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Physician astronaut recalls heights of spaceflight, depths of cancer

OCTOBER 23, 2017
Clinical Congress Daily Highlights, Monday First Edition

An astronaut’s perspective from outer space is oddly analogous to that of a patient looking up from the operating table: there is an utter dependence on others. Canadian astronaut Dafydd (Dave) R. Williams, MD, OC, OOnt, MSc, CM, FRCS, described both perspectives in the Martin Memorial Lecture, “Personal Best, Reflections of a Physician Astronaut on Leadership and Teamwork.”

Dr. Williams, an emergency physician, surgery professor, researcher and hospital administrator, is also a veteran of two space shuttle missions and three space walks, the most ever for a Canadian astronaut. Now 63, he survived a bout of prostate cancer at age 50. In his address, he called for a culture of medicine that delivers first-class care while accommodating the inevitability of human error: “One of the great opportunities for all of us is to understand how we can embark on that journey where we as humans can make mistakes, but prevent those mistakes from having significant consequences.”

People generally think of space as a zero fault-tolerant environment, Dr. Williams said. And yet, he added, “please don’t tell NASA, but every time I was in space I made mistakes.” The key, he emphasized, was to ensure that errors had “zero mission impact,” and not lose focus. 

“When you’re on a space walk and make a mistake, you have five seconds and then you have to get over it,” Dr. Williams said, noting that the same mindset applies to surgery and to hospital management. He currently serves as president and chief executive officer of Southlake Regional Health Centre in Newmarket, ON.

He said that the ability “to be a proper team leader” in both medicine and space depends not strictly on individual technical skills and competency, but on our “behavioral skills in helping people live and work together.”

As a hospital CEO, he said he does not focus on the impossible — eliminating clinical error. Instead, his goal is the same as it was in space: preventing errors from having adverse effects on patients.

Dr. Williams recalled potentially terrifying problems that developed during his space flights — a tiny hole torn in his spacewalk partner’s glove, a damaged tile on the shuttle fuselage that could have caused a disaster like the 2003 accident that killed seven astronauts.

In the case of the damaged tile, he said the space walkers were relieved when they realized that the exposed aluminum layer under the tile would stay below 350 degrees Fahrenheit during reentry. They reasoned that frozen pizza pans made of aluminum routinely are heated to that temperature and handle it easily. The lesson he took away from the experience, Williams said, was to remember to make data relatable for patients so they can make truly informed consent decisions about undergoing surgery.

Williams described his diagnosis with prostate cancer at age 50 as another perilous journey that started with a panicked moment. But he quickly focused, began calling friends for urological surgeon references, and embarked on the long, difficult journey. 

“I lost everything that meant anything to me except my loved ones,” he said, listing in particular his pilot’s license and astronaut’s medical clearance.

He ultimately went to Peter Scardino, MD, FACS, at Memorial Sloan Kettering Cancer Center in New York, who, he said, “gave me my life back.” Williams is now 13 years past that diagnosis and even flew in space after his recovery.

Additional Information:
The Named Lecture, Martin Memorial Lecture, was held October 23, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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