Jerri Nielsen signed on as the only doctor ina remote Antarctic research station, completely unreachable during the eight dark months of winter. When she found a lump in her breast, she knew she faced the ultimate test of body and soul.
Mary Ellen Mark
Nielsen outside her home in Canfield, Ohio
“What’s her name again?” Like every woman I knew, I’d heard about the doctor who discovered she had breast cancer while working at the South Pole in 1999. I remembered the small, horrifying news item in The New York Times explaining that she was trapped at a polar station during the long, dark austral winter. Then I read about how she had performed a needle biopsy on her own breast and administered her own chemotherapy. A superwoman, I thought – an ice queen. When I heard that she had finally been airlifted out, I was relieved. I hoped she would survive, though I suspected she would not. I still did not know her name. Almost exactly a year after her dramatic rescue, I am on my way to meet that doctor – Jerri Nielsen – at a restaurant in a small hotel in Alexandria, Virginia, where she is undergoing media training in preparation for her upcoming book tour. By now I’ve learned more about Nielsen: that she underwent surgery immediately after returning to the States; that she has written a memoir, Ice Bound: A Doctor’s Incredible Battle for Survival at the South Pole (Talk Miramax). But, I wonder, who is she really? A survivor, yes. But has she gotten over the trauma of waiting in the polar darkness as her body was ravaged by her disease and the treatment? Will she be grim and brittle, or cool and formidable, deflecting sympathy with a tight smile?
The person who greets me – clasping both my hands in hers and telling me how very glad she s that I have come – defies expectations. She is small and rounded, with soft blonde hair, merry amber-brown eyes, and a smile that could melt a glacier. You might expect to find a woman like this beaming over a freshly baked pie in the kitchen of a Midwestern farmhouse – her native environment, as it happens, but one she has left far behind.
“I always wanted to live on the frontier,” she explains, as a waiter places glasses of ice water on the snowy white tablecloth. “I always wondered what it would be like to cross the prairie on a wagon train and to have no idea what was over the hill.” Even as a young girl in rural Ohio, she wanted to go to Africa. Or the moon, if that was where the action was. Nielsen came from an adventurous family. “They didn’t have the money to travel. But they were adventurous in their own minds,” she says. Her mother served Nielsen and her two younger brothers philosophy with dinner, cultural history before bed. Lorine Cahill, a stoic of Swiss-German stock, believed her daughter could do anything – and endure anything. “When you are the hammer, strike,” she told her; “when you are the anvil, bear.”
Nielsen has always seen herself as a healer, a rescuer. As a young doctor, she was drawn to emergency room medicine. After marrying a fellow medical student in the mid-seventies who seemed to share her ideals, she switched to family practice in order to spend time at home in Sandusky, Ohio, with their three young children. The marriage was a disaster almost from the start. Nielsen writes about it as “a textbook case of domestic abuse.” Her husband never hurt her physically – instead, she says, he tormented her psychologically, shattering her confidence, isolating her from her friends, and terrifying the children with episodic violence. One time, she writes, “he strangled the family dog right in front of me and our daughter, to teach us a less…. Then he shot him to finish it off.”
And yet Nielsen didn’t leave. “If someone with my profile walked into the ER, I would have spotted her immediately, but I could not see her in the mirror.” She writes that it wasn’t until she caught her husband physically hurting their two sons that she took the children and ran. She says that she got a restraining order but allowed her husband’s abject apologies and promises to lure her back. “I didn’t think anyone could be that cruel,” she says now. “Or make things up on that level. I still can’t believe it.” Soon her husband was back to his old behaviors, and she made her first mistake: having a brief affair. After her husband found out, he agreed to a divorce. Nielsen says she asked the children to come live with her in another town, but her daughter wanted to finish her senior year of high school. Her husband suggested she say in the house while they worked out the legalities. She did – that was her second mistake. Nielsen claims that while she was working full-time to build a new life for her and the kids, her husband had a chance to turn them against her. The more she fought to connect with the kids, she says, the more he manipulated them. By the time she left for good, he had gained custody and she was all alone.
