Table of Contents

Space Medicine

Canada's Aerospace Medicine Pioneers

Dr. Carpentier: Apollo flight surgeon

William Carpentier, a small-town boy from Vancouver Island, British Columbia, started his university career with plans to become an engineer, not a medical doctor. Throughout his short career at NASA, he experienced a number of other unexpected turns, like jumping out of a fast-moving helicopter into the ocean and serving as flight surgeon for Apollo 11, the legendary spaceflight that carried the first men to the moon.

• The World Famous Physician
• From Physics to Space Medicine
• The Gemini Years
  • First Signs of Physiological Adaptation to Microgravity
  • Recovery Team Training
  • Pre- and Post-Flight Testing: Orthostatic Intolerance in Astronauts
• The Apollo Years
• Moving On
• References

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The World Famous Physician

It was the fall of 1969 and Dr. Bill Carpentier was on a goodwill tour of the world in the company of the first men to walk on the moon. As the Apollo 11 crew flight surgeon, he’d been waiting for Neil Armstrong, Edwin (Buzz) Aldrin and Michael Collins in the recovery helicopter that hovered over their spacecraft after it dropped into the Atlantic Ocean on July 24. He’d been locked up with the crew through nearly three weeks of quarantine, performing medical tests and watching for signs of illness after their return from the moon. And then, medical bags in hand, he was at their side during a seemingly endless succession of parades, press conferences and state dinners during an exciting but tiring 45-day world tour.

Ferried by the presidential airplane, Air Force One, the astronauts visited 27 cities in 24 countries. So many people wanted to see them that they couldn’t possibly fulfill all requests; as a result, Carpentier was often pressed into duty as a substitute by the State Department representative on the tour, who would tell people that "we’ve got somebody else, almost as famous, for you."

"The State Department guy would say, ‘Get me the doctor, he’s famous enough.’ " Carpentier remembers with amusement. That’s how he acquired the initials WFP (World Famous Physician) after his name on the Air Force One manifest. The astronauts and their wives jokingly referred to him as "Famous."

In Spain, Carpentier visited a flamenco nightclub as the astronauts’ stand-in. The owner, who was expecting the Apollo 11 crew, had alerted the media. "It was supposed to be very hush-hush but there was an enormous crowd and television cameras," said Carpentier. "The owner came to the car and said, ‘Where’s the crew?’ He was told they weren’t able to come but ‘we have somebody almost as famous.’ He said, ‘You’ll have to do.’ I got out looking as regal as possible. The cameras followed me into the club and the entire audience stood and applauded. That was my ten minutes of fame in Madrid."

Throughout the tour, Carpentier carried two medical bags at all times. One was a standard kit; the other contained equipment for treating serious trauma. It was only a few years after the assassination of President John F. Kennedy, the man whose edict sent these men to the moon. "I was living in fear that something was going to happen," he said. "The crew were in open cars all the time."

Fortunately, the only medical incident was a non-event in England—although it became a media sensation that caused Carpentier to miss the state dinner at No. 10 Downing Street. It all started innocently enough with a request for the astronauts to take calls from school children with questions. The event was cancelled because there just wasn’t time in the schedule. What was unfortunate was the way the refusal was phrased. "We said they were not able to do this," said Carpentier. "The phrase ‘not able’ was interpreted as indisposed." The next thing he knew, there were headlines suggesting that "moon germs" had felled the astronauts.

Carpentier immediately got a call from Charles (Chuck) Berry, NASA’s medical director of manned space flight, in Houston, asking what was going on. Explaining the situation made him late for the dinner at Prime Minister Harold Wilson’s residence. "By the time I got there, dinner was well underway. I drank gin and tonic in the anteroom. After it was over, everybody came out, mingling and talking and having port. That’s when I met the Prime Minister. The one time I ever get to meet a Prime Minister of England and the thing he said to me was, ‘Hrmph, you’re the villain the press is talking about.’ "

Still, it was all quite a rush for a young Canadian doctor who hailed from the small town of Lake Cowachin, British Columbia. "I got to meet crowned heads in Europe, I met the Pope, prime ministers and presidents. It was pretty heady stuff. That was an incredible thing to happen to a kid from a logging camp town in the middle of Vancouver Island."

Certainly, it was not the path he’d expected his life to take when he first embarked on a medical career.

From Physics to Space Medicine

In high school, Carpentier wasn’t even thinking about medicine. He enjoyed physics and planned to become an engineer. But after his first two years of university in Victoria, B.C., he found he really disliked physics. His sister, a nurse, introduced him to the world of medicine. "She showed me around the hospital and I got to talk to a few people. And I thought, here’s where I belong, here’s what I want to do."

