April 27, 2021

With Great Knowledge, Comes Great Responsibility

Many have fears rooted in experience or the unknown. The 1990 ‘comedy’ film “Arachnophobia” started mine even though my suburban childhood was filled with tales of Charlotte spinning words in webs and the infrequent daddy long legs scrambling across the backyard. In this movie, swarms of deadly spiders invaded a suburban town and my 9-year-old self adamantly vowed to stay far from these creatures as I lay in bed, unable to sleep.

Ten years later, armed with Wilderness First Aid training and brimming with self-confidence (after all I could inject an orange with epinephrine to save it from certain anaphylactic death), I was ready to guide! My group of novel campers and I reached our secluded island off the coast of Maine to claim our camp and as dusk descended, I noticed a single daddy long legs scurry across the campsite. And then another. And then more than I can possibly describe descended on our group like a biblical plague. As this scene from a horror movie unfolded, we packed up and hiked to the far end of the island – safe and shaken but resilient.

A few years passed and I moved to Australia, still brimming with the bravado of youth. Although Bill Bryson’s “In A Sunburned Country” recounted each way in which nearly everything can kill you down under, I took this as hyperbole. As I was on a sunny jog in Sydney, a single silken string touched my face and startled me. I turned and saw a rock wall with dozens of funnel shaped webs hanging in the open. Bravado wasn’t enough to protect me from Sydney’s funnel web spider (Atrax robustus), so I scurried back to the safety of my hotel. I soon travelled north and settled into the country boarding school campus where I was to teach, safe from the Sydney arachnids but unaware of new dangers on the horizon. I awoke one morning and as my eyes sleepily gazed towards the ceiling, the eyes of a Huntsman spider (Sparassidae spp.) with its dinner plate leg span stared back. I rushed to grab an instrument of destruction returning only to find it gone and so was I for the next few days. My Australian colleagues laughed while they commented, ‘they are good luck, they eat the rats!’ followed by weekly glass jar gifts on my desk each with a new deadly spider. These were usually accompanied by a lighthearted but serious ‘oh don’t open that one; that one will kill you’. It appeared that living despite everything’s ability to kill you grants perspective.

Medical school amplified that conclusion. As we learned of the sheer multitude of pathogens and missteps our body can take that can lead to deadly disease, my arachnophobia was put into perspective. I even started to admire the artistry of the innocuous Cross orb weaver spider (Araneus diadematus) with beautifully intricate webs that catch the ever present rain during residency in Seattle. In fact, countless patients came to the emergency department wanting evaluation for their spider bites – though most often they were of the needle nose variety (Injectus heroinicus).

My journey continued to California where tarantulas (Aphonopelma spp.) and black widow spiders (Latrodectus spp.) abound but my concerns were normalized after I took care of my first patient with the abdominal cramping and muscle fasciculations of latrodectism from a confirmed bite. The effects were uncomfortable but manageable with treatment. Even so, I would rather avoid a first-hand experience.

At times, working in wilderness medicine affords exciting opportunities and in my last pre-pandemic adventure I served as medical director for an expedition length ultramarathon in the Atacama Desert. As I pulled into our campsite on the fourth night of the race I was quickly ushered by staff to see two black widow spiders at the edge of camp. I didn’t want to worry the competitors or the volunteers, but I wanted to alert the medical team spread over miles of this unforgiving desert. Our communication channels were shared and limited, so I sent a group text reporting ‘the presence of a Latrodectus species and to be aware if you see competitors with symptoms.’ I knew that they would understand and others would likely not, but that did not stop near constant jokes about my word choice on their return. The jokes helped distract me and I slept soundly that night despite many more sightings at camp that evening.

The wilderness can be a scary place with many dangers lurking – bear maulings, avalanches, traumatic falls, environmental exposure - but so is the rest of life, especially during a pandemic. Our duty as physicians, at work and in the wilderness, is to impart our knowledge to help our patients, teams, families, and friends stay as safe as possible. Continue to pass on your knowledge. Knowledge helps make uncomfortable things less intimidating – and you don’t have to like spiders to practice wilderness medicine, but you have to tolerate them.

Someday, I aspire to reach Batman’s level of taking my fears and making them my strength, but Spiderman’s origin story is a bit different.

Patrick Burns MD DiMM FAWM
Secretary/Newsletter Editor – ACEP WM Section