If your bucket list includes ambitious family hikes, you’d better be prepared for that bucket to overflow.
Debby Orsini, mother of Winthrop resident Caroline Orsini, wanted nothing more for her 73rd birthday than to hike the Inca Trail with her family. Not everyone was game for the trip, but Debby, Caroline, her two sisters, and her uncle and his wife flew down to Peru together in September.
At 61, Caroline’s aunt was, according to Caroline, the most fit person on the trip. She was, however, anxious about the elevation of the trail and was worried that she wouldn’t be able to stay hydrated. Caroline is a family doctor currently practicing virtual urgent care, “but always at sea level,” she says. “I should have done more research about hiking at high altitude!”
Hiking the Inca Trail usually takes four days, with the second day being the most intense because it involves going over Dead Woman’s Pass at nearly 14,000 feet. Caroline’s aunt felt great the first day but on the second day she was too nauseated to eat. The guide had been checking her oxygen saturation level throughout the trip, which, Caroline says, “made me wonder if he’d had a bad experience in the past.”
It was, after all, the guide’s 396th trip on the Inca Trail and he had told Caroline that in all those trips, only six of his clients had not been able to complete the trail due to illness or injury. Caroline’s doctor brain wondered what types of illness and injury had befallen those six people, and she thought to herself, “At some point when my mom isn’t around I want to hear the guide’s story of the worst incident.” Little did she — or the guide — know that the worst was about to unfold.
Caroline’s aunt made it over Dead Woman’s Pass, but that evening in camp she grew dizzy and disoriented. At about 9:30 p.m., Caroline’s uncle called out for the guide; his wife was agitated, confused, and unable to form complete sentences. Shortly after that she vomited, seized, and became unconscious.
Caroline knew that her aunt needed medical attention urgently and says she naively assumed that the guide could call for a rescue and a helicopter would buzz in and lift her to safety. “Um, no,” the guide told her, “there’s no place for a helicopter to land here and plus it’s dark and foggy — we are going to have to carry her out.” So at about 10 p.m. an evacuation was organized, with the trip’s four porters carrying Caroline’s aunt on a litter — “the true heroes of the story,” Caroline says. She went along on the evacuation, while the rest of the group continued the hike with the assistant guide and other porters.
Although no one was equipped with an injectable steroid that might have helped with what seemed to be a case of high altitude cerebral edema (HACE), the guides were able to get Caroline’s aunt on oxygen. Caroline also had the idea of crushing up a steroid pill into a paste and placing it under her aunt’s tongue. Both measures, in addition to embarking on the evacuation immediately, surely saved Caroline’s aunt’s life.
The evacuation on foot was brutal: two mountain passes, rough terrain, wet and muddy trails, fog, and a rainstorm. The porters initially thought they might reach the end of the trail by 5 a.m., but after several hours of carrying they revised the estimate. “My aunt is tiny,” Caroline says, “but it’s still heavy to carry a human on a stretcher, especially on difficult terrain.”
When they reached the next campsite, where other parties were spending the night, the guide tried to swap porters for a fresh crew, but no one would trade. “They all seemed to know it was an unconscious woman on the stretcher,” Caroline said. “She was maybe going to die. No one wanted to be a porter on the trip with the fatality.” So the four exhausted porters picked back up the litter and resumed the evacuation.
During the evacuation Caroline was monitoring her aunt’s oxygen saturation level, which remained low. “At that altitude, her oxygen would be low anyway,” Caroline says. “We were told that as long as it remained above 80% it would probably be ok. Hers hovered around 75%, so we were rationing what little oxygen we had just to try to make it last the trip.”
Caroline’s aunt seized again and her oxygen level plummeted. The porters carried her into a cave to get her out of the downpour and assess the situation. Their patient was soaking wet, her breathing was labored, and her arms were flexed with her hands curled — an extremely bad sign. “We needed to get her into dry clothes but she was so stiff we couldn’t get her wet clothes off — we had to cut them off,” Caroline says.
When the evacuation resumed, the porters were walking so quickly that Caroline couldn’t keep up, so she told them, “Don’t wait on me — just get her down.” So the porters sped ahead and, eventually, reached a train that would take her to a medical facility.
When Caroline reached the train tracks there was a porter waiting for her. “You can still make the train,” he said, “but you’ll have to run.” So Caroline ran along the tracks until she caught up to the train and climbed aboard.
Caroline’s aunt eventually made it to the medical care she needed and was diagnosed not with HACE but with hyponatremia: low sodium levels. She remained in intensive care, unconscious, for 24 hours. When the rest of Caroline’s party finally joined her at the hospital, her aunt was conscious and stable. Caroline decided that this was a good time to ask the guide to tell her about his worst guiding incident. “Turns out it was a sprained ankle or something like that,” Caroline says. “Nothing in his past experience was even close to comparing with this one.”
The group had one more day left before their flight departed Peru, so Caroline took the train back to the Inca Trail and hiked up to Macchu Picchu, which she had missed due to the evacuation. But at least she got to see the ruins. On her last trip to the Inca Trail 20 years ago, a mudslide had blocked the trail and they hadn’t been able to visit the ancient city.
Caroline’s aunt arrived home in Florida in the wake of Hurricane Ivan and is recuperating. “She’s doing pretty well,” Caroline says, “but she still doesn’t remember anything about the trip.”
