Doctorin' in the Dark

So what exactly is it that I’m doing here?  Just to be clear, I’m not asking in an existential way.  I’m already depressed enough by the telescope guys, who tell me that studies of the cosmic background microwave radiation suggests that after 13 billion years or so of continued expansion, the universe will both fly apart as the bonds of gravity are loosened between galaxies and they drift apart, and that the hydrogen that fuels our stars will be used up, and that the universe as we know it will simply die.  So nothing means anything as it all simply leads to annihilation.  The telescope guys will try to put a hedonistic spin on it, saying it means that you can do anything you want because it won’t make a difference.  But I can tell that they don’t really believe it, because scientist never tell you the whole truth when sober, and they never spread happiness and cheer with a drink in their hand.

As best I can tell from the South Pole Personnel List…because I have no actual job description I’ve ever seen…my role falls under the category of Mission Assurance.  What that means in practice is that I’m here to serve as the primary clinical caregiver, providing or supervising all on-site patient care.  I’ve already mentioned that while the medicine is essentially the same, the practice environment is far different, and I do everything from taking vital signs to drawing blood, doing lab tests, obtaining x-rays, and changing the bedsheets after the patient visit.  While it’s a lot of things to juggle, the time commitment really isn’t that much more time per patient than it would be in a domestic ED, because here there are no competing interests.  It may take me an hour to move someone through the system, whether I do everything myself here or depend on nurses and techs to do routine tasks while I see other patients.  Still, it’s a valuable lesson in appreciating the work that others do on my behalf; and learning to work IV pumps and ventilators, transfer blood in little pipettes from test tubes to lab equipment, and how much peroxide you need to clean up spilled blood on the floor (and that you know there’s still some blood left when you spill a bit more peroxide and the tile bubbles) are all useful lessons in medicine behind the scenes.

Thus far, most of what we’ve seen has been minor illnesses and injuries.  There were a few cases of GI distress due to copious ingestion of expired (10/8/22) Lucky Charms; explanations that it was not the expiration date, but instead that six different kinds of colored marshmallows present a formidable sugar challenge to the gut, seemed to resolve the crisis.  I’m of the era when there were only four monochromatic Lucky Charms and only three colors of Froot Loops, so I can be a clinical Luddite and blame almost anything gastrointestinal on modern cereals.  That being said, I still justify my intake of Froot Loops and Apple Jacks by saying it’s the same nutritional value as a severing of fruit, so maybe there’s some self-serving deception here. (I know it’s not the expiration date because I’ve been eating Twix bars from 2016.  The caramel is kind of hard and fractures with the bite, but if you think about it like a slightly thawed frozen Milky Way it works.) 

We’ve also started to use liquid nitrogen to burn off warts, mostly because we have access to lots of liquid nitrogen and after you treat the wart, you can take a piece of citrus fruit, dunk it in the thermos of liquid gas, and then hit it with a hammer and watch it shatter into a zillion pieces.  Cleaning up afterwards, when you have to hunt down the microsegments of orange that have found every possible nook and cranny, is not as much fun.  After our first Adventure in Fruit Smashing, we learned to whack the citrus in a box to prevent flying fragments.

It is truly great fun to smash fruit with a hammer.  That being said, there’s a small part of me that feels bad for destroying an orange, no matter how old and shriveled and unfit for further consumption, because after reading about the failed Scott Expedition I’ve developed an intense phobia about scurvy.  Scurvy is caused by a lack of Vitamin C in the diet; most animals make Vitamin C, but humans and other primates, bats, capybaras, and guinea pigs do not.  Lack of vitamin C causes problems with the synthesis of collagen, a key component of the connective tissues of the body.  (Home Tip:  If you have collagen in your butt, you probably don’t have scurvy.)  Clinical features of scurvy include weakness, bone and joint, pain, easy bruising, gum disease, poor wound healing, and emotional changes.  Untreated scurvy can result bleeding, liver failure, seizures, and death.  This is probably why you don't see a lot of expeditions to the ends of the earth led by South American rodents or chimpanzees.  

