David Buckler’s job to ensure that every participant gets to realise their dream — and lives to tell the tale
For those of an adventurous disposition, tackling the Everest Marathon is the ultimate challenge. And, as chief medical officer, it’s my job to ensure that every participant gets to realise their dream — and lives to tell the tale.
The biennial race, which has raised more than £600,000 for Nepalese charities since it began in 1987, is recognised by Guinness World Records as the highest marathon in the world. The starting point is Gorak Shep, a frozen, sand-covered lake bed in Nepal, at an altitude of 17,010ft. At that height the views are sublime. However, the rarefied air provides just 50 per cent of the oxygen available at sea level. Those who fail to adapt properly will be in serious trouble, and could perish on the mountain if untreated.
My five-strong medical team and I — all volunteers, though subsidised by the race organisers — have a duty to make sure the 80 or so runners are sufficiently acclimatised and in good health at the start line. The course undulates but it is mostly downhill. We end at the Sherpa capital of Namche Bazaar, at 11,300ft, so if you are feeling all right at Gorak Shep, you will probably reach the finish line.

I’m proud to say no one has died on my watch, and in the past two events everyone who signed up — and paid the £3,000 entry fee — managed to finish. There have been a few scary moments, though, and in the past we have needed to airlift sick people down the mountain.
My preparation for the race starts about a year out. I gather together a medical team who are compatible with one another, and who can survive without creature comforts for four weeks. Together, we carry the medical supplies required for every eventuality, so that 100 people will be safe for a month away from civilisation. There is no budget for drugs, so we have to beg, borrow and steal to get them.
Three weeks before the race, the group flies to Kathmandu. Then we take a tiny plane to Lukla, one of the world’s most dangerous airports, and the site of many air tragedies. It is carved out of the mountain and has a landing strip of just a few hundred metres. Next follows a two-day trek to Namche Bazaar, the starting point for nearly every Everest expedition in the past 50 years. Gradually we increase altitude, and spend four or five days trekking up to 18,000ft — so as to be fully acclimatised — before dropping down to rest. We then hike to a different valley for the actual run.
Related article Rise of the runners Running in the clouds: a new ultra-marathon in the Alps It’s vital to “stress” bodies — that is, to introduce them to an environment where there is significantly less oxygen, so they naturally make the necessary changes. The body concentrates the blood, squeezing more of it from the bone marrow. This also makes you pee a lot.
The secret to acclimatising is to move up the mountain slowly enough that the body adapts. The two main potential problems are swelling of the brain (cerebral oedema) and fluid in the lungs (pulmonary oedema). The tell-tale signs of these include shortness of breath, an unwillingness to do anything and headaches.
We employ a buddy system, so you can dob in your tent mate if they are looking peaky and might be too macho to flag up their discomfort. It takes 10 hours for altitude sickness to reach its maximum, and it’s not ideal to treat someone at 3am, when it’s pitch black and -10C.
As a rule of thumb, the Everest Marathon takes twice as long to complete as a road marathon. Because I sweep up the stragglers, I usually register a time of 10 hours or more, and complete the race in darkness, guided only by a head torch and instinct. I’m particularly looking forward to the race next November, because my wife Jennie is taking part for the first time. Completing the world’s highest marathon alongside her will make it an extra special experience; the pinnacle, you might say.
This article was first published in The Financial Times Weekend Magazine in December 2016