In the middle of a deep Canadian forest, a ferocious mid-afternoon windstorm knocked down a tree, beneath which five very cold and unprepared people tried to ride out the unexpected weather. The tree’s collapse crushed the group’s not-really-competent tour guide; the blunt-force trauma to his chest killed him immediately. For the people whom the guide had been leading—four novice trainees for an upcoming wilderness adventure race—the windstorm was the last straw in a series of disasters spanning the last 24 hours. The group’s equipment had floated away during a botched water rescue the night before and therefore the entire group hadn’t eaten in more than a day. When the tree uprooted, “Monster,” a 41-year-old habitual drug user just 30 days sober, went running for help, slipped, and had a finger shorn off in the crook of a tree branch, in addition to lacerating his upper arm and dislocating his shoulder. Bobby, the eldest of the group, had suffered an open fracture of the lower left leg and an arterial puncture on his upper left thigh when the tree fell across his leg. His nephew, Hugh, was in severe hypothermia, never having warmed up after having fallen in the river the night before. Eric, Bobby’s friend, had aspirated water while assisting with Hugh’s rescue the previous night and had sprained his ankle besides. After the tree comes crashing down, Eric puts his “bad” foot on Bobby’s arterial bleed while jabbing Hugh with an EpiPen and waving one of Hugh’s free arms to keep circulation moving, in a desperate attempt to do something to help. The shouts from Eric and Monster alert a passing group of hikers, all of whom are trained responders.
Yesterday, this scenario was the final simulation we ran to wrap up our five-day Wilderness First Responder course sponsored by Boreal River Rescue at The Barn just 30 minutes north of Ottawa, in the lovely Gatineau Hills of Quebec.
Lots to cover here. I’ll start by reviewing the WFR course, then reflecting on the “life, love and wilderness medicine” points referenced in the post title before wrapping up with final thoughts.
Wilderness First Responder
The best definition for the WFR role comes from Wilderness Medical Associates, the organization that bestowed my certification:
Wilderness First Responder is the definitive course in medical training for outdoor educators, guides, SAR team members and others who work or play in remote areas. The curriculum is comprehensive and practical, including all of the essential principles and skills required to assess and manage medical problems in isolated and extreme environments.
It’s an 80-hour training that includes basic life support, healthcare provider CPR certification and additional training for specialty subjects including field reduction of some joint dislocations, special CPR protocols, and the injection of epinephrine to treat anaphylaxis or asthma.
The setting—springtime in Quebec!—proved ideal, the 10-to-11-hour drive notwithstanding. Days fluctuated between sunny and 70s F and rainy and 40s F. Our group consisted of 10 WFR students plus four additional WFR recertification candidates who joined us on Day 3. They were a fascinating, beautiful group of humans:
- Danny, the director at Boreal River and our instructor for the course
- Caleb, Evan and Alex are all (very) younger guys who will work this summer as professional guides
- Andrew, Joey and Julien are experienced guides and outdoors enthusiasts
- Mike and Tom—older fellows—took the course for personal enrichment
- Jessy, Ben and Chris—also younger guys—took the course for fun in the context of their existing interests
- Alex and Colin, a couple who live near the training facility and sometimes work with Danny; they’re about to take their teenaged son on a year-long adventure trip, so they recertified early
- Plus sweet, loveable moi
I parked at The Barn around 9p on Tuesday, May 1. Arrival consisted in picking a bed, sheeting it and getting ready for the next morning. The next few days all ran between 10 and 12 hours long. The first several sessions consisted of basic drills (spine-stable rolls, positive pressure ventilation, using masks, assessing lung sounds, taking blood pressures with cuffs and stethoscopes, splinting, etc.) and mastering the “three triangles” of the Patient Assessment System: Scene size-up, primary assessment, secondary assessment. The course was structured to build on skills iteratively. The drills started first in identifying “emergency or not-emergency” for the circulatory, nervous and respiratory systems. Then we layered in assessing changes in vitals or mental status over time, then performing rapid full-body exams and spine/neuro assessments, then asking the “right” questions for a SAMPLE history—after which the drills added identification of anticipated secondary problems, then treatments, then the administration of treatment via simulation. All the while, we had to keep reasonably good SOAP notes for PAS drills and our simulations so that when Danny brought the video camera into our faces and asked, “What’s your problem list?” we could tick off a few actionable problems or body-system red flags in two or three seconds without pondering or mumbling or speculating about treatments.
