Episode 12: Why, What, How to Begin in Real Estate with Kekoa Lwin

EPISODE 09 

[INTRODUCTION]

00:00:06

ANNOUNCER: If you’re struggling with your vitality, energy, mood, focus, or sleep, this podcast is for you. Your host, Dr. Ann Tsung, ER doctor and aerospace flight surgeon, will help you reach for the stars and remove the barriers or blockades that have been holding you back from living your best life. If you’ve been challenged by your health, relationships, or productivity, then it’s time for a breakthrough. So, here’s your host, Dr. Ann Tsung.

00:00:40

Ann Tsung  

Hello, welcome to It’s Not Rocket Science Show. This is Session Nine. And I’m your host, Dr. Ann Tsung. Today is a part two of a three-part series on what it’s like to be a NASA flight surgeon and how I got here 14 years after I set that goal. And part one, if you have had a chance to listen to it, it’s in Session Eight. And I talked about my experiences from when I was young until I got into the aerospace medicine, residency training, some of the actions all the experiences I’ve had. Today I’m going to be talking about the actual training the two-year training I went through with University of Texas Medical Branch in Galveston. And then in our next episode, part three, we’ll talk about what it’s like to become, we’ll now be working as a NASA flight surgeon, what are the day-to-day tasks and my roles or responsibilities. So, let’s go ahead and dive in. 

00:01:39

Regarding the aerospace medicine residency, the reason why I chose University of Texas Medical Branch Galveston, because they have a long track history in space medicine and a close relationship with NASA. It’s only an hour drive from Galveston to NASA, the Johnson Space Center. And there have been multiple graduates from the program who got jobs at NASA. And so, I wanted a program that had a long track history, is closely associated with NASA, has rotations with NASA. There’s also another program with Mayo, that’s also a civilian residency. And there are the military residency and aerospace medicine with the Army, Navy and the Air Force. Regarding the UTMB residency, the annual deadline for application is October 1. And there is a ton of information on the UTMB website and the aerospace medicine residency website. And I would definitely suggest you taking a look, I’ll put that in the show notes on ItsNotRocketScienceShow.com. 

00:02:42

So, what happened was, I went through the Emergency Medicine Residency Critical Care Fellowship for two years. And I took a year off and actually worked a little bit and my fiancé and I traveled for eight months. And that’s when I submitted my application. By the way, that’s highly recommended. If you ever have any thoughts of long-term travel, just put your stuff in storage and go, my fiancé and I have had no regrets. So anyway, applied to the residency, and interview, the interview was in December. I remember I flew back from our travels just to interview and then went back out to travel again. And you’re notified very soon before the end of the year if you receive the spot or not. When I applied, there were three spots, the spots will fluctuate and I believe it’s still the same. Now, there are three spots at UTMB. I can’t say how many spots they have at Mayo last year and 2020 they graduated one fellow from Mayo. So, if you’ve been practicing for some time, in your own specialty and you’re making attending money, you do have to take note that when you go in to this residency, no matter how many years of training you have had, you will be considered a PGY-4 postgraduate year four. So, what that means is that last time I checked, PGY-4 your annual salary is about 62,000 which is not bad because in Texas there’s no state income tax. So, you do have to save up though, if you’ve been making attending money, you do have to take finances into consideration. So, you begin in July. And you start by taking the PASM course, the Principles of Aviation Space Medicine course, which is something I have mentioned from the last episode, you can participate in as a rotation if you’re a fourth-year medical student, and it’s highly recommended. That short course, you’re introduced to NASA personnel, the physicians, astronauts, to FAA, and learn about aviation medicine and space medicine. You learn about hyperbaric you learn about neurology, cardiology, essentially all the specialties and what they go through in order to certify the pilot and the astronauts to fly. You learn about mishap investigation; you get to tour the mock ups of International Space Station and NASA. This is pre-COVID. And hopefully we’ll be able to do that soon you can get also get to visit a neutral buoyancy lab, take a look at the medical kits, the medical equipment they have on station. So, it’s a pretty awesome course you get to learn quite a bit. 

