Easter Island Day 2 (Sunday)

Since its my blog I've taken the liberty to include all the "traveling" in Day 1 - and just talk about Sunday evening as day 2. After getting settled in our hotel, ( Picture a sort of tropical garden - with simple rooms - no a/c - no tvs - no internet - somewhat threadbare towels - but a flush toilet and warm shower) we headed out to find some dinner (for all those who think you are missing something not getting food on a domestic flight think again).

We headed to the beach. It was beautiful. Very blue water, warm air, lots of kids out surfing. We found a little place to eat overlooking the water. I ordered some garlic chicken - which was just that - some chicken in a garlic sauce. No sides or anything else. It was pretty good though, espcially once I got a side of rice to go with it. I also had a pisco sour. Different than Peru - it had brown sugar around the top of the glass and no egg component.

After dinner we continued to hike down the coastline from Hanga Roa to Tahai, which consisted of some of the standing Moai. We watched the sunset over the water and then headed in for the night. A shower and a flat place to sleep was awesome!!

Easter island - day1 travels

We left Augusta around 5pm on Saturday to begin the journey to Easter island. One of the goals of my fellowship was to plan an expedition where I'd be in charge of planning and executing a trip to a new location taking into account medical resources, safety, CDC recommendations, group travel and just about everything else :) I decided on our way to the Atacama desert for Racing the Planet would be a great time to work on this requirement.
I decided to plan a trip for Mike Caudell, my fellowship director and I to go to Easter Island. I'll be sharing more about the planning my experiences from that end afterwards.

From Augusta we flew to Atlanta - had a 3+ hour layover in which we feasted on lots of the foods we'd miss while traveling including some Georgia IPAs and salad. The flight from Atlanta departed around 9:50 PM and we arrived the next morning in Santiago. I think we both slept off and on. Not great sleep, but could be worse. Once in Santiago we paid the repriprocity fee ($160) just to enter the country. We cleared customs without a problem - our luggage all made it too :) We had a couple hours to spare before our next flight but were both exhausted so we napped while small children ran around screaming in spanish at our next gate. LAN airlines does a cool boarding style where they board by sections of rows. It seems to go much faster or perhaps people just bring less stuff. 5 hours later - just about 24 hours after we left Augusta we landed on Easter Island. Surprisingly the time zone there is EST.

We headed into the very small airport, bought park passes, collected our luggage and headed to Hotel Orongo where we were staying.

Park city - WMS conference

I spent February 14-20 in Park City at the WMS winter conference.

Dave and I flew in from Charlotte. Unlike my last trip to slc this one went much more smoothly and we were making turns on the slopes by noon :) We skied at the park city Mtn resort the first day.

On Friday we headed up to snowbird and skied there.

Saturday we headed down to salt lake and met up with Adam who took us up passed alta on a backcountry ski trip. Avalanche conditions were low with a few pockets of moderate. We climbed up some cat tracks to a peak near mt wolverine. It was great weather and there were still a couple areas to make fresh tracks.

Saturday evening the conference started. Several of the WMS members who'd gone on Everest treks spoke about their experiences including one who summited.
Afterward there was a reception.

Jenn flew in Saturday night so Dave and I went down to salt lake and picked her up.

Sunday the conference started bright and early at 715am. Lectures include updates on hape and have. Lectures were over by 1130 leaving plenty of time to hit the slopes at canyons after conference was over.

Monday was similar to Sunday. Seth lectures about anticoagulation in the wilderness. Paul auerbach also talked about travel medicine. I hung out with Mike and Seth for a Appalachian center board meeting Monday night.

Tuesday lectures were more geared towards search and rescue with several case report presentations. Tuesday evening we had a banquet and hit up the hot tub afterwards.

Wednesday Luanne freer spoke about frostbite. There were also some lectures about risk taking.

Wednesday afternoon we headed back to slc and dropped Jenn off at the airport. Then we checked out the backcountry store and got some great Mexican food at the red iguana.

WMS student elective

I spent feb 9-12 up at Camp Wesley Woods at the WMS student elective. I'd come here 4 years ago as a student and am now back to teach.

