The Abominable: A Novel

Tuesday, May 12, 1925

Babu was unconscious when we evacuated him from Camp III last night, Monday night. The others had come out of their tents at the sound of our shouts—reacting first to his laughter, then to our calls for help—and we’d gathered and knelt around the still splayed, supine, and unconscious Babu Rita.

Reggie took one look at the knot and spreading bruise on the Sherpa’s temple, tossed the first-aid kit to the Deacon, pointed to two other Sherpas while giving orders in their Nepalese language, and then ran with them back to the tents to put together a stretcher out of spare tent canvas and poles. The Deacon crouched next to Babu, carefully lifting his heavily bleeding head. He quickly set two gauze pads against the freely bleeding areas on Babu’s scalp, then lashed them into place with quick loops of a gauze bandage. He cut the bandage with his pocketknife and knotted it with swift, sure movements.

“Will he be all right?” I asked. Everything about me, down to the lifeless tone of my voice, was signaling guilt and responsibility for my porter’s accident. Jean-Claude looked equally guilty.

“Head wounds are weird things,” said the Deacon. He’d been lifting Babu gently by the shoulders, gingerly touching the short man’s neck and back, down to his tailbone. “I don’t think there’s any spinal damage. We can move him. The best thing we can do is to get him down to Base Camp and to Dr. Pasang as quickly as we can.”

“Is it really safe to move him?” asked J.C., who’d long ago told me that Chamonix Guides were trained not to move a fall victim if there was any chance at all of spinal or serious neck injuries.

The Deacon nodded. “His neck isn’t broken, as far as I can tell by touch. His back feels all right. I think there will be less danger in moving him than in leaving him up here all night.”

Reggie and Nyima Tsering returned with the jury-rigged stretcher, its canvas doubled over and lashed tight to the two six-foot poles.

“We’ll need someone to carry him down,” said the Deacon. “Six men, I think. Four to carry and two more along to spell the others.”

“We’ll carry him,” Jean-Claude and I said in pathetic, guilty unison.

The Deacon nodded. “Pemba, Dorjay, Tenzing, Nyima, you four go down with the sahibs.”

Reggie quickly translated to the three Sherpas who spoke no English. I saw that she had also brought back from the tents two lanterns and two sets of the headlamps. She waited until we crouched next to the unconscious Babu and—on the count of three and with infinite gentleness—transferred him from the snow to the unfurled stretcher.

The snow remained caked with Babu’s blood, and his bandages were already bleeding through.

Silently, Reggie handed lanterns to Pemba and Dorjay and the headlamp rigs to J.C. and me. “Tejbir!” she called to the tallest of the watching Sherpas. I remembered that Tejbir Norgay spoke English. “You go ahead as runner as quickly as you can. Tell those in Camp Two and Camp One that we may need new volunteers to carry as we get to each camp. But don’t waste time at those camps—hurry straight on down to Base Camp and see if Dr. Pasang can come up and meet the stretcher bearers along the way. Tell Dr. Pasang exactly what Babu Rita’s head wounds are like and what caused them. There’s a third lantern outside the big tent here—pick it up as you go.”

Tejbir nodded once and jogged off the snow slope, snatched the lantern as he ran past on the rough, snow-covered moraine at the campsite, and within seconds had disappeared behind the ice pinnacles and was up and onto the glacier path.

Jean-Claude took the left front end of a pole and I grasped the right rear. Nyima Tsering grabbed the right front and Tenzing Bothia was at the rear with me. On the count of three again, we lifted the stretcher waist-high. Babu Rita seemed to weigh nothing at all.

“We’ll follow you down as soon as we get things sorted out here at Camp Three for tomorrow’s carries,” said the Deacon. “Tell Dr. Pasang that I’m bringing everyone down to Camp One or Base Camp.”

