The Big Interview - Professor Daniel Martin OBE
From Everest to ññަitñޙs not your usual career journey
Professor Daniel Martin OBE extends his arms in an L-shape to frame the dimensions of Mount Everestñޙs summit. ñޜItñޙs not too dissimilar to this in terms of size,ñޝ he says, gesturing to our surroundings at the top of Fox Tor in Dartmoor. ñޜItñޙs just an extraordinary, spiritual place, covered in prayer flags. And you get this astonishing view of the Himalayas, with Tibet on one side and Nepal on the other.ñޝ
Today, under heavy skies that constantly threaten a wintry soaking, the view is, understandably less dramatic, but nevertheless full of its own symbolic landmarks. Surrounding us are the tors and trails that Danñޙs stepfather walked as a Devon lad, nurturing a love of the outdoors that he would later imbue in his son. And to the south-west, bathed in the weak orange light from the setting sun, you can see ñ, home to the university that Dan joined in the spring of 2020 as its first Professor of Perioperative and Intensive Care Medicine.
ñޜWalking and climbing has always been a big part of my life,ñޝ he says, balancing upon one of the many weathered granite blocks that angle up from the top of the tor. ñޜAnd Iñޙve had the good fortune to be able to combine the two in a tangible way to undertake research that is impacting upon intensive care medicine.ñޝ
From Everest to ññަitñޙs not your usual career journey. But then as we are to discover, Dan Martin is anything but your average academic.
Captain Robert Falcon Scott; George Hedley Stainforth; John Paul Stapp; Yuri Gagarin and Dan Martin. Five men who, according to the BBC in 2012, were the five greatest daredevils to have advanced science. Like Scott and Gagarin, Danñޙs feat required elevation and cold temperatures. Unlike record-breaking speed merchants Stainforth and Stapp, it was anything but fast.
ñޜI hold the ñޘrecordñޙ for the lowest level of oxygen ever recorded in the blood of a living human,ñޝ he says with a matter-of-factness befitting an academic tome (in this case The New England Journal of Medicine, in which the full scientific story was chronicled). ñޜMy blood-oxygen level was 80% lower than where it would normally be, and less than half of that which would trigger an urgent admission to intensive care.ñޝ
The backdrop to this record was the 2007 expedition ñޓ the first of Danñޙs two research trips to the worldñޙs tallest mountain, in partnership with a team of doctors, nurses and scientists who specialise in both climbing and physiology. The 250-strong, three-month mission sought to simulate the extreme conditions that intensive care patients endure and study the effects of oxygen deprivation on the body ñޓ known as hypoxia.
ñޜWhen people go into intensive care, they are commonly suffering with low levels of oxygen in their blood,ñޝ he says. ñޜSome can tolerate it, some canñޙt, but our understanding of it is very poor and there is still a great deal of uncertainty as to what oxygen levels you should set a patient when they are on a ventilator.ñޝ
Typically, Dan says, hospitals will try to elevate a patientñޙs oxygen levels by mechanically blowing it into their lungs with a ventilator. One of the aims of the Xtreme Everest project, which is based at the , has been to question whether that is always the best approach.
ñޜOur method from the outset has been ñޘletñޙs look at ourselves rather than animal modelsñޙ and altitude seemed to be a place where you could really push people to the edge of their physiology,ñޝ Dan says. ñޜWhile it is not entirely the same as being on a hospital bed with multiple organ failure, people at altitude have very low oxygen levels, particularly if you push them with a bit of exercise and their cognition is altered due to the stressful environment.
ñޜAnd we have found remarkable similarities in human cells in those two environments. We have learned things on the mountain which we have subsequently seen in patients.ñޝ
The ascent to the summit on that record-breaking trip began on the night of 22 May, at the tail-end of the climbing season. By first light at around 4.30am they found themselves on the precarious knife-edge of the south east ridge of Everest in windy conditions ñޓ but mercifully, with the mountain to themselves. No queues, no waiting to climb over the Hilary Step, and no one to witness them dropping their trousers!
For, once they reached the summit two hours later, the ñޘreal workñޙ was due to begin ñޓ taking blood from one another in this oxygen deprived environment. But the windy conditions meant they could not do the tests at the summit, so after a period of reflection among the prayer flags, they descended 400 metres to a more sheltered ridge.
ñޜWe put up a tent, removed our oxygen tanks for half an hour, and then did the tests,ñޝ Dan recalls. ñޜWe had to take the blood from the femoral artery and this presented us with something of a logistical challenge. On an earlier climb of Cho Oyu (8,188m), we had experimented with these special suits that had flaps over the groin. But we couldnñޙt locate the anatomy very well and we ended up furtling around in these little holes saying ñޜI canñޙt see your groin!ñޝ We tried to take blood from the radial artery in the wrist but that proved too difficult due to the temperature. So on Everest, we simply had to resort to removing our trousers!ñޝ
Later, the team discovered that it was not only the trousers that had dropped to the floor. A healthy level of blood oxygen in an adult is typically 12ñޔ14 kilopascals. When the samples were analysed, they found that Danñޙs measured just 2.55.