The first documented treatment for scurvy was discovered by the British Naval Physician Dr. Joseph Lind in 1747, when he noted that citrus fruits were able to cure scurvy in what we call one of the first controlled experiments.  Extracts of citrus such as lime juice became standard ration aboard during the 1860’s (leading to British sailors being known as “limeys”).  Apparently Captain Scott, though a loyal, card-carrying member of the Royal Navy, failed to get the message.  He recognized during an earlier expedition that eating fresh meat kept scurvy at bay, so presumably if he took along a lot of pemmican…a mixture of dried meat and fat…that should do the trick.  It didn’t.  One of the members of his polar party, Edgar Evans, had a wound that failed to heal, likely contributing to infection, sepsis, hypothermia, and death; Scott’s second-in–command, Lt. Edward Evans, nearly died of the disease as a member of the support team.  The story goes that Teddy Evans was thought to be dead until the tears of his comrade falling on his face roused him back to life, probably because the warm tears froze and hit like icicles on the way down.

While we now know clearly what causes scurvy and how to prevent it, I freely admit to an unwarranted degree of fear.  Each morning I’m the one looking for the canned orange slices in the fruit cocktail, or drinking glassfuls of the reconstituted grapefruit juice.  (I don’t even like grapefruit juice.)  There’s a scratch on my right forearm that’s six weeks old and still not fully healed.  The logical side of me knows that wound healing takes longer at higher altitudes and with the cold.  The other part of me, the one that has the dreams where my teeth fall out at night, is absolutely convinced that I have scurvy, and gets up at 3 AM to fetch another glass of citrus. 

Cold injury is always a concern, but so far we’ve been doing pretty well.  People are doing the right things to prevent problems.  There have been a few cases of minor frostbite, but nothing requiring anything more than gentle rewarming and some moisturizing cream.  What’s of interest is where we see it; not really in the fingers and toes, but more along the cheekbones and sides of the upper face, because no matter how tight you cinch up your balaclava these areas remain exposed, as any goggles or eye protection you might use to cover these areas invariably fog up.  There’s more danger walking blind than walking cold.

The one exception to the rule of good care has to do with pictures, and especially in the last week or so since the auroras have been out.  No matter what the package says, even the thin glove liners with the little plastic grip pads over the thumb and index fingers don’t work with a cellphone.  So if you’re outside and want to snap a picture of the heavens on your mobile device, you need to take your glove off and do so with your bare hand.  At the current temperatures (-70 to -80 F) and wind chill (up to – 130 FG), the effective time unexposed flesh can be exposed to the cold without developing frostbite is less than two minutes.  But you start to feel it long before that time; after thirty seconds or less, you feel a numbness in your fingers that is immediately replaced by a deep burning pain that simply keeps getting worse and your hand feels like it can’t move although by all rights it still can.  It’s a unique kind of pain, deep and boring; and one you can’t rationalize because the rest of you is snug and warm and in the darkness, you can’t see your hand turning red, than pale, and then dusky violet as the cold tightens its’ grip. 

Frostbite is quite common, especially among unprepared amateur climbers or daredevils who seek challenges that push the limits of sense and safety.  The Internet is full of pictures of black and blistered fingers, noses, and toes.  But here it’s not just a caution, it’s an everyday concern.  Some of our group know of someone from the Greenland Summit Station who wandered outdoors and wound up as a double amputee.  Likely the most famous victim of frostbite is Captain Lawrence Oates of that same Scott party who, with frostbite on his feet making him unable to continue and a drag on his companions, left the tent with the words "I am just going outside and may be some time." Like forever.  And while it’s true that I have my little heroic fantasies of being The Doctor at the South Pole, keeping someone alive and out of pain while their limbs mummify, die, and fall off is not one of them.

While I’m delighted that none of my friends and colleagues have thus far suffered any serious problems, I will admit to longing for some of kind of medical heroic moment, where I step in with just the right mix of skill and daring to save the day at the Bottom of the World.  I even have some ideas about what that moment would look like.  But if I told you what that was, I would break the ER taboo that mandates you never say the name of a specific condition or a particular scenario because if you do so IT WILL HAPPEN, which is not a myth but is ABSOLUTELY TRUE, which would mean one of my compatriots here would need to be critically ill or injured just to satisfy my need for transient glory, which hardly seems fair even though it’s an easy way to get on the Motivational Speaker Circuit. 

