Do we compromise our skin’s health by constantly scrubbing off the mortar? Does our skin want us to bathe every five days? Hard to say. It’s true that especially zealous hand washers—hospital personnel and certain obsessive-compulsives—often develop irritation and eczema. Twenty-five percent of the nurses in one study, writes Larson, had dry, damaged skin. Ironically, the nurses may be exacerbating the very thing that hand-washing seeks to prevent: the spread of infectious bacteria. Larson says healthy skin sheds 10 million particles a day, and 10 percent of those harbor bacteria. Dry, damaged skin flakes off more readily than healthy, lubricated skin and thus disperses more bacteria. Damaged skin also harbors more pathogens than healthy skin. As Larson says, “Perhaps sometimes clean is too clean.” Most Americans don’t wash often enough to cause skin problems, but they certainly wash more than necessary. In the words of some academic I can’t name because I’ve lost the first page of his paper, “Personal hygiene as practiced in the U.S. today is largely a cultural fetish, actively promoted by those with commercial interests.”
In space, as in the military, bathing is more an issue of morale than of health. Space agencies, recognizing what one researcher called “the psychological inadequacy of sponge baths,” devoted a lot of time and money in the 1960s trying to develop a zero-gravity shower for space stations. One of the earliest prototypes tested was a “shower suit.” The technical report I read included the following less-than-encouraging summary: “Results leave much to be desired in the showering, rinse, and drying procedures.” The usual arrangement doesn’t work; the water sprays from the shower head for a few inches and then collects in an expanding blob: fascinating, but of little ablutionary help. If you hold the shower head close enough to forestall the big blob, then the water ricochets off your skin, forming floating drops that you then have to spend ten minutes chasing down to keep them from floating out into the station. “It turned out to be easier just to forget the whole thing,” said astronaut Alan Bean, of the collapsible Skylab shower.
The shower on the Soviet space station Salyut used air flow to try to draw the water down toward the cosmonauts’ feet. It was minimally successful. Blobs formed, and blobs tend to cling to the body’s concavities, including the mouth and nostrils. To keep from choking, cosmonaut Valentin Lebedev and his crewmate Tolia Berezovoy wore snorkeling gear. “What an exotic sight it was,” wrote Lebedev in his diary. “A naked man [flying] across the station,…with snorkel in his mouth, goggles over his eyes, a clip on his nose.” Understandably, the crew of Salyut 7, like Elizabeth I, showered just once a month. These days there are no space showers. Astronauts wipe themselves with moistened towels and rinseless shampoo.
Bathing is more important on the space stations, because the missions are longer and they include daily exercise regimens that ratchet up the sweat level. As an adjunct to body wiping, Japanese astronauts on the ISS have been wearing “J-Wear,” developed at Women’s University in Tokyo out of fabric “with the function of dissolving foulness and body odor by photocatalyst and prevention of the rotten smell of sweat by the antibacterial nano-matrix finishing technique.” Astronaut Wakata Koichi (pronounced, perhaps aptly, co-itchy) wore the same J-Wear underpants for twenty-eight days without complaint.
The astronauts of Gemini VII could only dream of “comfortable everyday clothes for life in a spaceship,” as one press release calls J-Wear. They wore hot, heavy, bulky spacesuits for pajamas. The subjects in the Air Force Gemini VII simulation were plagued by “chafing and much irritation in groin.” In case you have ever questioned the value of thorough wiping and regular changes of underwear, here’s a reason. In people with poor bathroom habits or 1960s Air Force hygiene restrictions, fecal bacteria migrate. Wright-Patterson researchers sampled thirteen sites on the men’s bodies to check for E. coli. It was a remarkable Diaspora. Fecal bacteria had made its way to the men’s eyes, ears, and, in two cases, toes. Five out of six of the Soviet subjects who sat in armchairs for thirty days developed folliculitis—bacterial infection in the hair follicles on the skin. Three developed boils—especially bad, swollen, painful, infected follicles. (The Soviet paper uses the old-timey term “furuncle.” You almost want one just to be able to go around saying “furuncle.”)
