All In: The True Story of a Physician Living on the Edge

By John Charles Hill

In this powerful and entertaining memoir, Dr. John Charles Hill chronicles his climb of Mount Manaslu, the eighth highest mountain in the world. His keen observational skills and uncommon vulnerability bring to life the terrain, people, and experience of a professionally guided climb in Nepal. Meanwhile, the author’s family is in crisis at home in Colorado. Dr. Hill shares multiple personal stories from his unique perspective as a sports medicine physician, ultra-athlete, husband and father. He invites us into his world of unexpected disasters, life and death, spiritual encounters and miracles with an innate sense of humor and gifted eloquence. He demonstrates what it means to live a life "All In".

• Language: English
• Publisher: John Charles Hill
• Release date: Jan 24, 2020
• ISBN: 9781733629638

John Charles Hill

Dr. John C. Hill is an extreme athlete and renowned physician with a remarkable personal story. His extraordinary zest for life drives everything he does—from discovering revolutionary medical techniques and resuscitating lives at the base of Winter Park Ski Area to arduously completing the Leadville 100 Trail race, persevering to the end with a fractured foot. And at the heart of it all, John is a committed husband, father and grandfather. Dr. Hill loves mountains. He has climbed around the world and the US, including all of Colorado’s highest peaks. He has participated in ultramarathons; mountain bike racing; Nordic, Telemark, backcountry, and alpine skiing; rock climbing; ice climbing; mountaineering; and more. As a competitive racer, John has run the Boston marathon and was a 2010 Leadman, completing all the Leadville races in a single season including the Leadville 100 Ultramarathon and mountain bike race. In addition, he has assisted other extreme athletes, providing medical information in a rapid, humorous format to the runners and mountain bike racers of the Leadville 100 Race Series. He is a team physician at the University of Denver. He also rides a Harley. The Denver Business Journal named Dr. Hill one of the “Best Doctors of Denver” in 2014. The Leading Physicians of the World named him “Top Sports Medicine Doctor in Denver” in 2013. Nationally, Dr. Hill is a popular speaker in the areas of musculoskeletal ultrasound and sports medicine. He created the primary care sports medicine fellowship at the University of Colorado, and directed this fellowship for 20 years. His practice initially focused on Women’s Health and Wellness. He has delivered more than 1,000 babies. As a board-certified family physician with sub-specialty boards in primary care sports medicine, Dr. Hill holds four patents for his pioneer work in musculoskeletal ultrasound. He has developed many of the approaches and techniques that are now accepted as the standard of care, and as principal investigator has been awarded millions of dollars in grants. He is published in multiple medical journals, averaging ten to twelve articles per year. His humanitarian efforts include international cross-cultural medical work in Kazakhstan, Kenya, Jordan, Ecuador, Nepal, and the Dominican Republic. He has been married to Gail since 1982. They have two daughters and one grandson named Owen in heaven.

Book preview

Foreword

Holy crap! This may get ugly. The cliff in front of me seemed totally vertical. I couldn’t breathe, couldn’t think, and damn sure couldn’t hold on to the rope. Then again, where the hell did the rope come from? Trying to assess the situation in my mental fog was impossible. Then I looked up. There, again saving me as he repeatedly did on the side of this mountain, was John Hill: doctor, friend, and like the mountain, solid rock. He had somehow attached me to the rope and refused to let gravity have its way.

As you will learn in this book, John not only saved me from Mt. Manaslu, he most probably saved me from myself. Meanwhile he was depressed, impressed, and obsessed with his grief and then with the glory of the life and loss of Owen, his grandson taken to heaven far too soon.

You don’t find Leadville; Leadville finds you. So true of Dr. John Hill. And what a find! As medical director, his speech to the athletes as to what they could expect was informative and both entertained and scared the hell out of them. Then he had the talent and guts to back up every word, finishing the Leadman challenge repeatedly.

The last one to tell you that Dr. John Hill is special is Dr. John Hill. But special he is. His care and concern for those around him is second to none. He is definitely God first, the other person second, and he is third. His passion for the challenge before him is without limits. It’s not that he won’t quit; he can’t. That’s just not a part of his make-up. You too will become changed as you absorb John’s passion for life and those around him.

