Excerpted from An Astronaut’s Guide to Life on Earth
Nothing focuses your mind quite like flying a jet. That’s one reason NASA requires that astronauts fly T-38s: it forces us to concentrate and prioritize in some of the same ways we need to in a rocket ship. Although simulators are great for building step-by-step knowledge of a procedure, the worst thing that can happen in a sim is that you get a bad grade on your performance. In a T-38, an old training plane that’s fast but short on fuel and not all that responsive, you have to operate complex, unforgiving systems in a dynamic environment. You’re constantly forced to make judgment calls, like whether to turn back or push on when you’re low on fuel or a storm is coming or there’s something wrong with the plane. Making life or death calls, without hesitation, is a perishable skill; flying T-38s ensures we maintain it.
Even during an uneventful flight, it’s crucial that you’re focused and ready to work any problem that arises. When you’re 150 feet off the ground and moving at 400 knots, which is common for fighter and test pilots, you have to concentrate on what’s directly in front of you. If you don’t, you’ll die. That kind of intense focus is less about what you include than what you ignore. And by ignore, I mean completely block out; the argument with your boss, your financial worries—gone. If it doesn’t matter for the next 30 seconds, then it doesn’t exist. There is only one essential question: What’s the next thing that could kill me?
“Boldface” is a pilot term, a magic word to describe the procedures that could, in a crisis, save your life. We say that “boldface is written in blood” because often it’s created in response to an accident investigation. It highlights the series of steps that should have been taken to avoid a fatal crash, but weren’t.
Working as a test pilot reinforced my ability to focus on the essentials even in the midst of chaos. It didn’t occur to me, though, that the place where I’d really need to put those lessons into practice was on the ground.
If I hadn’t understood how to focus and work a problem, I would not have got to space a third time. As it was, I just barely made it.
In 1990, when I was a test pilot at Pax River, Md., I went back to Stag Island, Ont., with my family for a holiday. My parents threw a big party, the kind of event where people mill around playing guitar and drinking whisky and eating their weight in corn and hot dogs. That night I woke up with gut pain. Any time I ate a lot I tended to pay for it, but this was different. I was in agony, and when the morning came I headed to Sarnia General Hospital. They put me on morphine, at which point I began hallucinating vividly about roller coasters and spiders, and the doctors began talking about exploratory surgery.
Alarmed, [my wife] Helene got Charlie Monk, a physician and friend from Stag Island, involved. She explained to him that if I wasn’t back at Pax River in a few weeks as scheduled, healthy and fit, I could lose my flight medical. A military pilot’s career depends on medical clearance to fly; lose that, and you’re toast. Abdominal surgery is particularly problematic: if you’re in a fighter jet pulling G, the added load on your abdomen could rip the stitches open right there in the cockpit. Charlie explained this to the doctors, but after three days, they decided surgery was the only option.
After opening me up, they did find the problem: a single strand of scar tissue, formed after my appendix was removed when I was 11 years old, had bridged onto my intestine and, like a drawstring, was pulling it closed. The surgeon snipped that strand and sewed me back up, leaving an eight-inch scar across my belly. Still, I felt just fine. When we got back to Maryland, the U.S. Navy doctors cleared me to fly. A month after being released from the hospital, I was back in an F-18.
Over the next two decades, my most serious health problem was a head cold. I passed the physicals for my shuttle flights, no problem, and in 2001 I passed the most stringent medical exam in the world and was certified to go on the ISS. Then in the late fall of 2009, the crew for Expedition 35 was selected and I was told I’d be commander. It was something I’d been working toward my whole adult life, and I was both proud to get the assignment and humbled by it.
A crew is trained to look after everything on board, from the potable-water dispenser to all systems in the Japanese module, but there are varying degrees of expertise. By October 2011, I was a specialist in almost every ISS system, experiment and module. I’d been training hard for two years, regularly working nights and weekends, and spending 70 per cent of my time either in Russia or elsewhere on the road. I was happy to be back in Houston with Helene for a few weeks, only my stomach didn’t feel quite right. She was recovering from the flu, so I figured I’d caught it too but decided to go to the NASA clinic, just in case. The doctor there didn’t think my problem was the flu. He sent me to the hospital, suspecting an intestinal obstruction. An MRI confirmed it.
This was not good news, although sometimes a blockage will clear on its own. But it was one of those hospital stays where everything that could go wrong, did: after three days, when I was much sicker than I had been when I was admitted, the surgeon assigned to my case announced that he’d be operating on me the next day. He wanted to do what the surgeon in Sarnia had done back in 1990: make a big incision in my abdomen, open me up and see what the problem was.
