Right now in the medical facility of McMurdo Station, Antarctica, Kenneth Iserson, MD, is treating patients in one of the harshest environments in the world. Rather than sitting on a warm beach somewhere, Dr. Iserson has spent the first years of his retirement teaching and practicing emergency medicine in extreme environments on all seven continents. Find out what it’s like to practice in these conditions and what advice Dr. Iserson has for physicians looking for ways to continue using their medical skills after retirement.
McMurdo Station is located on the southern tip of Ross Island in Antarctica and serves as a research center for many groups, including the National Science Foundation. The station is only accessible by air or by ships, one month a year, after an icebreaker clears the way.
“I see this as my encore career,” Dr. Iserson said. “I retired from the University of Arizona Emergency Medicine Department after 30 years, early enough so that I could work around the world. For the last eight years, I’ve worked only in resource-poor settings, where, if we have an emergency, we can’t immediately get [patients] to surgery or to an intensive care unit. We really have to improvise.”
What it’s like being the only physician at McMurdo Station
McMurdo Station has a population of about 1,200 in the summer, but that number significantly decreases in the winter months when the station is a “closed,” meaning that there is, at best, a flight only every four to eight weeks. As the only physician, Dr. Iserson lives and works with his patients.
“It means that I’m trusted by our entire population because I’m their physician,” he said. “And I’m their physician 168 hours a week for the whole time I’m here, which will be about nine months.”
“Days are getting very short right now, and while there is still some light here, but it’s going away quickly. We’ll lose it completely on April 24 for four months,” Dr. Iserson said. “Traditionally that increases depression and the likelihood that people could get hurt outside. They can go a little stir crazy because, with the cold weather and harsh conditions, it’s harder to do outside activities.”
“We’ll sit and watch movies together,” he said. “They have some bars—I don’t usually attend. Last night we had game night. … We’ll also go on hikes together. We can only work so much of the time, and we have to spend the rest of it interacting.”
Confidentiality is crucial to practicing medicine in such an isolated and extreme climate, Dr. Iserson said. “It’s a tricky situation because we have a very close-knit and, right now, closed population. And we interact with each other in all kinds of situations.”
“When there’s anything serious that happens, everybody knows everybody else, [and] they’re reasonably upset and concerned about the situation,” he said. “But that’s the thing we have to be very careful about here because we eat with our patients, we shower in the same bathrooms, we walk in the same halls. Confidentiality is paramount.”
Dr. Iserson has seen major fractures, bad burns, crush injuries, pneumonias, significant eye problems, cardiac problems, appendicitis and much more. “It runs the entire gamut of what you might see in a serious emergency department, and we have pretty much all of the same equipment too,” he said.
“But it’s not meatball medicine,” Dr. Iserson said. “We’re much better equipped than Hawkeye’s MASH unit was. We’re in pretty good shape here. We actually have a regular ambulance with at least one available paramedic,” he said, “but that’s usually only for in-town problems or problems on a road, where it can be accessed.”
“We have a lot of rules that protect people, and preventive medicine really is the best thing,” he said. “If something goes wrong, we’re kind of short-handed. Every season, you work up a team of auxiliary people who can help you out if there is a health crisis.”
“Usually though, it’s just going to be the physician’s assistant and myself for most things,” he said. “The most common routine thing we see is called the McMurdo Crud—that’s an upper respiratory infection that just gets passed around the station. We’re in close quarters, and right now it’s a closed community. So, once it burns out, it should be done until the next group of outsiders arrives.”
Opportunities after retirement
Dr. Iserson’s first stint in Antarctica came in 2009 when he spent six months as the lead physician “during what we call ‘winfly,’ which means coming in at the end of the winter and leaving at the end of the summer,” he said. “I was asked to come back here this time for the winter.”
Before coming to Antarctica, everyone has to go through a physical qualification process, Dr. Iserson said. “They all have to be okay to come down here, and that’s a big deal—especially for an old guy like me. The people who are here generally can tolerate the cold, and we all have adequate clothing.”
“We are each issued what we call ‘Big Red,’ which are giant red coats,” he said. “We say we look like big red penguins. I’ve had some interactions with emperor penguins, and I think that’s what they think we are.”
“I’ve worked on all seven continents now, and also the Arctic,” Dr. Iserson said. “It’s an exciting life. People always ask me how they can do what I’m doing, and my answer is what we used to say in the military—check all the right boxes.”
“Have the skills [and] the preparation, and do your homework,” he said. “Most organizations want clinical experience, but they prefer people who have experience overseas in developing countries, and there are ways to break into that area.”
“There are a lot of volunteer opportunities around,” he said. “Some are paid jobs, but it depends on what specialty you’re in, what you’re willing to do or are interested in doing. You need to get tied into the right groups and know what you’re getting into.”
“One of my books is The Global Healthcare Volunteers Handbook,” Dr. Iserson said. “It tells you how to pack, prepare, and find positions around the world, and lists and describes a vetted group of volunteer global health organizations.”
“I do these things because they’re of interest or [because] I haven’t done them,” he said, “and because my wife lets me do them. She had to give her permission for me to come, and she thought about it a long time and then finally was gracious enough to let me do it.”