Around the same time, he developed an interest in flying and got his private pilot’s license between his first and second year in university. "That was something I came to like a great deal, being able to fly, but I couldn’t do much of it because I was putting myself through school and it was expensive. I got my private license but I didn’t do anything with it."

Once in medical school, he was initially attracted to psychiatry; he studied narcotic addiction and spent some time working in the prison system. But by the fourth year, his interest in this field had waned and his previous fascination with flying reasserted itself, so he decided to explore the possibility of a career in aviation medicine. Discovering that Ohio State University had a program, he applied there. Moving to the U.S. in 1961, he did his internship at Ohio State University Hospital and completed two years of residency in aviation medicine there.

"In the third year, every resident was assigned to some facility where they were doing more clinical aviation medicine. At that time, I didn’t know where I was going to go because I was down in the United States as an exchange visitor. I didn’t even have a work visa because I had never planned to stay. I was going to go back to Canada."

He went to McGill University in Montreal to talk with Geoffrey Melville Jones, a Canadian pioneer in aviation medicine research. Melville Jones arranged for Carpentier to study for his PhD at McGill, with the possibility of additional research training in aviation medicine at the University of Toronto or the Royal Air Force’s Institute of Aviation Medicine in Farnborough, England. "That’s what I planned to do. I was going to go back to Canada and do research for the rest of my life."

That was when he was confronted with an irresistible lure: NASA created an opportunity for third-year residents to train in operational space medicine. "It was the space program. It was just such an exciting thing for me to even contemplate. When they said they couldn’t pay me very much as a resident, I said, if necessary I’ll pay you."

Being a Canadian didn’t prevent him from winning the placement, but it did cause a six-month delay in starting the program because he needed to get a work visa and a top-secret security clearance. Finally, in January of 1965, at the age of 28, he arrived at what was then NASA’s Manned Spacecraft Center (later the Johnson Space Center) in Houston, Texas. 

The Gemini Years

Carpentier arrived after NASA’s first phase of human spaceflight—the Mercury program—had been completed but before astronauts started flying the second phase, the Gemini program. Ironically, his first boss was a Canadian. Owen Coons, a flight surgeon formerly with the Royal Canadian Air Force, had been lured to NASA in 1963 by Chuck Berry, whom he’d met while taking an aviation medicine course at Harvard University. Coons was a good doctor, a good leader and a personal mentor, said Carpentier. "I think everybody can go back and find people who were very influential in their life and he was certainly one of them."
(See "Canada’s Space Medicine Pioneers – Owen Coons")

Assigned to NASA’s medical operations office, Carpentier became one of the doctors who took care of the astronauts. With only a few space flights of short duration completed, the doctors were just beginning to get a handle on what microgravity did to the human body. Before humans had flown in space, there had been a lot of speculation—some of it rather wild—about a wide range of possible effects: Would astronauts be able to swallow in microgravity? Would their digestive tracts work normally? Would their hearts hold out? Would they experience psychotic episodes caused by isolation?

"Before we actually flew, we were talking about congestive heart failure, cutoff phenomena due to isolation and psychiatric difficulties. We worried about choking if they ate," said Craig Fischer, NASA’s Chief of Space Medicine and Health Care Systems. A veteran of the early days, he characterized most of the early concerns as "just off the wall."

Nevertheless, both the Americans and the Russians were sufficiently concerned that they flew dogs and monkeys first. The animals quickly disproved the most elementary fears. "The dogs ate well and drank well," said Fischer. Ham and Sam, two monkeys flown by the Americans, also did fine. NASA also tested human subjects on earth. "When we put our own people in zero-g for brief periods of time, we proved you could swallow just fine."

As a result, when Russian cosmonaut Yuri Gagarin flew the first orbital flight in April 1961, no one expected life-threatening difficulties and "he did it without incident," said Fischer. American astronauts Alan Shephard and Virgil (Gus) Grissom flew suborbital flights shortly afterwards and they, too, experienced no problems. But these flights were very brief; Gagarin stayed up less than two hours, while Shephard and Grissom experienced only 15 minutes in weightlessness. John Glenn, who flew the first U.S. orbital flight in February 1962, circled the earth three times in five hours. According to a NASA history document, "the astronaut’s performance during all phases of the mission was excellent and no deleterious effects of weightlessness were noted."

First Signs of Physiological Adaptation to Microgravity

It wasn’t until the last Mercury flight, a 22-orbit, 34-hour mission flown by Gordon Cooper in May 1963, that an astronaut stayed in weightlessness longer than a day. That’s when the first signs of the human body’s adaptation to microgravity became apparent. "After Mercury, we knew they could swallow and they could eat," said Carpentier. "The gastrointestinal tract and the urinary tract seemed to function. There wasn’t a great deal of vertigo and they could see and so forth. The first real problem was cardiovascular deconditioning."

