Episode 34: Sunday February 14

Drs. Sam Jejurikar @samjejurikar, Salvatore Pacella @sandiegoplasticsurgeon, and Sam Rhee welcome special guest Dr. Ramin Behmand MD. Dr. Behmand is the only board-certified plastic surgeon to have successfully summited Mount Everest. In part 2 Dr. Behmand shows his experience in photographs as he ascends the mountain from base camp.

We talk to Dr. Behmand about his unique experience climbing Mt. Everest. In the two years previous to Dr. Ramin's successful summit, nearly 40 people died in serious avalanches, the highest death rate on Everest to date. Over 300 climbers have died attempting to reach the top. Only about 5000 people have successfully reached Everest's summit since Sir Edmund Hillary and Tenzing Norgay first made it to the top in 1953. This singularly unique experience is riveting to hear.

Dr. Ramin Behmand began his esteemed career in cosmetic surgery at the Case Western Reserve University School of Medicine in Cleveland, Ohio where he was a member of the Alpha Omega Alpha (AOA) Medical Honor Society. Dr. Behmand completed his plastic surgery trainig at the University of Michigan. Certified by the American Society for Aesthetic Plastic Surgery (ASAPS), the American Board of Plastic Surgery (ABPS), the American Society of Bariatric Surgeons (ASBPS), and The Rhinoplasty Society, Dr. Behmand’s expertise spans many procedures and treatments, including breast augmentation and breast lift, liposuction assisted body contouring, and facial rejuvenation. He also maintains active membership in the American Society of Plastic Surgeons (ASPS) and the Alpha Omega Alpha Medical Society.

Full Transcript (download PDF here)
2021.02.14 RAMIN PART 2
Dr. Ramin Behmand: [00:00:00] Yeah. I just put a couple of things on, it's not a full slide show of of the client, but I'll just go through a few things.
So what you're seeing here and I put this up Somebody said that it looks like you just woke up. So there were three people in a tent on Denali and it's the end of the day. We're all pretty miserable. It's been rough and you get more and more sunburned. And when burnt and worn out these two guys, I was climbing with them were in a tent.
This is really a picture to show you. This is all it takes to climb Everest. This is every bit of equipment that I carry and that's it doesn't take a whole lot, but it's the logistics. That's expensive. There's a picture of Katmandu. You need to get out of there as fast as you can there. If you get sick, if you get sick, you are, your trip is done.
If you're going to respiratory infection, your trip has done. It is so crowded. People are falling all over each other. And as much as. You want to hang out and see things. You should do it after the climb, before the climb. Ideally you have a mask on nowadays. It doesn't seem strange. But before when I went, it seemed quite strange, but I had a mask on you worry quite a bit about picking up a respiratory infection that you won't be able to shut at high altitude.
This is the airport called Lou CLA Some consider it right about as the most dangerous airport. This is how you go from Katmandu to the mountain to the high altitude. Before you started your climb to Everest base camp. Do you see that picture down on the left bottom? You see how I runway ends?
Okay. There is a 1500 foot straight drop from there. So when the plane takes off, it's never going up. It goes there and it. Drops down out of sight and then starts coming up because it's such a short runway and it's quite nerve wracking. And when the weather is, and when the weather is bad, it just, the landing and takeoff is so unpleasant.
And there's been multiple crashes there with people not surviving it. This is a, the. Path of the hike towards base camp. You're that's me. And you can see I'm going through this town called  and it's the last place where if you need any supplies, this is a place to buy it. There's people yaks there is people carrying stuff.
It's a fun place. What, 
Dr. Salvatore Pacella: [00:02:51] What kind of stuff can you buy there? For example, if you were like, make it this far and you said gosh, I forgot my ice hammer, or cleats or whatever it is you use. Can you 
Dr. Ramin Behmand: [00:03:03] crap on you? Can you 
Dr. Salvatore Pacella: [00:03:04] buy like legit stuff here, like legit climbing gear.
Dr. Ramin Behmand: [00:03:09] Yeah. I was pretty surprised to see it because at this point you can't find anything, but this is the stepping stone to Everest base camp. And you can find some very high quality things there. If let's say your crampons broke or there's a problem with your boot or you need. Better goggles. You can mostly find it here.
It's pretty impressive. And if you can find it here, you can phone down to Katmandu and just wait there for a day or two and have the plane, bring it to Lou claw and then somebody bring it up to NAMTA Bazaar. So this is your last chance for getting things that you have forgotten, or you need 
Dr. Salvatore Pacella: [00:03:52] one other question to Ramin?
