Doctor's Review: Medicine on the Move

September 22, 2019
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Through hell and high water

Dr Ken Kamler on performing surgery in the world's most hostile environments

No course in medical school taught me the proper mixture of oxygen, IV fluids and Tibetan chants to treat a subdural hematoma in below-zero temperatures on a three-mile-high glacier," writes Dr Kenneth Kamler in his new book Surviving the Extremes: A Doctor's Journey to the Limits of Human Endurance.

When the New York microsurgeon found himself administering oxygen to a dying patient on Mount Everest surrounded by chanting Sherpas, he witnessed what more spiritual souls might call a miracle. Vice President of the prestigious Explorers Club, Dr Kamler has come to accept the fact that treating patients in some of the most remote, hostile and unforgiving environments on earth means sometimes witnessing a healing force for which there is no medical explanation. In fact, it is the body's often inexplicable, yet enormous capacity for survival that inspires his work, his life and his latest book.

In Surviving the Extremes, Dr Kamler takes readers on a journey from the deepest underwater caves to the great unknown of outer space to explore the body's reaction to extreme degrees of heat, cold, pressure, starvation and exhaustion. He weaves together personal experiences gleaned from his extensive travel journals with survivors' accounts to reveal what happens when we are pushed to the breaking point and beyond. When Dr Kamler spoke to DOCTOR'S REVIEW, he had just returned from watching polar bears in Manitoba and travelling around Nunavut.

Doctor's Review: Is the drive for you to explore extreme environments a personal or professional one?

Kenneth Kamler: It's both. Being a doctor, I like to study how the human body reacts in extreme environments, how it can be pushed to its limits. I also want to see how I respond when I'm pushed to my own personal limits. When you're in an extreme environment your body functions at its absolute limits -- you do things you can't believe the human body can do. It's astounding. It's very satisfying to find out that you're actually better than you think you are.

DR: When did your fascination with exploring remote environments begin?

KK: I grew up in New York City in an apartment house and when I was about eight years old, I did my first climb -- up my father's bookshelf. I saw a book called Annapurna, and it sounded like a funny word and I wondered what it meant. I pulled the book down and read it and it absolutely captivated me. It's a classic mountaineering story about the highest mountain ever climbed at that time, in 1950. It opened up a world for me I never knew existed -- huge mountains and incredible open spaces, all these strange people. The idea never left me. Growing up in New York I always had this idea of exploring and I started with a microscope; you can explore incredible worlds through a microscope. That led me to biology, which led me into medicine and I found that being a doctor is a way to explore the greatest unknown there is in the world: the human body. There are more mysterious places within the body than any place in the universe.

DR: So when did you start to pursue these interests professionally?

KK: I was in medical school and I decided to take climbing lessons in New Hampshire. The instructor was planning a trip to Peru and asked me if I wanted to go along. I had never been a doctor on an expedition before and I was just as nervous about that as my climbing skills. We were driving into the hills of Peru to get to the base of the mountain we were going to climb and a truck about a half a mile ahead of us teetered and tumbled into a ravine before our very eyes. It was filled with villagers on their way to market, so people and livestock were just flying all over the place. We were the only people around and I was certainly the only doctor.

So as it turned out, my first test of wilderness medicine was to deal with a full-blown disaster. I was able to stabilize all the people and we loaded them into our truck and drove to a place on the map that said clinica (a medical clinic) where we found there was only one doctor. I had more supplies with me than he had and so he asked me to stay overnight until we could evacuate these people to Lima. I did stay and I got a lot of notoriety in Peru for that.

DR: You mention early in the book that you didn't want to be "a prisoner of your profession." Does the medical establishment present limitations that you are driven to break away from?

KK: Yes it does, but I have found that a lot of those limitations are perceived. There are practical limitations -- patients need continuity of care and as a microsurgeon I need to keep my skills sharp -- but I was concerned that the other doctors might think I'm a flake and wouldn't trust me with their patients. I took a chance and I discovered those problems weren't real. The doctors, almost without exception, admired me for what I was doing. When I do grand rounds, the place is packed! There's really a lot of interest in what I do.


DR: Do many of your colleagues say that they're fascinated by your work but that they could never do it?

KK: A lot of them say they could never see themselves doing it, but there is a group of them that says: "I wish I could do that." I feel like saying to them -- you could do it, you choose not to. I often feel that way in life. Most of the time when people say "I can't," what they really mean is, "I won't." If you say, "I can't go to Everest," that's not true. You won't go to Everest because other things are more important to you, which is fine. You want to join the golf club, you want a big house -- whatever choice you've made, that's fine. But it's a choice.

DR: As a doctor, are there expectations that you should live a certain lifestyle?