This was manifested in a phenomenon known as orthostatic intolerance, in which symptoms such as lightheadedness, accelerated heart rate, and sometimes fainting occur when the affected person stands up. These are signs that the cardiovascular system is having trouble maintaining blood pressure and blood flow to the brain. Other symptoms can include tremulousness while standing, weakness, fatigue, and poor concentration.

In otherwise healthy astronauts, the condition results from one of the body’s adaptive responses to microgravity—a drop in blood volume. When they return to earth’s gravity and blood is pulled to the lower body, the reduced volume makes it all the more difficult for the cardiovascular system to keep blood pumping to the brain. The problem is further exacerbated by the fact that veins in the lower body may become more distended, allowing increased pooling of blood in the legs.

"Cooper got dizzy when he stood up," said Carpentier. "That was the first real medical problem that was observed and it has become the most studied problem in the entire operational space medicine program to date." It was a problem Carpentier would continue to study for the next four decades.

No one knew how much to be concerned about the results from Cooper’s flight, but they influenced planning for the upcoming Gemini flights. The major goal of Gemini was to test the hardware, procedures, and the people needed to fulfill President Kennedy’s 1961 pledge to send humans to the moon and return them safely to earth before the decade was out. Therefore, the Gemini flights gradually increased the amount of time the astronaut crews stayed in weightless up to 14 days. "That’s how long it was going to take to get to the moon and back," said Carpentier. "That was what everybody was working for; they had to determine, can a man survive in weightlessness for 14 days and come back and be okay."

The first manned Gemini flight, Gemini 3, lasted just five hours. Gemini 4 lasted four days, Gemini 5 eight days and Gemini 7 just under 14 days. (Gemini 6 and Gemini 8 through 12 were short-duration flights lasting less than four days.)

Recovery Team Training

One of Carpentier’s more hair-raising responsibilities during the Gemini program was learning how to jump out of a helicopter into the ocean. NASA had assembled a large medical team to go out on the aircraft carrier that picked up the Gemini 4 astronauts, who had spent four days in microgravity. "Nobody knew what was going to happen and they wanted all specialties represented in case an astronaut needed to be treated for whatever reason," said Carpentier. One of the doctors in that group was assigned to ride in the recovery helicopter that was sent out to pluck the crew out of the Pacific.

The recovery team included a group of Navy divers that usually functioned as an underwater demolition team (UDT). They jumped into the water to assist the crew out of the space capsule and into a life raft in preparation for being hoisted into the helicopter with a "horse collar" device. If the astronauts were injured or required medical attention in the raft, the doctor on the helicopter would also have to jump into the water.

"The guy who was assigned to this job on Gemini 4 was not a very good swimmer and he did not really like jumping into the water with the underwater demolition team to rescue injured astronauts should that occasion ever arise," said Carpentier. He, on the other hand, was intrigued by the idea. "Since I was a new, gung-ho flight surgeon and had taken competitive swimming courses and had scuba diving training, I thought jumping out of helicopters would be great fun."

He mentioned this to Coons and "after Gemini 4, he came to me and said would you like the job of riding the helicopter to rescue astronauts? I said, ‘Hell, yes. I’ll jump out of any helicopter you’ve got.’ So I went on Gemini 5, Gemini 6 and Gemini 7. I got the job of riding in the recovery helicopter and training the Navy frogmen for astronaut rescue operations in the event of possible astronaut injury or incapacitation."

Even though it was likely he would never actually have to jump, Carpentier decided he should practice the procedure. He recalls that a colleague in the medical office told him the Navy divers went out of the helicopter 40 feet above the water at a speed of 20 knots—something that definitely required being in good shape. "I thought, if they can do it, I can do it. Dr. Coons called the Coast Guard and said, ‘I’ve got a guy here who’s going to be going out on rescue for the space program, to pick up the astronauts, and he’s got to learn to jump out of a helicopter. Can you take him out in the Gulf and drop him in the ocean and pick him up, so he can get used to it?’ So off I go."

When the Coast Guard pilot asked him exactly what he wanted to do, Carpentier explained he needed to go out of the helicopter at 40 feet and 20 knots. "He said, ‘you want to do what?’ I said, ‘I’ve got to be able to do this because this is what the underwater demolition team does.’ He said, ‘Well, I don’t know if we can do that.’ And I said, ‘I’ve got to do it.’ "

They started off cautiously, doing a jump at 20 feet and five knots. The pilot then wanted to try 20 feet and 10 knots, but Carpentier decided to cut to the chase and went out at 40 feet and 20 knots. It gave him quite a jolt, but he kept telling himself he could do whatever the Navy divers did.

