Into the wild

Three alumni share a passion for high-altitude and wilderness medicine

N. Stuart Harris, M'99 (far left), assists in a rescue on Denali. (Photo by Menno Boermans)

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MedAlum@vcu.edu

November 16, 2022

This story was published in the fall 2022 issue of 12th & Marshall. You can find the current and past issues online.

Luanne Freer, M’88, says a blue hospital sign near Yellowstone National Park altered the course of her career.

When she was an emergency medicine resident at George Washington University Hospital, a faculty adviser talked to her about finding her niche. He asked what she loved to do more than anything and Freer answered, “Go on vacation in the mountains,” not believing she could align her passion for the outdoors with a medical career.

So, when she saw that “H” symbol while on a holiday amidst Yellowstone’s forests and peaks, a lightbulb went on.

“You mean I could work and practice medicine in the wilderness?” she says. “Seeing that little blue sign changed my life.”

Freer began working in Yellowstone National Park in 1992, later becoming the medical director. She also became a member of the Wilderness Medical Society and served as its president from 2004 to 2006. The society fosters and supports research and medicine in wilderness environments.

“‘Wilderness medicine’ is improvising your medical care in austere or resource-poor environments,” she says. “We like to think about treating a burn around a campfire or a broken leg on the side of a mountain. But we use wilderness medicine on urban streets when there’s an earthquake. We spend a lot of time educating ourselves on how we can safely improvise care when we don’t have other options.”

In 1999, Freer gave a lecture at a society meeting and an audience member approached her about joining a group heading to Nepal for a two-week medical mission. She had always wanted to visit the country, so she signed on for the trip, which proved life-changing. The scenery entranced her, but the people stole her heart.

“I had never met people with so little who were so rich in spirit,” she says.

On its opening day, 600 people waited in line to visit the clinic her colleagues had set up. “It’s considered a privilege to see a doctor,” Freer says. “It was the first time I had really seen the enormous need, and I had a gift of medical care I could offer these wonderful people. It made me so happy to do that. And I just wanted more.”

She immediately applied to return and work with the Himalayan Rescue Association, a nonprofit that provides health care to Nepali villagers using proceeds collected from visiting climbers.

In 2002, Freer lived and worked for four months in the shadow of Mount Everest at the clinic in the village of Pheriche—at an altitude of 14,343 feet. During that time, she was invited by friends who were climbing Everest to join them at base camp for a few days. What she saw surprised her.

“It was astounding to me that some of the well-funded expeditions had their own doctor, but some of those doctors had no experience or expertise in mountain medicine,” she says. “In some cases, they were really doing their patients harm because they didn’t understand proper treatment of frostbite or high-altitude cerebral edema.”

Again, a lightbulb went on. She wondered if she could extend the mission of the Himalayan Rescue Association and bring experienced mountain medicine experts to Everest. At base camp, she met Tashi Tenzing, the grandson of Tenzing Norgay, who first ascended Mount Everest in 1953 with Edmund Hillary. She pitched him her idea.

“This was a very male, testosterone-laden environment, and I didn’t know if anyone would listen to me,” she says. “I’m not an expert climber. I didn’t know if I had the street cred to pull it off.”

Tenzing believed in her proposal and offered help to fundraise for a base camp clinic.

“He used his name and his influence to get my foot in the door, and I really owe him a lot for that,” Freer says.

In 2003, Everest Base Camp Clinic, the world’s highest medical facility, opened at 17,600 feet in Nepal. That year, whatever could go wrong often went wrong. Critical pieces of equipment did not arrive, the generator malfunctioned, medicine froze and melting glacial ice flooded the floor of the medical tent.

“The first year was rough and there were plenty of naysayers,” Freer says. “I almost gave up.”

But she didn’t and she came back. The reason? “All you really had to do was save one life,” she says.

She recalls a Sherpa porter who staggered into a climbing tent where there was a doctor who was not well-versed in mountain medicine. The doctor pronounced the man drunk and sent him over to the Everest Base Camp Clinic.

“Thank goodness he did because he was dying of cerebral edema and probably had a couple of hours to live,” Freer says. “We were able to send him home to his family. You only need to do that once and it’s worth it.”

