ILLNESS, FAILURE TO DISCLOSE PREVIOUS MEDICAL HISTORY, INEXPERIENCE
Alaska, Denali National Park, Mount McKinley, West Buttress
On June 12, Tina James, a client with Mountain Trip led by Todd Ruthledge, was out on a summit bid when she began experiencing medical problems. The group had left high camp around 0930 and had reached Denali Pass around noon. James had been moving very slowly. When queried, she said she was having difficulty breathing and had a headache. She claimed not to be dizzy or nauseated and was not exhibiting any ataxia according to Ruthledge. He also discovered at this time from James’ friends on the trip that she seemed to be suffering from a chest cold and had taken an antibiotic, amoxicillin, though the previous evening she was not experiencing a cough. Ruthledge did not feel James was exhibiting any severe signs of Acute Mountain Sickness (AMS) and decided to send her down with assistant guide Drew Ludwig while he and the rest of the group continued to the summit. Ludwig and James began their descent back to high camp. En route James may have lost consciousness briefly and had to be physically helped the remainder of the way into camp. They arrived in camp at 1515 and immediately contacted the NPS. Ranger Meg Perdue and VIP Ranger Darren Castell were at high camp and responded performing an
initial assessment of James, whose chief complaints were severe headache, difficulty breathing, and chest pain. James described the pain as “crushing” and said that it was radiating down her left arm. She said she had no cardiac history but had had surgery five weeks earlier for a severed artery in her left forearm. Perdue later determined that James had not shared this fact with Ruthledge along with the information about taking antibiotics and taking meperidine for a toothache. James was placed on oxygen and allowed to rest in her tent while Perdue conferred with staff at the 14,200-foot camp. By 1600, James stated that the chest pain was gone and her breathing was improved with the supplemental oxygen, but she still had a severe headache. Though her condition had improved somewhat, due to the uncertainty and potential instability of James’ condition, the decision was made to attempt a ground evacuation from 17,200 feet. Gusting wind conditions prevented an air evacuation. After resting, James felt she could walk down rather than needing to be lowered. The decision was made to descend the ridge to 16,200 feet with Perdue short-roping James.
James was at 14,200 feet by 2135 and undergoing an assessment by staff there. She remained on oxygen and was kept overnight. Her condition was deemed stable and so James was released the following morning at 1000 to descend with her party to basecamp. According to Todd Ruthledge, the descent from 14,200 feet to 11,200 feet on June 13, was slow but steady; however, because the team had gone from 17,200 feet that day. James was exhausted so she decided to camp at 11,200 feet. On June 14 they continued their descent, though James’ headache had returned and she appeared weak. They met with Ranger Gordy Kito’s patrol at 7,800 feet. James was reassessed and advised to continue to descend. The group reached basecamp at 1600 and was able to fly out almost immediately. Upon returning to Talkeetna James called her mother, who reminded her she is allergic to penicillin. Amoxicillin is in that same family of antibiotics.
Here is another classic example of the importance of and need for good communication among expedition members, particularly between clients and guides. It also illustrates the equally important principle of not placing ambitions for the summit ahead of good judgment. If she had been willing to discuss her medical conditions and concerns with her guides, it may have been possible to avoid the situation she found herself in or at least lessen its seriousness. It is unknown whether there was more than an allergic reaction contributing to James medical problems, but it is clear that with so many conditions affecting her, respiratory problems of unknown etiology, a toothache, and major surgery within the past several weeks, a more conservative approach and willingness to place personal well-being ahead of the summit would have been prudent.