Baylor College of Medicine

How to Survive in Space: Engineering Human Spaceflight Exploration Medical Capabilities




[Intro melody].

Juan: And welcome to the Baylor College of Medicine Resonance podcast. I am one of your hosts, Juan Carlos Ramirez.

Eileen: And I'm Eileen Williams, another host.

Juan: And today, we're going to be talking about engineering, human spaceflight, exploration, and medical capabilities with Dr. Chris Lehnhardt. And in this episode, we will take an inside look at how Dr. Lehnhardt and his team of doctors, scientists, and engineers are preparing the next generation of astronauts to manage the health hazards of space travel to both moon and Mars, and possibly beyond. Dr. Lehnhardt will share his journey from his home of origin in Canada as an emergency medicine physician to spearheading the exploration medical capability efforts in the Lone Star State as a Baylor College of Medicine senior faculty member in the Department of Emergency Medicine and in the Center for Space Medicine, as well as his role as a lead scientist in exploration medical capability element of the NASA Human Research Program here at Houston's very own Johnson Space Center. Welcome to the episode.

Eileen: It's a pretty impressive list of qualifications and achievements. Dr. Lehnhardt--pretty amazing--he actually started out, received his Bachelor of Science in Biomedical Sciences from the University of Guelph in Guelph, Ontario, Canada in 1999 and his MD, followed by his residency in emergency medicine at the University of Western Ontario, Ontario in 2003 and 2008 respectively. He also completed the space studies program at the International Space University in Barcelona, Spain in 2008.

Juan: That's so cool. So, professor, Dr. Lehnhardt, has a lot of interesting skills and professional interests, of which include emergency medicine, as we mentioned before, extreme environmental medicine, aerospace medicine, wilderness medicine--he does teach in the wilderness medicine elective, Emergency Medical Services, and medical education.

Juan: The NASA human research program of, which he's a lead and an element scientist focuses on enhancing the health and performance of humans in spaceflight in preparation for an ultimate voyage to Mars.

Eileen: Which is crazy. I can imagine that involves a lot. The main five things that they focus on are International Space Station research and operations integration, space radiation, human health countermeasures, exploration medical capability, and human factors and behavioral performance. Seems like it covers a lot of ground there.

Juan: Yeah, lots--perhaps, lots of moving parts and something that I can only imagine is insanely complicated. I mean, medicine alone is already complicated.

Eileen: Yeah, definitely.

Juan: Yeah, when physics is a factor, you're just like, "oh my God."

Eileen: Yeah, I took the bare minimum of physics that I needed for medical school. So I am very impressed by people who are at that level. I think, I think it'll be really interesting to hear Dr. Lehnhardt talk about all of those things. And I know you also, you took one of his classes, is that right?

Juan: Yeah, I did. And just it's the human space exploration in medicine or some variation of that. But there are, you know, two electives and you take one which is pretty, pretty vague and a lot of old NASA scientists and Baylor faculty who also have a joint appointment at NASA. And also some physician astronauts, too, that just come to class and they share about, you know, their work and what they're doing, sort of cutting-edge research. And there's the second part, the second elective really dives in pretty, pretty detailed--and that's how I sort of came across Dr. Lehnhardt's work, a little more in depth. There is a Space Medicine Interest Group here at Baylor that kind of introduces people who aren't in the space medicine track, which--there is a space medicine track. It's just so interesting to see this other side of healthcare from a very outside the box perspective, you know, it's like "How do we solve problems with, you know, health problems here on Earth? Okay. Great. You know, those are challenging. Now, how do we do that in space with limited everything?" I can imagine how, you know that task being so--it's so demanding, you know, because essentially you're trying to create or come up with the Swiss army knife for, you know, for space travel. You know, how do you maximize, you know, efficiency and safety with so little?  

Eileen: There are so many challenges inherent in that--not to mention the fact that most of your astronauts are probably not also going to be physicians. So then you're dealing with limited space and limited personnel. I think it'll be really interesting to hear Dr. Lehnhardt talk about how to address some of these challenges and I know that he is a great teacher, so I'm excited to hear him explain some of these concepts for us.

Juan: Yeah, sort of give us an inside look at what it takes, really plan for these inherently complicated and dangerous things.

