NASA Shuttle-Mir Oral
History Project
Edited Oral History Transcript
Sam L.
Pool
Interviewed by Rebecca Wright
Houston, Texas – 3 August 1998
Interviewers:
Rebecca Wright, Kevin Rusnak, Franklin Tarazona
Wright: Today is August 3, 1998. We're visiting with
Dr. Sam Pool as part of the Shuttle-Mir Oral History Project. Thank
you again, sir, for making time out of your busy schedule to visit
with us.
Pool: Sure. You're welcome.
Wright: We'd like to begin by you explaining your
roles and responsibilities that you've had with the Shuttle-Mir Program.
Pool: Perhaps I should start by mentioning the fact
that we had a long working association with the Russians going back
to the early 1970s, so most of the people who we interfaced with during
the Shuttle-Mir Project we knew. The United States Government and
at that time the Soviet Government had an agreement enabling cooperate
in the area of Space Medicine and Biomedical Research. During the
[Ronald] Reagan era, as you know, many cooperative efforts were curtailed
or stopped; but, the cooperation in this area continued, so it was
not very difficult for us to begin to work on a new project with our
Russian counterparts.
Our primarily effort is to provide medical support for the astronauts,
and the people we dealt with in Russia have the same mission, provide
medical support. The two systems are quite different, and one of the
things we discovered as we began to work with them on Shuttle-Mir
Project was that some of the people who worked in the program were
new to us. Principally those in the military who had been restricted
in what they could do during the earlier cooperation were now in evidence
and working with us, primarily people at Star City. While several
of us had been to Star City, we hadn't really worked with the people
there very much, so we were introduced to a new group of people in
this process.
Just to describe to your briefly some of the differences in our roles
and responsibilities on each side, the American system, the system
we developed, follows the military model in that we provide health
care services to the astronauts as well as to their families, and
we provide health care pre-flight, in-flight, and post-flight. We
also organize emergency medical services that may be required. We
provide medical certifications for selection as an astronaut and each
space mission to which they are assigned. We've worked with the Russians
over the years to develop a somewhat similar set of medical standards;
however the standards are not exactly the same.
The Russians, on the other hand, have really developed separate and
almost autonomous systems. There are people who are involved in training
the cosmonauts and preparing them for a mission, and a different group
of people are responsible during the mission. At the time of recovery
of the spacecraft, representatives of both groups are frequently there
to assist.
We found, in working with them, that they didn't have, as best we
could tell, a single physician, a flight surgeon, who had worked the
entire process end to end from pre-flight training, to in-flight operations,
to post-flight rehabilitation. They didn't have anyone who had that
sort of experience, because their efforts were more focused and limited.
So that is a fairly big difference in the two systems.
Another difference in our approach involves the basis on which we
practice medicine. To the extent possible, we follow an “evidence-based”
mode in the practice of medicine. We tend to do certain tests because
we know that the yield from those tests, medically speaking, is fairly
high, whereas our Russian counterparts do many tests we no longer
think are necessary or, for that matter, valid. And their access to
and use of various medical technologies is still very much different.
We wouldn't think of doing all of the X-rays they do because of the
radiation exposure, for example. We don't do centrifuge runs routinely
on our crew members prior to missions, but they do. They have some
justification for that, because in the centrifuge arena, at least,
a reentry ride on the Soyuz is going to expose you to some fairly
strong G forces, whereas in the Shuttle, we really don't experience
that much anymore. They do certain types of altitude runs and stress
tests which we no longer do. They use rotating chairs to expose people
to a provocative environment and see if they can train them not to
be sick on orbit, but we know from our studies that we certainly were
unable to use similar techniques with good results in terms of being
able to protect people from being motion sick on orbit. It didn't
work. They continue to do it. We have a difference of opinion. Their
medical standards reflect what we would say is a more aggressive approach
to training and to medical studies, whereas we tend to focus on those
kinds of tests and exams that give us a fairly high yield in terms
of understanding the individual.
One of the things we realized fairly quickly was that we were going
to exchange people, and that we were going to have astronauts living
in Star City, and they were going to have cosmonauts living in Houston.