Ken Chlouber,

Founder, Leadville 100 series

Prologue

On April 25, 2015, an earthquake of nearly eight-point magnitude shook the Himalayan community of Kathmandu, killing thousands. Nepalese villagers and tourists alike fell victim to the mighty force of the quake and the avalanches it set off on the nearby mountains. I watched the news and felt like I was there. I had been there less than three years earlier when another disaster had struck the serene mountainsides of Nepal. And I was deep in the process of writing a book about it. This book.

As the news of this recent devastation unfolds, I listen to harrowing stories of Sherpas and other climbers trapped on Everest and heroic efforts of survival. I watch reports of injured climbers being unburied and rescued, evacuated to safety. With desperate realization, I know that even when the Kathmandu hospitals are intact, there are few beds and limited supplies and no way to restock. I feel an acute sadness, wishing I could somehow be a part of the relief support in this devastated, remote mountain region.

But Kathmandu has no infrastructure to handle the overwhelming flood of help from the rest of the world. The tiny airstrip has been decimated and most of the country is only accessible by helicopter or by foot. The helplessness I feel deepens as the death toll rises.

On Mt. Everest, the highest death toll is from basecamp, a location on the mountain where you feel safe, seemingly well protected from avalanches.

And it all makes me grateful to be alive... Again.

My life has been a series of near misses, direct hits, and bizarre survivals. From mysterious recoveries in the clinic to unlikely rescues on the mountain, from my faulty childhood to my accidental medical success, from my personal handicaps to the brief ecstasy of holding my extraordinary grandson in my arms I can only say, I’ve seen that God is real, and I’m living life all in.

Chapter One

From the Mountain

The mountain storm raged outside the uncertain safety of my neon yellow tent. Rain had been pounding for days and then the snow settled in, holding our climbing team hostage at 15,830 feet. We held up at basecamp in the highlands of Nepal and waited for the weather to clear before we could resume our ascent to the top of Manaslu, the eighth highest mountain in the world. Wearing my down expedition parka and blowing into my hands often to keep them warm, I sealed up inside my -20 sleeping bag and wrote. I scribed as quickly as I could, determined to capture on paper every detail of this remarkable story.

Expedition travel and climbing is an interesting business. Preparations are made months, sometimes years, in advance. We contact embassies; acquire visas, climbing permits and proper gear; arrange our schedules; reserve flights; relentlessly train our bodies for the rigorous climb ahead. And then things change.

I had no idea how different this trip would be from the glorious ascent I’d planned.

Our climb began in the wide-open delta near Kathmandu at 2,953 feet. We hiked through the sparsely populated and remote region of the Budhi Gandaki Valley in central Nepal, approaching one of the infrequently climbed Himalayan peaks, Mount Manaslu, with the goal to conquer its 26,758 feet (8163 meters).

We trekked upstream like a small moving village with nine climbers, two American guides, four Sherpa guides, and about 40 Nepalese porters. Even by the first day our crew of climbers seemed to fall in line. Each climber claimed a position where we felt comfortable, similar to taking a seat in a college classroom when everyone sits in the same seat all semester even though it is open seating. The trail took us through the valley as it narrowed and gradually gained elevation. We worked as a team and moved together in a relatively tight group, aware of the pace and the walking style of the person in front of us and the one behind.

The pace was set each day by one of the climbing Sherpas. I usually positioned myself in line directly behind him. If one of the older Sherpas led the pace, as was the case on my first day, I knew I would be able to enjoy the scenery and for the most part breathe. The second day of the hike I felt like I was running the Leadville Trail 100 again. The 23-year-old Sherpa at the lead had placed second in the Everest Marathon that year, one of the toughest marathons in the world. He had also summited Everest six times, as well as a number of other 8000-meter peaks.

This young athlete set a blistering pace, nothing like the peaceful pace of the day before. I followed right behind him most of the day—closely observing his biomechanics, his economic stride, the rapid, high turnover rate of his gait, his skills to climb efficiently and descend faster than most. He was pure beauty and efficiency in motion. I was attempting to mimic every motion, dreaming that someday I would be able to hike with his fluid effortless stride.

We were moving quickly across wet rocks, moss covered sticks, and clingy black mud. Typically I can jump from one rock to the next without much concern, but I soon realized I was wearing the wrong shoes to hike up this wet valley. My three-year-old pair of Brooks Cascadias had served me well through training and several races, and I chose the trail shoes for this part of the climb because they have an aggressive tread to grip loose dirt and rocks. The rubber is sticky and has excellent grip in wet conditions. However, I learned as we ascended the slick trail carved into the side of the valley that when rubber ages it loses its sticky characteristics and becomes as slippery as black wingtip dress shoes with shiny leather soles.

