An Astronaut's Guide to Life on Earth
No one had breathed a word of any of this to me or to the flight surgeons at NASA who would be directly responsible for my health while I was on the ISS. The secrecy and paternalism really bothered me. They trusted me at the helm of the world’s spaceship, but had been making decisions about my body as though I were a lab rat who didn’t merit consultation. One thing I’d learned was that I couldn’t expect every medical professional to be an expert on every single medical problem and procedure. The information we’d unearthed on our own had been crucial so far, and so had the opportunity to frame the medical risks in the context of the overall risks of space flight. Keeping me out of the loop only made sense if the experts were omniscient and I had nothing to contribute to the discussion.
The reasoning also bothered me. Just as a panel of hairdressers is likely to recommend that you change your hairstyle, a panel of surgeons is likely to recommend surgery. And that’s exactly what happened, even though three out of the four surgeons thought the chance of a recurrence was low or nonexistent.
So in January, I was asked to have surgery yet again. My starting position—“I will do it, but only if you absolutely insist on it”—quickly changed to a firm “no.” Helene and I had been researching like crazy, and the more we learned, the more this “quick look” idea seemed truly idiotic. There were, it turned out, two studies covering cases exactly like mine: after conventional surgery people had developed obstructions, which were then cleared laparoscopically. The rate of recurrence? Zero. To me, this was the best proof possible that I was a good risk to go to the ISS, particularly since in all other respects, my health was and always had been excellent. Plus, like any surgery, the procedure that was being proposed would introduce significant new risks. I might have an adverse reaction to general anesthetic, for instance, or I might develop an infection, or any number of surgical errors might occur—and any one of those things could then eliminate me from space flight. A needless operation simply made no sense for me and would also establish a troubling precedent. What about the other 20 percent of astronauts who’d had appendectomies and therefore might also have adhesions? Would they too be required to have “quick look” exploratory surgery?
There was something else to consider: the risks to the space program itself if I didn’t fly. I was backup for another commander, Sunita Williams, who was scheduled to launch in July. Who else could step in to cover her? The answer at that late date was, “No one.” Like Suni, I was left-seat qualified for a brand-new spaceship, the Soyuz 700 series, which is digital rather than analogue and therefore has different flight control displays and laws. If I was pulled, the CSA couldn’t replace me; no other Canadian was even qualified to fly the older type of Soyuz, let alone the new one. NASA couldn’t replace me either: my NASA backup was an astronaut who’d never been to space before. He was very competent, but he couldn’t possibly get qualified by July. In order to swap in someone who was qualified, as the Chief Astronaut at JSC pointed out, five crews would be affected, so there would be a significant ongoing safety risk to the entire program. If the likelihood had been high that I’d get seriously ill in space, there would have been no option but to take those risks. But the chances weren’t high. In fact, they were so low as to be negligible.
The next few months of my life, while I continued to train and to get ready for an expedition I might or might not lead, were Kafkaesque. I had to try to focus on training and on learning everything I could, and ignore the background noise. I was caught in a bureaucratic quagmire where logic and data simply didn’t count; internal politics and uninformed opinions were what mattered. Doctors who hadn’t ever performed a laparoscopic procedure were weighing in; people were making decisions about medical risks as though far greater risks to the space program itself were irrelevant. Helene and I, along with our flight surgeons, were spending vast amounts of time and energy digging up studies, talking to experts, emailing administrators, creating complicated graphs and charts comparing medical data and different risk factors—just looking for some other way to persuade administrators that it was safe for me to fly.
Meanwhile, the MSMB ruled: all the evidence we’d dug up convinced the international members on the board that I was fine to fly, but not the American, who wanted still more proof.
This was not good news. We’d presented what we and the experts who’d helped us considered to be overwhelming evidence. If that didn’t do the trick, what would? It felt as though we were mounting a case against superstition, which science is useless to dispel. You can present all the random sample studies you want to prove that it’s safe to walk under a ladder, but a superstitious person will still avoid that ladder.
