Polite Dissent

Flash #226 “Down Time”
Stuart Immonen and Kathryn Kuder, writers
Steve Lightle, artist

Flash #226 is an excellent combination of the medical and the super-hero. The story’s not perfect — the ending is too much of a metaphysical deus ex machina — but the synthesis of the super-heroic and the medical is well done. In a clever twist, it is the Flash’s own powers (or more correctly, his use of his powers) that lead to his downfall.

Wally West (the Flash) and Piper have joined a mountaineering expedition to climb some unnamed Himalayan peak. A group of rich folks are paying a couple of guides to get them to the top of the mountain and back down. It’s not a quick trip; the team will be going slow so that everyone can become acclimatized to the altitude:

Guide: We’ll be here a few days, get you used to the air.

Wally soon develops a near constant cough. As the group starts to climb to higher elevations, he notes that his feet are swollen. He develops confusion, blurred vision and then coughs up a bunch of frothy sputum and blood.

Wally has developed a severe type of altitude sickness known as HAPE (High Altitude Pulmonary Edema). Altitude Sickness is common at altitudes above 8,000 ft (2500 m); up to 25% of people at that altitude will develop the mildest form of altitude sickness known as Acute Mountain Sickness. It has been described as a horrible hangover sensation: headache, nausea, dizziness and dehydration. Given enough time, it will resolve and the climber can continue to higher altitudes.

Sometimes altitude sickness can progress to its most severe forms, HAPE and HACE. High Altitude Pulmonary Edema, what the Flash has, is caused by fluid backing up into the lungs. Symptoms include fatigue, breathlessness (even at rest), chest congestion, and cough. Frothy and blood tinged sputum are common (though not usually the frank blood the Flash was coughing up). Untreated, HAPE can lead to death.

HACE, or High Altitude Cerebral Edema, is caused by an altitude-induced swelling of the brain. It can lead to confusion, lethargy and changes in behavior. Coma and death can occur in a matter of hours.

The treatment for HACE and HAPE are the same: descent. The use of oxygen will buy some time, and some medications are thought to help (nifedipine and dexamethasone), but the best treatment is still going down at least 500-1000 meters as soon as possible.

As usual, prevention is the name of the game. Slow acclimitization to elevation is the best way to prevent altitude sickness. That is one of the reasons climbing the Himalayan peaks takes so long. The climbers arrive at camp. They spend several days to a week getting their body used to the new altitude. There may be some day hikes up the mountain, but the climbers always sleep down in camp. After the team is acclimated, they move on to a higher base camp and repeat the process.

Wally never bothered to acclimatize. While the rest of the group was getting used to the altitude, he was running off visiting his wife or stopping crime back in the U.S.. He never gave his body the chance to get used to the altitude and so it’s no surprise when he develops altitude sickness.

As an aside, swollen feet like Wally’s are common at higher altitudes as well. I’m not sure what the writers are suggesting is wrong with his vision, maybe snowblindness or corneal frostbite.

This comic is one of the best of the year in terms of realistic use of medicine and its ingenious way of tying it in to Flash’s super powers (not to mention the excellent Lightle art).