Given what I’d just been through there, the prospect of having an operation at that hospital didn’t appeal to me. Furthermore, I knew that if the surgeon operated the conventional way, with scalpel and large incision, I would not be going to the ISS in 2012. I would be medically disqualified. But I might still have a shot if I could get a minimally invasive laparoscopic procedure. We had 24 hours to work the problem and I was, by this point, really feeling ill. Helene got on the phone and in short order I was moved to another hospital. I was soon scheduled for laparoscopic surgery with Dr. Patrick Reardon, who’d treated Barbara Bush.
He made two very small incisions in my abdomen and, using flexible snake-like devices just three millimeters wide, quickly located the problem: the surgery back in 1990 had created a four-centimetre adhesion—a glob of sticky scar tissue, basically. The vast majority of abdominal operations result in adhesions. This adhesion, likely inflamed by the flu virus, was essentially gluing my intestines to my abdominal wall. When Dr. Reardon released the adhesion, everything sprang back into its proper place. He told me I should have no further trouble.
I knew this wasn’t accurate, though. Now there was a whole new problem to work: convincing the powers that be that I was healthy enough to go to space. If I had a recurrence in space, our mission would be cut short and we’d have to fly home early. Another crew would have to launch earlier than planned. The cost would be astronomical.
Before I could persuade anyone else I was fit to fly, I first had to convince myself. I needed to find out what the risk of a recurrence really was, so Helene and I started researching and talking to doctors. In the meantime, I was cleared to go back to training—but I wasn’t cleared for space flight. Every country that funds the ISS would have to sign off on that.
Over the next two months, a panel of experts—surgeons, military doctors, authorities on the medical aspects of space flight—considered the issue in order to make a recommendation to the Multilateral Space Medicine Board (MSMB), which includes representatives from the U.S., Canada, Europe, Japan and Russia. In order to decide whether I was a good statistical risk or not, they needed statistics. So a medical doctor was hired to review the research. As it turned out, most of the studies had been conducted before laparoscopic surgery was common; many of them lumped together people who’d had minor procedures like mine with people who’d had really serious problems like massive internal trauma after car accidents or operations to remove tumours. And these studies did show that the risk of a future problem was unacceptably high: 75 per cent.
I’m no medical expert, but common sense told me that that data had little bearing on my situation. Dr. Reardon had told the MSMB that the risk of me having another intestinal obstruction while I was on Station as just one-tenth of one per cent. The chances that we’d have to evacuate the ISS to get me home were, in other words, significantly lower than the chances that an astronaut would have to be evacuated for a tooth abscess.
I felt it was important to put even that very minimal risk in context; going to space is inherently dangerous, and activities such as spacewalks compound the danger. Seen in that light, the risk of a recurrence was inconsequential. I made my case directly to the two Canadians who served on the MSMB, presenting as much information about laparoscopic procedures. When the members of that international panel convened in November 2011, their ruling was unanimous: they cleared me for space flight.
Phew. All’s well that ends well. Only, it wasn’t really over. Two months later, I learned that some doctors at NASA hadn’t been satisfied, and had gone to their Canadian counterparts asking for more proof. So, unbeknownst to me, a new panel of four laparoscopic surgeons had been asked to consider whether it would be a good idea to have what they kept calling “a quick look inside”—in other words, to perform exploratory surgery to see whether I really was okay or not.
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.
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 non-existent.
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. The rate of recurrence? Zero. Plus, like any surgery, the procedure would introduce significant new risks. 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. 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 was, “No one.” Like Suni, I was left-seat qualified for a brand-new spaceship, the Soyuz 700 series, which is digital rather than analog 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. He couldn’t possibly get qualified by July. In order to swap in someone who was qualified, as the chief astronaut at Johnson Space Center pointed out, five crews would be affected, so there would be a significant ongoing safety risk to the entire program.
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 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. The CSA kept telling me to relax and not to 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.
And then, at the 11th hour, just days before a March meeting where NASA would decide once and for all, someone on the MSMB volunteered a solution: an ultrasound. 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.” 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 per cent rate of false positives.
When the day came, Helene and I were both resigned during the 45-minute drive to the hospital. We had fought the good fight. 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 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. 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. 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. 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 turned the monitor so that I could watch, too. 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? So, my eyes glued to the monitor, I started breathing more shallowly, tensing and relaxing my stomach muscles, actively willing my insides to slide.
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. Another doctor came in and verified it, and 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. But there wasn’t time to celebrate the victory. I had work to do.
I was going to space, after all.
Excerpted from An Astronaut’s Guide to Life on Earth, on sale Oct. 29. Copyright © 2013 Chris Hadfield. Published by Random House Canada, a division of Random House of Canada Limited. Reproduced by arrangement with the publisher. All rights reserved.