“Before I went to medical school, I had a seemingly unrelated job as a backcountry mountaineering instructor for Outward Bound. At the beginning of each season, I’d sublet my apartment, freeze my credit cards, breakup with my boyfriend, and drive my truck out to Colorado. I’d spend the summer traveling on foot through the high mountain passes and rough-hewn peaks of the Rocky Mountains, carrying everything I needed on my back. I slept in meadows under the stars, drank from streams, and wore the same socks for 3 weeks at a time. 

My students, mostly young adults, signed up for an Outward Bound course to gain wilderness experience and mountaineering skills, and to push themselves physically and psychologically. Many of them had never camped before. In the month or two I spent with them, I had to teach them how to navigate off-trail by map and compass, climb technical peaks with ropes and ice axes, and eat, sleep, and poop in the wilderness. I also had to keep them alive in the process. 

As an assistant instructor my first summer, my role was to support the lead instructor, and to watch and learn so later that summer I could lead a group safely on my own. Early on my first course, we were making our way up and over a pass when the clouds turned black and heavy. Rain started to trickle and then to pour, and lightning flashed on the peaks. We all stopped hiking and tore through our packs looking for our waterproof gear and warm layers. 

One of the students wandered over to us. 

“My hands are freezing”, he said. His thin gloves were wet from the day before, and so worn that a few of his fingers were sticking out the tops. I looked down at my waterproof overmitts, layered on top of a pair of thick fleece gloves, and I felt a twinge of guilt at my superior gear. Plus, the rain was turning to sleet, and like everyone else, I just wanted to get moving again. 

“Here”, I said, “take mine.” I stripped off my gloves and handed them to him, leaving my fleece gloves underneath exposed to the rain. The student thanked me, and walked away happily pulling them over his fingers. 

My instructor gave me a sideways glance. “Don’t do that again”, he said. 

”What do you mean?” I asked. 

”Don’t give your stuff away”, he said. “You need it.” 

“I’ll be fine,” I said. “I have enough other warm gear.” 

He stopped packing up and looked me in the eye.

“I don’t want you ‘fine’”, he said. “I need you better than that. We have nicer gear than they do because we need to be able to take care of them. You made his hands warm, but someone else is going to come to you wanting a hat, and then somebody else will need jacket. Pretty soon you’ll be wet and hypothermic and useless to the group if we need to set up anchor or do an evacuation. It’s not being selfish to keep yourself the warmest and the driest; it’s being smart.” 

He was right. I had a finite amount of fleece accessories, and I needed them to protect my most valuable asset – my ability to care for others in an emergency. It’s in our nature to want to help people, but sometimes we lose sight of the fact that by helping them a little in the short term, we wear ourselves down in the long term. And then we aren’t in any shape to help at all. 

As an intern on the medicine wards, I drew on a surprising number of my Outward Bound skills. Colorado thunderstorms regularly prohibit afternoon travel in the mountains, so I was used to waking up at 4am and powering through my work before the deluge. I was adept at managing my hydration and nutrition for long, physically grueling days, and conveniently located hospital cafeterias made food resupplies easy. I could sleep on dirt, grass, pine needles, or a stained foam mattress in a musty call room. But the most helpful lesson was the one about the gloves. 

Intern work-hour restrictions required us to leave the hospital by noon on our post-call day, after a 36-hour shift admitting new patients and covering the wards overnight. After a long night of admissions and pages, I watched my co-interns doze off during dictations, drag through their notes, and barely stumble out of the hospital in time, often needing a shove out the door from the chief resident.