|Coping with Breast Cancer--When the Patient Is Also the Physician
By Elaine Cassel
Marymount University and Lord Fairfax Community College
Thinking the position might help her get over the pain of a bitter divorce and custody battle and help give her a new outlook on life, Dr. Jerri Nielsen took a year off from her Cleveland, Ohio emergency medicine practice to become the only physician for the forty-one members of the National Science Foundation's scientific base at the Amundsen-Scott South Pole Station. When she discovered a lump in her breast shortly after her arrival in November 1998, she became her own physician as she treated herself for breast cancer before being rescued and returned to the U.S. Nielsen writes of the adventure that was far more than she signed on for in Ice Bound: A Doctor's Incredible Battle for Survival at the South Pole (Hyperion, 2001).
Nielsen tells how she guided some of her fellow residents to perform a breast biopsy while she looked on, the results of which were sent to doctors in the United States by computer-based videoconferencing. She taught them how to hold the antiquated IV-bag so that the powerful chemotherapy (air-dropped from the States when weather permitted) would infuse at a rate that would help cure rather than kill her. She adapted to her illness and self-treatment so that she could continue practicing medicine at the Pole while suffering from the physical affects of chemotherapy. And she survived a daring rescue mission that literally risked her life and those of her rescuers. All these events are reasons enough to read Ice Bound.
But psychology students will appreciate learning how Nielsen coped with this life-threatening challenge in the dark Antarctica winter. Coping is defined as one's cognitive and behavioral efforts to manage specific demands that tax one's resources. In Ice Bound we see how Nielsen used components of the two common approaches to coping--problem-focused coping and emotion-focused coping--to face her fears and help heal herself.
Problem-focused coping involves confronting the problem, seeking social support, and trying to solve the problem. As a physician, Nielsen spent little time denying the problem. Once she discovered the lump in her breast, she began to worry that it was cancerous. She communicated with doctors at home who encouraged her to measure the lump and keep an eye on it for a while. After all, weather conditions at the time were such that Nielsen could not be taken out of the station nor could medical supplies flown in. Nielsen developed a support system by identifying members of the station's research team who could take on some of her professional tasks if she got sicker (which she did). She taught several of them how to perform routine medical procedures; she chose a few in whom to confide her fears, giving her much needed emotional support. These preparations paid off when she was undergoing chemotherapy and was too sick to work and too frightened to be her usual upbeat self.
As the lump grew, the need to diagnose it became apparent. Using only the most rudimentary tools, Nielsen guided some of the residents in taking a biopsy of the lump's tissue. Once the diagnosis was made by stateside physicians, Nielsen began to faced the possibility of dying of breast cancer at the South Pole. Through email, she confided in her oncologist, an empathic woman who stressed that Nielsen had to maintain a positive outlook and think like a scientist. When Nielsen asked for percentage chances of metastasis and death at the Pole, the physician reframed the issue in terms of how great were the chances of containment of the cancer and survival.
Nielsen's parents and brother were a major source of support (she was estranged from her nearly grown children, though she tried to contact them) through constant email exchanges, but they too urged her to rely on her cognitive skills as a physician and to keep her fear under control. Nielsen used emotion-focused coping strategies such as thought control, distancing from the problem, and positive cognitive reappraisal. She fretted about her cancer when she was off-duty so that she could step back from the problem when she was working. She replaced imagining what it would be like to die at the Pole with daydreams of going on a sailing trip with her brother when she returned home.
Eleven months after her arrival, the New York Air National Guard deployed planes to Antarctica to await weather conditions that would permit them to land at the Pole and rescue Nielsen. With a window of opportunity measured in hours, she ran to the station's tarmac on October 16, 1999, where she was airlifted and returned to the United States. Her cancer did not spread and she is now in remission. Of coping with cancer at the South Pole Nielsen wrote, "I think it was easier to have cancer here, at the South Pole, than back in the world of high-tech medicine. Here, I had no option but to accept my fate" (p. 341).
Nielsen's acceptance paved the way for her to cope with and recover from a life-threatening disease under the most primitive and frightening conditions. But Ice Bound is more than a book about coping. It is about the goodness of others, personal courage, and resilience.