I slipped on a rock, my foot shot to the right, and my body folded as I launched off the side of the trail. Instead of attempting to catch myself with my hands or on my feet, I landed at least ten feet below onto brush, rocks, and trees. Somehow during my fall I tucked, flipped over, and landed squarely on my backpack, cushioning the impact.

The fall could have ended my climb, but besides a small scrape on my shin—and my bruised ego—I was essentially unhurt. One of the climbers lowered a rope down to me and I scrambled back up onto the trail. I wish I could say that at that point the hiking pace slowed down, but it didn’t. However, I did become more careful about my foot placement. And my pride? Not careful enough, as I would discover higher up on the mountain.

By the third day of our trek all of us were in a groove. I had switched to my high-top hiking boots that were only about three months old, broken in, comfortable, and with sticky tread. One of the older Sherpas set a slower pace and I followed closely behind, enjoying the serene journey.

There are no flat surfaces in Nepal. As we marched single file up and down the hills no one spoke. We retreated into ourselves and tried to conserve energy as we ascended deeper and deeper into the valley, climbing up the narrowing trail until the valley tapered into a gorge. Aside from the roaring river below and the sounds of our footsteps, the world was silent.

My world is too well connected. As a physician I am available to others 24/7. My cell phone is always on, I have email at my fingertips, I can receive and send text messages in the middle of the night. Even at 4:00 a.m. when all the world is sleeping, others can be in touch with me and usually receive an answer to their text before morning coffee. I am acutely plugged into my job at the University of Colorado School of Medicine.

But in my alpine world I can completely unplug, and with that loss of connection comes profound peace. As we streamed along the gorge trail I found myself thinking again, without interference. I could talk to myself, I could hear myself think, pray, and finally be in a position to listen to God.

I thought about my family and the trauma they were dealing with in my absence. During the past weeks our lives had been turned upside down as we faced life and death in ways we’d never imagined. My wife, Gail, and I had talked for hours about the possibility of canceling my climb, but we finally agreed I should keep my plans. I was in serious burnout mode and needed a break. This trip had been planned for months. Yet, part of me struggled at the thought of being away from home right now.

The approach from Arughat Bazar at the mouth of the Budhi Gandaki River to basecamp is an arduous seven-day journey, exhausting, but at the same time tranquil, hypnotic and intensely beautiful. The valley is lush, emerald green. Raging waterfalls seem to emerge from every corner and the narrow trail itself is gorgeous. The days and nights started to turn cooler as we slowly climbed in elevation. I can’t help but imagine that the Khumbu Valley leading to Everest basecamp must have looked this way 35 years ago before the volume of flights at the airport in Lukla exponentially grew and before ever enlarging teahouses sprang up that looked like they were constructed by the Hyatt. In contrast, the Budhi Gandaki Valley has not changed much in the last 100 years.

I was drinking it all in, walking at a brisk pace, my thoughts to myself, when a forceful impression struck me. In an instant such overwhelming emotion hit me that I began to weep. And I knew.

Something was happening at home on the other side of the planet.

I could see my wife, my daughters, my grandson, as though a movie screen hung suspended in front of me. And I could hear singing, sweet and joyous, as audible as if my ear buds were deeply inserted in my ear canals with my iPod in my pocket playing the old hymn, It Is Well with My Soul. For almost an hour I experienced bipolar swings of intense emotion—one moment irrepressible joy, the next wrenching sorrow. All the while I hiked quietly in line as we slowly ascended the valley.

And as vividly as the revelation had appeared, the second followed: I needed to tell Owen’s story. The entire, great story in full detail.

But I was petrified I would forget something. I couldn’t write down all of my thoughts while I was hiking, and what if as quickly as the specifics of the revelation came, they vanished from my mind? I spent the rest of the day obsessively reviewing an outline in my mind, committing it to memory, desperate to include everything, and as I did, more details filled in.

That night I recorded my mental outline in my journal. I thought this whole revelation thing was kind of strange and wasn’t sure what to think about it. After I finished recording the day and all the events, I added, I do not know if there is any validity to my feelings. It might be heartburn or maybe I am just an emotional basket case, who knows.

Later that evening, my wife contacted our expedition climbing headquarters in Seattle. They put in a call to Kathmandu and gave the message to the Sherpa who heads up the office there. He made a satellite phone call to our head Sherpa on the climb who contacted our lead guide who then relayed the message to me. Gail confirmed what I already knew. I’d seen it from the mountain.