The sims became quite complex. In the final sim, I played the role of Eric. Danny (the instructor) gave me instructions as well as makeup for my bruises and a series of if-this-then-that branches while the simulation unfolded. For example, after the rescuers moved me away from my friends, I had to complain of being very, very hungry because I also had mild hypothermia and low blood sugar. Whatever they first fed me, I was allergic to; if they asked in advance about allergies, then I could eat something else, otherwise, I had to develop anaphylaxis after eating the food. My breathing was labored, and I did have to feign anaphylaxis, so ultimately the rescuer had to distinguish anaphylaxis from the fact that I was in respiratory distress (bordering on respiratory failure) from pulmonary edema secondary to submersion—while I was very obviously in acute stress reaction from watching my friends screaming in pain before my very eyes. That information surfaced from asking good questions during the SAMPLE history and then bothering to listen for crackles in my alveoli. And as for “Bobby” (played by Tom)? We actually rigged up a turkey baster and tubing with stage blood, as well as bone fragments applied with surgical wax to his shin. And the hapless guide, played by Colin, chomped a blood capsule as soon as the first responder arrived. Hugh (Evan) had blue makeup on his face and lips. Best of all was Monster’s amputation; Ben (the actor) had full-on wax and blood as well as a mannequin finger still stuck in the tree with blood and bone sticking out of it. Delightfully gross but very realistic looking.
We got to mix things up a lot, too. On Day 4, I was in charge of the scene with a rescuer who had a stroke on a steep hill while we were already trying to rescue a person who evidenced hives and mental status changes. So two rescuers and two patients at first, later joined by several more rescuers. The hives guy resolved with epinephrine administration and a bit of rest; the stroke guy we had to apply good airway management while packaging in an improvised litter and team-carrying him to the “helicopter.” And in our first sim, on Day 3, I was primary medical for a guy with an unstable wrist injury from an ATV crash, who crashed because he was significantly hypoglycemic. So I got to cover the main roles (victim, primary medical, secondary support, scene leader) across all the sims, which was totally freaking awesome because you get a really different view of things depending on your vantage point.
The bottom line is that this was an excellent course, taught well by Danny, with a supportive and focused group of student-colleagues. I am not afraid to tackle a medical emergency in the backcountry. I am also quite happy to recommend Boreal River for any of their programs and education, based on my interactions with Danny and those members of his team whom I was privileged to meet.
(My only real regret is not whipping out my camera at some point. I managed to take an iPhone photo of some of the hills of Quebec on my drive south to Ottawa, which is the cover photo for this post. Otherwise, nada.)
I left The Barn at 6:15 p.m. on Sunday, May 6, and drove non-stop back to Grand Rapids, arriving at 4:25 a.m. So, quite a hoof. Turns out, Toronto is the half-way point, time-wise. Both directions, I routed through Port Huron/Sarnia (I-96 to I-69) and took the southern route across Ontario (highways 402/401/416) and Autoroute A-5 in Quebec. Didn’t get tired the whole way back. Three stops in Ontario to pee and visit Tim Hortons at ONroute facilities significantly helped, as well as a late-night food stop at a McD’s just past Flint. But I didn’t get drowsy or even yawn all that much, because my brain was firing at a mile a minute as the kilometers ticked by.
So, lots of time to reflect on my way home. Three things pop out—just like the buds did in my absence. When I left, no green on the trees and the wind was chilly. When I got home just before dawn, the birds were chirping and it was warm and I saw leaves. Everywhere. In just a week. It felt like a triumphant welcome home. But I digress.
First, fitness. Holy hell. I did okay, but during the first simulation, Danny recorded the three different scenes. I saw my report-out about my patient’s problem list and expected evacuation requirements during our debrief the following morning. After seeing that video I said to myself, “Self, you have additional opportunity to augment your cardiopulmonary fitness.” Although in my head I might have used more colorful language.
For me, weight and fitness have always been directly correlated with stress. A big stressor lately (the day job) has been taken off the table. Today, I’m just so remarkably serene about everything that I’m looking forward to getting into a new set of habits now that my life has been completely shaken up. I sit here typing this blog post with the windows in my home office open, birds chirping, a gentle breeze passing through and sun passing obliquely over the shelves, bathing both the room and the cats with a warm pale glow. I did a fair amount of heavy breathing over the last week. So now, I sit here, and I feel good. Good. And I went grocery shopping this morning. Bought fish and veggies. No carbs. No junk food. Turns out, I actually like cooking, and the foods I really like are tasty and nutritious. What a shame it took me 41 years to figure this out.
