Book Review: A Sand County Almanac By Aldo Leopold with Introduction by Barbara Kingsolver, Oxford University Press : 1949, Introduction : 2020
Aldo Leopold (1887-1948), writer, philosopher, and naturalist was an early champion of the US environmentalist movement, most notably in the domains of biodiversity and wildlife management. His best writings have been gathered posthumously in A Sand County Almanac, required reading for budding conservationists or anyone trying to better understand our relationship with the natural environment.
In the first section, Leopold uses his “naturalist’s gaze” to recount his observations of the secret lives of the flora and fauna inhabiting his “sand farm” in rural Wisconsin, emphasizing the interdependence of a variety of species. The attention to detail and passion he uses to describe the natural world and its wider implications reminds me a lot of Edward Abbey’s Desert Solitaire. Leopold’s writings must’ve undoubtedly been an influence for the Southwest’s most famous raconteur. In the second section, the author gives the same treatment to other notable North American biomes - I especially enjoyed his account of a canoe trip through what were once the green lagoons of the (now desiccated) Colorado River delta in Sonora.
In the latter part of the book, Leopold offers his treatise on developing a land ethic that should inform future conservation and land management efforts. Although written over seventy years ago, Leopold’s writing seems just as evergreen today. Leopold discusses how farming, wildlife management, hunting, outdoor recreation, and infrastructure have been essential to modern human evolution but must now be looked at with a different lens if we are to save the wild places that continue to influence us. Even the National Park System isn’t spared (although perhaps not as scathingly as Abbey does in Desert Solitaire).
I think what separates Leopold’s writings from many other conservationists, as noted by Barbara Kingsolver in her introduction, is his approachable, nonjudgmental, authentic appeal that is refreshing in today’s climate change polemics where “even the word environmentalism has become a civic hand grenade”. Just as enjoyable are the book’s many incredible quotes, some of which I could not help but include in this book review. From more well-known aphorisms such as:
Man always kills the thing he loves. And so, we the pioneers have killed our wilderness. Some say we had to. Be that as it may, I am glad I shall never be young without wild country to be young in. What avail are forty freedoms without a blank spot on the map?
To hidden gems about wildlife management such as:
Relegating grizzlies to Alaska is about like relegating happiness to heaven; one may never get there.
And even ones relatable to us, wilderness medicine providers:
In general, the trend of the evidence indicates that in land, just as in the human body, the symptoms may lie in one organ and the cause in another. The practices we now call conservation are, to a large extent, local alleviations of biotic pain. They are necessary, but they must not be confused with cures. The art of land doctoring is being practiced with vigor, but the science of land health is yet to be born.
I highly recommend reading (and re-reading) this book during your next trip to one of our remaining, wild “blank spots on the map”.
Reviewed by Marc Cassone, DO, FAWM, DiMM
Posted on October 4th, 2023
2018 Thai Cave Rescue, Documentary and Podcast Review: The Rescue (2021, Disney+) and ACCRAC Episode 242: The Rescue (11/21/22)
This summer will mark 5 years since the rescue of 12 teenage soccer players and their 25-year-old coach who spent over two weeks trapped in the Tham Luang cave in northern Thailand. In 2021, National Geographic released a documentary on the events titled The Rescue from the successful husband-and-wife duo Elizabeth Visarelhyi and Jimmy Chin (directors of the Oscar-winning climbing documentary Free Solo). For the documentary, they expertly combine up-close, live footage from the events, diving scene reenactments, and exclusive interviews.
The film follows the progression of events over the course of 18 days and does an incredible job of conveying the immense scope of the operation, as well as the impossibility of the task at hand. Multiple groups from around the world took on organizational and leadership roles, with thousands of volunteers on the ground supporting the mission. Key players included Thai government officials, Thai Navy SEALS, American military personnel, and the unlikely heroes of the story: several middle-aged, awkward, self-effacing, amateur cave divers. The documentary intersperses intimate moments with these obscure sport adventurists, highlighting their stories and personalities. In these interviews, they share the backgrounds that led to their interest in diving and demonstrate their ability to control the anxiety, fear, and doubt they feel in a setting that would lead most to panic. They are clearly passionate about and proud of their little-known sport, finding peace and calm in the deep, dark unknown of unexplored caves.
The story includes both the technical aspects of a complex wilderness rescue situation as well as the inspiring humanistic components of generosity and the value of persistence. Visarelhyi and Chin also do well to feature the Thai cultural and spiritual influences that inspired hope for many locals. They weave in naturally dramatic aspects of the situation without over-dramatizing or losing out on accuracy, honoring an incidental love story and a retired navy SEAL who lost his life volunteering for the mission.
The documentary alone is gripping and educational. For those interested in the more detailed aspects of the medical considerations, Dr. Richard Harris, the cave-diving anesthetist featured in the documentary, spoke recently on an anesthesia and critical care podcast about his thought processes regarding the pharmacological and the physiological concerns at hand.
In the Anesthesia and Critical Care Reviews and Commentary (ACCRAC) podcast, host Dr. Jed Wolpaw interviews Dr. Richard Harris and discusses his concerns after arriving in Thailand as well as his plan for sedation of the victims during the complex rescue. He recounts carefully considering multiple sedatives – benzodiazepines, dexmedetomidine, and ketamine – and ultimately settling on ketamine due to his experience with the drug, its preservation of respiratory drive, lower risk for laryngospasm, and ability to be administered intramuscularly. Additionally, he chose small doses of oral alprazolam for initial anxiolysis, along with co-administration of intramuscular atropine to reduce oral secretions. He then teaches his fellow cavers how and when to administer “top-up” doses during the dive for maintenance of anesthesia.
Dr. Harris outlines additional concerns for the long dive, such as flooding of the masks with water or secretions, positional airway obstruction, and the possibility of severe hypothermia with the cave waters at a mere 23°C. From a diving perspective, positive-pressure facemasks were used to prevent filling with water. Interestingly, he posits how this probably also provided some continuous positive pressure to stent the airway open and added buoyancy to keep the head in “sniffing” position. Surprisingly, most boys had measured temperatures of about 32-35°C (mild hypothermia) when pulled from the cave; this he attributes possibly to the sympathomimetic effects of ketamine.
In my humble opinion (especially as a fellow anesthesiologist), both the documentary and podcast are well worth the investment in time for any medical adventurist intrigued by this remarkable, once in a lifetime story and complex search and rescue scenarios.
Reviewed by Mary Rosegrant, DO.
Posted on August 22nd, 2023
Book Review: At the Mercy of the Mountains: True Stories of Survival and Tragedy in New York’s Adirondacks by Peter Bronsky (Lyons Press, 2008)
In this historical perspective, author Peter Bronski tells various stories of survival and tragedy from the 1800s to the present in northern New York’s famed Adirondack Mountains. Although not as grandiose or imposing as their western sisters (the Rockies and Cascades) or as broad as their eastern neighbors, the Appalachians, the Adirondacks (or “ADKs”) do hold an important part in Americans’ relationship with the outdoors. As Bronski explains, the Adirondack Park is one of the biggest parks in “the lower 48” (over six million acres), one of the oldest in the nation (established in 1892), and was one of the earliest outdoor escapes that urbanites looked to when vacating the increasingly congested East Coast cities during early 20th century (where the American term vacation comes from). This long history of Americans exploring - and getting lost in - this vast wilderness serves as the backdrop for many of the accounts Bronski chose to highlight in his book. As an ADK local, I am admittedly biased and did enjoy reading stories that take place in many of the mountains I have explored, however, I do think there are many lessons that would interest a wider, wilderness medicine-inclined audience.
