High altitude pulmonary edema (HAPE) is a potentially lethal noncardiogenic pulmonary edema1 that accounts for the majority of deaths from high-altitude illness.2 The availability of health care facilities at high altitude in the Himalayas saves the lives of many trekkers, mountaineers, porters, and pilgrims. However, patients with HAPE that are airlifted to hospitals in Kathmandu (1300 m) are sometimes mismanaged because HAPE and high-altitude cerebral edema (HACE) are unfamiliar to these urban practitioners. We present the case of a porter who experienced HAPE and HACE and was mismanaged when he was airlifted to a hospital in Kathmandu.