When we at last arrived in the village of Samagaun, elevation 11,200', the high altitude air was dry, crisp and clear, with a cool breeze. Clouds rolled around Manaslu and I stood for a long time staring at the clouds, waiting for portions of the mountain to be exposed. For brief moments I could see the snow-enveloped summit looming miles above the small settlement of Sama.

This was our last village before the stretch to basecamp and our final chance for last-minute purchases. When I packed my duffels for the climb I had not intended to write a book. I took books to read but only one blank journal to write in, not enough pages to record all the swirling thoughts scrambling to be captured on paper. I searched the local open stands built of rocks stacked on top of another with no mortar and wood ceilings, most the size of a kitchen island. Prayer flags flapped in the wind as I scoured through the few counters of goods and noticed the limited inventory.

Far from typical tourist shops, these tiny stands carry essential supplies like rice, lentils, plastic tubs, and a few items of clothing for the residents of Sama. I finally eyed a short pile of elementary school tablets about the same size as the composition books I used in college to record my organic chemistry lab results. The paper inside the booklets was similar to a Big Chief tablet. Each tablet had about 30 pages and I bought six of the ten available, already feeling a bit guilty about buying so many of the school children’s notebooks. I hoped the book wouldn’t be too long as I stuffed the tablets into my pack.

Once we reached basecamp I was eager to begin writing, but we had jobs to do. And we needed to acclimatize, which essentially required climbing a distance up the mountain over and over, day after day. If a guy from sea level gets dropped on the top of Mount Everest and he isn’t used to the altitude at 29,000 feet he would die in less than an hour. To be able to live above 20,000 feet—or in this case almost 27,000 feet—we had to slowly allow our bodies to get used to the altitude.

As a doctor at Winter Park Ski Area near Rocky Mountain National Park, I see at least one case of high altitude pulmonary edema every day during the peak of the ski season. That’s because people aren’t acclimatized when they fly from sea level to Colorado, get in a bus or a car, drive up to the ski area that is at 10,000 feet, and ski like crazy all day. The body hasn’t had a chance to make enough red blood cells to carry the oxygen. And you kind of need oxygen to breathe. And think straight.

We would climb to crampon point where the glacier begins, then to Camp 1, then back down to basecamp, back up to Camp 1, spend the night, climb to Camp 2 then back to basecamp. Prepare gear, plan food, do laundry, then do it all over again. Not much time to write.

After one of these rotations we returned to basecamp and the weather rolled in. It began with continuous rain at basecamp and snow higher on the mountain. Eventually, the rain turned to snow at basecamp and for the next eight days we were socked in. During this time, it was impossible to do rotations or move up the mountain any further. The heavy wet new snow on top of the old was unstable and dangerous. The only thing we could do was hunker down in our tents and wait for the end of the monsoon season.

After more than a week of being trapped in my tent while the storms outside thundered on, I had part of one extra schoolbook left over. I had filled the other five books. Finally, one morning the sun came out and the storms stopped.

And the avalanches roared on.

As we sat in our relatively safe location, we could hear one avalanche after another release higher on the mountain in an incredible show of force, sometimes seeing three at one time. As the day progressed the avalanches slowed down, the snow appeared to stabilize, and eventually the upper mountain became quiet.

Owen’s story was recorded, the snow was probably stable and we would be climbing again tomorrow.

That climb, though started, was never finished.

Chapter Two

Critical Issues

I am not a philosopher. I am a physician. I believe every person is born for a reason and has a purpose in life to fulfill, a plan uniquely theirs. I recognize not everyone shares my belief, and the ongoing debate of destiny versus randomness is not going to be settled anytime soon. Admittedly, the revelation I had on the mountain seems a little out there.

I don’t usually get cosmic disclosures from another world that make me cry. What does seem to happen to me on a regular basis is an intuitive knowledge about what is wrong with a patient. I don’t know why, but it just sort of happens.

Frequently, I see patients with unusual problems who turn out to have other diagnoses. For example, I was referred a patient from one of my orthopedic surgeon colleagues to do an injection in their posterior tibialis tendon (a common tendon problem on the inside of the ankle). Something about this patient was unusual; I thought there was more than simply a tendon issue. The tendon was normal when I evaluated it with ultrasound, but he seemed generally weak and this fit-appearing person could not stand on his toes. A bizarre thought then crossed my mind: I wonder if he has Lou Gehrig’s disease. Why would I think this normal-looking 35-year-old male might have Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease)? Turns out he did.

