番茄社区

Welcome to "Medical Mavericks," a new series from 番茄社区 featuring interviews with healthcare professionals working in unconventional fields of health and medicine.

We spoke with Anna Fisher, MD, MS, a retired NASA astronaut, about her transition from emergency medicine to becoming a medical officer and mission specialist in space.

After working as a candy-striper in high school, Fisher became the first person in her family to attend college -- and later, medical school. In 1977, after graduating, completing an internship in family medicine, and being accepted into a surgery program, she happened upon a very different opportunity she'd dreamed of since she was 12 years old: the chance to become an astronaut. NASA was looking for not only pilot astronauts, but for mission specialists for the new space shuttle program. While she waited to hear about the status of her application, Fisher spent a year practicing emergency medicine (a non-boarded specialty at the time). Once she was selected by NASA, she didn't hesitate to accept.

In 1984, Fisher and her team took part in NASA's first "salvage mission" to bring two satellites back to earth.

This interview has been edited for brevity and clarity.

Can you detail your astronaut training and the role medicine played?

Fisher: I had a background in chemistry and medicine, so I think that was helpful to getting selected by NASA. Initially, I tried to practice medicine for the first year after I went to NASA, but it was too difficult to do two very demanding careers at the same time.

When talking about training, there are different phases. There's the initial training when you first come in: we had to learn shuttle systems, we had to learn astronomy, geology, meteorology. We had to learn how to fly T-38s [a supersonic jet trainer], which was how the pilots maintain their proficiency as pilots. For those of us that were mission specialists, we had to learn how to navigate and communicate in a very high-performance jet. It was like starting over in a new career.

We also did get some medical training, but very little. That has changed a great deal in the current environment. Many of the crew members that go to the International Space Station get medical training, kind of up to the level of an EMT, particularly if there's no doctor on board; we have doctors in the office, but we don't have enough doctors to assign to every mission, every shuttle mission, every space station expedition.

Anyway, that first phase is really the general training. Afterward, there's crew-specific training once we were assigned to a flight. Kind of like medicine, you do all your general medical training, and then you get more specialized. The same thing happens in the astronaut office.

You mentioned having enough doctors in "the office" but not on every mission. Can you distinguish between those roles?

Fisher: There are medical officers, which was a role I played, and then there are flight surgeons.

The astronaut doctors [medical officers] are astronauts. That's our main job: to be an astronaut and to do whatever your particular mission is.

The person ultimately responsible for the crew's health and well-being is the flight surgeon. But they typically don't go into space. It's kind of a private doctor for the astronauts. If you have a serious medical problem or concern, you could request a private medical conference with your flight surgeon [on the ground]. They also schedule a private conference once a week for every crew member, and they ask questions about how you're doing -- it's both a physical thing and a psychological assessment.

What did your role as a medical officer entail, and what kind of health conditions did you treat?

Fisher: One thing we were looking at was what should be included in the medical kit on board [the shuttle], and all the doctors in the office, including me, contributed to deciding what we would take. The medical kit primarily had IV fluids, some equipment for simple laceration repairs, lots of medicines for various things. It was a pretty small container, so we really didn't have much medical capability on the shuttle. We were also starting to develop the facilities and equipment for the space station.

We also worked on developing techniques for CPR in space. The technique is the same, but you have to figure out a way to restrain the patient and the person doing CPR. So, we have a special board where you would Velcro the person down who's receiving CPR. And then you also have to restrain the person doing CPR because they can't exert force on the chest if they're floating. So, you have to have a mechanism to tie yourself down while you're doing it, and then of course provide oxygen as well.

The main kind of health issues you deal with on orbit with a generally healthy population are often the same things you might encounter here on the ground. But there are some common conditions you confront on a mission.

One thing that's perhaps unique to being on orbit that I dealt with a lot was back pain. I didn't personally have it, but some of my crewmates did. Once you're out of the gravitational field, your spine elongates. So, you gain about an inch in height. And for some people, stretching of the ligaments leads to back pain. Also, a lot of people really miss having a hard surface to sleep on. That can also contribute to the back pain. So, you have medicines for back pain.