And then as a first-year with the residency, you also get a master’s in public health. So, in your first year of training out of two, it’s a master’s in public health course. So, it’s graduate school, you go to school, it’s a Monday through Friday schedule, typically, throughout the two years of training. And again, I’m talking about the two years if you’ve done a specialty before, there is the combined internal medicine, aerospace medicine that takes four years, and that’s a different schedule, you start off by doing your primary specialty first. So, for the first year of the two-year program, you’re going to class, it just depends. It’s Monday through Thursday, typically, and the class times vary. And you’ll be doing projects, you’ll be doing a lot of presentations, you learn about population health, toxicology, occupational health, and preventive medicine. And I must say that it has really changed my perspective as an emergency medicine physician tremendously. Before, in Emergency Medicine and Critical Care Medicine, I was more focused on individual medicine – individualized care – and didn’t think much about population medicine or preventive medicine. And it has completely revolutionized the way I think. And it also teaches you on how to assess an article because there’s biostatistics course. And you really get to learn the various ways that data can be analyzed, and then you assess how that data is analyzed, and whether you can draw the right conclusion or not from the study, which is tremendously important. And this is something that I wish I had known when I did journal club back in residency but it’s never too late, never too late. 

So, the first year of your residency in aerospace medicine is the Master of Public Health in toxicology, and occupational medicine. And during October of that first year, you are also responsible with your other residents for hosting to provide the medical support at Wings Over Houston air show, it’s a fantastic opportunity to learn the medical kit, the resources that you need to learn logistics, how to plan and organize it, and recruit volunteers for this. And as if you’re a third-year medical student, or if you’re an undergrad, or if you have any sort of you know BLS type skills, you’re welcome to volunteer for Wings Over Houston, it’s a fantastic opportunity for you to get to know the aerospace events and residents, other physicians there are. When I did as a third-year medical student and fourth-year medical student, I met astronauts I met other military flight surgeons and NASA flight surgeons and I got to pick their brain on what it’s like to be on the job and what it’s like to go through what they’ve gone through to even what it’s like to be an astronaut. So, it’s a fantastic opportunity and get to mention in part one of the series, and that’s what I would highly suggest you can contact UTMB coordinator to inquire more about the opportunity to volunteer, October every year. 

So going back to your responsibility as a first-year resident. So, you will be recruiting volunteers to staff to basically walk the grounds of the airshow and you have basic kits that you carry around and you have physicians, attending physicians who volunteer to be the medical director, there are two medical tents. So really, really great opportunity. And the skills that you learn are going to be skills that you’ll need as a NASA flight surgeon as well or really any flight surgeon. And there are also clinical rotations at NASA as a first-year resident there. I did the rotation when occupational medicine. So, I saw patients from Johnson Space Center and it’s certified that they’re safe to do their job, that they’re qualified to do their job annually. And also, there’s the flight medicine rotation, and that’s the clinic for flight directors and also astronauts and retired astronauts as well. And that’s when you can, you know, get to talk to the astronauts. It’s pretty awesome and even retired Apollo astronauts to get to, you know, understand them, see what their experience was back in the days. And third rotation that I did as a first-year was a BHP. Essentially, it’s behavioral health is psychology. You get to work with psychologists, psychiatrists. And it’s a very, very important component and the astronauts in the International Space Station, even in lung, you know, Moon and Mars missions down the line. I mean, the mindset, behavior, the behavioral psychology is huge, you have to be able to have good coping mechanisms to deal with the stress of being away from your family, and to be able to live and work with people from various countries and cultures in a closed environment in a very, very small habitable volume. So, I did a rotation there and got really got to understand that the training that they go through, that astronauts go through and behavioral health and got to kind of pick the brains of you know, their thought process, their mindset and how they deal with stress how they achieve their goals. And they do a private conference, like a psychological conference to check in with the astronauts every two weeks, and you get to participate in that, which is pretty awesome. 

So those are the three rotations in your first year with NASA. And now, throughout all that there are opportunities for you to participate any research. So, I reached out to SpaceX and reached out to Virgin Galactic because the SpaceX medical director graduated from UTMB residency, and the Virgin Galactic medical director at the time, he used to be a UTMB. And then the assistant medical director was the UTMB program director just a few years back, which again, that’s why I picked UTMB for the aerospace medicine residency because of the networking opportunity and the connections that this residency has. Reached out to them and I was able to get to projects with both of them. With SpaceX, I was able to work on the mishap plan and a contingency plan from a medical perspective. And with Virgin Galactic, I was able to participate in a research on assessing the data that they have on pilots. So essentially, they have heart rate monitors. And also, it’s something called the Zephyr, so it’s something that they can wear to monitor heart rate, their EKG, the respiratory rate, and the G forces. And essentially, I was looking at their heart rate response to the G forces that they endured, either in the practice acrobatic flights, or in centrifuge, or in the actual space flight. So that was pretty awesome opportunity. Just as a first-year, I was able to visit Virgin Galactic get to see the Spaceport America and just to see how they operate. Yeah, the opportunities are there, if you look for it. 