Yeah. How is the transaction performed at this point? Like at a place like this, do you carry cash with you? Credit cards work or, 
Dr. Ramin Behmand: [00:04:04] yeah. It's really interesting. You asked that because the first time I went, it was all cash. Everything was cash and a dollar cash, not anything else. Us dollars. The second time I went, they took credit cards.
So that was a, in a span of four years. So it was a huge amount of technical technological advancement and change. And they actually seem to prefer credit cards because. People are much more likely to buy things if they're just charging it as opposed to have to whip out a little bit of cash that they had, you don't carry that much cash with you.
You already have to consider that at the end of the trip, you're going to want to be tipping people that have helped you all along this client, from the cooks to the people, carrying things to the yak, herders, to your. Sure per climbing partner the guides. So really all the cash that you carry is just about enough to take care of people.
And so at credit card being being able to use that makes a huge difference. Is there, 
Have you heard of any crime in these areas taken advantage of, out of towners or is there any time there's a transactional component like this. There's probably somebody who's going to take advantage.
Dr. Salvatore Pacella: [00:05:22] Have you heard of anything like that or any crimes at the base camp 
Dr. Ramin Behmand: [00:05:26] or anything like that? The it's two-fold the answer is yes. And mostly it seems that anything that happens is not conducted by the local people. It tends to be the foreigners o o that outsiders that are doing. Thanks. And it's related to whether you get sabotaged, somebody steals your rope, or somebody takes a battery pack that belongs to you or your boot disappears.
It's that kind of stuff. There's really no petty crime theft. The people in the higher altitude of the mountains they're Buddhists and they're kind, and they're gentle. It's very different than the population down in Katmandu where there's a hustle bustle of a big city. People are very spiritual as you're going to the higher ground.
So crime comes from unfortunately from outsiders. Oh yeah. This is typical Swiss made bridge to go over gorgeous. You come across them all around through the trip to get to the base camp. They're steel, wire bridges, and they swing wildly when it's windy. I was going to put a video in there, but I didn't So here, you can see some of the path is very picturesque and you go into a higher altitude.
This is at around 14,000 feet and it's not particularly cold,  it's below freezing at night times. This is a tea house. And it's like luxury accommodations in places on the way to base camp. This all ends in Farah Che. And from there on your intent, the next close to two months, but this is really nice.
And you get to have a cozy place to asleep. You see a lot of these guys they're huge. And you don't want to be in their way. They get spooked and they'll push you off to college, but they're not yeah. Vicious. It's just, they get spooked very easily. So this is the first view of what of Everest.
I marked it because what is Lhotse, which is a fourth, highest mountain in the world, on the right. And on the left, you're seeing Everest, the tippy top of it. Let me see. Do you guys see my pointer on your screen? Yes. Yep. Okay. So this here is the South summit from there, from here to here, which is the actual summit is about 300 feet difference in altitude, but it takes about two hours.
And this is the South summit is where a lot of people end up turning around. The Hillary step is around here just before the actual summit. And the Hillary step is like a 35, 40 foot a rock climb upwards that has changed a little bit with the earthquake of 2015. It seems to be shaped differently, maybe not even as.
Particularly a difficult as it used to be. This is the last village before base camp is called Farah Che. And these are tea houses that you're seeing here and here. You stay there and then you head to base camp. So now we've gone to base camp. We're backtracking to this mountain called  and that's me.
I'm doing a training run on. The slope. I put another picture of this slope to give you an idea of the steepness and the ice that's there. Holy cow. Wow. It the P this one doesn't capture what you're practicing. And it's a great training mountain. I don't. Fine. That is particularly dangerous, but it's, it can be very IC.
Then you may camp up top to get used to 20,000 foot altitude because base camp is only about 17 and a half thousand feet. And then you come down next day and go back to base camp. And this is what the entrance to base camp looks like. There's this rock there with a bunch of signatures on it. And some prayer flags.
So the picture I showed you is down here and base camp is all this. It's a huge area. It takes from here to here. It takes a good one hour to hike. And these are the Icefalls starting where it says crampon point. You can go with our crampons or. What cell called cleats up to here. And then this is where the very difficult, steep stuff with moving ice blocks starts and up to here.
