Extreme Medicine: How Exploration Transformed Medicine in the Twentieth Century

With degrees in medicine, astrophysics and engineering, Fong has dedicated as much of his life to discussing the health challenges of space travel as he has to treating trauma patients. In Extreme Medicine, he writes of those challenges as well as more terrestrial medical advancements that have pushed the boundaries of possibility. “While our medical pioneers weren't concerned with geographical conquest,” he writes, “they were very much in the business of exploration.” From the tale of a young woman revived after hours without a heartbeat in an icy Nordic river to stories of World War II soldiers who served as early guinea pigs for facial skin grafting, Fong interweaves historical accounts with engrossing stories of clinical doctors charting new territories to save their patients. In each case, their encounter with physical extremes powered rapid medical advances. The next frontier to push science forward, Fong writes, may be sending humans to Mars. The book shows how, “by probing the very limits of our biology, we may ultimately return with a better appreciation of precisely how our bodies work, what life is, and what it means to be human.”

Fong structures his book chronologically. He begins with the explorer Robert Falcon Scott’s death by freezing in Antarctica in 1912 and ends with the medical issues presented by a future manned trip to Mars. Each chapter is made up of linked sections and stories told enthusiastically at a fast pace. It’s a particular style — casual, choppy, visual. “Extreme Medicine” is fun to read, but it doesn’t read like a book. It has episodes not chapters. It’s broad not deep, and it doesn’t develop so much as unroll. For example, the chapter on Mars begins with Fong’s arrival as an intern at NASA. It cuts to the physiology of weightlessness, then back to his experience in an antigravity lab, on to the physiology of gravity, and concludes with NASA’s decision to reduce the Mars budget (“Once again the Red Planet receded into the future”).

I could almost see the animated Red Planet moving away from us in space and hear the voice-over. It felt more like watching a PBS documentary than reading a book, and I wondered if it had started out as a television show. In fact, Fong presents several of the book’s stories, themes and expositions on a BBC series.

This isn’t necessarily a bad thing, but I did have to ratchet down my expectations. Rather than develop an argument, “Extreme Medicine” is a moving picture of dramatic historical moments, explanatory pauses and Fong’s real-life experiences.

I also had to change my expectations of the writing. Fong weaves much of the text out of clichés; for instance, in a few pages we read about “drug-fueled gang wars,” a city that “jockeys for position,” “shady characters” and “a thick Colombian accent.”

The language can be clumsy — “The absence of gravitational load takes on a new dimension, transforming from a novelty into a creeping threat” — sometimes so much so that meaning is lost. For instance: “The layers of epidermal cells, constantly being born and marching forward, are like a never-ending conveyor belt of foot soldiers throwing themselves at the wire.” I had to read the sentence three times to understand that it was referring to the layer of cells that divide, grow and move up to the surface of the skin.

Fong tells a good story, and in this time of unrelenting criticism of our medical system, we need to be reminded of how much we’ve learned in the past hundred years, how much we know, how miraculous it all is, what a blessing.