Eileen: We're really lucky here at Baylor to have these opportunities to get to work with doctors like Dr. Lehnhardt and to be right next to NASA and have this space medicine exploration track. I think it's a pretty unique opportunity.

Juan: Yeah. For sure. And for Baylor students and non Baylor, students, non-medical students, and just anyone interested in cool science and being on that leading end, I think you're really going to enjoy, as well as I am, right here about Dr. Lehnhardt work and how it can impact all of our lives in a very positive way, and inspire the next generation.

Eileen: Let's get started.

Juan: Cool. Let's go to the episode because we've talked too long already and let's talk to Dr. Lehnhardt.

[Interlude melody].

Juan: And we are here with the Baylor College of Medicine Resonance podcast and we are now joined by Dr. Lehnhardt. Please welcome Dr. Lehnhardt.

Dr. Lehnhardt: Thank you, pleasure to be here.

Eileen: Very glad to have you. I'm Eileen. I'm another one of the writers and producers for the Baylor College of Medicine podcast.

Juan: Yeah, and as we've mentioned in the roundtable, today we're going to discuss Dr. Lehnhardt's role in engineering human spaceflight exploration medical capabilities.

Juan: And if you are not a space nerd, like we are, and you haven't heard about all the cool things that the NASA is preparing to do, Dr. Lehnhardt's spearheading the element, NASA's human research program and he's here to share with us all about what he's doing. But if you haven't heard of Dr. Lehnhardt--could you take this time, Dr. Lehnhardt, to tell us a little bit about your background? What motivated you to pursue a career in medicine and human spaceflight?

Dr. Lehnhardt:  So it's a--it's a long story. So I will start at the beginning but I won't go too long. So if it's not evident yet from my accent, I'm originally from Canada. And as a small kid growing up in Canada, I had a passion for spaceflight. And I was really enamored by the space shuttle and all the different missions that NASA was doing and the Canadian Space Agency--there is a Canadian Space Agency and it's, it's kind of small compared to NASA, but they like to say that they punch above their weight. So they, they are very active in the space world. The Canadian Space Agency had astronauts and I always thought that would be really an amazing opportunity to be an astronaut and that was something that was a big interest to me, but I had no idea how to get there and how to even pursue it.

Dr. Lehnhardt:  So when I was a kid growing up, my favorite fields were in the biological sciences. And so I had thought about medicine and one of my guidance counselors at the time in high school said, "Why don't you look at the profiles of Canadian astronauts and see what they did? And then maybe you can do human spaceflight stuff." And one of the Canadian astronauts was a guy named Dave Williams and he was an emergency physician and I thought cool, I'll be an emergency physician and maybe I can go to space.

Dr. Lehnhardt:  So, my initial thoughts were not exactly well thought out, they weren't terribly mature, but they got me on the right path. And so I did all of my undergraduate training and medical training in Canada at the University of Guelph first, and then at the University of Western Ontario. And then I did an emergency medicine residency, which in Canada is a five-year residency and one of the opportunities I had during my residency was to spend some of my elective time focusing on an area that was of particular interest to me. And for so for me, that was space medicine, but to broaden it a little bit more, it was about the medicine of extreme environments and how we provide medical care in extreme environments. And so during my residency, I got to spend time learning about aviation medicine, about diving medicine, about military medicine, and about space medicine. And I just loved all of it. And so I eventually tried to steer my career towards "How do I become involved in the medicine of extreme environments?" And so I ended up here at Baylor as a faculty member in the Center for Space Medicine. And I now work at NASA as the element scientist, which is the lead scientist for exploration medical capability. And our job in exploration medical capability: we are a part of the NASA Human Research Program and we focus on the design of medical systems for space exploration. So now I get to take that passion that I've had about space and about medicine and space and I get to try and come up with the systems or help to come up with the systems that astronauts are going to use when we go to the moon and Mars to take care of each other.

Juan: It's a very compelling story and I think it's only the abbreviated version, but from sort of your spoken words and your passion and your background and career track, you seem to have pick up the picked up an impressive, an extensive list of accomplishments in the realm of extreme medicine, as you just highlighted, and space-related activities. But I think--is Physician Astronaut still on the--your professional bucket list? I--I'm guilty to ask, but I feel like there's a lot left in the tank of for Dr. Lehnhardt.