Now, moving on to second year. Second year is so wonderful because you finally finish your master’s in public health. And now it’s all focused on space medicine. And there are elective rotations that you can pick and you can really make second year however you want. Some of the core items though, when I did the residency, we did weeks of rotations in the aerospace medicine clinic, in first year and second year actually, to see pilots and certify them to make sure that they are good to fly either Class One, Two, or Three. Some of the other core rotations is with NASA. Again, you can do flight medicine, you can do more occupational medicine. There’s also what they call medical operations, rotation. So, what that means is that you are following the flight surgeons at NASA who is currently assigned to a mission and following a crew on the International Space Station. So, you will go with them and see what their day to day is like through some of the meetings that they have, some of the international coordination with Russia with European Space Agency, Canadian Space Agency, and JAXA, the Japanese Space Agency, and you get to sit on console with them. You know, the console is the mission control at NASA Johnson Space Center. And there is a seat for Mission Control that the flights are doing with staff for the primary part of the day. So, you really get to understand what it’s like to work at NASA as in a flight surgeon to active mission or current mission right now on the International Space Station. And then there are other rotations where there’s a space radiation group where you get to really understand how space radiation affects the spacewalks and how they measure the radiation. Other rotations include the Federal Aviation Administration, there’s a one week a minute basic course you get to do there. You basically can assess pilots now as their flight surgeon to make sure that they’re certified and qualified to fly and other rotations that I did as an elective is that I was able to go to SpaceX for about a month. So, two weeks I spent in Florida and Cape Canaveral. And there’s two weeks I spent at Hawthorne, California, what I did in Cape Canaveral was I certified what they call the dragon personnel, the people who have to, you know, be around the Dragon capsule, the capsule that takes the astronauts up, and there’s a risk that they’re exposed to dangerous rocket fuel. And they have to wear something called the escape suit, and I certified people that they’re qualified to be in the escape suit. So, there are other things I helped them I was like a medical kit creation, I was able to participate in the in-flight abort test, where they shot up the rocket with a Dragon capsule, and there were, they blew up the rocket to test the Dragon capsule escape system, which is pretty freaking awesome. And I was on the ship, being in charge of one of the ship, and to make sure they have the medical kit, the medical resources in case anyone got sick. And I was able to go to Hawthorne to participate in multiple projects there to get to see how SpaceX operate in Hawthorne, California, tour the facility, and it was just just a fantastic experience. I would say though, one of the coolest things about the second year is the trip to Antarctica. And I mean, what residency do you get to go where going to Antarctica is a required rotation, right? You go there because you get to learn remote medicine. It’s a perfect analog to International Space Station, where you have limited resources. You’re separated from friends and family. So, there’s a psychological component as well. And there’s a need for evacuation, but because of the weather and the environment that sometimes can be very tricky with the logistics, you weigh the risk and benefits of evacuation of medical care, which is very, very similar to medical care International Space Station. So, there’s a lot of telemedicine that happens as well in Antarctica. So, it was pretty awesome. We went in November. And right now during COVID times, there’s increased quarantine time. So, by when I went, we went in November there is often delay, so I was delayed for about a week, now I was there for four weeks for the rotation. You work in the clinic at  McMurdo Station, and essentially just see patients provide medical care, I saw a lot of stress, psychological, the psychological breaks that we had to deal with. And also, a lot of times they come in what they call the crud. So, it’s like nasal congestion, sore throat, similar to a viral illness that happens very commonly at McMurdo. And other items like trauma, small trauma, cuts, scrapes, bruises, and quite frequently, occupational hazards like, and they do a lot of repetitive work and mechanical work, where they get injuries and their elbow or their neck is sore, they’re carrying heavy equipment, or if they’re driving the vehicle with a lot of vibration, sometimes that can hurt their wrists as well, and their fingers. So, a lot of occupational visits. So that was pretty awesome experience. And I was able to go to the South Pole for about three days. It doesn’t happen all the time. But I was able to go just because you know it was available, their receipts. And I was also able to participate in multiple medical evacuations. Two from the South Pole. Also, there was a patient from McMurdo and also was able to get on the Hilo for a field camp medical evacuation, which is a fantastic experience. So, I learned so much from that experience. It was such a unique time. And I would forever be grateful for that. And other rotations that you get to do. I talked about Virgin Galactic FAA, SpaceX. And in the second half of my second year, I did something called, it’s a required course, so it’s the Aerospace Medicine Course that they host in the Air Force at Wright Patterson. There’s 101, 102, 201, 202. Essentially what it is, is you learn about the Air Force way of the flight