“I am going to the Arctic for summer vacation,” is the sort of statement that elicits two types of reactions. There are the people who say, “Wow, cool!” and those who say, “Huh, why would you go there?” Being from northern Wisconsin, I grew up an avid skier and learned from a young age to thrive in the cold. When the temperature dipped below zero, my dad and I would bundle up and go for “Arctic walks,” in which we would try to reach the closest gas station for a cup of hot chocolate before trudging back home. Once we even hiked to an igloo pulling a pulk and slept there overnight for fun (my mom declined the invitation to come along).

Thus, as the world emerged from pandemic restrictions and lockdowns, it was not a stretch for me to head to the Arctic this summer for vacation. In fact, this is my sixth summer making a trek to the Arctic. To those who ask “Why go there?”, I regale them with tales of majestic wildlife, enchanting ice, and stunning landscapes. However, the Arctic is more than a feast for the senses. It is also a place where one can perceive the entire circle of life with astonishment as the vast, interconnected web of the ecosystem is laid out against the backdrop of mesmerizing topography. With the Arctic Ocean predicted to be ice-free in summer by 2050, it is a threatened environment increasingly strained by climate change. Additionally, the Arctic is a region in which complex political jockeying is occurring as nations race to dominate it for military, strategic, and economic exploitation.

I volunteer as a physician on small expedition cruise ships in the polar regions, generally with 100-200 passengers. This was my fifteenth voyage as an expedition physician, but my first stint on an expedition ship in the COVID-19 era. Interestingly, I was in Antarctica in early 2020 when COVID first emerged in China and I was able to get home before borders shut down. My regular job is the Senior Medical Officer aboard a US Navy aircraft carrier, so I already had extensive experience managing COVID at sea.

A significant challenge aboard military and civilian ships is the inability to socially distance given the number of people relative to the space available. As a result, the definition of a “close contact” is often different on ships than the standard definition – otherwise the majority of the ship’s population would soon be included. There is also not enough space to isolate every positive case as one would prefer to do on shore. COVID management on a small cruise ship is a delicate balance between preserving quality of life for the individual and their close contacts (on an expensive trip-of-a-lifetime) versus prioritizing prevention and the good of the group. The same public health questions and ethical issues we deal with societally – protecting people who are not sick, mask wearing protocols, isolation/quarantine, and vaccination status – are the same issues that arise in the microcosm of the ship. Of course, vaccinations and pre-departure testing are mandatory for cruises, but once the ship casts its lines off from the pier, COVID and its challenges inevitably appear.

My voyage in Svalbard this summer began and ended in Longyearbyen, where there is a commercial airport. We travelled north along the west coast of Spitzbergen, east across the top of the island (up to 80.5 degrees North latitude), and South between Spitzbergen and Nordaustlandet. We then retraced our steps west and south to see Hornsund and Bellsund. The passengers were keen wildlife observers and photographers so we explored the fjords along our route by zodiac and ashore by foot. The voyage was very successful from a medical perspective. Despite diagnosing a dozen COVID cases, no one was terribly ill despite a mean age of 65 years among the passengers. I went through more acetaminophen and throat lozenges than anything else. However, on previous voyages, I have attended to broken bones, lacerations, dislocations, a myriad of infections, and high-risk complaints like chest pain, abdominal pain, and shortness of breath – all with little diagnostic capability beyond vital signs, history, and physical exam. Given the remoteness of many destinations in the Arctic and Antarctic, there is an added level of peril practicing medicine in this environment. Furthermore, it is often said in hospitals that healthcare is a “team sport” replete with doctors, nurses, techs and support staff. This is not so on an expedition in which the physician is the medical team and must perform any and all medical-related tasks. To mitigate this risk, I always determine which passengers and staff have medical training in the event that I need assistance. Even a single critical patient in this austere environment would fit the definition of a mass casualty by exceeding the resources available.

Physicians understand that bad things can and do happen, that a stomach ache might be mesenteric ischemia for instance. The prospect of a dangerous diagnosis in an environment where it is hard to make a diagnosis and potentially impossible to treat it, certainly makes expedition medicine more stressful. But my concerns are tempered by the extremely rewarding nature of the work. Being an expedition physician has enabled me to see a mother polar bear nursing her cubs, feel the force of a calving glacier, smell a whale’s breath, hear the peeps of penguin chicks, walk in the footsteps of Ernest Shackleton, kayak in the Southern Ocean, and stand atop the world at the North Pole.