When he went out to the carrier that would pick up the Gemini 5 crew, he met the UDT team, comprised of men twice his size and much younger in age. "They said, ‘Have you ever jumped out of a helicopter.’ I said, ‘Yeah, I went out at 40 feet at 20 knots.’ And they said, ‘you did what?’ " It turned out that they usually went out much lower and slower. In fact, they told Carpentier, the helicopter typically hovered over the spacecraft during the recovery operation. "So not only did they have an old guy—I was 29 at that time—but they had a demented 29-year-old," Carpentier laughed.

Several years later, during a training exercise for the Apollo program, he accidentally jumped out at more than 100 feet above the water as a result of a miscommunication between the helicopter pilot and the UDT team. He remembers thinking that it was taking a very long time to surface after the jump. Unfortunately, the mishap occurred in view of the carrier, so they were ordered to return immediately and everyone got chewed out. Afterwards, the UDT team presented Carpentier with parachute wings because of the height of his jump—even though it had been accomplished without the benefit of an actual parachute.

Although Carpentier did numerous jumps during training exercises, it was never necessary during real recovery operations. "There was never any time that an astronaut needed medical assistance during the whole thing."

Pre- and Post-Flight Testing: Orthostatic Intolerance in Astronauts

One of Carpentier’s major responsibilities during the Gemini program was to conduct pre- and post-flight tests on the astronauts to determine the extent of orthostatic intolerance they experienced as a result of being in weightlessness. He did this by putting them on a "tilt table" that tipped them from a horizontal position to 70 degrees for 15 minutes while he measured their heart rates and blood pressure. These were among the first tests done on crews returning from space.

Earth-based studies had previously suggested that orthostatic intolerance resulted from an actual loss of blood volume in space. This theory was borne out by tests on the Gemini astronauts; on Gemini 4 and Gemini 5, NASA doctors measured reductions in both the volume of blood plasma (the liquid part of blood) and the number of red blood cells.

This phenomenon is a direct result of the body’s adaptive response to microgravity. On earth, bodily sensors that regulate fluid volume allow for the fact that gravity is pulling blood toward the lower part of the body. In space, fluids are more evenly distributed throughout the body—that’s why astronauts appear to have puffy faces—and the sensors are confused into thinking there’s actually too much fluid volume in the central part of the body.

The result is that astronauts start losing fluids rapidly—for example, their urine output increases as soon as they get into space. This causes a drop in plasma volume and reduced production of red blood cells. "Plasma volume has been shown to decrease about 20% in the first 24 hours in orbit," said Carpentier. It then appears to stabilize at about 10 to 12% below pre-flight levels within eight to ten days. The reduction in red blood cells is also rapid during the first few days and also stabilizes at about 10 to 12% lower than pre-flight levels within 10 days.

When astronauts get back to earth, their blood is again pulled to the lower body by gravity and, because the total volume has dropped, there’s an increased likelihood of blood draining from the brain, causing faintness.

Today, many researchers believe that the changes in plasma and red blood cell volume contribute significantly to post-flight orthostatic intolerance, Carpentier said. After flight, this results in a significant decrease in standing blood pressure and an increase in standing heart rate compared with pre-flight values. He added that whatever the adaptive mechanism involved, "there is a large variability in individual tolerance and ability to adapt to weightlessness and to readapt to earth gravity."

Back in 1965, Carpentier was particularly alarmed when he saw the results of post-flight tests on the Gemini 5 crew. They’d been in space eight days and their response on the tilt table did not bode well for a 14-day moon mission. "Their heart rates soared and their blood pressure dropped. They were both significantly deconditioned in eight days, compared to when they went up." Carpentier compared these results with those from Gemini 3 and 4 and found a disturbing trend. "The heart rate was going up in a line—a straight line—when you plotted it out against the number of days. When you plotted it out to 14 days in space, there was no way anybody was going to be able to maintain that kind of heart rate during a tilt test." Based on measurements of the astronauts’ calf circumference, he believed that pooling of blood in the lower body was at least part of the reason for the Gemini 5 results.

Although the astronauts returned to normal within a few days after returning from space, Carpentier was most worried about the first few hours they were back on earth. "I was the guy who was going to be in the helicopter that was going to have to pick those guys out of the water if they should be incapacitated. I was incredibly concerned how they were going to get out of the spacecraft, into the helicopter and into sick bay."

Gemini 7, which was scheduled to last 14 days, was his major concern. On return to earth, the astronauts would be sitting upright in the spacecraft with blood pooling in their legs until the flotation collar was attached to the capsule and the divers could open the hatch. Moreover, on the previous Gemini missions, the spacecraft had landed a considerable distance from the carrier; Gemini 5 had been about 90 nautical miles away—about an hour by helicopter.

Carpentier was concerned that Gemini 7 might be equally distant. "I had a vision of me, an almost qualified flight surgeon, with three frogmen, two unconscious astronauts, about an hour away from the aircraft carrier and help. You bet I was concerned. So I did a lot of practicing with the underwater demolition team, trying to work out the best method of getting the crew out of the spacecraft onto the life raft and how we might possibly be able to do CPR on a pliable raft in six-foot seas."

