From the Space Station to the COVID Ward

Serena Auñón-Chancellor M.D., Physician and Astronaut, Recounts her Life in Space and Teaching Residents and Taking Care of Patients on the faculty of LSU Health New Orleans School of Medicine

For Serena Auñón-Chancellor M.D., M.P.H., Clinical Associate Professor of Medicine at LSU Health New Orleans School of Medicine’s branch campus in Baton Rouge, the NASA/SpaceX Crew Dragon Demo-2 mission brings memories rushing back. Memories of experiences that few human beings have ever had – or ever will. Memories of her own 2018 launch into space.

The circumstances were different, but with ties to today. The quarantine she endured was not due to an illness. It was routine before going into space, although COVID-19 pandemic quarantines are part of her world today. Because NASA ceased launching its own spacecraft after the last shuttle mission piloted by astronaut Douglas Hurley in 2011, Dr. Auñón-Chancellor had to fly to Moscow to launch from Baikonur Cosmodrome in Kazakhstan aboard a Soyuz spacecraft headed to the International Space Station.

“It is very different when you don’t launch out of your own country,” Auñón-Chancellor says. “The last time I saw the United States was a good two months prior to our actual launch date as I took off out of Houston to fly to Moscow.”

Regardless of where the rocket blasts off, the astronauts share a common mindset.

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“I think all crews are in a similar state of mental preparedness,” notes Auñón-Chancellor, who graduated with a degree in electrical engineering before going to medical school. “We know it’s game time… and we’re anxious to get the mission started.”

But even after years of intense training and mission preparation, sitting atop a 300+-ton bomb would give anyone pause, no matter how fleeting. Especially for the first time.

“I think everyone’s a little bit afraid right before those rocket engines light,” admits Dr. Auñón-Chancellor, who was named to the 9-member 20th NASA Astronaut Class in 2009. “I will say, however, that our training is so good and prepares you for just about anything. On launch day, I was stunned at how calm everything was and how calm I felt inside. Once the Soyuz launches, it’s about eight minutes and 40 seconds until you reach orbit. You are so focused on the operation of the vehicle and everything you’re supposed to be monitoring, that the time goes by in an instant. And before you know it, you’re in space.”

One of the most memorable parts of the launch might come as a surprise.

“I think one of the best parts about launch was when the shroud came off of our vehicle,” recalls Auñón-Chancellor. “People don’t realize that we’re actually completely encased inside the rocket as we lift off from the launch pad. We cannot see outside our windows. When that shroud does finally come off… and you see the curvature of the Earth and the beautiful blue… It’s stunning.”

Auñón-Chancellor, who served as Flight Engineer for Expeditions 56 and 57, spent 197 days on the International Space Station (ISS).

“I think the biggest adjustment, certainly during the first couple of weeks, is your body adjusting to microgravity,” says Auñón-Chancellor. “You feel it almost immediately when you’re launching. After that eight minutes and 40 seconds when the third stage finally cuts off, your brain does not perceive your environment the same as it did back on Earth. I almost felt like everything was at a 45-degree tilt to the left in front of me, and even the control panels and the console in the Soyuz vehicle itself appeared different. That took a couple of hours to resolve. Many astronauts say when they first launch and reach microgravity, they get something called an inversion illusion, or what they like to term the ‘Spiderman Illusion’ where you feel like you’re hanging upside down.”

Besides fluids suddenly shifting to the head area producing a stuffy, very full feeling, there are other physical effects.

“Once you finally arrive on station, you don’t feel great,” Auñón-Chancellor remembers. “Your stomach doesn’t feel great. You don’t eat a whole lot. There’s some nausea there.”

And then there’s the disorientation.

“Remember on ISS, you can operate in 3D meaning there is no up or down really. I mean we have a perceived up and down within the ISS structure and how we line up our laptops. But even with that, I can do science on any side. I can do science on the ceiling. I can do science on the walls. I can be flipped upside down. I can eat upside down. It doesn’t really matter. So, it takes a little while for your brain to get used to that. We kind of call that the first reprogramming phase.”

But the brain has an amazing ability to adjust and adapt.

