AMSA's 2015 Annual Convention
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February 26 - March 1, 2015 

Physicians Without Wings

NASA FLIGHT SURGEONS PROVIDE SPACE TRAVELERS WITH NECESSARY MEDICAL GROUND SUPPORT.

The New Physician March 2001
A trip into space isn’t for everyone. Some people are claustrophobic and couldn’t take being cooped up for weeks in a tiny spacecraft. Some have no desire to leave terra firma, while others can’t pass the rigorous physical examinations preceding astronaut selection. That’s the case for Dr. Terry Taddeo, whose less-than-perfect eyesight will keep him grounded at NASA. But that doesn’t mean there’s no place for physicians like him at the federal space agency—Taddeo serves his country another way, as one of 14 NASA flight surgeons.


Flight surgeons serve as general practitioners to the astronauts and their families. “You do everything but fly with the crew,” Taddeo says. “If the guy sprains
his knee playing basketball, your job is making sure he gets through the system and making sure he maintains flight status.” Flight surgeons can become astronauts, but once selected into the astronaut corps, they have other duties.


Dr. Sam Pool, the assistant director of Johnson Space Center’s (JSC) Space Medicine and Life Sciences Directorate, came to NASA as a flight surgeon in the early days of manned space flight, and he echoes Taddeo’s impression of the flight surgeon’s role. “I was sort of like a family practitioner. Most of the serious medical matters, of course, were handled by consultants. And that’s still the case, although…now we have psychiatrists, internists—a fairly broad spectrum of people.”


Taddeo, who did a residency in aerospace medicine at Wright State University and gained training in many specialty areas, spends most of his time at the on-site medical clinic at JSC in Houston, where he helps care for all the astronauts and their families. “Taking care of the families—that’s a real important job because if [the astronauts] know the families are being cared for, they can focus on the job at hand,” he says.


All medical care isn’t done in the clinic, though; flight surgeons are among the few physicians left in America who also make house calls. Taddeo says he enjoys the personal relationships he is able to develop with the astronauts and their families. “That’s one of the real rewarding parts of the job.”


T-MINUS 10...9...8...


When he’s not in the clinic, a flight surgeon is training with his assigned crew. Taddeo specializes in long duration flights; he’s served as the flight surgeon for a mission to the Russian space station Mir, for the inaugural expedition to the International Space Station (ISS) and for a shorter shuttle mission.


Flight surgeons are assigned to their crews several years before the mission—Taddeo has already been assigned to the ISS’s Expedition Eight, which isn’t scheduled to leave the launch pad until May 2003—but he says the real work with the crew begins about a year out. “You live, eat, sleep with the crews,” he says of that final year of training. “You become their representative. I have no problem going over and ticking off as many people as I need to for the good of the crew. And I have.” He says the crews need him to be their advocate because astronauts who voice medical complaints frequently get labeled “whiners.”


Much of the training in that last year is focused on ensuring the crew knows how to operate the volume of on-board emergency medical equipment. Once in flight, the crew has access to its flight surgeon only through radio contact, so astronauts must be prepared in case there’s a medical problem.


Once the crew leaves, flight surgeons take their place at mission control, where they monitor the health of the crew for the duration of the flight. For expeditions to the ISS, that could mean six months, during which time, Taddeo says, his duties really involve environmental and occupational medicine.


During regular conversations with crew members, the flight surgeon’s job is to ascertain the status of their physical and psychological health. These private conversations could be just casual chats, or they could be about a medical problem an astronaut solved in orbit. Taddeo says he does very little real-time guidance; mostly crew members will explain what they did after the fact. “‘Someone got something in his eye, we flushed it out with saline and didn’t see anything. He’s fine now; is there anything else we should do?’” are common questions for the flight surgeon, Taddeo says.


Launch prep for flight surgeons also means issuing a seemingly endless battery of medical tests each potential astronaut must take and pass. The medical standards are so stringent that even after astronauts are screened into the astronaut corps, flight surgeons administer even more medical tests in the months leading up to their launch.


Pool helped draft the stringent medical standards in 1977. “We borrowed heavily from the Department of Defense and from the [Federal Aviation Administration] in the development of those standards, but some of the standards…were a bit unique to NASA,” he says. “As time has proceeded, we’ve gotten a little bit more sophisticated in that area. The standards now truly do begin to reflect the kind of medical criteria that should be applied to people who travel in space.”


It’s a big book of standards, Pool says. “For example, in the vision area for pilot astronauts, their vision standards are more rigorous than mission specialists’ for obvious reasons. We are very careful about evaluating people for surgeries, for example—particularly surgeries that involve the abdomen. We’re very interested in ruling out cardiovascular disease in its early stages. Basically, the standards are put in place to try to select people into the astronaut corps who have a high probability, from the standpoint of their health, of being able to serve in this fairly demanding environment. If you’ve had, for example, a kidney stone, we do not currently permit you to fly in space. The reason is that if you are assigned to a long mission,…the problem with calcium excretion in the urine only compounds the likelihood that you would be troubled with yet another kidney stone.”


“These are the most highly selected and screened people on the planet,” Taddeo says.


And astronauts would agree. Biochemist Peggy Whitson, Ph.D., who is scheduled to spend five months on the ISS later this year to study the kidney stone problem, is in the last phases of her training and medical tests. The psychiatric tests alone lasted eight hours, she says, and the eye exam was several hours as well. “Pretty much every orifice you have, they look at,” she says.


And in the final week before launch, placing the crew in a medical quarantine further screens out the possibility of exposure to illness. “Families do have limited access, but we really try to limit that in the last week,” Taddeo says. “It’s kind of hard. I’ve had to tell friends, ‘Sorry, you just can’t go in there right now.’”


A DIFFERENT WORLD


Challenges in the flight surgeon’s world are more than medical, though, Taddeo says. “In some ways it’s not the job, it’s having to do this within this huge engineering system and trying to explain that the most important system is the human system.”


Taddeo says the hierarchy for physicians at NASA is different than that of a hospital. “We’re not on top here. We’re not the ones in charge. You could tell the [flight] commander, ‘This guy should not be flying—he’s got Ebola virus,’ you know, but the…commander could still send him.” He says he can’t imagine any of the flight commanders with whom he works ever overruling his advice, but he operates with the knowledge that they could.


And because he works mostly with long-term missions to the ISS, he also functions within the confines of the international partnership governing the ISS procedures and protocol, and in this case,
cultural differences and political agendas sometime conflict. “Even NASA thinks it owns the thing,” he says, adding that medical guidelines are really controlled by the Multilateral Medical Operations Panel, an international government body of medical personnel of which Taddeo is a member.


But even the challenges are rewarding, Taddeo says. He enjoys working for NASA. “Everyone is truly focused on what the job is,” he says. “Very few people can say they’re going to work to put people in space. They’re really neat people.”