Are there tales of physician glory at the Pole?  The first physician to spend the winter in Antarctica was Dr. Frederick Cook, an American who was working with the 1898 Belgian de Gerlache Expedition when their ship Belgica was unexpectedly trapped in the ice and the crew forced to spend the winter near the Antarctic coast.  Dr. Cook was credited with saving lives on board by hunting fresh meat to prevent scurvy.  Today, Cook is probably better known as one of the claimants for the discovery of North Pole, for decades locked in a bitter controversy with Robert Peary as to who arrived first at the Top of the World.  There’s real doubt over whether Cook or Peary actually reached the Geographic North Pole.  The one person we know for certain did so was Roald Amundsen, also the first to reach the South Pole, who flew over the landmark in the airship Norge in 1925.  Quite a Daily Double for the Norwegian.

Dr. Cook also claimed to be the first to reach the summit of Denali, which was also contested and largely debunked.  Later in life he spent time in prison for participating in a fraudulent scheme to promote oil drilling in Texas.  Was Cook a great explorer but a truly bad record-keeper and businessman, or a charlatan through-and-through?  That’s yours to decide.  But clearly not everyone who over-winters here goes on to bigger and better things. 

(In a strange example of how Antarctica is a small world, the multinational crew of the de Gerlache Expedition included Roald Amundsen, Frederick Cook, and Henryk Arctowski, the latter of which is the namesake for the current Polish research station on the continent.  And one of Cook’s visitors in prison as he served his sentence for fraud was Amundsen.)

The first physician to reach the South Pole was Dr. Edward Wilson of the Scott Party, who perished with his remaining comrades on the return from the Pole.  I have to admit to a bit of hero-worship for Wilson, and not merely because he was a physician (by the time of the polar expeditions, he was probably thought to be more of an illustrator and naturalist).  By all accounts, Edward Wilson was a truly good man, the Mr. Rogers of polar exploration.  Devout, studious, forgiving, ascetic, able to make peace between those at war, he was affectionately known as Uncle Bill among the Scott team. 

Wilson was a key member of three remarkable journey on the continent.  During the Discovery expedition of 1902-3, he accompanied Scott and Ernest Shackleton to within 500 miles of the Pole, a record for the time.  The return trek saw Shackleton suffering from scurvy and exhaustion; his furlough home by Scott led to an enduring distrust between the two great British explorers. 

Wilson’s second journey was notable not for the distance covered, but for the hardships endured.  Along with Henry “Bertie” Bowers and Apsley Cherry-Garrard, a 1911 quick mid-winter run along the coast to acquire some emperor penguin eggs for study became a disaster aptly called “The Worst Journey in the World” by Cherry-Garrard in his subsequent memoir.  While his style is writing may be awkward for today’s reader, the account is harrowing and is highly encouraged for anyone who wants to know what Antarctica is really all about and why, like Australia, the continent seems to consciously want to kill you.  It puts my whining about needing to put on cold weather gear to go outside to look at the pretty stars into perspective, because when I get cold I just go back inside.  (Perspective seems to be one of the best things I’ve learned over the past few months.)

After reading about the 1911 excursion, one wonders why Wilson choose to go back for another round, but loyalty was a linchpin of Wilson’s character.  Thus it was that he accompanied Captain Scott and three others (including Henry Bowers) on the final ill-fated journey to the Pole.  Even on the way back, as winter was closing in, Wilson still took time to make scientific observations and collect geologic samples, which is a large part of the enduring scientific legacy of the Terra Nova expedition.  His peaceful acceptance of his fate was perfectly consistent with his faith; he was found in the tent with the bodies of his compatriots sitting up against the side wall with a contended smile upon his lips.

