Xtreme Medicine

Something for the adrenaline junky? Beyond the marathon? Tougher than the triathlon? Approaching the ultimate on the Shackleton scale of adversity is Eco-Challenge, the premier multi-sport endurance competition. In the deserts of Morocco, Utah, or Australia, the jungles of Borneo or Fiji, the mountains of British Columbia or New Zealand, mixed teams of four test the limits of their mental, physical, emotional, and spiritual endurance.

The event combines a mix of mountain biking, bushwhacking, jungle or glacier trekking, horseback riding, white-water rafting, scuba diving, kayaking, canoeing, canyoneering, and mountaineering. Racing virtually nonstop, 24 hours a day, the teams cover hundreds of hazardous miles. Only teamwork leads to success: loss of a member through illness, injury, exhaustion, and, presumably, death disqualifies the entire team. Five to 10 days later, less than half of the 60 to 70 teams will cross the finish line. And to patch up the survivors and rescue the injured along the way is Dr. Adrian Cohen and the highly trained and experienced medical rescue team from his Australian company, Immediate Assistants.

As yet, there have been no deaths, but Cohen admits: "One of these days it is going to happen. We are not supermen." And very serious accidents do happen. Cohen remembers day four of Eco-Challenge 2000 in Borneo, when a competitor skewered his chest on a tree branch. "He could have died instantly," says Cohen. "As it was, he had only a tension pneumothorax." And there was the competitor who slipped on ice on a mountainside in Argentina and came to rest on the edge of a precipice over which lay her certain death.

The rest is cuts, scrapes, and abrasions; sprains, strains, and fractures; hypothermia, hyperthermia, and exhaustion; bruises, bumps, concussions, and "blisters from hell." Cohen sums it up well: "Eco-Challenge is like M*A*S*H for podiatry students."

Why do people do it? "It is the competitive spirit in humanity. Some are driven by achievement. Some by the fear of failure or the desire to finish. Some are testing their physical limits. Some people thrive on adrenaline. As a species, we are adrenaline-dependent. We could not survive without it."

Cohen has also been part of the onsite medical support team for the past four seasons of the CBS smash hit Survivor. Though the participants are more likely to suffer from hurt feelings, bruised egos, and wounded pride than broken bones or punctured lungs, even on Survivor, serious injuries do occur. In one memorable Survivor episode in the Australian Outback, a participant fell headfirst into a fire and severely burned his hands. Immediate first aid and a helicopter evacuation led to an excellent outcome.

"It's seeing the whole system work that gives me the biggest buzz. It's teamwork, timing, and training," Cohen says with pride. He is a great believer in teamwork and co-operation. "Argument in Eco-Challenge is the mind killer. It destroys teams. It saps energy. You can watch people fall apart. It's the really cohesive teams that do really well." He applies the same philosophy when he assembles a medical rescue team.

On and Off the Job

In 1986, only three years out of medical school in Australia, Cohen founded Immediate Assistants. Initially, the company only arranged for surgical assistants. Now it offers a wide variety of services: training courses for paramedics and cruise ship doctors; medical rescue, resuscitation, and retrieval; field equipment testing; first aid publications; and medical coverage of events and venues ranging from Eco-Challenge to alcohol and ecstasy-fueled New Year's celebrations to baked bean eating competitions.

At 6 feet, 220 pounds, the tanned and well-muscled Cohen isn't your typical sit-in-your-office CEO. He's likely to be found on the job rappelling down a cliff or jumping from a helicopter. And when not on the job, he is rollerblading with his partner, Suzy, and their 14-year-old son. A former rugby player, Cohen says his approach to athletics is "brute strength and ignorance." Up until a freak knee injury at age 34, he considered himself indestructible. Now, at 41, he considers himself only relatively indestructible.

Over a fine meal and a good bottle of Australian wine, I asked Cohen what drives him. This is a man who describes himself as having a short attention span. Whose MMPI personality profile is characterized by a high drive, a very low boredom threshold, a strong work ethic, and a degree of hypomania. A man who travels with an espresso machine, "the Italian Reanimator." Who believes that there is something "sick" when a doctor passes an accident for fear of being sued. Whose life philosophy is: "I'd rather regret the things I've done than the things I should have done."

The Legacy

Cohen feels that the crucial decision in his career was not dismissing law (his parents' profession) as "unsexy" or choosing medicine because it had "scope," but turning down a job offered by a professor of orthopedics. Instead, he decided to go full-time with Australia's Westpac Helicopter Rescue Service: "An exciting job!" It was there that he discovered how poorly spinal injuries are handled at the accident site. "Twenty-five percent of spinal injuries get worse before they reach hospital. That's one in four. Even if it was only one in 400 it would still be a terrible tragedy." Thus was born the Necksafe mission. He started haranguing authorities to do something. He wrote the Guidebook for the Management of Acute Spinal Injuries. He created videos, lectures, seminars, and training sessions. All designed to teach lifeguards, coaches, trainers, first aid attendants, paramedics, and even athletes and the general public what to do, and, particularly, what not to do in the first few seconds and minutes after a spinal injury. When it comes to spinal injuries, this is a guy who believes passionately in doing the right thing at the site before any thought is given to hospital transfer. This, he hopes, will be his legacy.

Legacy aside, in chatting with him and looking over his list of accomplishments, it is clear that his real forte is communication. With a background in public speaking, acting, and debating, Cohen claims to be able to talk underwater "with a brick in my mouth." He regularly appears on TV and radio, in the press, before medical audiences, and face-to-face with the public. He now hosts Medquest, a new US television series that examines a medical world that borders on the mysterious and the dangerous. He finds it puzzling that we select medical students on the basis of their marks in math, chemistry, and physics rather than their ability to communicate. He says, "My job is to communicate with people whose own doctors don't."

This is a man who clearly loves what he's doing. A man who is driven. A man who believes we just need somebody or something to squeeze our adrenals a little bit to make life more exciting.

So, now I must ask you: what have you done for excitement lately?

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