Oncology, Etc. — Out of this World: Astronaut Physicians (Part 2)

In the second of our two-part interview, Oncology, Etc. hosts Drs. Patrick Loehrer (Indiana University) and David Johnson (University of Texas) continue their conversation with two physician astronauts. Hear the incredible stories of Drs. Robert L. Satcher (MD Anderson), Ellen Baker (MD Anderson), and their lives on and off this planet. If you liked this episode, please subscribe. Learn more at education.asco.org, or email us at [email protected].   TRANSCRIPT David Johnson (Dave): I'm Dave Johnson at UT Southwestern Medical Center in Dallas, Texas. I'm here with Pat Loehrer, my good friend who also happens to be the Director of Global oncology and Health Equity at Indiana University. Welcome back to Oncology, Etc. And part two of our conversation with Dr. Ellen Baker and Dr. Robert Satcher. Dr. Baker and Satcher are former NASA astronauts now practicing in Indiana Cancer Center in Houston. In Episode One, we learned about their time at NASA and some of their spaceflight adventures. In this episode, we will learn more about their post-NASA activities. We will rejoin the conversation with Pat asking Dr. Baker, how her work in space informed what she does now. Patrick Loehrer (Pat): I know Ellen, you do work with Project ECHO, which is doing work globally. Tell us a little bit about that if you could. Ellen Baker: You know NASA seems a million lenses away now. I sort of vaguely remember my flights which were a long time ago, more than 25 years now, but seems like yesterday. But you learn a set of skills that are transferable, I think. You come into NASA with some skills that are transferable and you leave with those. We did a lot of work with international partners, particularly in the 90s with the Russians. And I now do a lot of work with international colleagues, particularly in Africa, Central, and South America. I think that's one of my transferable skills, perhaps from NASA. And I don't know, Bobby, it's thinking on your feet and being adaptable and not getting flustered and compartmentalizing, and quite honestly, a lot of those are skills I think you develop in medicine as well. So, there are a lot of similarities and I think a lot of benefits flow in both directions. Dave: Could you elaborate a little bit on Project ECHO that you're involved in? What sorts of things are you doing with Project Echo? Ellen Baker: Project ECHO is very simple, it's a video conference where you connect specialists generally at academic institutions with medical providers in rural and underserved communities where perhaps specialists are not available. And the intent is to meet on a regular basis and provide assistance and support and patient care. So, providers in isolated or rural communities or underserved communities can care for their patients locally and patients then don't have to be referred to a tertiary care center, often very far away at great cost, etc. It was designed by a gastroenterologist at The University of New Mexico, Sanjeev Arora, who started the ECHO program, it stands for “Extension for Community Health Care Outcomes. In New Mexico, it was at a university in Albuquerque, there were maybe 30,000 patients around New Mexico who had hepatitis C, and were not being treated except perhaps in his clinic. And he partnered with about 21 providers in the community around the state and gave them the support they needed to be able to provide care for patients with hepatitis C, locally. This was back when the treatment was quite toxic. A lot of primary care providers didn't feel comfortable delivering this sort of care. That was sort of the beginning of ECHO, and it's since been applied to many different disciplines. At MD Anderson, we have, I don't know, I think maybe 13 Different ECHO programs for cancer prevention. That would be cervical cancer prevention, tobacco treatment, melanoma detection, also for treatment, primarily with partners who are international. We worked a lot with partners in Mozambique for the treatment of chronological cancers, breast cancers, and hematologic cancers, survivorship, palliative care, and even health care policy. So, that's sort of the ECHO in a nutshell, and we use it quite a bit at MD Anderson, but we're just one of the hundreds of different institutions that use the ECHO model for this. Pat: What I get from you, Ellen, though, is a sense of telemedicine and teamwork and collaboration, which is a lesson that you have to have, I think, as an astronaut to be able to do that. And Dr. Satcher, your extent and your thoughts now, how has that experience as an astronaut informed your current work? Robert Satcher: A lot of the skills are transferable. You come in with skills like medical training that you use and build upon when you become an astronaut. And then once you leave If you come back to the medical profession, there are a lot of skills that transferred to that field too. I see what I do is surgery, it's sort of an activity, which has a beginning and an end similar to spaceflight. And operationally, a lot of the skills that we learned as astronauts actually do transfer very well to doing surgeries. Now, one of the things that were more recently brought over is just the whole idea of a pre-brief and a debrief, which we do for surgeries now and that wasn't the case when I was training back in medical school. So, it’s sort of a recent adaptation. But while I was at NASA, I would often think about that. Now, this actually would work really well, when doing surgeries, because it would help improve the process and actually make sure that you're making the best use of resources, people, etc, which they do a very good job of training you as an astronaut. The telemedicine aspect of being an astronaut and taking care of people that way, we finally are doing that at MD Anderson, reluctant adapters in the cancer world to using technology sometimes like that, although in the ER, we use a lot of technology, I think there's still this notion that there needs to be a real face to face connection between doctor and patient, very strongly rooted in the cancer world, for obvious reasons, in the past, being diagnosed with cancer, and certain types of cancer, certainly, was just amounted to a death sentence, because there weren't good ways of taking care of people. But now with advances and what we've been able to do, the outlook for cancer patients is much better now than it's ever been and continuously improving. And the pandemic is really the thing that forced this change in the cancer world and I was actually part of the effort introducing video visits at MD Anderson, which is part of something that it's going to be doing moving forward. Fortunately, the advantages of it are kind of obvious. You don't have to come into the institution for everything. It basically allows continuity of care and it potentially allows you to reach more people. That's