Space surgeon

Vivian McAlister’s experience as a small-town doctor, key member of a legendary London transplant team and a soldier who enlisted at age 52 — and went through basic training — caught the eye of researchers looking for a surgeon who was resourceful and willing to push the limits. McAlister is exploring a new frontier in medicine — operating in near-zero gravity

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Balanced on a single finger, his body floating above his patient, London surgeon Vivian McAlister watches drops of blood float up.

He notes the oddity, but briefly. In 25 seconds, gravity will pull him to the floor of the jet with a thud. His work in the heavens, however brief, might save lives on Earth.

Space surgeon — that was a designation the 59-year-old McAlister never imagined for himself as he floated weightless above the skies of Ottawa in a former Canadian Forces jet now used by the National Research Council to simulate near-zero gravity.

He was told to brace himself against nausea that leaves many vomiting as they endure a flight whose path is like an hours-long roller coaster.

It was a risk he endured in the name of science and research that might someday save countless victims of trauma from bleeding to death.

McAlister was tapped for the work after more than two decades specializing in one of the most difficult types of surgeries, transplanting livers, and for much of that time, he’s done them with a world-renowned transplant team at London Health Sciences Centre.

But skill alone wasn’t enough and maybe not even the primary need: Surgery to fix most internal bleeding is pretty simple, as far as surgery goes. The bigger task is doing so in remote environments away from the equipment and technology of big hospitals — an obstacle that’s left many people bleeding to death before they can be taken to a surgeon.

It’s why the Canadian Armed Forces helped to fund the flights and why space agencies in Canada and the United States have long backed similar research.

What they needed was a surgeon who was resourceful and willing to push the limits — and that trait propelled McAlister from Dublin, Ireland, to distant battlefields of Afghanistan to earthquake-ravaged Haiti.

Dr. Vivian McAlister, a London transplant surgeon who joined the armed forces at age 52, completed four tours in Afghanistan and is now researching surgery in near-zero gravity, poses for a photo outside of his home in London, Ont. on Tuesday July 21, 2015. (CRAIG GLOVER, The London Free Press)

McAlister was born in Dublin in 1956 to a family steeped in medicine; his grandfather was a doctor while his father and two siblings were dentists.

His path to Canada was serendipitous. An older classmate at medical school had moved to Manitoba and loved it, so when an advertisement sought a doctor for Uranium City near the northern border of Saskatchewan, he and his wife of one year made the move in 1981.

“I went for an adventure,” he said.

One year after he arrived, the mines closed, the town’s population began to collapse, and McAlister might have returned to Ireland but for another ad, this for a doctor in a tiny town near the American border called Lampman.

Being remote proved invigorating. In Ireland, his responsibilities would have been narrow and he’d refer complex patients to a regional hospital. In Saskatchewan, McAlister cared for patients from start to finish, huddling with colleague to tackle tough cases and learned to be as resourceful as the people they served.

“It wasn’t just medicine. We had to have a spirit of innovation and made do with what we had,” he said.

More than 6,000 kilometres from his birthplace, McAlister was home.

“I became Canadian and definitely changed my allegiance. I just identified with the people . . . It fitted my philosophy,” he said.

Demands proved so high he was asked to perform surgery, a need that prompted him to return to Ireland to train to become a surgeon. He intended to come back to Western Canada, but five years later, his training as a surgeon complete, fate intervened again. The head of one of North America’s top organ transplant teams was seeking a fellow to train, and soon McAlister was off to London to join Dr. Bill Wall at University Hospital.

This was a frontier of another sort. Wall led a team transforming transplants of the most difficult sort — the liver — to a procedure so refined it produced a high success rate. By that time, McAlister had worked at close to a dozen hospitals, but none had such a lineup of innovators as UH.

“University Hospital was the most exciting place I’d ever worked,” he said.

Soon, he was flying all over North America to perform surgery on donors and bring back life-saving organs to London, where Wall would await.

After completing his two-year fellowship, McAlister was recruited to a Halifax hospital to build a liver transplant program. He was missed in London. Wall tried to recruit him back in 1995, but McAlister wanted to finish what he had started.

In 2001, after a decade in Halifax, he agreed to return to London and the transplant team. That same year, the Canadian Armed Forces sent commandos to intervene in Afghanistan. McAlister couldn’t have known so at the time, but their deployment would change the trajectory of his life and vault him to weightlessness.

By 2007, NATO was running operations in Afghanistan, Canadian forces were there in greater numbers and casualties were on the rise. One of his former medical students, Dr. Brian Church, an anesthetist who had joined the Canadian military, came to London to speak about the challenges of providing medical care in a country where the threat of traumatic injury was everywhere.

McAlister spoke out, convinced that service shouldn’t be only the domain of the young, that when soldiers place themselves in danger, experienced surgeons need to have their back.

McAlister travelled that year to Afghanistan to volunteer as a civilian, and was awed by the camaraderie in the face of s river of traumatic injuries suffered by citizens, allied forces and Canadians. Lacking all the equipment of home, they improvised and work quickly.