We decided we were going to send a flight surgeon with the astronauts
to Star City, so we trained some of the flight surgeons to speak Russian.
We had several flight surgeons who volunteered and we have had NASA
flight surgeons in Star City from the very onset of the program.
We wanted the Russians to send flight surgeons to work with us as
well, and after some negotiations on the subject, we started that
part of the exchange, and they sent one physician at a time, usually
for six months to a year. So we put their physicians into our process
and let them assist with taking care of the cosmonauts, and trained
them in our system. Similar training took place in Russia for our
physicians. We took care of our astronauts in Russia and we got involved
in Russian training.
We also put a physician in the control center in Kolingrad, representing
our interests and our crewmen. We also worked to provide an updated
medical kit for the Mir. As a result of perestroika and Russia losing
a number of its satellite countries, they then began to have to purchase,
from places like Czechoslovakia, medications which they needed, and
sometimes these were simply unavailable to them for whatever reasons,
and we wanted to make sure that we had a modern medical kit on board.
So we worked closely with the Russians to define what that kit would
be, and developed the Mir medical kit supplement, which was a substantial
United States' contribution to medical capability on board the Mir.
We developed an agreement which stipulated that a crewperson being
named to a mission would be reviewed by the host country's medical
certification board, with the attendance of a physician from the other
countries medical board. So when [Sergei K.] Krikalev and [Vladimir
G.] Titov were selected initially by the Russian side, Dr. Arnold
Nicogosian at NASA headquarters and I attended the Russian Principle
Medical Commission--that's what they called their medical certification
board, and as a result of this we understood pretty well the medical
history of the cosmonauts involved. Similarly, when we sent our people
to Russia, we invited the Russians to participate in our medical board
meeting, and they did, to review the medical histories of the people
we were sending over, Norm [Norman] Thagard and Bonnie Dunbar.
So if I were to synopsize the roles and responsibilities that I've
just reviewed for you, you first find us providing health care. We
also got involved in training, particularly in medical training. We
had a longstanding cooperative agreement with the Russians, which
made it easier for us to transition, because we knew many of our Russian
counterparts. We found new participants on the Russian side as a part
of this opening the door of cooperation with them. One of our responsibilities
was to provide an updated Mir medical kit and another was to try to
resolve differences of opinion between the two medical groups over
medical tests to be done and training.
Wright: Those first days that the flight surgeons
were involved, were you the one who spoke with them to give them the
information? How did that all evolve of getting the flight surgeons
involved to volunteer to go and be a part of this program? I'm sure
they had lots of questions. I'm wondering if you were the one that
was having to put together all the information for them.
Pool: There were some discussions amongst the fight
surgeons about this and we found that we had some flight surgeons
who were eager to do this job so they “self-selected,”
and we approved. Dave Ward and Mike Barratt were the first. Mike had
some knowledge of Russian, and Dave Ward went with Norm Thagard to
Monterey [California] to study Russian. Later a Russian language course
was offered at JSC. Then they rotated to support the first increment.
Wright: What from your experiences working with the
Russians in the previous years were you able to share with them to
help them know how to handle those experiences once they got over
into Russia? Did you have any good advice for them, or had things
changed so much?
Pool: Things had changed a lot, although perhaps
not for the better during that period of time, when we were dealing
with our Russian colleagues during the Soviet era, we were dealing
with the academicians, and they were “very well placed”
and could get things done. After the changes that were made politically
in Russia, we found that our group of friends and colleagues, while
they were still academicians and revered for their knowledge, were
not necessarily capable of getting the same sorts of things done,
and this created a little bit of a problem. It did help very much
to have Star City and the military cooperate, and they could get things
done. But working with us in this way was a new experience for them
too so we sort of had to learn some of these things together.
How do you get an American flight surgeon to Baikonur for pre-launch
surveys and then eventually to go with the crew to the launch site?