Without revealing too much, I found the stories of some of the earliest guides entertaining, the whitewater mishaps gripping, and some of the more recent stories were absolutely harrowing (notably the passages taken directly from the journal of an ill-fated through-hiker on the Northville-Placid Trail as he spent weeks waiting for rescue). Bronski also tells the story of the first skier death due to avalanche in the Adirondacks and its implications. An especially poignant story is that of the canoeist who was both the first and second person to activate a PLB (personal locator beacon) in the continental United States. Bronski’s discussion of the ramifications of this 2003 event seem to ring through even today, twenty years later. I especially enjoyed the last chapter, in which the author, an experienced backcountry rescuer himself, discusses the heuristic traps that lead to bad decisions in wilderness environments - many of which are the same fallacies that we as providers can be prone to in our daily clinical practices. At a minimum, I think readers (both local and non-local) will come away with a greater appreciation for one of America’s great wild spaces - the ADKs.
Reviewed by Marc Cassone, DO, FAWM, DiMM
Posted on May 5th, 2023
Book Review: The Emerald Mile by Kevin Fedarko (Scribner Books, 2015)
The harrowing account of three renegade river guides taking the iconic dory, Emerald Mile, through the Grand Canyon’s myriad of rapids, eddies, and narrow passages during a record-breaking flood in under 48 hours makes for a fantastically gripping tale. However, it is the rich detail and backstory- clearly informed by Fedarko’s pain-staking research and experiences as a boatman- that really help readers appreciate this feat worthy of the Grand Canyon. While the canyon herself is central to the story, the author spends significant time on other important characters as well- the Colorado River, the National Park Service, the river guides, the Bureau of Reclamation, as well as Glen Canyon Dam and the men who built, maintain, and sustained her during massive damage from record snowmelt. The idea that Lake Powell was so full that Glen Canyon Dam almost spilled over (wait until you read how they prevented it) and threatened massive floods seems hard to imagine while reading in 2023 when the dam and Colorado River watershed are critically endangered by just the opposite. I must also compliment Fedarko on his ability to make dry topics such as dam spillway architecture and river rapid hydrology (not easy to explain in words) seem interesting (or at least make me care about in this instance!).
Wilderness medicine practioners and whitewater enthusiasts may take particular interest in the chapters describing the events taking place in the canyon during the flood (up to 72,000 cfs). While the crew of the Emerald Mile came out relatively unscathed, many of the commercial outfitters and their clients did not. It is an interesting case study in how the National Park Service and its rangers managed hundreds of boaters during some of the most dangerous river conditions in recent history- all in a time before satellite phone communication. I found myself often wondering, “What would I have done?” My only suggestion would be that Fedarko includes an updated coda in his next edition with insights on the current state of the Colorado River and more recent attempts to break the speed record. I highly recommend this book for anyone with even a passing interest in big water and big adventures.
Reviewed by Marc Cassone, DO, FAWM, DiMM
Posted on April 19th, 2023
Documentary Review: Buried - The 1982 Alpine Meadows Avalanche (2022)
Buried: The 1982 Alpine Meadows Avalanche is a feature length documentary (97 minutes) produced by Realization Films and directed by Jared Drake & Steven Siig. It was released in 2022 and is available to stream on Amazon Video.
Ski culture runs deep at Tahoe. From skiing gold rush prospectors in the 1800s, to the 1960 Winter Olympics, and continuing today with a world-class skiing experience, Tahoe and skiing are synonymous. With this ski history as its backdrop, Buried describes the unthinkable — the deadly 1982 avalanche at Alpine Meadows, one of Tahoe’s many ski resorts.
The film begins by describing the natural conditions of Alpine Meadows and how mountain orientation, terrain features, and local weather patterns create ideal conditions for avalanche danger. It outlines the resort’s avalanche mitigation measures and cutting edge snow science program that may have led to a touch of overconfidence. Historic storms brought unprecedented amounts of snow and wind to the area in March 1982 and mitigation measures were no match for mother nature. While the resort had the foresight to close the mountain to recreationalists, several workers and bystanders were buried in an enormous avalanche that blanketed the access road and destroyed the Summit House. Rescue efforts were able to recover seven victim bodies and locate one survivor, found after 5 days of burial.
Overall, Buried is a compelling documentary that tells a story that should never be forgotten. Historic and modern interviews are gripping and the musical score adds to the dramatic effect. The discussion of avalanche risk and mitigation techniques is a great review for the wilderness medicine professional as is the search effort for survivors.
Take home message: Under certain weather conditions, no amount of avalanche mitigation and planning can ensure safety, even at a reputable resort.
Reviewed by Stephen Mowery, MD
Posted on April 11th, 2023
Movie Review: Against the Ice (2022)
Against the Ice (2022), a Netflix film directed by Peter Flinth, tells the story of Denmark’s 1909 polar expedition based on Ejnar Mikkelsen’s astounding autobiography. The film is 103 minutes in duration and rated TV-MA for animal harm, language, and smoking.
In the late 1800s, an American expedition explored northeast Greenland and claimed a region dubbed “Perry Land” as a separate island and American territory. Denmark sent an expedition to disprove this assertion by creating accurate maps of the region to assert Denmark’s claim to the land (as part of Greenland). This initial Denmark expedition of 1906-1908 was successful in creating the maps, but the crew did not return and the maps were stashed in the newly mapped territory. Mikkelsen was tasked by the Danish government in 1909 to retrieve the charts and this is where the film begins.
After Mikkelsen and his crew traveled as far north as possible by ship, Mikkelsen and his inexperienced sidekick Iver Iversen continued on foot/sled for the remaining several hundred-mile trek to the location of the charts. They located and retrieved the documents, but upon return to their ship found it crushed by sea ice and abandoned by the crew. They survived for an additional two years in a cabin built from the dismantled ship. Bear attacks, hallucinations, and interpersonal conflict make daily life appear exciting when the reality of the day-to-day was likely much more dull. The explorers were eventually rescued by a whaling ship and returned to Denmark with acclaim.
The film reinforced that even the well-prepared may struggle for survival in such an unforgiving landscape and made me ponder the management of minor medical emergencies, such as frostbite or a neck abscess, in this environment. Current best practices recommend waiting weeks or months to amputate frostbitten digits (rather than the next day), but early amputation was the accepted treatment in the early 1900s. Additionally, heat sterilizing a knife for an incision and drainage was the best available option to reduce risk of infection during a necessary procedure.
Overall, this was an interesting expedition story worthy of the big screen. The plot was difficult to discern from the movie alone and viewers would be well-rewarded by reading briefly about the historical expedition before watching this film.
Reviewed by Stephen Mowery, MD
Posted on March 23rd, 2023
Series Review: Aftershock (2022)
Aftershock: Everest and The Nepal Earthquake (2022) is a Netflix mini-series directed by Olly Lambert that tells firsthand stories of survivors of the 2015 earthquake. The three-episode docuseries highlights search and rescue efforts in remote regions of Nepal, including Everest, as well as in the city of Kathmandu. The series is rated TV-MA for language.
The first few moments of Aftershock start out as a calm journey through Everest’s Khumbu Icefall, but quickly become a terrifying trek as the earthquake shakes the earth beneath the climbers’ feet and an avalanche quickly appears. You are next introduced to Dave McKinley, Dave Hahn, Sara, Gopal and other survivors who were on the mountain that fateful day.
The film highlights survivor’s experiences, not only on Everest, but also in the Langtang Valley and Kathmandu. One of my favorite elements of this docuseries- and perhaps one of the most sobering- is the use of real time footage from those who were in Nepal during the earthquake. I have read several books and watched other series that tell stories of the 2015 earthquake, but I have not come across another medium that so eloquently combines survivor stories with real life footage.
The end of the series highlights several ethical dilemmas and the importance of cultural competence and respect, especially in such grave and devastating situations. I personally enjoyed that this series not only tells the stories of Westerners and other travelers in Nepal during the earthquake, but also the accounts of locals as well. This earthquake took the lives of 9,000 people, injured many more, and caused irreparable harm to once thriving communities. My only critique of this excellent docuseries is that it could have included even more stories from a local perspective.