Dr. Lehnhardt: Yeah, don't feel bad about asking. I tell everyone I meet that I want to be an astronaut. I'm not, I'm not shy about that. So I would personally love to do that still and it's still something that I will apply for and continue to try and do for as long as I can. And then maybe eventually if no one else will pay for me to go to space, maybe I'll figure out a way to pay for myself to go to space. So commercial human spaceflight is starting to come online soon and there's a number of different companies now that are looking to fly people to space. But ultimately, yes, I think that my, my goal would be to be the doctor in space that's taking care of the other astronauts. But if I get to--if all I get to do is stay on the ground and help NASA to do that, I would consider that to be extremely fulfilling.

Juan: Which is also no minor accomplishment. But you mentioned your lead role as a lead scientist and element scientist. Could you explain to our audience what an element scientist is, and sort of what your role… what your… how does your work on a day-to-day or if you could provide a detailed description of how you integrate the exploratory medical capability element medicine and engineering.

Dr. Lehnhardt: It's a, it's a really fascinating area because my background is not in engineering. And… but yet I get to work every day with scientists and engineers and clinicians who are trying to tackle this really hard problem of, how are we going to take care of people in space when we can't come home again? So, the example we always use is the mission to Mars. And if you think about the mission to Mars, we're going to have a spacecraft that's going to be pretty small. What you see on the science fiction movies like The Martian, of this enormous spacecraft where everyone has tons of room and they can all float around really easily.

Juan: --Hermes--

Dr. Lehnhardt: That, that may be the future, but it's not where we are today. And so our plans for Mars are going to be a small spacecraft and a small crew and they're going to have a very long trip to Mars. It's going to be anywhere from six to nine months just to get there. And once you start going to Mars, you can't just stop and turn around and come home again. So, what we have to do from a medical perspective is we really have to think about, can we predict the number of, can we predict the number of conditions or the types of conditions that are going to occur from a medical perspective? And can we make sure that we have all of the stuff on board to diagnose and treat and manage those conditions? And can we predict that so far in advance that we can plan the entire mission? So that we have, not only the stuff, but the people on board, who can execute the tasks and use the stuff so that we have real capabilities.

Dr. Lehnhardt:  And it would be like, for example, saying that you are going to have all of the supplies and all of the staff, you need to run an emergency department. You'd have no capability to change your people, get new equipment or change your equipment, and you'd have to run for months and months at a time without any additional stuff. And so it's a, it's an extremely complicated problem. But in essence, from a, from a mathematics perspective, it's what we call the "backpack problem," which is the--you have a limited amount of space or resources you can have; how do you select the highest yield things? And so my team that I work with, I provide them with leadership and guidance from a scientific perspective and they do the work of designing the systems and trying to predict the conditions that are going to occur so that we can make sure that we have all the right stuff when we go and we have all the right skills on board to take care of everyone for these really long missions.

Eileen: Well, I can imagine, I can imagine that even just trying to run an emergency department on Earth would be very challenging if you couldn't change any of your equipment or any of your people, but I'm sure there are also extra health challenges that come with working in space. Is there any particular health risk that's more critical than others on a long-term space, space flight? And what do you do to mitigate these risks?

Dr. Lehnhardt: It's a, it's a complex problem because there are a number of hazards of space flight that we have to take into account. And they include things like the lack of gravity, the high radiation environment of space, the isolation and confined nature of a spacecraft, the distance from Earth, all of these things are the are the hazards or the types of hazards that we face.

Dr. Lehnhardt:  Everyone's got their own personal favorites that they are most concerned about. The ones that my group focuses most on are related to the distance from Earth challenge, which comes with the inability to return home--so no evacuation, the inability to resupply due to the distance and the time, and then the lack of communications with the ground. And so as you go further and further away from Earth, you no longer have real-time communication. So you can imagine trying to have the conversation we're having right now if after I said something, I had to wait 10 minutes to hear you say something. And then you had to wait 10 minutes to hear me say something. It becomes a very long and boring conversation very quickly. So the, the distance from Earth hazard is the one that that we focus on the most in exploration medical capability because it's related to our system design problem. But all of the hazards work together. So, for example, some of my colleagues in the Human Research Program focus on the synergy between the low gravity environment and the high radiation environment, and the effects that those may have on the human brain in the way that people think and execute tasks. And so, we have other colleagues in our group, in our program, who focus on the counter measures that people need in terms of nutrition and exercise to stay healthy and productive during their missions.