(An aside:  While I admire Dr. Wilson, I feel for Capt. Lawrence “Titus” Oates.   Oates was a Royal Army officer who joined the Scott expedition to care for the Siberian Ponies used in lieu of dogs on the March to the Pole.  The ponies didn’t work out, and Oates was detailed at the last supply depot to join the polar party.  All evidence points to the fact that he didn’t want to make the final push.  His duty done with the demise of the ponies, he was ready to return, and there’s a suggestion that he was added only so Scott could have Royal Army representation on his Royal Navy Team.  Oates also had one limb shorter than the other due to a prior combat wound, so sledging and travel over the ice was more difficult for him as well.  Nonetheless, as a man of duty, we went along until, his feet affected by frostbite, unable to walk and in great pain, he exited the tent on the return journey with the words, “I am going outside.  I may be some time,” in an effort to save his companions. 

The 1912 Terra Nova expedition was fortunate to have the services of Herbert Ponting as photographer.  Photos of Wilson show a man at peace, content, genial.  Phots of Oates show a man who seems relaxed around only horses, but otherwise stares straight into the camera, and his fate, with both infinite sadness and resignation. It’s haunting.)

In modern times, people may have heard of Dr. Geri Nielsen, who suspected she had breast cancer, did her own biopsy, and was assisted by an airdrop of chemotherapy agents in the darkest part of winter.  She later wrote a book and then hit the Motivational Speaker circuit.  (This seems like a good racket if I can avoid the whole cancer thing.)  I’m told that there was an appendectomy here at the Pole over a decade ago.  Apparently the procedure was hampered by the lack of good anesthesia, and the grapevine says that the patient would start to wake up from time to time, requiring a few strong arms to keep him down until the next dose of sedatives could be administered.  There’s a picture of the surgeon and the patient near the entrance to my office, so presumably everyone came out okay and no one was the wiser for bad style points.  The ultimate gutsy polar doc, however, has to be the Russian doctor in the 1960’s who did his own appendectomy under local anesthesia using a hand mirror.  You can watch it online.  Bring popcorn.

As far as prominent patients, there was controversy in the press over a decade ago when the over-winter Station Manager suffered what was felt to be a stroke and was unable to be evacuated until the weather was stable.  The conflict arose because the patient wanted out (supported by online physician second opinions as well as her US Senator), and the Antarctic Support Contractor and the National Science Foundation decided that while they would get her out on the first flight that spring, the trade-off between getting the patient early care and the risk to aircraft and crew meant that no earlier medical flight could be attempted.  I get both sides of this…if I had a stroke I would want follow-up specialty care as soon as possible.  But after being on-site, I have to sympathize with the ASC and the NSF.  It’s a Wrath of Khan moment:  The needs of the many outweigh the needs of the few, or the one.  And clinically there’s the consideration that if the patient is stable, it’s probably okay to wait for further evaluation until the transfer can be done safely.  The situation resolved itself with the transfer of the patient on the first flight out and fortunately she made a full recovery; but it speaks to the issue of setting realistic expectations for care in the over-winter crowd.

While Prince Harry’s recent memoir notes an episode of frostnip to the Royal Member, that happened on an excursion to North Pole; he specifically notes that when he joined wounded veterans on a trek to the Southernmost Extremity, he had a custom–made warming “cock cushion” in his pants to prevent a further injury to the Little Prince.  (And I thought codpieces had gone out of style.)  And while it’s not a particularly medical story, moonwalker Edwin “Buzz” Aldrin stopped by while on a tourist excursion at the Pole and left behind a tissue, which is now preserved for near-eternity at -60 F, along with an ice sculpture of Roald Amundsen and a tribute to the My Little Pony franchise, in the ice caves below the Station.

The last big medical event here was in 2016, when two patients were flown out in the mid-winter darkness, the most serious case for needed surgical evaluation and care for a life-threatening condition simply impossible to do at the Pole.  The event is still fresh in the mind, and we’ve already had a meeting to discuss what we might do in such an event.  On the clinical side, a winter medical evacuation is much different than usual.  Up north, most air medical transport is performed in aircraft specially designed for medevac flights, or that can be easily configured to hold a recumbent passenger, medical attendants, and needed gear. 

That’s not true of the Twin Otter aircraft that would swoop to our rescue at the Pole.  These aircraft are equipped with an extra internal fuel tank which occupies most of the space within the fuselage.  If a patient was to be transported lying down on top of the tank, there’s about four inches of head room between the patient and the ceiling, which pretty much eliminates the ability to provide any kind of critical care.  There’s no place for a medical attendant to sit alongside the client, and nowhere to put medical equipment within easy reach.  There’s a great sense that if the patient needs to be recumbent, you essentially lay them out on the fuel tank, cross your fingers, and hope for the best.

