Tuesday, March 11, 2014

Extreme Medicine: How Exploration Transformed Medicine in the Twentieth Century by Kevin Fong

I've always been interested in science and medicine, but I admit that reading the Temperance Brennan series by Kathy Reichs helped draw my attention to this Goodreads giveaway for this book. The technical details about forensics in the series reawakened my desire for actual knowledge rather than my more casual interest of the past. So upon seeing Dr. Kevin Fong's book comparing and paralleling extreme medicine and exploration, I was intrigued.

Right away, I could feel Dr. Fong's passion for both medicine and exploration. The book is well organized and easily understandable. Dr. Fong is good at using analogies that make the body processes and affects on the body comprehensible. There are 9 different areas of focus, and all are kept to an easily readable length.

The first area of exploration is ice, we learn about Robert Falcon Scott's ill-fated but crucial expedition to the South Pole and what happens to the body during hypothermia. Dr. Fong takes us through some of the technologies developed to allow us access to such temperature extremes so that we may learn more about our planet. And in the final segment about ice, we learn of the first time that doctors used hypothermia as a medical tool to save a live.

In the section on fire, we learn how World War I doctors and pilots provided the basis of modern day plastic surgery and why burn injuries are so dangerous.

In the heart section, I was shocked to learn that the heart was forbidden territory for a very long time, and that the field developed so quickly. There are many interesting personal stories in each section, that put a human face on these explorations into new medicine and environs, but if I share them here I'll be doing Dr. Fong's work for him.

Trauma and intensive care are closely associated with hospitals in my mind, and with each other. These two sections trace the development of each specialty. Our current procedures for triaging injuries in emergency situations comes from the personal tragedy of Dr. James K. Styner. He went on a crusade after his family was in a plane crash, and the local small town doctors didn't know how to prioritize cases. He had to function as his children's own emergency doctor while ignoring his own injuries. The inside look at the SARS epidemic and seeing how intensive care units were started was also interesting. I didn't know half of the side effects of polio, I guess my generation is lucky that way.

This passage from the water section gave me the shivers, the thing to remember is that Dr. Fong really did this. Imagine how terrifying it would be if it wasn't a training exercise.
"The water is rising fast now, already up to my waist, and every fiber of my body is telling me that I should unclip that harness and punch through that window. But to do that would be fatal. Free of the seat, I'd be swilled around the cabin by the inrush of water; finding my way to the exit and then locating the metal bar that jettisons the window would be impossible. If I'm to survive this, I have to wait. The water continues to bubble into the cabin. It's at my chest now, and the whole vehicle is overbalancing, skewed by the weight of the engines and rotors above, turning upside down in the darkness. The water is up to my chin as the cabin starts to rotate. These are my last few breaths, and I'm still strapped into my seat, resisting the urge to get the hell out of there."
The sections on Orbit and Mars, look at the medical challenges of space travel. Dr. Fong is an astrophysicist as well as a medical doctor, and he was lucky enough to get training at NASA on dealing with astronauts medical issues. I knew about the weakness they feel after an extended space stay, but knowing the reasons for it and how it's combated put a new perspective on things. Seeing the technologies that are being developed so that long term space travel can be achieved, along with the possible health issues resulting from a trip to Mars made me see why we haven't done it yet.

You would think that space travel would be as far as medicine could go, but it's not. The final frontier section looks at elderly medical care. It looks at how the body's systems slow down, and the delicate balance that doctors need to find. The judgement they need to decide whether it is more humane to treat the health issues or to let things run their course.
From the outside, progress often looks like it happens smoothly and is planned in advance. I like that Dr. Fong points out that leaps of progress are full of stops and starts and are often accidental. That we focus on the successes rather than the failures and the cost of getting to the successes.

Happy reading!

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