Dr. Lehnhardt:  And one of the biggest problems that we have is that when you look at each of these problems in isolation or each of these risks or challenges in isolation, you might come up with a great solution that works for that one thing. But can I take all of those individual solutions and can I fit them all together or integrate them all together into a small spacecraft that has limited mass and volume? And so it's the actual integration of all of these things that is where the rubber hits the road, so to speak. And that's where the biggest challenge is. How do we define what the, the highest yield stuff is to take with us? And how do we make sure that we manage as many problems as we can, given our resource constraints? And so the example that I use a lot is sometimes it--when you're designing something like a spacecraft, the designers of the spacecraft will come back to you and say, "I can't possibly fit all the stuff you want me to take. Show me what you're going to get rid of." And then we suddenly have this whole thing where everyone's fighting about their favorite thing and what they believe they need to have to manage their individual problem. But we really need to be able to do is take a systems look at everything and say "what is the thing here that gets me the least bang for my buck?" And that's probably the thing that's going to come out of the system.

Dr. Lehnhardt:  And so a lot of the work that that my team does and the work of the human research program is not only trying to identify and characterize the risks and come up with countermeasures or solutions to those risks, but it's also integrating all of those things together into one comprehensive system and figuring out how we're going to fit it all on this small spacecraft that's gonna go to Mars.

Juan: Wow, it's very complicated. As students of Baylor College of Medicine, we have the luxury of taking space medicine electives. And I took the elective this last, this last term, and I--you spoke about essentially what you just said and a term called "trade space analysis" and this involves, you know, the integration of all systems, right, basically systems engineering to--for risk mitigation. And that largely involves devices or technology. That--my question is, sort of, to what extent do you incorporate soft skills and do that risk mitigation? So, you know, sending an emergency physician and Mar--to Mars or not. Does that play a heavy role in that trade space analysis?

Dr. Lehnhardt: It does, and trade space analysis is really about helping us to try and come up with the optimized solution to a given problem. And one of the challenges that we have seen is that in many cases, there's a belief that if we if we fly a laryngoscope, that someone can intubate someone in space. And that's a not an unreasonable belief if you're flying a physician. But if you're flying a non-physician or someone who's had minimal training and how to do that, we know that that is a difficult skill. And one that we spend a lot of time learning before we actually practice it on patients. And so the need to incorporate what we were referring to as the knowledge skills and abilities into our capabilities matrix for this system is very important. So our goal is to not only identify the stuff that we would need to take, but also the skill set needed to make that capability real. The example I'll give you is: one requirement you may have for a medical system is that the medical system has to be able to provide intravenous fluid resuscitation. Well in order to do that, we need to have not only the bags of saline and the IV's and the lines and all this kind of stuff, we need to have a person on board who has the necessary training to do that task or—maybe and/or--we need to also be able to help refresh the skills of that person in doing that task or maybe even teach it to them for the first time. So to keep this example going, if the person on board who normally takes care of, everybody is a doctor, but the doctor is the person who gets sick, then one of their crew members, one of the other astronauts is going to have to be able to place the IV in that doctor. And as a result, they may have to learn how to do that on the fly. So we may have software that we could use on board that the astronauts would be able to do just-in-time training. They'd basically be watching a YouTube video, for lack of a better term, and figuring out how to put an IV in--and then they put an IV into their colleague because that, because they would have to do that. So, the skills were important, the ability to maintain the skills are important, the ability to teach new skills on the fly are important, as well as the training that we do before they go. So, how can we best prepare them on the ground to be able to execute those skills in that environment?

Dr. Lehnhardt:  So ultimately a system design, the system has to include the operators of the system and those, those people are going to be essential in executing the tasks that make the capabilities real. Having a laryngoscope that no one can use does not mean you have the ability to do airway management as a capability on a spacecraft.