Wilderness medicine is a growing field and this film highlights the importance of strong disaster assistance teams and displays the necessity of cross-cultural understanding and partnership during disaster relief efforts. This film leaves me with many good questions regarding triage in emergency situations and ethical decisions associated with medical evacuation during and after catastrophic events. If you are interested in learning more about the practice of wilderness medicine during disasters, Aftershock: Everest and The Nepal Earthquake (2022) is a great series for you.
Reviewed by Megan Smith, RN, MSN, CPNP-AC
Posted on February 3rd, 2023
Movie Review: Infinite Storm (2022)
The movie Infinite Storm is based on the 2019 article High Places: Footprints in the Snow Lead to an Emotional Rescue by Ty Gagne. It is based on the true story of search and rescue team volunteer Pam Bales (Naomi Watts) and her annual November climb up Mount Washington in New Hampshire. Mount Washington, while a relatively accessible hike in good weather, is infamous for high wind with gusts recorded up to 231 mph and sudden onset of horrific weather conditions. It is widely known as “the most dangerous small mountain in the world” and boasts to be “home of the world’s worst weather.”
Movies and television shows based on reality can challenge our capacity to suspend disbelief. This is particularly true if the topic is within an area of our expertise. Seasoned firefighters and paramedics watch shows like 911 and cringe, physicians watch Grey’s Anatomy and sigh with disappointment, and when climbers and mountaineers watch Cliffhanger, their collective dismay is audible as they defend Black Diamond gear and dispute the accident that literally defied the laws of physics. Sometimes the depiction challenges and insults our experience and training. The incorrect representation could even qualify as misinformation and cloud the expectations of patients. Overall, we found the portrayal of events in Infinite Storm to be gripping, the pace of the movie made us feel the character’s pain, and, luckily, we did not sustain intense waves of disbelief (see below for a few exceptions).
The movie begins with pleasant weather and Bales hikes in a tank top. The weather changes rapidly and she dons additional layers of clothing. The weather becomes increasingly fierce with heavy snowfall and she abandons her summit bid. My first disbelief happened around 13 minutes in when she slips and breaks her climbing pole. We have abused climbing poles and have never had one break under a mechanism as seemingly minor.
Later in the movie, Bales, an experienced and concerned rescuer, follows a set of sneaker footprints leading off the trail and falls into a tree well (a hollow area under a tree where the snow is blown around and does not completely fill in the area). With her crampons, she makes several attempts at climbing out despite falling back in and getting buried. The tension is palpable – the actors and filmmakers did an excellent job of portraying the terror and technical difficulty of being trapped in a tree well. She is ready to give up when the will to survive overcomes her and she desperately climbs out. A true rescuer, she covers the hole and marks it with branches to prevent anyone else from stumbling in (glad they included this!). She continues to search for the wearer of the sneakers in the horrific storm and unforgiving winds.
Eventually, she finds a hypothermic, nonverbal man in shorts and sneakers. She names him “John.” She notes he is “dressed for the beach” and starts with trying to rewarm him in a survival bag and dresses him in her spare clothing (an accurate depiction of hypothermia treatments!). As she begins walking him down the mountain he falls multiple times, remains nonverbal beyond “I can’t,” and is only mildly cooperative. If you have ever tried to rescue someone who is hypothermic you know their capacity for reason is diminished. Cold exposure freezes the brain. The actor who plays “John,” Billy Howle, does a great job depicting the confusion, instability, and irritability of a truly hypothermic patient. When the pair reaches a point in the trail where they must cross moving water on a slippery log. “John” falls in and is washed away in the freezing rapids. Bales continues to hike down. Is he gone? Will she find him again? …
If you want to know how this story ends – read the article or watch the movie! Even if the movie production of Infinite Storm took some liberties with certain aspects of the story, it is possible, through skill coupled with sheer will to survive, to overcome a desperate situation of this magnitude. Ultimately, the filmmakers present a believable scenario that did not challenge our reality. Infinite Storm's special effects and filming location (Slovenian Alps) rang true to bad weather mountain experiences in the White Mountains. This movie reminds viewers, that we do not truly know how we would fare until we are faced with a daunting challenge like Pam Bales. We felt Bale’s solitude and the slow pacing of the movie made us feel her pain. It felt a little like a snowy version of Castaway. We recommend watching this movie. It is an intense, inspirational, sometimes painful, and gripping story of the will to survive and the will to save another.
Reviewed by Sarah Spelsberg PA-C, FAWM, FEWM, MD Candidate (Class of 2023); Sara Filmalter MD, FAWM Candidate, DiDMM Candidate; and Abraham Boxx, BCP, NR-P, FP-C, BSN, FAWM Candidate
Posted on November 30, 2022
Gila Lost and Found: Search and Rescue in New Mexico
By Marc Levesque
Marc Levesque’s Gila Lost and Found: Search and Rescue in New Mexico strives to make the rigidly technical world of search and rescue (SAR) understandable for recreationists. He states his goal directly early on, “that you will take away a better appreciation of what’s required to search for and rescue people in southwest backcountry areas. You will also gain awareness of how to better plan and enjoy your outings and how to survive if you ever become lost or stranded in the backcountry.”
Through detailed descriptions of SAR missions in which he himself has participated during his fifteen-year career with Grant County (NM) Search and Rescue, Levesque conveys the staggering amount of resources that even a simple-seeming SAR mission often requires. He writes with empathy and a cheeky sense of humor that prevent the tales from reading like dry incident reports. Some of the missions are deeply personal, such as a three-day search that culminated in the discovery of the body of a fellow SAR member’s fiancée.
He covers a wide range in a relatively short book: dehydration, flash floods, mental illness, GPS technology, and heuristic traps. Even though much of the book is drawn from personal experience, it’s peppered with citations from risk management, leadership, outdoor survival, and psychology literature. The book has a tight regional focus on southwestern New Mexico, including the Gila National Forest – one of the largest and least visited in the National Forest System. Nevertheless, the lessons apply to wilderness everywhere.
My biggest criticism of this book is that its maps could be better. Detailed topographic information plays a critical role in SAR missions. The author could have used them more effectively here to better illustrate the sheer magnitude and remoteness of some of the search areas – which are not confined to the designated trails that serve as narrow passageways through the wilderness for most of us. Instead, the maps are grainy screenshots with scant labelling that give minimal context.
Sub-optimal cartography aside, Gila Lost and Found is a lively, thorough, and personal book that may give wilderness medical practitioners a little more insight into how people end up in emergent situations to begin with, and what it takes to get them out.
Reviewed by Jeff DeBellis, SOLO Wilderness Medicine Instructor and Cibola Search and Rescue member based in Albuquerque.
Posted on November 16, 2022
Where You’ll Find Me: Risk, Decisions, and the Last Climb of Kate Matrosova
WMS Book Club – February Selection
By Ty Gagne
The WMS Book Club is a quarterly virtual book club for WMS members. Run by Aubri Charnigo, MD, and assisted by other volunteer member hosts, book club members select a book to read once every 3 months and we hold a virtual discussion of the book via Zoom at end of each 3-month period. In 2021, we read Into Thin Air by Jon Krakauer and Deep Survival by Lawrence Gonzalez.
The Winter 2022 book club selection was Where You’ll Find Me: Risk, Decisions, and the Last Climb of Kate Matrosova, by Ty Gagne. The book details what is known about Kate Matrosova’s fatal solo mountaineering trip in the White Mountains of New Hampshire in February 2015. Kate was a 32-year-old experienced mountaineer and had planned a single day “light and fast” traverse of the Northern Presidential Range. The White Mountains are infamous for having some of the world’s worst weather conditions and on the day of her trip, a “weather bomb” hit – resulting in sustained winds of 116 mph and a wind chill of -71 degrees F. In need of aid, Matrosova called for help on her rescue beacon, but due to weather conditions, rescuers could not go above tree line until the following morning. Ultimately, over 40 personnel were involved in Matrosova’s rescue attempt and body recovery. Ty Gagne provides an analysis of Kate’s plan, the weather conditions, and the search and rescue efforts to analyze where Kate went wrong.
