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The Penguin Press



Extreme Medicine: How Exploration Transformed Medicine in the Twentieth Century

Anesthesiologist, intensive care expert, and NASA adviser Kevin Fong explores how physical extremes push human limits and spawn incredible medical breakthroughs.

Little more than one hundred years ago, maps of the world still boasted white space: places where no human had ever trod. Within a few short decades the most hostile of the world’s environments had all been conquered. Likewise, in the twentieth century, medicine transformed human life. Doctors took what was routinely fatal and made it survivable. As modernity brought us ever more into different kinds of extremis, doctors pushed the bounds of medical advances and human endurance. Extreme exploration challenged the body in ways that only the vanguard of science could answer. Doctors, scientists, and explorers all share a defining trait: they push on in the face of grim odds. Because of their extreme exploration we not only understand our physiology better; we have also made enormous strides in the science of healing.

Drawing on his own experience as an anesthesiologist, intensive care expert, and NASA adviser, Dr. Kevin Fong examines how cutting-edge medicine pushes the envelope of human survival by studying the human body’s response when tested by physical extremes. Extreme Medicine explores different limits of endurance and the lens each offers on one of the systems of the body. The challenges of Arctic exploration created opportunities for breakthroughs in open heart surgery; battlefield doctors pioneered techniques for skin grafts, heart surgery, and trauma care; underwater and outer space exploration have revolutionized our understanding of breathing, gravity, and much more. Avant-garde medicine is fundamentally changing our ideas about the nature of life and death.

Through astonishing accounts of extraordinary events and pioneering medicine, Fong illustrates the sheer audacity of medical practice at extreme limits, where human life is balanced on a knife’s edge. Extreme Medicine is a gripping debut about the science of healing, but also about exploration in its broadest sense—and about how, by probing the very limits of our biology, we may ultimately return with a better appreciation of how our bodies work, of what life is, and what it means to be human.




“Every chapter combines personal stories, dramatic medical history and clear, vivid science writing…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 and a dash of curiosity.” The Washington Post

“In Extreme Medicine, physician Kevin Fong reminds us that virtually everything we take for granted in lifesaving medical intervention was once unthinkable… Dr. Fong’s engaging and fast-paced narrative is liberally sprinkled with his own harrowing experiences as a specialist in anesthesia and intensive-care.” The Wall Street Journal

“[Fong] weaves first hand, nail-biting ER experiences with gripping historical narrative as he recounts 100 years of breakthroughs…[Fong] looks forward as well: He offers tantalizing ideas about surviving long-term space travel and other possibilities that await us in our relentless quest to explore.” Discover

“With clear, evocative prose, he takes readers to ocean depths and mountaintops, and also deep within our bodies, in this entertaining exploration of human limits.” Mother Jones

“Anatomy and physiology are elegantly explained, not as abstract theory, but as counterpoint to gripping stories about survival against the odds. Real stories of life and near-death form the compelling backbone of the book. The book could easily have ended up as a series of Boy’s Own tales of derring-do, but Fong elegantly balances heroism with rationalism, courage with compassion, shock with humility and humor.” The Observer (UK)

“A gripping read. It’s the kind of book you want to read peeking through cracks in your fingers; you want to look away, but not as much as you want to know what happens… I held my breath, I shed a tear, I laughed out loud, and I struggled to keep my lunch down at various points through this book, and that can only be a good thing.” —Guardian (UK)

“Fong has dramatic first-person accounts to give, and many more… he also proves himself to be a genuinely talented author… Fong has come up with an often fascinating and actually rather inspiring account of western medicine’s ever-increasing expertise.” —Daily Mail

“In Extreme Medicine, the ever-intrepid Kevin Fong reveals the fascinating link between geographical exploration and medical innovation, with stories that are as strange and intriguing as they are illuminating.” Atul Gawande, surgeon and author of ComplicationsBetter, and The Checklist Manifesto

“It would be hard to find anyone better qualified to write a book on the limits of human physiology than Dr. Kevin Fong. His experiences in human spaceflight at NASA, in frontline medicine, and his deep scientific knowledge, shine through. If you want to know what the human body can take, and why we must continue to push ourselves beyond the limit in the name of exploration, then read this book.” — Professor Brian Cox, author of The Quantum Universe

“A medical thriller of the first order.” Kirkus Reviews (starred)

“[An] eloquent history of how 20th-century science and medicine moved us toward ‘improved survival’—and with it a better understanding of life and death… these are thrilling stories that describe the limits of human physiology.” Publishers Weekly

Author Q&A

Q: Your expertise is space research and medicine. When did you first become interested in outer space exploration?