Nearly 20 years later, the clinic still runs from early April through May, and the volunteer doctors see an average of 500 patients a season. Ailments range from sore throats to coughs to gastrointestinal illnesses to frostbite to high-altitude sickness.

Since retiring from her role at Yellowstone in 2021, Freer also has stepped back from the Everest Base Camp Clinic. She still serves as medical director and helps select the volunteers each season, but the Himalayan Rescue Association now handles operations with more local physicians involved.

“My desire from the very beginning was to have Nepali doctors run the clinic,” she says. “It’s on track to put me out of a job. That’s my goal.”

She now devotes time to raising money for the Himalayan Yokpu Foundation to expand a new hospital. “My focus is fundraising and being happy watching other people do the uncomfortable work of sleeping on glaciers,” she says.

Discovering a second career

Harvey Lankford, M'76, H'77, H'79, F'81, jokes that no mid-life crisis sparked his enthusiasm for mountain climbing. Actually, he has been interested in the outdoors since childhood when his father took the family to the Sierra Nevada for the first time.

A practicing endocrinologist in Richmond, Virginia, for more than 30 years, Lankford counts Bill Blackard, M.D., H. St. George Tucker Jr., M.D., and especially Richard Kirkland, M’48, H’52, among his mentors from the MCV Campus.

“My career was altered because I met Dr. Kirkland when I was a fourth-year medical student,” he says. “I didn’t know it at the time. I had no clue that I was going to be an endocrinologist, but you never know in life where anything is going to lead.”

After working in a multispecialty medical practice for 10 years, Lankford switched to a solo endocrinology practice for the next two decades. The move allowed him to devote more time to his mountain climbing hobby.

His two sons, to whom Lankford passed down his love of nature, were active in the Boys Scouts of America. Their scoutmaster taught the three how to survive at zero degrees in the Virginia mountains. They, along with his wife Clemmie Lankford, shared many backpacking trips in the Sierra. Lankford traveled even further afield.

“I basically took that knowledge and went higher and higher and higher,” he says.

Beginning in 1997, he climbed the 18,500-foot El Pico de Orizaba, the tallest mountain in Mexico; the 22,800-foot Cerro Aconcagua in Argentina; and the 19,177-foot Amphu Labsta, the 20,210-foot Imja Tse and the 21,000-foot Mera Peak in view of Mount Everest in Nepal. He has also scaled peaks in New Zealand and Canada.

Along the way, he began to dive deeply into literature about mountaineering and high-altitude medicine. His research led to writing for various medical and lay journals on a multitude of topics.

“I take a high-altitude medicine term, condition or disorder and use the descriptions, writings and quotations of mountaineers and physician mountaineers from their era and follow the path to the current, improved state of medical knowledge,” Lankford says.

One of his first articles, “Brains and Video Games at High Altitude,” appeared in Wilderness & Environmental Medicine in 2000, and examined how altitude affects the brain.

“We took a Game Boy and kept score at different altitudes,” Lankford says. “By the time we got to 19,000 feet, we were stupid. We could not operate it. Our reflexes were slow, our attention span was short.”

Nearly 20 subsequent pieces have been published in Wilderness & Environmental Medicine, High Altitude Medicine & Biology, Wilderness Medicine Magazine and The Himalayan Journal.

After three knee surgeries, Lankford hung up his crampons (the spiky devices that attach to shoes for icy hikes) and retired from practicing medicine in 2012. He still hikes in Virginia and Pennsylvania and ventures on trails in the Sierra, which he has now visited 30 times.

His current research involves color vision at extreme altitude. The idea stems from a climbing trip in the Himalaya, when he and a group were at 17,000 feet. They had acclimated to the altitude and the cold and started playing Crazy Eights in the bright sunshine. (“Something simple,” Lankford says. “That’s all you can do at altitude.”) Suddenly, the cards’ red and black colors became dulled.

“They were not invisible, but they were clearly different,” he says. “There is a scientific kernel in this story; it’s not just cardplaying.”

This project will take a year for Lankford to finish, but he doesn’t mind.

“It's a way for me to vicariously be back on the mountain,” he says. “It’s good for my mental health.”

Called to the outdoors

Family lore recounts that N. Stuart Harris, M’99, and his parents embarked on a camping trip in the Great Smoky Mountains when he was just two weeks old. At the campsite, a bear walked between Harris and his parents, and the infant took the encounter in stride. It seems he’s always been comfortable in the outdoors.