Lovell doesn’t recall any skin problems. “The difference is zero G,” he told me. “That’s the key to the whole deal.” When a man floats a few inches above his chair, when his arms hover out away from his sides, he has less of the chafing and irritation normally caused by damp, filthy clothes rubbing sweaty, unwashed skin. The astronauts’ underwear didn’t get plastered to their buttocks. Whatever bacteria lurked in their sweat, it wasn’t getting ground into their follicles. There is a condition called hot-tub folliculitis, which often appears on hot tubbers’ buttocks and the backs of their thighs—just where the friction and pressure is. (The water in a hot tub is hot, but not hot enough to kill bacteria. An undertreated hot tub is essentially, quoting University of Arizona microbiologist Chuck Gerba, “E. coli soup.”)
DAY SIX OF GEMINI VII. Frank Borman is on the mic. The exchange is proceeding in the macho, jargony manner of pilot-to-ground communications. Until:
MISSION CONTROL: Stand by for the Surgeon, Gemini VII.
BORMAN: [silence]
MISSION CONTROL: Gemini VII, this is Surgeon. Have you had any dandruff problem up there, Frank?
BORMAN: No.
MISSION CONTROL: Say again.
BORMAN: N. O. No, negative!
Commander Borman did not wish to discuss skin care. But later, in his memoir, he would write about “our scalps” and about the case of “terminal dandruff” he had. Though it probably wasn’t, technically speaking, dandruff. Dandruff is caused by an inflammatory skin response to oleic acid, which the scalp fungus Malassezia globosa excretes after dining on your scalp oils. Either you’re sensitive to oleic acid or you’re not. If Borman didn’t have dandruff before he went into space, he didn’t have it afterward, says dermatologist Jim Leyden. Leyden once paid prisoners to not wash their hair for a month, specifically to see if they developed dandruff. They did not. The flakes on Borman’s head and skin were most likely the accumulation of millions of shed skin particles—particles normally washed away in the shower—mixing with sebum and clumping together.
The atmosphere in Antarctic field camps is similarly dry and shower facilities similarly nonexistent or cumbersome, making the six-week Antarctic Search for Meteorites field season a good analog for space hygiene. “Six weeks of dead skin is like two whole layers,” says team leader Ralph Harvey. Sometimes it all comes off at once, in the first wash. Harvey admits to being fascinated by the spectacle. “I remember coming back and taking a shower and the whole end cap of my finger would just come off.”
What makes the dander situation bearable in Antarctica is that you can step outside your domicile and shake out your long johns and sleeping bag. You can’t do this in space or simulated space. The description of the Navy space cabin simulator at the end of the experiment was like a ski report. “A fine layer of powdery scales was found to cover the floor of the chamber.”
In zero gravity, the flakes never fall. I asked Lovell about this. I believe my exact words were, “Was it just like a snow globe in there?” He said he didn’t recall anything like that. Or not “of such magnitude that it would stick in my mind all these years.” (For the thing that did stick in his mind all these years, see chapter 14.)
The head in general is a problem. The majority of our sebaceous glands are attached to hair follicles, thus the unwashed scalp quickly becomes a greasy thing. So much so that the bathphobic hordes of the sixteenth century would rub powder or bran into their scalps before retiring for the night, much as homeowners today sprinkle kitty litter on motor oil spills. Like sweat, sebum develops a distinctive aroma as bacteria break it down. “At least two of the Skylab astronauts reported that their heads developed offensive odors,” noted space psychologist Jack Stuster in a 1986 NASA report on space station habitability.
BORMAN AND LOVELL did not stay in their suits the entire flight, as NASA had originally planned. On day two, flight surgeon Charles Berry began lobbying NASA management on their behalf. A compromise was struck: Only one man had to stay suited (in case of a depressurization emergency). Borman drew the short straw, and Lovell squirmed out of his suit. For years, Lovell recalls, his son would tell friends, “Dad orbited the Earth in his underwear!”
By hour 55, Borman has his suit unzipped and halfway off. By hour 100, he petitions NASA management to let him take it all the way off. Five hours pass. Houston comes back on the line. Borman may take off his suit, but only if Lovell gets back in his. Lovell tries to resist (“I would prefer to leave it this way if you don’t mind”), but NASA stands firm. Hour 163: Lovell is in, and Borman is out. Eventually, Berry prevails, and both suits come off. Otherwise, Berry recalls in his oral history, “I don’t think we would have completed fourteen days in that spacecraft…. You’ve got two guys in spacesuits and they’re sitting like this, your leg over in the other guy’s lap. It’s a really difficult situation.”
It could be worse. Try living in bed for three months.
What If You Never Got Out of Bed?