“I thought (the television show) MASH was a fiction. It’s not,” he said. “There’s a great team spirit. It’s exhilarating.”

After two months, McAlister returned intent to enlist even though that meant going through basic training the following year at age 52.

The six-week program was arduous, and everyone else but one was his junior by 20 or more years. He climbed fences and walls, learned survival skills and endured marching with heavy packs.

Others would sacrifice, too. His family endured his four tours of Afghanistan and one to Haiti after the earthquake. Colleagues on the transplant team in London take extra shifts when he is deployed.

On McAlister’s last tour, this one in Kabul, his team helped the medical school there create residency programs so Afghans could train their own doctors — a critical legacy in a country ravaged by war since 1979.

In Afghanistan, he met another surgeon, a reservist named Andrew Kirkpatrick, Canada’s leading researcher on how to stop trauma victims from bleeding to death in remote locations, from isolated farms to distant battlefields to outer space.

No surgeon in Canada has logged more weightless hours than Kirkpatrick or worked as closely with NASA and the Canadian Space Agency. Kirkpatrick wanted McAlister to perform surgery in micro gravity for research whose lessons might apply in orbit or on the ground.

McAlister, who has made a life out of testing his limits and working with like-minded teams, couldn’t refuse.

By June, both were aboard a Falcon 20 jet. Kirkpatrick was turning mid-air somersaults for fun and McAlister was doing surgery on a realistic model for stints of 25 or 30 seconds at a time.

The flights test mind and body. The jet races skyward, creating forces twice as strong as the Earth’s gravitational pull on its surface, then stalls, creating about 25 seconds of near-weightlessness, before repeating that cycle again and again.

“You know when to start (surgery) because you can feel yourself floating,” McAlister said. “It’s (like) a roller-coaster.”

It’s been quite a ride for an Irish lad who as a 13-year-old in 1969 watched Neil Armstrong become the first person to walk on the moon but never dreamed his work would be the stuff of stars and astronauts. “If you’d asked me a month ago, I wouldn’t have believed it.”

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Bleeding out

Time and space are twin killers that claim victims of trauma who bleed to death from injuries that could be repaired if only the fix could be done within minutes.

Those are the villains Dr. Andrew Kirkpatrick has set out to overcome.

“(The) ultimate aim is trying to stop people from bleeding to death anywhere in the world,” said Kirkpatrick, a leading surgical researcher from Calgary.

Bleeding out is the No. 1 cause of preventable death among trauma victims. Too many soldiers and civilians die from internal injuries that would be a simple fix for a surgeon — but they die before any surgeon can reach them.

So Kirkpatrick has for 15 years been publishing research whose aim is to get help to trauma victims quickly even when a surgeon is far away, most recently recruiting London surgeon Vivian McAlister to operate in near-zero gravity that simulates outer space.

Among Kirkpatrick’s strategies is to equip first responders with video cameras linked to surgical experts available around-the-clock to observe the trauma and guide the treatment, what he calls telementoring.

His research has applications in any remote setting, from a farm to a battlefield in Afghanistan, one of his major backers is the Canadian Forces, and those who run space programs in Canada and the United States have worked with him so often he’s logged more weightless hours on research flights than any Canadian doctor.

“We’re trying to make the un-survivable survivable,” he said.

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Micro-gravity

To simulate what it would be like to perform surgery in space, NASA and Canada’s National Research Council use modified commercial jets to fly a path that has them do a steep ascent, then a sudden drop that creates near-weightlessness for 25 to 30 seconds.

Hollywood import

A Cut Suit that simulates bleeding in movies is used to stand in for patients in medical research, including in space surgery.

“We couldn’t do it without it.”

— Dr. Andrew Kirkpatrick

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Space Surgery

“It takes longer. You have to be more organized. But with planning, almost anything is doable.”

— Dr. Andrew Kirkpatrick

“You have to anchor yourself (to the ground with a knee) or a finger (to the wound). . . A lot of people get motion sickness but I was lucky.”

— Dr. Vivian McAlister

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Latest research:

• Began in December 2013
• Partnership between the National Research Council, Canadian Forces, the University of Calgary, the College of Physicians and Surgeons of Canada, Innovative Trauma Care Corporation, and Strategic Operations, developer of the Cut Suit
• A Falcon 20 jet flew 27 parabolic circuits in the Ottawa area June 26 and 27, each producing about 25 seconds in which gravitational forces were reduced to near-zero
• 14 surgeries were done by London transplant doctor Vivian McAlister.
• Tested a new device to close wounds called an iTClamp and a GoPro camera to see if it would be useful to medics getting remote help from a surgeon
• Tested the effect weightlessness has on ability of a surgeon to perform
• Tested techniques used to stop or control internal bleeding, including the injection of an expanding foam
• Lessons learned may be applicable to other remote locations such as submarines, naval ships, research stations in Antarctica and remote communities.