Here is a snapshot of a typical day when working in my role as Lead Medic for the US CBS TV Show 'Survivor' that is filmed on a remote Pacific island.
The basic premise of the show is 18 contestants battle it out over 26 days to be the ‘sole survivor’ and win one million US dollars.
I start the day at 07:00 in our island clinic seeing and treating local and international crew before they head off to work. The bulk of this is primary care; dealing with minor injuries, wound care, diarrhoeal illness and a sprinkling of tropical medicine.
We’ve had plenty of challenging cases – including extreme bradycardia due to Ciguatera poisoning and a memorable shark bite. You just never quite know what’s going to walk through the door next, which always keeps our WEM team on its toes!
At 09:00 I attend a whiteboard meeting with the challenge team, camera crew, producers and director, in which we preview what’s being filmed that day. Then at 10:00 I’ll check in with the contestants individually in a tent on the side of set, before we then shoot the ‘challenge’ (typically, an obstacle course with some puzzles). Our team is always ready on the side of set ready in case any medical issues arise.
The afternoons are made up of meetings, clinic work, the odd visit by boat out to the Tribe Camps and a chance for some downtime. At 18:30 we shoot ‘Tribal Council’. This is when one of the contestants is voted out of the game by their tribe. It’s fun to follow the game as it unfolds in real-time, and I’ve enjoyed learning how the different stories and creative elements come together. Every day is mapped out on a timetable, (the ‘call sheet’) so everyone knows where to be and when.
Back home I have two kids (aged 2 and 5) and I find that being away from home for longer deployments is hard. It’s particularly tough on my wife while I’m away, as she has to juggle being a consultant paediatrician with single parenting. ‘Survivor’ does shoot on a predictable schedule each year, but most other work in the TV/film industry comes up with incredibly short notice, which can lead to some tricky marital negotiations! But it’s all about getting the balance right. I am very selective about what I take on, so that I don’t neglect my roles as a husband and a dad as I hate missing important family events like birthdays and anniversaries. Sometimes, unfortunately this goes with the turf.
There is nothing more satisfying than a successful medevac. It’s often a bit ‘messy’ - you do learn to embrace this - but I love seeing the team switch into gear and perform.
Getting a patient ‘in-extremis’ from a wild location to definitive care safely and effectively is a feeling like no other. We have needed to medevac numerous crew and contestants via boat, land and helicopter over the years, and I’ve dealt with head injuries, shark attacks, sepsis, cervical disc prolapse, Achilles tendon rupture, cardiac sounding chest pain and kidney stones.
Contestant medevacs have the added challenge that they are filmed and potentially broadcast to a large audience. Over time, I’ve learned to ignore the cameras and focus on the medicine and the patient. But at first, it can be disconcerting to be working with a camera pointing right at you.
On expeditions and film projects medical contact can be infrequent. Therefore, skill fade is a big problem and these are the top three things that have helped me:
1. Regular, targeted CPD – e-learning, reading journal articles, attending courses. I’ve recently completed PHTLS, ALS and RTACC which are all simulation-based and extremely relevant.
2. Keeping up the day job. Getting plenty of patient contacts as a GP back in the UK, as well as being a GP in ED, helps me maintain my clinical skills.
3. Team simulation – I’m a big believer in simple, low stakes, low fidelity micro-sims during any down time. I think this is something we should all be doing as often as possible.
Here’s an article and Instagram video that help to explain more: https://worldextrememedicine.com/blog/extreme-medicine-posts/train-hard-fight-easy-the-benefits-of-in-situ-wilderness-simulation-training/
Self-care is a vital component of being an effective medical practitioner in any setting (extreme or otherwise) and it’s so important to know how to clear your head. I’m a firm believer that we all have a duty to put back in what the day takes out of us, so that we can bring our best to each and every patient encounter.
When I’m on an expedition or film project, I try to make time for a few minutes each evening of meditation and journaling. This helps me to process and regroup. I’ll typically take a pair of trainers and some swimming shorts with me wherever I go. A run and/or wild swim is pure therapy. If space allows, I also like to pack a small travel guitar; that’s a great release too.
A humble pair of nitrile gloves is always stashed in my pocket. When responding to an incident the first thing I do is take a moment to put these on. This serves three functions: it’s essential PPE; it gives patients confidence that I know what I’m doing; and it’s also my ‘thinking time’ while I do my scene survey. The main pitfall here is when your palms are sweaty, and the adrenaline is flowing, they can be an utter pig to get on! (Pro tip: always go for ‘powdered’ gloves!).
We do a lot of boat transfers between islands and during ocean-based challenges on ‘Survivor’. These are small, fast RIBS and open boats. By far the most common ailment I treat under these conditions is sea sickness and I’m a big fan of buccal or oral prochlorperazine (Stemetil) it’s effective and versatile. In the US, Dimenhydrinate (Dramamine) seems to be a popular choice, so I have a stash of both on my person ready to dispense.
In terms of my favourite reference book or app, please can I have four?
It would be a toss-up between the BNF, MDCalc, JRCALC and Auerbach’s Field Guide to Wilderness Medicine – I couldn’t live without these! (see links at the end of the blog).
It’s hard to pick just one piece of great advice that I’ve been given. I’m a bit of a magpie; always hoarding nuggets of wisdom from those around me. Here’s one from my WEM colleague and Space Medic (and newly appointed Virgin Galactic Science Astronaut) Dr Shawna Pandya that really resonated with me is this: ‘If you’re not experiencing rejection then you’re not playing in the right league!’ You can follow Shawna here https://www.instagram.com/shawnapandya/?hl=en.
There are some great opportunities out there for medics, but they aren’t always easy to find. You’ll need to be a self-starter. You will need grit. The inevitable setbacks along the way will test your character.
My advice? Find your own niche. Ask yourself what do your interests and skills align with? What really makes your heart sing? Perhaps that’s Dive Medicine, maybe it’s working in Conflict Zones or Conservation Medicine and One Health? It helps to have a focus (at least to start with). Seek out relevant courses and start to build up your knowledge and experience. The WEM extreme medicine courses are a great starting point https://worldextrememedicine.com/extreme-medicine-courses/.
Google companies, NGO’s and organisations that do the kind of thing you’re interested in, find a contact and start firing out emails (and lots of them!) It's a numbers game so you need to be persistent. Put yourself out there, don’t wait for others to come to you.
Each one of my mentors has at some point told me to keep going, which is sound advice because finding those unique opportunities takes time. You will face rejection, but remember you are always growing, always learning. Be kind and courteous and give others a leg-up wherever you can. Eventually doors will start to open for you.
Luck doesn’t just happen. Luck = preparation + opportunity (+ luck!).
Finally, I’d have to say let other people go for the easy stuff. Don’t be afraid to fail and always follow your heart.
Good luck and I’ll see you out there!
Huge thanks to Dr Will Duffin for this pretty awesome blog and we hope you’ve enjoyed it as much as everyone at Red Square medical HQ.
We’re fascinated by the world of extreme medicine as it’s part and parcel of what we do every day in our maritime world. If you’d like to find out more about Dr Will, please use these links and make sure you check out the incredible WEM conference in November.
Book and App References: