Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK.
A normal day for Dr. Pierre Pili may involve being helicoptered up to a glacier in the Alps, and then lowered by cable 30m down into a crevasse to assess and treat casualties. Few of us see patients in such a difficult and unforgiving environment but this is Pili’s consulting room. A mountain rescue doctor based in Chamonix, he is involved in about 1500 rescues per year, and when not on the mountain, he works as an emergency medicine doctor.
On his first rescue he was called to help two skiers who had fallen deep into an Alpine crevasse. One was dead and one was seriously injured. Pili talks about the mixed fear and excitement of doing this work: anxiety associated with trying to assess and treat these patients deep in the ice, where he too could be buried in an instant, and excitement knowing that this was what he had been trained to do.
He joined the mountain rescue team earlier than he had planned or expected, but, sadly, not through good fortune. Two of his emergency medicine colleagues who worked in mountain rescue had been caught in an avalanche in Norway; one died and the other later decided on a career change. Pili was next in line. Like all of us, he had his doubts and anxieties about his credibility and ability. It’s an extremely demanding career and not all his patients survive.
Some of Pili’s patients get into trouble by accident but others have taken risks. The mountains are unforgiving, the winter weather capricious, and there are inherent risks in climbing, skiing, and all other mountain adventure activities. Yet he believes his role is to treat everyone as he finds them, not to judge his patients. When asked to comment on a recent and controversial high altitude rescue in Pakistan where one victim escaped alive but with severe frostbite, while her companion died on the mountain, he replied that he had great respect for those who try to explore the farthest reaches of the planet. They know the risks and potential consequences.
There is a long term professional link between the mountain guides in Chamonix and their counterparts in Nepal and, similarly, with the hospital in Chamonix. As part of his role, Pierre spent some time teaching staff in Nepal about managing injury at high altitude. He shared some insights into the different perspectives of those who work in the mountains in the two continents: In Europe, and with Mont Blanc in particular, the mountains are a passion and those who visit and work in the mountains are fired by a love of the high peaks and their challenges. In Nepal, however, the mountains are a way of life. The emergency facilities are very different too, and access to casualties much more difficult and delayed. When urgent help is needed, the team can lift off from the helicopter rescue base in Chamonix and be with a casualty anywhere in the Mont Blanc massif within minutes, weather permitting. Those ill or injured in Nepal are often reached by rescue workers on foot and it may take days. Pili reflected fondly on his brief time in LangTang and his sadness that, a short time afterwards, following an earthquake, a landslide struck the village. Boulders, part of a glacier, and ice from a frozen lake, tumbled down a couloir and destroyed most of the village.
The life of a mountain rescue doctor is dramatic, exciting, and action packed and such a contrast to the average medical career. At the same time, it’s a tough and demanding job. I was taken by Dr. Pili’s honesty about the stresses of the work and the self-doubt that he feels at times, as we all do. I was impressed by his approach to those whom he is called to rescue, his reflections on the passion of those who explore the mountains, from the weekend skiers to those who balance greater risk at high altitudes. And, above all, I was impressed by his humility as he introduced us to his rescue team partners in the audience of the lecture he was delivering, the mountain professionals with whom he works, and pointed out a medical colleague, whom, he said, was much better than he.
Domhnall MacAuley attended a discussion with Dr. Pierre Pili on his work as a mountain rescue doctor based in Chamonix. Dr. Pili has recently published a book about his experiences: “Chamonix-Langtang” Les Editions du Mont Blanc. 2018. ISBN: 978-2-36545-039-3