Norm was launched from Baikonur, so all of that took a little work
on everybody's part. There was a fair amount of negotiation, spirited
negotiation, over the medical testing that would be done supplementally
by the Russians. What we had tried to achieve with the Russians was
to accept their medical certification of cosmonauts and to get the
Russians to accept our medical certification of astronauts. If they
said, "Fly these people," we would fly them and vice versa.
That way we wouldn't be doing tests over and over again on the astronauts
or cosmonauts, or doing different testing in each country.
But that was only partially successfully. The Russians had a number
of tests that they considered training, we considered those same tests
medical tests, and we had a lot of long discussions about this. Eventually
we finally reached agreement. Frank Culbertson was one of the key
people who helped us negotiate the agreement.
Wright: Was that agreement signed here in the United
States?
Pool: No, it was signed in Moscow.
Wright: Could you share with us more details?
Pool: We had had months of discussion about the limitations
that we wanted placed on the testing that the Russians would do, and
finally we reached an agreement which we shared with agency managers
for the project.
Wright: Was that at the end of the long stay in Russia
for you?
Pool: It was a component of a fairly major meeting
on the Shuttle-Mir Program.
Wright: Did this program take you to Russia several
times a year or on occasion?
Pool: I would usually go to Russia two to three times
a year. I remember going to Russia for a meeting of their medical
board, and I stayed in Russia slightly less than twenty-four hours,
and then came home. It was a quick trip. That's a long way to go for
a meeting.
Wright: More time in the air than you did on ground.
Is that a correct statement?
Pool: Yes. About twice as long in the air as on the
ground.
Wright: When your surgeons were there, they were
there day to day with the astronauts?
Pool: Yes. Our flight surgeons lived in the Russian
post flight rehabilitation facility called the Prophylactory.
Wright: Were you instrumental in setting up their
initial stay? Was that part of your negotiations?
Pool: Sure. We had to get agreement with the Russians.
That was very easy. The Russians were very quick to accommodate them.
We agreed that part of their Prophylactory, at the Gagarin Cosmonaut
training Center, which is similar to a small hotel, could be used
by NASA. We still use an area on the second floor of the building.
The physicians who are sent to assist our crewmembers stay there.
Wright: Once the American residents are on the Mir,
your flight surgeons are in contact with them on a daily basis. Is
that correct? Or can be?
Pool: Yes. The communications with the Mir, as you
may know, is very limited. It's one of the really difficult areas
for people supporting the program, because the opportunity to speak
with the crew on board was very limited. It's a matter of satellites
and ground stations and access. So we asked the Russians to permit
us to speak to our crewmen privately, each day, and to a certain extent
we achieved that. But there were days in which we didn't get to talk.
Wright: Was that something that was new for them,
to have that request?
Pool: They didn't talk--still don't, as far as I
know--that often, but they do have infrequent private medical sessions
with their crew.
Wright: Is there an area when you were negotiating
that took more time than others to reach the area of satisfaction
that you wanted?
Pool: The most difficult negotiations we had over
the course of the program was the medical certification issue. What
constituted a medically certified crew member? We had experience working
with internationals. The Russians had had experience working with
internationals as well, so maybe our experiences were somewhat comparable
in that. When we first started dealing with ESA and other international
partners, I think we had some pretty carefully thought-out limitations
on what we would accept from them in terms of data and tests and so
on. So we frequently reran all the tests they had done. As we developed
a relationship with them, then we became more open and more trusting
in our work with them, and now we accept them pretty much as equals
in this arena, in this medical arena.
The Russians had maintained their sort of limited, less trusting relationship
up until the start of Mir. So one of the difficulties we had was to
develop the ability to trust each other. But that sort of thing takes
time, and it took time in this case.
Wright: Was there a turning point or a specific situation
when you realized that that trust and that relationship had now begun?
Pool: Well, there's certainly points along the way
that seemed to push us in that direction, but we've not resolved all
the issues with them yet. Perhaps even as we fly the international
space station, we will still be resolving issues. I would expect that,
as a matter of fact.
