May 26, 2016

Nature : Wilderness Medicine

 A couple of weeks ago I had a particularly rough time at work.  It felt like there was so much to do for each patient, and small things took a disproportionate amount of time, and there were so many small and big things.  Most days, I can take this in stride and in some ways the difficulties are part of what makes this work really rewarding.  But that week, there were some nights I went home and went to sleep carrying in my chest a frustrating interaction or barrier to care, waking up heavier than before rest.

So it was a welcome change to attend a conference on wilderness medicine in Bass Lake, California, which is about half an away from Yosemite. I expected to feel more relaxed in the outdoors and after having some free time to process. 

As often happens with the expansive power of being outside, the experience was more filling than I could have anticipated.  The basic tenet of wilderness medicine is that there's only so much you can do. You can learn how to maximize your resources, and once you do that, you can accept that you've done everything you can and the rest is out of your hands.

I learned that I didn't necessarily need more stuff, but that I just needed the same amount of the right stuff.  With these limited resources, I learned to create solutions to problems like bleeds and fractures. Most of us know from watching movies how to makeshift a tourniquet, but I learned that 90% of what we think of doing doesn't actually work, and I learned what's actually effective.  We learned a lot about what items can be versatile and most valuable in packing.

I also learned about the give and take of certain crucial decisions, like when to call for a helicopter evacuation.  When does that burden actually make sense?  Because it's important to consider that the efforts to care for a person are efforts, and that we need to balance maximal care for people with sustaining the resources of the caretakers.  For example, I learned that while snake bites can seem frightening enough to require a helicopter rescue, most of them fare just as well with regular transport.

A lot of what can seem intuitive isn't the most practical.  We learned that when people get lost, going back the way they came is the second most successful method of finding their way again, but it's the least common method they use.  One of the most common reactions to getting lost is to trial random directions, which in a removed setting we can say is irrational, but is the most palpable solution when we're in the maze itself.

Being outside and doing things like backpacking and camping, where you're reminded to care for minimal needs, you realize how much better you can feel when you stick to the basics.  In primary care, when responsible for so many aspects of one person, it can often feel like you're doing too little, that there always more resources to seek out and provide.  But sometimes it's best to narrow and focus on what is feasible, accessible and natural.

From all this I learned that 1) you can do a lot with very little, and 2) doing a lot can still feel like very little.  And so on days when I feel like there's so much more that I could and should be doing, I try to remember that our man-made clinics aren't so different from the wide expanse of woods and mountains. We have powers and we have limitations, and we occupy the space that we can, and are humbled by how much, much more exists beyond that.

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