Such organized exercises—known as "scenarios"—are key elements of the wilderness medicine elective, allowing students to test their skills in a realistic environment. The course, which is run by the Weill Cornell emergency medicine department in conjunction with COE, aims to get students out of both the hospital and their personal comfort zones, practicing medicine stripped down to the basics—no advanced diagnostic tests, limited supplies, and a need to rely on their physical exam skills and their wits. "We want our future doctors to be good doctors no matter where they are," says Gaudio, an assistant professor of medicine. "Whether they're in a world-class, tertiary care center or traveling in the back country, we want them to be good at their medicine."
The elective is held twice a year. In the spring, the class takes a trip out West, most recently to Arizona. In the fall they go to Camp Dudley, a bucolic collection of log cabins five hours north of Manhattan that's the oldest boys' camp in America. The students, mostly fourth-years, get a grounding in such topics as heat exhaustion, frostbite, dehydration, insect bites, burns, animal attacks, poisonous plants, fractures, dislocations, and lightning strikes. "Medicine today can sometimes be excessive—and by 'excessive' I mean you do all of these fancy tests, and in the end it doesn't really change the management of the patient that much," says Queens native Cynthia Santos, the lone Weill Cornell student on the fall trip. Now in her third year of medical school, Santos grew up the daughter of an environmental scientist, taking trips to swamps and rainforests and visiting the family farm in the Dominican Republic. Though she's also interested in a career in infectious disease, it was her passion for international medicine—in which doctors in developing countries must often treat patients using severely limited resources—that drew her to the elective. "I like the thought of wilderness medicine because you don't have MRIs, you don't have CT scans. You just have your hands and your head. It forces you to rely on what you know and the things around you."
Students participate in the scenarios by day and have fireside lessons each evening, on topics from identifying medicinal plants to removing a ring from a swollen finger. (In addition to their time at Camp Dudley, this year's group went on a three-night canoe-camping trip and hiked 3,352-foot Ampersand Mountain in a punishing rainstorm.) They also learn survival techniques, like navigating with a compass and obtaining potable water. "Most of the time when we have students from the city and a scenario of a patient with a sprained or broken ankle, we ask, 'What do you want to do now?' " Gaudio says. "They may say they want to call in a helicopter to evacuate the patient. But that might be logistically impossible—not having a landing field, not meriting that kind of resource, not having a cell phone. Sometimes they don't know what it takes to rescue someone. An evacuation might take hours or days, and they have to be able to take care of the patient, keeping him warm, hydrated, nourished."
Students swap being "doctor of the day," responsible for leading the team during the scenarios—which range from the snakebite incident to a trio of ankle injuries (incurred during an attempt to retrieve a Frisbee) to altitude sickness and hypothermia while climbing Ampersand. "You're thinking outside the box— that's the most important thing," says Lemery, an assistant professor of medicine who attended Camp Dudley as a child. "We've become more subspecialized in medicine and more reliant on technology, but you don't want to abandon the skills of being a doctor." After each exercise, the physicians and Miner give the students feedback on their performance. Following the snakebite scenario, for example, they note that the student doctors hadn't taken Greene's vital signs or removed the ring from his injured hand. "Tim was just sitting by himself," Miner notes. "I would have assigned someone to him, because he might have gone south."
The day after the snakebite exercise, Chris McStay, MD '02 (an assistant professor of medicine at NYU on the trip as guest faculty), portrays a victim in one of the most dramatic scenarios—a boating accident that necessitates a water rescue. He, Lemery, and guest faculty member Liz Edelstein (a professor at Jefferson Medical College who did her emergency medicine residency at NewYork-Presbyterian) row to an island about a quarter-mile from Camp Dudley's dock; Lemery, playing a park ranger, radios in a call for medical assistance, warning of a possible head injury. "You'd better get a response team out here," he says, "because people could be in jeopardy."