The CSA kept telling me to relax and not worry; they were sure that in the end everything would go our way. This was completely in keeping with national character: Canadians are famously polite. We’re a nation of door-holders and thank you-sayers, but we joke about it, too. How do you get 30 drunk Canadians out of a pool? You say, “Please get out of the pool.” Under normal circumstances, Helene and I would be the first people out of that proverbial pool, but these were not normal circumstances; we felt the Canadians were being just a little too Canadian, trusting that logic would eventually conquer all. To us, it was plain as day that our data collection efforts were crucial, both for me personally and to protect Canadian interests. Many millions of dollars had been invested in my flight; many Canadian experiments were slated to go on board during my expedition, too. Having a Canadian in command of the world’s spaceship was not only a source of patriotic pride but also a vindication of the space program, whose funding, like NASA’s, is perennially under threat. If we stopped working the problem, I wouldn’t be going to space, though, since a single individual in senior medical management at NASA could prevent it.
And then, at the eleventh hour, just days before a March meeting where NASA would decide once and for all, someone on the MSMB volunteered a solution: an ultrasound would likely reveal whether I had another adhesion. I was dumbfounded. For months I’d been asking whether there wasn’t another way, something less invasive than surgery, and for months the answer had been, “No, surgery is the only possible option.” Now, suddenly, everyone was on board for an ultrasound, so long as one particular highly qualified radiologist performed it—he was, however, on holiday, so I had a week to do some research, long enough to discover that the ultrasound test had a 25 percent rate of false positives. In other words, the test might determine that I did have an adhesion, but there was a one in four chance it would be dead wrong. And even if I did have an adhesion, who was to know whether it would be threatening or not? No one seemed concerned about this but me and Helene.
When the day came to get the ultrasound, we were both resigned during the 45-minute drive to the hospital. We had fought the good fight right to the very end. Now it was time for a death sim of sorts: we needed to talk about what we’d do when I failed the ultrasound. We discussed a lot of different options: staying in Houston longer than I’d planned, maybe, or retiring and looking for work as an aerospace consultant.
The main thing we decided during that drive is that we would not be defined by this experience. I wouldn’t go through the rest of my life being the commander-who-wasn’t, that poor guy who didn’t get to go to space a third time. We’d seen what had happened to other astronauts who were scrubbed from missions, and we thought that the next thing that would kill us, metaphorically speaking, wasn’t an ultrasound but a loss of our own sense of purpose. Fortunately, we also knew the boldface that could save us: focus on the journey, not on arriving at a certain destination. Keep looking to the future, not mourning the past.
We arrived at the hospital feeling pretty good. Whatever happened, we knew we would be all right. The expert plunked goop on my stomach, then used different ultrasound wands to look at the area. The inspection didn’t start off well. The doctor said, “Oh, that wasn’t what I expected to see”—he needed to observe movement, what’s called “visceral slide.” He turne
d the monitor so that I could watch, too. Helene was holding my hand, her back to the screen, tense but resigned. A minute passed. Even I had to admit that nothing was moving.
I’d failed. But more than disappointed, I felt curious: Had I really been so wrong? Was there something wrong with me after all? So, my eyes glued to the monitor, I started breathing more shallowly, tensing and relaxing my stomach muscles, actively willing my insides to slide. I wanted to go to space, of course, but I also wanted to be certain that I actually was okay.
After years of studying and training, this was what it all came down to: whether a minuscule portion of my intestine could move on command. And then, miraculously, it did. The doctor smiled, and turned on a recorder to capture the movement on video: visceral slide. Another doctor came in and verified it, and then the relief in the room was palpable.
Back in the car, Helene and I started calling the few people who’d known about this whole ordeal. We felt we’d won an epic David and Goliath sort of battle, one I’d been getting ready for, without knowing it, my entire adult life. It had been the ultimate “out of control” test, working a serious, complex problem while in freefall, professionally, without losing my focus on the true goal of the mission: making sure our crew was ready for space flight whether I was going with them or not. But there wasn’t time to celebrate the victory. I had work to do.
