A NASA astronaut and flight engineer for the Expedition 19 space mission, Dr. Barratt blasted off on March 26 from the Baikonur Cosmodrome in Kazakhstan aboard a Russian Soyuz TMA-14 spacecraft. This first space flight for Dr. Barratt makes him the second medical school alumnus to live and work in space; on May 25, 1973, physician-astronaut Joseph P. Kerwin, MD ’57, served on NASA’s first-manned Skylab 2 mission.

Going boldly where still few have gone before, Dr. Barratt arrived at the ISS thanks, in part, to his expertise in aerospace medicine. “I went into medicine because I liked working with people,” said Dr. Barratt in an oral history produced by NASA. “It was a relatively broad field, but as I went through it, I realized that I’d like to broaden out a little bit further, and started realizing that there was this entity called aerospace medicine, that I love to fly and do a lot of other things that were outside of the normal office routine.”

A broad field in its own right, aerospace medicine involves the health, safety, and performance of persons engaged in air and space travel, according to the Aerospace Medical Association (AsMA). The extreme environmental aspects of this specialty area require knowledge of the effects of microgravity, radiation exposure, G-forces, and hypoxia, to name a few conditions, on the human body.

While Dr. Barratt completed a “civilian” aerospace medicine residency and master’s degree program at Wright State University in Dayton, Ohio, other specialists often obtain their training via the military where they have access to flying personnel. For example, 38 percent of AsMA’s membership of 3,000 has military ties. For the small, but significant, number of Northwestern alumni who count themselves as aerospace medicine specialists, serving in the military began as a way to finance their medical educations and give back to their country. It has also allowed them to care for a high-flying patient population, ensure the safety of those involved in air and space travel, and offer general clinical services. Such has been the case for three alumni of the medical school—featured here in this Ward Rounds story—whose aerospace medicine expertise gives new meaning to the “friendly” skies.

Navy Lt. Christine R. Stehman, MD ’04, doesn’t speak either of the two official languages of Afghanistan—Pashto and Dari (Eastern Persian)—but that didn’t stop her from volunteering to run an Afghan women’s health clinic during a recent deployment. In March Dr. Stehman returned to the states after serving as the flight surgeon for a squadron of some 300 Marines stationed on a NATO base outside of Kandahar. In addition to her assigned duties, she provided health care services to spouses and children of members of the Afghan National Army who were being mentored by coalition forces.

Explains Dr. Stehman, “They didn’t have a lot of female health care providers to see these women who, because of cultural restrictions, aren’t allowed to take off their burkas in front of men.” Filling this void until a permanent female physician could take over the clinic, she helped to raise awareness about the importance of improving the medical treatment of Afghan women.

Dr. Stehman attended Northwestern on a Navy scholarship. After graduating from the medical school in 2004, she completed a one-year internship at Naval Medical Center San Diego. At that point she was ready for one of five operational tours, working either with undersea, shipboard, clinic, Fleet Marine Force (a branch of the Navy), or flying units. She chose flight surgery training—a combination of six months of specialty coursework and on-the-job experience—because it offered a skill set that she felt would likely not come along once she traded the Navy for civilian life. In fact, this summer she left the military—although she remains on active reserve—and started an emergency medicine residency at Chicago’s Stroger Hospital of Cook County on July 1.

“We treat a relatively healthy population of people who must stay in top shape,” explains Dr. Stehman about her former job. Based at the Marine Corps Air Station Miramar, she cared for helicopter squadron personnel. “If someone is not paying attention or they do something wrong with a helicopter, a lot of people could die.”

Dr. Stehman’s duties as a flight surgeon—a term from the past used for all military physicians even though most were and continue to be primary care specialists—focused on general internal medicine concerns with a little preventive medicine or orthopaedic work thrown into the mix. She also provided human-factors counsel for investigations of aviation mishaps as well as advised commanding officers on medical matters from grounding a pilot to sending a Marine home from a deployment. The “flight” in her title required that Dr. Stehman log time in the air. She flew as part of a helicopter crew. Describing the military copters she traveled in as hovering 15-passenger vans, she literally served as a backseat “flier.”

“The pilots in these helicopters can’t see beyond 3 p.m. and 9 p.m.,” says Dr. Stehman. “The crew helps them with seeing down and back.”

While flying became very much a part of her job, Dr. Stehman enjoyed her military air travel due to the trust she placed in those whose health she oversaw. “I liked flying with my guys and doing what we did,” she says. “If you stuck me in a little Cessna, I don’t know how excited I would be about that.”

The fighter pilot had recorded 3,000 hours flying F-106 fighters. Capable of making sharp turns and pulling out of dives with ease, the F-106 was the go-to plane for “dogfights” in the air 50 or so years ago. One day assigned to fly an F-105 bomber, the pilot did what he had always done in the F-106—he dove toward the ground at high speed. Unfortunately the sharp pullout he expected didn’t occur.

As the Air Force (AF) accident investigation board tried to figure out how an experienced fighter pilot could make such a fatal error, it was a physician sitting on the board who provided the answer. “I had been the flight surgeon for a squadron of F-106 fliers so I knew how those planes reacted,” explains Col. James H. Oliver, MD ’57, MPH, now retired and living in Upland, Indiana. “The board thought this pilot should have been able to pull the plane out of its dive but I asked, ‘Have you ever flown an F-105? If you had, you would have never tried a deep dive, expecting the plane to pull out of it quickly.’”