Second, experiences. I loved hearing the stories from the folks in the group about the things they’ve done or hope to do. Many of the guys were really quite funny and remarkably accomplished for their ages. Everyone was so chill about everything. There wasn’t a sense of one-upmanship at the table. If someone said, “I did this cool thing in this remote place” then other people would be like, “OK, I’d love to try that some day myself, so can you give me any tips?” The stories were so respectful, honest and non-competitive that you could (and I did!) just immerse joyfully in the stories.
I bring this up because I’m so accustomed to dealing with people angling for advantage that spending a week with people who just wanted to share was rejuvenating. It’s a good reminder to reflect how I approach conversations as well as to think about the level of venom I’m willing to tolerate in my dealings with others.
Third, May 2. That’s the day the WFR course started. It was also the official last day of my employment with Priority Health (slash Spectrum Health System) after nearly 18 years of service. It’s the day I started working for myself instead of for someone else. That evening, after the first-day classes had concluded, I sat down with a book. But I wasn’t really reading that much. Instead, I was just reliving highlights of my career. Lots of stuff went right, over the last 18 years. Lots of failures, too, most of which were self-inflicted. I sat for hours, tracing the steps from my middle-school days at St. Anthony to my trajectory at West Catholic High School to my choice to attend Western Michigan University and the ways that my life shaped from the choices I made in those years. In the working world, I think I did okay, despite this occasionally half-hearted dual pathway in health care as well as freelance editing and publishing. I don’t think I would have picked this life when I walked out of the door of St. Anthony in 1990, or W.C. in 1994, or even WMU in 2003. But I’m happy with how it turned out to this point. They key take-away is that the next time I’m at a pivot point like this, that the subject of my reflection should not be me being okay or not-okay with “how it turned out” but rather assessing results given that it’s the outcome that I planned for and executed instead of merely allowing to occur.
Seizing the reins of one’s own destiny, as it were. Which, as a self-employed consultant as of today, I must do without a safety net. But I think the chance to decompress in Quebec was one of the best possible ways to make this transition. Not only was WFR certification on my bucket list for several years, but the experience of achieving it kicks off my consulting work on the right emotional foot. (And believe me—the last few weeks have been an emotional roller coaster.)
Love is a funny thing, and it can be evidenced in funny ways. My landlord, who very kindly looked upon my feline overlords in my absence to ensure they didn’t lock themselves in cabinets or otherwise get themselves into trouble, told me this morning that they got “pissed” when they heard rustling at the back door, ran into the kitchen then found that it was him instead of me. So that was sweet. But love evidences itself in other—human—ways, too. During our first big simulation, I eventually moved to a different scene and served in a supporting medical role. I helped Alex (the female one, who was a patient at the time) with head stability given a traumatic brain injury and obviously rising intracranial pressure. So I kept reassuring her: “You’re in good hands.” “I know it hurts, we’re doing our best to help you.” And so on. In our post-scenario debrief, she specifically called out that gentle attention as a big deal to her. And when I was “Eric,” I made a point of getting despondent and almost crying about my friends—and it was that expression of grief that prompted my primary rescuer (Caleb) to really just stop and go into full reassurance mode instead of just ticking off the boxes on his SOAP note. Bedside manner matters. A lot. And not just in a wilderness rescue situation. I know it sounds trite, but it’s true: Being a decent human being is hard, rare and worth it. Empathy is a skill significantly stressed by the ubiquity of smartphones.
While dining and conversing with my fellow students, I heard some really wonderful stories about their adventure travel over the years. Colin and Alex had gone to Kilimanjaro in January; Andrew is going in August. Julien came to Quebec from Patagonia—a four-day journey. Most of the non-teen group had stories about South America, or Africa, or Asia. Wonderful, engaging stories. And you know why? Because it’s their passion. It’s what they love. Do what you love, and happiness and success will follow. Do what you love, and your heart will fill with love.