So from here to here is the Icefalls then camp one is here. Basically a hike to camp two, it takes about six to eight hours. It's not particularly difficult and, but it's extremely hot. It's in the Valley here. And while the temperature is below freezing, most people can have heat issues with feeling like the temperatures, but the sun beating on them has their body temperature or their suit temperature be well over a hundred degrees.
So you'll see people have shedding clothes. And then camp three is in the middle of the Lhotse face. Then there is a saddle area here. That's South call where the deaths zone starts. It's a saddle between Lhotse the fourth, highest mountain in the world. And Everest, the tallest mountain in the world. You stay here.
You're only a few hours because now. Your body's degrading. You need to use oxygen and you're just resting for a few hours before you start your summit bit, which is about 3000 vertical feet to go from here to here, but you're starting at 26,000 feet where there is. Less than half the usual oxygen in the air.
And you're going to climb all the way to where, to the summit, where the oxygen in the air is. One-third. 
Dr. Sam Jejurikar: [00:12:13] Are you carrying this oxygen with you though? Are your Sherpas carrying up from base camp? Where does 
Dr. Ramin Behmand: [00:12:17] this oxygen comes from? The oxygen is a good question. They, oxygen is carried from base camp over here.
By Sherpas and left at camp two is part of stocking camp two, but once you're in camp two, you carry your own oxygen. It's a, the cylinder is about 17 pounds and you put it in your backpack with your equipment, with a with a tube coming out and going to your mask. And from. You try not to use oxygen, going up to camp three, you pushed things as much as you can.
And even a little bit above camp three but you're carrying your oxygen. And then somewhere around camp three and above you start using it, you have to start using it otherwise. By the time you get to South call you've unnecessarily worn down. Quite a bit and you're using it at half a liter to a leader a minute.
Dr. Salvatore Pacella: [00:13:14] Rameen I got a question for you. 
Dr. Sam Jejurikar: [00:13:16] Are you tech 
Dr. Ramin Behmand: [00:13:17] say that again? 
Dr. Sam Jejurikar: [00:13:18] Oh, 
Dr. Salvatore Pacella: [00:13:19] Sorry. Rameen can I ask a question here?  You mentioned before how, you saw these people just die in front of you. And  I've looked into Everest a little bit previously and saw some photographs of just bodies laying up and down the mountain.
And so when someone dies, they're gone, you just have to leave them. Like I, here, I've I see these macabre pictures of somebody, a corpse that is their entire jacket has been degraded by the, and you're just see their bare preserved back. Or I hear about this marker green boots.
Did did you see this or what, tell me about  the death that's laid on the trail. 
Dr. Ramin Behmand: [00:14:03] How do you feel about, so on that. On this side of the mountain, which is the South side, the deaths are much more likely to happen around here, on up down here. If somebody dies, you can get them down.
I really did not see anybody that was. Had passed away or died in this area. But what I did see is as the ice falls, this river of ice starts melting. People have died in years past, start showing up, melting out of the ice down here closer to base camp. And yeah, one day I found an arm of a person You don't know whose it is.
It may be 10, 20 years or 30 years old, and somebody else found a, another person, but they're not visible the way green boots for example is, and that happens a lot more on the North side. So look at this picture, I was showing you, you see how the South side is very steep going up. It's On average 45 to 50 degrees.
This is the North side. It's much more gradual, but it's a lot longer. So you're doing this same climb at a less steep angle, but you're at high altitude, much longer. It's more likely that somebody dies on the North side and you can't get them down. Whereas on the South side, oftentimes people who die are blown off the mountain and you don't recover the body on the North side, green boots is on the North side.
And when I was there, climbing was the 20th year anniversary of Into thin air and Scott Fisher actually is One of the few people that is on the route he's around here, or we called the shoulder. This picture doesn't show it. You make a 90 degree turn to go a different direction around here at 27 and a half thousand feet.
And he is sitting off the path leaning back against a rock and he's completely frozen. You don't. Recognize that as a person, unless you know what you're looking for, you go close to see it. There's heavy, snow and ice up there. So you don't see as many bodies as you might hear about like on the North side.
So this is base camp. This is a dining tent where everybody in a group sits there. These are communication tent. Porta-potty our tents. Porta-potties a pleasure to go to because soon there is no port-a-potty and you wish you had that. And if you see this blue thing They have a bucket of water that on days that it's warm enough, they try to heat it to let people take showers.