something that makes cancer care more equitable, which is something that needs to happen similar to how becoming an astronaut needed to be more equitable. So, a lot of these kinds of things do carry over. The other aspect of training at NASA, which I think I can relate a lot to, was actually when I did the spacewalks and being focused on getting some specific tasks done. It felt the most like doing surgery and we were actually doing some repairs on the robotic arm because it was very technical, using these specialized instruments and having to be very careful. Dave: How do you keep from spinning off in space by using one of those ratchet tools? Like they put tires on NASA? Do you have to use something like that? Robert Satcher: Well, they thought of all of these things, of course. You have all of the foot restraints, other ways of stabilizing yourself. The foot restraint is one of the main ways you also have a restraint that's sort of like a, how do you describe it, it's like… Pat: A tether? Robert Satcher: There's the tether to keep you from floating away. But it's a restraint that's mounted on your belt, essentially. And it’s sort of a screw mechanism that makes it flexible, then you can attach it to a rail or whatnot. And then you rigidize it by screwing in the opposite direction, which is a very clever device but it helps you to keep from spinning as you say. Dave: So, both of you have really gotten into global health in your own separate ways, I suppose. And maybe this seems obvious, but did your experiences looking back at Earth have any influence, or were you interested long before you began your NASA careers? Maybe we should start with Ellen. Ellen Baker: I think I was interested before my NASA career. I was actually one of the only members of my medical school class who did a rotation abroad, back when almost nobody did rotations abroad as a fourth-year med student, and I like to say, well, I kind of got distracted by this NASA thing. And after I finished with that, I came back to medicine and sort of rekindled my interest in global health. Dave: And Robert, what about you? Robert Satcher: Yeah, I did too. We traveled. When I was growing up, we spent six months in Uganda. That piqued my interest in traveling and then when I was in medical school, the rotation in Gabon as part of the Schweitzer fellowship, and then when I was in residency too, I did several trips and a couple of attendings in orthopedic surgery when I was doing these trips to South America. And that's when I did those, and, in fact, continued when I was a faculty member at Northwestern, doing some additional trips to under-resourced countries. So, that's been sort of my interest. Pat: Thank you for your work. It's incredible. We have a couple of questions. I wanted to talk for another couple of hours, but we weren't able to do that. Dave and I talked about books. What I do want to know from you is what is your favorite movie about space that you think is the most accurate one and maybe perhaps the best book or any other recent book that you've read? How about you first, Robie? Robert Satcher: I don’t get any answer for the book because I haven't read a lot of Space books, but for the movie. 2001 Stanley Kubrick. Dave: Absolutely. Robert Satcher: At the time, they did that really well. And that was before I became an astronaut. When I go back and look at it now. I still think, yeah, just very intelligent. Obviously, it's a very thrilling movie too. Pat: I'm not saying that I'm old, but I remember in high school and grade school reading 1984 as a futuristic novel, and 2001 came out as futuristic and now it just blows your way that it's 40 and 50 years ago, that happened. Ellen, how about you? Ellen Baker: I have to say there are a lot of space movies out there that I don't like. I'm not a fan of space movies, where there are vehicles exploding and getting lost, and I find it a little bit offensive when the laws of physics are ignored. So, I would say there are some really good documentaries out there. And the real thing, I think, is at least as exciting as Hollywood. So, there are a couple of really good documentaries that are actually current right now. And in terms of Hollywood, I would say the Martian was pretty good and it was a bit classic in the astronaut office. I think they did try to obey most of the laws of physics. And there were one or two folks in the astronaut office who we thought could definitely be the Martian. Pat: That's a great book. It has the best opening line of any book ever written, which I am not going to repeat here, but if you're curious about it, pick up the book and just read that first line there, it says it all. Dave: Another question, we'd like to ask our guests, and we'll start this time with you, Ellen. If you could speak to your younger self, knowing what you know today, what advice would you give yourself at the beginning of your medical career that you didn't know then but you know now? Ellen Baker: I think when you're 25, you think you have all the time in the world. And as I got older, there was so much more I wanted to do in medicine and perhaps I would have focused a little bit more, and I wasted a lot of time. I had a lot of fun. But what seems the older I get, the more I've got to cram into the time that I have left. And maybe that's just life, that would be it, I think. Dave: I think that's an important point. I often tell residents and my colleagues that you can lose a lot of things and regain them, but you can't lose time and regain it. So, use it wisely. Robert, what would you tell your younger self? Rober Satcher: I'd probably say there's no such thing really as perfection that that shouldn't be something that you obsess with. Over the years, I've learned that and I saw an article recently about a surgeon talking about good enough is good enough and the enemy of good is better. I think that has a lot of practical ramifications in terms of how one should wisely spend their time. So, I would emphasize that to my younger self. Dave: So, thank you for that. I think both bits of advice are very helpful. Well, that's really all the time we have for today. We could go on, I'm sure for several more hours. I want to thank both Dr. Baker and Dr. Satcher for their participation in an incredible conversation. I also want to thank our listeners for tuning in on Oncology, Etc. This is an ASCO educational podcast where we'll talk just about anything. If you have an idea for a topic or a guest, please send us an email at asco.org. Pat, before we sign off, do you know why an astronaut would be a good spokesperson for the COVID vaccine? Pat: No, I don't, Dave. Dave: Come on! You got to know that they like booster shots. Pat: That's good. Dave: Alright guys, thanks a lot.   Thank you for listening to the ASCO education podcast. To stay up to date with the latest episodes. 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