Published On September 22, 2006
AS THE ONLY TEAM DOCTOR ON EXPEDITIONS TO MOUNT EVEREST, the Amazon rain forest and many inhospitable environments in between, Kenneth Kamler, 58, has used all manner of technology, from the primitive (employing the pincers of soldier ants, gathered from the jungle floor, to suture wounds) to the futuristic (helping develop robotic surgery in NASA’s underwater astronaut-training capsule). Here he discusses the promise and problems of advanced medical technology in places as far-flung as Bhutan and Mars—and questions of survival that no technology can ever address.
Q: Recently mountaineers on Everest drew fire for leaving a climber for dead. Is there a point at which it is acceptable, or even necessary, to leave someone behind?
A: Only when there’s significant risk to your own life. But I don’t think the climbers on Everest were in that situation. I’ve been at that height and higher and can’t imagine ever thinking that the summit’s more important than a dying person. It doesn’t fit with anything I believe about mountaineering.
Q: You wrote a book called Surviving the Extremes: A Doctor’s Journey to the Limits of Human Endurance. Do people who live their entire lives in extreme environments have different expectations of medical science than we do?
A: They don’t expect nearly as much. They’re accepting of injury and illness: If they fail to produce, they become a burden on their family and their village. I knew a Sherpa who worked for two years with a dislocated ankle. He had to—otherwise his family would have starved.
Q: In everyday life, you’re a microsurgeon, director of the Hand Treatment Center in New Hyde Park, N.Y. How does treating people in extreme environments differ from the way you practice at home?
A: In New York I repair nerves and blood vessels under a microscope. It’s quality-of-life work; I don’t treat life-threatening situations. In the field, I’m at the other extreme. I’m working without help, under primitive conditions, trying to save lives.
Q: Telemedicine, in which doctors treat patients at a distance by directing other doctors on the scene with verbal and visual online communication, has made it possible to treat people in extreme environments. What experiences have you had with this technology?
A: I’ve used telemedicine in the Himalayan kingdom of Bhutan, where doctors in remote villages have posted patient photos and X-rays on the Internet, and we’ve advised them on treating problems ranging from rashes to radius fractures.
Q: What are the biggest obstacles to treating an astronaut injured on the moon—or Mars?
A: The time delay—the time it takes to transmit across vast distances. It’s not a huge issue with telemedicine, but for remote surgery it’s hard to see how the problem can be overcome. A surgeon, working remotely, can tie a suture with a two-second delay. With a three-second delay, hand-eye coordination is no longer possible; because neural circuits work on immediate feedback, it would be like trying to drive a car by looking out the back window. The time delay on the moon is 2.5 seconds. On Mars it’s 20 to 40 minutes.
Q: How does NASA envision solving that problem?
A: Surgery would have to be pre-programmed, as in a player piano. Magnetic resonance images would be radioed back to Earth and analyzed. Then doctors would figure out the operation needed, program it into a computer and send the information to a robotic surgeon on Mars. That’s the only way it could be done—unless you can speed up the speed of light!
Q: Progress is being made on robotic hands that can “feel” texture. Why are such devices desirable?
A: Because there’s more to surgery than just looking. It’s important to be able to feel tissue planes, scar tissue and organs; sometimes you have to palpate an organ to know a tumor is there. Even when tying a knot, you need to feel the tension to know it’s right.
Q: Would it be feasible today for a specialist in New York to perform robotic microsurgery on injured children in, say, Sri Lanka or Darfur?
A: It’s virtually impossible because the local people don’t have the expertise to set up the equipment and keep it going. If something breaks, you have to wait months to get it fixed. Even telemedicine poses problems: Because bandwidth is limited, the quality of images sent back and forth is poor.
Q: What’s the single most important thing you’ve learned from practicing medicine in extreme locations?
A: Each time I return to the West, I come back with a greater appreciation of what the mind can do and how an optimistic outlook can affect healing. You need to have a larger purpose to survive in extreme environments. That’s what gives people in those places such incredible energy.
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