A: Space is pretty much the first thing I remember. I have a memory of being woken up one night in the summer of 1975, when I must have been four years old, to come down and watch the television. I remember watching the fuzzy black and white picture on our TV set, of astronauts and cosmonauts floating in the hatch between their space craft. It was the Apollo-Soyuz test project, the last mission of the Apollo era, which saw the former Soviet Union and the United States collaborate in space for the first time. Of course I didn’t know any of that at the time. Only that these people, floating together in space, hurtling around the Earth, somewhere out there in the darkness above, looked like the stuff of magic. I think I always stayed interested in space exploration after that.

Q: You studied astrophysics and then medicine at University College London. Why did you decide to merge the two career paths?

A: It all sounds much more orchestrated than it was. I’d love to tell you that, with an ambition to work for NASA, I decided to study astrophysics and then medicine to make sure I was properly qualified for the job but it’s just not true. The decision to study astrophysics came from my love of space and exploration. Later, when I was at university I decided that—though I’d enjoyed the musing about stars and the origin of the universe—perhaps I should do something more practical. Medicine to me felt like a vocation in its truest sense—something I was prepared to completely dedicate my life to. When I chose to go on to study it I thought I‘d left astrophysics behind forever.

It was only towards the end of my medical training, when I began to miss the esoteric beauty that I’d found in astrophysics, that I started looking for a way to keep that stuff alive for me. I wrote letter after letter to NASA, first asking them if they had any grants that I might apply for but later simply asking for a chance to spend some time working in one of their laboratories. Back then I think I would have paid good money just to walk around Johnson Space Center for a couple of hours. When the invitation came to apply for an aerospace medicine training rotation there I put all my energy into it. I wasn’t optimistic that I’d be successful—there were a handful of places available worldwide—but I applied anyway and forgot about it.

I still remember the letter coming, a thing US Government envelope with the unmistakable NASA meatball in the top left corner. Opening it to find out I’d been accepted was—to me—like Charlie opening his bar of chocolate and finding the golden ticket.

From there on I never looked back. I completed the rotation and kept finding excuses to keep going back. It was at first a kind of cathartic release from the demands of junior medical training. But later both human space flight and the frontiers of medicine began to make sense to me as feats of exploration. And that’s kind of where this book came from.

Q: You have experienced many extreme situations, including flying in a reduced gravity aircraft, training with the Royal Navy to escape a helicopter crash over water, and treating victims on the scene of the 1999 London bombing. What was the most extreme situation you have ever experienced, and how has it influenced your work today?

A: The terrorist bombing in Soho, in 1999, was by far the most extreme. I’ll never forget it. I was very junior, only a few months out of medical school, and yet there I was in the middle of this thing—literally right there out in the middle of the street amongst the casualties with people looking at me, expecting me to do something.

Although the drama of that day is usually about the drama of hours surrounding the blast it was the days and weeks that followed which really changed my view of medicine. There were many, severely injured people who were admitted to London’s intensive care units from that attack and yet, bar one, every single person who arrived at hospital went on to survive. I think that experience made me appreciate just how far medicine had come in being able to intervene in even the most extreme situations. And in turn that sparked my career choice to specialize in anesthesia and intensive care medicine.

Q: In Extreme Medicine, you share the story of your family’s experience with a polio epidemic in Mauritius. How did learning of that experience influence you personally and professionally?

A: It was a surprising thing, interviewing my own father. He had talked sometimes about his experiences growing up in Mauritius and I realized I hadn’t ever really listened. I was startled by just how alien his experience of childhood—in what was essentially a developing country—had been from mine. I was frankly shocked by how little they as a family had. And modern medicine was almost absent entirely absent from the scene.  In that context listening to him explain how the polio epidemic had ripped through the family, with nothing to stand in its way, was both fascinating and horrifying. I knew of, and had visited Angele, his sister who had been paralyzed by polio. I had no idea that he had had another sister, Audrey, who had not survived the epidemic—an aunt I never knew or, until I wrote this book, knew of.

Q: In addition to the many hats you wear, you are also a gifted storyteller and writer. How did you find time to write this book in between all the roles you are responsible for? What were some factors that contributed to your decision to write this book?

