When I started writing this post, it was Monday 7/26 and I was lying in an ICU bed on the 10th floor of the University of Colorado hospital in Denver breathing 80% oxygen through a positive airway pressure mask. I had been diagnosed with a presumed case of acute altitude sickness known as High Altitude Pulmonary Edema (HAPE). As someone with no previous respiratory history and a pretty clean bill of health, this was not where I expected to be after what was supposed to be a quick weekend trip to the mountains. What follows is a recap of what led to this point and some information about altitude sickness to increase awareness of this common, but potentially lethal condition.
I flew into Denver (elevation 5,280 ft) from Austin(elevation 498 ft) on Saturday morning 7/24. I hopped in a rental car and drove straight to visit my girlfriend in Silverthorne (elevation 9,035 ft).Naturally, having an IV bar at my disposal, I took the opportunity to get a little IV hydration the day before my flight since I knew I’d be traveling.Unfortunately, I was not aware that being at elevation requires someone to be even more hydrated than one would need to be at sea level. Significantly more hydrated, in fact. In addition to that, the rapid change from 498 ft to nearly 10,000 ft is a huge shock to the system, and it’s much more than just getting winded more easily when you’re taking a walk. I didn’t do anything physically strenuous on Saturday and spent a relaxing evening with adult beverages and TV bingeing.
On Sunday (7/25), we took a short hike in the morning which lasted no more than an hour. There was a slight uphill grade to it, but nothing demanding, and I didn’t even break a sweat. I did notice that I was slightly short of breath during the hike, but I expected that given our altitude. Going back downhill, I didn’t feel short of breath at all. We hung around the house afterward and went to visit friends for dinner that afternoon. It wasn’t until we got back from dinner that I suddenly noticed I had chills and felt really tired. It struck me that I hadn’t felt that way since having COVID in February. So, I just laid in bed and watched TV. But as the evening wore on, I started noticing a little nausea. Was it maybe something I ate? Then there was this intermittent coughing. And then I noticed my heart was beating harder and faster than normal. And then it occurred to me that I was a little short of breath and breathing faster… but why was that happening when I was just relaxing in bed? It wasn’t until I tried to take deep inhales and exhales that I heard and felt the popping and crackling in my chest.
Sometime after medical school, I had read the book Into Thin Air: A Personal Account of the Mt. Everest Disaster, by Jon Krakauer. In it, he described various forms of altitude sickness, one of which was High AltitudePulmonary Edema (HAPE). For some reason, the description of this condition has stuck with me ever since. HAPE typically occurs when “lowlanders” rapidly ascend to 8,000-10,000 ft with early symptoms showing coughing, shortness of breath with activity and a decreased exercise capacity. As it progresses, shortness of breath occurs at rest and people may noticed a faster pulse, faster breathing, elevated body temperature and crackles in the chest. As I was lying in bed feeling all of this, it occurred to me that I either had COVID again (which I thought was unlikely given I was fully vaccinated and these symptoms felt worse than when I originally had COVID), or I had HAPE.
When I woke up Monday morning (7/26), I wasn’t feeling any better. Even sitting up in bed felt like a huge physical undertaking. Walking to the bathroom left me panting. I knew I was supposed to fly back to Austin that evening and was hoping that the 90 minute drive back to Denver and its lower altitude would help me feel better. Now when I coughed, I could feel what felt like a thin, runny, salty fluid in the back of my throat. It felt very distinct from the thick sputum you get with an upper respiratory infection. My shortness of breath and rapid breathing was easily noticeable to anyone who looked at me by this point. Even though my flight wasn’t until the evening, my girlfriend and I decided I would drive back to Denver early to see if it made me feel any better…and if it didn’t she convinced me to go to an urgent care and get checked out before going to the airport. The drive from the mountains to Denver did not make me feel any better. I parked at an urgent care near the airport and the short walk from the car to the building with my mask on almost made me pass out. I couldn’t breathe. The provider in the urgent care took one listen to my lungs and told me to go straight to the ER. In typical doctor fashion, I was being stubborn and wanted to just get on my plane and get back to Austin’s altitude which I knew would take care of the problem. She told me, “Flying right now could very well kill you.”