Dr Kevin Fong is a man of many talents: an expert on space medicine, a Consultant Aneasthetist, an author, broadcaster and lecturer in Extreme Environment Physiology. He presented Extreme A&E for Channel Four, is often seen on Horizon and presents science and medicine related programmes on Radio 4 and the World Service. He is the founder of the Centre for Altitude, Space and Extreme Environment Medicine and as a medical student, went to work for NASA. His latest book Extremes: Life, Death and the limits of the human body, which recently won an American Association for the Advancement of Science award, is an exploration into the limits of science, medicine and the human body. PRN spoke to Kevin to find out more about his work with NASA, his time as a Wellcome Trust Engagement Fellow, and some of his most extreme experiences as a doctor.
PRN: How have you managed to combine such a unique career of medicine, broadcasting and writing - not to mention working for NASA?
KF: I’ve just been lucky really. There is no secret to it all, mostly it’s just been about being in the right place at the right time. That and abandoning any idea of a conventional career I guess. But I started out studying astrophysics at university and then went on to study medicine and, after that, juggled my junior medical training with regular visits to the United States to work with NASA, so I’ve never really done the thing I’m supposed to do.
PRN: As one of the first Wellcome Engagement Fellows appointed by the Wellcome Collection alongside Dr Richard Barnett (coincidentally also interviewed for this magazine), how important is the role of public engagement to you?
KF: I’m enormously grateful to the Wellcome Trust for their support. I think they really changed the course of my career. Public engagement is massively important to me.
I never really thought about public engagement and science communication as being something that could be part of a medical career. Before the fellowship I did it mostly in my spare time and because I thought it was important. When I was growing up my parents wanted to find a way to point me at a career that would be secure and would mean something. I don’t think they were sure how to do that - neither of them had been to university - but they decided to try and get me interested in science.
They sat me down in front of science documentaries, stuff like Horizon, and I guess they figured if it was a big enough idea for people to stick on TV then it was a big enough idea for us to talk about around the dinner table. I have my parents to thank for driving my interest in science but I have the people who were out there engaging the public to thank for providing interest worth driving. It would be nice to be able to do the same, to take people with an interest in science and push them over the line to take up careers in medicine and science.
The Wellcome Trust fellowship, made me realise that I might be able to do that and came at the ideal time for me. I think it’s fair to say that it changed the course of my career.
PRN: Why do you think the general public have such an appetite for programmes such as Extreme A&E, 24 Hours in A&E, Trauma, One Born Every Minute etc?
KF: I think that people want to see stories that mean something to them and in medical documentaries there’s always something that strikes a chord or someone you can identify with. It’s great that we’re now seeing more and more documentaries which tell stories more directly from the perspective of patients and doctors, rather than through the filter of presenters who often have little or nothing to do with the medical profession. It’s important for people to see for themselves what the job really is, warts and all, and not what someone else thinks the job is. For that to happen we, as practicing medical professionals, have to be prepared to tell our own stories.
PRN: You’ve said that being involved in the 1999 Soho bombing was one of the most extreme experiences of your life - can you explain why this was, and what the word ‘extreme’ means to you in this context?
KF: I was very newly qualified when that bombing took place. I was in my first year of my career, I was just a surgical house officer with only a few months of experience. It all happened very quickly. The request came to send a team out to the scene of the bombing and somehow I got thrown in the back of an ambulance. It was extreme in very respect, the scale of the incident, the nature of the injuries amongst the people we attended, the speed with which it unfolded - all of it out of the blue and utterly unexpected.
It was the first time I really appreciated what medicine was capable of at the limits of survival, in the face of such critical injuries and I think its a large part of what later drove me to a specialise in anaesthesia and intensive care.
PRN: How do you think pre-hospital care has advanced since 1999?
I think pre-hospital care is unrecognisable today compared to 1999. Nobody would even think about sending a house officer out to a scene like that today. We’ve gone beyond just being reactive to scenarios like that.
