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Journal of the American Academy of Physician Assistants:

A Day in the Life

Benner, Cristopher D. PA‐C, MMSc, FAWM

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Cristopher Benner works in emergency medicine in the San Francisco Bay Area. He has indicated no relationships to disclose relating to the content of this article.

In addition to practicing in emergency medicine, I am a Fellow of the Academy of Wilderness Medicine, Wilderness Medical Society, and I volunteer with a search and rescue (SAR) team that responds to incidents all over the state of California. Because SAR work is voluntary, everyone involved has a “real” job that pays the bills. Balancing work duties, personal needs, family obligations, and SAR can be challenging at times.

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▪ 4:45 PM

As I am preparing for a night shift in the emergency department (ED), my SAR pager starts beeping. A person was reported missing 3 days ago. Other SAR teams have already been searching unsuccessfully for 2 days, and my team's participation is requested.

Getting paged for a missing person search is bittersweet. On the one hand, I love searching for people and getting dirty as I crawl through brush and mud, all with the hope of helping someone in need. On the other hand, someone is missing and may be injured. His family is probably worried as well.

While I'd really like to use my day off tomorrow to run errands and relax, a missing person undoubtedly needs assistance. I notify my SAR team that I'm working until 2 AM but will be available after that.

I get my SAR backpack in order, kiss my very understanding wife good‐bye, and inform her that I may not be home for a while.

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6 PM

The first few patients I see in the ED have the usual aches and pains or minor bumps and bruises. A few are intoxicated. One patient seems pretty straightforward on paper—his chief complaint is back pain.

The 54‐year‐old man describes back pain after moving furniture 3 days ago. Sounds pretty benign. But then he says that about 15 years back, he had surgical repair of a thoracic aortic dissection. He swears that this “is just a muscle strain,” and all he wants is a prescription for pain medication. His pain is not exacerbated with movement, and the remainder of his examination and vital signs are normal. Nonetheless, a gnawing feeling in my gut tells me this might be more than a simple muscle strain. I inform the patient of my concern about an aortic dissection and order a CT scan of his chest, abdomen, and pelvis. Walking out of the room, I wonder whether I've just ordered an unnecessary, expensive test all because of a simple muscle strain.

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▪ 7:15 PM

I receive an update on the missing person. He was last seen at an altitude of about 7,000 feet in mountainous terrain. Even though it's July, temperatures and weather patterns in the nearby mountains fluctuate erratically, and summer snowstorms are not uncommon.

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▪ 8:30 PM

The unit secretary in the ED yells my name, “Cris, radiologist on line 3!” Calls from a radiologist are rarely social. The radiologist confirms my hunch that the man with back pain has a massive aortic dissection. The vascular surgeon recommends transfer to a facility with bypass capability; the barrage of phone calls to tertiary‐care facilities begins.

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▪ 10 PM

A helicopter arrives to transport the patient to a tertiary‐care facility. “Good call, Cris,” says a colleague as the helicopter takes off.

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▪ 1:45 AM

I discharge my last patient, finish up my dictations, and change into my SAR uniform. Since SAR teams are on call 24 hours a day, I keep clothing and gear in my car. As a Type I SAR team, my team is expect‐ ed to be able to search in any weather condition, at any time of year, on any terrain.

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▪ 3:30 AM

Figure. I helped fin...
Figure. I helped fin...
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Driving toward the search site, I realize that I am on highly tortuous mountain roads. I need to be extra vigilant about watching for deer and drunk drivers.

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▪ 4:00 AM

I stop for gas and to recaffeinate. What is the mean lethal dose of caffeine, I wonder.

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▪ 5:15 AM

One of the benefits of driving at this time of day is witnessing the sun's first light behind the Sierra Nevada. Black skies turn to violet, and a light fog adds to the mystique of the scenery.

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▪ 6 AM

After 3 hours, I reach the command post. Teams are rolling in from all over. I grab a quick nap before the briefing.

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▪ 7 AM

The missing person has only the clothes on his back, no food or water. Daytime temperatures have been in the 80s and nighttime temperatures in the 40s. There are many cliffs and fast‐moving rivers in this area, and thoughts of hypothermia, drowning, and falling enter my mind. My team is to search a large area of rugged terrain at an altitude of 8,000 feet—3,000 feet higher than where I am currently standing.

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▪ 8:30 AM

Boots laced, packs on, and water bottles full, my teammates and I line up 50 feet apart and start walking. Initially, our pace is brisk, as we're walking on giant, flat granite slabs. We slow down, however, when we come upon a field of chaparral. While not poisonous or thorny, this 3‐ to 6‐foot high dense shrubbery slows movement to a crawl. If I were out for a hike, I would simply walk around it. Today, however, I need to search—meaning I need to walk in and through it. Fortunately, I have eye protection and long sleeves because with every step, branches swat and slice at my body. I have a hard time believing anyone could have walked through this mess of vegetation.

I prepare myself mentally to find the subject. SAR teams often search for despondent or suicidal individuals. While I hope to find this person alive, I also prepare for the worst. I have seen many dead bodies in a clinical setting, but a body that has been exposed to the elements looks very different and more disturbing—than one on a hospital gurney.

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▪ 11:15 AM

Seated in the shade, I see a seemingly infinite ocean of granite mountains that extend to the horizon and beyond. I've hiked and played in this backcountry many times; its beauty never fades. On this visit, instead of an outdoor playground, I see a potential graveyard—a place so vast and rugged, it's hard to imagine that anyone could survive unprepared out here. For a moment, I lose faith in my search efforts. Then I remember being stranded myself in the Appalachian Mountains. I had planned on going for a short day hike but spent an unexpected night in below‐freezing temperatures. When I eventually found my way home, the joyful tears of friends and family floated my exhausted soul. These memories serve to re‐ignite my drive to search for our subject and to provide closure for his worried friends and family.

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Our second search assignment begins. I am walking on steep, slippery terrain, constantly looking up, concerned about falling rocks. In a momentary lapse of concentration, I forget to look where I'm stepping and I hear a telltale maraca sound that makes my adrenal glands pump. Twelve inches from my feet, a rattlesnake is staring me down, rattler shaking like mad. I back away with a nervous smile.

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▪ 2:15 PM

My radio crackles: The missing person has been found alive! My teammates and I cheer and head back.

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▪ 4:00 PM

Debriefing begins: A helicopter spotted the missing person 6 miles from where he was last seen. He had hiked over rugged terrain and crossed several swift‐moving rivers. A medic who rappeled out of the helicopter and staff at a local hospital have cleared him for release to very grateful family and friends.

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▪ 5:00 PM

I grab a bite to eat, caffeinate some more, and start for home.

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▪ 8:15 PM

At home safe and sound, I'm thoroughly exhausted, yet I cannot help but smile. In the past 24 hours, I slept very little, ate too many stale energy bars, and drank too much caffeine. But I witnessed a beautiful sunrise, got dirty at one of the most beautiful places on earth, and more importantly, helped find someone who was terribly missed by family and friends—a very satisfying feeling indeed. I think it's time for nap.

© 2009 Lippincott Williams & Wilkins, Inc.


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