Aerospace Hogwarts

"So, when are you going to fly in space?"

It's a question we get asked a lot. The underlying assumption is based on the misnomer, "Flight Surgeon."  

In the NASA realm, a Flight Surgeon does not fly in space (only astronauts do), and they are almost never surgeons.  Think of it like the Surgeon General: the title "surgeon" is merely an old military term that dates back to the 17th century, when units had their own doctors, many of whom at the time were surgeons.

In the military, however, Flight Surgeons do occasionally fly in the back seat of fighter jets and other aircraft.  

These days, Flight Surgeons often have backgrounds in Family Medicine, Emergency Medicine or Internal Medicine, as well as training in Public Health (epidemiology, infectious diseases, etc.) for the unique patient populations to which they are assigned.

Since the inception of the job title in WWI, flight surgeons helped significantly reduce the human factors (AKA “pilot error”) causes of WWI aviation deaths.  This continued contribution to pilot safety was deemed so important that flight surgeons are designated as rated aviators in the military, along with pilots and navigators. This means they are formally decorated with wings as part of their uniforms, and placed in a category separate from other military physicians. 

Ideally, a flight surgeon is one of a flier’s closest assets. They are trained to appreciate--and personally experience, as part of their training--many of the physiologic and psychological factors inherent to high-performance flying (fighter jets, cargo planes, spacecraft) and critical in-flight duties (air combat, navigation, emergency procedures, etc).  This unique doctor-patient relationship has historically been adversarial because flight surgeons have the authority to temporarily or permanently strip a pilot of their flying duties for medical reasons, AKA  “grounding.”  This understandably can rob an aviator of their career, and often identity.  However, the field has come a long way in this regard, and the overall goal is to work with pilots to keep them flying safely throughout their career.

Why does a pilot even need medical support?  Consider this: suppose you’re getting on a commercial flight home for Christmas.  The night before, your airline pilot had a fight with his wife, and they’ve decided to get divorced.  For various reasons, he may not be awarded custody of their children.  In addition, he is understandably feeling depressed, is overweight, and has been having some chest pain, but hasn’t mentioned any of this to anyone.  Prior to takeoff, he has numerous technical checklist items that cannot be missed, and that require focused concentration, in order for the aircraft to function safety.  In his current state, is this who you want in the cockpit?  Is this who you want in the front seat of an F-15 assigned to fly a critical mission?  As a flight surgeon, your patient isn’t just the pilot.  It’s the taxpayer and the general public.  Ensuring pilot physical and mental health is crucial to flight and mission safety and success.

While an astronaut’s flight surgeon often has the additional distinction of carrying Sharpies for their astronaut to sign autographs, as well as Band-Aids, Tylenol, and many other “just in case” items when on the road with them, gaining the trust of any aviator is not something to be taken lightly, and the flight surgeon privilege cannot be taken for granted, no matter where your flying environment.

Our program has us attend a flight surgeon-specific training course as part of our graduation requirements.  And in short, it's like Aerospace Hogwarts.

James & I with the Apollo 15 capsule

In addition to significant classroom time focusing on medical standards, waiver criteria, and physiology, you experience the pilot's environment.  How do you get inside a pilot’s head? For us, this includes a number of exposures:

1) Hypoxia (oxygen deprivation): this is done in hypobaric chambers, where, once the doors are sealed, the atmospheric pressure and thus oxygen content can be altered to mimic what it feels like to be at 25,000ft above sea level.  This helps us, and pilots, recognize our reaction to oxygen deprivation.  For example, I consistently get lightheadedness and tunnel vision.  If that happens in flight, that is my warning that something is wrong- either I need to put my mask on, there is a leak in the cabin, or both. Pilots need to recognize this, too, because hypoxia can sneak up on you and make you black out before you know it.  Blacking out when you’re screaming along at Mach 1 in a fighter jet at 35,000ft is the last thing you want to happen.

2) Pressure changes: The hypobaric chamber demonstration also helps us identify which methods work best for us personally to clear our ears during large pressure changes (similar to the ear discomfort people experience when flying or diving).  This is useful to know before you find yourself sitting in a high-performance aircraft or on a time-critical mission.

3) Spatial disorientation: This is done in simulators--typically a windowless cockpit that is mounted on a spinning post--or an acrobatic flight in a stunt plane, similar to those you see at airshows. We did both.

    Doing aileron rolls, barrel rolls, loops, half Cuban 8’s, Immelmans, split S’s and spins will make your blood swish and swill, and can make you experience gray-out (the period before black-out, AKA G-LOC: Gravity-induced Loss of Consciousness).  Again, no one wants aviators blacking out, so they teach you straining maneuvers to counteract this, and let you fly the plane so you understand what happens with which maneuvers. Wicked. Awesome.

4) Finally, FLYING!  Experience is the best teacher, and our Instructor Pilots were amazing--all retired military pilots with up to 18,000 flying hours apiece in various aircraft.  After our familiarization flights (i.e., “This is called the throttle. You pull back to make the plane go up,” etc.), we did a number of touch & go landings, formation flying (think Blue Angels), a timed mock bombing run using charts and landmarks for navigation, and a night/IFR (Instrument Flight Rating) flight, using GPS capabilities and autopilot when weather and clouds can cause spatial disorientation.  Our instructors let us fly the planes, taking over only when correction or guidance was needed. Fun!

In the end, James and I made some great friends, learned a ton and grew as student pilots.  As icing on the cake, we invited our favorite NASA flight surgeon mentor to come pin on our wings at graduation.  He mentioned there is something to be said for passing on the flight surgeon tradition to the next generation.  In this vein, there are a number of other folks who James & I would have loved to have there, namely our aviator grandfathers, and those who have always encouraged and supported us along the way. This post is for you.