Surviving Medicine Stationed in the vast expanse of Antartica, Rob Conway reflects on the tough judgement calls that are a constant feature of life as part of an expedition rescue crew

It is summer here in Antarctica, though the temperature still hovers at minus 30 degrees Celsius. As I open the door I am struck by the bitter cold, and a view that stretches across the world’s largest ice cap. Unsurprisingly, the journey here was a long one, via London, Madrid, Santiago and finally Punta Arenas in the southernmost tip of Chile.

The emergency call comes in at 10pm. I pull on my giant insulated boots before heading over to the communications hut where I find that an expedition team has called in asking for a pick up.

The satellite phone rings and I answer: a few beeps, then a voice, slurred and distant. “Is that the doctor?” The voice on the phone in- forms me that his team member has been vomiting blood. At 89 degrees south, they are more than 900km away, and about 100km from the geographic South Pole.

Alarm bells ring. In my experience, it is not until you are put in position of genuine danger that you realise how alone you are. And here in Antarctica, you are not only a long way from help, but invariably at altitude.

Still on the phone, I continue to take a medical history. Might the blood be from repetitive retching? Is this simply down to exhaustion? We agree that they should pitch camp and further assess the situation before calling back.

Sometimes you have to act quickly. Recently a climber lost consciousness and was unable to breathe; had I not immediately opened his obstructed airway, he would have died. At other times the best course of action is to stand back and take stock. Expeditions are inherently risky, but an unnecessary pickup flight in Antarctica has the potential to do more harm than good. Although accidents here are extremely rare, they are almost always serious: last season a crew of three was killed when a cargo flight crashed.

The phone rings again. This time it is the expedition leader, calling for an immediate evacuation. It is hard to know what is happening on the other end of the line. Experience tells me that expeditions often budget only a small amount of emergency supplies, and tend to be so determined to complete their goals that they sometimes ignore ailments until they have become critical.

The patient eventually comes to the phone. She sounds afraid as she tells me about the blood she has been coughing up. I have checked her medical file, which is unremarkable; but on further questioning it transpires that she has a history of stomach ulcers. Although I believe the blood is due to repeated vomiting secondary to exhaustion, I cannot be sure it isn’t something more sinister. We need to get her.

I activate our emergency protocol. The pilots are notified, as is the science base at the pole – the Amundsen-Scott South Pole Station – that can be called upon in life-threatening emergencies. They have facilities to stabilise the casualty if she continues to bleed, and she is currently closer to them than I am to her. I stash the bags of intravenous fluids inside my jacket to stop them freezing. Climbing the ladder to board our Twin Otter ski plane, I double-check my own emergency gear: tents, food and supplies in case bad weather strikes and we are forced to camp. The cabin is cold and unpressurised, making the eight-hour flight – including a refuelling stop on a remote and uninhabited ice runway – uncomfortable at best.

As we near the team’s last-known coordinates, the pilot spots a red flare against the glare of the white snow. There is no runway here, just ice, and my heart jumps as the skis touch down with a thump. As I disembark I find the team packing up camp. If this was the life-threatening bleed I dreaded then surely there would be more urgency? Not taking any chances I help the patient into the aircraft and insert an intravenous drip to address her fluid loss and deliver medication. She looks exhausted but relieved.

As the engines fire up she lies on the stretcher and I monitor her vital signs continuously on the flight back to base. Once there I assess her; luckily today there is no evidence of further bleeding. By chance there is a flight from the mainland arriving in a few hours, and I manage to evacuate her to Chile with a referral for further management.

It has been a long day. I am providing medical support for a number of expeditions heading out over the coming days, most scattered across the vast ice cap, but some setting out to climb Mount Vinson, the highest mountain in Antarctica. In the morn- ing I know there will be a queue of people asking advice or seeking treatment; so I climb into my tent on the glacier, 15,000km away from home, to catch some sleep before my next patient arrives.

Words: Rob Conway
Illustration: Robert G. Fresson

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