Interesting how we are all made. No two of us are exactly the same. We all have issues and none of us is perfect. One of my issues is ADHD (Attention Deficit Hyperactivity Disorder). I was the kid who could not sit still. As my dad pointed out, I was a sticky little fly; I had to touch everything. Johnny could not sit long enough to learn how to read. I had a reputation and it was not stellar. When my teacher called roll in elementary school on the first day of sixth grade, she looked up from her paper, engaged my eyes and said, So you are Johnny Hill. I have heard a lot about you. She went on to say, And I don’t believe a word of it.

ADHD is not entirely evil. I remember when ADHD was the cover story for Time magazine about 25 years ago (July, 1994). One of the quotes in the article was from a behavioral psychologist, an adult with ADHD. He said, Living with ADHD is like living with a dragon that can burn and devour you at any minute, but once you learn to tame that dragon, it is like living with all the magic. I understand this quote on a visceral level. I wished I could sit and concentrate for long periods of time like some of my classmates during medical school, but I could not. I was only good for short periods of time. During my first two years of medical school I restored two British sports cars and began participating in triathlons.

What I have learned is that my ADHD gives me almost magical powers to handle emergency situations. When it seems like the world around me is in chaos and others do not seem to know what to do next, I feel the world move into slow motion. I can see the person bleeding, the one not breathing, the individual seizing from a heart attack or any number of other serious issues. The multiple tasks that must be accomplished simultaneously do not seem overwhelming; I can prioritize them in my mind, assign duties for others to accomplish, and make sure the critical issues are performed first. I feel calm. My distractible personality has the ability to hyper-focus on diverse tasks at once. I love emergencies, life and death situations, speeding on a motorcycle, any form of adrenaline addiction. This is what I was created for. This is also what gets me scrambling to keep up with mountain racing Sherpas and trapped in snowstorms at extreme altitudes. I take the good with the bad.

One day I was waiting on the Labor and Delivery floor at Rose Medical Center for a woman in labor who was being transferred to our hospital from Vail. The ER doc in Vail called and said her cervix was dilated to 4 cm and the woman’s husband was driving her to our hospital. Adding to the urgency, the baby was breech and this was her first baby.

My mind immediately went to: What kind of idiot would transfer a woman in active labor, who was having her first baby presenting in a breech position, by a private car? I found out later that this ER doc was smarter than I thought, because now the problem was mine and not his.

Once the cervix is dilated to 4 cm, that is the point of no return. The cervix will continue to dilate and the baby will be born. Usually, the first baby takes longer to be delivered, but the drive from Vail takes at least two hours even if the traffic is light. When the baby is presenting in the breech or butt first position, it raises red flags. Why is the baby not in the head first position? Is the head too large to fit in the pelvis? Perhaps the woman’s pelvis is narrow and will not allow the baby’s head to fit. What if the placenta is growing in the way, and that’s why the head won’t fit? All of these and many other possible reasons could exist. Because these are significant risks, the standard of care is that when a first time mother has a baby in breech position, you always deliver by Cesarean.

I notified Labor and Delivery that this patient was on the way to our hospital. The head nurse yelled at me for accepting the transfer—didn’t I know this was a high-risk pregnancy and that she would likely begin delivering her baby in the car? I had a similar conversation with the anesthesiologist and the Labor and Delivery deck doctor. After everyone finished chewing me out, we prepared the OR to do a crash C-section as soon as the patient arrived.

One of the operating rooms on L&D was prepared. The instruments were laid out, the neonatologist (newborn pediatrician) was notified and they prepared the warmer, oxygen, and supplies to receive the baby. The nurse and resident scrubbed in and I was ready to examine the patient as soon as she hit the deck.

Eventually, we got a call from the emergency room that the patient and her husband had arrived and did I know she was in active labor? Another opportunity for someone else to yell at me.

I met her at the elevator and we wheeled her back to the OR. A quick ultrasound confirmed the breech position of the baby. I performed a vaginal examination, expecting the cervix to be almost completely dilated, but she was still at 4 cm. That was odd. With the strength of the contractions she was currently experiencing and the fact that it was now two hours later, she should be at least 8 cm dilated.

The anesthesiologist placed a spinal block for pain control. The nurses prepped her for the Cesarean and I scrubbed in. I made the transverse incision in the patient’s lower abdomen, opened