I feel slightly fraudulent writing this; many expedition medic blogs are full of near attacks from bears, from snakebites and extreme conditions in remote places, and here I am writing about a trip in the UK as the event medic with a big team of people, none of whom suffer from any issues resulting from war-torn regions or horrendous tropical infections or 5 day hikes to seek medical care.
So who knew looking after the health of a group of educated and able could be such a challenge, and having been a part of trips more akin to those mentioned above, just as, if not more rewarding! The brief was to be the event medic on behalf of World Extreme Medicine for the 5 female participants, including Alex Jones, presenter of the BBC’s ‘The One Show,’ all of whom had had some form of maternal health history; the logistics and organisational team, Across The Divide; the crew from The BBC One Show and the crew from Sports Relief. In total, between 30-50 people, 24 hours a day, for 7 days.
The Sport Relief 2018 Challenge as viewed by the event medic
The aim, ‘The Mother of All Challenges’ included a relay swim in Loch Ness, at 4.5 degrees Celsius; a mountain climb in the Lake District, that after our recent weather was covered in snow and ice; a gruelling bike ride over 3 of the hardest passes in the UK; a day underground in the caves where the water level was so high that parts were inaccessible to all but cave divers; and a coastal marathon relay on the Gower in Wales. The small glitch; none of these girls had done anything like this before. The idea was to raise awareness of, and funds toward maternal health and address some of the social taboos surrounding this.
I was to find out rather quickly that trying to apply my normal medical organisation to this diverse group was going to be akin to herding cats!
Prevention is always the key with expeditions, wherever you are. A perfect trip, from a participatory point of view, and the medic’s point of view, depending on how you look at it, is one where they don’t do any active medicine. Now there is a truth behind that that we hide as doctors unfortunately, and, in a lot of ways, the public does too. A bit of action and gore is much more exciting than a blister. Let’s be honest about that.
So whilst this trip was never going to have any issues with altitude illness, crevasse rescues or scorpion stings I was surprised how interesting it was medically.
For starters, getting the medical details off those coming, for who I was meant to be responsible, was nigh on impossible from some. So I had to rely on probability to plan the event medical kit each day. I had no idea whether the over-40s going up that mountain had cardiac disease or not. So, I had to plan for the worst.
The swim was the event that worried me most. Whilst there was a huge amount of experience and feet on the ground with the safety team, no one can stop a cardiac arrest form cold-water immersion if it’s going to happen.
We had drilled this scenario with the water crew and land crew. Simulation (Sim) sessions in hospital are great, Sim sessions on the edge of Loch Ness with speedboats and a real-life potential for the problem add a whole other level of ‘I love my job’. Thank goodness none of them did, but to plan for it and train for it is a bit of an adrenaline rush.
Most people who do or want to do expedition medicine are those who are pretty active and love the outdoors. So for me, watching others cycle a stunning route whilst in the car, waiting for any disasters, was a personal test. But one I was surprised how easily I passed. You’re still in one of the most beautiful places in Britain, and the sense of achievement you feel from encouraging and facilitating some one else to achieve and learn to love what you love is very special.
Watching one of the mums go from minimal exercise to enjoying running and talking about the next challenge she wants to set herself, to go all mushy, does ignite a flame and the smile you feel etching onto your lower face is a powerful one.
The experiences on trips like this are far flung. You are in a position where you observe the best of humanity. One of our stops on the cycle was a café in Keswick in the Lake District that employed people with learning disabilities and someone to work alongside them. There was a parallel with these ladies pushing their limits and feeling like they had added value with all of the awareness they raised for maternal health, drawn for comparison alongside those who worked here. Everyone needs to feel valued and everyone needs his or her own challenge; what may be one person’s Everest may be one person’s average commute. But it doesn’t matter.
Whilst you see all walks of life in hospital, working on this trip I was lucky enough to meet incredible people, each with their own story and their own challenges; each trying to add something to the world around them, whether that be in pictures and film, in awareness and to their own physical and mental health, or in providing a clap and a cheer of encouragement, or a much needed slab of cake and a brew.
And who said tropical medicine wouldn’t enter into this trip. Film crews travel a lot. Many of those I was looking after had been to bizarre places in the preceding few weeks and so whilst it wasn’t always the first on the differentials, malaria and leishmaniasis weren’t out of the equation when someone got sick.
The caves offered a new curveball. I wasn’t down there with them and we had no communication contact. I was reliant on the experienced caving team to do what they are trained to in an emergency. It’s a very different feeling leaving potentially complex medical care to non-medics you have never met, never mind worked with, compared to working in resus with a team you know and can rely on, and know that everyone will go into auto-pilot and do what needs to be done. But, that’s part of the immense satisfaction that comes with expeditions. Bringing together a whole group of people, who often haven’t met, are from all walks of life; to play their part of the tune that culminates into achieving a common aim is truly wonderful.
When one of the film crew had been stuck in the cave for 5 hours, was hypothermic and didn’t want the beautiful pasties made for us by the local pub, I knew she must be bad. It’s always interesting being aware of the potential for a quick ‘downhill slide’ when everyone around you is fairly unaware of possible consequences, and a fun trip in a cave turns into a rapid one to hospital with abnormal heart rhythms. Again, thankfully, I managed to treat her out of hospital, but not without a good few hours of monitoring, including a near-break-in to the hotel room because we thought she’d collapsed in the shower.
Having wittered on about all this, that is why I loved this trip, and why I love being the event medic on trips like this. Facilitating others step from their comfort zone and take on something they could never have imagined is an incredible honour, and one every medic should remember how lucky they are to have been a part of.
There are always unexpected challenges but I think the key to expeditions is to expect the unexpected.
Following a cameraman is like taking out a toddler who’s had a double espresso, with sugar; you have to think several steps in advance and cover for every eventuality. If there is a cliff-edge, they will go near it, if there is an ice-covered rock, they will stand on it, if there is a car coming, they will step in front of it. The participants, it turns out, are the ones I didn’t have to worry about too much!
Medicine is getting a lot of bad press at the moment in the UK and many talk about it being a ‘bad time’ to go into it. I disagree. One, I love my job; the patients I meet and the academics of it; none of that will change with politics. Two, nothing is ever perfect. You have to be responsible for your own path in life and if traditional medicine in hospital can get a bit much sometimes, why not see the world and support others in striving to achieve. Medicine does not always have to be about patching up what has happened. Whilst that can often be the way, prevention is better than cure; whether that is seeing a slip that stops a broken ankle, or invigorating and giving someone the experience and mental strength to succeed, and then apply this to the rest of life. As medics we are, in part, responsible for people’s general wellbeing, and I think expeditions are an incredibly effective way to change someone’s perspective on life for the better, potentially forever. What a great intervention to be part of.
I’m an outdoors person, so what better way to be spending time; being paid to do a job I love, and to be doing it on a mountainside with a cracking team and getting lots of ‘kudos’ on Strava for an especially beautiful run! A warning, 27.6km with the event medic kit on your back does need some pre-trip training!
Dr Laura McArthur, March 2018
World Extreme Medicine / Across the Divide Event Medic