I Got to hear some lectures on search and rescue, heat and cold injuries, traumatic brain injuries, drowning, and ballistics. Spent time outside with the students as they practiced the rescue cube and some tracking techniques.

Met a lot of awesome and enthusiastic medical students and residents.

Gave lectures on lightning, ocular injuries and wound care.

Got to enjoy the wilderness with a short hike and saw a barred owl.

I'm looking forward to coming back in the future to teach and support future electives.

Utah ski trip

View from Alta

Despite all the fun trips I get to go on for work i still take some of my own.

My brother and I planned a ski trip to Utah a couple of months ago. The plan was to fly out early Thursday morning - take advantage of the quick start ski pass - which gives you free skiing on your day of arrival - and then ski Friday, Saturday and Sunday. We stayed with Adam and his roommates down in Salt Lake City.

Riding the lift at Alta

Of course great plans never go as planned. On our way out an ice storm hit salt lake and our flight was diverted to Denver where we waited for several hours. Eventually we made it to salt lake around 5 or 6ish. Managed to rent a ford focus and head to Adam's. We contemplated night skiing but were both exhausted after our 445 am est wake up. We went to the red iguana - an awesome Mexican place and called it a night.

Friday Stephen and I drove up to alta. We skied there all day with a brief stop for some lunch. It was great. No crazy powder but nice snow ( especially for nc natives). Friday night we hit up a local Thai place and crashed early.

Adam in the backcountry

Saturday Adam was off and the avalanche forecast looked promising ( for no avalanches) so we headed to Mill D in big cotton wood canyon. We skinned up a summer road past multiple cabins and eventually entered the groves of tree and made our way up to an open peak. It took about 3 hours to make it up. We saw several other groups out as well. We dug a snow pit and used compasses and a cline meter to determine the best way down. It had just started snowing as we headed down.

Going down we cut through fresh powder with a few tracks and then cut through the groves of aspen trees. It was awesome!!

Fried Twinkies

We sorta skipped lunch - so hit the bayou for dinner and beers. Plus fried twinkles for dessert :)

Today ( Sunday) we hit snowbird for a couple hours of skiing prior to flying home. For the first time you could see blue sky when we left salt lake. By the time we made it to snowbird the snow was beginning to fall. It became heavier as the day progressed. To the point all the ski tracks were covered up by the time you rode the lift to the top. It was a bit windy too.
We made it back down to salt lake as planned to catch the plane. The trip to the airport was a little sketchy as the roads were completely covered in snow. I drove pretty slowly as the ford focus isn't a great snow vehicle. We made it through security and grabbed a bite to eat prior to heading to the gate. The snow continued to come down and our plane was diverted elsewhere. Not a good travel trip for e. after over a 4 hour delay we are headed home with a 3 am arrival time. Ugh!

The trip was well worth it. Two great days of resort skiing and a day in the backcountry!

Medical Student Elective

One of the cool parts of my job is getting to help with the 1st year medical student elective in wilderness medcine. Today I did lectures on ortho injuries and splinting and also on airways with a emphasis on crics. The students then got to rotate through stations to practice intubation, crics and splinting techniques.

Its always rewarding to realize how much you've learned when teaching medical students and see how enthusiastic they are to learn new practical stuff.

Ethics and DNR

Emergency medicine can be a tough field. We don't have pre-existing relationships with most of our patients, nor do we have time to discuss the intricacies of their wishes when things are going poorly. Last night with very little warning a patient rolled in from a nursing home who was profoundly bradycardic (HR 7 - 10) with a BP in the 50s.  Due to inadequate respirations the patient had a combitube (which is a supraglottic airway) placed by EMS through which the patient was receiving assisted respiration  This paperwork accompanied the patient. What would you do?  

This case demonstrates to me the need for physicians and families to have candid discussions with each other regarding end of life care. To me it seems medically futile to perform chest compressions without giving drugs and without establishing an airway. I think part of our duty as physicians and healthcare providers is to have these difficult conversations and help guide people to make the right (and medically appropriate) decisions for their loved ones.