“I can feel it,” she said out loud.
“Good,” Doc said, all trace of his earlier nerves gone as he focused on the display readout. “Looks good over here too. All the levels are showing optimal.”
“Perfect,” Mo said, and then turned her head to give Haskins a reassuring smile. He sat on a stool in the corner of the room, well out of the way. When the pilot arrived, Doc informed him in no uncertain terms that he was to sit there, not move, and not say a word until spoken to. The normally brash and cocky father-to-be agreed, his face paler than normal.
“All right, Mo,” Doc said, pulling her attention back to the task at hand. “Are you ready?”
“Let’s do this,” Mo said. “Set your laser scalpel to two point one…”
“She’s the most beautiful thing I’ve ever seen in my entire life,” Haskins said, his voice thick with awe. Mo smiled and tried not to resent him as he cradled the amazing, precious, overwhelmingly perfect little life that was their daughter. It wasn’t that she begrudged him the time…no…no it was. Haskins was a good man, and would no doubt be a good father, but damn it, she wanted to hold the baby!
“All done here, Mo,” Doc said, sounding both tired and triumphant. He had sutured her up himself, since the automated sickbay was busy keeping her anesthesia levels correct. “Just move slowly, okay?”
“I want to hold her,” Mo said. She knew she sounded demanding and unreasonable, but at that moment, she didn’t care. She’d carried the kid for nine months, she ought to be able to cuddle her!
“Sure, baby, sure,” Haskins said, his voice breaking with joy as he carried his child over to her mother. “Here, she’s right here. Look at her, Mo! Look what you made! She’s even got your red hair.”
He bent down and laid the blanket-wrapped bundle in Mo’s arms. For the first time, Mo looked into the face of her daughter.
She was wrinkly and red, and looked thoroughly pissed off. But Haskins was right, she did have a shock of dark red hair on top of her head. Mo blinked as her eyes filled, and sniffled, then bent to press a kiss to the baby’s forehead. Her lips had never touched anything so soft.
“Stella,” Mo whispered. “Stella Dare Haskins.”
“Oh, Mo,” Haskins said, “You don’t have to do that…”
“You’re her father,” Mo said. “She’ll carry your name. Unless you object?”
“Hell no,” Haskins said with a laugh. “Not in the least. I just figured you’d want to give her your name.”
“That’s okay…” Mo said. She would have said more, but she trailed off as Stella opened her eyes. From what Mo understood, most babies’ eyes were a dark and indeterminate blue for several weeks after birth. Not Stella’s. Her modified eyes gleamed green in the harsh light of the sickbay.
“Congratulations, you two,” Doc said. “And welcome, Stella Dare. I would normally say welcome to Earth, but that doesn’t exactly work here. So instead, I guess we’ll go with this: Welcome to the Stars.”
EPILOGUE
Doc picked up the new infant and rewrapped him in a bundle of swaddling. A healthy boy, he had been given all the advantages, (or upgrades as Doc still liked to call them), that had been worked out with Stella Dare. The infant looked up at him with eyes that were still an unnatural green to Doc’s own Earth-born eyes, but would soon become the norm for Bonfils. The baby burbled at Doc as blue eyes peered intently into the boy’s green.
“What sights will these eyes see? What new things will you discover?” Doc whispered to his son.
In response a new voice spoke up, a young child’s voice.
“Can I see him now, Mr. Doc?” asked Stella Dare Haskins, the first Homo stellaris. Like Doc, her too-green eyes stayed riveted to the infant. “Please?”
“Sure, honey. You just have to sit down first.”
After waiting to be sure she was settled in a chair, Doc squatted down to Stella Dare’s level, and gingerly placed the baby boy into her waiting arms. She held him with all the solemnity of a child of four given a great responsibility. Doc still stayed crouched, ready to take the infant from her when needed.
Doc looked up as Mo walked into the room, having washed up from delivering the new child. He winked at Mo as she first looked at Stella and then to him.
“She was anxious to see him,” he said, “and besides, it isn’t every day you get to welcome the first child born planet-side, I bet she remembers this moment.”
Mo smiled at Doc. “Sure,” she said. “Mama’s sleeping well. She’ll be out for a few hours.”