She felt trapped in her life. But one of the things her Irish-American father had taught her was how to be an escape artist. As a carpenter and owner of a construction company, he had seen buildings collapse around him and knew the importance of escape routes, always pointing them out to his children. In the early years of her marriage, Nielsen – pregnant, in a leg cast, and holding a 2-year-old – had found herself in a hotel fire. “I was the second person out of the darkened building, because on the way in I had automatically counted the doors to the exit stairway.”
Still, escaping the chaotic, depressing circumstances of life after divorce seemed trickier. “Life had taken on a sameness,” she writes in Ice Bound. “I loved the work but hated hospital politics…I was back where I started, living with my parents with no future in sight. My dreams had frozen.” Then she saw an ad for a job as a doctor at the South Pole. And with the surefootedness of a woman trained to flee a burning building, she made her move.
The Antarctica of Nielsen’s imagination was a place of vast and terrifying beauty. Here, on frigid ice prairies that seemed to stretch and billow to infinity, Robert Falcon Scott’s 1912 polar expedition came to an end as Scott made his famous pronouncement, “Great, God, this is an awful place,” before freezing to death with his crew. No single country own Antarctica: It is administered by international treaty. Scientists and others who work on bases there have to be prepared for physical and emotional discomfort (the temperature in summer is seldom warmer than zero degrees, and the isolation can be unnerving).
To Nielsen, the South Pole sounded like heaven on earth: She would be the only doctor on a base at the end of the supply line – “eight hundred miles from the next base, and that’s nowhere,” she says. She would have no nurses, no orderlies, no support staff. She would have to do everything, from the delicate brain surgery (if that was what was required) to scrubbing the operation room floor. In a pinch, she would function as a dentist, largely on the strength of a five-da crash course in dentistry. (“Are you afraid of dentists?” Nielsen would ask a patient in her chair for a filling. “Yes,” the patient would answer. “Don’t worry,” Nielsen would cheerily assure her. “I’m not one.”
As soon as she arrived at the South Pole in November 1998, Nielsen felt at home. She approached the base – a cluster of orange-red buildings beneath a geodesic canopy – with a feeling of unmitigated delight. “Dome Sweet Dome” was what the “Polies” called this unheated shelter arching above buildings that looked like refrigerators – except that their thick metal doors kept the cold out instead of in. “Everyone who has written about Antarctica says it’s a blank slate on which you write your soul,” Nielsen says. The vistas – the fields of ice beneath a piercingly blue sky, the summer sun ringed with ice crystals – and the razor-thin air literally took her breath away. “It was cold from another dimension, from an ice planet in a distant galaxy,” she writes. Even inside the heated buildings, the ice constantly threatened to close in. The floors were frigid; if you dropped a wet towel, it would freeze on the spot. Nielsen felt like an astronaut or a character from Star Trek.
People on the “Ice” had nicknames. There was Big John (Jon Penney_, the station’s heavy-equipment mechanic, who whispered sweet nothings to the machines. there was Comms Tom (Tom Carlson), who tracked the satellites that gave Polies access to e-mail via the Internet. And there was Power Plant Thom (Thom Miller), who repeatedly kept the ancient and leaky generators from failing. The station will be dismantled after its replacement is constructed (scheduled to be completed in 2005). Keeping the dome’s fragile systems running until then requires miracles of improvisation and skill.
Of the 41 people on the base, only nine were women, most of them in their twenties. Dorianne, a onetime literature student from Wisconsin and the base’s cook, became Nielsen’s closet female friend. The two took morning walks to nowhere, past waves of ice call sastrugi that produced varying musical notes when struck, like glasses of water do when tapped by a spoon. The two women would lie back on the ice and look at the sky as the sun proceeded in its tiny circular orbit.