He also spoke to the commander, Frank Borman, telling him, "When you land, do everything you can to keep blood pumping until we can get you out of that spacecraft. Don’t just sit there and let the blood pool in your legs. You’ve got to keep your feet moving, keep your legs moving, keep your blood pumping up until we can get you out of there." In a later television interview, Borman commented, with some astonishment, that some people were afraid the crew was going to faint. "I was certainly one of them," admitted Carpentier.

Chuck Berry had some concerns as well. He was later quoted as saying that "the most miraculous thing was when they could get out of the spacecraft and not flop on their faces -- and they could go up into the helicopter and get out on the carrier deck and walk pretty well."

As it turned out, neither astronaut fainted during the recovery. One did faint during a tilt table test about an hour after splashdown, but the other, tested about two hours after recovery, did not. "In fact, his tilt test showed him to be better off than either one of the Gemini 5 crew that were up for eight days," said Carpentier. He was greatly relieved because this finding demonstrated that orthostatic intolerance didn’t inevitably continue to get worse over time—in fact, it levelled off as the missions got longer.

Carpentier was convinced that one of the most important factors that determined the extent of post-flight orthostatic intolerance was pre-flight physiological conditioning. "The better shape you’re in when you start out, the better shape you’ll be in when you come back." Back in the Gemini and Apollo days, he noted, there were no prescribed conditioning standards for the astronauts. "Each astronaut was in charge of his own physical conditioning and nobody knew enough even to tell them what to do. That was one of the things I got interested in doing."

Although the fact that orthostatic intolerance levelled off over time was good news for the moon missions, it didn’t entirely eliminate the potential problems it could cause, as far as Carpentier was concerned. The worst of the deconditioning occurred during the first four days in space—about as long as it was going to take to get to the moon and land. He began raising questions about whether the astronauts were likely to be compromised in their ability to work on the lunar surface.

He proposed performing a pre- and post-flight exercise tolerance test on the prime and backup crews on the four remaining Gemini flights, all of which were expected to last a few days each. This seemed to him a significant issue, but his view was not widely shared. "It did not seem to many other people to be that important. It was just one more thing that was interfering with the main goal, which was to get to the moon and back safely by the end of the decade. It seemed to many other people that we already had enough information to show that they can do it and they will do it."

He recalls going down to Cape Kennedy—leaving behind an ill child—only to have a crew member refuse to do the tests. "It really made me angry because my oldest son was sick and I had left him in the hospital with my wife. I had flown to the Cape specifically to get this information. I said, ‘Why the hell didn’t you let me know so at least I wouldn’t have had to leave my son in the hospital to do this?’ "

The astronaut explained he was willing to do the test but had been instructed not to. In the end, Carpentier was able to get some testing done, but not as thoroughly or as promptly as he had hoped. He was allowed to test only one of the two crew members on each of the four Gemini flights and the tests were done 24 hours after the astronauts returned, not immediately after they were recovered. Even so, he found evidence that all four experienced a reduction in their exercise tolerance. How much this would affect the work abilities of the lunar astronauts "was going to have to wait till Apollo," he said.

As for the astronauts, they epitomized the attitude that author Tom Wolfe famously characterized as "the right stuff." They believed they could take anything that was thrown at them. And they believed it, said Carpentier, "because, almost always, it’s true."

The Apollo Years

The Apollo program got off to a tragic start on January 27, 1967 when the first manned crew, Gus Grissom, Edward White, and Roger Chaffee, died in a flash fire during a test of the Apollo command module on the launch pad.

Carpentier was not directly involved in the Apollo 1 mission; he was on assignment at an industrial contractor in California. Astronauts often visited the sites where space hardware was being built to check the equipment and provide advice from the flight crew’s point of view. "If an astronaut was taking part in a test that had a hazardous environment, they always sent along a NASA flight surgeon. At that time I was switching out of the Gemini program and becoming a liaison for the medial operations office for the Apollo program," said Carpentier.

He heard about the fire on the news. He knew the three astronauts who died, although not well, and, like everyone else at NASA, was severely shaken by the event. "It was one of those things that sort of hit you in the gut, like the terrorist attacks on the World Trade Center."

The greatest impact of the fire on his responsibilities came much later, when he was assigned as the crew flight surgeon for Apollo 7, the first manned Apollo flight, which occurred in October 1968. The tragedy had delayed the Apollo program for a year and, with Kennedy’s end-of-the-decade deadline looming ever closer, the urgency to get the program back on track had escalated enormously.