The trip back down the glacier was grueling, especially since it came at the end of our long climbing day. Before we’d climbed onto the glacier for our descent, Reggie had handed Pemba a full oxygen rig with three full tanks on the frame. The idea was that as we grew tired, we’d fall out and take some English air from two of the tanks, while Pemba or Dorjay filled in for us. Babu Rita would breathe from the third tank all the way down. It just added 22 pounds to the weight of the stretcher.

But neither Jean-Claude nor I dropped out during the four-hour descent through the camps, even while the Sherpas took turns relieving one another. Once or twice after a difficult bit—such as the detour down into the glacier and up and out its steep slopes again—Pemba held the oxygen mask up to J.C.’s face, then mine, and we drank in some rich English air and continued on. Babu Rita looked asleep behind his chamois-cloth mask.

Dr. Pasang met us at Camp I and had us set the stretcher on some crates while he did a preliminary assessment of Babu by lantern light.

“I believe your Mr. Deacon was correct about there being no immediately obvious neck or spinal injury,” said Pasang. “But we do need to get him down lower. Can you carry him again—as far as Base Camp—or shall I get fresh porters?”

Jean-Claude and I had no intention whatsoever of allowing anyone to take our respective corners of the stretcher. Of course, that attitude was absurd since it was as if we were punishing ourselves, but I thought then—and believe to this day—that we, especially I, deserved punishment. If we hadn’t acted like idiot schoolchildren—if I hadn’t started that behavior with my stupid, playground-level showing off, Babu Rita would have been eating dinner at Camp III right then and laughing with his Sherpa friends.

We reached Base Camp a little before eleven p.m. The infirmary tent had its side curtains raised, and the night was surprisingly warm for an altitude over 16,000 feet. There was no wind. Half a dozen kerosene lanterns hung hissing from the tent eaves, and I could see why Dr. Pasang would want to do any serious medical work here, where the air was relatively thicker and warmer and the light was much better than at any of the other camps.

The four Sherpas who’d come down with us went off to their tents, and J.C. and I collapsed on the floor of the medical tent while Pasang began his careful inspection of Babu Rita’s wound. My arms were so tired I felt that I’d never be able to lift them again.

After the thirty-minute examination, which included Dr. Pasang taking Babu’s blood pressure, pulse, and other vital signs before he cleaned the wounds and put on fresh bandages, not a word was said. Finally, when Pasang had put an oxygen mask in place over Babu’s face, turned it to full flow, pulled two blankets up to the Sherpa’s chin, and moved away one of the lanterns and both of the mirrors he’d been using, I said, “How bad is it, Dr. Pasang?”

“His respiration is very shallow, pulse is weak, breathing labored,” said Pasang. “I’m ninety-five percent sure that Babu has a hematoma—a blood clot on the brain—where his head hit the boulder.”

“Can you do something for that?” asked Jean-Claude. I knew the guide had seen men die in the mountains from brain embolisms before this—some from injuries, some from high-altitude illness that triggered a blood clot in the lungs or brain. For me, it was only a phrase.

Dr. Pasang sighed. “The oxygen should help a little. In a regular hospital setting, I would do my best to identify the precise location of the clot or clots and then, if the patient did not awaken and the vital signs grew weaker, might perform a craniotomy. Here, in these conditions, the best I can do is an old-fashioned trephination.”

“What’s the difference?” I asked.

Pasang moved his large hand above the bandaged areas on Babu’s skull. “For a surgical craniotomy, I’d shave this part of Babu’s scalp and then make a surgical cut through the scalp—with no X-ray machine, I’d have to make my best guess where the blood clot is and where to cut. Then I’d drill a small hole in his skull and remove a piece of the skull…we call that a bone flap. Then I’d remove any skull fragments that are pressing against Babu’s brain and drain off the solidified and pooled blood. If his brain is swollen by the injury, I might leave the bone flap off—that would technically turn the operation into a craniectomy. If there’s no serious swelling, I’d use small metal plates or wires or sutures to put the bone flap back in place.”