Juan: It also reminds me of what you had mentioned during your course is that dilemma of taking an AED--you know, how often do AEDs get used? I mean astronauts are relatively healthy but you just never know. It seems like a lot of pros and cons to "Do we need it? Do we not need it? Can this person do it?" So and it also sounds like, from what you were saying, is that cross-training is becoming a very important thing. I know NASA trains them in like first aid and I'm not sure what the extent of basic capabilities, but there will likely be some continuous training en route and back, I assume.

Dr. Lehnhardt: Very much so, and when you think about the size of a crew to Mars, so, right now, some of the mission designs that people are looking at are four crew members, maybe six crew members. There's an awful lot of skills and knowledge that have to be available to those folks on board and it's either got to be in their brains or it's got to be in their computer systems that they can access or in their checklists in a way they can access it in a very rapid manner. And they have to be familiar with all those protocols and all those procedures and they have to be able to do all of those tasks. Just in that small number of people.

Dr. Lehnhardt:  So, the astronauts of today and the astronauts of tomorrow, are absolutely cross-trained and will be cross-trained in lots of different areas. They will have many different opportunities for refresher training and just-in-time training during these long missions. And some of that frankly might actually end up being really valuable to them because one of the arguments are one of the, the points we've heard from some of the astronauts is there's actually a reasonably good chance on the way to Mars that you would get bored. Because it's not like there's actually that much to do every day on the spacecraft. So, so that ability to learn new skills, to cross-train to run simulations and practice using different skills--those may actually end up becoming kind of fun activities or we can design them in ways that they're more entertaining and fun activities than they might have otherwise been. Because it might, in that sense, be multi-purpose. It helps with their isolation and confinement because they are they're learning something new and interesting. But it also makes sure that their, their skills are up to speed for when they need to execute them either in an emergency or some other contingency.

Juan: Right,  so it sounds like there would consistently remain engaged and it's probably good psychologically, as well. I just can't blend it to words of "astronaut" and "bored" together. I don't, I don't think they go. But, yeah, very good point, and it just seems like on, on that path that this, of not being bored in the psychological aspect--does that, is that taken into account during your risk mitigation and planning? Or is that just there's another piece of the pie that needs to be solved?"

Dr. Lehnhardt: The, the psychological countermeasures that are being considered in the Human Research Program have to do a lot with the selection of the of the right people for these kinds of missions. And, and so there's a, there's a phrase or a term that gets used a lot, which is "the exploration mindset" or "the exploration skill set." And that's people who don't become bored easily. People who don't have problems being in small groups, and living with small groups of people for extended periods of time. People who are very collegial and easy to get along with. Those kind of expeditionary skills are very important and so we have to make sure we select the right people to go. Then we have to train them appropriately and part of that training is how to deal with the psychological challenges of isolation, and confinement, and being in an environment, where frankly, everything around you is trying to kill you.

Dr. Lehnhardt:  You have to be, you have to have to be able and be prepared to deal with that and to face it during the mission. But then there's lots of research going on into, during the mission how can we give them extra things that will assist their mindset? And so, it may be simple things, like yoga and meditation type exercises. They're all kinds of advanced technologies that we're looking at to, with things like virtual reality. On the space station today, the astronauts have really good communications with the ground, so they get to speak with their friends and family on a regular basis. How can we make sure that they can maintain some communications with their friends and family? Even when they're really far away. All of these different things are the mitigation strategies for dealing with the psychological challenges of space exploration and all of those have to be incorporated into our broader systems. So, if we develop a system that requires virtual reality for psychological challenges, then I can use the same virtual reality system for medical training, or I can use the same virtual reality system for some kind of maintenance on a piece of equipment that breaks inside the spacecraft.

Dr. Lehnhardt:  There's lots of different ways to blend and meld together the different types of capabilities and countermeasures that we develop for psychological issues, for medical issues, for lots of different, what we call crew, health and performance challenges.

Eileen: It sounds like everyone on the team is wearing a lot of hats. We've got astronauts now getting medical and yoga training. I think it's really interesting to consider how people fulfill these different roles. You mentioned earlier that you don't really have a background in engineering, so I was just wondering what it was like for you when you really started working with a lot of engineers? How you got into that mindset and how your work is really able to synergize between the two different disciplines?

