Medicine in the Middle of Nowhere

There was still some light in the sky that evening after supper, when everybody started shuffling over to find a spot near the fire. The heat of the day had faded only slightly. Still, they were carrying extra layers and puffy jackets. And headlamps: one thing these last three weeks in the woods had taught them was that no matter how much they’d sweated under their packs during the afternoon, once the sun slipped behind the canyon, the world got very cold and dark, very fast.

“OK,” said Stuart Harris, looking around the circle at the dozen or so faces looking back at him. “I think we’re all here. Ready?”

The 20- and 30-somethings nodding in response were medical students, most just days away from graduation and the start of residencies at teaching hospitals in Delaware, Minnesota, New York, Virginia, Massachusetts. Soon, when the phone rang at 3 A.M. with the news that a patient couldn’t breathe or was having chest pains, they’d be the ones who would have to decide what to do.

For now, though, they were still medical students, and this was one last chapter in their education: a course called “Medicine in the Wild,” a month-long backpacking expedition through western New Mexico’s remote Gila Wilderness, where they learned how to cook pizza and brownies from scratch over a gas flame and to tie their food in trees out of the reach of bears, how to read a compass and follow a trail map, how to set up a campsite and find water and cross a river safely. They’d seen javelinas (small wild pigs native to the Southwest) and a rattlesnake and heard coyotes; one night, some of them had watched several elk crossing a meadow, bigger than anything they’d imagined, bugling wildly. A couple of people had spotted a bear.

The course, led by instructors from the National Outdoor Leadership School (NOLS) and a fourth-year medical resident from Harvard, also introduced them to wilderness medicine, which is pretty much what it sounds like: providing emergency care, using limited tools, to people who get sick or injured in remote environments (Harris’s succint definition boils it down further: “the provision of resource-limited medicine under austere conditions”). Along the way, there’d been lectures and simulated scenarios—the most dramatic was a feigned leg fracture, requiring the students to construct a litter out of backpacks and sticks and carry the “patient” to a helicopter rendezvous at the top of a hill.

The course had also offered some unplanned pedagogy: a mild bout of altitude sickness, which struck one student after the first day’s climb (she recovered with a night’s rest and two doses of Zofran), and, later, an unexplained allergic reaction that forced one of the instructors off the trail a few days early with a fever and a red, swollen face (she, too, recovered). One year, Harris recalls, a rabid fox wandered into camp in the middle of the night and bit a student’s foot through his sleeping bag, breaking the skin. The incident led to an in-the-field vaccination and yielded a scholarly paper: “Rabies Exposure—Implications for Wilderness Travelers.”

Read the full story here.