What Does It Take to Be a Doctor and an Astronaut?

The "what I wanna be when I grow up" dream checklist:

• Rock star

• Secret agent

• Pro athlete

• Astronaut

(And perhaps more recently "social media influencer," but I digress.)

Nicolas Nelson, an MD candidate (MS4) at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania, always leaned in the astronaut direction.

He grew up in Southern California and often went camping with his family in the Mojave Desert, where the night sky was darker and the stars shone brighter. Nelson remembers looking up and listening as his grandfather talked to him about the vastness of space.

"That's what hooked me into wanting to be a doctor in the first place — thinking how tiny our lives are and wanting to help people live their best lives," he recalls.

And while "doctor" may also be on a lot of kids' career wish lists, what kind of educational, motivational, and talent mix does one have to muster to become an MD and an astronaut?

It starts with something like this:

As Nelson pursued a path to become a radiation oncologist, he never stopped looking up at the stars. He came across the book Space Physiology and Medicine and was intrigued by the idea that he could potentially merge his two interests.

He reached out via email to one of the book's authors, Arnauld Nicogossian, who pointed Nelson in the direction of the Aerospace Medicine Association, the leading professional organization for those working in the fields of aerospace medicine and human performance.

"That's when I realized that aerospace medicine is a legitimate discipline," Nelson says.

A Specialty With a Colorful History

"Aerospace medicine is a small field, but in fact it's been around since the 1950s," explains Natacha Chough, MD, MPH.

Chough is a flight surgeon at NASA's Johnson Space Center, though "the term 'flight surgeon' is a total misnomer," she says, "just like the Surgeon General of the US is not an actual surgeon nor a general."

Chough is a ground physician who cares for astronauts before, during, and after their spaceflights. She likens her position to being a member of a group of doctors assigned to a professional sports team. NASA has around 30 flight surgeons, she says, and two are usually assigned to each mission — a primary and a deputy.

Most flight surgeons never leave the planet. Chough has completed four missions and has been assigned a fifth. "There's no requirement for a doctor to be in space," she says. "We train astronauts to be an extension of us in space."

This includes teaching them how to draw blood, put in stitches, start IVs, and perform CPR in zero gravity.

From the ground, Chough monitors the astronauts' schedule to ensure an appropriate work-life balance to avoid fatigue and burnout, which can be particularly dangerous in an inhospitable environment like space. She also has a standing telemedicine appointment each week with the astronauts and sits in mission control, particularly when a spacewalk is scheduled.

"That's a really high-stakes day for the entire ground control team," she says, "but particularly for us, because going outside into the vacuum of space is the most dangerous thing we ask astronauts to do."

Become a Physician on a Mission

As she entered college, Chough already knew she wanted to work at NASA and planned on becoming an aerospace engineer. But after an unpleasant encounter with calculus, she switched her major to biology.

"I didn't know how that was going to get me to NASA, but I'd figure it out," she recalls.

Chough attended a NASA summer internship on life sciences and discovered that they also hired physicians. After serving in the Peace Corps as a health educator, she went to medical school.

Knowing she would need a strong, broad foundation in order to pursue aerospace medicine, Chough specialized in emergency medicine (this is a common thread, as you'll see). After completing her residency at Stanford, she enrolled in the University of Texas Medical Branch Aerospace Medicine program in Galveston, Texas — an additional 2-year residency.

"During that training, I was like, 'I can't believe I'm getting paid to do this,'" she says. Physicians in the program get a lot of the same training that astronauts do, including parabolic flight training (simulated zero G in the vaunted "vomit comet"), which Chough describes as being "like Christmas Day."

That's not to say that Chough wants to be an astronaut. "I would love to go into space," she says, "but I don't think I could tolerate a lot of what astronauts do, mostly because 90% of their career is not in space. They're on the ground, in training, going to Capitol Hill asking for money, and answering questions from third graders about whether they've seen aliens." (Spoiler alert: They haven't.)

But What if an MD Did Want to Go to Space?

Haig Aintablian, MD, is an emergency medicine physician and the inaugural fellow to the UCLA Space Medicine program — the first of its kind, preparing a new generation of flight surgeons for trips to outer space.

Aintablian sees demand for space medicine expanding, and soon. "It's a really exciting time to be alive," he says. "The way things are going with space tourism — the fact that we're now sending regular people and not only superhumans into space — you're going to need direct medical support more so than just telemedicine."