On the evening of February 1st, WMS members had a robust discussion of the book. We talked about where errors were made, whether this accident was preventable, and what we took away from reading the book that we can apply to our future outdoor trip planning, as well as our clinical work. Below is a summary of our take-aways on how to avoid errors in trip planning and in the mountains:
How to Avoid Errors in the Mountains:
- Start early (before sunrise) and build in extra time
- Carry rescue/self-rescue gear (i.e. headlamp, shelter, water filtration device) so that you are prepared to spend the night if you have to
- If in the White Mountains – obtain a “Hike Safe New Hampshire” card which details the 10 essentials to carry when hiking
- Plan a turn-around time and bail-out points
- Know how to use your technology and rescue gear
- Realize that a rescue attempt will likely occur hours after your initial call for help
- Be adaptable
- Assess whether you have the hard skills (knot tying, climbing skills, physical fitness) as well as the soft skills (decision-making experience, emotional control, self-awareness and self-care techniques) to complete your objective
- Undertake a pre-mortem exercise pre-trip: imagine that your plan resulted in the worst possible outcome, and then work backward to figure out what factors led to failure
Finally, here are some of the take-away lessons from some of our members:
- “It’s okay to give up, the summit will be there another day” – Michael N
- “Plan, plan, plan!” – Ali M
- “Pre-mortem plan” – Kristina D
- “The importance of soft skills” – Adrian P
- “Don’t be too focused on the final goal, but enjoy the journey” – Jonathan W
Thank you to everyone who participated in our recent book club discussion and we look forward to the next! The next book to be read and discussed in May 2022 will be Wild Rescues: A Paramedic’s Extreme Adventures in Yosemite, Yellowstone, and Grand Teton by Kevin Grange. As an added bonus, we will be joined by the author for our discussion! You may register for the session beginning about a month in advance on the WMS website.
If you are interested in joining the book club, please sign-up with the following FORM or register at the link on the WMS website. Simply add it to your shopping cart and hit check-out (no cost for WMS members).
Reviewed by Aubri Charnigo, MD, FAWM, DiMM
Posted on February 20, 2022
Surviving the Extremes
By Ken Kamler, MD
Penguin Books: 2004
Despite the title, this is not another Bear Grylls/Survivorman-esque paperback on survival techniques for different environments. Instead, Dr. Kamler, best known as being the doctor at Everest's Camp III during the fateful events highlighted in John Krakauer's acclaimed Into Thin Air, draws on his wealth of experiences and research to detail the pathophysiology of the human body in extreme environments. In an approach that is unique in wilderness medicine texts, Dr. Kamler focuses specifically on the intricate ways the human body reacts - or fails to adapt - to different environments. In each chapter, Dr. Kamler does an excellent job of explaining complex processes such as HAPE, G-forces, and decompression sickness in a way that even seasoned wilderness medicine practitioners can appreciate while still making the book accessible to readers with limited medical training. Dr. Kamler gives salience to his discussion of physiology by sprinkling in his many experiences, including expeditions across the world (and under the sea) with various organizations like the National Geographic Society, NASA, and the Explorer's Club. Of special interest are his chapters on altitude medicine and the physical and mental effects of long-distance space travel. This is recommended reading for both wilderness medicine neophytes and experts with an interest in the pathophysiology of extreme environments, or just reading about (and being inspired by) some of the many adventures of an incredible career in wilderness medicine.
Reviewed by Marc Cassone, DO, FAWM
Posted on January 12, 2022
The Devil's Highway: A True Story
By Luis Alberto Urrea
Little, Brown and Company: 2004
This national bestseller chronicles the events leading up to, during, and after the tragedy of the Yuma Fourteen: a group of Mexican immigrants illegally crossing the U.S.-Mexican border along the Devil's Highway in 2001. Urrea's in-depth research and interviews help contextualize the motivations, perspectives, and conditions of the many different groups that find themselves along this fraught section of desert: from the various border patrol agents and Mexican consular services to the immigrants, coyotes, and guías who lead them. Another important character in the story is the Devil's Highway itself: an unforgiving stretch of desert between Arizona and Mexico's state of Sonora. Urrea deftly paints this land as a complicated place through time and space- from the controversial geopolitics at play today reaching back to the first indigenous peoples and conquistadors who attempted to traverse this barren landscape. Of special interest to WMS members is Chapter 9: Killed by the Light; here Urrea uses a chilling second-hand perspective to describe how the human body - and mind - experience the ravages of heat exhaustion, heat stroke, and eventually death to help better understand the experiences of the Yuma Fourteen. Readers should expect an extensive discussion on desert survival and the idea of drinking urine to survive. For those looking for an auditory experience, I'd recommend listening to the author reading this section of the audiobook as highlighted in Outside Magazine's Science of Survival podcast's two-part series. This gripping narration is, in my opinion, required reading (or listening) for those with an interest in the American Southwest and Mexico, heat-related afflictions, and better understanding some of the many factors that have contributed to the current situation on the U.S.-Mexico border.
Reviewed by Marc Cassone, DO, FAWM
Posted on January 12, 2022
Tactical Paramedic Certification & Practical Application
By Kyle Faudree
The last page of Kyle Faudree's Tactical Paramedic Certification & Practical Application is a dedication to Sergeant First Class Marcus V. Muralles. It lists Muralles' long list of decorations, and training. Sadly, it also reports that after over 17 years of service to his country, Muralles was killed in action while serving in Afghanistan as a special operations flight medic. Faudree honors his lost brother, by authoring a needed literary addition to tactical medicine.
Tactical medicine and wilderness medicine are not so far apart as some believe. They both focus on rendering lifesaving aid to patients in austere, hazardous, and dynamic environments. The tactical environment presents uncommon risks, and operators encounter unique challenges. Tactical paramedics and responders are expected to sally forth into risks known and unknown to save the lives of victims and teammates alike. In this assignment, everyone's life is your responsibility, and the tactical environment is a wilderness environment like few others. This text is a one-stop-shop review for tactical medics, and a must-have for those aspiring to such an important position of trust.
The International Board of Specialty Certifications (IBSC) administers examinations to providers responsible for working in a tactical setting to ensure proficiency in matters related to safely and efficiently negotiating the intricacies of lifesaving operations in this most challenging of wildernesses. Many tactical medics attend a Tactical Combat Casualty Care (TCCC) or Tactical Emergency Casualty Care (TECC) course in preparation for operating in their assigned role. However, these courses only cover a fraction of what knowledge is needed to operate safely in a tactical environment. Additional areas of education needed for this role include medical mission planning, specialty medical care, canine trauma care, the nuances of tactical operations, and many more. In Tactical Paramedic Certification & Practical Application, Faudree guides the learning of tactical medical providers by effectively preparing these medics for the exam to become certified. More importantly, he uses a combination of visual aids and concise language to refine his wealth of tactical and wilderness medical knowledge into a complete, yet digestible, resource for tactical medics.
Reviewed by Frank Zuccala, RN, CEN, WEMT, TR-C
Posted on July 13, 2021
The Photographer: Into War-torn Afghanistan with Doctors Without Borders
By Didier Lefevre, Emmanuel Guibert, Frederic Lemercier
This graphic novel tells the story of Paris-based photographer Didier LeFevre on his first assignment as a photographer accompanying a group of MSF expats establishing clinics in Central Asia during the 1980's Soviet-Afghan War. Didier is a relatable wide-eyed narrator providing a glimpse into the cultural, physical and medical challenges of the mission. The group spends weeks trekking across various mountain passes just to reach some of the remote villages. The book is interspersed with Didier's photographs that help further depict the stark beauty of Central Asia's mountains and people. This is a great read for those interested in humanitarian medicine, practicing in remote locations, or just an escape to a far away time and place.