Pre-hospital care is a subspecialty in its own right with a growing evidence base and tightly honed set of protocols. The most mature services now have a comprehensive clinical governance structure too and, in that way, the speciality and its procedures continue to develop and improve.
It’s been amazing to see the systems of pre-hospital care in the UK evolve over the past couple of decades. I spent most of last year working with Kent, Surrey and Sussex Air Ambulance and was hugely impressed to see what they and other organisations like them are now capable of.
PRN: Do you think there is an argument for physician-led pre-hospital care in emergencies other than trauma?
KF: Yes, I think that’s the way it will inevitably evolve. In many ways it’s already beginning to happen; for many of the existing HEMS teams emergency medicine is a significant fraction of their work. When it comes to critical illness - just as in trauma - delays in accessing appropriate levels of care lead to poorer outcomes. And so to me it makes sense that pre-hospital care should develop that way.
PRN: What is your opinion on nurse anaesthetists such as those practicing in the USA? Do you think the UK should be encouraging and training nurses to this degree?
KF: We already have anaesthetic practitioners in the UK and, in the few centres that have them, they work pretty well. In the best clinical systems there should be a decent overlap between the capabilities and skills of the team members; it’s what makes the team greater than the sum of its individuals. That’s something I learnt during my time with Kent, Surrey and Sussex helicopter emergency medical service. So yes I think it’s a great thing to encourage and develop. But there are a couple of things to watch out for. First, I think it works both ways - doctors too need to have a much deeper understanding of the of the role of other members of their team. And second, this overlapping of roles should be about enhancing the performance of the team rather than trying to find a way to replace one professional with a another.
PRN: Is there a breakthrough in either science, space exploration or medicine that you wish you could have been part of?
KF: I’d love to have been around in the heady years of the Project Apollo. I get the sense that there was a massive sense of optimism and drive in the teams of engineers and scientists who delivered those missions. But I kind of like to think that we’re all part of the greatest endeavours in science. If you talk to the people who watched Neil Armstrong step onto the surface of the Moon in 1969, and how they recall that event, they certainly feel as though they were part of something much bigger. That’s what I love about the biggest ideas we have in science and medicine, that the best of them are big enough to carry all of us along.
PRN: Where do you forsee human exploration heading next?
KF: I’m not sure. No one can be. Today there are plenty of ways to explore without leaving the comfort of your broadband connection. But it is possible that we’ll decide that the final frontier of space flight is just too hard to keep involving human explorers directly, as occupants of our vehicles of exploration. Maybe we’ll decide that everything can be done better through remote presence, using rovers like Mars Curiosity which is currently on the surface of the Red Planet and driving around sending back wonderful stuff. But I like to think that, when it comes to human exploration, of the sort which sees human beings physically explore new territory, we won’t be content to call it quits just because we once got as far as the Moon. Human beings have always explored, it’s what we do.
PRN: Is there a point where you think the quest to save live at all costs overtakes the reality of being mortal?
Medicine isn’t about trying to save life at any cost and death isn’t always a negative outcome. I think all of us, as medical professionals, understand that at some level or other. At times though I guess it can appear as though we lose sight of that, particularly in specialities like intensive care. But I think the truth is that the nurses and doctors who work in the field of critical care medicine are more realistic than most about where the limits of science and technology lie and what can and can’t be achieved.
PRN: What next for you after publishing Extemes? Do you have any more books or TV series in the pipeline?
KF: It’s always a huge juggling act, balancing my medical responsibilities alongside the public engagement stuff. I think both are important to medicine in different ways. I’m in the middle of trying to write another book at the moment, which always feels like a marathon task to me. And there always seem to be radio and television projects in the pipeline. But in the end I’m a doctor first and foremost - that’s what I’m trained to do. I think if you’re not a doctor practising at the sharp end it’s very difficult to represent the realities of the profession and the science that underpins it responsibly, so I guess the juggling’s going to have to continue.