A: It’s nice of to be thought of as a writer or storyteller, gifted or otherwise. I have trouble seeing that myself. I do remember loving the study of English when I was growing up. Neither of my parents spoke English as their first language. For my mother it was more like her third—after Maurititan Creole and French—for my father it was his fourth (Chinese was also there in the mix ahead on English). I loved reading and writing back then as much as I loved science but my father worried that a career as a journalist or writer might not be secure enough for a second generation immigrant, and he encouraged me to pursue subjects which he thought would more likely lead to a professional qualification: an accountant, an engineer; perhaps even a doctor.

That was all part of it. I wanted to write this book because I wanted to write. It was really hard to find the time but that I guess was part of the fun of it. One of my friends at The Guardian asked me, after reading the book, if it was a sort of therapy. I guess in a way it was. A way of reconciling the two seemingly separate strands of my life and resolving the whole thing as an unapologetic act of exploration.

Q: You profile many brave pioneers of medical and scientific research in Extreme Medicine. Do you have a personal science hero?

A: It’s hard to choose. There are so many. And over time I guess it changed more than once. As a boy growing up Neil Armstrong would have been it, he was who I wanted to be. Later it shifted a little; I came to admire the great physicists: James Clerk Maxwell, Erwin Schrodinger and later Richard Feynman. Feynmann’s effortless ability to perform as a scientist and as a communicator really caught my attention as a teenager.

At university I discovered Schrodinger’s book What is Life? which was a physicist’s musings on the nature of life and I think that led me on in part to my fascination with the human body. Finally, as a student journalist I interviewed the Nobel Laureate Professor Maurice Wilkins and talked with him about his role in the discovery of the double helix structure of DNA alongside Watson and Crick. He had also started out life as a physicist and had worked during World War II as part of the Manhattan Project. Later he was filled with regret about this and what he saw as his part in the bombing of Hiroshima and Nagasaki. I remember being singularly impressed that someone could have played such a huge role in 20th century science and technology and be sitting there, talking with me and my tape recorder, seeing out his time in a British university as an Emeritus Professor in a cramped office with its less than spectacular view of a brick wall. When I packed up to leave he asked me what I was studying. When I told him it was astrophysics, I remember he said, “Ah, yes, I used to be into that … but I decided to come back down to Earth.” There were many things that contributed to me moving from physics to medicine but that comment, from an accomplished scientist to an impressionable undergraduate, was perhaps the coup de grace.


From the breastbone, the route to the heart is two and a half centimeters in a straight line, but that trivial distance took medicine the best part of twenty-five hundred years to travel. The twentieth century would see centuries of dogma set aside and cardiac surgery advance in great leaps and bounds. These feats of exploration lay open the continent of the heart to science and medicine in the same way as Robert Scott paved the way to the Antarctic interior. Our exploration of the world’s extremes is, in essence, an exploration of ourselves and the limits of the human body. It is our physiology, and our inability to protect it effectively from the physicality of the outside world, that put the remote corners of the Earth beyond our grasp until well into the twentieth century.

That exploration also saw us turn to the frontiers of medicine to explore the limits of physiology in health and disease. The same revolutions in science and technology that extended our explorations of the physical world helped to push back the frontiers of medicine and surgery.

There were at the start of the twentieth century many facets of human anatomy and physiology that stood largely unprobed—foremost among them the human heart. While nineteenth-century scientists had begun to map the organ’s function and complexity, it remained a territory upon which medicine feared to trespass. As late as the fifth decade of the twentieth century, as the Second World War raged, the heart was still a continent as dangerous and unknown in the eyes of surgeons as Antarctica was to explorers of the heroic age.

Physicians saw the heart as largely inviolate: a sacred and complex whole that must remain intact and unaltered; an organ with which surgeons could and should not interfere. This dogma was as old as Aristotle’s teachings and remained unchallenged until the very end of the nineteenth century. Medical textbooks warned against tampering with the heart. In his 1896 text Surgery of the Chest, esteemed surgeon Stephen Paget made his position clear: “Surgery of the heart,” he famously declared, “has probably reached the limits set by nature, no new methods and no new discovery can overcome the natural difficulties that attend a wound of the heart.”

Overcoming the received wisdom of the past, making that leap of surgical faith, was a feat that required the terrible but unique catalyst of war.