EXTREME MEDICINE MAN
AN INTERVIEW WITH DR. KENNETH KAMLER, AUTHOR OF "SURVIVING THE EXTREMES"
by Jason Zasky

If it weren't for the physical and mental limits of the human body, climbing Mount Everest or traversing the Sahara desert would be relatively straightforward. That explains why the stories of daring outdoor enthusiasts are compelling; these adventurers push—and sometimes push past—the boundaries of what the human body can endure.

Dr. Kenneth Kamler knows all about what it takes to survive in the most hostile environmental conditions. Although he makes his living as a surgeon, he's best known for the work he does outside the office—namely, serving as expedition doctor on countless ventures to the most remote parts of the globe. In the course of his travels, Kamler has treated patients (natives and explorers alike) everywhere from the Andes to the Amazon to Antarctica. In the process he's encountered everything from spider bites to statue-like frozen limbs, and learned a number of unlikely medical techniques—such as how to close wounds using the jaws of soldier ants.

In his book "Surviving The Extremes: A Doctor's Journey To The Limits Of Human Endurance" (St. Martin's Press), Kamler relates many of his most rarified experiences, taking time to examine how humans react and adapt to extreme circumstances, adding a unique twist to the outdoor adventure page-turner.

What prompted you to write "Surviving the Extremes"?
I've been the doctor on every expedition I've been on. When I come back people are always interested in where I've been and what it's like to endure extreme environments. I thought it would be fascinating to explain how the human body can adapt—or not—to these environments. The body is endlessly fascinating and it's amazing the strategies we have to adapt to places where we don't belong. I just thought that would make a great combination—the open spaces of the world and the inner spaces of the body.

How did you get started in expedition work?
Since I was a little kid I've always been interested in exploring. I grew up in New York and there weren't any mountains for me to explore nor did I know anybody who had ever done that kind of thing. So I turned my interest in exploring into a fascination with the microscope. In fact, I stayed with that my whole life and I'm now a micro-surgeon. But I never gave up the idea of visiting the wide-open spaces. When I was eight years old I read [Maurice Herzog's] "Annapurna"—-a classic mountaineering book. It's the story of what was, at that time, the highest mountain ever climbed. It just captivated me. As I got older I decided to take climbing lessons so I could get myself into those environs, and I did. Obviously, being a doctor people were going to turn to me when something went wrong. It wouldn't be enough to say, "I only do micro-surgery. I can't take care of a broken leg." So I made a real effort to learn as much as I could about the kinds of problems people would encounter on expeditions. I became somewhat of a repository of information and people began to turn to me for that information. That allowed me to go on even more expeditions because people like to have me around.

How much time do you spend on expeditions versus at your practice in New York?
It varies quite a bit. I have years where I don't go anywhere, and I have years when I go to two or three places. Expedition work is a fairly small world and a lot of it is word of mouth. I travel roughly once a year, but that's just an average. I have gone two years without going anywhere but this month I'm going to Bhutan.

Do you consider yourself an expert in "extreme" medicine?
I don't know if anybody can be an expert because the field is so diverse. You have to know everything from how to set a broken leg to understanding the toxicology of snakebites. So I wouldn't say I'm an expert. I would say I'm very experienced. I've treated a lot of conditions and make a conscientious effort to know as much as I can about each one.

Has there ever been a time when you were in a remote area and felt like you were in over your head?
I'm very often in situations where it is very hard to gain control. For instance, doing surgery in the mud on the child [with the machete gash] in the Amazon [chapter 1]. On Mount Everest I took care of hypothermic frostbitten climbers on the slope of the mountain [chapter 5]. I guess you could say you're in over your head, but you swim anyway. Whatever you do for people they understand you are doing your best and usually it's the best that can be done because of the drastic situation you're in.

I assume that on most expeditions you're the only physician?
I'm always the only doctor. Sometimes when you get on a big mountain like Everest there are other expeditions that have doctors and we can team up. But when something bad happens very rarely is there another doctor around. I'm pretty much a one-man show wherever I go.

When you are in a remote part of the world what do you fear the most?
A lot of these environments contain hazards that are not commonly seen and not commonly inflicted on human bodies. I could be faced with a situation where someone is reacting to a bizarre bite in the jungle or the kind of conditions where people are exposed to extreme cold or been underwater too long. Being faced with the responsibility of trying to save somebody who is suffering from something that I can't understand is most upsetting to me.

