Doctoring on the ice

This post may be most interesting to my medical colleagues.  But feel free to read if you'd like. 

The McMurdo General Hospital was built by the US Navy in the early 1970's.  It has since switched management to the NSF (National Science Foundation).  The building still has much of it's original structure and doors though thankfully most of the equipment has been updated.  It 's in a central location in town and though people don't necessarily drop by socially, they all know where we are and access is free for anyone on station.  We are open 6 days a week, no appointment needed though can be helpful in the busier summer months.

As the Lead Physician here at McMurdo, my primary task is to manage the health of the workers.  That includes employees of the ships that periodically come through and Scott Base (New Zealand's nearby base) when they need more than first aid.  In order to deploy here, everyone has to go through an extensive medical and dental evaluation and they have to physically "qualify" to be able to work and be here.  This process is more stringent in winter compared to summer due to the more severe weather conditions and less staff (including medical) to be able to help to survive the harsh environment.  One of the biggest factors in medical is that we cannot get patients to a higher level of care (like a hospital) in a timely fashion.  We don't have any airplanes permanently here on Antarctica.  Any planes that do fly down come from Christchurch, New Zealand which is a minimum 6 hour flight.  And that requires weather conditions that are conducive to flying and our airfield has to be adequately prepared.  In other words, if we have a serious medical condition that requires more than what we can offer, they may not survive the wait to have a plane fly down and also fly them back to New Zealand.

Our trauma bay with ventilator, cardiac monitor with pacer and IV drips

Needless to say, this causes me some stress and worry.  I want to be as prepared as possible for any and all health related situations a patient may find themself in.  Because I'm not trained in Emergency Medicine, I haven't worked in an Intensive Care Unit and am not a surgeon, I have to rely on the training I got in medical school and residency.  So I've been brushing up... a lot.  The team that was here over summer was more robust with a couple nurses, a flight surgeon, a dentist and some other team members in addition to the lead doctor and PA.  I overlapped with some of them for my first week here, so had them orient and teach me as much of what might be useful as possible.  In winter, there are just 2 of us.  My PA had previously worked as a flight paramedic so he's comfortable with some of the procedural things that I'm a little rusty on.  But of course I want to be as proficient as I can be.

In my office enjoying some kiwi freshies

Specifically, I'm trying to review things like ACLS (Advanced Cardiovascular Life Support), how to intubate, IV hydration, drips and procedural sedation.  Thankfully I drew a fair amount of blood while working in Alaska so I can locate a vein and should be able to start IVs.  I feel competent about managing simple fractures and can reduce small fractures if needed, larger fractures or dislocations may be more challenging.  Managing pressors or antiarrhythmics are not in my wheelhouse so I'll need cardiology guidance which theoretically we have from UTMB in Galveston, TX.  And if we need a Medevac, a medical team from Christchurch will come down on the plane and accompany the patient back to Christchurch since neither myself or my PA can leave station.      

On a daily basis, we manage simple things like colds, scrapes and sprained ankles.  Sometimes there are more exciting things like a fish bone stuck in someone's throat that we were able to visualize and remove.  We can draw blood, run some labs and take x-rays.  I've had limited training on this but thankfully there are robust books and manuals available on how to run the machines.  There's ultrasound which my PA has taken to well and I'm dabbling in a bit.  We also have x-ray in dental, I figure as long as we can point and shoot at the ailing tooth, we may be ok (??).  In theory, there are specialists back in the US available by phone and even VTC (video teleconferencing) if we need them.

Our simple x-ray room with an older machine (yellow) and the newer but broken one off to the side

Dental is a space I'm definitely not comfortable in since that's not something I've ever been taught.  Anyone I've seen back in the US with a tooth problem in primary or urgent care has been referred to see a dentist.  Since there won't be a dentist here at McMurdo until summer, anyone with a toothache is now my problem.  I should be able to distinguish between an infection or a cavity.  An infection I can handle.  But I'm also expected to drill and fill cavities when plausible, recement crowns.  We have a bunch of human teeth to practice on (!!), it's quite something.  I think I'll be able to do some simple repairs, at least get the patient through until they can fly up to New Zealand for more proper treatment.  But yikes.

Our dental suite, makes me nervous just thinking about it

There are many unknowns but I have to trust that we have enough medical knowledge and experience to get us through this winter season.  Though a lot is on my shoulders, there is remote support and everyone wants the best for the patients here.  As the days get darker, I pray that we are able to stay clear about our objectives and do the best we can with the limited resources available.  It's a demanding process and I need to be up for the challenge.

Collection of old medical equipment