Like many boys born in the 60s, my heroes were often frontiersmen.  I grew up watching the Daniel Boone television series, with Fess Parker.  (I can hear the theme song in my head as I type.)  I watched the Disney production of Davy Crockett, and had a comic book of the same.  I never missed a chance to watch John Wayne die on the walls of the Alamo (also as Davy Crockett).  I could go on and on about my favorite movies, like Jeremiah Johnson or Little Big Man.

Later I learned to love the writings of Allan Eckert, a historical novelist who wrote about the Westward expansion, with much of his book The Frontiersman homage to Simon Kenton, a fierce hunter, scout, explorer, settler and fighter of the Appalachians, particularly the area where my family came from.  Any man who could, reputedly, load a Kentucky Rifle on the run was a man I admired.  As a child I was ever looking for trails in the woods, wondering which were game trails and which were the remains of old trails left by explorers or Shawnee raiding parties.  The echoes of the frontier were always there for me.

While I later learned more about that time in history, and learned that the television shows and movies got a lot of things wrong, I remained fascinated.  And I remain so.  To this day I walk through the wood scanning the ground for arrowheads, looking for pottery shards or signs of anything from times gone by.

Today I am working in the mountains of Western North Carolina.  Driving to my locums shift at Tiny Memorial Hospital, I passed a historical marker along the side of the road.  I had always wanted to stop, and I had extra time.  Along the upper Chattooga River is an old farmstead, the Russell Farm, where a vibrant and industrious family farmed and had a rest station for stage coaches going up into the mountains in the 19th century.  The main house was burnt almost 30 years ago, but the footings remain, and the barn, cellar and other buildings.  I lingered there in the cold, the river and its feeding streams rippling, muffled by the wind of an impending winter storm.  (The Southern Appalachians are blistering in the summer and bitter in the winter; it’s why the people are so irascible.)

Just beyond the homestead, across the river, had been a Cherokee town, once recorded in a British census in the 18th century.  I didn’t have time to walk around the site, but I will one day.

I climbed back into my truck, that same childhood sense of history swirling all around me.  Not ghosts, but ghostly.  I drove on up the mountains to my job.  And I realized that sometimes, our jobs in medicine are on the frontier.  Tiny Memorial is perched 4,000 feet up in the Blue Ridge, and sees only 5,000 patients per year.  In winter, it is very quiet.  But it has to be staffed.  The outpost has to be manned.  I thought about that sense of driving into the middle of nowhere.  My big truck, stocked with blanket, brush knife, first-aid kit, food, water, lighter, pistol in the glovebox.  The same stuff I have almost everywhere I go, but in the mountains it seems more appropriate, far from the comforts of quick 911 response times.  Even on the way to work, I might end up at some crash scene or who knows what.  I might be the crash scene and spend a cold night in the woods.  One never knows.  But then, that’s the joy of being the scout, the explorer, the one willing to go out there.

In truth, and to my sorrow, I’m only a tolerable outdoorsman.  I’ll never be a Simon Kenton, a Daniel Boone.  But now and then, in rural places, on blustery days, I still understand the joy of solitude, uncertainty and challenge.  The physical challenge of getting to those places, the medical challenge of identifying and stabilizing whatever comes in, far from the hallowed halls of academic trauma centers.

Out here medicine, life, is still a little on the edge.  And as I drive over cold rivers, or look out the window at the freezing fog on stark bare trees, as I check for deer and bear on the side of the road, I think I understand why those men and women of old went out where they did.

Challenge and uncertainty, even danger, make us feel alive.

And maybe too much certainty, too much safety, simply allow us to die bored and too soon.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of the Practice Test and Life in Emergistan. 

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