'Survivor David vs. Goliath': The Inside Story of That Shocking Season Premiere

Survivor-David vs. Goliath - Publicity - H 2018
Robert Voets/CBS

[This story contains major spoilers for the season premiere of CBS' Survivor: David vs. Goliath.]

Everyone enters Survivor understanding their time in the game will likely end before the final 39th day, but nobody could have anticipated the way in which the new season's opening round would send off the first one out: not through a vote at Tribal Council, but through a medical emergency.

The closing moments of the Survivor: David vs. Goliath season premiere pulled back the curtain on how the veteran CBS reality franchise operates, in harrowing fashion. Filmed in the Mamanuca Islands of Fiji, Survivor is shot across several closely clustered islands, necessitating transportation by boat for castaways and crew. Following their loss at the first immunity challenge, the David tribe boarded a boat to take them back to their camp on an island roughly 15 miles across the sea from the site of the challenge. Mere minutes into that trip, the David tribe's boat encountered rough waters, due to the turbulent weather conditions brought on by Tropical Cyclone Josie, a storm that claimed at least four lives in Fiji in early April.

During the ride, the David tribe's boat encountered a particularly bumpy stretch of sea, resulting in an impact that left property manager Pat Cusack with a back injury. His pain was severe enough that the boat turned around and returned to the challenge beach. There, Pat was treated by the Survivor medical team, a group led by Dr. Joe Rowles. Shortly after inspecting Pat, the medical team ruled the possible extent of his injury would require examination at a hospital — a decision that would necessitate his removal from the season. Despite protesting through the pain, Pat was pulled from the game.

Listen to the full story of Pat's evacuation in the final episode of "First One Out," in the player below.

The Hollywood Reporter was on location in Fiji during Pat's evacuation, albeit not at the exact site of the incident. The following morning, THR spoke with executive producer and host Jeff Probst about what occurred. The following four paragraphs constitute his account of events, lightly edited and condensed for clarity:

"We finished the challenge. It was a great challenge. The Davids lose. They're going to go to Tribal Council. It's dumping rain, sideways. Maybe the most rain we ever had in a challenge. As they're getting ready to leave, I asked Pat, 'What does this mean? You're the David tribe. This is how life goes, right?' And Pat says, 'Yeah, Jeff. The truth is, this tribe's going to lose an artery, but the heart will remain beating.' He walks off. It's a great way to summarize it. Someone has to go, but it doesn't mean the tribe will disband.

"They leave, and what happens next, in terms of the show's logistics, is they get in a boat and are transported back to their island, which is quite a ways away. We've been doing this since season one, when we only had five boats. We have never had a problem — until yesterday. They hit some hard waves, which rocked the boat, and jarred Pat so badly that his back really got messed up. It doesn't sound like much: 'OK, you hurt your back. Rub it out a little bit.' No, it really messed him up, so much so that the boat captain turned around and headed back to the challenge [location] where we still were.

"They got Pat off the boat and immediately put him in a stretcher. His pain was so bad that it became pretty clear pretty quickly that they needed to give him some morphine. It became clear to those of us watching from the outside that he wasn't going to continue. He didn't know that. He was struggling to even be conscious of what was happening. You could tell he was hearing you every so often, but mostly, it was the doctors saying, 'Pat, stay with us. Are you with us?' We were very much aware of his vital signs; we were monitoring them. The helicopter was already loading up and flying over to evacuate him. We got very lucky that there was a brief break in the rain where the chopper could land.

"Pat was trying his best to communicate through his oxygen mask, saying, 'Not like this. Not like this.' It was heart-wrenching. Pat wanted to play this game for forever, and you hear his story, which he told in the first few minutes of the episode … and you kind of wonder, does anything ever go right for Pat? He gets out here and he's the first person in the history of Survivor to get injured on a boat ride back to camp. It wasn't the game. It wasn't Tribal. It wasn't an alliance. It was just a freak accident."

Rowles, better known to Survivor fans as "Doctor Joe," also spoke with THR about the accident, stating there was no question in his mind that Pat needed to be evacuated from the game.

"When you see it, you'll understand why," he said. "It was fairly clear that he wasn't going to be able to continue. Anyone who sees it will totally understand. With the level of confusion he had, he wasn't able to make a rational decision about the game. At that point, our main responsibility is to Pat and to look after him the best we can. We were past the point of keeping him in the game. We had to keep him safe."

Pat is the second person in Survivor history to be the first player eliminated due to medical reasons. Kourtney Moon was evacuated in the season premiere of 2012's Survivor: One World after injuring her hand in the opening challenge. The list of castaways who have been evacuated from Survivor for medical reasons at other points in the game is vast. It includes but is not limited to season 19's Russell Swan, Bye Bye Man screenwriter Jonathan Penner, and veteran reality star Caleb "Beast Mode Cowboy" Reynolds.

In those three aforementioned examples, the evacuated players eventually returned to Survivor for second chances at the title. Speaking with THR in person in July, months after the accident, Pat made it clear that he wants a second chance of his own.

"I live by a motto right now," said Pat in an interview conducted at the Black Bear Inn in his hometown of Watervliet, New York. "There's been a lot of returning players to Survivor. I look at this season as God having a plan. It was destiny that I was put on David vs. Goliath. This is just one more path David has to take to reach the final goal. This season, I named it as the prequel to my sequel. I want to play again. I most certainly want to play again. I hope I get to play again."