Dr. Lehnhardt: It's a, it's been a really great experience for me, learning how to work with all these different folks and be truly interdisciplinary. And looking back on it now, if I could go back to myself when I was a kid and say, maybe you should go be an engineer, maybe I would have done that. That seems like it would have been a cool job as well. But one of the things I realized very quickly in my work, was that the doctors and the engineers typically approach problems in a different way. And so I realized that one of my tasks as the as the lead scientist for the group was to try and make sure that I could understand both sides and how they approach problems differently and find the commonalities between them so we could build a bridge between the engineering side and the medical side.

Dr. Lehnhardt:  And so where that I think is, particularly interesting, is, is that mindset for how they approach problems. And from a physician's perspective, especially in the emergency department, when I see a patient and they have chest pain, the first thing I do is I think of all the terrible things that could be happening to them. And my job is to figure out that they don't have any of those terrible things. And the engineering position is: what is the most likely cause of the chest pain?

Dr. Lehnhardt:  And the most likely cause of the chest pain is not one of the terrible things, because the most terrible things don't happen that often. So the engineers approach a problem from the likelihood and consequence associated with that condition, or that problem, whereas the physician side of me is the "come up with a differential diagnosis, identify the worst things on it, and then rule all of those out." And so what I've actually found in myself is that my practice in medicine now uses a little bit of both. I still think about the worst case scenario, but I also think about, more about what's most common and most likely. And so I'm actually using that bridge, if you will between engineering and medicine in my own daily practice in emergency medicine. But by understanding where each of the different groups is coming from, you start to be able to understand how you can help them to communicate better with each other.

Dr. Lehnhardt:  And one of the things we realized is that the medical community communicates in terms of what the worst possible outcome could be, the engineering community says, but how often does that actually happen? And do I need to design or build an entire system just to deal with something that may never occur? And what we have to do is find that happy medium between the two where we can get to what I'll refer to as an acceptable risk profile for any given condition. So maybe I can't rule out the worst possible things because I don't have all of those capabilities on the spacecraft. But at the very least, I should be able to identify the highest likelihood conditions and manage all of those to a reasonable point.

Dr. Lehnhardt:  And so it's that, finding that consensus position and being able to back it up with a rationale and the evidence that justifies the need for it, allows the engineers to then say, okay, I hear what you're saying. I understand why you need it. We're going to go and build it for you.

Juan: Sounds like a fine line to navigate, especially given time constraints.

Juan: If, if you will, what is one of the, like, the coolest projects, you were able to work with engineers and---lately? Or to date?

Dr. Lehnhardt: So I think that the, the most---What I'll say one of the, one of the really rewarding projects that I worked on, is one that we call autonomous medical officer support software and and what that is, is a software capability that allowed us to take astronauts, who had never performed a particular complicated medical procedure before, and we could use this software to guide them through how to do this procedure from beginning to end. And while we were doing that, we didn't allow anyone on the ground to talk to them.

Juan: Wow.

Dr. Lehnhardt: And what we were trying to demonstrate was that we could--and that's where the word autonomous comes from--in an autonomous fashion, we could help non-physician astronauts to perform medical procedures without any support from mission control. And that's really important when we start talking about the types of communication delays that we're going to see on the way to Mars. We need them to be more self-sufficient and what we're calling Earth-independent. And so this ability, this software, what we did was---one procedure that we wanted to be able to have astronauts to do, was we wanted them to be able to do ultrasounds for the kidneys and bladder. And the reason we wanted them to do that is because one of the problems, some of the problems we occur and see in spaceflight are related to either urinary retention or kidney stones. And so, we had to be able to know that the that an astronaut could perform one of those tests without the ground having to tell them "move your probe 3 centimeters to the left." We had to have them be able to learn how to do the task. And so they open up the software, they turn on the ultrasound, they follow all the procedures and they got a bunch of really good kidney and bladder ultrasound images, which they could then transmit to the ground for someone on the ground to read and interpret. And they did all of that on their own without any prior training or knowledge of how to do it.

Dr. Lehnhardt:  And so to me, that is the, it's one of the first real demonstrations that we've ever seen in spaceflight of astronauts performing complex medical procedures on their own, in the way that we would see it when they go to Mars. And so that to me was very rewarding.

Eileen: That's, that's pretty crazy and difficult to imagine, but very impressive. I'm wondering how you see that technology affecting us here on Earth. It seems like people who are in other extreme environments could also use similar types of strategies.

