Abstract
Paul S. Auerbach is often called the father of wilderness medicine. Sometimes it annoyed him. “I get a lot of credit for wilderness medicine, but that’s not fair. I am just the tip of the iceberg. There are so many people doing incredible things out there.” (WMS Fireside Chat—Paul Auerbach: Maintaining Joy in Medicine,
Dr Auerbach was born in New Jersey and educated in the eastern United States before making California his family’s home and becoming an educator, researcher, writer, speaker, entrepreneur, adventurer, environmentalist, and healthcare leader. His 56-page curriculum vitae demonstrates the breadth of his extraordinary accomplishments, but for his family, friends, colleagues, students, and mentees, he was much more than a list of activities. It was his friendship, support, and endless devotion to making the world a better place that will be his greatest and most enduring gift.
Months before he died, he talked about his mission: “Bravery, compassion, and fun—when I look back on my career, and why I became a doctor, those were what was important at the beginning and are the most important at the end.” (WMS Fireside Chat—Paul Auerbach: Maintaining Joy in Medicine,
Fun
The motto of the Wilderness Medical Society (WMS) is “Combine your profession with your passion.” It is no surprise, then, that Paul helped found the organization; the motto sums up his approach to life. He sought joy in everything he did, combining adventure and curiosity in every project. “We need happiness measured in hugs, handshakes, and smiles… a sense of newness and wonder. We need a learning environment. Discovery. Companions and friends. Mates. Loves. Days in the wilderness or at least outside.” (WMS Fireside Chat—Paul Auerbach: Maintaining Joy in Medicine,
Dr Peter Hackett described Paul’s personality: “He was charismatic, focused, full of positive energy and confidence, unstoppable, and certainly unforgettable. He was a person hard to refuse and easy to love. Sometimes, like an avalanche, it was hard not to be overwhelmed by him. His energy was contagious. If Paul was involved with something, like a bike trip to Bhutan, a trek in the Alps, starting a hospital in Nepal, writing an article or book—whatever it was, if Paul was doing it, you’d want to be part of it.”
Dr Auerbach’s wilderness medicine accolades were well deserved: In 1983, along with Drs Ken Kizer and Ed Geehr, he founded the WMS and, with Dr Geehr, wrote its first textbook, Management of Wilderness and Environmental Emergencies (now Auerbach’s Wilderness Medicine, in its seventh edition). He was also the founder and first editor of the academic journal Wilderness & Environmental Medicine, from 1990 to 1995. In addition, he conducted early wilderness medicine research and, unable to entirely suppress his ironic sense of humor, wrote about farting, officially naming that disconcerting, gaseous mountaineering condition high altitude flatus expulsion (HAFE).
Paul was always looking for another adventure. He never seemed to sit still. “When I would bump into him at meetings, I often had trouble carrying on a long enough conversation because he was off for this bike ride or this great hike in between all of his official responsibilities,” said Dr Andrew Luks.
Dr Ed Geehr remembers the young adventurer: “Way back in the 1980s, I took Paul cross-country skiing for the first time. He did fine until the track began to turn, but then he plowed right through the trail, heading for the tree. Just before impact, he tucked his shoulder down and managed a forward flip. His skis catapulted up over his head (‘I thought I might be able to take out the tree,’ he explained later). One of his skis hung up in the branches of the tree, suspending him upside down, laughing. It took quite a while to disentangle Paul from the tree.”
Past WMS president Dr Robert “Brownie” Schoene remembers: “I first met Paul back in the 1980s. That first day, I thought with his big talk and enthusiasm that he was full of hot air. By the end of that meeting week, I realized that he was the real deal. Over the ensuing years, he not only continued to accomplish Herculean tasks with zeal and success, but he was a dedicated friend who never judged. Besides, he was a hell of a lot of fun…”
Even the respected leaders of the WMS were not safe from Paul’s play. Dr Luanne Freer, former WMS president, recalled: “Dr Auerbach talked all of the past presidents of the society into publicly posing for a photo wearing silly temporary tattoos. It was Paul’s idea to start the ‘tradition’ of WMS presidents posing together in semi-nude, risqué photos with their personal parts obscured by nature; he then projected these photos in his lectures to audiences of thousands, to the chagrin of those so coerced.”