"There was tremendous time pressure, incredible pressure on the crews," said Carpentier. As a result, he encountered a strong sentiment among program managers, and even within the medical directorate, to cut back on medical investigations involving the astronauts. He said he was getting a message that "we’ve already shown that man can last 14 days in space and do quite well. We don’t need to know any more. The goal is to get to the moon and get back and all you guys need to do is listen to their chests and make certain they’re not sick, shake their hand, and say, ‘God speed, John Glenn.’"

Carpentier did not share this view. He passionately believed it was wrong to pass up an opportunity to study people who would be spending time in a unique environment that was known to change human physiology. "I believed that we did need to learn more, otherwise we were not going to be able to do a decent job of being flight surgeons in the future. There was so much more we could learn and we owed it to the development of medicine."

He prepared a memo for Owen Coons arguing that the medical operations office should have three major goals in the Apollo program. The first was crew safety. The second was preventing contamination of the Earth in the unlikely event that living organisms accompanied the astronauts back from the moon. The third, he argued, was to continue studies on the physiological effects of weightlessness on the human body. Program managers accepted the final goal "with the caveat that it could not interfere. It was a number three goal. We could continue to try to understand the effects of the weightless environment on man, but if something else came up that was more important, that was going to have to slide. So at least we had a mandate, an acceptance to go on."

He and his colleagues developed a program that would build on what they’d learned in the Gemini program. In addition to testing the astronauts for orthostatic intolerance and exercise ability, they also wanted to study the changes in blood and fluid volumes and in blood chemistry. NASA management approved the tests and then the doctors tackled the next difficult step—selling it to the astronauts. They went to Cape Kennedy to brief the Apollo 7 crew, commander WallySchirra, Donn Eislie and Walt Cunningham.

"Wally Schirra was not a big fan of flight surgeons," Carpentier remembers. In fact, none of the crew appeared enthusiastic about the testing program and the meeting broke up without any decisions being made. Schirra asked Carpentier to stay behind and, as Carpentier recalls the conversation, "he let me have it about what was wrong with physicians in general and NASA physicians in particular." Schirra told him that the doctors "had an incredible amount of audacity to even suggest that this elaborate, time-consuming program should take place and that I was way out of bounds."

The commander not only objected to the time the tests would take, but also to the nature and amount of data that would be collected about the astronauts’ physiological condition. In those days, astronauts had little medical privacy; "everything was immediately made public," Carpentier noted.

As a young flight surgeon with no mandate to make policy decisions, he felt overwhelmed by the situation. "It was scary, because I was out of my league." Nevertheless, he pressed his case to Schirra because he believed that studying the first Apollo crew was crucial to the future of operational space medicine. "I knew and he knew that what he did, everybody was going to follow. I told him, ‘I think there’s a reason for it to be done. I think we owe it to future generations to learn, to understand, and to progress and we can’t if you guys aren’t going to co-operate. Because if you don’t, that may be the end of the medical data gathering on the Apollo program. If you don’t, nobody will.'"

Schirra was still balking. Carpentier then asked him what he would be willing to do, saying that he wanted to ensure that whatever tests could be performed were done as well as possible. "So he said, ‘Let’s go through this.’ I went through it step by step—what I thought we could learn, what I thought was important about it. We started at the top and an hour later we got to the bottom and he said, ‘I will do that.’ " Much to his amazement, in the end, Schirra had agreed to the entire program.

Carpentier brushes aside the suggestion that he must have been exceptionally persuasive. "I was scared to death. I don’t think I convinced him, I think he convinced him."

For him, the event was "a kind of baptism. I learned more from Wally Schirra about being an operational flight surgeon than I ever did in school. That it was my job to make sure that what we did was in the best interest of the crew."

As events transpired, however, he had cause to wonder whether he would get any data at all. On the Apollo 7 flight, the astronauts developed head colds and became downright grumpy with Mission Control during a tussle over whether to wear their helmets during re-entry. Schirra wanted to leave the helmets off to allow the crew to blow their noses if their nasal passages were stuffed up—a problem that’s worse in microgravity because mucus doesn’t drain as it does on earth.

Waiting on the aircraft carrier, Carpentier got word that the crew was not in the best of moods. "I got a call from Dr. Berry saying, there’s been some problems with the crew in terms of their co-operation and the probability that you’re going to get any co-operation out of them post-flight is close to zero. Do not push it. Do what you can, but do not push anything. So I said, fine. I didn’t know what was going to happen."

Much to his relief, the crew proved to be very co-operative. "We started at the top and went right straight to the bottom and we got every piece of data that was planned. Everything went off without a hitch. Not only did we get it, we did it well." He attributed this to the fact that, in the end, the astronauts were professionals and "when they said they were going to do something, they were going to do it, and they were going to do it well. We owe a lot to Wally Schirra."