What is the worst kind of injury to suffer when treatment is not readily available?
A head injury. Head injuries are the hardest to treat under any conditions. It's very hard to know what is going on without modern equipment—CT scans and MRI's and that kind of thing. The brain is very unforgiving. An injury to the brain is very hard to recover from and you don't have much time to work. Plus, it is so fragile that if you do something wrong it can be unfixable at that point.

How do patients with the most spectacular injuries—impaled on a stake, for instance—manage to remain calm and composed?
It is interesting you ask that because I was on The Oprah Winfrey Show a few months ago and they aired a video of a girl falling out a second-story window and getting impaled on a fence. Oprah asked me how she could survive and stay calm? I'll generalize a little bit but when you are faced with a life-threatening situation where your survival is at stake you are programmed to remain calm. It's a survival adaptation because if you felt pain in proportion to a massive injury you wouldn't be able to react. You'd be so flooded with impulses and pain that you would not be able to act logically and efficiently to save yourself. So your body has this natural kind of squelching mechanism where in a really desperate situation you don't feel pain. Contrast that with someone who is howling because of a splinter. If they didn't feel pain they might very well react by ignoring it, in which case it would get worse and might get infected. So your body inflicts pain when you need to do something and might otherwise ignore the issue. If the problem is massive and you obviously know you're in trouble you don't need pain to mobilize yourself to react in the best way possible.

What was the outcome for the girl on Oprah?
She hung upside down for an hour and a half. Then Emergency Medical Services came with some kind of power tool—it was a wrought iron fence—and they actually cut the fence around her and brought her to the hospital with the fence in her. They pulled it out in the hospital. She'll be the first one to tell you that she didn't feel pain until she was in the hospital and knew her survival was no longer at stake.

Are there any other factors that help a person when he or she is in a struggle for survival?
The mental part is by far the most important parameter by which survival is going to be measured. It's not just the macho cowboy types that survive, it's people who have self-controlled discipline. It's the people who, in their everyday lives, have the ability to defer immediate gratification for a secondary goal—who will do something because they think it is the right thing to do rather than for the accolades of others. These people can control themselves and I think this kind of discipline is what it takes to make your way through a survival situation. I've seen it on the big mountains. The people who perform the best are very often the quiet ones—the ones who don't complain but just get the job done.

Are there any new or forthcoming developments that will help doctors practice medicine in remote places?
Yes, there certainly are. There's this whole concept of telemedicine and robotic surgery. I actually did two projects with NASA on Everest in 1998 and '99 where we tested telemedical equipment. We brought over incredibly sophisticated stethoscopes, ultrasound machines and microscopes. I would put a stethoscope on somebody's back and the sound would be digitized and sent by satellite to Yale University, where a pulmonologist would listen to the sound in real time and give me his expert opinion. He would say things like, "move it to the right, move it to the left, have the guy cough." I would do that and he would tell me what he thought was going on. Then we took slides of blood smears and put them under the microscope at Base Camp. The slide image would go right to the pathologist at Yale. Again, he would say, "move it to the left, move it to the right, change the magnification." [With telemedicine] you can get expert opinions in the most remote places on earth.

Now doctors are taking that one step further with robotic surgery, using remote vehicles that can pick up an injured person—the military is leading the way on this—put them inside a pod, and do remote surgery in the field. This has enormous application for people in wilderness settings.

Is there any expedition you'd like to do but haven't yet had the opportunity?
I'd like to go almost anyplace where something interesting is being done. Bhutan is this little lost kingdom in the middle of the Himalayas. We're going to this very remote part in the east where you need special permission from the king. We are going to do photo-documentation of a particular ethnic group and then create a photo library and present it to the king.

Have you ever considered bringing Antonio [a native Indian from the Amazon jungle, featured in chapter 1] to New York for a visit?
[Laughs]. I don't think he could handle it. Maybe he could. He's probably more resilient than I think he is. But I don't think he wants to leave.

I'll bet Antonio would be a sight on the streets of New York City.
Oh, boy. It would be mind boggling for him. I'm not sure it would be a good experience.