Patients may also be transported sitting up, but even this isn’t problem-free.  There’s no bathroom on board, and the patient must be able to self-care as there is no space nor resources short of a pee bottle to help with bodily functions.  The patient must also be able to use supplemental oxygen, as the cabin is unpressurized, and the overall clinical condition must be one that does not worsen with altitude.

The non-medical aspects of air medical evacuation are even more complex.  The skiway, which has been unused for months and his now covered by blown and drifting snow, needs to be groomed using heavy equipment that may or may not function in the cold.  The flags that usually mark the airstrip have been removed to prevent them from being buried over the winter, and even if they were still present they couldn’t be seen in the dark.  Flashing approach lights need to be placed on the ice to guide the plane in, and smudge pots (basically fire markers) indicating the edge of the runway need to made out of cut-down 55 gallon drums and placed every 800 feet down the two mile span.  Portable buildings for aircraft fueling and service need to be dug out of winter storage, transported to the runway apron, and connected to power.  Provisions for aircraft crew food and rest need to be set in place as well.  The preparations extend to even such small details such as making mats out of bamboo and rope to place under the aircraft’s skis so they will not freeze to the ice, rendering the plane immobile.   

(To be fair, these are winter-over problems.  Once the sun comes back comes back and regular LC-130 flights resume in late October, medical evacuations are accomplished in the same manner as we do at home.  The Hercules is a large, pressurized aircraft landing in daylight on previously prepared strips, and can easily transport any number of patients on stretchers, along with their attendants and any needed medical equipment.  McMurdo Station employ a flight nurse over their summer season specifically to accompany transfers between the continent and New Zealand, and McMurdo and the Pole.)

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Patient care is the primary reason for my existence at the Pole.  But as the only medical professionals on-site, as well as bodies with the most time on our hands (no patients, no work), both the Physician Assistant and I have expanded roles beyond the clinic walls.  Much of the effort on my part involves emergency response.  As the expression goes, Antarctica is a harsh continent, and potential emergencies are everywhere. As an isolated outpost with no chance for help, it becomes mandatory for everyone to be involved in contingency plans.  There are four primary Emergency Response Teams (ERT’s) encompassing first response and communications, fire, logistics, and medical teams.  Ad-hoc teams are also in place for search and rescue and spill response. 

(I should probably clarify the term “First Response.”  For those of us in emergency medicine and prehospital care, a First Responder has  refers to a specific level of training and certification, most often a 40 hour course in basic scene safety and first aid.  Here, First Responders are simply the initial folks who assess the nature of the incident and mobilize the appropriate resources.) 

We actually have two levels of medical volunteers at the Pole.  The first are those who are members of our Emergency Response Team.  It’s my responsibility to serve as Team Lead, and to offer weekly training for them to support their actions.  There’s no formal curriculum, and each doctor at the Pole does things differently...there are a multitude of training files on our computer, and all of them differ.  I’ve got thirty weeks with my crew, so I’ve tried to build a curriculum that’s a cross between a First Responder and an Emergency Medical Technician (EMT) level of skill and training, with a special focus on patient care scenarios situations such as hypothermia, frostbite, and problems of altitude.  It’s not perfect, but so far it seems to be working.  I’ve seen their skills improve every time we drill, and the crew seems to be learning and having fun.  For me, while much of the allure of the skills themselves has worn off after three decades of use, but it’s fun to see the team come together and grow.  You can see in their faces the novel feeling when you first started to use a stethoscope or put someone in a proper splint.  My medical youth rekindled, if for just a moment.