ñޜIt is a very strange thing, having this record,ñޝ he says with a wry smile. ñޜIn meetings and conferences, when I tell them how low my oxygen levels were, there is this audible gasp. But at the time, I had been able to function relatively normally, take blood samples from my colleagues, talk on the radio and climb. But we just donñޙt see those levels of oxygen in patients in hospitals ñޓ they donñޙt exist.
ñޜOf course, we'd had the time to acclimatise, and this was part of our whole drive to do this research. We werenñޙt trying to look how low I could get my oxygen; it was a demonstration that given time, some individuals can acclimatise to that very low level. And potentially that has implications for how we manage patients on ventilators.ñޝ
Unlike that landmark occasion on Everest, there is barely a breath of wind on Fox Tor today. Walkers are out in abundance, with several stopping out of curiosity as photographer Lloyd Russell goes about his craft. A head tilt to the horizon here, a gaze out across the landscape there; Danñޙs easy compliance is of a man familiar with the lens of a camera.
His high-altitude exploits have resulted in regular appearances in radio and television documentaries, such as The Wonderful World of Blood, when he put Dr Michael Mosley in a hypoxic chamber at ISEH and subjected him to oxygen deprivation. He was even a consultant on the BBC documentary How to Grow a Planet when ññޙs Professor Iain Stewart was locked inside an airtight Perspex box with half the oxygen removed for 48 hours with only oxygenating plants for company.
When you factor in his considerable body of research published in high-impact journals, and the extensive number of prestigious honorary positions he holds, there is little argument that Dan Martin is a hugely significant ñޘsigningñޙ for both the University and Derriford. How, we ask, did ñ convince him to leave the capital, where he was a Professor in the Division of Surgery and Interventional Science at University College London, and an Honorary Consultant in Perioperative and Critical Care Medicine at the Royal Free Hospital?
ñޜWell, it probably began five years ago when I first met Professor Rob Sneyd,ñޝ he says, referring to the Universityñޙs inaugural Dean of the Peninsula Schools of Medicine and Dentistry. ñޜRob personally knew Mike Grocott, who led the Xtreme Everest expedition in 2007, and so he was familiar with our work. But it became more serious when I came down for Robñޙs retirement event and he started to say ñޘyou should come and work hereñޙ ñޓ itñޙs the only obvious solution to your life! Thatñޙs where the idea was seeded.ñޝ
With the arrival of Professor Sube Bannerjee as the new Dean when Rob retired in 2018, ñޜthe dream started to become a very real scenarioñޝ, and after some constructive discussions, the position of Professor of Perioperative and Intensive Care Medicine was created. In May 2020, after more than a decade at UCL, and in the midst of lockdown, Dan officially became a member of the Faculty of Health.
ñޜIt was quite surreal ñޓ I couldnñޙt step foot in my office due to the lockdown,ñޝ he says. ñޜIndeed, it was months later that I finally made it on to campus; it was certainly not the usual way to start a new chapter in your career.ñޝ
One of Danñޙs first actions upon being made a professor was to call his former science teacher who had played a truly formative role in his academic direction. By his own admission, Dan was not a particularly well-behaved pupil at the private school he attended in leafy Hampshire, courtesy of the assisted place scheme that enabled talented children from low income families to benefit from a more exclusive education. Wrestling with a dyslexia that robbed him of any feel for languages, and an underlying unease at being surrounded by wealthy pupils, it was through science that he finally found some of clarity in learning.
ñޜScience was logical and explained the world around me, about how living things worked,ñޝ he says. ñޜAnd there was this particularly inspiring teacher, Tim Dilks, who spent a lot of time with me, nurturing my interest in science and was one of the people who suggested I go to university. The expectation from my family was that I should follow the path of those generations before me and join the Navy. The whole concept of university was somewhat alien.
ñޜBut I applied for a degree in medicine because I was drawn to the opportunity to learn more about the human body. I canñޙt say I was one of those people who, at the age of four, wanted to be a doctor and save lives. It was the understanding rather than the healing that drew me.ñޝ
Eschewing the safe choice of neighbouring Southampton, Dan sought a degree of independence by enrolling at Leicester on a six-year course that included an Intercalated Bachelor of Science. He enjoyed its modern approach to medicine, and it was here that he met the second major influence upon his career.