Antarctica was an odd environment for a woman. In the great era of its exploration, during the early years of the 20th century, men arrived to conquer the continent. But at the century’s end, it was women who began to tame it. Nielsen and other women on the base – particular for a woman. In the great era of its exploration, during the early years of the 20th century, men arrived to conquer the continent. But at the century's end, it was women who began to tame it. Nielsen and other women on the base-particularly the older ones-understood the importance of marking time with celebrations. "Time contracts and then expands in unusual ways because there's no night and day as such," she explains. Physiologically, human beings need the alternation of light and dark, and during the winter they sometimes get "toasted," becoming distracted and antisocial. "People walk away in the middle of a sentence-they forget they're talking to you. Or they just sit and stare," says Nielsen. "You have to shake them and say their name a couple of times to get them out of it." Dressing for dinner or taking part in a poetry slam or a pig roast helped to shape the amorphous hours. So did humor: A M*A*S*H* bash was thrown in the biomed building, with chips and dips served in sterilized bedpans, and martinis dispensed into glasses from IV drip bags. "And I found that it was usually the women who observed holidays and changed the seasons for people," Nielsen says. "You realize that things like that are important, like everybody wearing stupid masks on Halloween."
Rules helped, too. And they were tailored to this strange world where there was no such thing as privacy. "You could hear people roll over in bed or unzip their pants. And when you live in that way, you have to make new rules for society," Nielsen says. So you never spoke in a hallway. You never acknowledged anything about a person that you knew made him or her uneasy. You hoarded what you could. Reza, a scientist from Bangladesh, dug a little hole in the ice and buried a bunch of apples just before winter, when the supply of "freshies" is scarce. "He gave me one later on as a present," Nielsen recalls. 'And this apple looked like one of those Popple people with faces that are scrunched up and gray and violet. It was such a beautiful gift!"
Nielsen never got toasted. She loved the long night and the silence. "People go into convents and they say they're feeling God or having spiritual experiences," she says. "That stuff is probably going on in all of us all the time. But when you're trying to listen to traffic reports and somebody's calling you in your car and your kids need you and you have to make dinner and you have a deadline at work, you don't pick up these things." As an emergency room doctor, she had been sensitive to people's needs. "But when you have no new info coming in, you realize that you can understand people without speaking to them, you can tell how they feel by the way they stand and hold their eyes. I could tell when someone was sick without them saying anything."
Talking now about winter at the Pole, Nielsen's expression is rapt, yet serene: It's the look an Olympic athlete might get just before a crucial event. It was March 1999, she remembers. The last plane had departed February is-no more supplies or emergency evacuations until October at the very earliest. Nielsen had been looking forward to this: the outlandishly long period of cold and darkness that would give her the chance to test her spirit. A few weeks later, she was in her room reading when she felt the mass, at a point just above her right breast. She palpated it, then tried to make a medical judgment: cancer, or just another benign cyst, the kind she had had before? The mammogram she was given just before leaving for the Pole had been negative. She decided to wait and see.
A month passed. She was feeling happy, convinced that she had finally made sense of her life, and e-mailed her mother: "I have changed a lot. Mostly, I now know what I want and who I am. I am back to believing in myself." She continued: "I love it here so much that I don't ever want to leave."
By May, Nielsen was writing to her mother that the base was in the middle of a brownout. The situation was dire-if they lost power, there would be no way to survive. Big John and others managed to keep the power plant running, without actually finding out what the problem was or when it could recur. Polies were feeling
the effects of the long night and the deep freeze. But Nielsen was in her element. "I suppose this was the greatest irony of my own life," she writes. "Now that I finally felt fully and completely alive, I had to face the possibility that I was dying."
The mass in her breast had grown. And she now had a painful swelling under her right arm. As a doctor, she judged it was likely to be cancer. She also realized that she would have to tell the station manager, who suggested that she e-mail Gerald Katz, the doctor in charge of Antarctic medical stations. Nielsen laid it on the line for him: "What I am asking is tough. You know the Ice. Should I sit on this for five more months, or should I perform an operation on myself and remove it?"
Test of the spirit: Can you do whatever is necessary in extreme circumstances? Nielsen's answer was yes. The medical consensus was that she should not operate herself, however, but perform a fineneedle aspiration of the mass to determine whether there was fluid inside. Clear fluid would indicate a benign cyst; cloudy or no fluid would indicate the possibility of a cancerous tumor. To assist her with this procedure she recruited an electrician on the base who had trained with a trauma team. But the mass was solid, and it was impossible to extract any fluid.