“Thank you,” Doc said. “For everything.”
“No thanks needed, Doc, you know that.”
For her part, Stella Dare could at first only stare at the new boy, but at her mother’s encouraging nod, she began to speak.
“Hi,” she said. “My name is Stella. I’ve been waiting for you to come play with me. I can’t wait until I can show you the garden, it’s so big! We are going to have so much fun there. And then there’s the heffalumps, you are going to like the heffalumps, they are my friends. They’ll be your friends too, and then…”
Maintaining Crew Health and Mission Performance in Ventures Beyond Near-Earth Space
Mark Shelhamer
Dr. Shelhamer is on the faculty of Johns Hopkins where he started as a postdoctoral fellow in 1990. He has bachelor’s and master’s degrees in electrical engineering from Drexel University, and a doctoral degree in Biomedical Engineering from MIT. He had support from NASA to study various aspects of sensorimotor adaptation to spaceflight, amassing a fair amount of parabolic flight (“weightless”) experience in the process. He also serves as an advisor to the commercial spaceflight industry on the research potential of suborbital spaceflight. From 2013 to 2016 he was on leave from his academic position to serve as Chief Scientist for the NASA Human Research Program at the Johnson Space Center. In this role, he oversaw NASA’s research portfolio to maintain human health and performance in long-duration spaceflight.
Human spaceflight is challenging and calls on great personal resources even from professional astronauts. This has always been true, and its truth is not diminished by the fact that we now “routinely” send people into space for six months (or even a year) at a time on the International Space Station (ISS). A sense of the challenges in maintaining human presence in space can be gleaned from a glimpse at the physiological and psychological procedures (countermeasures) in place to maintain health and performance in this demanding environment. We will discuss those in a moment. When people venture further out, in distance and duration—to the Moon, to Mars (in the foreseeable future), and eventually beyond, these countermeasures will be taxed, in some cases beyond their limits. New interventions and conceptualizations will be needed: the enabling of the crew to deal, on its own, with issues that have not been identified before the mission begins. In other words, it is not the countermeasures themselves that will be as important as the mission structure that is put in place to create countermeasures “as needed” when new unexpected circumstances arise. We will discuss how this might be accomplished.
All of this is challenging enough, but when we then consider journeys not of exploration but of settlement or colonization to destinations that make Mars seem like a close neighbor, we enter a whole new realm of thinking. We assume that human physiology and psychology will be the same, and thus some of the same approaches to maintaining their integrity will still be relevant. However, the range of physical, mental, and emotional stressors will take on a new magnitude, leading to new problems that require new solutions. Extrapolations of solutions from today’s flights will be stretched, hopefully not to the breaking point, but it is clear that new ways of thinking about health and performance will be needed. This will be made especially compelling because many of the foundational aspects of our lives here on Earth—things that we have learned to rely on to the point of taking them for granted—will be left behind forever.
Explorers on Earth, no matter how difficult the journey, can
at least be comforted in being able to breathe fresh air, to experience the sights, sounds, and smells of nature, and even be reassured by the familiar tug of gravity. Extraplanetary settlers will have no such assurance of familiarity, and the resulting stress can have widespread negative consequences if not understood and controlled. This will be exacerbated by the fact that space journeys of today—and in the near future—are undertaken by small groups of select and very highly trained professional astronauts. High standards of motivation, discipline, dedication to duty, and expertise are accepted facts. Larger groups of people that will be needed for journeys of colonization will almost certainly exhibit a much wider range of variability in all these traits. Such diversity can be beneficial in many ways, but in the initial flights of these more ambitious undertakings it is not clear how to balance such diversity with the known successful approach to assembling an astronaut team.
Let us begin our journey out to the planets of the future with a look at current thinking for astronaut well-being followed by some informed conjectures as to where that might lead us.
SPACEFLIGHT HAZARDS TO HUMAN WELL-BEING
To go about systematically addressing the major risks to human health and performance in long-duration spaceflight, it is useful first to delineate these risks. The approach that NASA currently takes is to identify the main spaceflight hazards (environmental conditions) and then determine the specific human risks associated with each hazard (Francisco and Romero 2016).