In this case, the pilot paid dearly for his mistake. Yet for Dr. Oliver, who helped analyze the human factors involved in several accident board investigations during his more than 20 years of active duty in the Air Force, this particular incident didn’t follow the usual pattern. Rarely did pilot error cause an aviation accident, according to Dr. Oliver, whose area of medical expertise gave him special insight into the world of aviation.

Drafted into the military like many of his fellow physicians at the time, Dr. Oliver chose aerospace medicine because he liked working with pilots and flying. “As a flight surgeon you are basically a general practitioner who cares for pilots and their families and periodically you get to fly on an airplane,” he says. “If the pilots feel you are a ‘good guy’ you might even get to pilot the plane!”

Dr. Oliver spent his first four years in the military as a flight surgeon stationed at Elmendorf AFB in Alaska. He then went on to an aerospace medicine residency at the University of California at Berkeley for one year and at Brooks AFB in Texas for another two years. Dr. Oliver logged 1,800 hours of flight time during his career and flew in 27 different airplanes in which he often sat in the copilot’s seat. Stationed in Thailand during the Vietnam War, he flew some 50 combat missions in large helicopter gunships. Following the common practice of flight surgeons, Dr. Oliver took to the air not only to better understand the physical stresses that flight places on pilots and passengers but also, and most importantly, to strengthen patient-physician relationships. Close bonds help keep the lines of communication open so that pilots feel comfortable discussing rather than hiding their health concerns. “Most pilots are scared to death of doctors because they fear being grounded because of health reasons,” says Dr. Oliver. “You have the potential to ruin a pilot’s life.”

In 1978 Dr. Oliver retired from the military although he remains a “regular” officer and could still be called for duty. He went into private practice in preventive and general internal medicine first in Kansas and then Indiana and provided Federal Aviation Administration (FAA)-required physicals for commercial and recreational pilots as a certified FAA senior aeromedical examiner. He retired from medicine in 2007.

Dr. Oliver had the good fortune of combining two interests—medicine and aviation—in a long and enjoyable career. He passed on the latter passion to son Bradley, now an AF major and F-18 fighter pilot working at the Pentagon in Washington.

When Jon M. Casbon, MD ’80, completed his family practice residency at St. Joseph’s Hospital in Phoenix in 1984, it was time to pay back the Air Force for financing his Northwestern education. Although he completed training to become a flight surgeon, the Air Force had other plans. It first assigned Dr. Casbon to practice family and primary care medicine and then steadily promoted him to leadership roles at bases in the United States and Europe.

Moving up in the ranks to his current position as an AF colonel stationed at Offutt AFB in Nebraska, Dr. Casbon didn’t practice aerospace medicine until August 2003 when he became commander of the 89th Aerospace Medicine Squadron located at Andrews AFB in Maryland. In this role he led and directed some 160 military and civilian personnel in areas of aerospace medicine ranging from flight medicine and bioenvironmental engineering to aeromedical staging for the reception and care of wounded soldiers returning from Iraq and Afghanistan. He also got to see a lot of “very important” people land and take off from Andrews, home of the official U.S. presidential aircraft known as “Air Force One.”

“At Andrews I finally got to use the ‘wings’ I had earned so many years before in flight surgery school,” remarks Dr. Casbon. “So in 2003 I had my first real exposure to the specialty and I decided, ‘Hey, I really like it. This is what I want to do,’ and that’s when I had my midlife crisis!”

So in 2005 at age 49, Dr. Casbon enrolled in the Air Force’s aerospace medicine residency program at Brooks AFB—one of only four accredited U.S. residency programs in the specialty. As part of the curriculum, he earned an MPH degree at Johns Hopkins University in 2006. A year later he became board certified in aerospace medicine and then opted for a third year in his residency program to achieve accreditation in occupational medicine. Dr. Casbon completed his training in July 2008 and moved on to his next assignment as commander of the 55th Medical Operations Squadron at Offutt AFB. In charge of guiding 300 military and civilian personnel providing primary and specialty care to 29,000 individuals, Dr. Casbon—ironically—does not have any aerospace medicine responsibilities. He does, however, serve as the base’s occupational medicine consultant in matters pertaining to flight medicine as well as traditional concerns of the specialty such as hearing protection, exposure to hazardous chemicals, and workers’ compensation.

“Aerospace medicine, like other specialties, has links to preventive as well as occupational medicine,” explains Dr. Casbon, who enjoys the epidemiological aspects of preventing disease and reducing occupational hazards. “Aviator is an occupation, and there are many different types of aviation occupations from flying to repairing planes.”

In regard to his own career in aerospace medicine, Dr. Casbon is once again paying back the military for his recent graduate medical education. Although currently in a clinical role and not in charge of fliers, his situation could change. After all, in the past 12 years, he has moved every 24 months to different AF jobs and bases. Says Dr. Casbon, who has already served 25 years in the military, “Well, the Air Force still has a commitment of a few more years from me due to my residency training, so you never know. I could get to use my wings in the future.”

As Dr. Casbon and his fellow Northwestern alumni have discovered, practicing the specialty of aerospace medicine presents many opportunities outside the usual office environment that can take off at a moment’s notice. From flying off to the “wild blue yonder” to residing in space as Dr. Barratt is now exploring, practitioners of this unique area of medicine feel especially fortunate for their colorful and exciting experiences—from below as well as high above the Earth’s atmosphere.