How Physicians Care for Patients in the Most Isolated Place on Earth
When physician Dale Mole stepped off the C-130 turboprop plane that had landed at the South Pole in January 2012, he felt a twinge of disappointment. It was only minus 25 degrees Fahrenheit. Granted, it was summer—but he had expected worse.
“The average winter temperature is minus 85,” he says. As the weeks and months passed, however, the thermostat dropped as low as minus 107. Mole’s exhaled breath would freeze in mid-air; no one dared leave bare flesh exposed more than 10 or 15 seconds; teeth would ache for hours after exposure.
Once, as Mole was cresting a snow bank, his face mask froze. “I had to remove my mask to breathe and the super-cooled air felt like ice daggers in my throat,” he says. “I was afraid my windpipe was going to freeze, which could prove fatal.”
In Antarctica, the coldest and most isolated place on the planet, even the simple act of breathing becomes an endurance test. Home to three permanent U.S. expedition outposts—McMurdo Station, Amundsen-Scott South Pole Station, and Palmer Station—it’s inaccessible eight months out of the year due to oppressive weather conditions. Researchers from a variety of countries fly in with the knowledge they’re about to be effectively cut off from the world.
But what happens when a medical situation arises? More than 2800 miles from the nearest hospital in New Zealand, Antarctic crews must rely on the expertise of a single physician responsible for upwards of 150 people. (The number varies by season.) Working autonomously, the doctor is charged with analyzing x-rays and blood work, providing aftercare, overseeing pharmaceutical duties and even performing dentistry. Serious conditions that could be managed in a major facility become radical emergencies. Surgery is a major undertaking, and intensive care can’t be sustained.
Such adversity is not for the claustrophobic or easily shaken. But for Mole, volunteering was academic. “I signed up,” he says, “because I wanted the challenge of providing medical care in the most remote and austere environment on Earth.”
The Right Stuff
Scott Parazynski, M.D., had spent 16 years in NASA's astronaut corps and was an experienced mountaineer when the offer came to become Chief Medical Officer overseeing healthcare for the National Science Foundation’s U.S. Antarctic Program (USAP). Having tended to climbers all the way to the summit of Mount Everest, he was familiar with the psychological and physical demands of practicing medicine without a net.
“It takes a really broad skill set,” he says. “I call it MacGyver medicine. What can you do to diagnose and treat conditions in a really remote environment when the chips are down? You have to invent solutions on the fly.”
Physicians who volunteer typically have backgrounds as surgeons or emergency room veterans. When Parazynski selected former submarine medical officer Mole to go to the South Pole, the 63-year-old underwent a rigorous screening: an EKG to assess cardiovascular health, an ultrasound of the gallbladder to rule out any simmering problems, and a psychological test.
“Some of the items I remember from visiting the doctor in the 1950s,” he says. There was a World War II embalming kit, a straitjacket, and glass syringes with reusable needles. “Some of our lab equipment was also designed for use on animals, but was perfectly suitable for humans. The x-ray unit was the portable kind used by veterinarians, but it worked.”
Ventilators, ultrasound, and critical life support devices are also present, though luxuries like an MRI device would be cost-prohibitive owing to the small population. “You’re relying upon clinical judgment and your resourcefulness,” Parazynski says.
Because the Antarctic workers are carefully screened for any major conditions, Mole and other physicians frequently find themselves treating conditions common to any industrial environment: slips, common colds, and lacerations. The plummeting temperatures and non-existent humidity also give rise to dry skin conditions and respiratory ailments. One, “the McMurdo crud,” is a hacking cough that tends to nag at patients.
Despite the cold, frostbite is not as common as one might expect. Mole saw only a few cases, albeit one that resulted in a patient losing part of an ear. Most injuries, he says, “were sports related, as many played basketball, volleyball and dodge ball on their off-duty time.”