Leon M. doesn’t appear to have the “right stuff.” He has a messy past and lingering debts. His most recent job was as a security guard. These days, Leon spends entire weeks in bed, watching movies and playing video games. Beneath the sweatpants and tattoos, however, there’s an astronaut of sorts. Leon’s skeleton has been diminishing at about the same rate as an astronaut’s in space.
Leon is part of a NASA-funded bed-rest study at the Flight Analogs Research Unit (FARU) at the University of Texas Medical Branch in Galveston. For decades, space agencies around the world have been paying people rather handsomely to lounge around all day and night in their PJs. That’s how it was presented to Leon, who heard about the gig on one of Howard Stern’s odd-ball-headline roundups: NASA WILL PAY YOU TO LIE IN BED.
For three months, twenty-four hours a day, Leon does not get up—or even sit up—for anything: not to shower, not to eat, not to use the toilet. Bed rest is an analog, or mimic, of spaceflight in that staying off one’s feet causes the same sorts of bodily degradations that weightlessness causes. Most direly, the bones thin and the muscles atrophy. Space agencies study bed-resters to try to understand these changes and figure out how best to counteract them.
Bed-rest studies often assess the helpful (or not) effects of drugs or exercise devices—countermeasures, as they say in aerospace medicine lingo—but the one for which Leon has volunteered is simpler. The researcher is comparing certain changes in men versus women. Leon pauses an episode of Magnum, P.I. on the smartphone that he bought on the Internet with his first check. “So basically, yeah, I’m just deteriorating. And they just want to watch it.” He reports this as cheerfully as someone else might report a promotion or a good night at the blackjack table. Leon has high cheekbones, longish, springy black hair, and an appealing smile.
The human body is a frugal contractor. It keeps the muscles and skeleton as strong as they need to be, no more and no less. “Use it or lose it” is a basic mantra of the human body. If you take up jogging or gain thirty pounds, your body will strengthen your bones and muscles as needed. Quit jogging or lose the thirty pounds, and your frame will be appropriately downsized. Muscle is regained in a matter of weeks once astronauts return to earth (and bed-resters get out of bed), but bone takes three to six months to recover. Some studies suggest that the skeletons of astronauts on long-duration missions never quite recover, and for this reason it’s bone that gets the most study at places like FARU.
The body’s foreman on call is a cell called the osteocyte, embedded all through the matrix of the bone. Every time you go for a run or lift a heavy box, you cause minute amounts of damage to your bone. The osteocytes sense this and send in a repair team: osteoclasts to remove the damaged cells, and osteoblasts to patch the holes with fresh ones. The repaving strengthens the bone. This is why bone-jarring exercise like jogging is recommended to beef up the balsa-wood bones of thin, small-boned women of northern European ancestry, whose genetics, postmenopause, will land them on the short list for hip replacement.
Likewise, if you stop jarring and stressing your bones—by going into space, or into a wheelchair or a bed-rest study—this cues the strain-sensing osteoclasts to have bone taken away. The human organism seems to have a penchant for streamlining. Whether it’s muscle or bone, the body tries not to spend its resources on functions that aren’t serving any purpose.
Tom Lang, a bone expert at the University of California, San Francisco, who has studied astronauts, explained all this to me. He told me that a German doctor named Wolff figured it out in the 1800s by studying X-rays of infants’ hips as they transitioned from crawling to walking. “A whole new evolution of bone structure takes place to support the mechanical loads associated with walking,” said Lang. “Wolff had the great insight that form follows function.” Alas, Wolff did not have the great insight that cancer follows gratuitous X-raying with primitive nineteenth-century X-ray machines.
How bad can it get? If you stay off your feet indefinitely, will your body completely dismantle your skeleton? Can humans become jellyfish by never getting up? They cannot. Paraplegics eventually lose from one-third to one-half of their bone mass in the lower body. Computer modeling done by Dennis Carter and his students at Stanford University suggests that a two-year mission to Mars would have about the same effect on one’s skeleton. Would an astronaut returning from Mars run the risk of stepping out of the capsule into Earth gravity and snapping a bone? Carter thinks so. It makes sense, given that extremely osteoporotic women have been known to break a hip (actually, the top of the thighbone where it enters the pelvis) by doing nothing but shifting their weight while standing. They don’t fall and break a bone; they break a bone and fall. And these women have typically lost a good deal less than 50 percent of their bone mass.