Harris is the founder and chief of the Massachusetts General Hospital Division of Wilderness Medicine and the director of the MGH Wilderness Medicine Fellowship. He also serves as a full-time attending physician in the MGH Emergency Department and an associate professor of emergency medicine at Harvard Medical School.

As a third-year medical student, Harris noticed an ad in the New England Journal of Medicine promoting a research grant award. He put together a proposal based on his awareness of high-altitude literature at the time that suggested Tylenol could be used to treat high-altitude headache without increasing the risk of deadly high-altitude pulmonary edema.

“In retrospect, I was in way over my head,” he says. “But there was a fair amount of science behind it.”

He earned the grant and Richard P. Wenzel, M.D., emeritus chair and professor of the VCU Department of Internal Medicine, stepped in as his mentor. “He couldn’t have been kinder or more supportive,” Harris says. “I owe a lot of the successes of my career to his willingness to believe in this medical student’s atypical ideas.”

After medical school, Harris completed the Harvard Affiliated Emergency Medicine Residency and fully intended to head back south. But Massachusetts General Hospital offered him a unique opportunity to pursue his interests in health as an ecological phenomenon. “Whether high-altitude illness, climate change or how permafrost thawing in Siberia might impact emergency department visits in Boston, all health starts with a functioning biosphere,” he says.

In 2004, he, along with colleagues at the National Outdoor Leadership School, created the medical school course “Medicine in the Wild,” a month-long backpacking expedition in New Mexico to encourage students to recognize the ecological basis of health.

“We are a story-driven species,” he says. “Physicians are the storytellers of science. Physicians should be leading public awareness of the impact of climate change on human health. In the Gila Wilderness, it is obvious that environmental conditions are the basis of health. It is a great teaching tool.”

Harris mentored his first fellow the next year and a formal Wilderness Medicine Fellowship was named in 2007. In 2009, he founded the Wilderness Medicine Division at MGH.

“A huge portion of my career has been to try and create opportunities that didn’t exist when I came along,” he says.

By drawing medical students into wilderness medicine, Harris hopes to educate the next generation of physicians who can talk about health from an environmental standpoint and ultimately recognize climate change as a health emergency.

“If you don’t have a functioning biosphere, no hospital in the world can save you,” he says. “I think physicians are uniquely poised to talk about climate change in a nonpartisan way. This is acting in people’s interest, whether it's vaccination or putting on your seat belt or safe-sex practices. Prevention beats attempts to cure. This is what you do to minimize suffering.”

In between his duties at MGH, Harris has traveled afar to treat patients in Alaska, Nepal, Siberia and Japan after the 2011 tsunami. While providing care is vital, he stresses the importance of hearing people tell their stories.

“I’m a huge believer that the diagnostic engine of medicine is narrative,” he says. “We don’t recognize it, but if you have one superpower in medicine it’s not an MRI, it’s not labs, it’s listening to the human being in front of you.”

His research has continued, including work with the Himalayan Rescue Association and the U.S. Army Research Institute of Environmental Medicine. Research teams from MGH’s Wilderness Medicine Division are active on Mount Kilimanjaro, in the Andes, far Eastern Siberia and Alaska. Recently, his team at MGH ran a research study using inhaled nitric oxide to treat acute COVID-19. In nine days, the team went from having the idea to getting approval. Within two weeks, they were enrolling patients in the trial.

Since early 2022, Harris has focused on expanding wilderness medicine to include space medicine, which until now has largely depended on a strategy of risk mitigation—choosing very healthy astronauts and rapidly returning to earth for medical care if something goes wrong.

“Our species is going back to the moon,” he says. “Mars won’t be far behind. As we move away from low Earth orbit, we won’t have the luxury of rapid return to Earth. We’ll have to diagnose and treat undifferentiated surgical and medical disease under austere conditions. This is wilderness medicine.

“I am thankful for my medical education in Richmond, my teachers and the great clinical training I received,” he adds. “My career has granted me the ability to explore the broad, universal underpinnings of human striving. To see humanity as a fascinating subsegment of our natural environment—our ecology—but also to be curious and be directly helpful to people in the immediate term.”