In cardiac anesthesia, a monitor gives me information. It does not make the decision for me. The number still needs a person who understands what is happening, what has changed, and what to do next.
That distinction is central to how I think about expedition medicine. In January 2027, our ASCENT expedition through Pulse at the Peak is planned for Aconcagua, a mountain approaching 7,000 meters. The question I want to explore is straightforward: What can we learn about people under extreme stress, and how do we turn those observations into something useful for the next person?
On Kilimanjaro, a climber developed signs of high-altitude cerebral edema. Their Lake Louise score came back positive, and with a handheld Butterfly ultrasound we measured optic nerve sheath diameter on the spot, a live read on intracranial pressure that a pulse oximeter can’t give. That turned a vague worry into a clear decision, and we treated them much faster than symptoms alone would have allowed. It taught me that one number means little until context and a second measurement make it actionable.
My training is in caring for people during heart surgery. That work makes me interested in more than whether a device can produce a reading. I want to know whether the reading helps us understand the person in front of us. What does it add? What does it miss? Would knowing it change what we do?
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On a mountain, those questions become harder to put off. High altitude means less available oxygen. Cold and exertion add to the demands on the body. The setting is nothing like an operating room, and the support I normally work with is not something I can assume will be there.
I do not see medicine without a hospital as an invitation to be heroic. I see it as a reason to be more deliberate. What can we manage with the people and supplies we have? When do we stop? What happens if the next step we would normally take is unavailable?
A monitor cannot answer those questions by itself. Collecting more information is not the same as having more options. I want the research to make that distinction clearer, not blur it.
There is another gap I care about: the distance between collecting information on an expedition and publishing something another physician can use. The climb has an obvious endpoint. The research does not. Getting everyone home is essential, but it does not finish the work of checking the data, explaining how they were collected, and deciding what conclusions they can support.
I do not want an expedition’s scientific value to depend on how compelling its photographs are. A striking setting does not fix a weak study. Neither does a large collection of recordings. If we cannot explain what we measured, what is missing, and where our interpretation could be wrong, we have not given other physicians much to build on.
That is why ASCENT matters to me. It is an opportunity to plan for useful evidence before the expedition begins, rather than hope a paper emerges afterward. I want us to ask clear questions, be honest about the limits, and make the work understandable to people who were not on the mountain.
I am not claiming that a study of climbers will directly tell us how to care for a patient having heart surgery. Those are different settings and different people. Any connection has to be tested. What carries across immediately is the discipline of asking whether a measurement is reliable, relevant, and tied to a decision.
My takeaway for other physicians is simple: Before collecting another number, ask what you would do differently if you had it. If the answer is unclear, that does not automatically make the measurement useless. It may be a research question rather than a clinical tool. But we should say which it is. The person being monitored deserves that distinction, whether they are in a hospital bed or preparing for the next stage of a climb.
I want ASCENT to produce more than a story about reaching a summit. I want it to help us ask better questions, do the work after we come home, and leave something useful for the physicians who come next.
Michael Grinn is a cardiac anesthesiologist.