Dr. Lehnhardt: That is the, the ultimate goal, is to--we want to take stuff on Earth and use it in space and we want to take stuff in space and use it on Earth. And so, the application of a lot of the work that my team does on, on exploration medical capability has a lot of different applications on the ground in remote environments or in austere environments. And so you're absolutely right. It's, it's easy to imagine a world now where some would be able to have software on their phone or on their tablet, have a portable ultrasound device that they could take almost anywhere in the world and they would be able to use that software to guide them through how to perform any reasonable type of ultrasound exam in a fashion that would allow them to take care of that person or diagnose that condition in that environment.

Dr. Lehnhardt:  So I would love to see applications where you could start deploying software like this into all sorts of different environments, where--if they have access to all the experts then, great use them--but when they don't and they're on their own, we should be able to help people take better care of themselves, anywhere in the world.

Juan: Wow, that's very interesting. I've tried to keep up with technologies that NASA creates and how they're implemented on the ground. You mentioned earlier the virtual stuff, being able to teach someone virtually, I could possibly see that being translated during these sort of difficult times where everyone segregated. And, you know, we are medical students and we, we had to reduce our clinical time or clinical exposure because of these things. And I could see that possibly being I think where, well, we can teach who virtually and, and it won't be just like a like a "sign in to zoom" kind of thing. So it'll be like a very hands-on virtual experience. Thank you for sharing that.

Juan: So as sort of, as a way to conclude this, this awesome interview and we hate it to end, but we wanted to get… so a very inspirational tone for those who haven't already been inspired. What advice would you have to, sort of, dreamers out there who aspire to one day, do what you do? And may one day, one day want to set foot on sort of a celestial body--moon, or Mars, or beyond?

Dr. Lehnhardt: I think the advice that I always try to share is that the, there's lots of different niches in medicine and there's many different ways for people to find the area that they are most interested in. And for me, my niche is fairly specialized and, and not something that a lot of people do. And when I was going through medical school and residency in Canada, one of the, when I would tell people that my interest was, was space medicine, I got a lot of blank stares from people. Or, they would tell me that "you can't do that" or, or "why would you do that; why don't you just go be a cardiologist?" And, and I had to try and explain to people that what I was trying to do was to bring together different areas of interest, or passions, that I had in a way that I thought was going to be fulfilling. And that was a little bit out of the norm, I think, for a lot of the people that I was talking to. And so they couldn't see a world where I would get to do that. And frankly, neither could I. But at the time, I just knew that I--this is an area I wanted to pursue. I knew that it existed and that other people did it and I was going to find a way. And so that's my general advice to people in, if---regardless of what the niche is, or the thing that you're interested in, find other people out there who share that passion with you and then figure out how to do it.

Dr. Lehnhardt:  And so, for me, what I did is I literally sent a cold email to a doctor who worked for the Canadian space agency and I said, "I think I kind of want to be you someday, can you help me do that?" And he did. And he was my first kind of foray into the world of aviation medicine and diving medicine and space medicine, and that's what started all of this.

Dr. Lehnhardt:  And so, finding those people who can help you is really important. The other part of it, though, is finding the other people who are, who are your peers, who are like you and want to do similar things. And for me, where that was, was I had talked to some of my mentors and done a number of different training opportunities that I could find in, in aerospace medicine. And when I'd exhausted those, one of them said, "why don't you go to the International Space University?" And I was like, "That sounds fake. What is that?" And I've discovered that it's totally not fake and I went and it was great. And what it was, was there was an opportunity for me to learn all the stuff about space that I didn't know because I've been focused solely on the medicine in space and I got to see the broader, the broader community, if you will, of people who are interested in human spaceflight. And that helped me to find all of these peers and fellow space nerds, if you will, who I could commiserate with and share my passion with. So I didn't---the mentors were really important in helping me to find the opportunities to do the things I wanted to do. But my people, if you will, the space people, were the ones who helped me to really discover my passion and keep it going and to seek it out.

Dr. Lehnhardt:  And it was after that opportunity, that I started to truly try to pursue space medicine as part of my career. So the---people might tell you that what you want to do is a little bit different, but if you find the right people to help you along the way and the right people to share your passion, that's going to go a long way towards driving you to where you want to be.