Reviewed by Marc Cassone, DO, FAWM
Posted on April 12, 2021
From Cholera to Ebola: Confessions of a Humanitarian Doctor
By John Parker, MD
Austin Macauley: 2020
In this 212-page turner, Dr. John Parker narrates the highs and lows of his 25+ year career in humanitarian medicine working for various international NGOs including MSF and Red Cross/Red Crescent. Dr. Parker gives candid and raw first-hand accounts from refugee camps in Zaire, an HIV clinic in Uganda, rural health clinics in Afghanistan, a burn unit in Iraq, and more recently an Ebola Treatment Center in Sierra Leone. The author does not pull any punches when describing the challenges of working in limited resource settings. The highs are high (meeting an actual Nigerian Prince, successfully performing an improvised craniotomy) and the lows are low (losing many patients to preventable diseases, the ravages that war, malnutrition, and epidemics have on individuals and communities). Dr. Parker is equally forthcoming about his personal challenges - learning how to work and lead a team in dire environments, coping with the jarring return home from missions, and his battle with PTSD. Highly recommended for anyone interested in global health and humanitarian medicine, with their inherent challenges and rewards.
Reviewed by Marc Cassone, DO, FAWM
Posted on April 12, 2021
National Parks Our Living Treasures:
A Time for Concern
By Dr. Gil Lusk
Columbus, OH: Gatekeeper Press; 2019
August 25, 2019 was the 103rd anniversary of the National Park Service (NPS). If you have had the good fortune to visit one of "units" in the park system recently, this might be a very good time to reflect on the origins, expanse, and challenges facing the NPS today as elucidated by Dr. Gil Lusk.
Dr. Lusk's history with the NPS will inspire envy in anyone who cares deeply about preserving our natural resources and has longed to sport with pride the official Smokey Bear insignia. Dr. Lusk joined the NPS in 1962 as an NPS student trainee in St. Augustine, Florida, rising through the ranks over a 35-year period, crisscrossing the US through one glorious park after another, eventually managing the international Glacier and Big Bend National Parks. Since its inception in 1916 by an act of Congress, as of 2018, the NPS has grown and continues to grow, to over 400 parks, monuments, memorials, seashores and other areas, 23 national scenic and historic trails, 60 wild and scenic rivers—84 million acres in all, with a maintenance backlog of 12 billion dollars. There are 19,000 NPS employees but over 200,000 volunteers; the latter have grown 2% per year since 1990 as official employee numbers are falling. In 2017, visitation to the parks was a staggering 331 million people, 5 million more than the population of the US at that time, with international visitors growing in number.
Dr. Lusk distinguishes between National Parks and National Monuments; the latter are managed by the Bureau of Land Management, in the Department of the Interior. BLM permits logging, hunting, and grazing in Monument lands, which means they are not protected, unlike the NPS’s management of the parks. While being sold as more productive to local economies, this does not consider that environmental resources are eventually depleted, but travel and tourism dollars will endure if these resources are protected. The public may not be aware of this difference, as evidenced by low numbers of attendance at public meetings on park issues. Dr. Lusk relates the long-standing tension between the National Park Service and the US Forest Service, which should have similar goals, but are often at odds—even Smokey has spurred sparks of controversy.
Ken Burns calls the National Parks "America’s Best Idea." What does Dr. Lusk say? He minces no words in this passionate, thought-provoking, encyclopedic tome. Reading it is not for the faint of heart; at times, it can be as challenging as climbing Half Dome, but the reader is rewarded with a commanding view of the NPS by the end. Dr. Lusk asks a not so sanguine query of our citizens: "America has put its trust in the National Park Service to protect and sustain our National Treasures...[it] needs to recommit itself, strengthen its ability to withstand undue political pressures and achieve great support from the millions of people who use and respect their National Treasures. Risk at every corner, certainly. Worth fighting for? Well, is it?"
Note: The review copy of the book that was sent to the editors of Wilderness Medicine Magazine could use editing. Hopefully the publisher will make the necessary changes before the book is more widely released.
Reviewed by Nancy Pietroski, PharmD, FAWM, WEMT, CTH
Posted on October 25, 2019
Search and Rescue: A Wilderness Doctor's Life-and-Death Tales of Risk and Reward
by Christopher Van Tilburg
In this new volume, Dr. Christopher Van Tilburg adds another decade of sage advice and personal reflection to his first book as a member of the Crag Rats, the mountain rescue team of Hood River, Oregon. His first book, Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature, was reviewed in Wilderness & Environmental Medicine and was described by this magazine as one of the best wilderness medicine books ever published.
Opening with a description of a very serious skiing accident which, in a turn of events, resulted in him being the trauma patient, Dr. Van Tilburg ponders the concept of risk and why it is vital to a happy and healthy life. The book is replete with details of various rescues for mountaineering accidents on Mount Hood, Oregon, and for other types of mishaps befalling outdoor adventurers in the vast and wild Columbia Gorge.
Adding a third dimension to his descriptions of the rescues, Van Tilburg paints a vivid and colorful picture of the history and geographic features where the rescues take place. You can well imagine that you are a Crag Rat when you are jolted awake at night with a page, scramble to gather your gear, meet your fellow rescuers in whom your trust is implicit, assemble the team, and plan the approach to the injured or ill person with the help of multiple agencies, render medical care often in the cold and darkness, and feel the deep fatigue after harrowing rescues. While the book contains technical details on Search and Rescue (SAR) and specific wilderness medicine interventions, the value of the book is in its narrative style--what the author is thinking and feeling and being challenged by every time he goes out on a call. It is a personal account, a bird’s eye view into the life, heart and soul of a lifelong adventurer, father, author, teacher, clinician, and many more things. Even though it is focused on the perspective of a physician, Van Tilburg gives grateful appreciation to every member of the SAR team, acknowledging how each must rely upon the strengths of the others. He ends with a comprehensive list of how to take positive risks in the wilderness, wherever you may travel, but how to keep accidents and consequences to a minimum. The most basic and easiest advice to follow because you’re likely doing it already? “Get outside, it will make you feel good.”
Reviewed by Nancy Pietroski, PharmD, FAWM, WEMT, CTH
Posted on January 18, 2018
The Adrenaline Junkie Bucket List: 100 Extreme Adventures to Do Before you Die
by Christopher Van Tilburg
New York, NY: St. Martin's Press; 2013
If you're the type who always has a stash of gear and a duffel packed waiting for your next fix, then this book is your pusher. Passionately compiled by lifelong adventurer and physician Christopher Van Tilburg, this “list” is divided into roughly nine geographic regions, and is chock full of running, sailing, climbing, diving, skiing, trekking, kayaking, biking, driving, fishing, and even more exploits. When you've thoroughly exhausted yourself but realize you're not yet replete, you can always try volunteering---on the trail, training a pooch, rendering aid far, far away from home, to name a few.
For those who will quibble about what should comprise the 100 adventures or complain they don't have the time, money, babysitter, pet sitter or expertise -- there's “Pit Stop,” which covers shorter trips. For those luxuriously lucky (or extremely good planners), there's “Extended Play,” for the whole enchilada.
To make sure you can participate in these adventures before you die - but not perish in the process - there are comprehensive and concise sections on traveling smart (passports/visas, insurance, skills, clothing/gear), traveling safe (protection from sun, bugs, bad water/food, high/cold mountains), and two great appendices on gear, including first aid, and relevant guidebook/adventure narratives. The responsible "Toolbox" section exhorts you to get the proper training before you. ..er...dive into any risky activity.
I drugged myself into a dreamy stupor reading the book and some of the pages already have track marks. Anyone with ADD should not read it in one sitting or they will be in danger of leaving their boring job, selling the house and kids, and packing up the dog and RV to hit the road or air. Now how to cure that dreaded exercise hangover....