1. Hazard: Altered gravity level (in space or on a planet other than Earth)
a. Spaceflight-induced intracranial hypertension/vision alterations
b. Renal stone formation
c. Impaired control of spacecraft/associated systems and decreased mobility due to vestibular/sensorimotor alterations
d. Bone fracture due to spaceflight-induced changes
e. Impaired performance due to reduced muscle mass, strength, and endurance
f. Reduced physical performance capabilities due to reduced aerobic capacity
g. Adverse health effects due to host-microorganism interactions
2. Hazard: Hostile and closed environment
a. Acute and chronic carbon dioxide exposure
b. Performance decrement and crew illness due to inadequate food/nutrition
c. Injury from dynamic loads
d. Injury and compromised performance due to EVA operations
e. Adverse health and performance effects of celestial dust exposure
f. Adverse health event due to altered immune response
g. Reduced crew performance due to hypobaric hypoxia
h. Performance decrements and adverse health outcomes resulting from sleep loss, circadian desynchronization, and work overload
i. Reduced crew performance due to inadequate human-system interaction design
j. Decompression sickness
3. Hazard: Isolation and confinement
a. Adverse cognitive or behavioral conditions and psychiatric disorders
b. Performance and behavioral health decrements due to inadequate cooperation, coordination, communication, and psychosocial adaptation within a team
4. Hazard: Distance from Earth
a. Adverse health outcomes and decrements in performance due to in-flight medical conditions
b. Ineffective or toxic medications due to long-term storage
5. Hazard: Deep-space radiation
a. Risk of space radiation exposure on human health
THE RISKS TO HUMANS
It is easy to see from this list that almost every system in the body is potentially impacted by long-duration spaceflight. Note that these risks also include psychological and interpersonal issues that might arise due to the confines of any practical spacecraft for the foreseeable future.
NASA and its Human Research Program work to mitigate the major risks shown in the list. Some are more critical than others, and their criticality and priority depend on the type of mission. For example, the likelihood of a medical problem or a teamwork issue will be higher with a Mars mission simply due to the longer mission duration and the need to deal with in-flight problems without help from the ground. In fact, the majority of the problems are worse with longer and farther missions such as one to Mars. On the other hand, an issue such as sleep impairment might be less critical on a longer mission. Sleep is disrupted on the ISS because of a high workload and operational pace, occasional emergency procedures, and altered light-dark cycles. On a deep-space mission lasting months or years, it might be that a normal operational pace could be achieved during the journey itself, enabling a more normal sleep pattern. This is critical because of the key role that sleep plays in so many other systems, not to mention its effects on performance.
The most ambitious mission scenario now in the planning stages is a three-year mission to Mars, which would entail up to eighteen months on or near the planet. The most important risks in that mission fall out easily from the list above, given the duration, distance, and high degree of crew autonomy. This issue of crew autonomy is an especially important one to which we will return later. The key risks for Mars are the following:
Radiation. Galactic cosmic rays and solar particle events are the two main categories of radiation in deep space, and their levels are higher there than on Earth or in low-Earth orbit. There is a long-term increase in the lifetime risk of acquiring cancer from this radiation. This is not a major operational concern for a mission that might last just a few years, but it can lead to significant burdens on healthcare systems in longer-duration flights of many years unless proper shielding is in place or other countermeasures implemented. Of more immediate concern during a mission itself are its degenerative and cognitive effects, which are not yet fully characterized, but may occur with chronic exposure at lower radiation levels than the known cancer risks (Parihar et al. 2016). Nevertheless, the prospect of a crew being exposed to a solar event that induces radiation sickness and immediate cognitive decline is sobering. This is especially true when it is recognized that a deep-space crew must have a high level of autonomy due to remoteness from Earth. The radiation-related risks are a major concern with both short-term and long-term consequences.
