Virginia Eubanks, professor and investigative journalist, recently sat down with Jill Fisher, Professor of Social Medicine at UNC-Chapel Hill, to discuss how unexpected lessons from outdoor survival training informed her understanding of caregiving, trauma, and resilience. Drawing from her personal experiences, Eubanks shares the insights that inspired her latest book, A Guide to Open Water Lifesaving — exploring why caregiver trauma remains largely invisible and what it truly means to care for others in times of crisis. Those who were unable to attend can watch the Medicine/Pediatrics Ethics Joint Grand Rounds recording by accessing the UNC Center for Bioethics online video archive.
What was the moment when you realized that outdoor survival skills could teach lessons about caregiving?
In 2015, my beloved partner, J., was the victim of two violent attacks, the first just steps from our home. In the weeks, months, and years that followed, we struggled to stay afloat as we faced wave upon wave of setbacks: police disinterest, suspended health insurance, inadequate medical care, lost income, lost friends, endless paperwork, and, for J., a serious case of post-traumatic stress disorder. Five years later, I developed what is known as collateral PTSD, a condition common among caregivers but rarely discussed.
I found help in an unexpected place: an old open-water lifesaving manual. Inspired by its lessons, I signed up for instruction in wilderness first aid, kayak self-rescue, winter mountaineering, map and compass navigation, bushwhacking, lifeguarding, and more. This approach was largely intuitive and scattershot, but I found that the lessons I learned from outdoor survival were surprisingly germane to caregiving.
Which survival lesson surprised you most in its relevance to caring for someone experiencing trauma?
New York State Department of Environmental Conservation Forest Ranger Liz told me, “Rangers don’t rush. We have a saying: ‘Slow is smooth and smooth is fast.’ That’s how you can tell who the forest rangers are. We’re the ones moving deliberately when everyone else is running around in a panic.”
I asked her what advice she had for people lost in the wilderness. “Sit down,” she said. “If you know longer have clarity, stop doing everything, and just sit down…unless you’re about to get crushed by an avalanche, don’t move again until you are thinking clearly. Sit down, sit down, sit down.”
I didn’t expect a first responder to tell me that I should sit down until my cognition came back on-line. But it was a surprisingly apt lesson for caregiving: Don’t let the emergency set the pace of your response.
You discuss collateral PTSD among caregivers. Why do you think caregiver trauma is so often overlooked?
Family caregivers are asked to do the work of trained professionals without preparation, support, or resources. In this context, the cost of caring for kin is enormous: poorer physical health, lower earnings and wealth, and emotional strain. In fact, a 2015 study found that sixty days after a family member’s admission to the ICU, 23 percent of their primary caregivers met the clinical criteria for PTSD. The authors conclude, “From a psychologic perspective, to have a critically ill relative hospitalized in the ICU equals the experience of enduring and surviving an earthquake.”
There are 13 million people diagnosed with PTSD in the US right now – and 59 million kin are caring for adult family and friends. And yet, I felt as if I was the only person who had ever faced the kind of crisis we encountered after J. was attacked. It was so isolating.
Part of the blind spot around what’s known as “collateral” PTSD is undoubtedly about erasure – this happens to all exploited workers. But another part is social and more internal. Every time I tried to explain how much I was struggling, it felt like I was betraying J., who had suffered far worse harm. I felt both structurally necessary and like I was being asked to erase myself.
What role does self-care play in effective caregiving, and how has your understanding of self-care evolved?
I believe the outdoor survival training was so attractive to me because it allowed me to resolve controlled crises. It was just a broken arm! Just a capsized kayak! I had training – I knew what to do. I had a team supporting me. It was deeply calming.
There’s a lot of talk about self-care right now, and for good reason. But bubbles baths won’t fix a catastrophic care crisis, and self-care isn’t sufficient when you are being asked to shoulder a responsibility as an individual that is, in fact, a social and collective responsibility. What I learned from wilderness survival is that caregivers need competence – training, tools, and team – more than they need self-care.
The saying “no one survives the wilderness alone” appears central to your message. What does that idea look like in practice?
That was the most joyful surprise in researching and writing A Guide to Open Water Lifesaving. Everywhere I looked—on the tops of mountains and at the public pool and in the chapel crypt—I found more and more networks of care that had once been invisible to me. The forest rangers who will come find you if you don’t arrive back at the trailhead when you are expected. The marine radio and the culture that requires boaters to drop everything and respond if they hear a mayday call. The bushwhackers who carry extra maps for hikers whose cellphones die. The two and a half pound first aid kit I now carry every time I go out into the woods.
This is the kind of support that caregivers need and deserve.
This was your first time giving Grand Rounds. What was your experience like talking with this audience and spending time with people in the UNC School of Medicine and UNC Health?
I didn’t know what to expect; in fact, a colleague warned me that the room might be hostile. But that’s not at all what I found. I saw a lot of nods of understanding and fellowship in the room. Medical professionals and family are on the same team. We all want the patient – our loved one – to heal.