This was a low point for Nielsen, who knew that a fast and definite diagnosis was crucial. Two days later, she received an e-mail from Kathy Miller, a medical oncologist at Indiana University who had been introduced to Nielsen's case by a close friend who knew Miller. The doctor was against surgery because of possible complications. Nielsen agreed that doing her own surgery would be a bad idea but thought she could manage a biopsy. And if supplies could be air-dropped to the base (a dangerous proposition because jet fuel might freeze or cargo doors stick), she could also undergo hormonal therapy. Assuming this cancer was fueled by estrogen, as was likely in a woman in her late forties, the therapy could halt the hormone's production, but it would also catapult her into premature menopause.
With these eventualities in mind, Nielsen finally e-mailed her parents and brothers. It was a letter packed with details and with a stoic resolution worthy of Lorine Cahill's daughter: "More and more as I am here and see what life really is," Nielsen wrote, "I understand that it is not when or how you die but how and if you truly were ever alive." Predictably, her parents and siblings rallied around her. Nielsen says her mother and sister-in-law left detailed messages on an answering machine for her ex-husband and children, but no one ever called back.
Nielsen prepared to perform the biopsy. The thought of it didn't faze herthough she was secretly terrified of needles ("I've never given blood!" she tells me). Nielsen had long known that because she was type 0 negative and the base had no blood bank, if anyone needed a transfusion, she would be the designated donor. Having steeled herself to the idea of possibly drawing pints and pints of her own blood, Nielsen says, "putting needles in my breast and jabbing them up and down wasn't that big a deal."
She recruited helpers: Welder Walt, who had trained as an army medic, and Bill Johnson, the carpentrv foreman, who knew something about suturing. Anesthesia would be minimal: to numb the area, lidocaine and-the one thing that wasn't in short supply-ice. Walt and Nielsen practiced sticking needles into an apple, a yam, and a potato. Meanwhile, Choo Choo Charlie Kaminski, a telescope expert, and Lisa Beal, a computer technician and close friend, rigged up a video microscope that could magnify the stain on a slide and transmit it to laboratories in Denver and Washington, D.C.
Nielsen, her head elevated on the operating table, did the initial aspirations herself. Then she leaned back and let Welder Walt take over. But despite his and Nielsen's best efforts, they later learned that because of an outdated stain, the slides couldn't be made clear enough for the pathologists to read. A better microscope would be needed, along with drugs and other medical supplies. An airdrop would have to be arranged.
Nielsen wasn't so sure of that. If this really was an aggressive cancer, wasn't she likely to die anyway? Would leaving the mass alone a few months longer make any difference? Why should pilots risk their lives for a lost cause? Demoralized and frightened, she e-mailed Miller, who convinced her to let the airdrop happen so that chemo could begin. The bottom line for Miller: "I have not yet made a woman immortal, but if I can help it she won't die of breast cancer!"
In late June, the station began making preparations. Big John tuned up -and talked to-his machines. Comms Tom double-checked the radio and computer systems that would enable the base to stay in contact with the plane. And life continued, including a Fourth of July pig roast at which Wilbur, a 140-pound suckling pig, was the featured attraction. On July 10, an aircraft buzzed overhead and scattered six parcels of medical supplies and other items over fields of ice. The Polies, including Nielsen, dashed out to retrieve them before the contents could freeze. Though the ultrasound machine smashed on impact-which meant she couldn't image the tumor for diagnostic purposes - the microscopes and medicines remained intact. There were even freshies. "I ate a nectarine," Nielsen writes, "that tasted like sunshine."
It would take more than polar darkness to keep the media away from such a story. Because she had requested anonymity, Nielsen was described at first as a mystery woman. But soon details leaked—thanks in part to her ex-husband, who Nielsen says fed wildly inaccurate information to the press. According to Nielsen, he insinuated that she had faked her medical credentials and that she didn't have a tumor at all- she was just a glutton for attention. A newspaper quoted her 18-year-old daughter, Julia, as saying she didn't care what happened to her mother: a death blow to the heart. Tabloids hawked stories about her disastrous marriage, her affair, her estrangement from her children. To make everything worse, the National Science Foundation and Antarctic Support Associates, which had authorized the drop, were pressing Nielsen about the scandal. "God," she wrote to her mother, "all I was doing was trying to turn my life around."
