10 things I've learned from climbing...

Aside from how to do the splits, that is.

I'm talking about things that I've learned from climbing that also apply to medicine. Note that I may be using this post to justify spending more time climbing than, say, for example, studying for the family medicine licensing exam.

#1: Communication is key.

Gee, was that two tugs on the rope means "ready to climb", or three? Best to make sure that everyone's on the same page before you're separated from your climbing partner by 60 meters of rope, or before your patient takes 15 mg of coumadin everyday instead of every other day.

#2: Be prepared.

It's one thing to go fast and light, but another thing entirely to shiver on a ledge during a hailstorm because you didn't check the weather forecast and forgot to pack your gortex shell. Similarly, most hospitals have a dusty box full of tools for difficult intubations. You want to know where this is and how what's inside works before you put your patient to sleep and figure out that you can't intubate and can't ventilate.

#3: Know your limits.

Heartbreaking as it is, I've retreated from climbs, often less than 100 meters from the summit, because it's getting dark, because I'm too tired to continue to climb safely, or because I didn't bring the right kind of equipment. There are plenty of situations in residency where a little bit of knowledge and experience can get you into a lot of trouble. Try to see one before you do one, and know when to ask for help.

#4: Sometimes though, you've just gotta go for it.

It'd be nice to trundle along forever on top-rope where there's virtually no potential for falling, but the day eventually comes when you start leading (Photo right: me on one of my first leads, an easy route next to Takkakaw Falls in B.C.). You'll never learn what you're capable of if you don't push your limits. The same thing's true in medicine, where sooner or later, you've got to take the risk of being wrong. Scary, but true.

#5: Double-check everything.

A few years ago, as a beginning climber, I made a mistake that should have resulted in a 120-foot fall to the ground. There's no room for complacency in climbing, and although the results in medicine are rarely as immediate or dramatic, I've gotten in the habit of always double-checking my patient's medications and orders. This is how I discovered that the unit clerk had transcribed my order for 175 units of innohep, a drug used to treat blood clots in the lung, as .75 units by accident.

#6: Mnemonics are good...

Especially when it comes to double-checking. BARK is an easy mnemonic for checking a rappel set-up (Buckles, Anchor, Rappel/Belay Device, Knot) that would have prevented me from making the mistake above. Similarly, the DOPE (Displacement of the breathing tube, Obstruction, Pneumothorax, Equipment failure) mnemonic has helped me to avoid the "deer caught in the headlights" look by giving me a place to start when a patient with breathing difficulties suddenly deteriorates. Other handy medical mnemonics can be found here.

#7: Take care of yourself.

You wouldn't voluntarily spend 36 hours on a mountain without food or water. Don't skip lunch when you're on call. Popcorn from the nurses' station doesn't count.

#8: Take care of your team.

Because they take care of you. Enough said.

#9: Practice makes perfect.

In climbing, the term "redpointing" refers to repeatedly practicing a climb until you're able to climb it from top to bottom without falling. I think it's one of the most satisfying feelings in climbing. Likewise, I'll never forget how I felt when I succesfully started my first IV after blowing more veins than I can count (my thanks and apologies to the patients).

#10: It doesn't have to be fun to be fun.

Thus spake Mark Twight, a famous alpinist who has climbed 60 hours without sleeping. I know of climbers who have carried snowballs in their bare hands, or practiced tying knots one-handed in an ice-cold shower in the dark. I'm not personally into that kind of suffering, but there have been times when a busy call shift has reminded me of when I got up at 4 AM to haul a full pack across a glacier and climb one of the spires in the Bugaboos (see photo, left). The moral of the story? You'll get through it... and it'll make a good story someday.