As Carpentier predicted, Apollo 7 set the pattern for medical investigations on future flights. "We never missed a data point on any other flight." Apollo 11, however, provided some additional data-gathering challenges because the astronauts were quarantined as soon as they returned. For three days while they were in the Mobile Quarantine Facility (MQF) on the carrier, Carpentier was the only doctor who had access to them.

"I didn’t want to give up anything, so we modified every test so that I could do it by myself in the quarantine trailer. Again, I was told, ‘Back off, they’re coming back from the moon. This is one of the great events in the history of mankind. Listen to their chests and look in their mouths and take their pulse and be happy.’ And I said, ‘No, I don’t think so. I think we can do better, I know we can do better.’ "

Prior to the mission, Carpentier and the engineer who was also going into quarantine evaluated the medical procedures and equipment in the MQF. Precautions were taken to ensure that nothing could escape, even though no one really believed the astronauts would bring back any moon bugs. Conditions on the moon seemed to preclude any conceivable life form, but no one could say the odds were zero and "we just couldn’t take the risk," said Carpentier.

They were forced to take one risk, however—they had to open the hatch of the command module and extract the astronauts while it was bobbing in the ocean. The alternative was to lift the command module out of the water with the crew still inside, but the winch on the carrier was not "man-rated"—that is, it could not be used for an operation that could put the astronauts’ lives at risk. "It was elected to bring them out of the spacecraft because the winches were not felt to be reliable or safe enough to bring them up in the spacecraft," Carpentier said. "If they lost the capsule, they lost the capsule, but they were not about to lose the crew."

This was a calculated choice made by NASA officials, in consultation with science advisors appointed by the President and based on the belief that the probability of organisms coming back in the spacecraft was so remote that it did not justify jeopardizing the crew. Nevertheless, extra precautions were taken. The astronauts donned biological isolation garments and respirators inside the spacecraft and when they got out into the raft, the divers, who were also in isolation garments, washed their suits and everything else down with chemicals.

Looking very much like visiting aliens in their grey garments and respirators, the astronauts emerged from the recovery helicopter on the carrier deck and marched straight into the MQF. Carpentier was right on their heels. He’d set an ambitious testing schedule for the first hours of the quarantine and found he didn’t really have time to ponder the fact that he had, virtually to himself, three men whom the entire planet wanted to get their hands on. "I knew this was an incredible, momentous occasion, that I was very close to history, but I didn’t think about it too much. I had 15 things I had to do per hour if I was going to get all this medical testing done, because I had to do it in series on each person. I was never so busy in my entire life."

Although the crew was very co-operative, they were anxious to get out of jail. When asked about operations in the quarantine facility less than a week after returning, Mike Collins said bluntly: "I want out."

Perhaps inevitably, Apollo 11 was Carpentier’s favourite mission. "That was what the entire program was about." It was for precisely this reason that its successful conclusion prompted him to start questioning what to do with his future. For the time being, however, he remained at NASA and was peripherally involved in the infamous Apollo 13 mission, in which astronauts James Lovell, John Swigert, and Fred Haise were engaged in a life-threatening struggle to limp home from the moon after an explosion in the service module crippled their spacecraft.

On that fateful night in April 1970, when Lovell announced: "Houston, we’ve had a problem", Carpentier was working in one of the support rooms that back up the front-line flight controllers in Mission Control. Over the next few days he was involved with other medical personnel in dealing with concerns about a build-up of carbon dioxide in the spacecraft that was produced by the astronauts’ breathing. The medical experts provided advice to the controllers and engineers who were troubleshooting Apollo 13’s myriad problems regarding the physiological consequences to the crew as CO² concentrations increased.

The Apollo spacecraft carried canisters containing lithium hydroxide, a chemical that removes carbon dioxide from the air, but the problem on Apollo 13 was that the crew had had to shut down the command module, which had lost most of its power, and use the lunar landing module as a lifeboat to get them home. The lunar module was equipped to support two men for two days, not three men for the nearly four days it would take to get back to earth. A day and a half into the return journey, the CO² concentrations in the lunar module approached dangerous levels.

Unfortunately, the lithium hydroxide canisters used in the command module were a different shape than those used in the lunar module. In what was literally a case of fitting a square peg into a round hole, the engineers on the ground found a way to jury-rig the canisters so they could be used in the lunar module—a troubleshooting exercise highlighted in the movie Apollo 13.

On the day the crew was scheduled to come home, Carpentier and his colleagues crowded into Mission Control with the flight controllers. There were several heart-stopping minutes during the "blackout" period that always occurred when the spacecraft’s fiery entry into the earth’s atmosphere blocked communications with the ground.

