• Anaesthetics

No waiting room, no on-call bleep, no inpatients and no clinics. No nursing staff and, in fact, no medical colleagues at all. No CT scanners, no MR scanners and only the most basic of x-ray machines (you will be developing your own x-rays in the bath). No lab, though there is an old microscope in the cupboard that looks as if it was last used by van Leeuwenhoek. No surgical colleagues, though beside the microscope you have seen a burr-hole kit, to which some joker of a predecessor has added the label: “Not to be used in anger.” No internet access and no telephones apart from a spine-shiveringly expensive US-military-maintained satellite phone system. Welcome to practising medicine in the Antarctic.

To be true, there are not many patients either. Fourteen, if you count yourself, and so the likelihood of needing any equipment more comprehensive than that outlined above is fairly slight. In terms of neurological skills, you are unlikely to need to localise a lesion to the medial longitudinal fasciculus using diagnostic acumen alone, and as the neurosurgeon who gave us predeployment training in the use of the burr-hole kit said: “If you're unwrapping this kit down there, the patient's gubbed anyway, so you might as well have a go.”

Training as a medical officer for this job involved being sent for six idyllic months to Derriford Hospital in Plymouth, to be supernumerary and learn whatever it is that you feel you need to. What you will likely need is orthopaedics, dermatology, ear, nose and throat, a little ophthalmology, a lot of General Practice, genito-urinary medicine (for the sailors you will meet as ship's doctor on the way down, rather than the Antarcticans themselves) and a lot of common sense. After two weeks in theatres the anaesthetists at the Derriford will have you administering short simple general anaesthetics, using only the old mechanical ventilators and volatile anaesthetics available down south, along with large doses of morphine. The surgeons will happily teach you to put traction on a femoral fracture, or whip out an appendix. But most Antarctic doctors never need to worry themselves about any serious eventualities at all.

So if hardly anyone gets sick, what will you be doing? Well, that is up to you. In the short summer period there are science projects and logistics, field parties coming and going, and all of them looking for volunteers to help out. You will be organising and replenishing field medical boxes, as well as the major incident stores secreted around the base in case of large-scale emergency. At a bigger base, for the peak of the summer season, you might even find yourself having to run a small primary care clinic every morning. But for the bulk of the year, and especially for the overwintering period when personnel numbers are down to a minimum, you will be looking for alternative occupations. For my base, this period lasted 10.5 months.⇓⇓⇓⇓

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Figure 1

Emperor penguins in summer.

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Figure 2

British Antarctic Territory coat of arms.

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Figure 3

The author with some of his new patients.

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Figure 4

Map of Antarctica.

I ended up as an assistant aeroplane mechanic, refuelling and tying down planes at the end of each busy flying day, as well as taking a series of breathtakingly beautiful copilot flights over limitless immensities of ice. I finished my year as an aficionado of waste-management, and can now rivet lids onto waste drums faster than a ship-building panel-fitter on speed. I learned a language (those Linguaphone courses really can work if you go somewhere with few enough distractions), wrote a book and became pretty quick at cross-country skiing. I learned to drive bulldozers and service diesel generators. I also spent an enormous amount of time with emperor penguins who had a colony close to the base, and followed their year through the months of total darkness, and months of perpetual light. That there was at least one other species that shared that place, and that extraordinary winter, was at times a great source of comfort.

Antarctica is special because of its extremes—extremes of cold, of distance, of wind, of elevation and of light and the absence of light. It is the latter that gave rise to some of my most memorable experiences—the astonishment of the aurora, the stillness of −55°C, the peace, on firewatch nightshift, of being the only human being awake for hundreds of miles in any direction.

The winter darkness also gave rise to the only neurology I practised there—a neuroendocrine study of circadian rhythms, and how quickly they can be entrained following a 12 h switch in body-clock. During our 3 months of darkness there was so little light on base that our pineal glands were oozing melatonin ‘night’ and ‘day’. Some of my fellow base members began free running to a genetically ordained 23 or 25 h rhythm, rather than the celestially ordained 24. I had various attempts, with various degrees of success, to keep them all on track with the use of supplementary light boxes. For those who are interested, take a look at the work of Professor Jo Arendt at the University of Surrey, with whom this work was published.

But at the end of it all, after more than a year on the ice and 18 months away from home, I returned to medicine in the UK. Because of my work in the Antarctic I probably know more than the average general practitioner (GP) about delayed sleep phase syndrome, and the uses and abuses of melatonin. I might even know a bit more about cold injury and the effects of ultraviolet light on the eye. But more than these I learned about the tenacity and simplicity of the lives of emperor penguins. I learned about the feel of sun on your skin after 15 weeks of darkness. I experienced the purity and silence of a landscape with nothing in it of the human. And it was these latter discoveries that made it all worthwhile. Gavin Francis is a GP practising in Edinburgh. He is a former Medical Officer of Halley Research Station, Caird Coast, Antarctica, and the author of True North—Travels in Arctic Europe (Polygon, 2010) and Empire Antarctica—Ice, Silence & Emperor Penguins (Chatto & Windus, 2012) www.gavinfrancis.com.