By Chet Yarbrough
Narrated by Jonathan Cowley
Kevin Fong, a physician, believes exploration and extreme medicine are linked. Fong’s book, Extreme Medicine, links exploration and medical advance with real-life stories of adventure, discovery; failure and success. He argues that exploration of the unknown transforms medicine.
Fong begins with a story of frostbite in the early 20th century. The two edges of subzero weather are revealed; one edge destroys while the other preserves life. Fong recounts the life of a mariner that dies from frostbite that slowly saps life from his limbs, his brain, and finally his heart. Then Fong tells of a skier’s accident in freezing weather that leaves her clinically dead for three hours. The skier lives even though 20 minutes without an operating autonomic system means death.
The mariner slowly succumbs to extreme cold and dies. The skier rapidly succumbs to extreme cold and lives. To Fong, this is a transformative discovery in medicine. The skier’s recovery demonstrated the value of rapidly reducing one’s body temperature to arrest deterioration from physical trauma. Doctors who treated the skier were using extreme medicine to preserve life when history suggests she would never recover. That extreme medicine became standard operating procedure for certain kinds of traumatic injury.
Fong offers several more stories of extreme medical practice. Extreme medicine may initially kill patients but what was extreme before may become a life line in the future. Big examples are heart surgery and organ transplants. In the beginning, physicians abhorred the idea of cracking a living person’s chest to operate on a human heart. Fong correlates humankind’s instinct for exploration with doctor’s exploration of medical practice.
There is some truth in that suggestion but there is an ethical difference. Doctors are taking someone else’s life in their hands. An explorer of the North or South Pole is choosing to risk his own life in exploration. As a patient, an explorer’s fear of death is the likely motivator. The doctor’s motivation is more prosaic.
Ethics come into issue in a doctor’s sale of extreme medicine to desperate patients. Life is always, to quote a previous book review, a matter of “me before you”. Doctors are human. Money, power, and prestige affect their decisions just as they affect all human decisions. The difference is that the patient has more to lose than the doctor.
This is not to deny the theme of Fong’s book. Living life is, by nature, an exploration. Human beings who choose to explore extremes do advance knowledge. Knowledge drawn from exploration does transform medicine. Knowledge transforms everything in life. Life on earth is finite. With exploration, life is potentially infinite.