Space, The Final Medical Frontier?

Clifford Reilly is a fourth-year medical student at the University of Vermont, Larner College of Medicine.

In the following blog post, Reilly writes about his aerospace medicine clerkship experience at National Aeronautics and Space Administration (NASA).

Clifford Reilly

“Do we need doctors in space?”

“Do we need doctors in space?” This is the question that occupied my thoughts as I contemplated potential career paths while I wrapped up my third year of medical school. As a general principle, wherever a person might go, a doctor may also be needed. Physicians practice in a whole host of austere environments, from the Arctic Circle to cruise ships isolated at sea. Considering that astronauts inhabit the International Space Station 24 hours a day, 365 days a year, it seemed reasonable to assume that medical professionals would be indispensable in space as well. A quick Google search could not quite answer my question, but it did lead me to an application page for The National Aeronautics and Space Administration (NASA) Aerospace Medicine Clerkship. I applied immediately.

An Out-Of-This-World Educational Experience

Several months later, I found myself standing in front of the Lyndon B. Johnson Space Center in Houston, Texas, full of anticipation. The next four weeks involved a series of aerospace medicine lectures and tours of various NASA facilities, such as the self-explanatory Mission Control Center and the Neutral Buoyancy Laboratory—an intense training pool where astronauts prepare for spacewalks. As part of this incredible experience, I completed a research project examining medical records from the Apollo Program. Delving into the decades-old paper charts, I sought to better understand what medical symptomology the astronauts might have experienced during their famous moonwalks. 

What I Learned

What I learned during my time at NASA was fascinating, to say the least. I realized that, despite the engineering feats we’ve achieved, space can still be incredibly hazardous to one’s health. The lack of gravity takes its toll on the human body—affecting bones, eyes, and other organ systems. Cosmic radiation, if not correctly mitigated, can significantly impact an astronaut’s lifetime cancer risk. Even the mundane becomes complex when one is miles above the surface of the planet: exposure to loud sounds and hygiene concerns (yes, I did attend an entire lecture about the space toilet) are just a few of the unexpected occupational hazards that come with space travel.

So, Are There Doctors In Space?

Interestingly, the answer to whether we need physicians on the International Space Station (ISS) is both yes and no. As it turns out, the current consensus is that a designated ISS physician isn’t a necessity. Although there are many physician-astronauts, they do not currently act in the role of a physician—as in, they’re not directly providing medical care—while on the ISS. Instead, there is always a physician with board certification in aerospace medicine available in the Mission Control Center. They’re able to collaborate with the astronauts and guide them through any medical issues that may emerge; walking the crew through any diagnostic process needed in real time. These essential ground crew members are equipped with a host of gadgets that allow them to medically assess an astronaut’s health remotely. They even have a special line to maintain physician-patient confidentiality–it’s like interstellar telehealth!

How To Examine An Ear In Space

One of my favorite anecdotes from my time at NASA was an explanation of how to examine an ear in zero gravity. All seasoned medical students understand that the key to a good ear examine is gentle retraction of the earlobe to get a better view. However, if you were to gently pull on someone’s earlobe in space, instead of opening the ear canal, you would just pull the entire patient’s body towards you—no gravity, no resistance. The solution to this problem is the Crew Medical Restraint System, known colloquially as CMRS, because, as I quickly learned, everything at NASA has an acronym. The CMRS is essentially a specialized medical cot in the center of the ISS that allows the medical officer to anchor the patient appropriately, including a head strap for ear exams. This simple, yet effective, solution extends beyond ear examinations and addresses other medical scenarios as well.

For instance, performing chest compressions during CPR heavily relies on the force of gravity. While CPR has not been required in space thus far, NASA has nonetheless accounted for this possibility. Therefore, the CMRS also has anchors for the medical officer’s feet to allow proper leverage for administering chest compressions. This is just one of the many thoughtful solutions NASA developed to address healthcare challenges borne from the lack of gravity.

New Frontiers 

NASA has committed to returning humans to the Moon by the end of 2024, with the aim of working our way towards the first manned mission to Mars in the coming decades. But these new goals breed new challenges, particularly for medicine. While an on-station physician may not be required for ISS missions, the longer distances associated with deep space travel will introduce communication delays, making real-time medical guidance from Earth impossible.

Approximately half of my lectures at NASA concerned current research into various medical challenges, and solutions, associated with long distance space travel. Truthfully, it is an exhilarating period for the aerospace medicine community, and as a medical student, I am grateful that I had the opportunity to witness these advancements firsthand.