Preparing For Space Travel: Nursing at NASA

Peggy W. Dryden RN, MS, MBA, MLS

Disclosures

August 10, 2005

Have you ever wondered what it would be like to work for the US National Aeronautics and Space Administration (NASA)? Who provides healthcare to the astronauts? In this edition of eLetters, we asked 2 nurses working for NASA, Carole Porcher, RN, and Belle Wallace, RN, about their positions. Some of what they do is routine. However, for these nurses, a space shuttle launch is exciting and has a very personal impact.

Question: Carole, you mentioned that you enjoy your work because you are learning things about manned space flight you never knew before. Can you describe some of what you have learned?

Carole Porcher, RN: Even though I have always been interested in manned space flight, I had no idea before coming to the Johnson Space Center (JSC) what a monumental task it is to get a spacecraft safely launched into space, then safely home again.

I also had no idea about how hard spaceflight is on the human body. For example, I didn't realize that astronauts lose bone density and lean muscle mass while in the weightless environment for extended periods of time. I know now what countermeasures are taken to minimize the bone density and muscle mass loss in orbit. Also, I didn't realize that being outside Earth's atmosphere exposes our astronauts to much higher radiation. I now know how the International Space Station and the shuttles are shielded to protect our crewmembers as much as possible. We keep very close records of each astronaut's medical and flight-related radiation exposure. We also attempt to get radiation exposure data from all medical procedures and report to the department that keeps running records of all spaceflight and terrestrial radiation exposure by astronaut. This information is used when determining qualification for both short- and long-duration spaceflight assignments.

Before coming to JSC, I had no idea how risky space walks (extravehicular activity or EVAs) are. Now I know how each astronaut assigned to do an EVA practices his or her task over and over in the huge pool known as the Neutral Buoyancy Laboratory until he or she can perform the task flawlessly. I also know now how an astronaut prepares for each EVA by prebreathing oxygen for a specified period of time to help prevent decompression sickness. And I know now how astronauts go to the bathroom, bathe, and cut their hair in space!

The nurses don't have any involvement in development of systems and products for personal hygiene on orbit -- we just hear how it's done. There are toilet simulators here on site where the astronauts go to get trained on how to go to the bathroom in zero gravity (hint: it involves vacuum!)

Question: What is a typical day like in the clinic? Who do you see?

Belle Wallace, RN: NASA has 94 active astronauts and 42 astronauts in management. The clinic delivers primary outpatient care to these astronauts and their families. Additionally, we care for many of the former astronauts. It is a small clinic that averages 250 monthly visits. We provide very personal care. Some of the nurses have been working with these astronauts for many years and watched their children grow up and really know each one by name. The first week of my employment, I met 1 of the original 7 Mercury astronauts and an astronaut who had walked on the moon. I was amazed and thrilled with how friendly and open they are. The experience was unforgettable!

Carole Porcher, RN: A typical day in Flight Medicine Clinic (Figure 1) is very similar to any ambulatory care clinic setting, except for the patients seen. Patients are American and "international partner" astronauts, their families, NASA pilots, NASA flight engineers, and military pilots working at the JSC. A lot of our time is spent performing very comprehensive annual qualifying physical exams. It really becomes fun when we are preparing for a shuttle mission or a Soyuz mission to the International Space Station, and when we are involved in the selection of new astronauts.

Johnson Space Center Flight Medicine Clinic.

We work mostly with flight surgeons who are certified in aerospace medicine, but also with our family clinic physician who specializes in internal medicine and pediatrics. In general, our patients are very healthy and very motivated to stay that way. In order to qualify to fly in space, each astronaut must maintain their health and fitness, so we have a very motivated group of patients!

Most of the astronauts are married and have children, so we also provide well-child care as well as care for sick children. Because of our relatively small patient population, we have the opportunity to get to know our patients very well, and we feel that every baby born is part of our immediate family. We very rarely have emergencies in our clinic, but when we do, we are assisted by the staff at the JSC Occupational Medicine Clinic, who stabilize the patient for transport to a local emergency room.

Question: What are the stresses involved in your position? Could you describe a rewarding or harrowing moment you have experienced?

Carole Porcher, RN: My most rewarding and harrowing moments as a NASA nurse occurred on and after February 1, 2003, when we lost Columbia and her crew. Despite the nightmare of having to go about our business feeling the profound sadness and shock, the emotional bonds that developed between staff members and between staff and patients were incredible. Despite the gallons of tears being shed, we helped each other get through those first terrible days and weeks. We did our best to support our astronauts who were out in the field working alongside the people searching for debris. We did our best to keep the grieving families well while they endured the multiple memorial services and subsequent funerals.

Question: Do you have any suggestions for readers who may be interested in a position with NASA?

Carole Porcher, RN: Let me tell you how I got involved with NASA. I had been working in inpatient psychiatry for my entire career and was ready for a change. A friend, my recruiter when I'd joined the navy reserves, called me and asked if I would be interested in interviewing for the position that she was vacating. I was a little skeptical at first because it would be such a major change for me. Basically, my years of management experience, my master's degree, and my exposure to military medicine definitely helped me to land my current position. I knew that leaving a management position in a hospital and going into a clinic situation would mean a reduction in salary, but my excitement at getting into the aerospace environment made me willing to make the sacrifice.

Most of the nursing positions at NASA sites are in the occupational medicine area, so experience in occupational medicine, and certification in occupational health nursing is advantageous for a nursing position at NASA. At the Kennedy Space Center, there are nurses on board the crew transport vehicle that transports the shuttle crew from the orbiter to the receiving facility after landing. These nurses assist the crew surgeons in assessing the condition of the crew and providing any care that might be necessary. Space flight, including launch, zero gravity, and re-entry, places a great deal of stress on the body that warrants close monitoring of the astronaut in the immediate period following return to earth. Experience in acute care and/or the emergency room is essential for these positions. There are also nurses in other positions throughout NASA, including astronaut family support and research. Most of the nurses working at NASA, including myself, are employed through contractors.

I believe it is a great privilege to serve our flight surgeons and our astronaut family at Johnson Space Center and could not be more satisfied with my job!

Carole Porcher, RN, a native Texan, worked in the mental health field for 32 years before coming to the Johnson Space Center's Flight Medicine Clinic in 2002. Currently, she is the Chief Nurse in the Flight Medicine Clinic. Belle Wallace is the process improvement coordinator for the Flight Medicine Clinic at the Johnson Space Center.

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