Extremes: Life, Death and the Limits of the Human Body by Kevin Fong

David Green on the risks and rewards of medical progress

March 14, 2013

“We explore simply because we must. And that makes us human.” Anaesthetist, intensive care expert and broadcaster Kevin Fong’s closing words confirm the underlying theme of a book that takes us on a journey through events that marked key discoveries, both in far-flung places and in the innermost sanctums of our own bodies.

In an age of interventional medicine where lives can be salvaged in the face of seemingly impossible odds, it is sobering to consider moments where leaps of faith have gone on to inform the medical team standing over us in our hour of need. Indeed, this book’s subtitle, Life, Death and the Limits of the Human Body, applies equally well to both patients and the individuals looking after them - particularly after yet another 36-hour shift. What never fatigues is the delight in exploration and sense of wonderment that permeates Extremes, where the ice shelves of Antarctica are no colder or more foreboding than the heart of a nail-bomber’s innocent (and never nameless) victim slumped in the streets of Soho, just five minutes from a major trauma centre.

Fong weaves together seemingly unconnected events in this world and beyond in a series of breathless vignettes. The loneliness of exploration finds its echo in the loneliness of facing up to the death of someone fate has placed in your care, if not your capabilities. These tales are told in an unapologetically personal fashion, framed either by Fong’s own experiences or information that appears to be taken not from time spent poring over dusty reports, but from chats over a skinny latte in an airport coffee shop as a string of remarkable protagonists pass through with time and anecdotes to spare. All these conversations are conveyed with an appealing mix of academic eloquence and matey talk: Brian Cox with a stethoscope, if you will. It is a voice you would welcome if your nearest and dearest were hooked up to a battery of white machines bleeping and flashing in a dimly lit room. Although in that situation you might want to lose the one- liners, such as the one Fong uses when describing a bullet that necessitates cardiac surgery: the patient, he says, “harbours an unwelcome visitor in one of the citadels of his wellbeing”.

Intensive care is a place where time in the face of entropy is a commodity purchased by risks taken by our forefathers

Risk and adventure are never far away, as Fong extols the courage of patients, physicians and explorers in equal measure. Some are brave, some choose bravery, and still others have it thrust upon them. Desperate times call for desperate measures - such as continuing to try to resuscitate a patient named Anna, even though she has been lifeless for what must have seemed like an age. Sometimes, just sometimes, unlikely successes offer a chink of light that will later shine in places far from the original scene. It would have been easy for Fong to simply paint a picture that is equal parts Boy’s Own adventure and inexorable progress, but a humane undercurrent of ethical considerations and personal clinical dilemmas is ever present here, even though the answers are never divulged.

Should one intervene in a throbbing aortic aneurysm, shock a fibrillating heart for the nth time, translate plates of healthy skin like a sliding puzzle, or even place another person’s entire face on the seared aftermath of an electrical burn in an attempt to recreate normality, whatever that means? When should we stop and give up hope, and when do the risks of succeeding outweigh the risk of success? Lives and careers can be on the line - following years of preparation or in the blink of an eye. Clinicians must make these life and death calls. But despite deploying prose with the breathless pace of a crash team racing to meet a patient in dire straits, Fong’s book affords dignity to all. Thus, the donated face he describes as “a dull thundercloud grey” is excised against the clock to fill not only the void of US transplant patient Dallas Wiens’ face, but also “the hush that fills a room in his presence”.

That clock does not always run with metronomic regularity. The slow death march of polio or the rapid loss of blood from an unknown puncture are set against the creep of medical progress. Every so often someone stands facing a precipice that requires someone else to take a leap of faith. Such leaps are often not understood, wanted or fully appreciated even when successful. Indeed they are often unsuccessful, but we must still try to expand our armoury not only to cheat death (because you just never know) but also to explore our capabilities as humans and extend the envelope of life. Our success is defined by our willingness to face failure and loss. It is a sobering moment when Fong introduces us to Mr Hudson, lying in a hospital bed with pneumonia but statistically less likely to die today aged 103 than he was before his first birthday or on the battlefields of the First World War. This, then, is how far we have come.

