“I didn't practice what I preached to others on the boat,” he said.
He treated the wounds with topical vinegar to take away the sting but had an itchy, painful rash “for a couple of days.”
Other situations have been more dramatic. During an expedition in Nepal, he assisted a trekker who had developed high-altitude cerebral edema. He placed her inside an inflatable body-size pressure bag known as a Gamow bag, and zipped it up. But she became claustrophobic and began to panic, so he climbed in the bag with her. “Then she vomited,” Dr. Auerbach said. “That wasn't real pleasant, but it's part of the job. She made it okay.”
Going forward, Dr. Freer said, a key challenge for the wilderness medicine field is to develop “a strong scientific body of knowledge.” Wilderness settings may not lend themselves to large controlled, randomized trials, she acknowledged, “but more research is needed. Like a lot of what we do in general medicine, sometimes what we recommend in wilderness medicine is based on what we've always done, not because it's based on controlled, scientific studies that prove a particular treatment works best.”
Dr. Auerbach agreed. “In wilderness medicine, as in all of medicine, good science trumps anecdotes,” he said. “The progress of our specialty will be measured by the quality of our research investigations.”
In Bear Country, Don't Hike Alone
Despite being warned to not hike alone through “bear alley,” a portion of Wyoming's Yellowstone National Park that many wild grizzly bears consider home, one man decided to make the trek solo.
Some people just don't listen.
“The park rangers advise people to hike in groups because when we hike in groups, we make more noise and give the bears warning that we're coming so they clear out,” recalled Dr. Freer, who was working at Lake Hospital in Yellowstone at the time, in the early 1990s. “This fellow wanted to have an experience by himself.”
He hiked about 10 miles into the backcountry and surprised a female grizzly bear with her cubs, which “is the most dangerous thing to come across,” Dr. Freer said. “They're very aggressive.”
The grizzly bear mauled the man, who had learned from park rangers to play dead in the event of a bear encounter to demonstrate that he was not a threat.
“He curled up in a ball and slept outside with the grizzly bear in the area,” Dr. Freer said.
The man survived the ordeal and hiked out the next morning. “He came to our hospital and we spent about 3 days caring for him, getting his wounds cleaned up, [and] giving him medication and rabies prophylaxis,” Dr. Freer said. “He had a good outcome.”