines at what felt like a snail’s pace. As we approached and the flattened peak slowly steepened, I parked in the midst of the widely dispersed men.

They looked miserable. Their shuffling legs weakly slid snowshoes shackled to weary feet. Men tilted their heads upward, mouths open with gasps of misty gasps, rifles dangling around their necks and packs latched to their backs so large and overstuffed one might think we were filming a far-fetched comedy. In addition, some of the guys were strapped to sleds that carried other extra cold-weather gear such as camp stoves and tents. 

I hopped out of the vehicle.

“Hey, where is he? I got the doc!” I shouted. Most of them didn’t know what was going on, as they were leading the pack. My frantic eyes shifted through the dispersed crowd until two Marines hauling another in the sled came into view. Doc stepped out and ran to meet them as they headed my way. Once pulled to the rear compartment of the SUSV the black Marine’s dark, convulsing shirtless body highlighted the full whites of eyes now rolled back into his head. I rested my palm on his forehead. He was burning up. 

“Stay with us,” doc said, tapping his face. 

His white eyes and quaking body disregarded the officer’s command. We promptly loaded him into the back of the SUSV as Doc hopped in and pulled out an IV bag. I watched him stick the needle and raise the bag. Doc gave me a nod.

I shut the doors, assumed the wheel and trucked down. Taking bumps and turns with more care, I reigned in my gas pedal to provide as smooth and speedy a descent as possible. As we approached base camp, his condition improved. Though still disoriented, he regained consciousness once we arrived. 

Doc’s examination revealed that the Marine didn’t eat breakfast and may have had an sickle cell anemia, predisposing him to less efficient oxygen delivery. This combined with the most grueling hike at nearly eight thousand feet set in motion the perfect storm. That was when I learned to never disrespect or doubt Murphy when the seemingly impossible happened. Doc diagnosed him with HACE.

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