Out of Thin Air: Acute Mountain Sickness Creates a High-Altitude Dilemma in Bhutan

Appalachia, December 2004

By Mark Goodreau

In the longing that starts one on the path is a kind of homesickness, and some way, on this journey, I have started home.

—Peter Matthiessen, The Snow Leopard

Northwest Bhutan (14,5000 feet)
I'm standing in an alpine meadow under a cloudless sky, surrounded by towering snow peaks. The snow that fell last night so late in the season coats the stony earth, reflecting the midday sunlight, and the world is dazzling white and blue. My high-altitude headache is exploding; I'm nauseated, dizzy, and exhausted, unable to keep pace even with the lumbering yaks, now out of sight, though I can still hear the soft chiming of their bells. I have acute mountain sickness (AMS), and it's getting worse by the step.

I ask Tsheten Lodhe, my Bhutanese guide, how much more we have to climb before we reach the 16,000-foot pass between here and Lingzhi, today's stop. Pointing up to a distant promontory, he tells me it's only a little farther. I know I should retreat — it's the sure way to safety — yet I've come too far to turn back now. If I can just make it over the Nyile La, the rest of the day is downhill. And our next campsite is no higher than the last, so my AMS symptoms should subside. But if I get sicker on the other side of this pass, I could be risking my life. What should I do?

I never thought I'd be facing such a dilemma when I began this journey less than a week ago, thirty miles south of here and 6,900 feet below.

Paro Town (7,600 feet)
I've traveled to Bhutan to explore and photograph the alpine wilderness along the Tibetan border, a refuge for rare and strange beasts: the bizarre takin (a large, moose-like mammal), blue sheep, the elusive snow leopard, and the mythical yeti. I've come also to glimpse this ancient Buddhist culture before it disappears into the twenty-first century, along with the steady influx of satellite TV, immigrants from overcrowded neighbors, and tourists like me. I'm here, simply, to walk along the roof of the world and to live in the present tense, free of ordinary distractions, with no plans or worries clouding my vision.

Yesterday I arrived in Paro, where I'm resting for three days to begin adjusting to the higher altitude. After a quiet day of sightseeing followed by a loud night of thunderstorms, this morning breaks clear, the fresh mountain air tinged with pine scent and wood smoke. From the porch of my hillside cabin, overlooking the Paro Valley, scattered farmhouses below appear to float among glistening fields of rice and wheat; massive Paro Dzong, a seventeenth-century fortress (the political and religious center of the community) dominates the township to the east, while to the north and west, the greater Himalayan Range stretches three miles above this valley floor, forming the natural boundary with China. Tomorrow, I'll begin my journey into the high country...

—Mark Goodreau is a resident and native of Portsmouth, New Hampshire. He currently works as a freelance consultant, writer, and outdoor photographer, and enjoys hiking and backpacking, especially in the low mountains of northern New England.