On Monday, May 1, Dr. Jonathan Sugarman died at Camp II of Mount Everest. The event marked the first American fatality and fourth overall fatality on Mount Everest this season.
Sugarman, 69, was a returning climber to Mount Everest with the company International Mountain Guides (IMG). The company confirmed that a climber on the expedition died at Camp II, though they did not identify the individual directly. They further clarified that the event was not the result of “a climbing accident or route condition” and that it did not pose a safety concern for other teams on the mountain.
An accomplished mountaineer, Sugarman climbed in college before quitting for a number of years. He returned to the sport in his fifties when a friend invited him to Tanzania to climb Mount Kilimanjaro (19,341 feet). Sugarman went on to dominate some of the world’s most impressive peaks including Aconcagua (22,837 feet) in Argentina, Denali (20,310 feet) in Alaska, and Chimboarzo (20,549 feet) in Ecuador. In 2022, Sugarman attempted Everest for his first time. He reached his goal, Camp III (24,000 feet), and also summited Lobuche (20,161 feet) and Island Peak (20,210 feet).
In an interview with Uphill Athlete in August of 2022, Sugarman shared how he had struggled with high altitude pulmonary edema (HAPE) in 2016. “Despite never having had altitude issues previously,” Sugarman noted, “I experienced an unfortunate episode of high-altitude pulmonary edema at camp I on Cho Oyu.” This resulted in an aborted expedition at Camp I (21,000 feet). However, following the incident, Sugarman detailed how he trained rigorously to improve his metabolic efficiency and to achieve a lower heart rate while sustaining higher workloads. He surpassed the 21,000-foot ascent on future expeditions.
While the cause of Sugarman’s death has yet to be confirmed, HAPE represents a major cause of death related to high altitude and recurrence rates can be high.
HAPE is a type of noncardiogenic pulmonary edema most often occurring in unacclimatized lowlanders who rapidly ascend to altitudes over 2,500 meters, as was the case in Sugarman’s experience during his assent of Cho Oyu. HAPE is thought to be caused by an exaggerated response to hypoxia consisting of pulmonary vasoconstriction and elevated pulmonary arterial pressure. Without treatment, HAPE may progress to worsening dyspnea, cyanosis, tachycardia, and respiratory distress. The most effective method of prevention of HAPE is slow ascent. In particular, individuals with a history of HAPE are recommended to avoid vigorous exercise during the first days of high altitude exposure, as those with a prior incidence of HAPE may have a recurrence rate as high as 60%. There exists some data in favor of the use of prophylactic medications such as nifedipine, tadalafil, and dexamethasone for HAPE prevention in susceptible individuals. The potential use of prophylactic acetazolamide for HAPE remains unclear.
In the cases where HAPE does ensue, descent is the first priority. If descent is delayed, nifedipine is recommended. For climbers with access to medical resources, supplemental oxygen (goal SpO2 >90%) and/or portable hyperbaric oxygen chambers are important modalities.
Less than a year before his death, Sugarman reflected in his interview with UpHill Athlete, “I thought it might be worth an experiment to see if HAPE was an inevitable consequence of returning to similar elevations [such as Cho Oyu], so I began to plan for a trip … to see if I could climb to 7,000 meters.” He was successful: Sugarman surpassed 7,000 meters of altitude avoiding HAPE. Studies have shown that an individual’s level of fitness is not proven to be a protective factor from HAPE and mortality rates are still as high as 11% even when appropriate treatment is given.
There remains limited research on the recurrence of HAPE and effective means of prevention of recurrence. As climbing increases in popularity, closing this gap in the literature may help to minimize the incidence of HAPE and even save lives.
Dr. Sugarman on the summit of Lobuche peak in Nepal.