Life is a Mountain: Into Thin Air and Beyond

I once met a bumper sticker that read, “Life is a mountain, not a beach.” For much of mine, mountains have been among other things, my favorite metaphor. But sometimes you can get too much, even of a good metaphor.

Take, for example, the tragic events that unfolded high on the highest place on Earth in the spring of 1996. Catalyzed by a sudden, late afternoon storm, a somber drama unfolded that ended with five people dead as they were attempting to descend from the summit of Mount Everest.

A freak late afternoon storm was the last ingredient added to a brew of human factors that set the stage for disaster. Among these human factors were the limited experience and physical reserves of come clients of this guided climb, crowding resulting in back ups and long waits at several bottlenecks, and the inability of guides to communicate with each other because of lack of radios, both within and between the two commercial groups heading toward the summit that day. Sometimes there is added safety in numbers, but also on Everest nowadays there are more pins standing at the end of the bowling alley when the big ball rolls.

When the game was all played out, three guides (including the leaders of both groups) and two clients were dead; two others suffered severe frostbite. Add six more deaths in other accidents and one has the biggest loss of life yet seen during a climbing season on Mount Everest. What with websites fueled by a satellite communications system that made the world aware of events almost as they occurred (including the phone-patch reassurances to his pregnant wife in New Zealand of one of the leaders, unable to descend and soon to die on the South Summit) small wonder that even those with affinity for flatter environs were transfixed by what transpired. And, as this 1997 spring season confirmed, such loss of life will continue, and for much the same panoply of reasons related both to human ambitions and limitations and the inevitable vagaries of nature.

In the aftermath of such disasters, many questions abound. How do those who pursue such a seemingly useless, selfish activity justify to themselves and their loved ones the possible loss of life or limb? Do they have a death wish? What about those with more money than experience? Should they be able to buy their way into what for them is an even greater risk than for the more experienced and self-reliant mountaineer? Shouldn’t we prevent such folk from putting themselves at risk, protect them from their own stupidity? Or can Everest be safely guided? What do we mean by “safely”? Many have referred to that tiny bit of the earth’s surface that extends more than 8000 meters (about 26,000 feet) above the sea as the Death Zone. Up there the barometric pressure is so low, the air so thin, that even moving slowly is close to the limit of what most can do; climbers have little left over with which to face the unexpected. When the chips are down, individual survival can be sorely tested, and even guides may be hard-pressed to get someone down who can no longer remain upright and at least wobble slowly downhill. Mount Everest is not Mount Rainier.

Even so, Everest and Rainier have much in common, including the opportunity for tragedy. An example with great personal meaning was the death of my friend, Willi Unsoeld, on Mount Rainier in 1979. In March of that year, Willi and a student from Evergreen State College were buried in an avalanche while the group Willi was leading were attempting to descend during a storm. Willi and I had shared many summits together, including Everest’s. Such moments when nature is calling the shots are not limited to the Himalayan giants but are pare-and-parcel of an uncertain destiny in many settings.

Having looked at an example of risk that some might view as verging on pathological, I have the chutzpah now to declare that, even though at times maybe we cannot live with risk, also we cannot live without it: risk is an essential dietary constituent.

So what is risk all about? The Oxford English Dictionary defines risk as exposure “to the chance of injury or loss.” Chance means uncertainty; it’s the roll of the dice, not knowing the outcome ahead of time. Climbing mountains is a form of gambling, but metaphorically no more so than many other activities in our lives. Dick Emerson, for many years a professor of sociology at the University of Washington and a climbing partner, posited that uncertainty about outcome is what maximizes motivation; certainty either of failure or of success would diminish the intensity of commitment to an undertaking. He showed that individuals communicate in ways that maximize uncertainty, for example by countering optimistic or pessimistic information with that of the opposite kind, called negative feedback. Risk and its attendant uncertainty are essential to motivation.

I view risk like a drug, and as with any drug, dose matters. Too much or too little may not be good for one’s health. Dose varies from those who are risk averse, avoiding uncertain situations as much as possible, to those experiencing symptoms of withdrawal if deprived for too long of their risk fix. Between these extremes are those of us who are risk acceptors, maybe even savoring its seasoning, yet for whom the lust for a longer, fuller life is manifest by an inclination to minimize unnecessary risks. Bertrand Russell characterized such a dose this way: “A life without adventure is likely to be unsatisfying, but a life in which adventure is allowed to take whatever form it will is likely to be short.”

Although the dietary requirement may vary among us, I see risk as an essential ingredient to a variety of human endeavors that take us beyond ourselves and our present circumstances: creativity, decisive action, and the ability both to generate and also to accommodate to societal change.

Creativity: Alfred North Whitehead wrote: “Periods of tranquility are seldom prolific of creative achievement. Mankind has to be stirred up.” Acts of creation involve risk, whether as a climber or writer or, for example, in another realm where I was able to exploit some of my own risk affection: research. Some investigation is like mountain exploration, treading into realms unknown. Answers are sought, sometimes to questions not even posed before. The journey may be measured in months or years and the path taken, i.e. the methods, may be one not traveled before. In the end, the odyssey may result in discovery, a new “aha!”, or it may lead nowhere. This kind of creativity, whether in science, the arts, business or our relationships with each other, involves the possibility of failure as well as success.