Auñón-Chancellor explains, “Your brain quickly adapts to this new environment to say ‘Hey you know what? It’s ok if I put myself upside down and then move into another module. I’ve learned how to reconstruct where I am in space, and therefore, I don’t get disoriented.’ You get disoriented a lot during the first week or two, especially on your first flight. You really try to maintain that head being up feet being down attitude, and then by the third or fourth week, and certainly by the first month, you can deftly float and spin and fly and twirl in and out of each module with no concern for what direction, where your feet or pointed, where your head is, you know where you are, and the brain has really adapted beautifully to that. And it was fascinating to watch it myself after hearing about it all those years.”

The days were long and filled with hard work.

“Our day would start with what we called a morning DPC—Daily Planning Conference—where we would touch base with every mission control. Not just Houston, but there was Mission Control Moscow, Tsukuba, Japan; Munich, and finally Huntsville, Alabama because they ran a lot of our science,” notes Auñón-Chancellor.

That was at about 7:15 a.m., and they worked until about 7 p.m. Although every minute of every day was filled with activity, the majority of the day was spent doing science.

“Everything from life sciences to material science research, physical sciences, we’d get as much science done as possible,” she recounts.

NASA reports that her 56 and 57 crews contributed to hundreds of experiments in biology, biotechnology, physical science and Earth science aboard the International Space Station. Investigations were led into new cancer treatment methods and algae growth in space. They also installed a new Life Sciences Glovebox, a sealed work area for life science and technology investigations that can accommodate two astronauts.

The astronauts also performed repairs and preventive maintenance, prepared for spacewalks and practiced with the robotic arm, which is the only way to capture cargo vehicles bringing food supplies and experiments. A critical activity was daily exercise.

“It’s very important to maintain fitness while you’re up there and also to stave off bone mineral density loss and also muscle mass loss, and we did that by working out every day for two and a half hours,” says Auñón-Chancellor. “That included an hour of aerobic activity and an hour and a half on our ‘weight machine’. It’s actually called an ARED – Advanced Resistive Exercise Device. By using vacuum tubes, you can generate load, so that’s how we would lift.”

Auñón-Chancellor’s most memorable experiences ranged from the magnificently exquisite to the movingly deep.

“If I just started listing them off – watching thunderstorms roll across Africa at night during a night pass was one of the most amazing things I’ve ever seen; being able to see the entire Milky Way was beautiful. Just watching your body adapt and float and feeling so free wherever you moved inside the Space Station and in space itself never got old – floating never gets old; I don’t care what anybody tells you, even after 197 days. And at times you realize what an honor it is to be up there and what an honor it is to serve your country, to represent your country on board that Space Station, and really to serve the world and mankind. And quite frequently our crew would pause, and I’ll say step back, but we really didn’t step up there, we floated, and we pondered that. We thought about that, and we talked about that, and you could see the importance that it held for everybody and how much we valued that experience, but we understood what it meant. We never took anything for granted, and we realized that there were a lot of people counting on us to do the right thing and to do our jobs well, and so that’s what we tried to do every day.”

What she missed most besides her family, was unexpected yet achingly profound.

“As much as I was able to look out the cupola, which is sort of our viewport to the Earth and get this amazing view that I knew no one else would ever have unless they were here, I could see the Earth, but I couldn’t feel it. I mean, you feel the presence, but you don’t feel the wind, and you don’t feel the rain, and you can’t smell the sky right before it starts to rain or right after the rain. You can’t feel the bitter cold of a winter’s day or the iciness of a breath you take when you’re standing on a mountain. And that sort of feeling we missed up there. We would talk about it. We could see the Earth and all its beauty, but you still felt somewhat disconnected because you couldn’t feel it. And it was amazing after you come back how much more I appreciate an early sunrise; how much I appreciate wind; how much I appreciate just standing outside during a quiet moment. It means a lot more to me now I think than it did before.”

Expedition Crew 57 safely returned to Earth on December 19, 2018. Though Auñón-Chancellor remains a member of NASA’s Astronaut Corps, she entered academic medicine joining the faculty of LSU Health New Orleans School of Medicine last October. She is based at its branch campus in Baton Rouge.

“I’m one of the academic clinical faculty as part of the Internal Medicine Residency Program here at LSU Health New Orleans medical school branch campus,” states Auñón-Chancellor, who is board certified in Internal and Aerospace Medicine. “I’m doing absolutely one of my favorite things, which is teaching residents and medical students. I’m super excited to be here. Being academic medicine faculty is one of the most, if not the most important. things to me. I love being part of the critical years of a residency program where I get to take part in the shaping and molding of young physicians. The right faculty and the right mentor can really make all the difference, and that’s what I wanted to return to.”