Cognitive and behavioral issues. Isolation and confinement for long periods of time with a small group of people are challenging even for small, highly trained and dedicated crews. Obvious problems include disagreements with other crew members. But potentially more dangerous are difficulties with teamwork that can arise from these interpersonal issues that can have a direct negative effect on the success of the mission and the survival of the crew. This is an issue of particular import because teamwork problems can be exacerbated by cultural differences and misunderstandings about individual roles on the crew. Given the desirability of personnel diversity, these will undoubtedly be major factors in future expeditionary and colonization crews. Related to these are effects on cognitive function, which is negatively impacted on long flights for reasons that are not fully understood. This is sometimes referred to as “space fog” and it is a general perceived slowing of mental processes. Space fog may be related to high workload, elevated CO2 level, altered sleep cycles, and other stressors inherent to current spaceflights. Awareness of this issue is a key aspect of minimizing its impact, and professional astronauts are so highly screened that even with a decrease in cognitive function they are still high achievers. Nevertheless, the prospect of a crew undertaking a demanding mission at less than full cognitive capability must be considered.
Gravity (or the lack thereof). Due to the lack of gravity (more properly, the lack of a net gravity or inertial force vector), astronauts experience a shift of body fluids toward the head. This has been recognized for decades, and results in sinus congestion, puffy faces, and spindly legs, among other more serious issues. One of these is the relatively recent finding of changes in visual acuity after extended stays on the ISS. This is, as current thinking goes, due to the small but constant elevation of fluid pressure ins
ide the head, which finds its relief by moving fluid down the optic nerve toward the back of the eye. This pushes on the back of the eye and distorts its shape, changing its optical properties. This is serious enough when dealing with high-performing individuals in demanding situations, but the prospect that it might be just an early indicator of lasting neural damage that accrues over longer periods of time in space is especially troubling.
Altered (reduced) gravity loading on the body also leads to a host of other problems. Constantly fighting against gravity while on Earth, so as to maintain upright posture and sufficient blood flow to the brain, provides a natural continuous form of exercise. This helps to maintain muscle strength, bone integrity, and cardiovascular function. In space, these physiological functions deteriorate unless measures are taken to protect them. Among the most effective measures is exercise, as discussed below. With proper exercise, astronauts can now return to Earth with sufficient muscle tone, cardiac function, and bone density. There is a caveat, however: While bone-mineral density is currently well preserved, it is not clear that bone strength (fracture resistance) is preserved, since bone is a complicated entity whose strength depends on its internal structure, not just its density.
Food. The ability to provide nutritious and enjoyable food is also a concern. The shelf life of foods is limited by storage technology, processing, and inherent chemical processes. The food problem is more, however, than simply making sure that caloric content and balanced nutrition are achieved, particularly since packaging for preservation and storage often sacrifices palatability. Food is one of the very few pleasures that crews can enjoy during flights. It is a familiar and comforting reminder of home and the strong social ties attached to group dining are important for crew cohesion. Thus, a variety of healthy and pleasurable foods must be provided or grown in the spacecraft or habitat.
Medicine. The likely occurrence of a significant medical condition is another major concern. The crew will consist of a small number of people who are highly fit, maintain healthy lifestyles, and are provided with opportunities for exercise and proper nutrition. Nevertheless, over the course of a three-year mission during which they will be exposed to a dangerous environment and called upon to be very active in new and unusual tasks, it is likely that medical concerns will develop. These might be as conventional as abrasions, sprains, and related simple injuries, or as complex as systemic changes initiated by fluctuations in the gut microbiome due to altered gravity and diet, and medication use. Head and back pain is common even on shorter flights to the ISS due to headward fluid shift and decompression of the spine. Rashes and minor injuries from floating debris are common. Particularly troubling is the increased possibility of kidney stones, either in space or on reaching a planetary setting, since the calcium lost from bones is excreted in urine and may form stones. These are just some of the issues that are known, as are many others which so far have been treatable and have not required a medical evacuation from the ISS. Simply due to increased time in mission and the challenges of going to Mars, however, it is likely that medical issues will arise and so a systematic and realistic approach must be taken. As one example of the tradeoffs involved, consider in-flight surgery. Current NASA thinking is that the amount of supplies and apparatus needed to perform even minimal surgery in space—not to mention problems of maintaining a sterile field and controlling blood and other fluids—will preclude surgery for the foreseeable future. This may change as noninvasive procedures are refined and the feasibility of surgery in resource-limited settings increases, but a realistic appraisal demands that consideration be given to the possibility that one or more crew members will not survive an entire mission because of the limitations of practical medical care.
Stellaris: People of the Stars Page 10