As a medical student and aspiring NASA flight surgeon (the doctor caring for astronauts), I recently participated in JSC’s aerospace medicine clerkship (aka elective). I felt called to be a NASA flight surgeon ever since learning about it through the NASA Academy internship in college and was eager to finally get a taste of the flight surgeon role.

First, I get a lot of questions on this, so, some clarification on common misconceptions:
1) Medical school is 4 years long, and requires a college degree first (like graduate school). Everyone graduates from med school as a general M.D. The fourth and final year of med school is when you decide what KIND of doctor you’re going to be (i.e., pediatrician, neurologist, surgeon, psychiatrist, obstetrician/gynecologist, internal (aka general) medicine doc, family doc, emergency doc). Your fourth year is thus spent applying to and interviewing at various programs around the country for a RESIDENCY in that specialty. Residency is ~3-5yrs long and is when you TRAIN in your chosen specialty.

2) Flight surgeons are not literally surgeons. They are M.D.’s or D.O.’s who usually have done a broader residency like family med, ER, or internal med, and then do a second, shorter residency in aerospace medicine (offered by the Air Force, Navy, UTMB-Galveston, Wright State or Mayo). The term “surgeon” is an old hold-over from the military, just like the government’s Surgeon General title. Still, it sounds cool on-console.

3) Flight surgeons do not fly on-orbit with the astronauts. FORMER flight surgeons have applied to, been accepted to and flown in the astronaut corps (e.g., Mike Barratt), but once in the corps, they no longer practice medicine as a licensed professional.

The aerospace medicine clerkship is a 4-week rotation at JSC for senior medical students, set up by Wyle, one of JSC’s life sciences contractors. The clerkship not only offers an opportunity to learn about being a flight surgeon and network within the field, but is also a potential applicant pool from which Wyle may select future flight docs. Half the time is spent working on a research project with a mentor, one of the current flight surgeons. The rest is spent in lectures on space physiology, medical selection requirements for crew, close calls and accidents, toxicology, radiation, etc., and on tours of facilities such as NBL, Ellington Field, Building 9, the neurovestibular lab, and flying the Space Shuttle Motion Simulator. All these experiences culminate in final presentations and by working through a number of case scenarios, real and hypothetical, clinical and ethical, with JD Polk, current chief of Space Medicine.

Flight docs often report having “the second-best job in the agency.” In terms of mission operations, they participate in much if not all the same training as crewmembers and support three major areas: pre-flight crew selection and training, monitoring of on-orbit crew, and post-flight debrief/rehab. Some docs are also stationed with our Russian partners in supporting training, launch and landing ops in Star City and Baikonour. Flight docs assigned to a mission not only take care of the crew, but are also responsible for crew family members as a point of support and contact, especially during mission contingencies. While these docs work direct mission medical ops, other surgeons staff the JSC clinic, seeing active and retired astronauts, and still others work on research/advanced projects for the future.

Probably one of the most challenging aspects of being a flight surgeon is that you in effect must try and serve two masters—an impossible job. Not only is your patient your responsibility and you their advocate, as is good general medical practice, but your patient is a civil servant in which NASA and US taxpayers have invested millions of dollars worth of training. But most importantly, your patient is a person, colleague, and friend, with a family on the ground. Therefore, a major medical event can disrupt work timelines, jeopardize missions, cause political strain between international partners, and create incredible family stress on Earth, all at once. This places the surgeon in a critical role of often rapid decision-making, sometimes with limited information, that must be appropriately justified to management, all while trying to keep the best interests of patient, agency and family in mind. No easy task.

All told, a good day for a flight surgeon is a boring one, especially on-console. They conduct regular private medical conferences with the crew in addition to addressing any current medical concerns. Three on-orbit events in particular send a surgeon’s heart rate skyrocketing: toxic exposure, rapid cabin depressurization, and fire/smoke inhalation. The surgeon on-console works in conjunction with BME (biomedical engineer) and can consult any medical specialist necessary for medical events such as these.

Separate from ops, constant good communication between medical and engineering/science personnel is also essential during hardware design and planning in order for the crew to do their jobs safely and efficiently. Flight docs often find themselves having to justify to engineers the medical reasons for certain design or schedule modifications or why a particular piece of hardware cannot be cut from the payload manifest despite its adding weight. In an engineering-dominated center such as JSC, the physician is often an outnumbered but necessary liaison between those who design the missions and those who ARE the mission.

Historically, flight surgeons were seen as “the bad guys,” the ones who held the authority of whether or not to ground crewmembers. But conscious efforts have been made to change this stereotype, and I believe this will continue to improve with longer duration spaceflight. Already, what I witnessed during the clerkship was a much more collegial relationship designed to support NASA family, with the patient-doctor relationship remaining sacred.

I knew being a flight surgeon was the right fit for me the day I realized it is not so much the nature of NASA’s work that fuels me as it is being able to support the people with whom I work. As it turns out, as a flight surgeon, that IS your job. The ability to care for NASA family in the role of physician is a pay-it-forward type of exchange: you keep crew performing to the best of their physical and mental abilities, and they in turn are able to explore on behalf of all of us. To quote a colleague particularly enamored with this task, “it’s like taking care of Lewis and Clark.” I look forward to that privilege.