Sean Roden, M.D., who stayed during the comparatively warmer summer months prior to Mole’s arrival, recalls that altitude sickness was a problem for many: Antarctic stations are 9500 feet above sea level. Staff and crew take Diamox, a drug that helps adjust the body’s chemistry to the environment, but it isn’t always effective. “I had a headache for over two months,” Roden says. “Everyone was just constantly short of breath, had a headache, had a hard time sleeping. You get winded just brushing your teeth.”
Summer also invites a scourge of insomniacs, with the sun refusing to go away and inhabitants putting up blackout shutters to try and cope with the irregular seasons. “People were walking up and down hallways, not really awake, not asleep,” Roden says, “like zombies.”
When Doctors Get Sick
It’s a hypochondriac’s worst nightmare: alone in the Antarctic, with the lone physician too ill to care for anyone else. Modern screenings have reduced that possibility, but the area has been home to a series of legendary crises.
Some countries require their doctors undergo an appendectomy to ward off the potential for appendicitis. If that seems excessive, consider the case of Leonid Rogozov, a Russian physician who diagnosed himself with a swollen appendix during a 1961 expedition. Trapped in the Austral winter with no flights in or out—the harsh weather can prevent aircraft from functioning properly—he deputized a few researchers to be his surgical assistants and cut out his own organ using only local anesthesia. He recovered in just two weeks.
In 1999, Jerri Nielsen discovered a lump in her breast. She performed a biopsy using only an ice cube to numb the area; upon discovering a cancerous growth, she had drugs air-dropped to her until she was able fly out for treatment.
If anything similar were to occur today, physicians would have the benefit of teleconferencing with colleagues. “We can look remotely in someone’s ear, eyes, listen to their heart, share views of ultrasound or EKG tracing,” Parazynski says. “We can look over their shoulder and be part of the decision making process.”
That assumes, however, communications are working. Mole says Internet access was available only a few hours at a stretch. Without it, “You rely upon textbooks you either brought with you or were available in the small South Pole medical library.”
Much of a physician’s time is spent in preventative preparation, training staff in the event of an emergency. During his stay, Roden orchestrated the medical evacuation of a crew member who had fallen ill with a neurological issue more than 400 kilometers from base. “We had rehearsed it in a drill, so we were prepped for it.” (The patient recovered and returned to work.)
Off-duty, Roden says numerous groups were devoted to salsa dancing, knitting, or Doctor Who viewing parties; Mole read, ran four to six miles a day on the treadmill, and ventured outside sporting at least six layers of insulation—anything to stretch out from his cramped 6 x 10-foot living quarters. He says he experienced none of the depression that can result from a lack of sunlight for months at a time.
“Being at the South Pole was like living on another planet, one with only one day and one night per year,” he says. “There was always something unique to experience, so I was never bored or felt an overwhelming desire to leave.”
Breaking the Ice
After 10 months, Mole saw his first plane, thought of his wife, and breathed a sigh of relief. With winter over, he was able to return to the States in November 2012. During his tenure, he had attended lectures on art history, cared for a group requiring everything from dentistry to physical therapy, and trained non-medical staff to provide critical care in the event of an emergency.
Roden’s four-month stay was a kind of sensory deprivation. Back home, life had gone from being a blinding sea of white to glowing Technicolor. “Coming off the ice, seeing a sunset, the colors were just, wow,” he says. “Getting back to sea level was amazing. I felt great.”
Such experiences are more than an endurance test: they help inform future remote care in environments as varied as rural America, third world nations, and even Mars. Advanced handheld diagnostic tools, Parazynski says, are already on the way. “The notion is to develop a device that would have the diagnostic capabilities of a full lab in a major hospital. Not overly prescriptive, just basic physiological parameters, blood chemistries. It will help revolutionize healthcare in remote and in regular health care.”
While the efforts of Mole and other physicians are a valuable learning tool for future explorers, it’s the physician who may benefit the most. “The months of profound darkness, the majestic starry skies, the shimmering auroras, the icy desolation, going to bed at night a few feet from where all the lines of longitude converge …” Mole trails off. “These are the memories I will carry with me to my grave.”
This story originally appeared in 2015.