Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature. Christopher Van Tilburg. New York: St. Martin’s Press,

2007. 304 pages. Hardcover. $24.95.

Few titles dramatize with greater flair the nervy, adrenalin-driven world of mountain rescue than Christopher Van Tilburg’s new memoir. Packed with detail about the anatomy of these operations, the book runs at a break-neck pace, quickly bringing readers into this world of primary surveys, intubation, and resuscitation, without the hysterics that sometimes accompany such accounts.

The book opens with a description of treating an injured hiker who had fallen from a trail in the Columbia Gorge National Scenic Area. “As Jim lowers me into the abyss, I also have to haul down the stretcher and medical bag, as the brush is too thick and entangled to drop the gear down on a rope. So in addition to keeping myself upright, bushwhacking backward down the hillside, and trying to watch for the upcoming cliff edge, I am dragging the stretcher. Wiry vine maple branches reach out, grab the stretcher, and pull it back up the hill. As I tug, the vine maple fights back and tears my shirt. Finally, I yank the stretcher with all my might. It pops free, slides another ten feet, and nearly bowls me over. The rope goes taut again: Jim’s got me.”

This tense, active opening leads immediately to background about emergencies, adventure sports, and descriptions of the rugged landscape around Hood River County, Oregon, where the author lives. An emergency room physician and a member of the Crag Rats (the first official volunteer mountain rescue group in the nation), Van Tilburg details his mountain rescue work season by season, describing operations he participated in, such as skiers floundering in tree wells, hikers falling off cliffs, mountain bikers soaring off hillsides, cliff jumpers suffering back fractures.

The account includes detailed information about how mountain rescues are conducted, neatly inserting this information into the narrative so that it feels nothing like a text book or a how-to. Each of these operations requires flexibility, training, judgment, and caring. The reader comes away impressed with the dedication of Van Tilburg and his colleagues, as well as the toll it sometimes exacts on their family and professional lives. The book highlights the tensions of fitting mountain rescue work into the rest of his life, taking time away from his daughters, his wife, his career, and his own outdoor adventures, while giving his life a meaning and purpose that is compelling.

The book’s seasonal organization doesn’t provide much in the way of narrative direction. You don’t feel that the rescues, emergencies, and personal challenges will add up to something greater or will yield deeper insights. Instead, the book seems embedded in the point of view of the author himself, who reacts to these emergencies and doesn’t seem to have time to put them into a wider context, because his beeper keeps going off.

The exception to this is the chapter on the most recent Mt. Hood tragedy, in 2006. Van Tilburg participated in the rescue and gives a clear, informative account of its progress, much more analytical and reflective than the overheated hyperbole that appeared in newspapers, magazines, and television. Though he doesn’t directly criticize the three men’s decision to climb a difficult route on the north side of the mountain with a storm coming in, he makes it clear that their fast and light approach didn’t leave much margin for error, especially given the severity of the storm.

When he returned from the rescue, his daughters, six and eight, bombarded him with questions about it and its aftermath: three men dead, one of them, Kelly James, leaving four children behind. The author answered them simply and directly. “The mountains are not necessarily dangerous,” I say to them. “You just have to learn to be careful. You have to respect nature and the mountain.”

There is much distilled wisdom in that answer. Moments like this give the book its authenticity and poignancy. You come away impressed with Van Tilburg’s knowledge, practicality, sensitivity, and appreciation for the pleasures as well as the dangers of mountaineering, convinced that he’s the kind guy you’d want to call if you ran into trouble in the mountains.

Nicholas O’Connell