We've developed more formal ways of working with them. We've established
the Multilateral Space Medicine Board, we have had our first meeting,
signed the charter. We agreed that partner countries, for example,
like Japan, had the need to do certain medical tests which we would
not normally do on our people. As an example, they are very concerned
about certain gastrointestinal tumors which are not unique to Japan,
but are much more prevalent in their society than in ours. So it would
seem reasonable that they would do tests like that, whereas we would
not require it of our people because the yield would be so low. So
our approach is getting more sophisticated.
Doing a psychiatric exam on someone who comes from another culture
is very difficult. We rely heavily upon experts in Europe or Russia
or Japan to assist with that. The Canadians and we are so much alike,
I think, that we could probably trade off. It is important to recognize
that behavioral issues in particular are very sensitive to culture.
We'll have to learn to deal with that as time goes on in constituting
crews. What constitutes a crew that's going to be able to work together
well? There are some things which we do which will help, for example,
train for a period of time before the mission with the crew as a unit
so that they can begin to function as a team.
Wright: When we were first training the cosmonauts
here, did your area have to make many adjustments in order to train
them, or did you train them just like you were doing your astronaut
corps?
Pool: Language has been an issue, and, I suspect,
will continue to be. There were some concerns at times about how well
understood the training was, and even getting good feedback as to
whether or not the training was appropriately received was difficult.
So I think language is an issue and will continue to be.
Wright: Did you prepare written materials in both
languages for them? How did we go about giving them what they needed?
Pool: We attempted to, but not in all cases were
we successful in doing that. It just takes too much time. The job
was just too massive, and I think it would really be difficult for
us to do that so that our Japanese, Italian, Dutch, French, you name
it. Fortunately, for many people, particularly in Western Europe,
they speak English really well, and it's not much of a problem. As
a matter of fact, many of the Japanese do as well, and certainly the
Canadians.
Wright: Might be interesting to have the translators
be skilled in medical knowledge.
Pool: Some are. We were very careful on occasion
to employ people who were skilled both in the language as well as
the discipline, physicians, for example, and other allied health personnel
who were also gifted in translating were used and are used today.
We did that early on. We've done that for years. We've had a group
of people both on our side and on the Russian side who could translate
for people having discussions of medical issues. That's absolutely
essential.
Wright: When the flight surgeons that have been part
of Shuttle-Mir first became employed with you, I'm sure that at the
time they had no idea they would be going to Russia to work with this
program, and I know that, as you mentioned, many of them volunteered
to do that. Is that something now that the ones that are coming into
your area are expecting to do, that this is a norm now that they will
be working with international partners?
Pool: Sure.
Wright: Is that changing maybe in your criteria where
they'll have people that are skilled in languages, or at least skilled
in desire that they want to do this?
Pool: Perhaps that will eventually take place, but
now I think it's necessary to give them language skills sufficient
to do their job. It's been amazing to watch how well they do. They've
done really well, sometimes on fairly short notice. Even the scientists
with whom we work, some of whom are self-educated in the other language,
maybe two or three trips to Russia, and the next thing you know, they're
off arranging MRIs and going around in the community and getting things
done, with the language skills they have, without a translator. I've
watched that change.
Wright: You're watched your personnel evolve into
the situation.
Pool: Some of us are still limited to a few phrases.
Wright: Well, maybe because you haven't been out
there for such a--they were there for several months at a time, is
that correct?
Pool: Not all of them. Some of them were just there
for a few weeks at a time. But they made a big effort to learn the
language, which is great.
Wright: I can ask you the same question, because
when you first started your job with NASA, did you expect to be working
with the Russians in your field?
Pool: No, although then fairly soon after I joined
the agency, we flew Apollo-Soyuz and we worked with the Russians at
that time.
Wright: How were you involved with that project?
Pool: Not very much.
Wright: Then as the astronaut corps or its crew,
your responsibilities, that was just one part of it. I know Shuttle-Mir
was just a part of it. Can you give us an idea of what else that you
do, or what other programs that you worked with other than Shuttle-Mir?
Pool: When I came to work for NASA, I worked on the
Apollo Project and was in mission control for all of the Apollo missions.