I was going to space, after all.
7
TRANQUILITY BASE, KAZAKHSTAN
A LOT OF PEOPLE ASSUME that the days right before launch are some of the most stressful ones in an astronaut’s life. Actually, the opposite is true: the week or so pre-launch might be the closest we ever get to serenity, professionally speaking. One reason is that nothing has been left to the last minute. We’ve been preparing for this specific launch for years, and thinking and dreaming about space flight most of our lives. The other reason is that we’re in pre-flight quarantine. Astronauts call it “white-collar prison,” only half-jokingly; we have minders, we can’t leave the compound and most visitors have to talk to us through glass. But of course we want to be there, and we’re catered to, fussed over and waited on so attentively that the casual observer might never guess the true purpose of our stay is medical. The idea is to protect us from catching infections on Earth that would make us sick—and less productive—in space.
On orbit, even a head cold is a big deal. Without gravity, your sinuses don’t clear and your immune system doesn’t fight back as effectively, so you feel much sicker, much longer—and in such a confined space, it’s pretty much guaranteed that the rest of the crew will be infected. That’s exactly what happened during the Apollo 7 mission in 1968. Commander Wally Schirra developed a bad cold partway through the 11-day mission, and by the end, all three members of the crew were so ill that they refused to put their helmets on for landing. They were concerned that as pressure increased during re-entry, their eardrums might burst, so they wanted to try to equalize the pressure the same way you would on a plane: by pinching their noses while trying to blow out—which would be impossible if they were wearing big fish-bowl helmets. The crew’s exchanges with Mission Control in Houston were famously fractious, and none of those three astronauts ever flew again. In later years Schirra did, however, appear in ads for Actifed, the decongestant he’d taken in space.
In the 1960s, astronauts frequently launched in apparently perfect health, but then, a day or so into the mission, a virus would make its presence known. The crew of Apollo 12 also wound up relying on Actifed; all three astronauts on the Apollo 8 mission experienced gastroenteritis, which is probably even less pleasant on orbit than it is on Earth. But not until 1970 did NASA decide it might be a good idea to isolate crews pre-flight. Apollo 13 was the last straw: three days before launch, a backup was swapped in to replace a crew member who’d been exposed to measles (but didn’t, as it turned out, ever fall ill). In flight, in the midst of a life-threatening crisis—an oxygen tank had exploded, causing serious damage to one of the rocket’s modules—another crew member came down with an infection. Thereafter, pre-flight quarantine became mandatory.
When the Shuttle was still flying we spent six or seven days in quarantine, roughly the length of time it would take a virus to run its course. At the Kennedy Space Center (KSC) our quarters were spartan—stark little rooms with a dresser and a hard bed, like a military barracks—but the mood was convivial. For crew members, launch was a momentous event, of course, but the Shuttle left Earth with seven people on board on a fairly regular basis. The people at KSC were accustomed to sending astronauts off to space. By the time the program ended in 2011, there had been 135 launches, most of which never even made the nightly news.
These days, when the Soyuz is the only manned vehicle going to the International Space Station, and it departs not from sunny southern Florida but the near-desert of the Kazakh Steppe, the whole experience of quarantine is different. Now just a dozen humans leave the planet each year and we stay in space for months rather than a week or two—long enough to start feeling at home there, and long enough that anything could happen in our absence. The knowledge that something bad might happen to people we love while we’re in space, yet there would be nothing we could do to help and no way to come back early, somehow injects a slightly more formal and contemplative flavor to the whole experience of quarantine.