The second level is that of the Medical Assistant (MA).  Two of the ERT-4 team members also work at this level.  The role of the MA is also difficult to define, but is essentially an extra pair of hands that knows what they’re doing.  The job shares some similarities with the office setting…they can register patients, take vital signs, and perform phlebotomy for laboratory testing.  There’s also a bit of ER Technician in the role, monitoring patient status and assisting with direct patient care.  We then throw in a touch of EKG Technician, a few small attributes of a Radiology Technician and a Respiratory Therapist, and a goodly dose of Concerned Watcher.  The focus is not just on the acquisition of rudimentary technical skills to free up the providers for more critical interventions, but to know normal, recognize when something’s wrong, and call for help.  So when I teach about cardiac monitoring, we focus not on the diagnosis and treatment of the different kinds of irregular heartbeat, but instead how things differ from normal and when to notify the higher powers.

Both the weekly ERT and MA trainings usually require the development of a didactic presentation followed by skill practice or patient care scenarios.  While I hope the crew sees value in our time together, the real benefit of the training for me is in being forced to go back and review the most current thought in concepts and skill that have, over time, become outdated habits.  I’m also forced to come face-to-face with technologies like IV pumps and mechanical ventilators, devices that I could order somebody to use but myself have no idea how to do so, kind of like the folks who are perfectly happy to buy food from the grocery, but have but idea, nor interest, in how it got there.  Now I have to know.

There are a host of other items on the agenda.  There’s laundry to be done (patient linens and scrubs from dishpit days), instruments to be run through the autoclave, humidifiers and “happy lights” to be issued, cleaned, and restocked.  There’s a regular cleaning of the clinic area including trash disposal, sweeping, and mopping.   Once a week I file Situation Reports (SitReps) on our clinical activities and training to Medical and Station leadership.  There are monthly rounds to check the health of the Automatic External Defibrillators (AED’s) within the Station and outbuildings, and seasonal excursions to check and stock the contents of more than fifty First Aid kits scattered on site.  Each month I do a kitchen inspection, during which I’ve learned what dunning is and why you don’t thaw a pan of chicken above a pan of fish.  Covid testing is on hold for now after the lockdown, as all 44 of us have repeatedly tested negative and no one is going in or out.  I suspect this will ramp up again in October when the summer crew begins to drops by, but as of now we don’t know what the Covid policy will be.  There’s also a monthly count of the narcotics in our safe.   

While this seems a long list, in reality each task can be knocked out pretty quickly, and there’s a lot of time on my hands.  The Physician Assistant, with the benefit of youth and a Puritanical aversion to sloth, has made himself invaluable to the Station as a jack-of-all-trades, helping with clearing snow from doorways and stairs, galley cleanup, fixing telescopes, and taking calls for the communications center.  You can almost see him quiver in anger at the very thought of inactivity.  With my total comfort with idleness, I’m filling my time with writing, jigsaw puzzles, late afternoon movies, and lunchtime naps.  And late afternoon naps.  And naps in the clinic ward bed after breakfast.  There’s a theme.

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Speaking of safes, here’s an interesting story.  In a utility room on the first floor of the station there’s a cache of emergency medical supplies to be used if we need a lifeboat.  One of our berthing wings is designed to act as a lifeboat in the event of catastrophic failure of the building or the power plant.  The lifeboat wing has its’ own power supply and reserves, and can be sealed off form the rest of the building if needed.  The cache is mostly medications and supplies past their expiration date but still useful, and a few pieces of medical equipment such as a cardiac monitor/defibrillator and some minimal surgical supplies.  In the midst of these, on a small raised pad of concrete, sits a safe.

The safe is a mystery to all.  Nobody knows why it’s there, who owns it, how to open it, or what’s in it.  We’ve heard that at one time there was a key, and that the last time it was opened there was nothing in it.  My original idea was that perhaps it held an emergency supply of controlled medications, but no none seems to believe that’s the case.  Maybe it’s pirate gold.  Maybe it’s a TASER to subdue an unruly agitator.  Maybe it’s the elector lists for 2020.  It’s quite exciting to think about.

We want to get rid of the safe as part of a clean-up project, but first we have to open it and make sure it’s empty.  The man doing the safecracking will be my friend The Engineer.  As far as I know…and there are some question you of course don’t ask…he  has no particular experience cracking open safes.   His prison time, if any, remains a mystery to all.  (This is as opposed to our sous chef, who is fond of letting us know his self-designated prison nicknames, the best of which is “Waffle House - Scattered, Smothered, and Covered.”)  So I have no idea if he’s going to use a crowbar, or try to blow it up, or just leave it outside for week and see if the metal cracks open with the cold.  I’m personally hoping for fireworks. 