The diagnosis came toward the end of the month: carcinoma of the breast. Although it was what she expected- she had even started hormonal treatment—the news was devastating. Nielsen felt doomed. Still, she agreed to proceed with chemotherapy: weekly infusions of Taxol to shrink the tumor. The side effects, Miller assured her, would be minimal.
That, at least, would be a blessing. The effects of the hormonal therapy were as advertised. "I had hot flashes," Nielsen recalls. "I would get so hot that I would just be covered with sweat, take off all my clothes, and then my sweat would freeze on me. And then I'd throw on all my clothes again."
Administering the Taxol drip was a challenge. Each dose had to be given within an hour. Less time, and she might have an allergic reaction; more, and she ran the risk of myelosuppression-which stops blood cell production in the bone marrow. Nielsen reassembled her team from the biopsy, with the addition of a heavy-equipment operator to help with the IV. Kathy Miller watched the procedure via an ingenious method of videoconferencing. This was medicine as improvisational theater. "Welcome to the Marx Brothers do chemotherapy at home!" Nielsen wrote to her doctor afterward.
Over the next two months, the tumor shrank, then grew again. It threatened to turn Nielsen into something she had never planned to be: a victim of circumstance. She was a doctor; how could she not be in control of her life? Then she remembered an Irish tradition she had read about long ago ("I'm Irish," she explains, "so I have a lot of those images in my thinking"): At funerals someone called a sin eater would eat the food placed on a corpse in order to consume the dead person's sins and send the soul straight to heaven. That, Nielsen realized, was her role as a doctor: She took on other people's pain. Now, in order to survive, she needed to learn to let others take on hers.
"It was a freeing experience," she says. "I didn't think I would like it, but realizing how much people need each other—it frees you to need people, as amazing as that is." It was the lesson her father had taught her as a child: "You have a job to do," she could imagine him saying. "You have wonderful friends. You may die this year, but isn't it wonderful that the last year of your life was the most beautiful?"
Nielsen kept working through the winter. Everyone pitched in to help with the hospital-and with the parties she continued to organize. When her hair started falling out during chemotherapy, the others threw a "make Jerri totally bald" party, complete with Bob Dylan music and an electric razor. Then, luring her into the galley, the women pulled homemade hats out of their blouses and gave her a surprise hat shower.
Finally, the sun began to rise. Polar spring arrived and, on October 16, so did the plane that lifted Nielsen off the Ice and brought her back to the States. She knew what she was leaving behind-close friends, a community that protected and nurtured her, an environment that challenged her to persevere despite almost unimaginable odds. She also knew what lay immediately ahead: surgery and intensive chemotherapy. But after that ...she really had no way of knowing.
It is now midafternoon in Alexandria. As Nielsen and I finish our second cups of coffee, we hear laughter at the far end of the restaurant. A waiter comes by to explain that the hotel is hosting a Halloween pumpkin-carving contest. Nielsen's eyes light up. "Cool!" exclaims the 48-year-old doctor. "See, that's a good thing, that marks time."
Nielsen's own time now is fluid. As far as she knows, she is cancer-free (on her return from the Pole she had a lumpectomy followed by chemo and radiation). There will be the book tour to deal with and, if she's lucky, an occasional break to spend time at her beach house in North Carolina. She will keep reaching out to friends from the Pole via e-mail; to her children, who she still hopes will come back to her; to strangers in pain and crisis. Her experience at the Pole has made her a celebrity and she's ready to run with that. "I might as well use it in a positive way to help people who have cancer. I've seen how people who are ill have responded to me, how happy I've made them. And so if I have that ability, why not?" She might look for a job in a hospital in Africa or South America. "I have that wanderlust," she says. "I don't dare even imagine my future, because it's too wild to imagine."
She might even find a community in the United States that needs a doctor like her. A close childhood friend who never left Ohio recently said to her, "When you were a little girl, I could have told you that you couldn't stay-but that you would come back." Nielsen laughs as she remembers that conversation: 'And I realized, My gosh, she's so right! I found the same happiness that she found, but I had to go all the way around the world to find it." .