Ever practical, Jerri Nielsens dad ticked off a number of personal health emergencies she might encounter during a year as the only physician at the Amundsen-Scott South Pole Station.
For two-thirds of that time, weather conditions would prevent anyone from flying in to assist her. What if she developed appendicitis? What if she fell into a coma? What if she found a lump in her breast?
Nielsen, her two brothers and her mother were always able to counter his concerns. If her appendix became inflamed, she would just take it out herself, as a Russian doctor had done in a similar situation nearly 40 years earlier. Coma was such a remote possibility that it was barely worth considering.
And breast cancer? Nielsen had a mammogram as part of a comprehensive physical required before she departed for the pole. It was negative. Shed be fine.
But in early March 1999, just a few weeks after the last scheduled flight until November picked up passengers at the pole, Nielsen felt a hard, irregular mass in her right breast. It wasnt long before Nielsen became known the world over as the South Pole doctor who treated her own breast cancer.
She would have preferred to remain anonymous, but reporters, armed with her age and occupation, figured out her identity.
Her ex-husband, also a physician, accused Nielsen in the press of making up her cancer diagnosis to gain attention. Their three teenage children, who remained with their father after the divorce instead of moving with her to a new city a few hours away, never responded to her e-mails from the pole.
Partly to reach out to her daughter and two sons, whom she has not seen since her return, Nielsen has just published "Ice Bound: A Doctors Incredible Battle for Survival at the South Pole" (talk miramax books, $23.95). The memoir is based on nearly 5,000 e-mails Nielsen, now 48, sent or received during her stint in Antarctica.
Nielsen, who appeared on ABCs "Prime Time Live" last night, was newly divorced and living with her parents in Ohio when she spied a medical journal ad seeking doctors to work at three research bases in Antarctica. She had always wanted to visit the frozen continent, and she had been looking to escaping the sameness that had become her life.
"When youre stuck in something, and you dont feel youre developing anymore or are bored with your life, youre much better off to think in a totally new way," Nielsen explained in a telephone interview last week.
Just six weeks after seeing the ad, Nielsen was settling into Biomed, an orange metal shack that was to be her living quarters and clinic for the next year. Most would leave for the winter, but Nielsen and 40 others would stay. They included scientists, or "beakers," and other support staff.
On the ice planet, as she describes Antarctica, she finally felt like she was home. "I loved it so much. If I werent sick, I would be back there right now."
In a physical environment like no other on Earth, Nielsen began practicing a whole new kind of medicine. First, there were the effects of the high altitude and extreme dryness and cold. Adhesive bandages wouldnt stick. Wounds took ages to heal. Nielsen hung an IV bag without a nurses help for the first time in her life. To perform pelvic exams without stirrups or a speculum, she used a metal washtub and two spoons.
But the biggest difference was her relationship with her patients.
Nielsen most recently had worked as an emergency room physician. Her professional and personal lives were separate. It was better that way. "A lot of people talk about caring in medicine," says Nielsen. "You do care, but its easier if you dont love."
At the pole, however, she was on call 24/7, and her patients were also her friends and her life support. "I loved all these people. I also totally depended on them."
All of the "polies," for example, took turns maintaining the bases power plant. If it went down, they soon would freeze to death in temperatures that could reach minus-100 degrees Fahrenheit in the long Antarctic winter.
But, despite her fathers worst-case scenarios, Nielsen never imagined how much she, the healer, would come to depend on her patients. For months, she kept the lump in her breast to herself, hoping it was just another of the benign cysts that occasionally cropped up, then disappeared.
Jet fuel turned to Jell-O in the long, cold winter. It would be impossible to evacuate her or even drop medicine or equipment.
Treatment would have to wait until her scheduled departure in November. By then, Nielsen thought, a tumor would have spread far beyond her breast. She would either die on the ice or shortly after leaving.
As the mass grew to the size of a hens egg, Nielsen had to acknowledge that it was probably no ordinary cyst. On June 10, she first told her immediate boss.
He urged her to contact the doctor in charge of Antarctic medical stations back in Denver.
"Should I sit on this for five more months, or should I perform an operation on myself?" Nielsen wrote in an e-mail.
That same day, she broke the news to her fellow polies. They would have to help her diagnose the lump and, if necessary, treat it.
"Training my friends was simple," says Nielsen. "Theyre some of the smartest human beings on Earth. The polies in general are people who can improvise. Thats why they want to go there. They want to see what theyre capable of. If you give them a problem as a group, they can solve it."
Two days later, using only ice to numb her breast, one of them repeatedly inserted a needle into the mass and tried to withdraw fluid. None came out, suggesting that the lump was indeed cancerous.
On June 14, she received the first of many e-mails from a breast cancer specialist at Indiana University. The doctor raised the possibility of getting a biopsy of the lump and sending the images via video microscope. If the lump was malignant, perhaps an airdrop could supply necessary drugs.
The next day, Nielsen e-mailed family and friends off the ice about her condition.
With the help of a welder who had trained as an army medic 12 years earlier, a biopsy was performed. Slides of the tissue were transmitted by video to Indiana, but the outdated stain used to prepare them made interpretation impossible.
The National Science Foundation, which ran U.S. research programs in Antarctica, and Antarctic Support Associates, Nielsens employer, proceeded with plans to drop fresh stain, cancer-fighting drugs and other needed medical supplies.
The drop was a success, and new slides of the tissue that had been removed from the lump confirmed Nielsens worst suspicions. Her friends, instructed by a doctor and nurse in Indiana via a videoconference, administered the chemotherapy. The tumor shrank dramatically at first, but then it started growing. Nielsens doctor changed her chemotherapy drugs and began urging that she be evacuated from the pole as soon as possible.
Nielsen wondered whether her prognosis was good enough to warrant such a daring effort.
"I know that theres just nothing worse than hearing that an ambulance crashed trying to get to somebody," she says. "I didnt want true heroes risking their life for me."
Knowing that another ailing polie was to be evacuated with her helped Nielsen feel more comfortable about the mission. On Oct. 16, 1999, a crew from the New York National Guard swooped down to pick up the pair up and drop off a replacement physician. It was the earliest in the Antarctic winter that a plane had ever landed.
Back in the world, as polies call life off the ice, Nielsens family had prepared to care for their dying daughter and sister. But medical test after medical test came back negative. "Its just like some kind of a major gift," Nielsen says. "It was a miracle."
At first, she underwent a lumpectomy. Last November, though, an ongoing staph infection in her breast required that she have a mastectomy, which was followed by reconstructive surgery.
Now she is trying to decide on her next adventure. To Alaska, perhaps, or to Africa. But her heart will always be at the pole.
"Something that big that grew that aggressively and then didnt spread, maybe it was because I was at the pole," Nielsen muses. "Maybe being at the pole saved me."