Decisive action: As a physician, particularly one practicing a critical care specialty (anesthesiology), and also as a medical educator for nearly four decades, I have come to believe that the ability to accept uncertainty is precious to functioning in moments of crisis.  As in the climbing of mountains, most of the time we are in control of what is going on. But occasionally events beyond us are calling the shots and we must respond as best we can. Some individuals seem to be naturally endowed with the right stuff, and many of the rest exhibit an impressive capacity to learn to manage crisis. For a few, though, to stay cool under fire just isn’t in the cards. Aversion to risk can paralyze action. My observation is that those who are most unsure of themselves, lacking self-esteem, commonly have great difficulty learning to function effectively in the face of uncertainty.

For some physicians, a curious opposite situation can also impair the ability to be thoughtfully decisive in managing crises. We physicians are programmed, or perhaps program ourselves, to be omniscient and omnipotent in the care we bestow. We wish to do no harm; primum non nocere is like an nth commandment. Thus we allow ourselves little room for error in providing safe passage for our patients, even when the knowledge we possess leaves us far from certain. Feelings of omnipotence sit poorly with an ability to accept the possibility of failure. Willingness to allow for imperfection provides the space to learn and grow, as well as to respond with creative decisiveness when the need arises.

Coping with the unexpected can be a powerful, at times painful, learning experience whether it be in the mountains, or medicine, or other aspects of life. What one learns that may be most precious of all is about oneself, how to live with uncertainty and accompanying fear in order to be able to act. Having been there before makes a huge difference each time such vital moments are reexperienced, in no small part because one’s own response is no longer unfamiliar. In both medicine and mountaineering I have seen a fair number of situations where appropriate, quick-thinking action has averted tragedy. I have also seen and known of situations where lack of such capacity has contributed to tragic outcomes.

Risk and society: Along with a higher level of affluence and comfort than we have ever before known, we Americans have come to place great value on being in a world that is safe and secure. A corollary of this urge is a diminishing willingness to accept risk, especially when imposed by acts of others. The potency of this unwillingness to allow insecurity, that is uncertainty, into our lives has profound societal implications. In a graduation address at Princeton some years ago, its president, Harold Shapiro, said: “The willingness to risk failure is an essential component of most successful initiatives…. The willingness to occupy new ground always involves the risk of losing one’s footing along the way….” My own observation is that American society has become too risk averse for its own good. Moreover as individuals become more risk aversive in their own lives, they become less and less tolerant of the risks taken by those in leadership positions. We are less tolerant of our leaders’ mistakes…. Indeed we often speak of failure as malfeasance and sometimes accuse our leaders of lacking courage and vision. Courage, vision, and change require not only our personal willingness to shoulder the risks of failure, but also a willingness to understand that some failed projects are an inevitable part of the great successes.

As I present this pitch for a touch of risk in our daily lives, my mind keeps wandering back to the tragedy on Everest. What went wrong up there? And why? Partly I feel that at lease some of those being guided up the mountain didn’t belong there. They had not learned the skills and acquired the experience and judgment to take care of themselves in a crisis. But then another part of me realizes that that’s what guided climbing is, whether on Mount Rainier or Mount Everest: substituting another’s expertise for one’s own, a way to shortcut the competence issue while lessoning the risk. Guided climbing is not unlike the doctor-patient relationship, as least as I have experienced it in  y own specialty. The client/patient delegates responsibility for his or her safe-keeping to another, trusting that other to possess the skills and judgment to enable safe passage, whether it be through anesthesia and surgery or to the top of a mountain and back down again. Sure, the risks are greater on Everest than in the operating room, a lot greater. But as we have seen, safe passage cannot be guaranteed in any setting, not on any mountain. The difference in magnitude of risk between Everest and lesser summits is quantitative, not qualitative.

I ask myself, how do these clients differ from Tom Hornbein or Willi Unsoeld when they were climbing on Everest in 1963? While some had a fair bit of mountaineering mileage under their belts, others did not. But basic skills can be quickly learned, at least to some degree, and the usual route up Everest is not technically so difficult. More essential are commitment, fitness, judgment and insight regarding one’s reserves to get not only up but back down again. That, in the company of a good guide, may suffice, so long as all’s well. But end-of-the-day fatigue, compounded by unanticipated bad weather can suddenly change the whole complexion of things. When guides aren’t there, one is left to make do on one’s own resources of character and experience. When either is in short supply, safety margins are wafted off on the wind.

Still, I am struck by the similarities between now and then. Although by now Everest had been climber over 3,000 times, still people are willing to risk their lives and plunk down $65,000. to try to reach the highest point on earth. Why? Exploration? Adventure? Testing personal limits? Fame? Fortune? Trophy collection? The mix of motivations seems much the same now as it did for us in 1963. Those who are bystanders have always questioned the rationality of the minority living closer to the edge, the risk acceptors. The questioning is less query than judgmental and no different now than in the past.

Risk is an ever-present part of our lives. We might wish to control the dose but, by definition, that is not completely possible. The control then that we seek is not of risk but of ourselves in living with and coping with risk, with uncertainty. For some of us, risk is more than essential to creative or decisive functioning. Risk helps define who we are, where we fit into the world around us and how we relate to and influence, for better or worse, the lives of others. I think the capacity to accept risk has helped me to be a better doctor and hopefully a better teacher, father, husband and human being. I feel blessed to have been born at a time early enough in the human relationship to Everest that the adventure could be both pioneering and lonely. Though times and the way things are done change, the needs we humans have to seek out new places in the soul to go remain the same.