Review: ‘Extreme Medicine: How Exploration Transformed Medicine’ by Kevin Fong

Susan Okie is a physician, poet and former Washington Post medical reporter and editor. She is a clinical assistant professor of family medicine at Georgetown University Medical School.

In May 1999, Anna Bågenholm, a 29-year-old Norwegian doctor, was skiing with two fellow physicians when she lost control, slid onto a layer of ice and fell through a hole into a mountain stream. Her friends managed to grab her ski boots but could not free her. She remained immersed in the fast-flowing water, breathing air from a pocket beneath the ice.

When rescuers arrived, 80 minutes later, Bågenholm was pulled out blue and pulseless — dead. But despite her more than two hours without a heartbeat, and despite her core body temperature of 56.7 degrees, a medical team at Tromso University Hospital tried to resuscitate her. They placed Bågenholm on a heart-lung bypass machine to oxygenate and rapidly heat her blood. More than three hours after her heart stopped, it began to beat again.

(Penguin) - “Extreme Medicine: How Exploration Transformed Medicine in the Twentieth Century” by Kevin Fong.

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Her recovery broke a record: No one had ever survived being cooled to such a low temperature. She awoke 12 days after the accident, paralyzed, yet within the next few months her nerves, too, began to revive. Six years after her rescue, she was able to return to skiing and to finish her medical training.

Bågenholm cheated death by hypothermia because the doctors treating her had the courage to try available technology and procedures in a seemingly hopeless situation, and her recovery led to a better understanding of how deep hypothermia can protect the brain, heart and other organs from damage. In his terrific new book about medicine’s efforts to expand the limits of human survival, Kevin Fong argues that this kind of risk-taking, though often futile, has always been the path to discovery in “extreme medicine,” those fields dedicated to keeping people alive in the face of injuries or environmental exposures that would ordinarily be fatal. War, epidemics, voyages of exploration and disasters encourage the kind of desperate improvisation that occasionally produces breakthroughs.

Witness the work of surgeons Archie McIndoe and Harold Gillies, whose efforts to reconstruct the faces and bodies of severely burned British pilots during World War II revolutionized skin grafting and burn treatment. Or consider the achievement of anesthesiologist Bjørn Ibsen, who, when a devastating polio epidemic struck Europe in 1952, invented the positive-pressure ventilator, which replaced the iron lung and remains the technology used today to treat patients who can’t breathe on their own. Ibsen tried his experimental device on a 12-year-old polio victim who was suffocating. When she fought his efforts to force air into her lungs, he bravely administered a barbiturate to sedate her, whereupon his hand-held ventilator quickly restored oxygen to her blood and slowed her heart rate to normal.

Each chapter of Fong’s book, “Extreme Medicine,” focuses on a different challenge to human survival. “Ice,” “Fire,” “Water” and “Orbit” explore medicine’s and technology’s efforts to keep people alive during or after exposure to extreme environments. “Heart,” “Trauma” and “Intensive Care” examine how doctors have learned to bring patients back from overwhelming injuries, infections or organ damage.

The heart, for example, was considered a surgical no-man’s land until 1917, when British surgeon Grey Turner resolved to try to remove a bullet that was stuck deep in the left ventricle of a soldier’s beating heart. Turner opened the chest, felt the organ with his hand, even punctured its muscular wall in several places to search for the bullet — but when he turned the heart over, “to his horror,” it stopped. The surgeon replaced the heart in its normal position and massaged it until, mercifully, it began beating again. Abandoning the operation, he closed the chest, and the soldier went on to live a fairly normal life, embedded bullet and all.

Fong, a British anesthesiologist, has treated patients in intensive-care units, emergency rooms, helicopters and on the streets of London after a bomb exploded in a Soho pub in 1999. However, his book comes alive because of two additional qualifications: He’s an adventurer and an excellent writer. The son of Chinese parents who emigrated to the British island of Mauritius, Fong studied astrophysics, becoming obsessed with spaceflight before he turned to medicine. Barred from regular employment at NASA because he was not a U.S. citizen, he enrolled in 1997 in an aerospace-medicine course at the agency’s Johnson Space Center in Houston. That led to further work and research at NASA on the body’s responses to spaceflight.

As associate director of the Centre for Altitude, Space, and Extreme Environment Medicine in London, Fong has flown on the “Vomit Comet,” a modified Airbus used to expose astronauts to brief periods of weightlessness, and has attended NASA planning sessions for a possible future Mars mission. His chapters on how the human organism fares during space travel are particularly detailed and fascinating. For example, orbiting astronauts lose muscle mass and bone strength, and even their hearts quickly get out of condition. On returning to Earth, they often experience faintness or sleep disturbances. “Returning crew members have been known to vomit at celebratory banquets, collapse in showers, or run their vehicles off the road because of transient disorientation,” Fong writes.

Every chapter combines personal stories, dramatic medical history and clear, vivid science writing. For example, explaining how scuba diving affects the lungs, heart and circulation, Fong recounts the time he was swept away from his companions by a strong current while reef-diving north of Fiji. Panicked and trying to swim against the current, he used up most of the oxygen in his tank and put himself at risk of decompression illness, popularly known as “the bends.”

“The simple fight-or-flight response that I needed to get myself out of immediate danger was adding fizz to the tissues of my body,” he writes, “trading improved performance in this moment for problems I’d have to deal with later.” Fong managed to reach his fellow divers and surface safely before his oxygen ran out, then spent an anxious night on land before he could be sure that he’d escaped decompression sickness.

Fong’s book presents daring moments in medicine along with lucid explanations of human physiology and of how medical professionals manage to keep people alive or pull them back from the brink. It should appeal to would-be astronauts, outdoor-lovers, mountain climbers, free-divers, armchair explorers, science enthusiasts, those working in the health professions or wondering about such a career — indeed, just about anyone with a heartbeat.

Susan Okie is a physician, poet and former Washington Post medical reporter and editor. She is a clinical assistant professor of family medicine at Georgetown University Medical School.

EXTREME MEDICINE

How Exploration Transformed Medicine in the Twentieth Century

By Kevin Fong

Penguin Press. 294 pp. $27.95

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