surgeon trainee, it’s a required flight surgeon training for the Air Force. And because I’m in the Air National Guard, that counted as on my flight surgeon training, which is pretty awesome. You learn about occupational medicine, the policies and procedures of the Air Force, and also going deep into the details of medicine and how to certify the pilots to fly. You also get to learn how to fly you get basic piloting courses, we went to the out to the airfield and I got to do some landings and takeoffs and it’s just fantastic. You really learn what the pilots go through. And the most awesome thing is you get to go through the centrifuge, you have a choice to do the 9G or not. And because I was in the Air Force, the Air National Guard with the F-15 unit, I had to qualify for the 9G. And I tell you, I was so sore from the anti-G strain maneuver that I had to do. You essentially have to tense your lower body so hard that it was like doing extreme workout. And I almost passed out but I didn’t. So that was a really, really fun time. And so that takes up about six weeks of your time. And after that, there’s a mishap investigation course as well, which is fantastic. But due to COVID it was shortened for us to one week. And other courses that you get to do. Again, when I went through, there was a jungle survival course. So, we learned how to boil water, how to start a fire, which is the wood and like a spindle, so like above fire, essentially. How to make shelter, how to create like an A-frame for your shelter, and pull vines and leaves to make your bed. Again, you know, survival skills is important because the astronauts go through a winter survival training. And sometimes if you crash in the middle of nowhere, or even pilots, if they crash in the middle of nowhere, those are some of the things that they need to know. So that was pretty fantastic. Other opportunities during my time there was that I got to from, due to my research project with Virgin Galactic, I got to travel to Hungary, to the International Congress of the Aerospace Medicine to present my findings. And the UTMB program is so fantastic. You know, if there are things that you want to do that has to do with aerospace medicine that benefits you, there’s funding and scholarships available for you in order for you to go to partake in that experience. It was my first time speaking in front of an international audience and meeting other flight surgeons from other countries and learning about how other countries work and the resources they have available. It was just fantastic. And I also was able to participate in the exponential medicine conference in California. It was from a suggestion of the FAA Medical Director, Dr. Melchor Antuñano. And they talked about how the upcoming technology and program like machine learning and AI and other various sensors that could be incorporated into medicine itself. And I go there to see what’s available for aerospace medicine, like there is a headband that measures the pulsations here to indirectly measure ICP, intracranial pressure, which is important right now, because we’re looking at the increased intraocular pressure, visual changes in the astronauts. And we think they have also increased intracranial pressure in these attributes, and long-duration astronauts. So, finding ways of non-invasive, intracranial pressure monitoring is very important to us. So, it was just a fantastic opportunity that UTMB allowed me to participate in that really expanded my medical knowledge, and how the other industries can help give us the tools of what we need for future exploration missions. So again, the residency, a lot of it is however you want to make it. There are core rotations and core knowledge that you need to learn also, tropical medicine as well as infectious disease, that’s something that we take as a virtual course. There’s so many elective time, so much elective time that you can really, if you look for your own opportunities, and the program approves it, you can go do it. There have been other prior residents who have gone to Germany to rotate other European Space Agency to understand what it’s like. If you want to do more research, you can go to Kami at the FAA that research institute and participate in their research there perhaps. So, the sky is really limitless. Overall, after finishing the residency, I am a much more well-rounded physician. I know emergency medicine. I know how to take care of sick patients. I know how to take care of critical care patients. And this gave me the tools to take care of patients from a preventive point of view, from an occupational point of view. And now when I see patients in the ER, the question I asked them is very, very different now and even in the ICU, it’s very different. I actually dive into their occupation, their exposures. I think more outside the box now. It’s made me a better physician overall. 

In the next session, we’ll be talking about applications to become a NASA flight surgeon, the opportunities, and what it’s like to be a NASA flight surgeon. I’ll include all the resources, and then the links in the show notes, itsnotrocketscienceshow.com. And I invite you to please go to the UTMB residency website, it’s going to have a ton of information of the programs and electives that they offer. So, I want to thank you for your time joining me and learning about the specialty, and I’m very grateful. Remember, everything that you need is already within you now. Thank you.

25:43

Announcer: That’s it for today’s episode. Head on over to iTunes and subscribe to the show. One lucky listener every single week that posts a review in iTunes will win a chance in the grand prize drawing to win a private VIP Day for a health and life makeover with Dr. Ann Tsung, herself. Then, be sure to head on over to itsnotrocketscienceshow.com and pick up your free gift from Dr. Sung. Then, join us on the next episode.

[END]