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At first she thought it was a practical joke.
When colleagues in Fort Wayne and Ohio contacted Dr. Kathy D. Miller, medical oncologist at the Indiana University Cancer Center in Indianapolis, about a woman at the South Pole who possibly had breast cancer, Miller wasn't sure at first whether or not to take them seriously.
Then she got a call from the woman - Dr. Jerri Nielsen, 47, the doctor at the South Pole who had found a lump in her breast.
"The problem," Miller said Saturday at "A Day at the Lake" fund-raiser for the Catherine Peachey Fund, "was that the polar winter doesn't allow evacuation for four to six months after she found it."
During polar winter, she said, temperatures are often below 100 degrees below zero, which turns jet fuel to a gelatin-like consistency, and planes can't fly into and out of Antarctica.
Another problem was that Nielsen was the only doctor at the base, so not only did she have no one to help her, but also she had to be available perform as the only medical staff at the base.
First, Miller had to establish a diagnosis - Did Nielsen actually have breast cancer? Then Miller had to determine how best to treat Nielsen while keeping Nielsen able to treat her own patients at the South Pole.
What followed was a long-distance treatment plan beset by satellite problems, outdated equipment, restricted communication and last-minute medical training of non-medical personnel.
Miller and Nielsen decided to perform a needle biopsy on Nielsen's lump, since it was the most non-invasive way to diagnose Nielsen's condition. Miller sent details of the procedure in advance, and Nielsen had the base's welder practice a needle biopsy "on a series of fruits and vegetables."
The base's computer staff worked out a way to connect a camcorder to the South Pole's only medical microscope, digitize each frame and electronically send pictures of the biopsy slides, Miller said. But once she got the slides they were useless because the only stain available at the South Pole for pathology work was from 1975 and was not effective.
Miller was able to send appropriate stain that was included in a later airdrop by the Air National Guard, and Nielsen was diagnosed with breast cancer.
Even the airdrop was an adventure, Miller said. Of the six boxes of equipment dropped, none landed in the designated drop zone, and the box containing the only ultrasound machine was smashed when its parachute didn't open.
All the boxes were equipped with strobe lights so the ground crew could see where they landed, but the plane crew, failing to take into account the sudden drop in temperature between the plane's interior and the Antarctic air, turned the strobe lights on too early, and the bulbs exploded as soon as they left the plane, she said.
"I also had to consider, what if the first treatment didn't work?" Miller said. "We only had one air drop, so we had to send a couple of different treatment regimens."
Now Nielsen's treatment began - using video conferencing equipment and relying on the people at the South Pole to help administer the chemotherapy.
"Imagine if you have to explain to people who have never seen feet how to tie shoes, and you can only tell them how in words and what they can see on the video internet conferencing system," Miller said of the last-minute training of Nielsen's colleagues. Miller and her nurse finally resorted to writing out the procedures and then taking them home for their husbands to read. If their non-medical husbands understood the procedures, then Miller was reasonably sure the South Pole crew would too.
Being dependent on the satellite for communication also was a harrowing experience, she said. The satellite connection for the video conferencing was available only two to three hours a day, and the time for that changed daily because of the rotation of the Earth.
The satellite wasn't available, however, during meteor showers, NASA testing and presidential trips - when then-President Bill Clinton was visiting Australia, NASA turned the satellite around so Clinton could communicate with the United States. That did not sit well with Miller.
"You can imagine me pleading with them, 'He can come home and she can't,'" Miller said. "And the amazing thing was that it worked and they turned the satellite around."
Other problems happened as well. Halfway through the first treatment the audio stopped on the video conferencing, and Miller and her staff and the South Pole people had to communicate by writing on note cards and holding them up to the cameras.
"We had to prepare for things that couldn't possibly happen because invariably they did," she said.
Because she was protecting Nielsen's privacy, Miller couldn't tell anyone, even other staff members, who she was treating or why. And communication, besides the video conferencing, was limited to e-mail, which was only available every 12 to 24 hours, she said.
Despite the extraordinary circumstances in treating Nielsen, Miller said, "Only the logistics were different. Her fears, problems, reactions were the same as every other patient. We just had to get a little tricky with the procedures we used."
Miller also said the involvement of the South Pole crew in Nielsen's disease and treatment reminded her that breast cancer affects a community.
"This is not just a disease that affects individual women," she said. "It affects the community in so many ways."
(Jerri Nielsen was eventually evacuated from the South Pole and was treated at IU Cancer Center in Indianapolis. She is now cancer-free, lecturing on breast cancer awareness and, Miller said, is going to return to practicing medicine.)