Reviewed by Nancy Pietroski, PharmD, FAWM, WEMT, CTH
Posted on October 31, 2017
The Hot Zone
by Richard Preston
New York, NY: Doubleday; 1989
Ebola! The very word evokes strong emotional reactions in most literate people around world. Ebola’s infectiousness and lethality contribute to the fear of or at least a healthy respect for this disease. Fortunately, although the outbreak that started more than one year ago in Africa continues, it appears to be abating.
The recent epidemic, however, does provide an excellent excuse to read or reread Richard Preston’s “The Hot Zone.” The author not only seems well versed in the scientific and clinical aspects of this virus, but also possesses the literary skills to conjure up some of the most disturbing mental images, guaranteed to send shivers up the vertebral columns of even the hardened, clinically-minded souls amongst us.
A case in point is his description of an Ebola patient; “His eyes are the color of rubies, and his face is an expressionless mass of bruises. The red spots, which a few days before had started out as starlike speckles, have expanded and merged into huge, spontaneous purple shadows: his whole head is turning black-and-blue. The muscles of his face droop. The connective tissue in his face is dissolving, and his face appears to be hanging from the underlying bone, as if the face is detaching itself from the skull.”
An excellent postscript to the book is last October’s New Yorker article, “The Ebola Wars”, which provides a contemporary insight into the battle to unlock the genomic secrets of this deadly virus.
Reviewed by Dale Mole, DO, FACEP
Posted on July 6, 2015
Here if You Need Me - A True Story
by Kate Braestrup
New York, NY: Hachette Book Group USA; 2007
A little girl plays outside. Her red mittens are later found beside a hole in an icy lake. A college student seeks to clear his head after finals by hiking alone in the woods, but he fails to return home as expected. A young couple go swimming outdoors, but drift in the stream channel and tumble over a waterfall.
For wilderness medicine practitioners, these scenarios conjure up search-and-rescue protocols, and guidelines for the management of drowning and hypothermia. For the first responders involved, these adventures end with grateful family members reunited with loved ones or survivors who will receive unfortunate news, usually with a law enforcement officer. Reverend Kate Braestrup is the uniformed chaplain whose job is to provide comfort and clarity through the ordeal. In her book “Here If You Need Me,” Rev. Braestrup relates in her simple and beautiful prose the experience of the first responders who regularly encounter such emergency events, the ones who perform the rescues and body recoveries, sit vigil with anxious survivors, and how they make sense of occasional tragedy.
Reverend Braestrup is the widow of a Maine State Trooper, and one of the first chaplains ever appointed to the Maine Warden Service. Her comrades are law enforcement officers of the Maine Fish and Wildlife Service. The book describes the tough and potentially dangerous job of these unsung heroes who patrol the woods and waterways of Maine—whose concerns range from poachers and litterers, to injuries and deaths, to car accidents and brutal murders. “Reverend Katie” describes the officers with genuine love, affection, and humor as they move from minor to major human crises within the backwoods of Maine. Through their patrols, Reverend Katie also experiences the beauty of the wilderness and enjoys rare sightings of moose, grouse, bobcats and other wildlife the wardens are bound to protect. She can see why even those who are sometimes ill-prepared are drawn into the wild.
As a Unitarian Universalist minister, Rev. Braestrup is comfortable with the deeply religious and the atheist alike. She doesn’t pretend to know the answers to the deepest questions, but she knows that the impulse to help other human beings runs deep, and is a profoundly unifying experience.
Reviewed by Leslie Popplewell, MD, FACP
Posted on May 14, 2015
The Last Ridge: The Epic Story of America's First Mountain Soldiers and the Assault on Hitler's Europe
by McKay Jenkinsl
New York, NY: Random House; 2004
In this 255-page chronicle, McKay Jenkins expertly recounts the formation and campaigns of America’s first elite mountain division. Brainchild of Charles “Minnie” Dole, co-founder of the National Ski Patrol, and inspired by Finnish ski troops who expulsed an overwhelming Soviet advance into Scandinavia in 1942, the 10th Mountain Division was born from the need to have an expertly trained cadre of troops that could engage the enemy both overseas and at home in rugged alpine environments. The Division recruited experts of all kinds; their ranks included forest rangers, trappers, college ski instructors, Olympic athletes, and some of the first men to scale K2. Years of training in the Cascades and Colorado 14-ers provided the men with some of the most rigorous military training sorties known to date, including month-long excursions in sub-zero temperatures at high elevations.
In the book’s second half, Jenkins gives a gripping frontline view of the Division’s treacherous WW2 operations, including defending the Aleutians from an invading Imperial Japanese army and the assault of near-impenetrable ridges of Nazi Germany’s Gothic Line during the Italian campaign.
In addition to presenting military history, Jenkins’ account also provides insight into many aspects of American mountaineering history that grew from the legions of the 10th Mountain Division. Beyond including the founding members of the National Ski Patrol, the men of the 10th would go on to help create many iconic outdoor institutions, such as NOLS, the Sierra Club, Outward Bound, Nike shoes, and many ski resorts including Vail, Breckenridge, and A-Basin. The Division’s training also served as the ideal incubator and testing ground for advances in outdoor equipment and new techniques in alpine rescue and mountaineering, many of which served as the basis for what we use today. One notable training trip tested early prototypes for down vests, mountaineering boots, dehydrated food, combustible stoves, and an early snowmobile during an attempt to summit Denali.
Jenkins based his research not only on official documents and articles but also on personal interviews and preserved correspondence from many of the individual soldiers, giving this account a truly personal and first-hand view of the formation and battles of the 10th Mountain Division. The Last Ridge is a riveting glimpse into how the challenges of a nation at war helped spur the men and innovations that would later have a great impact on how Americans have engaged with the outdoors ever since.
Reviewed by Marc Cassone, OMS-III, FAWM candidate
Posted on March 24, 2015
Desert Solitaire: A Season in the Wilderness
by Edward Abbey
New York: Touchstone Publishing; 1990
I first read Desert Solitaire in 1969 when I was stationed at Ft. Devens in the Army. Edward Abbey, while working as a park ranger in Arches National Monument (now Park), kept a journal of his activities and thoughts which became the basis for this book. Before he died in 1989, the publishers brought out a 20th Anniversary edition, which included a new introduction by Abbey and some beautiful pen and ink illustrations by Lawrence Ormsby. Abbey claims he is not a “nature writer” but just a writer, and denies the title of “The Thoreau of the American West” that Larry McMurtry coined in a review of his work. Abbey was a philosopher and a rebel, and although he was one of the founders of the environmental movement in the U.S., he was castigated by many because of his stand on immigration.
Abbey does remind me of Thoreau, in his relationship with nature and his somewhat disdain for civilization. Abbey writes in such a way that you are transposed to the desert and can smell the sagebrush after a rain or the odor of juniper burning in a campfire. Like Thoreau, Abbey allows one to become part of nature, not separated from it by technology or the machinations of modernity. Throughout Desert Solitaire, he details the geologic processes that formed the desert, and account for much of the beauty and attraction that the desert has for those who love it. Chapter after chapter includes intimate descriptions of the flora and fauna of the desert, and his reactions and interactions with them. Several themes recur throughout the book: “Industrial tourism” or the destruction of the land in the interest of increasing visitation by tourists, and the notion of solitude, or in Abbey’s words “I am twenty miles or more from the nearest fellow human, but instead of loneliness I feel loveliness.” Abbey interacts with a number of interesting characters, most of whom exhibit the love of nature and rugged self-reliance that he values in a soulmate and not the techno-modern, nature destroying actions of the “tourist.” Some of their stories are violent, some inspiring, but all have the grit and toughness that one associates with desert dwellers.
In conclusion, Desert Solitaire is one of the ten best “nature” books ever written (I have that list if interested) and I would encourage everyone interested in nature, ecology, human-technology interactions, the National Parks or the environmental movement to read it. It is a book that can be read over and over again and each time it is read the reader finds something new and provocative. I know I did.