“That sounds sort of primitive,” I managed to say over the feeling of gorge rising in my throat.

Pasang shook his head. “That’s the modern version. In these conditions, and with the surgical tools I have with me, I’d have to do a trephination.”

“What’s that?”

Pasang seemed lost in thought. Finally, he said, “Trepanning’s been done since Neolithic days. It’s just drilling a hole in the patient’s skull to expose the dura mater, thus relieving the pressure on the brain that bleeding or a blood clot or skull fragments from the injury can cause. I did bring a trephine with me.” Pasang crossed to the small crate of his surgical supplies and lifted out an instrument.

“That’s just a hand drill,” I said.

The Sherpa doctor nodded. “As I say, they’ve used such trepanning instruments for centuries. It sometimes works.”

“How would you seal up a drill hole like that?” asked Jean-Claude. I could hear the revulsion in his voice as well.

Pasang shrugged. “Such a hole, by definition, will be larger than the bone flap entry, but I could use wire sutures to replace the disk of skull material, or even screw in something so prosaic as a coin the right size. The skull has no nerve endings, of course.”

“Are you going to do it?” I asked. “The trepanning, I mean.”

“Only if it’s absolutely necessary,” said Pasang. “Such a surgical procedure at this altitude—and under these unhygienic conditions—would be very, very dangerous. And because at least three points on his skull and scalp made contact with the boulder, I wouldn’t be sure where the blood clot may lie. I’d hate to have to drill three holes in Babu Rita’s skull and still not find the right place.”

“Pardonnez-moi,” said Jean-Claude and left the tent. I hadn’t known that my French friend was so squeamish.

“We’ll give Babu ten to twelve hours,” said Dr. Pasang. “If he comes out of this coma, then we’ll just take care of him until he can travel on a litter and then get him back to Darjeeling as quickly as possible.”

I thought of the five-week trek in. There were shorter routes over higher passes, directly into northern Sikkim, but the passes were very high and open only during brief parts of the summer season. Neither the long way through the filthy Tibetan hill towns nor the dramatic shortcuts over blizzard-threatened high passes seemed appropriate for a man suffering from brain injury or a recent trephination.

Jean-Claude returned with our two Base Camp sleeping bags. “May we sleep on the floor of the infirmary tonight, Dr. Pasang?” he said.

Pasang smiled. “We can do better than that. There are two empty camp beds in the rear curtained section here in the infirmary tent, near where Ang Chiri and Lhakpa Yishay are sleeping. I’ll help you carry the beds out into this main area. You can stay near Babu Rita tonight.”

I sleep late—until after sunrise—and awaken with that terrible sense that something is wrong. I peek out of my sleeping bag and see that Babu Rita is sitting up, eyes open, and smiling broadly. Pasang stands nearby, his arms folded across his chest. I jostle J.C. awake in the cot next to mine.

“Oh, Sahib Jake and Sahib Jean-Claude,” cries Babu Rita. “Such fun before I never have had!”

I manage to return the Sherpa’s grin. J.C. just stares.

“I am so lucky that I am dying so close to the beloved Dzatrul Rinpoche,” continues Babu Rita, still grinning broadly. “I ask that you let His Holiness the abbot of Rongbuk decide what kind of funeral I should have.”

“No one’s going to be dying…,” I begin but stop when I see that Babu Rita has collapsed back on the high padded table where Pasang has watched over him through the night. The Sherpa porter’s eyes are still open, the grin still on his face. But I can see that he’s not breathing.

Dr. Pasang tries resuscitation for several endless minutes, but Babu Rita’s battered body and tremendous spirit do not respond. He is gone.

“I’m sorry,” Dr. Pasang says at last. He closes Babu’s staring eyes.

I can’t help but look at Jean-Claude. I can see in his gaze that he agrees: we’ve killed this good man with our boyish nonsense and lack of common sense.