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Wilderness is this Doc's Emergency Department, Classroom, Passion

April 29, 2014

A stint working at an AIDS hospice in Zambia and a run on the reality show Survivor are among the experiences that helped guide Gabriel Cade, MD, toward a fellowship in wilderness medicine, a growing subspecialty of emergency medicine.

This is the extended version of an article that will appear in the May 2014 issue of HealthLeaders magazine.


Gabriel Cade, MD

The road that Gabriel Cade, MD, took before starting his career in medicine is unorthodox, having taken him from a small North Carolina farm to a teaching job in France, travels throughout Europe, a thru hike of the Appalachian Trail, hospice work in Africa, a bartending gig, and a spot on a reality show set on a tropical island.

But considering the field of medicine he practices now, it was the right way to go.

Cade is an emergency medicine physician and a wilderness medicine fellow at Baystate Medical Center in Springfield, MA. Wilderness medicine is a relatively new subspecialty of emergency medicine, focusing on treating patients in remote areas and tough situations without the luxuries of a hospital setting.

Wilderness medicine further breaks down into two subcategories. Disaster medicine involves going to an area that has been unexpectedly hit with a traumatic event, most often a natural disaster such as Hurricane Katrina, or the Haiti earthquakes. Expedition medicine, on the other hand, is more recreation rather than response, which Cade likens to being a team doctor on a trip through the Amazon.

Cade's journey to the medical field started after the second time he dropped out of college. An avid traveler, he went to Africa to work in an AIDS hospice in Zambia, along with other work in Zimbabwe and Batswana. It was an experience that greatly moved him.

"I had to reapply to college from Africa and then come back and finish my undergrad and then medical school and then a residency," said Cade. "I always thought that I would do emergency medicine with a specialty in wilderness medicine. It just seemed like it was a job that was created for me."


Cade participating in an Advanced Wilderness Life Support Course in Guatemala.

Wild Education

As a wilderness fellow, part of Cade's job is to teach. He has taken his students directly into the heart of wilderness medicine by leading journeys all over the world.

One recent experience took Cade on a 12-day trip down to Guatemala, where he gave lectures on advanced wilderness life support (AWLS). His teachings focused on specific occurrences, such as treating a snake bite, or a victim of a lightning strike, but also on how to implement hospital-level care in wilderness settings.

Cade and his students visited Mayan ruins and climbed the highest volcano in Central America during the excursion. In these outdoor arenas, he would arrange scenarios where a person would pretend to be a patient and the doctors would work to treat the patient within certain parameters.

No matter what the lesson is, Cade emphasizes one point above all others: being prepared. One of his colleagues taught him that "time spent in preparation is seldom wasted," and it's a credo that Cade believes not only stands true in wilderness medicine, but all of medicine.

"One of the great similarities between wilderness medicine and all medicine is that prevention is really the key," said Cade. "Take your medications, lose weight, exercise, eat right, but in the wilderness, it means, check your knots, check your harness, make sure that your gear is all there."

Technology Challenges

Cade does a lot of work researching and developing methods to incorporate technology into wilderness medicine. The definition of wilderness medicine is operating without the resources of a real hospital, but technology has changed what that actually has to mean.

Smartphone apps are a big part of Cade's work. His apps include simple features that teach the user how to tie a basic knot or send out distress signals and automatically text loved ones. He also works with more complex pieces of technology, including portable ultrasound devices.

Cade understands that the trick isn't just creating the technology, but finding ways to power them. He has devoted portions of his research toward developing solar and thermoelectric chargers to power up smartphones and devices.

Cade works on technology projects with the director of the wilderness medicine fellowship, and the director of the ultrasound fellowship at Baystate. "I'm hoping that feedback on the technology that is out there and the ideas for innovation will make this technology both widely recognized and accepted as pre-hospital care," said Cade.

Becoming a Survivor

The physician has seen his fair share of unique medical emergencies in the wild. He's seen bad altitude sickness, lightning strikes, snake bites, broken limbs, whitewater rafting, and rock climbing accidents.


Cade during his stint on Survivor

The experience that prepared him for his medical specialty came when he was on camera in 2002 for the fourth season of the hit reality TV show, Survivor: Marquesas.

Cade, who was 22 at the time, got his first taste of wilderness medicine by observing the doctor who was on staff for the show. He also received a good amount of experience with the numerous medical emergencies that took place during the competition.

"I had a really bad machete cut to my finger and I broke a tooth, and another guy got bit by a moray eel, and also got a bunch of sea urchin spines in his hand, and another person tore the skin off their foot," said Cade. "There were medical problems that we were sort of asked to deal with without training."

Of all of the lessons that Cade learned during his time on the show, perhaps the most important one was dealing with the isolation from his friends and family.

"The physical stuff you either expect or get used to, and the emotional stuff related to the game is not a big deal, but doing those things in the complete absence of your emotional support group was very challenging and that has really stuck with me, said Cade."

"I try to remember that when I see patients in the emergency department, that their psychological relationship to their illness is a very important thing, and in the wilderness that becomes amplified."

A Wild Future

In conversations with colleagues, Cade sees a growing sense of global awareness and global responsibility, with doctors looking to use their skills where they would be greatly needed, whether it's for a disaster relief effort, or to help out a struggling village in a Third World country.

"I think as we see doctors and nurses and PAs and EMTs and civilians all seeking out ways to help the global community, then more and more interest will come to wilderness and international medicine," said Cade.

As for himself, Cade plans to continue working with the wilderness fellows at Baystate. Of course, he won't be staying in the classroom all the time. He plans on getting out into the field, not only to work on wilderness medicine, but also for his own personal satisfaction.

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