Another difference: the Russians, so austere and no-nonsense in their approach to many things, are big believers in downtime for space explorers. We’re quarantined longer in Baikonur, Kazakhstan, than we were at the Cape—12 full days—but you get the sense that Roscosmos doesn’t think that’s quite long enough. Before my last flight, my crewmate Roman was sent with his family to a health retreat in the country for five days before quarantine, to kick-start the unwinding process. (Post-flight, too, cosmonauts get months off work, while astronauts go back to the office just a few weeks after returning to Earth, though we’re certainly not expected to take on a full slate of responsibilities the moment we walk through the door.)
These days, the purpose of quarantine is as much psychological as it is medical: an enforced time-out ensures we pause, consider what we are about to do and deliberately begin to transition to a new kind of existence. Emotionally and physically, quarantine is a halfway house en route to life in space.
As we left Star City, Russia, to fly to Kazakhstan in December 2012, it was the usual mad scramble to get to the plane, then … calm. Tom, Roman and I were heading out of the murk of preparation and into the clarity of launch: the plane was almost palpably full of plans, hopes and dreams. Looking out the window as we made our descent, however, I found the view less than enchanting. The Syr Darya river flowed darkly through the flat brownness of the landscape, which was otherwise punctuated only by a scattering of low-slung, utilitarian apartment buildings festooned with satellite dishes. There were no hills and very few trees. It looked exactly like the kind of place where a rocket could crash without inconveniencing anyone or even, possibly, attracting notice.
Baikonur is a spaceport: space flight is its main industry, its reason for being, yet there’s nothing remotely slick or futuristic about the place. Nor is it hopping—seasonal extremes of temperature don’t encourage colorful street life. In summertime, the heat is oppressive, but when we arrived in December, it was so cold that after a few minutes outside under a bright blue sky, frost formed on the tips of my eyelashes. On the outskirts of Baikonur, camels wandered in and out of holes in the fences while stray dogs howled at the approach of winter. It felt like a ghost town redolent of history and Soviet-era, matter-of-fact triumphalism. The tree planted by Yuri Gagarin, the first human being to leave the planet, was somehow thriving on an otherwise barren plain.
There was an “as if” quality to my first day there, partly because the town itself is a little bizarre, both otherworldly and prosaic, but partly because I’d come so close to not being there at all. Checking into what’s known affectionately as the Cosmonaut Hotel helped me believe that ye
s, this was really happening. While the tourist attractions of Baikonur may not rival those of Cape Canaveral, it must be said that crew quarters are considerably more spacious: I had a whole suite of rooms, complete with a massive Jacuzzi. The overall ambience brings to mind the institutional charm of a sizable college dorm. Astronauts and cosmonauts are housed in one wing, while another includes support staff and instructors; there are Ping-Pong and billiards tables, a serious gym and a dining hall. Everything is spotless (sterile, actually: the floors and walls are wiped down with bleach daily to ward off germs) and the food is great (the kitchen staff is fanatical about hygiene, so there’s no chance we’ll get food poisoning).
Breakfast is oatmeal, yogurt, tvorog (Russian cottage cheese), omelet with red caviar, persimmons and honey, nuts and fruit compote, and to drink there’s coffee, tea or chicory. Lunch and dinner are varied banquets of homemade soup, grilled fish, cutlets, pelmeni (the Russian version of ravioli) or manti (a Turkish dumpling stuffed with meat), fresh vegetables and made-to-order dessert. Ask for a brownie, and they will cheerfully whip up a fresh batch, packed with nuts and topped with chocolate sauce.
Early in the morning of our first full day in Baikonur, we finally got to see our Soyuz—the real one that would actually take us to space. Back in the summer, we’d met with a delegation of the rocket’s builders for a traditional toast to success and friendship—with a little symbolic sip of rocket fuel, which, even when it’s cut with water, tastes like kerosene: just awful. In subtle ways, the rocket they built for us was different from the simulator in Star City; after almost every mission the vehicle’s design is tweaked a bit. During the primerka, or fit check, we spent about an hour inside, all suited up in our Sokhol pressure suits, figuring out where the switches really were and how long it would actually take us to do things. We were satisfied: the ship was sturdy and familiar.