The ultimate career… Physician-Astronaut?

Yep.  Why not? After my bid in 2008 failed to secure me a job with the Canadian Space Agency, the next recruitment for the Canadian Astronaut Corps closes next week and my application is ready to go.  Below is my (draft) cover letter.  I’ve decided to crowd-source editors (you!) to help me shine!  Have at ‘er in the comment section below 🙂

To The Canadian Space Agency:

The last time I applied to be an astronaut, I did so because I thought space exploration was an exciting and noble avenue. Since then, my commitment to being an astronaut has strengthened and my motivation has matured. As a physician and flight paramedic, I am uniquely suited to provide health care in adverse environments and stay calm and resilient in stressful operational situations. As a scientist, I am intellectually positioned to contribute to our understanding of the physical and biological world we live in, and ethically bound to the highest standards of integrity. As a traveller, public speaker and writer, I am well positioned to communicate the virtues of space exploration to a global audience; and as an accomplished collaborator, I have the temperament and disposition to represent Canada in the global space industry. Most importantly, my motivation and industrious nature, combined with my dogged determination, should assure you that I will succeed as a Canadian astronaut.

Since I was a child, I have been an explorer. I have a fascination with Earth, indeed having tried to visit every corner of the globe, from SCUBA diving the depths of the Pacific to hiking in the heights of the Himalayas. On every trip I take, I can’t help but lay out in the open air in the middle of the night, staring at the sky, noticing which constellations I can spot from different points on the earth. In these star-gazing moments, my mind wanders to what I assume are the borders of the universe, and knocks on what is beyond even my wildest imagination. The moon, particularly, makes me feel united and whole wherever I am on Earth; I reach for it, feeling both small and big all at once. So many worldly problems can be solved if we advance our understanding of the planet we live on. To do that best, we must sometimes leave it.

Allow me to articulate why I am a formidable candidate for the Canadian Astronaut Corps. You will find supporting evidence demonstrating these qualities and abilities in my CV.

Integrity. My mantra has always been “integrity above all else.” Success in both my personal and professional lives has been facilitated by my commitment to honesty, sincerity and effort. I have developed a reputation for being dependable, determined and trustworthy. As a scientist, the validity of my findings are judged first on my personal reputation, and then, on the methods of the research. In medicine, the bonds I have developed with other health care providers determines if my clinical opinion is respected and acted upon. I am invited to collaborate on international, national and local committees based on my past performance and ability to not only build but maintain relationships. This is only achievable when one places their personal integrity above all other considerations.

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I might be in over my head…

Judgment. Throughout my career, excellent judgment has lead to excellent results. As a flight paramedic, I was faced with critically ill patients, incomplete information, a small, loud environment where traditional stethoscopes and interviews were useless, and time was of the essence. Here I developed skills to make important clinical and operational decisions based on “best available” information, adapting plans as new information arose or clinical changes dictated an alternate course of action. In this mobile, dangerous and stressful environment, I developed the ability to control my own responses to stimuli, demonstrate resiliency, and maintain situational awareness. As a scientist, there are many “easy ways” forward but few “right ways”. Good judgment is required to ask the right question, develop a rigorous and ethical approach to answering it, and develop the systems and collaborations required to execute a research project. Further judgment is required to navigate the political and technical aspects of academia, grant mechanisms and publishing. As a physician in the emergency department, I have continued to develop outstanding judgment skills. While not as chaotic as the field, I have evolved in my ability to multitask: some days there are over 100 people in the emergency department at any given time. Lastly, my travels have taken me to 76 countries, many of which required cultural, environmental and security considerations. Whether scuba diving, mountain climbing or exploring an urban core, I have a commitment to absorbing all available information, processing it without undue emotional noise, and acting accordingly.

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I hope they were looking for my match-up of cranial nerves to the muscles of extraocular movement… “four to the floor, six to the sticks, and 3 for everything else”

Reasoning. I have a demonstrated ability to take large amounts of information and make sense of it. And when I do, I’m trained to check my assumptions against possible biases, challenging my mind and my gut to ensure I am on the right track. I believe in analytic, evidence-based reasoning so long as it passes the “gut check.” I am trained to intuitively and quickly make split second decisions, all while checking my instincts against tried-and-tested tests. Be it in medicine, flight paramedicine, scientific study, or the board room, I bring a questioning mind that formulates accurate answers.

