"What it's like to help select a new crop of astronauts"/ "What it's like to an emergency physician who's had enough"

This blog post is about careers as an astronaut and an ER physician:

Jun. 1, 2017 "What it's like to help select a new crop of astronauts": Today I found this article by Walter Sipes in the Globe and Mail:

Two broad groups apply to be astronauts: There are the early dreamers, who peer into space and think, ‘Wow, that’s so amazing.’ The other group are the late-deciders, who are plugging along … they might have been in the military, or a physician, and they decide to apply on a whim. One is no better than the other.

Twenty-five years ago, I was asked by NASA to be part of the team of clinical psychologists who assist with astronaut selection. I was also recently in Toronto to help the Canadian Space Agency interview 17 semi-finalists to be Canada’s two new astronauts.

We tag team with psychiatrists. The interview is usually about four hours. In that time, you get a pretty good idea of what a person is like. Some can put on a show for a while, but after a few hours, their true personality comes through.

Psychiatrists follow the medical standard, and evaluate everything from how they’ve coped with trauma, a death in the family, stress, or depression. And if they are on – or have been on – medication or have been hospitalized. 

The medical selection team scrutinizes their medical records. We have to prepare them mentally and physically, because in space, they lose bone mass. Calcium leaches out of their bones. They lose muscle mass. There’s equalized pressure through their whole body which creates fluid in the head, which swells. 

The latest thing we’ve noticed is there is some physiological changes in the shape of the eyeball. Astronauts have acuity change so their vision might go from 20/20 to 20/100ths. It’s due to microgravity.

Psychologists have their own interview book. We look at competencies. 

What kind of team player is this applicant? 

What are your worst teammate skills? 

We ask that to see if they understand themselves and if they’re aware of what they’re like.

 We want to know about the times you were a leader in something. But we all want to know if they’re good followers. If they can take direction. 

We also want to know what life-threatening events have occurred in their lives, and how they’ve reacted to it. We look for resiliency and empathy.

Once they’re hired, astronauts might not see a mission for 10 years, but the strain on the families while they’re training – being in and out of the home every other month – is typically harder to deal with than a six-month mission in space.

While on their mission, we have psychological conferences every two weeks. We ask how they’re sleeping, how the work load is, how the crew is interacting. Of course, there are disagreements in space, but they go through intensive conflict-resolution training, and it’s not typically a big issue. 

If you’re one of six people in a small lifeboat going around the earth, you pretty much work together because you depend on each other for survival and a successful mission. 

More often, the arguments occur with space agencies on the ground. I had an astronaut who was told to open up a panel and adjust switches three times. Each time, they questioned if he was doing it the right way. Finally, he filmed himself. The ground said: “Oh, something else must be wrong, then.” It’s those tensions that are more often front and centre.

We’ve had astronauts who have had a death in the family on Earth. We learned an important lesson from the Russians, who didn’t tell their cosmonaut right away. He was angry. Now, protocol is to let them know immediately, and we will set up taping – something to show at the funeral.

Because it’s such a high-pressure job, we also want people who are motivated and serious, but who can laugh at themselves. We have a guitar permanently on the space station, and we’ve sent flutes, and a keyboard (it had to be rigorously tested because if plastic burns it gives off poisonous gases). 

We’ve also sent up a didgeridoo, a wind instrument played by Indigenous Australians. 

Sometimes to lighten things up, astronauts play tricks on the ground people. One time, the cameras came on, and there was no one in the space station. They had Photoshopped themselves outside, peering into the space station. 

These are extremely bright, driven and competent people. But we also want normal. People who use humour in a productive way.

You might have come in a fighter pilot, a heralded physician or an acclaimed academic who ran a department. 

Now, you’re a baby astronaut, and you have to learn to be humble. We are not looking for perfect people. We are looking for human beings to fly in space and get along.

As told to Gayle MacDonald. This interview has been edited and condensed.

Walter Sipes is a former army helicopter pilot, who flew in Vietnam. He is a clinical psychologist who consults with NASA and the Canadian Space Agency, and backup support for Canadian astronaut Chris Hadfield. He is based in Tucson.

https://www.theglobeandmail.com/life/relationships/what-its-like-to-help-select-a-new-crop-of-astronauts/article35043698/

Jun. 2, 2017 "What it's like to an emergency physician who's had enough":  Today I found this article in the Globe and Mail.  This is a really good article about how being a doctor or nurse without a lot of money and resources is hard:  

When I first started [as an emergency physician] 20 years ago, if one or two patients were in the department for over 24 hours, that would really have caught our attention. We’d be like, “What’s going on?” Now, there are 30, sometimes more.

