SURVIVING THE EXTREMES A Doctor’s Journey to the Limits of Human Endurance Kenneth Kamler, M.D. St. Martin’s Press, 2004, 323 pp. ISBN 0-312-28077-7

Kamler, a microsurgeon, is director of the Hand Treatment Center in New York. He is also vice president of the Explorers Club, where he has organized a database of information about physiology and endurance. Kamler is the author of Doctor on Everest. This book contains much physiology and some adventure. The author has participated or written about expeditions in the six most remote and dangerous regions on earth: dense jungles, high seas, remote desert, ocean depths, high mountains, and outer space. There is considerable physiology and less adventure than I expected. In describing the remarkable adaptability and resilience of nature, he consistently credits natural evolution. “Woven throughout are observations and reflections on the evolutionary biology, physiology, and psychology that combine to give humans the means to prevail.” (12) Mosquitoes are a jungle menace far more deadly than crocodiles and are the single biggest reason why so few live in the Amazon. “Malaria has killed hundreds of millions of people worldwide over the course of history.” “Even when a malaria victim survives an outbreak, a nest of parasites always remains in the liver. Untreated victims can look forward to periodic outbreaks of the disease for their entire lives.” (35, 36) “Our doctors don’t wear face paint, but they do wear white coats, to keep that same separation between themselves and the people they treat, and they often use a big medical word when a simple one would do, to give an impenetrable, mystical quality to the knowledge they possess.” (38-9) “Alkaloids are chemicals that plants have developed as weapons of survival.” (69) “When I was young, there was warfare between tribes, and even shrunken heads. The arrival of the church stopped all that.” (Antonio in the Amazon, 75) “Tribes that have learned to protect themselves from headhunters, crocodiles, and poisonous snakes have never been attacked by modern civilization. They have no defense against something that targets not an individual but the entire culture.” (80) “The injection of an alien culture into the Amazon... will soon make the Amazon tribes extinct.” (81) “The capacities to feel guilt and appreciate beauty would seem to be odd evolutionary developments.” “But natural selection has fostered the development of noble feelings.” (97) “Sugars burn like paper. They ignite quickly, burn rapidly, but do not last long—a quick burst. ... Starches burn like wood. They require more heat to get going, but once they catch, they burn a lot longer and provide a lot more energy.... The liver and the muscles store them as readily accessible fuel depots. Once these storage areas are filled to capacity, the overflow of carbohydrates is converted to fat.... Fat is a concentrated fuel that can store energy more efficiently for the longer term.” (103) “The Marathon des Sables is an annual 160-mile race through the dry ocean of the Moroccan desert.” “Except for water stations at the checkpoints, the racers traversed the desert self-contained, with food, spare clothing, a sleeping bag, and emergency supplies in their backpacks.” (124) About 1/5 of the world’s surface receive less than 10 inches of rainfall a year. . (125) “Light skin reflects more heat and lowers the water requirement but allows more radiation into the body. Evolution has apparently not yet solved this dilemma....” (151) “Water is more than a thousand times heavier than air. As a diver descends, he must support the weight of the water, steadily increasing by the ton. The enormous pressure pushes in on the body, compressing it evenly on all sides. The only reason the diver is not crushed is that, like the sea, his body is made mostly of water—a liquid nearly impossible to compress.” (161) “If the air pressure in each space is not continually pumped up to match the increasing water pressure as the diver descends, his body cavities will very quickly collapse. The lungs would be the first to feel the squeeze. At a depth of 1 foot there would already be nearly 200 pounds of pressure on the chest wall.” (161) [Seals] “can easily hold their breath for over an hour, an adaptation they needed to develop in order to return to the sea, once their ancestors began breathing air.” (163) [It’s a bit awkward to speak of evolution ‘responding to a need.’ Seems to imply recognition and response, something we normally attribute to intelligence. dlm] “Less than 1 percent of the world’s ocean bottom has even been seen.” (167) “When nitrogen is inhaled under increased pressure, it becomes a narcotic, ...which is why divers who have gone too deep begin to feel drunk or hallucinate.” (169) “Deep-sea fish are so exquisitely adapted to their extreme environment that they are unable to survive when brought too near the surface, where they are exposed to the unhealthy conditions of light, warmth, and low pressure.” (181) “...we know very little about the sea itself. Huge currents flow between and around the continents, currents of which we have only the vaguest awareness....” (181) “Yet the sea remains the least explored, least understood environment on earth because it is the most hostile to man. The environment from which all life arose and on which all life still depends has become, to humans, through the nearly imperceptible small steps of evolution, the most extreme environment on earth.” (182) At 26,000 feet on Mt. Everest the temperature inside the tent was 30 degrees F below zero. The summit is 29,035 feet. (183) “I looked down on ice-covered mountains. I could see the curvature of the earth. I had climbed into outer space.” (189) “The Himalayas are young and still growing.” “The leading edge of India was driven under the southern edge of Asia, which began to rise and form ‘wrinkles.’ These wrinkles are now the Himalayan mountain range, stretching for 1,500 miles, 500 miles in width, and containing all the highest mountains in the world. India is still sliding under Asia, so the Himalayas are still rising, at the incredibly rapid rate (for geologists) of about one-half centimeter a year.” (190) “Too rapid an advance up the mountain would bring on acute mountain sickness, the most common high-altitude problem encountered by lowlanders. The symptoms—a throbbing headache and nausea—are very similar to a hangover, and the cause is probably the same too: dilation of blood vessels and a shift of fluid into the brain that increases pressure within the skull.” “For acute mountain sickness, the treatment is to g back down a way, or at least stop going up, until the vessels reequilibrate, which usually takes a day or two.” (191) “Air at 17,500 feet (base camp on Mount Everest) is under only half the pressure as air at seal level. At 29,000 feet the air pressure is only one-third that at sea level.” (193) “Lungs were never designed to function at high altitude.” (206) [Oops. The appearance of design is so compelling in nature that evolutionists must continually remind themselves to avoid using the term, which implies intelligence and intentionality. Here the author apparently slipped. Dlm] “Space walks are high-risk exercises because they put astronauts at their lowest level of protection. Once you step outside, your margin of safety is as thin as your space suit—your personal spacecraft. To keep you alive it must surround you with enough counter pressure to hold back the vacuum of space, insulate you from temperatures varying from 200 degrees F below zero to 200 degrees F above zero, provide you with an oxygen supply and handle carbon dioxide removal, and protect you from any haphazard micrometeor strikes.” (254) “...the work is strenuous, and doing them in a space suit is like exercising inside a thermos.” “Water-cooled long underwear is available for especially hard work.” (255) “It took either three days or forty-eight days, depending on where you were standing. On Earth, the planet made three spins past the sun. On the station, orbiting at 18,000 miles per hour, the dun rose and set and rose again every ninety minutes. This rhythm is hopelessly confusing to your pineal gland.” (256) “The cumulative effect of long-term exposure to cosmic rays may be unknown, but the effect of a solar flare is easy to calculate: one dose is fatal.” (262) I have observed four additive forces at work in the struggle for survival: knowledge, conditioning, luck, and the will to survive. (275-76) “I’ve witnessed the powerful effect of will, and the lack of it, not just in extreme settings but in hospitals and homes, where life-and-death struggles are just as real.” (279) “The winning strategy for survivors would seem to be a contradiction: they’re able to focus narrowly and sharply on the demands of their environment while at the same time maintaining their focus on a goal that transcends their circumstances and gives them a larger reason to survive.” (279) “The fundamental nature of the human will must remain unknowable. Ultimately, our explanations for surviving the extremes will require not just science, but faith.” (292) ******