Reviewed by Edward "Mel" Otten, MD
International Travel and Health
World Health Organization
Geneva, Switzerland: WHO Press; 2012
International Travel and Health (World Health Organization, 2012) is a compact guide—WHO’s version of the CDC’s Yellow Book—detailing environmental and infectious health risks, prevention, vaccines, high risk populations, and, in a separate chapter, malaria. The guide is more compact than other books, which is great for travel to remote locations. The outline format is easy to access information, and it includes maps and charts for disease distribution. Because the book packs in so much great information, the font is small. Print copy ~$36, PDF available for ~$12). Updates are published on the WHO website.
Reviewed by Christopher Van Tilburg, MD
Posted on December 29, 2014
Directors Peter Mortimer and Rick Rosen
This recently released and critically acclaimed documentary chronicles the feats and tragedy of celebrated Canadian rock climber and alpinist, Marc-André Leclerc. Marc-André, despite his young age and known reticence for the spotlight, has been lauded by the climbing community for his incredible firsts, including free solos of notoriously complex routes on Patagonia’s Cerro Torre and Canada’s Mount Robson, Echo Canyon, Rim Wall, and the North face of Mendenhall’s Main Tower. It is one thing to read about these feats on paper, but the amazing cinematography (including some edge-of-your-seat drone footage) truly reinforces how harrowing these exploits were. (I recommend watching this on a big screen TV to truly appreciate just the exposure on some on these routes.) Alpinism and free solo athletes have certainly captured the media’s attention (and rightly so, see 2018’s Free Solo and 2014’s Valley Uprising) and Marc-André and The Alpinist certainly deserve their place among them. In addition to highlighting his incredible accomplishments, the film also delves into the intrinsic forces that drive a climber like Marc-André to pursue such dangerous (understatement) quests. I believe wilderness medicine providers will be uniquely positioned to want to understand the why: Many of us are both avid recreationalists with the same love of the escape and purity of mountains yet also with a keen understanding of the costs of such endeavors (for athletes, loved ones, and rescue teams). The film certainly helps further ask the question about what amount of risk is worth it for ourselves and for others? I think the narrator puts it best in the final moments of the film, “…[It’s] hard to reconcile the idealism of his ascents with the tragic consequences- that’s why alpinism remains such a contradiction [and] such a mystery, but what Marc did with his time on Earth was beautiful- he followed the course of his own dreams.” Certainly a film that will make WMS members reflect on their own passions… and those of the ones they care for.
Reviewed by Marc Cassone, DO, FAWM
Posted on January 12, 2022
Florence Nightingale: A Life Inspired
by Lynn Hamilton
Florence Nightingale is well known as a pioneer of nursing. She single-handedly established formal training schools, and paved the way for young women to find independence through the newly professionalized career field. What many don't know is that Florence Nightingale was perhaps one of the modern era's most transformative wilderness medicine providers, and drove innovation into the heroically stagnant field of military medicine. In Florence Nightingale: A life Inspired, Lynn Hamilton paints a portrait of a war hero, a scientist, a healer, and social justice advocate that 21st century readers would do well to recognize and emulate.
This short biography traces the arc of a British gentlewoman of the Victorian era who smashes the gender roles of her time and chooses to reshape the world around her into a better one, not for her, but for all. Nightingale had to struggle to even be allowed into nursing, but when war broke out in the Crimea, she was appointed as the Superintendent of Nurses in Scutari, Turkey. When she arrived at the military hospital, she found conditions to be just short of medieval. Her time in the Crimean theater of operations is military medicine lore, or should be. Nightingale went on to pioneer issues like wound management, infection control, hygiene, nutrition, and field sanitation in military operations. She also helped establish the British Army Medical School and designed much of the curriculum for educating military physicians prior to deployment to the wilderness of 19th century combat. Nightingale's list of honors, awards, accolades, and famous initiatives is endless, and largely forgotten, even in modern nursing.
Hamilton discusses how Nightingale suffered permanent illness as a result of her service in the Crimean campaign, and likely also endured lifelong post-traumatic stress as a result of exposure to so much suffering and death. Despite her illness, she went on to modernize military medicine, hospital design, nursing education and professionalism, was an advocate for the poor, and a vocal supporter of Indian independence from British rule. Despite all the odds stacked against this Victorian gentlewoman, she reformed her world across several areas of specialization. Nightingale remains an example of how to effectively blend scholarship, compassion, determination, humility, and integrity into a single reformer. She is a model of righteous stewardship and transformative leadership to us all.
Reviewed by Frank Zuccala, RN, CEN, WEMT, TR-C
Posted on June 24, 2021
The Explorer's Podcast
By Matt Breen
You've heard of Drake & Magellan, Lewis & Clark, Columbus & Cortes, and Mallory, Hillary & Norgay - but have you heard of the adventures of Cabeza de Vaca, Nellie Bly and Pierre Savorgnan de Brazza? In his expertly researched and detailed multi-part series, podcaster Matt Breen takes listeners deep into the stories of these famous (and not so famous) historic explorers. Matt not only delves deep into the gritty details of the expeditions themselves (ever wonder what kind of boats Lewis and Clark used? what clothes Hillary and Norgay wore to the summit of Everest? what Tenochtitlan was like when Cortes arrived?) but also into the historical context of the expeditions and the lives of the explorers before and after their feats. The narration is balanced and flows well without a lot of the fluff and jarring adverts of many other podcasts, however, listeners beware: this podcast is not for those allergic to deep dives and detailed explanations!
This podcast is perfect inspiration on the long car ride to your next trailhead or an equally great escape during your routine commute. I recommend the Lewis and Clark 8-part series for the Midwestern stretches of cross-country road trips (and add the Zebulon Pike episode when you hit Colorado). For those looking for more exotic locations, the Burke and Wills (Australia), Franklin Expedition (Canadian Arctic), and Mungo Park (Niger River) episodes are certainly worth a listen. Available on Spotify and Apple Podcasts.
Reviewed by Marc Cassone, DO, FAWM
Posted on April 12, 2021
The Barkley Marathons
Directed by Annika Iltis, Timothy James Kane, 2014
For Those Who Leave it All on the Course: The Barkley Marathons: The Race That Eats Its Young
This 2014 (2015 wide-release) award-winning documentary will leave you lacing up your shoes, tuning up your bike, or sharpening your crampons halfway through, contemplating your next life-changing challenge. And if it’s anything like the Barkley Marathons, a race that in the first 25 years of its existence had only seen 10 finishers, this film is required viewing. Directors Annika Iltis and Timothy James Kane capture the drive behind the runners and the race founder and director Gary “Lazarus Lake” Cantrell in interviews and raw footage from the 2012 race. The Barkley Marathons has been going on annually since 1986.
Watching 40 runners, chosen by application that includes an exam, attempt the 100-130 mile race (there is some debate between the course director and the runners regarding the actual length of the race) in the hills of Tennessee, the viewer gets a healthy dose of what it takes physically and mentally to contemplate, train for, and participate in any endurance event. Iltis and Kane vividly document the runners’ medical considerations, from nutrition and sleep to trench foot, as well as their mental considerations, from navigating solo in the dark to running through a briar patch five times willingly. Early on, as the runners arrive from all over the world, the film directors discuss the history of the Barkley Marathons and the racecourse with “Laz” and the participants; making character judgments immediately is almost unavoidable. But as the race footage unfolds, the runners reveal the human surprises that come only from pushing yourself to the limit, and “Laz” is the ultimate proof that you cannot judge a book by its cover. Streaming on Netflix now, and available on Amazon, this one is a game-changer.
Reviewed by Liz Edelstein, MD, FACEP, FAWM
San Diego, CA
Posted on May 12, 2016
Directed by Jimmy Chin, Elizabeth Chai Vasarhelyi, 2015
“I always wondered how I was going to die. Now I know.”
