Adrián Castellote: Do we have to evacuate him?

Adrián Castellote is semFYC’s representative in WONCA Europe’s Network, EURIPA – the organisation for doctors from rural and remote areas in Europe. He is now embarking on a working trip on a sailing expedition to Antarctica. Follow his footsteps live with semFYC with hasgtag # MFenAntártida This is the second installment about his journey.

Adrián Castellote is semFYC’s representative in WONCA Europe’s Network, EURIPA – the organisation for doctors from rural and remote areas in Europe. He is now embarking on a working trip on a sailing expedition to Antarctica. Follow his footsteps live with semFYC with hasgtag # MFenAntártida. Here is another exciting step in his adventure.

At latitude 63º59'44"South, longitude 056º43'47" West, the ice began to accumulate, cutting off our path and closing the way to the islands of Seymour and Snow Hill, emblematic places of the fascinating expedition of Nordenskjöld 120 years ago, the incredible adventures of survival and rescue, in the history of polar explorations. We were in the Gulf of Erebus and Terror, and we knew in advance that the Weddell Sea was a place known for the unpredictability of its weather.
The previous days were impregnated with images that will forever be stored in our brains: having seen the calm ocean, penguins and sea lions adrift on icebergs, sightings of all kinds of whales next to the ship, glaciers that descend with violence towards the coast, beaches so crowded with polar life, submarine volcanoes, scientific bases, so many walks among thousands of penguins, the icy forms and the skies, the touch of hundred-year-old ice, the wind cutting your face, and the taste of hot tea when returning to the ship.

The dynamics are more or less similar every day: The expedition’s leader and his team devise landings that are then carried out – or not – depending on the weather conditions. If possible, we put the zodiacs in the water and look for a path between the ice maze to reach the coast, landing quickly between the breakers in water up to the thighs. Once on land, every day is different: we try to approach to the penguin colonies - Ginsto, Chinstrap, Adelie, King; or sea lions, Weddell seals, elephant seals; ascend to volcanoes, take a path through glaciers, explore new places.
I am fortunate, there is a rule that requires the doctor having to participate in all landings in case something happens ...

But at 63º59'44" S, 056º43'47" W we were going to have to turn around in all ways.

A young, healthy passenger (I'll call him Richard) who consulted me the day before for nonspecific abdominal pain and two episodes of vomiting, but with normal examination, was not evolving well. In less than 24 hours, the pain had become localised in the left flank and almost disabling, and the abdomen was distended in the same region. With the passage of hours, although the pain fluctuated, the patient stopped passing gas and faeces, no intestinal sounds were heard, he had tenderness upon percussion of the costovertebral angle and the rectum was empty and very dilated. I did not like the path the patient was taking, so I went to the cabin of the captain’s cabin, who listened to me attentively.

- "Do you think we have to evacuate him?"

It was a trick question. While in any other place, in a Primary Care center, I would rather order complementary tests, here it is not so easy.. A medical evacuation from a remote corner of the Antarctic is a spectacular mobilization: coordination of the few means that can operate in the region, with the Medical Radio Service, with the medical insurance provider. It also requires radically changing the course of the entire expedition for a member who has been waiting and preparing a long time for the trip of a lifetime. The uncertainty that a family doctors always carries in the back of his mind, here in Antarctica weighed more than ever. What if I'm wrong?

The Ship is only equipped with basic medical equipment and its not recommended to bring one’s own doctors’ bag on board. You will have to be creative with what you know and use what we have" - the captain told me the day I got to the ship. Well, the only diagnostic means on board are the stethoscope and the clinical eye, and in intravenous therapy it does not get much better. The captain was staring at me, waiting for an answer...

“Let’s take him out” I said. And the boat turned around in the middle of the ice and at went at full speed heading north to reach the Frei base. The night was intense: the captain contacted the central offices to report the situation, the expedition chief coordinated the evacuation with the Chilean base. For my part, I stayed with the patient all night, who was already on nil by mouth. Among the wobbles of the boat I started an intravenous (IV) line to give fluids that hung from a hook on the cabin roof, administering morphine on demand, the only IV analgesic we had on board, and other symptomatic treatment.

At dawn, the patient was much better and the volcanoes of the South Shetlands could be seen in the distance. The abdomen gave the impression of improvement, and the vital signs remained stable, as well as our doubts.

However, it was a great relief to make this decision jointly with Richard from the beginning. He wanted to be evacuated and cooperated at all times. When arriving at the bay where the Antarctic base was, winds of 40 knots and waves of 3-4 metres lashed the coasts, making any disembarkation difficult, however, the same wind that was shaking us, had delayed the flight that came to meet us from Punta Sands until further notice. We wait patiently anchored in the bay with everything ready waiting for an order. At mid-afternoon, the commander of the Chilean base gave the OK, and then we launched the zodiac and we were finally able to take the patient ashore to the very door of the plane.

Hours later, we learned that he was admitted to a hospital in Chile and we were returning to explore the glaciers that surround King George Island.

It was a hard and unexpected shock for the entire crew, but we still have forty days of travel ahead. Taking advantage of the favorable winds that blow from the southwest, we unfold the sails to Elephant Island, a mass of rock and ice in the middle of the ocean where the last men of Shackleton's expedition remained in an improvised shelter for four months of winter waiting for an improbable rescue.

Adrián Castellote