Dr. Lehnhardt:  The last thing I'll say on that though is, I could have never imagined in a million years doing this job for NASA. It was inconceivable to me. So if someone had said to me 10 years ago, "Where do you think you're going to end up?" I would have been completely wrong. So the last piece of advice I would give is always seek out opportunities and in a lot of cases, try to find a way to say yes instead of saying no.

Dr. Lehnhardt:  And for me, when someone came to and said, "Hey, there's this job at Nasa. You should apply for it." I could have simply said, "Oh no, that's---I couldn't possibly do that. I won't. I won't get it." Instead, it was like, maybe I should give this a shot and put my name in and see what I can do. And, and thankfully, I was successful. So, the the willingness to stick your neck out there and, and be rejected is a big part of trying to figure out here you want to go. And just to bring this whole thing full circle, lots of people who apply to be astronauts are rejected over and over and over again and they keep coming back. So you can't be scared of that rejection if you want to get to a to a truly unique position.

Juan: Absolutely. I give you agree with you wholeheartedly and you're just, you know, further convincing all of us that---that we hope that you continue to apply, because you've shown the resilience and you're not giving up, and you're doing all the work. And then one day it'll be like, we interviewed Dr. Lehnhardt and now he's in Mars and we're going to try to get a second interview with the 20 minute delay. But thank you so much for sharing. I think it's very inspirational, very informational. And I think our listeners will really appreciate it.

Eileen, do you have any other questions?

Eileen: Yeah, I just, I wanted to say thank you to Dr. Lehnhardt. It's been so valuable considering how we can blend different styles of thinking, giving us sort of a new perspective on things. I did have one final question. I know you were just saying that you can't necessarily predict the future and probably would have been wrong 10 years ago—yet, I'm still going to go ahead and ask you, where do you think space travel and human spaceflight will be in the next 20, 30 years?

Dr. Lehnhardt: 20, 30 years is a long time so that's a, it's a, it's anybody's guess. If you had asked anyone 10 years ago, if we could land rockets they would have said that you were crazy. And now we are landing rockets like once a month. So, it truly is amazing to me that, the pace of technology change. However, the rate-limiting step in all of this isn't necessarily the technology as much as it is the, the humans. We are the rate-limiting step for a lot of these missions.

Dr. Lehnhardt:  And even the mission of Mars is a great example. If we really wanted to build a rocket today, that could go to Mars and take people there, we could probably do it. Can we keep them alive and healthy and productive for the entire mission? That's where I'm not so sure. And so, the focus that we have on technology right now is fantastic. But the, the shifting of that focus towards the health and performance of the people is critical.

Dr. Lehnhardt:  And so, the--what I hope to see, and what NASA is trying to do is, is a mission to Mars in the, in the 2030s that is in the commonly referred to as "the Mars vicinity," meaning the first mission to Mars may not land on Mars, because landing on Mars is actually super hard and we don't really know how to do it yet from a technology perspective. But can we send people into deep space? Can they live in deep space for long periods of time? Can they be healthy and productive while they do it? That's the most important thing for us to determine. And then we can keep going further and further after that. So, I would love to see humans in the Mars vicinity in the 2030s, healthy and happy and productive.

Juan: Same here.

Eileen: Spoken like a true space lover and doctor.

Juan: Well, thanks again, Dr. Lehnhardt. Just one more, add--sort of an admin question for our listeners: if they want to get a hold of you or seek more of your information, is there a website or an email that you could point them to? Or a perhaps a website?

Dr. Lehnhardt: Sure. So my---I'm on the Baylor faculty pages, so you can generally find me there. I'm on Twitter as "Aerospace doctor," so "Aerospace" and then "DR." So you can always, I always post space and, and health stuff on there. And then lastly, my NASA email and my Baylor email are both public. So it's my first name (K-R-I-S) dot last name (L-E-H-N-H-A-R-D-T) at

Juan: Wonderful, thank you so much. Well there you have it. Please feel free to reach out to--if you'd like to pursue your dreams. And we really appreciate your time.

Eileen: Thank you so much. You know, this is a busy time for everyone. It was really wonderful to get the chance to talk to you.

Dr. Lehnhardt: It's been a pleasure. Thanks a lot.

Juan: Thank you.

Eileen: Bye.

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