After that I worked on a major project to develop technology, and
we weren't flying much after. I worked on a project to develop a telemedicine
system for application on the Papago Indian Reservation, and from
that NASA learned a lot about the future application, those sorts
of techniques, as well as providing, I think, a real service to the
Indian Health Services Center for R&D, as well as the Papago Tribe.
We gave them a much better health care access system.
Then I got involved in medical operations and developing medical systems
which we used to support the Shuttle.
I got involved, in 1977, developing the first set of medical standards
for space flight. The early medical selections for astronauts were
done without a set of standards. The individuals were ranked as to
their health, from the healthiest to the least healthy, and there
were no standards. There were things that physicians used from the
experience. Most of them had military experience. Military did have
standards for aviation, but there were no real standards for space
flight. So, in 1977, actually starting back in 1976, we reviewed the
standards of the DOD [Department of Defense] and the FAA [Federal
Aviation Administration], and began to craft a set of standards we
thought would be appropriate for astronauts.
At the same time, we moved from the pilot astronaut era to the era
of pilot. mission specialist, and payload specialist. So we had to
decide what were the standards for those categories, medically speaking.
Underlying this effort was the premise that we would select people
who would have, from a health point of view, a good chance, a very
good chance, of having a career uninterrupted by medical problems,
and we clearly wanted to eliminate those from the astronaut corps
who would have the potential of having a very serious medical problem
which might either affect a mission, themselves, or their colleagues
in an emergency situation.
In 1977, we published the world's first set of standards to medically
screen astronauts, and we've updated that about every five years since
then. We asked our Russian colleagues did they have a set of standards.
They said, no, they didn't, but about a year later they published
a set of standards which looked a lot like the ones that we had, and
that's normal, because our standards look a lot like the military
standards, too, because that was an excellent experience base for
us to draw from.
I've also been involved in a fair amount of research that's gone on
over the years. I was involved in the development of the NASA JSC
biotechnology capability, which is leading-edge science, and one of
the most important things we're going to do on Space Station.
Wright: Were you able to contribute any of your science
ideas or methods to what was happening on the Shuttle-Mir?
Pool: We put together the science package for the
Mir Program, at least initially, and then the extramural community
contributed to it. But that really started as an in-house effort.
We had a number of programs under way from which we drew to create
the scientific tasks which were to be done on Mir. It was a wonderful
opportunity for us, because now we were given the option of looking
at people who were flying in space for long periods of time, then
getting to see how they adapted and how they readapted when they came
home. We'd only done that with Skylab, and this was a real help to
us.
One of the things that we learned during our closer cooperation with
the Russians during Shuttle-Mir was that while they had a fair amount
of data, we felt that their scientific diligence was not the same
a as ours, and a lot of what they believed to be true was based on
anecdotal experience. There are a lot of limitations to doing human
research in space flight, but some of the things that we had heard
from our Russian colleagues and had previously accepted as factual
based on the science that they had done, we learned later in our Shuttle-Mir
experience were based on things that we would not have given so much
credence to, and, therefore, there were still open questions.
Flying in space, particularly in microgravity for long periods of
time, is not very friendly to the human body. There are a lot of body
functions which degrade. There's a fair amount of deconditioning that
goes on, and the countermeasures, including exercise, which we have
used over the years really haven't solved the problem. So we're still
working that puzzle very hard to try to figure out how to do better.
Cardiovascular system becomes less responsive, particularly on return
to gravitational field. Bone mineral is lost. Neurophysiology is definitely
affected. The Russians say--and I think they're quite correct--that
returning cosmonauts from long missions can't play simple games that
children play, because their coordination and so on is not up to it.
That's certainly been proven true now that we've begun to fly with
them and look at our people similarly.
Wright: Do you believe it's going to be a benefit
to moving into the International Space Station?
Pool: Sure.
Wright: Are there other benefits that you have found
the Shuttle-Mir will provide for ISS?
Pool: I don't think we could have asked for a better
testbed to learn what we needed to know. We looked at the good things
and we've also looked at some things that were lessons for us, and
we had better learn those lessons. The business of having appropriate
redundancy in various life support systems has been made very clear
to us. We must have the ability to deal successfully with contingencies
like fires, and leaking of the atmosphere to the external environment.