Bravery
That Paul was brave is a given. He did all kinds of things that most people would consider crazy—adventures on land and undersea, rescues (of himself and others), and working in the most stressful environments worldwide. His son, Danny, recalled a childhood incident: “We were driving down the highway going to a Little League game, and we saw a car that was flipped over. Dad pulled over and called a coach to get us. He showed up later at the baseball game, his arm all wrapped up in gauze. He’d crawled through the back window, cutting up his arm to save the guy in the car” (“Paul Auerbach, wilderness-medicine pioneer, dies at 70,”
But there is far more to bravery than not fearing injury or death. To be brave is to overcome fear of failure, self-doubt, criticism—to find a purpose and, despite all the passive resistance and active opposition, fight to make it real. That was Paul’s approach to life. “We’re all going to make mistakes. If mistakes render you immobile and disturb you so badly that you can’t carry on, you’re not going to get very far. You have to spot them, admit them, and then move on.” (Michael Killen podcast, Impact of Air Pollution on Human Health: Part 2, August 6, 2020,
His emotional, physical, and moral bravery led him to amazing and diverse accomplishments. Paul graduated magna cum laude from Duke University with a degree in religious studies, received his MD from the Duke medical school in 1977, and completed his emergency medicine training at UCLA in 1980. He immediately began a career in academic emergency medicine while continuing his passion for the outdoors. In 1981, Dr Auerbach joined the emergency medicine faculty at the University of California, San Francisco, School of Medicine. Two years later, still junior faculty, he teamed up to start an entirely new medical specialty.
He left academic medicine for the private sector for a decade, between 1995 and 2004, serving as an executive in major corporations such as Sterling Health, MedAmerica, and KAI Pharmaceuticals, as well as a venture partner for an investment firm in Menlo Park.
Dr Auerbach had an unparalleled career in academic emergency medicine, spent mostly at the Stanford University School of Medicine and ending his career as the Redlich Family Professor Emeritus in the Department of Emergency Medicine. He served in national leadership posts in the American College of Emergency Physicians and the Society of Academic Emergency Medicine. He was a prolific and wildly diverse author—publishing 72 peer-reviewed studies in journals including the New England Journal of Medicine, JAMA, BMJ, and Lancet. He wrote 91 book chapters and almost a dozen books on wilderness medicine, business management, and climate change. He even wrote a novel and, in his spare time, penned popular health pieces for magazines including Reader’s Digest, Field and Stream, Family Circle, Prevention, and The Wall Street Journal.
His reputation as an educator and lecturer was reflected by hundreds of invited presentations worldwide to audiences ranging from laypeople to global leaders, in places as mundane as Menlo Park and Bethesda and as exotic as Kathmandu and Geneva.
Paul consulted for major corporations and worked with the World Health Organization, the World Bank, the Environmental Protection Agency, the Department of Defense, USAID, the National Football League, the National Ski Patrol, and Divers Alert Network. He was a member of the Explorers Club and the Council on Foreign Relations.
Compassion
“You’ve got to be compassionate. Always.” (Remembering Paul Auerbach, MD,
Charitable opportunities
Wongchhu Sherpa Memorial Hospital:
WMS Auerbach lectureship:
Paul often spoke of the importance of compassion—not in a sentimental or ironic way, but with a straightforward simplicity of purpose. He helped on a large scale: saving hundreds after a disaster, creating a completely new specialty that could save thousands, and fighting for environmental awareness. But it was really the little things he did that stand out—he served as the team physician for Stanford wrestling, coached his kids’ teams, and supported and mentored hundreds of students and young faculty.
“Anybody that needs my help on anything… I’m delighted to be able to try to help… I want to help. I’ve always wanted to help. …when you come to this juncture in life, it will be looking back on the people that you helped—that is what is going to give you some peace.” (WMS Fireside Chat—Paul Auerbach: Maintaining Joy in Medicine,
Paul was the consummate listener, and when he recognized authentic passion for a project, he opened doors for his mentees to help put them in the right place at the right time. Smiling like a proud father, he gently pushed (sometimes more of a jarring shove) a hesitant young colleague forward and watched them thrive. Paul once encouraged a new author to revise a manuscript for the journal that had been rejected by other reviewers: “Dr Auerbach strongly wished young researchers like me working in far-flung places like Nepal would write more and seek publication. Following his sage advice, that is exactly what I have been doing (and encouraging others to do) since that time many years ago in 1992,” says Dr Buddha Basnyat. Receiving a push from Paul was a real vote of confidence in one’s abilities. There are hundreds of us whose careers benefited from Paul’s selfless support.
But even Paul acknowledged that he was sometimes too passionate about a project, a bit of a hothead, and he could be very demanding of those he mentored: “He did not suffer fools and woe be the person who did not produce or take as strong of a position to advance an organization or support a patient as Paul felt was needed,” said his lifelong friend and past WMS president, Dr Howard Backer.