Her husband was being heavily recruited by the Department of Physics at LSU while Auñón-Chancellor was still on the space station. A lot of his research deals with space radiation and clinical outcomes, so “we’re both kind of in the space business.” Her only requirement for moving to Baton Rouge was the existence of an Internal Medicine residency program. Enter Dr Steve Nelson, Dean of LSU Health New Orleans School of Medicine. Internal Medicine is only one of the residency programs at the School’s Baton Rouge branch campus. He felt that Auñón-Chancellor would be an excellent addition to his faculty there.

“Dr. Auñón-Chancellor is an exceptional physician and teacher – reasons enough to recruit her,” Dr. Nelson says. “But we also hope to build an aerospace medicine program around the breadth and scope of her knowledge.”

“The people are fantastic,” she says. “I’ve really enjoyed getting to know them. I feel like I fit right in. I feel like it’s my family, and I belong here.”

Besides teaching, it also got her back to patient care. She loves it so much, she resumed taking care of patients about six weeks after her return to Earth—after she learned how to walk again and could handle a 12-hour shift again.

“I love taking care of patients, whether they’re a little bit sick or a lot sick,” says Auñón-Chancellor.

Lately she has been taking care of those a lot sick -- with COVID-19.

“When Louisiana was seeing its peak of cases that first half of April, I was actually on the COVID ward at the hospital with my team of residents,” Auñón-Chancellor informs. “It was probably the most memorable internal medicine in-patient service I’ve ever been on. It was very difficult at times because these people were very sick, many of them dying. This is a disease where there really is no standard of care. The research is still up in the air. We’re looking at new treatments all the time, so we were using whatever experts you could and our best clinical judgement -- how sick someone looked, was it time to transfer them to the ICU, were they going to do ok overnight -- and you’re just trying to do the best job you can making that decision together as a team. It was hard. We had over 200 patients at our hospital, a lot in the ICU, a good number on ventilators. I think the toughest part was that because the families couldn’t be with the patients as much as they normally can, we were their families. So, we spent a lot of time certainly talking to the families on the phone, but also spending time with the patients letting them know we were there for them. It made medicine more meaningful, and it was something that definitely impacted you emotionally, impacted the team. It comes back to one of our NASA teaching lessons – self care and team care. It’s making sure you’re ok with how you’re doing in very, very tiring circumstances, but also making sure the team is ok when one of our patients dies and the family couldn’t be there or talking to a patient and telling them we have to move them to the ICU because their breathing isn’t good, and you see the fear on their face. You can’t escape that as a person. I felt like we were performing a tremendous service and fulfilling a sense of purpose. I’m so happy that our LSU Health Internal Medicine Residency Program has taken part in that. I think it’s important for the faculty and really important for the residents. Hopefully, pandemics come around only once a century, but this one is ours, and the number of teaching lessons that come out of this is tremendous. You walk away, and I think everyone has walked away, as a different physician.”

Auñón-Chancellor’s work with NASA continues as well.

“I still work in the NASA Astronaut Office, and I spend a good portion of my time covering medical issues with other astronaut physicians. That can be for the Space Station, for our commercial crew vehicles like this latest launch. It can be for lunar habitats because we are going back to the moon. It can be for exploration class missions to Mars. It just depends on the day, what problem we’re facing. But one of our limiting factors, certainly heading towards Mars or even back to the moon is the human – protecting the human, understanding how the human changes in microgravity and how do we provide for and protect the human during those long journeys, so that’s what I’m working on now.”

The new-era launch holds special significance for Auñón-Chancellor.

“I actually know Doug Hurley and Bob Behnken pretty well."

“Doug Hurley I’ve known the longest. I actually worked with him prior to becoming an astronaut. When I was a flight surgeon out in Russia supporting astronaut training, he was one of the first astronauts I ever worked with. He was one of the first ones I talked to about even applying to the astronaut corps. And so over the years I’ve really appreciated his friendship, his leadership and I understand the role he plays right now. This is a huge mission. I’m so excited to see Doug up there aboard ISS. The last time he flew up there, he was on STS 127, and I was his flight surgeon, so I looked after him and other members of his crew. I think everybody wishes they could be going with them, but we understand that these two are two of our best.”