These are the words of world-renowned climber Jimmy Chin, the man who was the first to reach the summit of Meru Peak (also known as the Shark’s Fin) in India. Along with his also-well-renowned climbing partners Conrad Anker and Renan Ozturk, Chin documented the groups’ two attempts to summit what is considered one of the most coveted prizes of the climbing world. Thankfully, Chin – who also makes a living as an expedition photographer/videographer/guide – turned this footage into the captivating documentary “Meru,” in select theaters.
Chin also directed, produced, and filmed the documentary along with Ozturk. The film is a little bit of a climbing film in that it wants us to understand what makes it perhaps the most challenging climb in the world (over 20 failed attempts before the first successful climb, including one previous failed attempt by this same crew). It keeps the climbing jargon, so for the non-climber there might be some unfamiliar terms, but nothing that will make that viewer feel completely lost. The film also does an excellent job of intimating the viewer with each of the climbers. It doesn’t want us to know just about Meru and the challenging ascent, it makes us care for the three men attempting it.
While Chin and Anker both are avalanche survivors, perhaps the most compelling story in the film is that of Ozturk, who summited only five months after suffering a catastrophic, life-threatening ski accident in the Tetons above Jackson Hole, Wyoming, including severe cranial and spinal fractures. In an interview with National Geographic in which Ozturk was named one of the magazine’s Adventurers of the Year in 2013, Ozturk said, “You have to ask yourself, ‘How do you draw the line between obsession and passion?’ You have to ask yourself, ‘What am I willing to sacrifice?’ With Meru, I think I was obsessed. I pretty much sacrificed my relationship. I could have sacrificed my life. You have to have that conversation with yourself.”
The documentary features interviews with all of the climbers as well as their friends and family, including author Jon Krakauer. Detail is given to each climber’s background, how they came to be a climbing group, and the mentor/student relationship that has developed between them. The film explores the unique perspective of the die-hard climbers and their need to find the next “big thing.” Combined with the breathtaking film work by Chin and Ozturk, “Meru” is a wonder of film and a glimpse into what it’s like to be where no person has been before.
“Meru” is playing in select theaters across the U.S. Do yourself a favor and if there is a theater near you showing it, go see it. Otherwise, keep it on your must-watch list for when it hits video release. Until you do, check out this interview from Huffington Post with Jon Krakauer and the filmmakers, and also take a look at Outside Magazine's profile of and interview with Conrad Anker.
Reviewed by Ryan Ingwersen
Posted on September 24, 2015
Directed by Juan Antonio Bayona, 2012
Story by Maria Belon
I remember in December of 2004 when the tsunami collided with the coast of Southeast Asia. I was not yet a nurse; however, watching the heart-wrenching scenes of destruction and devastation unfold on the television, my heart ached to be on the ground helping these people. Little did I know that my emergency nursing career would take me to some many remote and rewarding places in much need of medical care. In October of 2010, I embarked to Haiti to assist with the cholera outbreak, as a part of a small team of nurses working alongside exhausted locals attempting to care for many more patients than we had resources. Stacks of patients lined up seeking urgent care; sunken eyes, tenting skin, and lifeless bodies were carried to us from miles away.
This experience in Haiti is part of the reason why the movie “The Impossible” really struck a chord with me. The movie follows a family through their experience in the 2004 Thailand Tsunami and its resulting aftermath, touching home as an emergency care provider with a passion for disaster medicine. When the dad was desperately scouring victim lists to find his family, I had flashbacks of the nameless Haitian man we laid to rest under a tree, as we struggled to find where his family was. When the older brother was tending to his sick mom in the crowded resource-poor Thai hospital, I could not help but think of our days in cholera-stricken Haiti when we made a motto, “We will do the best we can do,” even though it meant sharing limited emergency blankets between patients, wiping down bottoms and stretchers and floors with one lonely mop, and valiantly trying to start IVs under the light of dimming headlamps. And then there is the generosity and kindness of the local people in Asia who helped out the tourists as much as possible throughout the movie, which just made my heart smile as I thought of the strong sense of community I witnessed while in Haiti.
For anyone with a passion for working in the developing world and in disaster medicine, this movie is a must watch. “The Impossible” truly demonstrates the tenacity and generosity of the human spirit, while highlighting the challenges of managing mass casualty incidents, especially in resource poor areas. Throughout the movie you will witness the plight of this young family as they attempt to reconnect with each other, and the difficulties emergency responders have in matching families together and keeping records accurate and up-to-date. This movie really makes me feel honored to be a healthcare provider and why I highly recommend it to Wilderness Medicine Magazine readers, especially those interested and/or already active in humanitarian/disaster relief missions
Posted on July 6, 2015
One Move Too Many: How to Understand the Injuries and Overuse Syndromes of Rock Climbing
by Thomas Hochholzer and Volker Schoeffl
Boulder, CO: Sharp End Publishing; 2003
One Move Too Many: How to Understand the Injuries and Overuse Syndromes of Rock Climbing is the English version of the German book Soweit die Hande Greifen, which went into its third printing in 2001. This second U.S. edition is available from Sharp End Publishing, a climbing centric publisher. The authors of this book, Dr. Thomas Hochholzer and Dr. Volker Schoeffl, are experienced climbers and experts in climbing medicine. Doctor Hochholzer specializes in orthopedic surgery and sports medicine and runs his own clinic in Innsbruck, Austria. His co-author, Dr. Schoeffl specializes in trauma surgery and sports medicine and has a passion for understanding climbing injuries, on which he has published many papers and regularly gives lectures.
One Move Too Many…is an excellent reference for any climber and a must read for parents of young aspiring climbers. The abundant photos are in black and white for this edition but are crisp and detailed, thus providing the reader an excellent reference to the accompanying text. The authors have either suffered or treated most of the injuries and syndromes described thus adding personal insight from these incidents to the provided descriptions.
This book is not a replacement for a healthcare provider or to be used as a diagnostic tool, but is a great reference for climbers who are pushing their limits and stressing their bodies while training and climbing. It provides information on how to understand the injuries and overuse syndromes of rock climbing and the physiology behind these medical aspects. Of particular help, the text describes anatomy and physiology specific to climbing and relates this information at various points to emphasize the reasoning behind the positioning, grips, and stances that optimize strength and reduce injury for climbers.
Common acute injuries are reviewed with the most up to date treatments supported by current research, references, and photos; keeping the text to a manageable length and providing climbers with an excellent resource. Overuse syndromes are covered comprehensively and include everything from the mildest case of medial epicondylitis to a complete A1 pulley rupture. Improvised field treatments are also included where applicable. One such suggestion included describes the use of climbing chalk to assist in staunching the flow of blood from a finger “flapper.”
Training, stretching, rehabilitation, and nutrition each are discussed in separate sections. Additionally, the authors tackle the controversial subject of taping head-on with science -based reasoning behind their recommendations. Current research on young climbers is discussed in the final section and tips on training techniques are covered giving appropriate information to aid healthy development of young aspiring climbers.
One Move Too Many…belongs in all serious climbers’ libraries. It is presented in a practical and comprehensive format and is finally easily available in an affordable edition here in the United States.
Edited by Sam Lightner, Jr.
Sharp End Publishing: $24.95
Reviewed by Deb Simon, RN, FAWM, DiMM
Posted on February 26, 2015
Traveller's Health: How to Stay Healthy Abroad, 5th Edition
by Richard Dawood
Oxford, UK: Oxford Press; 2012
Traveller’s Health: How to Stay Healthy Abroad, 5th ed, by Richard Dawood (Oxford, 2012) is designed for our patients. Jam packed with information, this somewhat compact book is a good reference for patient to keep at home but probably too bulky for a weight and space conscious traveler. In addition to infectious diseases, it contains complete travel information on a huge range of subjects, including recreational hazards like water and snow sports, working abroad, medical kits, and special populations like children, elderly and armed forces.
Reviewed by Christopher Van Tilburg, MD
Posted on November 18, 2014