A far off place.

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It would make a good viva question. are at an altitude of 5400 m (18 000 ft) and a member of an expedition to which you are the doctor. You are in a snowscape; the only sights are snow covered peaks, and the only sounds the crackle of ice and the rumble of distant avalanches. Three hours before one man has collapsed with a severe headache of sudden onset; he is semiconscious, dysarthric, has signs of severe meningism, and is developing a hemiplegia. Greatly helped by his partner he has abseiled down the mountain face and walked for an hour to his present location, where he has finally collapsed. The nearest roadhead is two days away and the nearest hospital three days away. You are in Peru. What would you do, doctor? Geoff s almost dead, I said, clear, decisive, cutting through the dead wood, but, on the whole, not boosting morale. The expedition had been going well until this point; we had had few problems. All the climbers had acclimatised well and I had been allowed to move up to the col of Mount Apalmayo to make a summit bid the following day. We were a 13 man expedition gaining high altitude experience in the Huscuaran region of the Peruvian Andes; the aim was for all the members to climb Mount Alpamayo. At this time we were split into two groups using a common base camp, and five members of the expedition were climbing Mount Artesonraju. Four of us had spent a relaxing afternoon at the col. Let's practise crevasse rescue, somebody had joked. Andy, go and jump in that crevasse. As things turned out it was a poor joke.