"The thing I remember most was that I was in Mission Control when they were re-entering," Carpentier said. "It was just like it was in the movie—that long silence, the blackout period that went on longer than on other flights." Like millions around the world who watched and waited through the agonizing silence, he experienced "the worst possible thoughts. Maybe they haven’t made it. Maybe we’re never going to hear from them again. You think all of those things. Then, when they did, the place just erupted." He recalls reliving those moments when he watched the scene in the movie theatre and "it was all I could do not to jump up."

Moving On

As the Apollo program started winding down, Carpentier was forced to consider what he wanted to do with his life. "All of the crews I’d worked with were leaving. Things were slowing down. NASA was becoming more and more of a bureaucracy." One thing he knew—he wanted to be a doctor, not a manager. "I had too much invested in being a physician. I was getting to the point where it was hard for me to maintain medical skills; I was getting behind."

He became interested in nuclear medicine after taking a course to qualify to use radiopharmaceuticals in the space program. Radiopharmaceuticals are small amounts of radioactive materials that are attracted to various tissues and organs. They emit radiation that can be detected and are used to diagnose various diseases. In the space program, they’re used to detect changes in blood and fluid volumes caused by microgravity.

His new interest in this field prompted Carpentier to enter a fellowship program in nuclear medicine at Baylor University in Houston, Texas. In 1973, after finishing the course, he accepted a job offer from the Scott White Clinic in Temple, Texas, where he has worked for nearly three decades.

Recently, he’s been drawn back into the space program when he joined a team of researchers from Denmark who are studying changes in the cardiovascular system in microgravity. Their experiment to measure skin blood flow in shuttle astronauts required someone to administer radioactive compounds, but "they did not have the required licenses to be able to inject a radiopharmaceutical into an American astronaut, so I got a call, because I do."

In addition, Carpentier is now devoting part of his time to organizing and analyzing four decades of medical data on orthostatic intolerance and cardiovascular deconditioning in astronauts. He believes this is a goldmine of information that has never been fully exploited because the day-to-day demands of the space program have left researchers little time to thoroughly analyze previously gathered data.

"Do I think it has been used to the extent it could be used? No, I don’t. Can it? Yes. There’s an incredible amount of data there that has not been completely analyzed and there is a great deal of information to be milked from it. It was hard-won data and we need to mine every single nugget from it. That’s what I’m doing with the Apollo data, the Gemini data, the Skylab data and any shuttle data I can get my hands on. It’s taken me years to get the data together, to put it into a database, to start analyzing it, to start seeing patterns. I’ve just done a back analysis of the Gemini and Apollo data and I really think that orthostatic intolerance is predictable and, to a large extent, preventable."

Carpentier’s work in nuclear medicine has been fulfilling enough that he doesn’t second-guess his decision to leave the space program. "We had a good time. I met incredible people and I enjoyed it, but working in the space program was not without its price. I became very focussed and narrow-minded. There was nothing more important than getting to the moon and getting back and doing it by the end of the decade. I bought into that and I would again. But that’s not all there is to life. I had two sons and a wife and my family was very important to me."

In the year leading up to the Apollo 11 mission, he was away from home 210 out of 365 days. His wife, Willie, remembers her oldest son’s fourth birthday party when he asked if his father would be home by the time he was five. She commented that, in some ways, her situation was worse than that of the astronauts’ wives; at least their husbands were at home between missions whereas her husband was away for nearly every mission.

Perhaps Carpentier’s biggest regret was that he never had an opportunity to apply for the astronaut program himself. "I would have sold my soul to do that," he said. Ironically, it was his Canadian citizenship that forestalled this dream. He wanted to apply in 1967 when NASA announced it would select a group of scientist-astronauts, but he had to be an American citizen to do so. The fact that his father had been born in Rhode Island should have made things easier, but this turned out not to be the case. "It became a problem because I would have to prove he did not commit an act of expatriation before I was born." His knew his father had lost his American citizenship after his birth because of joining the Canadian army during World War II.

The question was: had he done anything—such as voting in a foreign election—before his son’s birth that was considered an act of expatriation? Unfortunately, Carpentier was told that answering this question would likely take a lengthy investigation and he would have to wait five years to become a citizen. "It was too late by then," he said. "The deadline would be long past."

He remained a Canadian citizen until 1993, long after he’d left the space program. Today, he’s happy to see that people of many nationalities can become astronauts and fly on the space shuttle or the international space station. "Having Canadians, Europeans, Russians, and Japanese involved in a common goal has to be a good thing."

As for his own dream of flying in space, he decided that if he couldn’t be an astronaut, being a NASA flight surgeon was "the next best job in the world."

References

• NASA human spaceflight programs history:
  www.hq.nasa.gov/office/pao/History/humansp.html
• On the Shoulders of Titans: A History of Project Gemini, by Barton Hacker & James Grimwood:
  www.hq.nasa.gov/office/pao/History/SP-4203/toc.htm
• The Apollo Program:
  www.hq.nasa.gov/pao/History/apollo.html