Working life: Healthcare in the extremes

Published on: 29 Apr 2020


GP registrar in Somerset, team leader at Exile Medics, trainee in Exmoor Search and Rescue Team, expedition medic, research scholar at Severn Deanery School of Primary Care, and MSc student in healthcare improvement and patient safety at Plymouth University

Hours worked

40 as a registrar in ST3 practice; 40 sessions PA as research scholar; variable hours for other areas

Daneil Bunce


The race crew gets up for the longest stage of the Beyond the Ultimate (BTU) Ice Ultra 2020. It’s a bracing -21°C and the sun has yet to rise over Laxholmen, a remote island in a frozen lake in Arctic Sweden. Mercifully, the log fire is still burning, so inside the cabin is tolerable. We pack away sleeping bags and boil pans of water. Over the next 30 minutes, the 30 runners (from a starting field of 36) will filter in to get hot water, eat, and have last-minute problems with feet and joints reviewed by the Exile Medics team.


I brief the other five medics about their daily allocations and runners we need to keep an eye on. Three medics set out with the local Sami guides via snowmobile to set up the first checkpoints.


The runners gather in the chilly air to receive their daily briefing from Kris King, BTU race director. He outlines today’s route – 64km across frozen lakes and forests. I review the list of anyone who did not finish an earlier stage of the race, as they won’t be starting today. I find one of them eagerly packing her bag in her cabin. As I explain the situation to her, she’s clearly upset but understands the necessity of the decision. She’s reassured that she can still take part in the ‘sprint’ stage on the final day. Then they’re off. The pack of runners stretches off into the distance, at a light jog across the hard-packed snow and ice.


I head out on the snowmobile with Andy, BTU technical director. We carry resuscitation equipment and facilities for emergency evacuation.


Andy and I wait at the halfway point to assess how the main pack of runners are managing. Many have icicles hanging from their beards and their eyelashes are frosty. They’re grateful for the harder conditions underfoot and clear skies overhead. So far, there aren’t any major medical concerns, beyond the need for analgesia and antiemetics. They’ve all taken heed of the advice I give every night to keep warm, fed and hydrated.


We’ve just heard that one of the runners has withdrawn as he’s ‘knackered’. The medics are happy there are no concerns, and the Sami guides have radioed for transport to the overnight camp.


We go to the overnight camp at the end of Stage 4. It’s a gift shop on the Arctic Circle line. To get there, we ride the snowmobile across a frozen lake which groans and moves underneath us. We’ve done this for the past four days and the Sami guides assure us it’s safe, but we still find it disconcerting.


Checkpoint 5 confirm that all runners have successfully made the cut-off. As runners arrive at the day’s finish, the medical team assesses blistered, aching feet and levels of tiredness. Some runners need gentle encouragement to eat, others to get warm and dry, while some just want to sleep.


Everyone heads outside for the Northern Lights – something we’ve all been waiting for. We enjoy the spectacle before the cold nudges us back inside.


The last runner is still 2km away. I tell the rest of the medical team I’ll wait for her and they can get some rest.


The final runner comes through – a full 18 hours and 10 minutes after setting off from Laxholmen. She’s in high spirits – having had to withdraw last year, she’s more determined than ever. With no medical concerns, she’s looking forward to some sleep. I bid her goodnight.


Alarms are set, allocations are planned, and a pre-race clinic time is agreed with Kris for tomorrow. I climb into my sleeping bag still mostly clothed, and go out like a light.