The space medicine fellowship at UCLA is a 2-year program that Aintablian has helped develop with Jo Feldman, MD, and others in the field. The goal is to train physicians to not only sit in mission control, but also potentially provide medical care in space during long-duration missions, like travel to Mars.

Aintablian is the Doogie Howser of space medicine. He started college at 15 years old and quickly earned his bachelor's in biological sciences and his master of science degree in molecular genetics and biochemistry from the University of Southern California. His published research ranges from the mechanisms of viral replication to astronaut-associated pathologies. In 2020, Aintablian was honored with the national "Resident of the Year" award by the American Academy of Emergency Medicine.

His interest in space medicine echoes that of others: He was always looking up. "My dad and I would look up into the sky with a telescope he bought me when I was very young. Ever since then, it's been a passion," he says.

Aintablian, now 31, pursued emergency medicine because he knew it would prepare him for space medicine.

"I'm at my peak when the sh-t hits the fan, so to speak," he says. "You have to be MacGyver-oriented, because it really is true life-or-death situations you're dealing with, and with the whole world watching."

Aintablian describes the ideal physician for the program as someone who "can act like a Swiss Army knife. Someone you'd want to have with you during a zombie apocalypse."

Winning the Spacewalking Lottery

Kjell Lindgren, MD, has been to space and walked in space. Twice.

He wanted to be an astronaut ever since 1981 when his second-grade teacher wheeled a television into the classroom to watch the launch of the first space shuttle, Columbia.

Most early astronauts began as test pilots, and because Lindgren's father was in the Air Force, he decided he would train at the Air Force Academy in astronautical engineering. Once at the Academy, Lindgren had a reality check about becoming an astronaut.

Like Chough, an aversion to calculus pushed Lindgren toward a pre-med degree in biology. He earned a post-graduate opportunity to attend Colorado State University to study cardiovascular physiology, specifically as it relates to microgravity, and worked at the Space Physiology Laboratory at NASA Ames Research Center, which no longer exists.

"That was a dream come true," he says. "Not only because I got to pursue this area of interest, but I also got to work with NASA in a NASA laboratory."

The fire was lit. Lindgren separated from the Air Force and went to medical school at the University of Colorado, and completed a residency in emergency medicine in Minneapolis and a second residency in aerospace medicine at the University of Texas Medical Branch.

In 2007, Lindgren was hired as a NASA flight surgeon at Johnson Space Center, and 2 years later was selected as one of nine members of the 20th NASA astronaut class.

"Getting to realize this dream of becoming an astronaut feels a little bit like winning the lottery," he says.

Lindgren explains that the 2-year Astronaut Candidate Training Program comprises five core components that read like that little kid's wish list:

• Learning space station systems

• Using the robotic arm to move crew members around outside the space station

• Flying in the T-38 Talon trainer jet

• Becoming proficient in Russian

• Training to space-walk in the Neutral Buoyancy Laboratory's 6-million-gallon pool

In July 2015, Lindgren was aboard a Soyuz TMA-17M set for the International Space Station where he'd log 141 days in space. Once in orbit, looking back at Earth, Lindgren experienced what is commonly known to astronauts as "the overview effect," a cognitive shift and "state of awe" that occurs when seeing the Earth from space.

"When you look out the window, it reinforces whatever your belief systems are," Lindgren says. "I know a lot of people feel sadness or separation. For me, I just felt a sense of peace." He describes Earth as being a combination of breathtaking colors — a blue, white, brown, and green sphere that supports and contains everything that we know and love.

"You can see the changes that humanity has had on Earth," Lindgren explains. "You can see cities; you can see agriculture — and much of this is good. But you can also see deforestation, drought, and pollution, and it really reinforces the idea that this is all we've got, and we've got to do a better job of taking care of it."

Lindgren flew his first space mission as if it would be his only one. But in the summer of 2022, he was given a second once-in-a-lifetime opportunity as mission commander of NASA SpaceX Crew-4. He spent 170 days in space, returning to Earth in early October 2022.

While Lindgren always hopes that there might be the possibility of a third mission, today he's more focused on helping others have those extraordinary opportunities. By blazing a path for the growing number of physicians specializing in space medicine, he sees a way not only to support astronauts, but also to help preserve life on Earth — and beyond.

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