To Boldly Go…

Even the most observant physician may have missed it. There, behind a glass wall, the human quintet exhibited piloerection, an involuntary erection, of discrete bundles of keratin filaments as well as topographical changes in their outermost layers. South of the border, this physiologic phenomenon is known as “la piel de la gallina” due to its resemblance to poultry skin after plucking. In medical jargon, the appearance is known as cutis anserina or horripilation. Down in Texas, they are known as “goosebumps.”

Mounted above a room full of monitors and scientists, an interactive map indicated that the International Space Station (ISS) was hovering above South Africa. I had just entered Mission Control at NASA’s Johnson Space Center (JSC), colloquially known as “Houston.”

Third year rotations across the country include a wide array of experiences; however, many specialties are not a standard part of curricula. During fourth year, students are often encouraged to explore new areas of medicine prior to starting residency. I relished at the opportunity to find an experience outside the traditional walls of a classroom, laboratory, or hospital.

Having previously trained as a reproductive biologist, my interests naturally gravitated towards a career in obstetrics & gynecology (OB/GYN). As I interacted with my patients on the wards, I witnessed the direct effects on family planning due to increasing numbers of women entering the workplace and delaying childbearing. Addressing these challenges relied on primary prevention (designed to stop a disease or illness from happening in the first place [ex., vaccine for flu, regular exercise for cardiovascular disease, or contraception for pregnancy]), the development of innovative technologies, and the use of alternative health care delivery strategies. I began to draw parallels with a specialized cadre of practitioners, flight surgeons, and the obstacles facing a unique group of patients: astronauts. I realized that the very same tactics that attracted me to OB/GYN form the bedrock of a completely different specialty—aerospace medicine. Specifically, I envisioned investigating issues of spaceflight contraception and delayed childbearing due to career goals and cosmic radiation, issues where aerospace medicine and gynecology intersect.

As the space program sets its sights on faraway destinations, engineers will have the difficult task of solving problems associated with interplanetary expeditions. Greater still may be the psychological and physiologic challenges that even the most intrepid explorer has ever faced. Given these risks, each astronaut is assigned a personal physician and psychiatrist in addition to the team of biomedical engineers who monitor safety from the ground. I wanted to learn more about this cadre of practitioners comprising a highly specialized niche of occupational medicine.

As my classmates reviewed lecture notes for dermatology, anesthesia, or ophthalmology electives, I commenced a 21-hour road trip into uncharted territory. Sitting in Building 110, I fidgeted with the two forms of government-issued identification I had been instructed to bring. As I waited for security clearance, I imagined what was hidden inside the massive warehouse structure across the street. After receiving the necessary badges to officially enter the campus of the Johnson Space Center, I decided to explore a bit before reporting to orientation at 0730 hours.

She was about as long as the Statue of Liberty lying on her side. The warehouse, “Rocket Park,” was once the site of an open-air totem to space travel and now serves as an enclosed shrine to the impressive Saturn V (“Five”) rocket developed for Apollo missions to the Moon.

Five was also the number of chairs arranged around a circular conference table at the orientation site in Building 37. There I would also find my workstation for the next 4-weeks adjacent to the former sleeping and rehabilitation quarters of the Mercury 7, America’s first group of astronauts. As our coordinator began, the onslaught of acronyms overwhelmed my senses as if I was drowning in a bowl of alphabet soup. Nothing in my training had prepared me for discussions on orbital mechanics, aerospace engineering, or cosmic radiation.

This feeling would continue during a series of lectures by laboratory scientists, flight surgeons, and astronauts. Experts in each of their respective fields reviewed the basics of space physiology and the medical aspects of ISS operations. While the speaker mentioned anthropometric measurements, microgravity induced bone loss, or reactivation of latent viruses, I found often myself daydreaming in an attempt to even conceptualize this group of patients’ home in low-Earth orbit. Floating 250 miles above the planet Earth is a 450-ton habitable satellite housing astronauts and multiple research laboratories that spans the size of an American football field. And in the time that you read this last sentence, the Station has traveled over 75 miles (that’s a velocity of 5 miles per second!). As the content of these lectures seemed more and more like the setting of a grand space opera I was still just trying to convince myself that I was actually at NASA. I had commended myself on being adaptable, switching teams and changing services multiple times during third-year rotations. And yet, unlike in the hospital, I found it difficult to adapt to what seemed like a sci-fi fantasy. Each day felt more surreal than the last.

Perched on one side of Building 9 is a catwalk providing an aerial view of space-vehicle mock-ups from the ISS to the Orion capsule designed for a manned mission to Mars. Across the room is an area teeming with futuristic robots resembling centaurs, arachnids, and what appears to be a Cylon straight out of Battlestar Galactica. As a clerk, I was permitted on the ground floor. The crowded catwalk disappeared from my view as I entered the Japanese module of the Station, Kibo. I closed my eyes and imagined the hiss of the cabin pressurizing as we entered the thermosphere. Inside the third brightest object in the night sky, we made the 90-minute orbital free-fall around our home planet.

Later, I found myself in the cockpit of the historic shuttle spacecraft before ultimately sitting in a T-38 supersonic (the Talon) jet simulator, just one of the aircrafts that comprises NASA’s full fleet at Ellington Field. Admittedly, I could have used some scopolamine for the motion sickness.

We drove 20 minutes offsite to a secure location housing the United State’s largest swimming pool: the Neutral Buoyancy Laboratory. As you can imagine, having 6.2 million gallons right next to the Mission Control Center would not be the best move. I forgot my trunks, but I think the diving team wouldn’t have wanted me to disturb the local aquatic life: astronauts training for space walks.

Hidden behind a 19,000-pound double locked vault with a 150-pound watertight seal is a collection of rocks…from the Moon! In what could be a scene from a movie, we donned white bunny suits before stepping into an air lock to rid ourselves of debris before entering the elusive Lunar Lab. Dating back over 4-billion years, we received a guided tour from a geologist on how the ancient rocks were cut with a retrofitted, diamond impregnated meat saw.

As my clerkship came to an end, I pulled over to Rocket Park for one last moment with the Saturn V rocket. There in its awe-inspiring presence, I looked to the sky and imagined the 6-month deep space voyage to the Red Planet.

The semi-annual four-week aerospace medicine clerkship is offered in April & October. Details about eligibility, application, and selection process can be found here.