Resourcefulness. Whether treating patients in Ontario’s North or remote Uganda, I am often working in an underresourced setting. Just recently, I was the night physician for a music festival where 50,000 people camped out on a farmer’s field. Providing medicine in austere environments forces one to think outside the box, adapt previous habits, and solve problems with available resources. This includes managing physical as well as human resources to maximize operational effectiveness. I believe a key factor in one’s success in resource-limited settings is to know the resources available; when a preferred medication is not available, another might be appropriate for substitution; when a piece of equipment is broken and can’t be repaired, duct tape, suture string, or laceration glue may be sufficient to return the tool to service temporarily. In Uganda, I remember mixing salt and boiled water to make a sodium chloride infusion; a strong understanding of the solution allowed me to create what was lacking, rather than stare helplessly at the empty stock cupboard. Preparation and knowledge, when combined with experience and creativity, have allowed me to be resourceful in difficult situations.

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I like to think a ventilator is harder to operate than a space shuttle. Note PEEP actual vs PEEP setting.  Sigh.

Ability to synthesize plans. As one of my mentors used to say, “a vision without execution is a hallucination.” I try to keep this in mind when coming up with plans to execute ideas. Knowing the destination is a start, but the real work often occurs in mapping a route to success. In my efforts as a scientist in medical science, I worked in a very challenging field; out of hospital cardiac arrest. This involved huge data coordination and provider training efforts. The randomized clinical trials I was involved with involved over 200 ambulance operators employing over 10,000 paramedics, 100 receiving hospitals, dozens of dispatch centres and covered a population of 20 million people. Planning was key to the success of our trials, and a skilled interdisciplinary teams of stakeholders, computer programmers, data abstractors, statisticians, field providers and scientists worked painstakingly to execute trials across the network, landing several high profile publications that have influenced how cardiac arrest is treated worldwide. From this decade-long work to a day-to-day view, treating critically ill patients requires rapid synthesis of treatment plans that must be fluid and able to adapt to changes in patient condition, new information, and department demands. Whether planning for a long-term project or caring for a patient in front of me, I have developed strong skills in creating and executing plans to achieve the desired outcomes. 

Communicating and Public Speaking. I am an experienced writer. Whether scientific manuscripts, trade industry editorials, or public blogs that break down complex topics into understandable puzzles, I am able to clearly communicate complicated topics. I am also an accomplished and sought-after public speaker. I am frequently invited to speak locally, nationally and internationally on controversial and emerging topics in the area of emergency medical services. My audiences have included international scientists trying to grapple the challenges of just culture and patient safety (delivered using a live translator) to local groups of students eager to learn more about working on a medical helicopter. My written and oral communication skills are about to expand further; I am starting an intensive, 8-month fellowship in Global Journalism at the University of Toronto Munk Centre for Global Affairs. This mentored journalism program will teach me the skills needed to communicate with the public via traditional, online, broadcast and social media platforms and further develop my strong abilities as a communicator.

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Preparation.

Teamwork and Leadership. In both medicine and emergency operations, it is impossible to tease out leadership and teamwork; without one, the other cannot be. A strong leader motivates and directs teams to perform exceptionally. Strong leaders can transition into the role of a follower, contributing to the functionality of a group as needs change and roles evolve.   Perhaps this is most true in two of the environments I thrive best; the scene of an emergency and the resuscitation bay of an emergency department. In both these settings, up to a dozen or more people may be working under stressful and under-resourced conditions to save a life. Necessary steps must be prioritized and needs anticipated. It is in this environment that I have honed my leadership, teamwork and crisis communication skills to become a respected and valued resuscitator. Teamwork is also required in my research and governance activities. On the Board of Directors for the MedicAlert Foundation of Canada, I have led the transformation of a dying industry focused on bracelets to a healthy, mission-focused organization embracing wearable technology, satellite communications and e-commerce. In my roles with Resident Doctors of Canada and the Professional Association of Residents of Ontario, I work hard to represent the needs to residents and improve wellness and resiliency amongst my colleagues across Canada.

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I don’t even know what Geodesy is.  But I’m really good at Tetris.

Motivation. If the tone of this letter has not already conveyed the excitement and motivation I feel towards the possibility of joining the Canadian Astronaut Corps, be assured that serving in space is a serious endeavor for me. I work hard to be physically and mentally fit. I have sought advice of past Canadian physician-astronauts, particularly Dave Williams, as well as past physician candidates, one of whom I have worked with in the past. I have sat down with my “board of directors” – mentors and advisors from all walks of life – who have supported my decision to apply and challenged my motivations, biases and preconceptions of what this could mean for my life. I am beyond motivated; I am determined.

Living and serving in space is beyond unique and challenging,; my extensive preparation means I’m ready to serve in the Canadian Astronaut Corps.

Submitted respectfully,

Blair Bigham