In addition to his role as Safecracker, The Engineer is also our local Cult Leader.  His following started when he bought a grey South Pole Athletic Department sweatshirt and cut down the sleeves and the neck.  In our fashion-conscious community the trend caught on, and now over thirty of us sport the same outerwear, often daily.  The Cult has its’ own pose (“The Scarecrow,” with the body erect, arms out to the sides, elbows bent downwards at 90 degrees), and cult art have shown up at different places on the Station.  The whiteboard outside the clinic was distinguished by a drawing of a patient saying “Help Me!” surrounded by stick figures in red doing The Scarecrow.  This week we took a group photo of the cult members holding tea lights in their hands, surrounding our friend Nightime IT Guy (who has not joined the cult but is nonetheless a good sport) as a figurative sacrifice.  When we see him in the hallway, we bow the head and chant  his name in a long, low moan.   And it’s only April.

While we all follow the Way of The Engineer, perhaps his closest adherent is the MIT PhD who several weeks ago inquired about drinking fuel.  Today there’s a coolant spill in the generator room, so his beverage of choice this morning at breakfast switched to glycol.  No doubt this was inspired by its’ creamsicle color, and could the taste be a match?   Before I got a chance for a pithy answer, the Physician Assistant chimed in “about a cup and you’d vomit,”  which is probably the right answer but took away a good chance to experiment.  Then followed an earnest discussion about whether he would really drink the glycol, resulting in a consensus that he might at first momentarily resist, but then quickly relent and happily quaff it down Jonestown-style under the watchful eye of his leader.  It might incentivize him further if we told him that glycol would cause him to grow a mustache, for after three months of effort he has four visible hairs, or perhaps five if you look closely. He’s quite proud.

(Speaking of MIT, I was recently treated me to a showing of Orgazmo, a Matt Parker/Trey Stone (“South Park”) film about Mormon who raises money for his temple wedding by becoming a porn star.  For the record, the movie was rated R and there was no actual penetration; even the “stunt cocks” were discreet.   One of the characters, a scrawny young man named “Choda Boy,” was an MIT graduate who went into porn to have a better chance with the ladies.  We see our colleague's future on screen, home videos, and online sales.)

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One of my clinical concerns this winter is the mental health of those on station.  The long polar night coupled with isolation and monotony are well-known to be risk factors for anxiety, depression, and psychiatric crises.  Early Antarctic explorers were well aware of the deleterious effects of the constant dark.  A Belgian expedition led by the Baron de Gerlache became trapped in the ice the winter of 1898 saw several men go insane; and there’s the sad tale of one Sydney Jeffryes, a radio operator on the 1912 Australian Mawson Expedition, who started out developing an aggressive paranoia, becoming more combative over mid-winter and then sabotaging the wireless instrument.  Jeffryes never recovered and spent the rest of his life in an asylum.

Those who know me would probably ask me to first pay attention to myself, as the quality of my thoughts is always in play even during the best of times.  And as the Best Girl Friend Ever correctly notes, I’m not the most acute observer of human behavior; and when I do notice something going on, I often put a generous spin on events seen behind a pair of rose-colored glasses.  Still, even at this relatively early date, when we’re still in astronomical twilight with just the slightest hint of light still on the horizon, I can see some differences in our group beginning to emerge.  Some people are becoming more vocal, others less so; small groups are starting to physically separate themselves from others; criticism is more directed towards individuals rather than raging against the machine as a whole.  It’s difficult to tell if this is specifically related to the cold and dark or to other factors such as changing schedules and workloads, events at home, isolation and loneliness, or an inseparable mix of all.