KK: Most doctors in New York are very comfortable financially, they live in the best neighbourhoods, in the biggest houses, they belong to the golf clubs and country clubs. I don't know many who aren't that way. Although I get along very well with a lot of doctors, my friends are not doctors. Originally I didn't think I wanted to be a doctor because I didn't think I was that type -- but it turns out you can be any type you want.

The real rewards of exploring are not just where you go, but who you go with. I have had the good fortune to endure harsh environments with some of the finest people in the world. They have developed equanimity -- balance -- because they understand what's important. I try to do that also. When you're in a situation where you've got to stay warm to stay alive and you haven't eaten in days, those kinds of things reduce life to its essentials: food, water, shelter -- and friends. That's what keeps you going.

You lose that when you live in a civilized society like we live in, where we're so protected. Your biggest problems become traffic jams and being late for meetings. I'm not trivializing it, but you can't compare that with someone who almost died because they couldn't get enough water. It's those kinds of experiences that really forge someone's character.

DR: How do you handle going back and forth between the two worlds?

KK: After a while you wonder which is the real world. As long as I can go away and do what I want to do, coming back to New York is pretty tolerable. If this were all I had, I'd go nuts.

DR: You mention some examples of the placebo effect -- were you surprised at the extent to which the human belief in a cure or remedy was sufficient?

KK: I have been surprised -- like putting a tea bag on someone's head, telling them it cures seasickness and it works. But I'm not that surprised, certainly not anymore. When I have someone in my office who needs surgery, I can predict in advance who's going to do well and who's not because the personality is so important. It shows itself in survival situations pretty dramatically, but it also shows up in the hospital. You see these people who want to live to see their daughter's wedding and they do and then die right after. Something's going on there. We don't understand it, but it doesn't mean it's not there.

DR: When you practise medicine around the world you confront not just cultural difference but a language barrier, yet you say there is a "universal language of patient and doctor." Tell me about that.

KK: I find the same things over and over: a patient is a patient. When they come to a doctor they want to see someone they can have confidence in. Confidence doesn't have a language. In the jungle, before the medicine man treats a patient, he puts on face paint. That gives the medicine man a look of authority that differentiates him from this guy he's treating. And isn't that really the same thing as me putting on a white coat in New York?

DR: Are there any ways that practising medicine in New York can be as challenging as any of the extreme environments you've worked in?

KK: Yes, I'd say it's equally challenging, but different. When I'm in the Amazon I'm trying to construct an OR table out of a piece of plywood and oil drums. I'm looking to irrigate a wound and I've got to find some rainwater that doesn't have a dead rat in it. But when I work in New York, I do microsurgery and I'm trying to repair a blood vessel that is 0.9mm, that's challenging in a completely different direction. They're both challenging and I enjoy working on both ends.

DR: Have there been any recent developments in technology that you believe will impact the future of exploration?

KK: I recently heard about something being developed for soldiers who get shot or injured in the battlefield, but there are certainly applications for it in the wilderness. It's a T-shirt that remotely monitors various body functions: temperature, pulse, respiration, heartbeat, electrocardiogram -- anything you want. This information can be broadcast to a station where a doctor can monitor it.

They're developing a remote drone vehicle (the soldier will also have a GPS unit so they know where he is) that will drive out and pick him up in a pod. The pod drives to a specially equipped tank on the battlefield. It deposits the soldier in the tank and they can do robotic surgery in this little fortress within an hour. The first hour or so is critical in many cases.

It's not fully functional yet, but it's pretty far along. Robotic surgery is definitely in the future for space as well -- that's how it's going to be done. You can't expect any one doctor to be sufficient in all kinds of surgery.

DR: What do you hope people might learn from your experiences?

KK: I give a lot of talks and I spoke to a group of kids at a school in a very underprivileged area of New York. After I finished explaining how I got through Everest, one of the kids raised his hand and asked, "Is it fun?" The question was a good one -- probably even better than the kid realized. The answer is, "No, it's not fun." So then why do I do it? The reason is that as hard as it is when you're doing it, if you accomplish it, you get a sense of satisfaction that you can't get any other way. That's really it. You make yourself better than you were. That's the motivation for doing that kind of thing.

DR: Where are you off to next?

KK: I am going to Bhutan and together with the health minister, I'm going to assess the health needs of very remote areas. We will also have access to the easternmost part called Merak -- where no foreigners have ever been -- so it should be really spectacular. This trip is not going to test me to the limits, but I am always excited about exploring unknown environments. I got a topographical map of Bhutan and the eastern part is white and says "information incomplete." That's great; that's the kind of place I want to go to. If I can read about it in a guidebook, I don't want to go there.

