The first day of summer




Current conditions:  Con3; Temp, a warm 3ºF (wind chill -11ºF). Overcast.
Population = 318

The summer season has begun!  Yesterday, about 30 people arrived and 10 or so left, including the former Lead Doctor, Chris Martinez.  Dean is now in charge of the show.  Chris was former Air Force Intel who became an Air Force family practitioner.  He's a great doc with many seasons of Antarctic experience, formidable expertise with ultrasound and an encyclopedic knowledge of pharmacology.  He taught us a ton.  Fortunately, after a brief stint back home in Phoenix, he'll be passing through again on his way for the summer season at the Pole, so we'll have a chance to polish any rough areas we find in his absence.

As I've mentioned, in Winfly, there were only 250 or so people here in McMurdo.  The patient load was a bit underwhelming for three full-time doctors and a nurse.  Also, because medical care and a small amount of medication is free, people come in with trivial things that wouldn't hit a clinic at home.  So principally, we've seen minor muscle strains, colds, and rashes (eczema flares up here).  Also, we've had a few requests for birth control (half the population is in their 20's or 30's and most of them are single), one broken bone (a finger) and follow-up for a perirectal abscess.

Given the lightness of the clinical load, you might wonder what we're doing.  Well, the first thing I did today was shovel the steps of the clinic.  A storm blew in last night.  I wouldn't have known about it  (our room is windowless and tomb-like) except for the fact that my beeper kept going off telling me the change in the base condition.  Although weather pages are supposed to be silent, I had left the vibrate feature turned on.  A vibrating beeper on a metal nightstand-cum-file cabinet makes a ton of noise.  At 1:00 it was con2, at 3:00 it was con1, at 5:00 it was back to con2, at 6:00 it was back to con3.  The vibrate feature is now off; the alternative was to have a shattered beeper lying at the foot of the door.

Shoveling is just one of the many mundane tasks we do in the clinic.  We also do clinic "house mouse" (a Saturday clinic cleaning), dorm house mouse (an assigned biweekly task in the dorm--ours is trash removal), laundry (we wash all clinic linens), and a weekly count, pill-per-pill, of controlled substances.  We need to ensure every week that drugs are missing from the locked cabinet.  Once per month, we also have to count the pills in the controlled substance safe.  This tedious task takes about one hour but today, because we had to enter all the NDC codes, expiration dates, lot numbers and pill counts into the new pharmacy, continuously crashing, database, the task has taken all morning.  And we're not finished.

Half of the pharmacy.  We've hand-counted every one of those pills/vials, discarded expired meds, and
entered requisite data in the database.  Mega hours.

The other large draw on my time (discounting Stanford work, blogging, and email) has been spent in preparing medications for field camps.  As I mentioned before, most scientists who come to McMurdo--and a portion of the staff--don't actually work at the base.  Their research occurs out on the sea ice or in field camps scattered across this side of Antarctica.  To take care of medical emergencies or simply colds and upset stomachs, they're given an ammo box filled with medications, some OTC and some prescription.
Field kits

All of the 50 boxes contain 37 meds ranging from peptobismol to nitroglycerin as well as a wilderness medicine manual, a handbook of our USAP medications and their uses, SOAP notepaper, and logs for medication use.  Some of the deep field teams--for example, the Traverse teams--also get high altitude meds (acetazolamide, dexamethasone and nifedipine) and/or controlled substances (lorazepam and percocet) and an AED.

Before the teams go out, I go through each of the kits, making sure everything is there, that all the meds are not (too) expired, and replacing ones that are long expired or absolutely have to be current (Epi-pens).  The designated medical person on the team sets up an appointment with me and, together, we go through all the meds and their uses.  Fortunately, eleven (!!!) of the meds in the kit are antimicrobials and most of the rest are quite familiar: no Avastin or apixaban (phew!). Also, the field team is only allowed to give prescription meds if they call into the clinic and talk to a doc.   If they take a box of controlled substances with them, the process gets even more complicated.  The med designee needs to call me weekly and go through the pill count to again ensure that none are missing.  Not surprisingly, most teams seem to prefer not to have these meds.

It's a pretty good system but the initial set up is labor-intensive and tedious.

My office.  If you don't see your picture on the wall-of-fame, send one to me!







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