I think there’s a misunderstanding about what the problem with overcrowding is. As a country, we are high users of emergency departments. However, the sore throats and ankles are not a problem for us to deal with. They don’t occupy beds for a long time. It’s the admitted patients who get parked in emerg who are the big problem.

We’re a department of 38 beds and we often have up to 30 admitted patients. We see a volume of about 170 a day, which means we are trying to see 170 people in eight beds. So, we are doing a lot of hallway and make-do medicine.

Overcrowding causes real morbidity and mortality and there’s an incredible toll on the staff trying to deal with it.

I saw an elderly man who had a severe infection and ended up in the ICU. I realized that he had been in the waiting room the day before and left after five hours without being seen by a physician.

 I read the nurse’s notes from the evening before and he had symptoms of a urinary tract infection. I felt so bad because if he had just been given an antibiotic then, he might have been fine. 

The people who leave our waiting room are sometimes the sick older patients who need to be seen, but who feel too unwell to stay.

Another 70-year-old man fell down the stairs. He waited, I think, four hours and then left. He came back the next day and had a fracture of his foot that needed surgery and a wrist fracture. He had walked around on the foot fracture for 24 hours. I guess it’s not the end of the world, but you don’t feel good about that.

I could tell you about deaths, too – people who deteriorate while sitting in the waiting room or who leave without being seen and then come in having suffered a cardiac arrest.

Overcrowding makes us cut corners. Such as not doing a rectal examination or a pelvic exam, or not taking a sexual history because there is no private space. Whispering to a 14-year-old patient, “Are you sexually active?” because you are in the hall.

I cared for a girl who likely had appendicitis, but there was no bed to examine her in. So I found a Geri chair in the hall and put her in that. We had just let someone with kidney stones who was in that chair go. 

We were so crowded that we had run out of IV poles. The nurse had taped the IV bag for the previous patient to the wall. When he left, no one stopped the IV, so there was a puddle of water on the floor.

Her mom asked if I could examine her in a private area. I said I would like to but I just didn’t have beds. I said I wouldn’t lift her shirt. So I did a subpar exam. Her mom, who was very reasonable, looked at the IV bag, the puddle and the crowded hallway and said, “This is like third-world medicine!”

The lack of resources in the community is a real problem. People are parked in our department for literally days because no one wants to admit them and they can’t go home without help.

 Like someone with a stable pelvic fracture who, with a bit of help, could probably manage at home. That’s a daily occurrence.

I feel guilty that I am part of a system that does this to people. Patients are angry – and rightly so. I can think of umpteen dozens of patients where I just feel as if I am constantly apologizing. Personally, it’s taken an emotional toll.

I’ve even given up apologizing. I just agree with patients that this isn’t good care and ask them to complain to others because I am not having any luck.

We lost a lot of our good, experienced nurses a few years ago. It’s really hard on them.

Sometimes I wonder why they stick around. One of our nurses came back after six months. 

She said she missed the camaraderie and the team work. Despite it all, we have good people and we work closely as a team. That’s the fun part.

The saving grace is the people I work with. I love them. On bad days, it gets me through.

Karen Graham is an assistant professor at Queen’s University and has been an emergency-room doctor for 29 years.

This story, as told to Andreas Laupacis, first appeared in Healthy Debate, an online publication guided by health care professionals and patients that covers health policy and evidence-based medicine in Canada.

https://www.theglobeandmail.com/life/health-and-fitness/health/what-its-like-to-be-an-emergency-physician-whos-had-enough/article35014805/


There are 57 comments as of now.  Here are a few:

drsfreud

16 days ago

The first step is to admit we have a massive problem. Our healthcare system is NOT the best in the world as we have been told. These are the first symptoms of the babyboomer tsunami that will hit us. It is only going to get worse.

18 Reactions

99Bandit

15 days ago

In reply to:

The first step is to admit we have a massive problem. Our healthcare system is NOT the best in the world as we have been told. These are the first symptoms of the babyboomer tsunami that will hit...

— drsfreud

Let me be the first to say it, the more people we allow into Canada, the worse the problem will be. The baby boomers are only a small part of the problem, I suggest you spend some time in an ER

18 Reactions

BrianTesla

14 days ago

No worries! It's all free anyways!

3 Reaction