|  Our skills and works are but tiny reflections of the wild world that is innately and loosely orderly. There is nothing like stepping away from the road and heading into a new part of the watershed. Not for the sake of newness, but for the sense of coming home to our whole terrain. Off the trail is another name for the Way, and sauntering off the trail is the practice of the wild. That is also where paradoxically we do our best work. But we need paths and trails and will always be maintaining them. You must first be on the path, before you can turn and walk into the wild.
Gary Snyder One of the least discussed aspects of wilderness or survival medicine is the need for communication between the caregiver and the patient, especially in situations that appear frightening and desperate. In addition, depending on where you are when emergencies arise, this communication may have to take place across cultural boundaries as well. The following books deal with these issues in ways that I have found particularly helpful or interesting.
 Eric J. Cassell, Talking With Patients (Cambridge MA: The MIT Press, 1985), Volume I, The Theory of Doctor-Patient Communications, ISBN 0-262-53055-4; Volume 2, Clinical Technique, ISBN 0-262-53056-2. The author transcribes and analyzes real-life conversations between doctors and patients, demonstrating that patients and doctors sometimes appear to inhabit different planets. However, the books do show how it is possible to decode even the most rambling and garbled patient communications in order to understand what the patient is really trying to convey.
 Kaye Boyd Dernocoeur, Streetsense: Communication, Safety, and Control (Redmond WA: Laing Research Services, 1996), ISBN 0-938106-21-X. This book is written for urban street medics, and therefore contains material of marginal relevance in the wilderness, such as how to subtly frisk your patient for weapons while performing the physical exam. But the sections on patient communication, scene safety and control, techniques for physical and emotional self-preservation, and the psychological impact of trauma on both patient and caregiver are all first-rate.
 Anne Feldman, The Spirit Catches You And You Fall Down (New York NY: Farrar, Strauss and Giroux, 1997), ISBN 0-374-26781-2. This book is about a three-month-old child of Hmong immigrants to the United States who starts to have epileptic seizures, followed by a series of tragic cultural miscommunications, based on different ideas about the illness and its meaning, even though everyone involved both parents and doctors has nothing but the best intentions toward the child. The Hmong see illness and healing as spiritual matters linked to virtually everything in the universe, while the medical community marks a division between body and soul, and concerns itself almost exclusively with the former. The child's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness qaug dab peg the spirit catches you and you fall down and ascribed it to the wandering of her soul. The doctors prescribed anti-convulsants; her parents preferred animal sacrifices. This is a remarkable book about an almost total failure of medical communication across cultural lines.
 Geri-Ann Galanti, Caring for Patients from Different Cultures: Case Studies from American Hospitals (Philadelphia PA: University of Pennsylvania Press, 1997), ISBN 0-8122-1608-3. What happens when a Cherokee patient summons a medicine man to the hospital? Why do Asian patients rarely ask for pain medication, while Mediterranean patients seem to seek relief for even the slightest discomfort? If a member of your wilderness team is a Mormon, a Seventh-Day Adventist, or an Orthodox Jew, how might that affect the medical care you can give? This is a basic text, full of interesting stories about the ways that healthcare workers from different cultures in American hospitals both understand and misunderstand what their patients say and what their patients need.
 Robert T. Trotter II, et al., Curanderismo: Mexican American Folk Healing (Athens GA: University of Georgia Press, 1997), ISBN 0-8203-1962-7. A sympathetic account of curanderismo or Mexican American folk medicine, a non-biomedical healing system, with its own coherent point of view deeply rooted in native Mexican healing techniques. This is the first book to describe the practice of curanderismo, and its interaction with contemporary medicine, from an insider's point of view, based on the authors' three-year apprenticeships with curanderos.
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