Community: Life or Death

Food for thought for your Friday.

Back in 2002, I attended the annual convention of the Association of Clinical Research Professionals in Toronto.   Lots of keynote sessions and seminars and roundtables about the laws governing and best practices of carrying out research in human patients.

The one standout session was an address by Dr. Jerri Nielsen.  Dr. Nielsen gained notoriety in 1999 for treating her own breast cancer while stationed at a South Pole research outpost - during the Antarctic winter.

While a researcher herself, her talk wasn't about research.  Her talk was about life in some of the most extreme conditions ever experienced by people.

The research station buildings were all covered by an environmental dome as added protection from the elements.  Unlike most of the world that can travel almost on demand, travel is restricted for half the year at the South Pole.  You can't leave during the winter.  Aircraft can provide dropped supplies in an emergency but there are no landings.  Or takeoffs.  There's nowhere to go.  If anyone tries to travel outside the dome after the sun goes down, they're dead.  

Not uncomfortable.  Not inconvenienced.  Dead.

And their body won't be recovered until sunrise, if at all.

That means that the 40-odd people of all shapes and sizes have to get along with each other.  Conflicts ranging from the self-centered snit to the all-encompassing blowout had to be resolved to everyone's mutual satisfaction or they weren't going to survive.  You can't have "I win, I get my way, so you lose" as the standard for your conclusion.  You have to build true peace in the community even as there's disagreement or disapproval over the problem du jour.

Dr. Nielsen had lots of anecdotes about how to adapt.  Basically, she had to learn that the environment was going to change her life, no matter what man-made constructions had in mind.  She'd put some gear down in a particular place and, because of the snow underneath the building constantly compacting and shifting, the gear would end up sliding over to a wall.  After moving it around a few times with the same result, she decided to let the gear store itself where it landed because it wouldn't move any further.

Amundsen-Scott Station at the South Pole - how it looked when Dr. Nielsen was stationed with its crew.  A new station was completed in 2010 and the dome removed that same year.

  There were stress-relieving traditions that awakened with the polar sunrise.  The most daring souls joined the "200 Degree Club" when the outside temperature rose (!!!) to -100 degrees Farenheit.  It involved running  from a +100 degree room inside the complex, out the dome, a couple of laps around the ceremonial South Pole marker and back inside wearing only heavy boots and (for men) a blue baggie that comes with a bottle of Crown Royal.

A key element of the 200 Degree initiation.  The dome mentioned above is in the background.

It had to be pretty tense in there for anyone to think that was a good idea.  Dr. Nielsen shared that she was a proud 200 Degree member and did it without the Crown Royal baggie.

But the true test of the community's character came when Dr. Nielsen realized she had cancer and couldn't hide it from her crewmates.  It was winter and night - all six months of it.  The other crew members needed to help but none of them were oncologists or surgeons - how could they help?  Nielsen was the only doctor and was in the wrong place at the wrong time and the crew were the "wrong" people for a cancer patient.

Or were they?

First step was to communicate the medical emergency to McMurdo Station on the coast.  Messages were relayed up to the USA.  Medical supplies including IV kits, surgical kits and chemotherapy agents were airlifted.  (Remember, no landings for six months....)  Medical personnel were not part of the airlift; a communications relay was set up to talk the crew through the procedures Nielsen needed, from excising lymph nodes to hooking up an IV and hep-lock to mixing a chemo dose and adding it to the bag.

Step two:  decide who would perform the biopsy.  Of all of the PhDs and other advance-degreed personnel, which of them would perform the most difficult part of the treatment.  None of them.  Because in their minds, the PhDs weren't qualified.  The minor surgical procedures attempted were performed by a welder from the machine shop.  Said Dr. Nielsen, "A welder knew best how to take a material apart and put it back together again."  They could follow verbal technical directions and pick up new hands-on techniques on the fly.  It's so simple that it's not obvious to anyone who isn't living under life-and-death conditions.

Nielsen wasn't passive in all of this.  She was the team's doctor.  Her morale, her choices in how she mentally dealt with the situation had downstream effects on the psyche of every other member of the team.  She described her self as "introverted", shy, even "mousy".  She had to dig down deep and find some guts she didn't know she had not just for her survival but everyone's well being.  The members of the community were all that deeply connected at the station.  They had no choice other than dying out.

The instant the sun rose and the iced runway was safe to use, a flight landed at the Pole with a replacement physician and Nielsen was on her way back to the US to complete treatment she started herself.

The take home lesson Dr Nielsen wanted the audience to have was the lesson she herself learned at the station:

In any community, all members are needed, no matter who they are, or what they do.  It's important to accept people as they are.  You never know when someone's greatest weakness will become their greatest strength.