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.