After talking with Elisabeth here is my opinion about the pathology probably responsible for the death of Tomek.

He had been ill for a few days, his digestive troubles, like any other health problem, even minimal, were enough to impact the body’s ability to acclimatize.

Elisabeth evokes very well the big fatique that Tomek presented when arriving under the summit with the rise … “he had a lot of trouble advanced”.

This is due to dyspnea (abnormal shortness of breath felt-one of the first signs of HAPE (high altitude pulmonary edema).)

On the beginning of the descent, a cough associated with dyspnea, a sign of Alveolo-bronchial irritation due to the presence of fluid in the pulmonary alveoli (exudate that comes from the vessels) .

At this stage, the evolution is systematically fatal in the absence of very important descent, the mechanisms of acclimation being defeated.

Tomek blindness may be due to several things (major snow ophthalmia or hemorrhage or retinal ischemia problem seen in this context).

The state of Tomek has therefore worsened despite the descent around 7300 meters.

It can be imagined that Tomek had an acclimation threshold (threshold altitude beyond which his body is unable to acclimate physiologically) which was between the maximum altitude reached by Tomek in the past and the top of the Nanga Parbat (see threshold inf due to the inflammatory state punctual due to his “gastro”).

Elisabeth describes very well “traces of blood in the beard of Tomek …. it is the ultimate sign of HAPE … a” foamy pink exudate “which corresponds to the bronchial secretions with a little blood from the lesions alvéolo TOMEK’s HAPE was in its final stage, its oxygen saturation was to be particularly impaired and its ability to progress due to lack of fuel (= oxygen) at its lowest (hence its abandonment to climb back up to reach camp 2 or 3)

Tomek does not seem to have had high altitude cerebral edema because no neurological signs are present from what Elisabeth tells me. He remained coherent, non-delusional and conscious until very late. Tomek’s Disorders of Consciousness in the crevice probably due to deep hypoxia).

Tomek most likely died in the hours that followed (3,4,5 hours) falling asleep without suffering at all.

A little personal opinion about Elizabeth’s hallucinations because she will hear anything and everything.

These are not due to cerebral edema in my opinion because were resolutive … she recovered her shoe and had the lucidity to go down. Brain edema, such as pulmonary edema, would have increased without any improvement and evolved into coma then certain death without rapid and complete descent.

Dr. Frédéric CHAMPLY
doctor of the medical unit of high mountain of the Hospitals of the Country of Mont Blanc
Head of the Emergency Department / Mountain Medicine
Hospitals of Mont Blanc
380 Hospital Street

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