Medicine in Orbit

Space, some say, is the final frontier. For N. Stuart Harris, M.D., M.F.A., Massachusetts General Hospital Emergency Department physician and the NOLS Board of Trustees’ immediate past Chair, it’s very much today’s frontier.

Stuart, whose first NOLS course was a Fall Semester in the Rockies, is the Founding Chief of Massachusetts General Hospital’s SPEAR Medicine Division, a specialty dedicated to medicine that’s practiced in SPace, Ecological, Arctic, and Resource-limited environments.

While space medicine may sound like something out of a sci-fi movie, Stuart describes it as a direct descendant of emergency medicine and wilderness medicine, a division he also founded at Mass General.

“The definition of wilderness medicine is providing resource-limited medicine under austere conditions,” Stuart said. It trains people in the fundamentals of good medical care: listening to the patient, performing a thorough exam, and then asking that it be done under challenging conditions.

But what’s the connection between caring for a friend injured while hiking in the mountains of Wyoming and caring for an ill companion on a space flight?

Stuart’s response: Now that private companies have revolutionized the ease of getting into orbit—which allows a much broader, and potentially less healthy, population to travel into space—medical issues among the travelers will likely increase.

In the past, Stuart explained, when choosing astronauts for space travel, NASA had always been “extremely discerning,” selecting those who were exceptionally healthy. “For the last 60+ years, the vast majority of medical risk management in space has been based on preventive medicine, in part, doing everything possible to select the very healthiest.”

Great if you are only trying to send up a couple of astronauts at a time.

“But soon,” Stuart said, “the number of travelers is going to soar, and with that, we’re going to have a large increase in passengers with potential comorbidities, so they may be going up into space with heart disease, and may be going up with diabetes, they may be 90-year-old William Shatner, rather than 32-year-old Neil Armstrong. Just as they do on aircraft today, people will be going up with all the other things that are a normal part of American life.”

As who flies changes, Stuart continued, physicians need to be able to diagnose and treat those travelers where they are—in space. Enter Mass General’s SPEAR Medicine Division. It is comprised of scientists, physicians, ecologists, space experts, whitewater boaters, climbers, and mountain bikers, and its Space Medicine Fellowship is the first Graduate Medical Education reviewed program on the planet.

The two-year program focuses on how to maintain health in astronauts, from launch and landing to travel far from Earth, but also includes training in wilderness and rescue medicine, risk management, engineering, and prolonged training rotations at SpaceX and Vast Space.

“We’ve been working closely with our colleagues at MIT Aeroastro and our friends in programs around the country to help develop and define what exactly this specialty will be,” Stuart explained. “We’re looking at opportunities with SpaceX, Vast Space, and others, first to get experience pre-launch and during mission control, and then looking at what kind of engineering systems and tools and technologies we can develop, like AI-assisted ultrasound, for example, teaching people how to get good images, and then how to interpret them.”

Stuart had the opportunity in September to participate in parabolic “Zero G” research flights in Bordeaux, France, on a project with a half-dozen graduate students led by Dr. Lonnie Petersen of Massachusetts Institute of Technology.

“Dr. Petersen is doing a series of three different research flights throughout the year with the European Space Agency,” Stuart explained. “Our research project had three days of flights investigating ‘countermeasures’ – that is, how to keep people safe in this new environment.”

Each day’s flight started with a single “practice” parabola, Stuart said, “then there are three groups of 5×3 parabolas with a small break in between, and then the same again. It’s a total of 31 flights/parabolas per day over three days.” A cycle is roughly a minute and 15 seconds, and the typical period of weightlessness is 22 seconds, bracketed before and after with the hyper-G phases.

While flights were gut-jarring, Stuart was committed to his role performing ultrasounds on participants. “It’s called the vomit comet for a reason, but I was lucky! My focus was on making sure my research subjects were OK and that I was getting good ultrasound data.”

Healthcare in space is not, in fact, a storyline plucked from a science-fiction movie. “I heard a respected pilot from NASA describe this time in our lives as the Second Space Age,” Stuart said. “I think that’s apt. It’s a pretty fantastically different time in space right now, and I think that phrase, the second space age, is accurate.” And Dr. N. Stuart Harris and the Massachusetts General Hospital SPEAR Medicine Division are ready for it.