The holy grail of wilderness medicine careers is one where the provider's clinical time is spent outdoors. One of the most common questions from students is how to build a career accomplishing this. The question is difficult, since only a handful of providers in the United States have accomplished it—and Christopher van Tilburg is one.
Van Tilburg is a physician member of the Hood River Crag Rats, the oldest mountain rescue team in the United States. He is also editor of Wilderness Medicine magazine, a frequent writer in outdoor sports magazines, and a ski resort and emergency department physician. He describes the benefits and challenges of this hybrid career in Mountain Rescue Doctor.
Mountain Rescue Doctor fits most closely into the category of an out-of-hospital emergency medicine narrative,
1.with the added twist of placing the out-of-hospital narrative on the cliffs and wilderness areas of the American Northwest.
- Hawkins S.C.
Emergency medicine narratives: a systematic discussion of definition and utility.
Acad Emerg Med. 2004; 11: 761-765
What is innovative about this narrative is van Tilburg's introspection and stark honesty about his life and career decisions. Most books in this genre target the reader interested in exciting stories and don’t dig deep enough to complicate the simplistic role of protagonist as hero. Van Tilburg challenges himself and the reader to examine his motives and the consequences of his choices.
He notes, “I miss dinner parties. I shirk household duties like mowing the lawn. … I don’t have boys’ night out with the guys or go on many personal trips. … I also decided to work less and create a world in which I need less money to live on.” He writes about struggling to protect time with his family in such an unpredictable avocation. He writes about responding to rescues involving acquaintances or favorite recreation sites. He writes about his fears of getting injured on a rescue and the line between acceptable risk and unnecessary danger. He writes about the real challenges in a field wilderness medicine career.
His work is very reminiscent of Jon Krakauer's, a fellow climber who wrote the towering pair of wilderness narratives, Into the Wild
2.and Into Thin Air.
- Krakauer J.
Into the Wild.
Random House, New York1996
3.Both Krakauer and van Tilburg take the natural arc of stories of wilderness experiences gone horribly wrong and extend them into complex reflections about both societal and deeply personal issues. Van Tilburg's writing is also similar to Michael Perry's out-of-hospital emergency medicine narrative, Population: 485.
- Krakauer J.
Into Thin Air.
Random House, New York1997
4.These narratives explore the roots of the rescue ethos: why so many of us are driven to help others, and what that drive means for members of small, close-knit rural communities and even smaller and closer-knit rescue teams. Van Tilburg's places this dialogue in a wilderness setting and introduces the surfing concept of “tapping the source” as a psychosomatic explanation for why one might merge medicine and outdoor sports.
- Perry M.
Population: 485, Meeting Your Neighbors One Siren at a Time.
HarperCollins, New York2003
Structurally, the book is divided into seasons, with stories that correspond to each season. The stories range from the wry (a heart attack call that instead turned out to be someone “trapped” by ankle-deep water) to the poignant (body recovery operations after a plane crash) to the gargantuan (the epic Mount Hood rescue of December 2006). These stories frame perspectives on wilderness medical malpractice concerns, the politics and ethics of rescue, tensions involving jurisdictional and multiteam interactions, and the history of mountain rescue.
My only regret about the book is that the concluding chapter, “Coda,” is used to introduce a new story and topic (position locators and rescue legislation) that doesn’t successfully summarize the overarching themes of the book. Consequently, the conclusion feels abrupt, and the chance to highlight overarching themes linking the preceding stories is lost. However, the salient points are made well within those same stories.
The casual reader will appreciate the gripping stories about the highly specialized world of mountain rescue. Professional readers will appreciate even more van Tilburg's insightful and very specific discussions about the consequences of choosing a career that emphasizes wilderness field response. In particular, every member of a wilderness medicine student interest group, and everyone who has ever asked the question, “How do I get a job as a wilderness medicine doctor and spend most of my time in the field?” should consider this text to be required reading.
- Emergency medicine narratives: a systematic discussion of definition and utility.Acad Emerg Med. 2004; 11: 761-765
- Into the Wild.Random House, New York1996
- Into Thin Air.Random House, New York1997
- Population: 485, Meeting Your Neighbors One Siren at a Time.HarperCollins, New York2003
© 2009 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.