ñޜItñޙs where I first discovered research, thanks to a project I did with a newly-appointed cardiologist,ñޝ he recalls. ñޜIt was his first consultant job and I was his first research student. He is now Professor Sir Niliesh Samani, Medical Director of the British Heart Foundation. I still see him from time-to-time. Whenever I walk into the room he pats me on the back in a very fatherly way. It was a great year of research culminating in the publication of several scientific papers.ñޝ
After graduating, Dan worked at various East Midlands hospitals without settling upon a particular training programme. He briefly focused upon cardiology, before a move to the London Chest Hospital introduced him to the local anaesthetist community. As a scientist fascinated by physiology, the ñޘexquisite natureñޙ of putting a patient to sleep and controlling that process appealed greatly to him. He applied for a training position, and with a PhD at UCL completed in the interim, Dan finally qualified in 2011.
It was during those years of training that Dan also met his fellow co-founders of Xtreme Everest, who had first begun to study high-altitude physiology around the turn of the millennium. An avid climber from an early age, particularly on trips to Wales with his stepfather, Dan needed no second invitation to join the group on a climb in the Lake District. It was there that they told him of their ideas about conducting research in the Himalayas.
ñޜFrom there, it escalated rapidly with exponential craziness,ñޝ says Dan. ñޜMike Grocott was an inspirational, visionary person who could picture hundreds of people walking up and down base camp, and he made it all happen. We attempted to climb Baruntse in 2003, and then after our first 8,000-metre expedition to Cho Oyu in 2006, we moved on to Everest.ñޝ
For the second Everest project in 2013, Dan was the overall lead, an experience that he rates as perhaps the proudest of his career. While the team never set out to reach the summit, it did set its research sights much higher.
ñޜOne of the questions we were repeatedly asked after 2007 was ñޘwhat level of oxygen did you see when you looked at the Sherpas?ñޙñޝ Dan says. ñޜSo it was obvious we had to go back and do similar experiments comparing them with ourselves. It was ethically and logistically complex, but we found some exciting differences between the two populations.ñޝ
The expedition used 275 yaks to transport 15 tonnes of equipment, one tonne of dry ice and 160 litres of liquid nitrogen, with 65 Sherpas and 80 members of the public involved. It provided so much data that the team is still publishing their findings to this day. But by that same token, Dan admits, a watershed moment for the group is drawing near.
ñޜThere are five of us who run the show, which we have now formed into a charity. We try to meet once a year, and this summer we acknowledged that we have some decisions to make as to whether we shut up shop or have some form of handing over to the next generation. I donñޙt think for a moment that this will be our last trip to high altitude ñޓ and we are always formulating questions to answer ñޓ but it might be time to take a back seat and let the younger investigators lead.ñޝ
That theme of securing a legacy for the future is one, paradoxically, that is occupying Danñޙs thoughts during the infancy of his role at ñ. His remit is not simply to maintain his prodigious level of work (though he is due to begin the largest ever study of intensive care units in the country with ICNARC (Intensive Care National Audit and Research Centre), and potentially 16,500 patients). His primary concern, instead, is succession planning, and establishing a research base in the city that will become home to a multidisciplinary community of medics, allied health professionals, trainees and science students, all working around common themes in perioperative and intensive care medicine to tackle the big problems of the day.
ñޜAt big research-intensive universities you have this scenario of a successful professor retiring, and the lab is cleared and the next group moves in,ñޝ he says. ñޜThatñޙs a very short-sighted way of running things. Iñޙm here to create a foundation so that ñ will be a centre of excellence long after I am gone. It already has the building blocks it requires ñޓ the people Iñޙve met are extraordinary ñޓ but it needs a leader and an enabler in my field, and thatñޙs what I will try to be.ñޝ
That foundational process has already begun, with Danñޙs fiancée, Dr Helen McKenna, also joining the University from UCL on an NIHR-funded Academic Clinical Fellow post.
ñޜWe essentially do the same thingñަwell almost,ñޝ Dan clarifies with a smile. ñޜHelen is following a very similar track, but where I have drifted into these big clinical trials, that is absolutely not her thing. Her real passion is in the laboratory, the biological, molecular component of our work.
ñޜSo my coming to ñ adds an additional, complementary scientist ñޓ one who will ultimately bring far more to the table than I do!ñޝ
The vanishing point on the horizon to the west is suddenly smeared across the middle distance by an ominous column of grey advancing upon us. Itñޙs a sign from the weather gods that weñޙre pushing our luck with the moor.
Not that Dan appears to be remotely concerned. When youñޙve grown up sailing to France with your stepfather without even checking the forecast (and equipped with just a handful of Francs), and when youñޙve endured temperatures of minus 30 on the Alaskan mountain of Denali (ñޜThe only time in my life where I was too cold to sleepñޝ), you have a rather different perspective on the elements.
ñޜItñޙs a very natural thing to climb upwards ñޓ but it is unnatural to climb down,ñޝ Dan says as he carefully negotiates a section of potentially ankle spraining granite on our descent/retreat towards the sanctuary of the car park. ñޜAnd thatñޙs where so many climbers have historically run into trouble.ñޝ
Precisely how high Professor Dan Martin can climb on his quest to improve our understanding of intensive care medicine is yet to be written. Whatñޙs clear is that heñޙs not doing it alone.