The term Seasonal Affective Disorder (SAD) tends to be applied to our scenario, but because of the myriad of potential stressors I’m not sure that’s the right term to use.  SAD is a recurrent seasonal depression most common in winter, but can be seen with any season in any part of the world.  SAD appears to be somewhere on the spectrum of mammalian adaptive behaviors to winter darkness and cold (hibernation being an extreme end of this range).  Perhaps a better term is offered by the phrase “over-winter syndrome,” or the even more descriptive phenomena of “psychological hibernation.”  No matter what it’s called, symptoms include depression, unusual aggression or withdrawal, difficulties with sleep, and lack of focus and concentration.   Proposed mechanisms behind the syndrome include changes in melatonin production associated with disrupted patterns of light and dark, decreases in thyroid hormones linked to cognitive and mood disturbances (“Polar T3 Syndrome”), and deficits in serotonin production.  Serotonin is a chemical in the brain associated with mood and anxiety; serotonin deficits are correlated with clinical depression.  Many antidepressant medications fall into the category of Selective Serotonin Reuptake Inhibitors, or SSRIs.  The drugs work to make serotonin more available in the brain and thus elevate mood.)  I’m particularly intrigued by studies revealing that mice who lack adequate serotonin “act depressed.”  I’m not sure what that means to a mouse.  Lack of interest in cheese?  A lethargic, lower-pitched squeak?  Rodents that amble rather than scurry?  Perhaps it’s a nihilist view of the cat, a willingness to venture forth in daylight and shout, “GO AHEAD!  EAT ME!”  This is all the more intriguing when you note that even single-cell organisms like amoebas secrete serotonin, resulting  in severe diarrhea but elevated blood serotonin levels, which I think means you may be spending a lot of time in the bathroom but should be pretty pleased about it.

While the prevalence of SAD, or whatever you chose to call it, is fairly high (in some studies up to 60% over-winters exhibit some symptoms), true psychotic breaks are few.  There are whispered stories of a “mutiny” of several team members a decade ago, displaying aggressive bullying behaviors and barricading  themselves behind a pool table; and the hushed tale of a manager who became psychiatrically unstable, was confined to their room and escorted to meals, and contacted the media to relay the message that she was being held hostage.  (As I heard the story, she was actually greeted in New Zealand by American media who only realized what was really happening when they met in person.)  In all these cases, the truth is likely more and less what we hear; and it’s always an open question how much of the behavior was due to SAD, and how much to alcohol use or underlying personality disorders or other psychiatric conditions.  Still, even the existence of these kind of underground tales means it would be foolhardy to ignore the mental health challenges before us, especially as I start to see my friends just a bit more on edge than a few weeks back.

How all this is going to manifest itself this winter is uncertain.  I have a theory…maybe partially supported with real science…that when you are tired, or intoxicated, or have a degenerative brain disease like dementia, you become more of who you really are.  The frontal lobe of the brain mediates your behavior, and as its’ functions become impaired, that auto-regulation steadily dissipate.  That’s the best way I can explain why people who are perfectly reasonable at baseline may become nice drunks or hostile ones, and why some patients are “pleasantly demented” and others are hostile and paranoid.  (I’m fond of noting that anyone can be on good behavior for six months; it’s only long-term that you find out who someone really is.  After six months, you become mentally exhausted with the effort to regulate your behavior, and your true colors start to show.  So I wonder if what I’ll see is more of my first impressions…a magnification of those initial tendencies…or, as some recent literature suggests, simply withdrawal into a semi-aware state called the “Antarctic fugue.”

(The completely unscientific six-month time frame came from the fact that I got engaged to my two ex-wives after only six months of dating.  After ten years, I know what I’m getting in the Best Girl Friend Ever, and I could not be happier.  And after ten years together, she also knows what she’s getting with me, and I fall more in love with her each day because despite the fact that she knows me better than anyone, she hasn’t run away screaming.  In a Socratic moment of self-examination, I also recognize that should I be afflicted with dementia, I will more than likely be the guy in Room 43 of the East Wing of The Home trying to gnaw at this wrist restraints.)

Like most things here, there’s also a certain dark humor to the issue of mental health.  Even I’ve been guilty of participating in discussions of a betting pool to see who would crack first.  It’s harder to organize then you think…no easy brackets like March Madness.  It’s not enough just to name the person, but to avoid ties you’ve got to predict the date and both how and where exactly the person will snap.  Eventually this turns into a game of Clue, as the line wagered becomes “July 25:  The Doctor in the Galley with a Fork.”  Probably best if I avoid cutlery that week.