You know how every doctor always says, "take two and call me in the morning"? Well, my crewmates were having such bad back pain they were saying, "take all but two and call me in the morning."

We also have a condition that pretty much everyone -- probably about 60% to 70% -- of astronauts have called "space adaptation syndrome." That's just a fancy name for symptoms very much like being seasick, motion sick. I had that for the first 2 days on my mission. I took a medicine called Scope-Dex, which is a mixture of scopolamine and dextroamphetamine (Dexedrine). The Dexedrine is to counteract the sleepiness of the scopolamine. That worked pretty well.

Everybody works with their flight surgeon and decides what they're going to do. Some people opt to just tough it out and not take anything. Being a doctor, I believe in medications and using them when appropriate.

The other kinds of things that come up are often extravehicular activity spacewalk (EVA) related. Because we're going to a reduced pressure environment in the suit of 4.7 PSI, you have to worry about things like the bends.

Were you prescribing for the other astronauts on board?

Fisher: Yes, they would come to me and say their back is really bothering them or they have a headache. Also, you get a lot of stuffiness because of the fluid shifts. Again, because you're not in a gravitational field, the blood that normally pools in your legs in a 1G environment goes into your central venous system and is perceived as a volume overload. There's also a lot of congestion and stuffiness and everything, we think, due to the fluid shifts. But people can also get colds and things like that. So those are the kinds of medicines we had -- to cover motion sickness symptoms, back pain, decongestants. I treated mostly minor things.

In what ways did medical training influence your role as an astronaut?

Fisher: Initially, I felt my medical training didn't have a direct impact on what I did as a crew member, but that's because of my particular assignments. But the one thing that medical training did is that I felt totally prepared to be an astronaut -- even before I knew anything -- because of how difficult medical training was.

The years on the ward as a third-year, then a fourth-year student, and then as an intern, you know, the grueling nature of the way it was back then. You often did 36 hours with no sleep, scrubbing into surgery overnight with people who were in accidents, gunshot wounds. We saw everything, and so you were often just exhausted.

When I came to NASA, if you look at a timeline for a crew, they're always given 8 hours of sleep. It's a requirement when you're flying T-38s that you can only fly for 8 hours. You could go to 10 hours if you had a mission specialist in the back seat, and you could go to 12 hours if there were two pilots. But then you're supposed to get 8 hours of sleep before you do another flight. So, coming to NASA was refreshing because they thought you needed sleep to do a demanding job. And I was so used to having to do a demanding job without any sleep.

There were days -- for the Apollo 13 problem, for example – where you might be working a couple of days, nonstop for some big emergency. But that just wasn't the way you normally operated. Normally, people felt you needed sleep to do a good job.

What would happen if there was a major health emergency in space?

Fisher: The plan for dealing with a bad emergency was twofold. One, it begins with selection. In the selection process, anybody who had any kind of a medical problem, even if they didn't think it was a problem for going into space, you weren't accepted. So, they got around not having a tremendous medical capability on board the shuttle by selecting younger people and people in as good health as they could find.

This may have changed somewhat. We've learned over the years that if somebody has a certain set of qualifications, but they have say, a history of kidney stones or another medical condition, you could select them, but maybe they would only get to fly on a shuttle mission. They may not get to fly on a long duration mission.

Then, if you did have a really bad problem in space -- which has never happened because the selection process is so careful -- the plan was to do an emergency de-orbit and pretty much on every orbit, there is a place where the shuttle could land in a real emergency. But I don't know how realistic that was. And obviously it's not going to be 5 or 10 minutes like calling a paramedic.

What are you doing now?

Fisher: At first, I thought I would just be retired. Then I thought about going back and practicing medicine. I get emails pretty much every day from people needing doctors all over the country. I can really say there must be a shortage of doctors because I get so many requests. But I have a unique position right now where I do a lot of speaking, talking with young kids and young women and encouraging them to pursue careers in STEM [science, technology, engineering, and math] fields. So, I have a platform by which I can perhaps have some influence on the future generations. And I feel that's important too.

Comment