Dr Auerbach loved his patients and loved practicing medicine, even when he was not at work: “Paul was the world’s doctor. He would take the time to help any friend or acquaintance in need. No matter where we were, on the ski slope, at dinner, or on an international trip, Paul would receive calls and provide consultation or help with anyone or their family who had a medical problem,” said Dr Backer.
Paul’s desire to give back did not end with his mentorships and personal friendships but extended to those he had yet to meet. His focus was always on helping, and his work eventually turned to the world. “It’s just a question of how you can do the greatest amount of good for the greatest number of people. Cause the least amount of harm and just keep working that theme over and over again and just stayed centered…” (Michael Killen podcast, Impact of Air Pollution on Human Health: Part 2, August 6, 2020,
The 2010 Haitian earthquake changed his life. Recognizing the similarities between wilderness and disaster medicine, Dr Auerbach became a disaster responder for catastrophic earthquakes in Haiti and Nepal, where he shared his gifts for organization, inspiration, and leadership to galvanize teams of healthcare workers to help save lives.
Immediately after the 2010 earthquake, Dr Robert Norris, the chair of Stanford Emergency Medicine, asked Paul if he could lead a team to provide medical relief. “We have to go,” he responded, and left within days. With a small group of Stanford providers, he plunged into the horror and chaos of a shattered city with hundreds of thousands of dead and injured with essentially no one to care for them. “I didn’t train to do it; it just came naturally. For some reason, I’ve always been able to step back, and then when things get really chaotic and scary for other people, from a medical perspective, I generally get calmer.” (Remembering Paul Auerbach, MD,
Paul almost worked himself to death. “When we arrived two weeks later, I found him sprawled barely conscious on a pile of broken boxes with an IV in each arm in the courtyard of a crumbled hospital,” said Dr Tom Kirsch. “He propped open an eye, smiled wanly, and said ‘good luck.’” They had struggled in the oppressive heat, day and night, for two weeks with few supplies, among piles of bodies, trying to save as many lives as possible. Paul was at the center, coordinating, cajoling, encouraging. The experience almost killed him.
“When Paul returned from Haiti, he was definitely changed by the experience. Like combat, disasters have a way of changing people, some for the better, some for the worse. After he returned, some of the rough edges had been smoothed off. He was more introspective, more compassionate, more caring and more committed,” reported his lifelong friend and past WMS president, Dr Mel Otten.
As part of the International Medical Corps team, Paul returned to disaster response after the 2015 Nepal earthquake. Nepal was already a special place for Paul. He had led expeditions to the Himalayas and already understood the health struggles of the Nepali people. Responding to the earthquake was the start. Then, with Nepali physician Dr Rajesh Gongal, he helped develop and raise funds for the first ambulance service in Kathmandu (
His focus expanded during the last few years: He worked with the National Football League to design and build safer football helmets, and he became an outspoken communicator about the potentially devastating impact of climate change, writing a book, Enviromedics: The Impact of Climate Change on Human Health, with WMS past president Dr Jay Lemery. He was working on a project to create an organization to prepare US communities for climate disasters until just weeks before his death.
Paul died peacefully, surrounded by family, on June 23, 2021. He was 70. He is survived by his wife, Sherry, and children Brian, Danny, and Lauren.
Paul embodied bravery, compassion, and fun each day of his life. He was a force of nature, a positive power, a grinning, slightly goofy, scarily intense wilderness physician who made us all better people—always looking beyond himself to his family, his friends, the world. And in that Paul changed the world—from US national parks to Nepal, he made it a safer place for anyone who decides to step off the path and embrace the joy of nature, for the sick and dying in US emergency departments, for those suffering in the aftermath of devastating disasters. But what he really changed were people’s hearts. And minds. And purpose. He made us all just slightly better people than we could ever otherwise be—ever optimistic, always looking out beyond himself to the world. Seeking to make things better. Seeking the best.
Fellow Stanford Emergency Medicine faculty member Dr Grant S. Lipman described his impact: “One of the major life lessons Paul taught me was… that through a unique world vision, and belief in our own construct and purpose, we could create something novel and wonderful and magical, and will it into existence. I saw this through Paul’s words and actions too many times to count. His ability to grow, redefine, and create something new and poignant was amazing to behold.”
We must continue to advance his great loves of wilderness medicine, emergency medicine, and protecting the environment. But more important are the little things, the patients, the students, junior faculty, those who need healthcare even in the most remote parts of the world. We must follow Paul’s example and continue to nurture new generations who also want to make the world just a little better. In that perhaps we, too, can find the same joyous, unselfish love of a life well lived. That is all that we can ask for.
Consider honoring Dr Auerbach by making a donation to the Wongchhu Sherpa Memorial Hospital or the WMS Auerbach lectureship (see below).