In many ways, Extremes is the story of the 20th century. As we move through the 21st, exploration has obtained something of a bad name for being too self-indulgent and too costly after the mess the bankers - who took too many risks - left us with. Medical research is subject to strict rules, all of them well intentioned. However, having to deal with the ravages of war taught us lessons that society otherwise was simply not ready to learn. It appears that intensive care has evolved as much through accident as design - perhaps not inappropriately, given where its customers come from. It is a place where time in the face of entropy is a commodity purchased by risks taken by our forefathers; where Antarctic explorer Robert Falcon Scott’s icy demise led to an understanding of circulatory “down time”. Of course, much basic research was needed to join those two dots, but then forensic dissection of that process is not the point of this book.

Extremes prefers to bounce on the surface of the upper atmosphere rather than getting weighed down by the complexities of the human body - but you always get the point. In a book that reads like a series of BBC Horizon programmes shrink-wrapped into one, you can almost imagine the panning helicopter fly-bys (although hopefully not the one used for submersion escape training). In time-honoured documentary style, the text occasionally repeats itself, just in case you’ve gone to put the kettle on, but it serves to reinforce the sense of adventure and progress, and the argument that risk-taking is an imperative even with something as precious as life.

In such a personal journey, one naturally wonders which extreme holds the greatest appeal for Fong. The answer screams from the void: space. Detail absent elsewhere in the book abounds in the sections devoted to this subject, and the frequent glances to the US start to make sense (eg, all units are in imperial measures). Nasa, after all, carried the hopes of so many of the Western world’s 20th-century adventurers, and one suspects Fong’s, too.

We explore because we must, and if you have a sense of adventure and the miracle of life within you, then this book is for you. With or without a skinny latte.

The author

Kevin Fong, honorary senior lecturer in physiology at University College London and clinical lead in space medicine at UCL’s Centre for Altitude, Space and Extreme Environment Medicine, was born on the outskirts of London. “When my parents arrived in Harrow, they tell me they were only the second Chinese family in town,” he says.

“I now live in South London with my very lovely (and patient) wife Dee and our two boys, Jack and Noah. I love the city; it’s forever changing, which I guess means you can keep exploring. The only downside is that it’s become really bloody expensive.”

Fong recalls: “I became interested in science very early on. I have my parents to thank for that; they were always hauling me around museums and libraries.

“They went out of their way to inspire me. I remember them waking me up - I must have been around five - to watch the Apollo-Soyuz Test Project, the last mission of the Apollo era that saw the Russians and the Americans collaborate for the first time in space: people floating together in a tunnel linking their spacecraft, as if by magic.”

He attended UCL to study astrophysics. “Not too much thought went into that; it just sounded like it might be the sort of thing I’d enjoy. In the end it turned out to be hard work - a lot more hard work than I thought it would be. Thankfully my tutors were very supportive. I enjoyed it but by the end decided I needed to come back down to Earth and study something more practical. That’s what took me back to UCL to study medicine - something I’d long thought about but had never really believed I might have the opportunity to do.”

In recent years a familiar and engaging presence on television via Channel 4’s Extreme A&E and episodes of BBC2’s documentary series Horizon, among others, Fong acknowledges: “I feel lucky to have had the chance to have a go at a bit of broadcasting.” However, he adds, “that all happened by accident. It’s been great fun.”

Asked to name his favourite astronaut, Fong plumps immediately for Michael Collins - “the often-overlooked third man of the Apollo 11 crew, something that doesn’t appear to bother him at all. He coined a kind of personal motto, a sort of mash-up of the motto for the test pilot school and that of the air rescue corps: ‘Into the unknown, that others may survive.’”

Extremes: Life, Death and the Limits of the Human Body

By Kevin Fong
Hodder & Stoughton, 352pp, £20.00
ISBN 9781444737745
Published 14 March 2013

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