Carbon monoxide being released into the cabin as the result of a small
fire. All of these sorts of things have been very important for us
to learn. We've learned a lot about the efficacy of exercise and how
perhaps not to do it. And on and on; the list is long. I'm afraid
the list is longer than our learning curve. Let's see if I can say
it in a better way. There's a long list of lessons, and we have not
learned them all.
Wright: And for you? Do you feel like these last
four or five years that Shuttle-Mir has been fast and furious, the
lessons that you've learned regarding your profession, and how to
make decisions, or whatever you've learned? Could you share some of
those things personally, the growth that you've had a chance, maybe
even watching Russia change? I'm sure it's quite a bit of difference
from the first time that you went to when the last time that you've
gone.
Pool: Yes. I think I have a much better appreciation
of how medicine is handled in Russian society. Perhaps it's handled
a bit differently in the cosmonaut arena than it is in the general
arena of the population at large. I think we have a much better understanding
on both sides. I can't speak for them, but I can say at least for
our side, we have a much better understanding of why they do certain
things they way they do. I think that's helpful if we're going to
cooperate with them on the International Space Station, as we are.
We needed to learn how to do that. It's good to be a long way toward
that goal. We're not fully there, and as I said earlier, it'll take
perhaps a long, long time to ever truly complete this, but I think
we're far enough along we can handle it, which is very helpful indeed.
Now we've got to bring in the Japanese, people from ESA, and the Canadians,
and make it all work together.
Wright: And the book continues; just the chapter
title changes.
Pool: Surely over the years other countries will
want to participate, and we'll have to develop ways of bringing them
in and letting them participate.
Wright: Was there an increment or one of the missions,
even the Shuttle missions that went back and forth to Mir, that has
a special memory for you, that something you wanted to see accomplished
during this time period was accomplished, or just anything significant
that you'd like to share with us that brings back some good memories?
Pool: Well, I think we were all very pleased to see
Norm Thagard come home and get involved in the rehabilitation. I think
he came home with a good experience. Shannon [Lucid], as well. Then
we started to have difficulties, not with people so much, but with
the Mir systems--coolant leaks, a fire, a number of things like that
which, really, we had to work very hard. We first had to understand
what went on with our Russian colleagues, because in some cases we
were both in the fact-finding mode. Some cases they knew, and some
cases they had to share that with us, and some cases we both didn't
know. We just had to go find out. There were some difficult times
in dealing with this, and I think that's good because of what we learned.
I'll give you just one example of something we've--I hesitate to say
"learned." That may be not the right way to put it. When
they had the fire on the Mir, one of the problems they encountered
was that in a smoky cabin, with an oxygen mask on--which is, by the
way, what you ought to be doing--you couldn't communicate with each
other. They couldn't use hand signals very well because the smoke
in the cabin, and they couldn't hear each other. I don't know whether
you've ever tried to talk with somebody with a mask on, but the voice
is muffled, and you can shout as loud as you like, that may only increase
the difficulty of understanding. Plus you're speaking in a different
a language in a very stressful situation. So how do you fix that?
Well, one of the things we ought to consider doing very quickly would
be to develop a mask which would permit people to communicate with
other people who have the mask on. That would be helpful in a smoky
cabin, helpful if you're on each side of the cabin and can't shout
loud enough to be heard. So there are a lot of little things like
that, that we need to work on and ultimately fix for Space Station.
Wright: I think so many times when people think about
medical issues, they think of physical ailments or physical problems.
Pool: Well, we're more like an occupational health
unit in that we look at the environment and how the human adapts to
that environment.
Wright: I know your area was responsible for so much
of bringing back and testing and making suggestions.
Pool: Yes. We did bring back a lot of samples from
the Mir and the Shuttle, and still do, and test them for water quality,
air quality, whatever.
Wright: I'm glad you were there, and I'm sure that
those astronauts that were in residence as well as there on the Shuttle
that are glad that we have such a good crew of people down here supporting
them.
Pool: Thank you.
Wright: We thank you for your time. We appreciate
you doing it.
[End of interview]