It, a lot of times it doesn't work, but when it does, it's nice to rinse off. Most people go without a shower for a while. And let's see another port-a-potty here. That's me laying around in the tent. When I said that, you'll be in your tent thinking and people get all nerve doubts.
This is what it's like. You might be laying there for a full day. You read books, you listen to music. You may find a way to talk to your family. All of it is a little nerve wracking. Can you go through your equipment over and over again, you spend a few hours practicing every day ice climbing and crossing ladders and things like that here.
Practicing going across a small ladder over a crevasse. And it's all about how you get You're at the tips of your crampons to go between the rungs of the ladder. You got to have both the front and the back on there without catching anything. I sent a picture down to to my family. At the time I was using a satellite phone that let me do it.
And they zoomed in on it and looked at my nose. And everybody down here was sure that there's I lost my nose. I did have a little bit of frostbite, but it wasn't really, it was much worse looking than it really was. I can fix that for you. I'm sure you're I, my forehead right now, this guy has got a nice long forehead.
This should be fine. No hair 
Dr. Sam Jejurikar: [00:18:51] on it either.
Dr. Ramin Behmand: [00:18:52] So avalanche has happened and if you're close, there's really no getting away from it. This avalanche. Is about a mile away from me and it came at such speed when it started. I just stood there and I was looking at it and it takes a few seconds to realize that it is coming at you hard. When it comes at you, Oh, if there's big chunks, you're in trouble, but it hits you hard.
And this is a guy in front of me in this avalanche. Two people died, but we were far enough that it didn't really cause a problem here is above the ice falls camp one, you see all the tents up there. Will you come over the edge of the ice falls? And it's serene. It's like quiet and beautiful mountain on the right.
And this is Lhotse face on the left on. This is Everest here. Hey guys, if we're running short of time, tell me. 
Dr. Salvatore Pacella: [00:20:00] No continue. 
Dr. Sam Jejurikar: [00:20:01] Yeah. I think you're fine Ramin. Yeah, this is fascinating. 
Dr. Ramin Behmand: [00:20:05] So do you see all the steps in between here? What looks like snow drift that you can see the scale by knowing that these are individual tents.
And what you're seeing here is crevasses. This is where the glacier starting to break up, going down to the ice falls, which is down, starts down here and for you to climb, you're not going straight through to camp two. That's why this takes seven or eight hours. You're going here, going around the crevasse, finding another bridge, going another you're going back and forth.
Sometimes you climb down into a crevasse. You come back up in order to find a path to get to camp two, which is over here. 
Dr. Sam Rhee: [00:20:51] Wow. 
Dr. Ramin Behmand: [00:20:51] So novelty, we're starting to approach the Lhotse face and you get more of a sense what this 5,000 foot climb is like. This is the South shoulder up Everest. And my next picture is going to show you the scale.
This is the same shoulder. Now you're getting a better look at the people down here. And camp two is right over here. The mountain is massive. Massive. And Samira this isn't 
Dr. Salvatore Pacella: [00:21:31] like you're a 10 minute rep on the StairMaster at your country club, huh?
Dr. Sam Jejurikar: [00:21:36] Yeah. This is unfathomable to me. 
Dr. Ramin Behmand: [00:21:39] Ironically, sometimes the StairMaster seems harder, so
Dr. Sam Jejurikar: [00:21:44] yeah.
Dr. Sam Rhee: [00:21:45] I 
Dr. Sam Jejurikar: [00:21:46] did read I did Into Thin Air. That's probably the closest I'll get to this. 
Dr. Ramin Behmand: [00:21:51] I'm just climbing a ladder, crossing a ladder here. It's a small one. The way you do this as a one person crosses D do you see the shadow of this shadow here? There's a person who's Buddying up with the person behind you, grabs the rope and leans back on it so that there is a nice tension on the rope that you're holding when you're crossing and you can see it's not very cold.
I don't even have a glove on.
Ladders is a whole different story. Wow. This is a kind of ladder that I told you. Someone in front of me fell off of into a crevasse and. There is you need to double click on these meaning that there's yeah. Is a rope here. There's a rope here. The, this person is leaning back on holding tension on this rope and that person, even though it doesn't look like it.
Oh yeah, this is anchored into the ground here. So this is the only person holding tension. And then person crosses as you're crossing this ladder starts swaying. Side to side, there is stabilizing ropes, but this thing is moving. It's quite unnerving. Some of these crevasses can be a hundred, 200 feet deep.
At least to the extent that you can see, because it starts looking black down there.