He continued, "There's no doubt in my mind that if I had gotten back to camp that night? Gravy ain't the word. I was a cowboy steak loaded with mushrooms, onions, peppers, whatever you wanted. The game was mine. The game is built for me. But God said, 'Not yet. Not yet. You're going to prove to the world that if you want something hard enough, you go out and you get it — and even if you do get it, and it gets taken from you, you go back to get it. You don't give up. Dreams are dreams for a reason. Just because sometimes you feel that dream hasn't been fulfilled? There's always a bigger dream to dream. I dreamed of being on Survivor one day, and yeah, I was on Survivor. But I also dreamed about winning a million dollars. That dream has yet to come true. But with hope and faith, I'll at least get to a Tribal Council where I get to have my torch snuffed."

Pat said he was hospitalized for three days before returning to Ponderosa, the location in Fiji where players are sequestered before and after production begins. Contestants who are voted out before the jury phase of the game eventually embark on a short vacation before returning to the United States; Pat was healthy enough to join his fellow castmembers on that trip. He told THR he was back to exercising a week after the accident. Upon returning home, Pat learned he had mild spinal deterioration, common for someone in his line of work as a maintenance manager. The accident may have aggravated his condition.

"I'm going through some physical therapy to help strengthen the core and my spine, and to get some muscles rebuilt around my back," Pat said. "There's some disc deterioration that we're going to work on. Other than that? I feel great. I'm almost at 125 percent. I never want to be [only] at 100 percent; I want to be better than 100 percent."

As for the emotional damage of leaving the game under such drastic conditions, Pat, who had fantasized about playing Survivor since the first season aired in 2000, said his recovery began the day after the accident, while still in the hospital, thanks to a phone call he received from Probst.

"That's when it really hit me: This guy, Jeff Probst, filming season 37 of Survivor, is taking the time out of his day from his who-knows-how-busy schedule to talk to me," he said. "We talked for a good half hour, 40 minutes. As we were talking, I could feel myself coming to the light. I could feel myself climbing out of that hole."

At the time of Pat's exit from the game, climbing out of the hole remained an obstacle for the players still competing on Survivor — especially the David tribe, down a man, and one of their strongest men at that. (For his part, Pat insists that public defender Nick Wilson would have been voted out at the David tribe's first Tribal Council, if not for the medical emergency; the events as depicted in the season premiere seem to back that claim.) Due to the severity of the incident and the severity of the weather, Probst and the production team offered some assistance to the castaways in their struggle to weather the weather.

"Last night at about 3 a.m. we made the decision to send out an emergency fire-making kit," said Probst on the fourth day of filming. "We also sent a tarp with a note from me that says, 'This is unprecedented. Both tribes won fire, one by winning a challenge, and one by losing.' When you lose a challenge, you go to Tribal and get fire. [David] didn't get to Tribal, but they have fire, philosophically. In the spirit of the game, we always feel like you should have the chance to make fire. It would be too far to not even let you make fire.

"This morning, they received that package, and the note basically says, 'Use the fire-making kit to get the fire going. Use the tarp to stay dry until you don't need it. Then give it back to me.' In typical Survivor fashion, the note ends: 'If I have to ask for it, it will cost you more than the tarp.' There's an implied agreement that they deserve a break today, but they aren't getting the tarp for the rest of the run. This is Survivor. I fully expect they'll bring the tarp back at the next challenge, and if not, the one after that. We did this in Millennials vs. Gen X [in which the full cast was temporarily evacuated from the game due to cyclone conditions], and that's what they did."

Months after Pat's evacuation, and weeks after production on David vs. Goliath wrapped, THR returned to Fiji to observe the first few days of filming on the show's 38th season. In those days, Probst offered an update on how the weather ultimately impacted the outcome of season 37. In short: The storms kept coming. Indeed, an additional storm, Tropical Cyclone Keni, arrived in Fiji one week after Josie; its impact on the season will be revealed in the weeks ahead.

"The weather kept hitting us for a while longer, and it plays a part in the show," said Probst. "There were lots of nights where all of us were staying up. We're aware that they're living out there. The idea that they're alone is true, in that we're not going to intercede unless we absolutely have to. We all sit up at night and track the weather, worrying and wondering if we should make the call to do something. Do we evacuate? Do we send them a fire-making kit? We don't want to spoil their adventure, but we also don't want them to lose so much morale that they don't want to do it anymore. It's a fine balance.

"I was very impressed with how people handled it," he continued. "There was no complaining. Nobody was saying, 'What the heck, man? Are you going to come help us or not?' It was, 'This is our adventure. If help comes? Great. We'll take it. Because that means we need it. If help doesn't come? Then we don't need it. They're looking out for us.' It gives them the freedom to enjoy the situation, whether you want to call it an adversarial situation or an adventurous situation. Is it adversity or adventure? That depends on your approach to it. But I want players to know that if we're not coming, and the rain is dumping, it's because you're OK. Even though you're miserable, you're safe. If you see the boat show up? Then you're not safe. We're looking out for you."

The cast of Survivor will continue to weather the weather in the weeks ahead as David vs. Goliath rages on. Follow THR.com/Survivor for more coverage all season long.