In WFR training we learned about toxins and venoms and such. I believe that comfort is a toxin. So is fear of the unknown. Aversion to loss and resistance to habit disruption are such powerful instincts that they affect us even when we’ve got nothing to lose and a ton of stuff to win. I’m not ashamed to admit that on the first night I was in Quebec, before we even started the course, I sat in the common room at The Barn and was thiiiiiiis close to packing up and leaving. On the spot. A dozen rationalizations passed through my mind: The cats would be lonely. I’m not the “type” to be a rescuer. I wouldn’t fit in with the others. I might fail. You know: A noxious blend of Jonah Complex and Imposter Syndrome distilled and bottled at cask strength.
I stayed. I got through it. I’m a better person for it. But even with all that preparation and anticipation, it was different enough to be scary. And think of all the times that we confront this kind of “scary” on a daily basis. When we think it’s better to keep quiet than to stand up to a bully. When we think it’s easier to do what pays the bills instead of what fills the heart. When we find an excuse to avoid a necessary lifestyle change because we can do it “tomorrow.”
Before you can do what you love, you must love yourself enough to believe you’re worthy of the investment. For a lot of people, that’s a difficult proposition.
The WFR course reminded me of a few life lessons, as applicable in the backcountry as they are in the boardroom:
- Never let the perfect become the enemy of the good. You don’t need to arrive at a differential diagnosis of cerebral hemorrhage of the left hemisphere to know that you’ve got increasing intracranial pressure (or, ahem, whether someone was bitten by a Black Widow). The rising ICP is the emergent problem, regardless of its source. To wait to treat (e.g., to evacuate to a hospital) while fine-tuning a diagnosis means you’ll likely kill your patient. Similarly, waiting for all the stars to align—when enough stars have already aligned—is an invitation to inertia. Sweet, comfortable, toxic inertia.
- Assess the situation, not the problem. Then treat the problem in its context. A rescuer who sees a person with a head injury can leap into action to conduct a spinal exam and check for a traumatic brain injury, without realizing that the source of the injury is the very, very unstable pile of huge rocks on the ledge above them both. Similarly, identifying some area of self-improvement (e.g., weight loss) that’s undertaken as if “weight gain” were a problem severable from its environmental, emotional and psychological context, is futility. Almost no problems worth solving occur in isolation without any mix of direct and indirect causes or downstream consequences. To fix the problem, you must understand its causes and effects and only then can you develop a solution designed to succeed.
- Lead when you can. Follow when you should. Protect your command when you must. In the scenario were I served as scene leader, I radioed the RCMP (i.e., talked to Danny’s video camera) to arrange a specific evacuation plan. Then, I had to assemble the troops, tell them the plan, assign roles and oversee execution. So far, so good. Then we had new responders arrive who started barking orders. That was bad form, but understandable given the adrenaline and the training exercise. To keep control of the scene and to minimize harm to my patient, I had to assert leadership so that the existing plan wouldn’t be threatened by delays or miscommunication. Similarly, you must master Gillikinism #28: “Master the sword—when to wield it, when to sheathe it and when to fall upon it.” When leadership is necessary, supply it. When it’s not, don’t horn in. When you’re in charge and someone tries to knock you off the hill, kick him in the nuts and continue your benevolent leadership. Because sometimes, lives really are at stake.
I’m doing some assorted catch-up this week as well as fine-tuning the official launch of Gillikin & Associates. Very exciting. I have some editorial work to do with Caffeinated Press and just a lot of “what am I going to knock off my major-goals list in May?” planning to complete. I no longer have a Mon-Fri, 9-5 kind of job, but I obviously still have to work. The question of how I integrate work and enrichment and whatnot still requires forethought.
From the WFR perspective, my goal is a bit broader. I’m increasingly drawn to outdoors activity. I’m not really interested in a full-time career change into the outdoors industry, but here’s the thing. In addition to being a WFR and a reasonably experienced backcountry hiker (at least, in hemiboreal climates), I’m decent on my kayak and I’m a scuba diver. I want to blow that out a bit—more dive training, more (and more complex) kayak trips, more deliberate backcountry hikes. Maybe do some whitewater rafting training. Go places. I might not visit every cool hotspot between Banff and the Amazon or between Iceland and the Outback, but I can do a major guided activity every year or two. I’m thinking about it.
Otherwise, I look at the trip to Quebec as a door. On one side of May 2, I had one life. On the other side, I have a new one. My first life was mostly accidental. My next life? Not so much.