NASA funded the work that led to Carter’s computer models. “But it seems like no one there read our report,” he says. “They have this idea that they can send astronauts up and the bone loss will level off in a few months, but the evidence that has come back doesn’t support that view. If you look at a two-year mission to Mars, it’s kind of a scary prospect.”
SOME BED-REST FACILITIES call their volunteers “terranauts.” At first I assumed this was done to confer a sense of importance to the pursuit, like calling a janitor a sanitation engineer. But the day-to-day existence of the three-month terranaut bears similarities to that of an astronaut orbiting Earth. Each day begins with wake-up music on the speaker system. (It was Metallica* on the space station this morning; “some Beethoven thing” at FARU.) You spend your time confined to a small room, or cluster of rooms, and if you try to go outside, you are in trouble. Privacy is hard to come by. At FARU, closed-circuit cameras are aimed at the beds, so staff can be sure everyone is staying flat. (Subjects are allowed to pull the curtain that surrounds their bed only when they use the bedpan.) Whiners are not a good fit. Leon says he went through an irritable patch at the halfway point of his stay, but that he is “so chipper they didn’t notice.” In the half hour I’ve spent with Leon, I have heard only one complaint. It involved the chicken. “It’s little squares. I want chicken with a bone and skin on it! Don’t give me those cubes.”
Leon excuses himself, because the masseuse is coming. Unlike astronauts, bed-resters get a massage every other day to help with the lower back pain that is a common side effect of taking a load off. Obliviously, doctors used to prescribe bed rest for patients with lower back pain. According to a 2003 article in Joint Bone Spine,* regardless of what ails you, it is almost always a good idea to get out of bed as soon as you can.
Without the weight of a body compressing it, the spine’s curvature lessens and the discs between the vertebrae expand and absorb more water. Astronauts are as much as 2.5 inches taller after about a week in space. (The typical gain is 3 percent of one’s height.) Like children, they will “outgrow” their suits if a “growth” spurt has not been factored in.
AARON F. HAS BEEN “head-down” for eight weeks. (The term refers to the 6-degree tilt of the beds. Since weightlessness causes body fluids to shift to the upper part of the body, so must bed rest.) A large fan by his bed is running at top speed, not to cool him but to mask the noises out in the hall. He’s been feeling trapped, unable to get away from it. Not helping matters: His roommate Tim is still in his “ambulatory period.” He goes head-down in a couple days, but for now he’s allowed to pad around the unit in his slippers and sit cross-legged on his bed, which he is doing now.
A kitchen worker pushes a serving cart into the room.
“The high point of my day!” says Tim. He looks genuinely excited over the prospect of hospital food. Aaron accepts his tray without comment. He props himself on one elbow. It is odd to see people reclining for a meal. It’s a drab, antiseptic take on a scene from the Arabian Nights, men lounging on pillows, eating with one hand.
Tim takes me on a guided tour of supper, pointing with his fork. “We’ve got chicken…”
I think of Leon. “Diced?”
“Diced, yes. You could almost roll them! And over here are carrot coins,…” There is a rapt quality to his speech, as though we were gazing at gold doubloons. “…apple slices, milk, two rolls, Jell-O. I really love the food here.”
Aaron searches for something positive to say. “It’s a good variety.” But is struggling. “Then again, it’s the same variety. We get a lot of fish—”
“Oh my god.” Tim again. “The fish is amazing!”
Tim reenlisted after his first stint here, a few years ago. A sign on his wall says WELCOME BACK, 9290 in glitter paint borrowed from the pediatric oncology unit next door.
Before I can stop him, Tim slides off his bed to go ask the kitchen staff whether there is an extra dinner for me.
Aaron is antsy and squirmy, alternately bringing his legs up to form an A-frame under the sheets and then stretching them flat again. Like Leon and others I spoke with, he is here because he’s trying to pay off some credit card bills. Bed-rest studies are a modern-day debtor’s prison. It’s not just the amount of money—$17,000 for three months of service—but the limited opportunities to spend it. For three months, there is no rent to pay, no groceries or gas to buy, no bar tabs, no air fares. A bed-rest stint is a way to force oneself out of bad habits. (Though not entirely effective: Internet shopping has made FARU one of the busiest stops on the local UPS route.)
Tim graduated with a business degree and no money with which to start a company. He moved into a Vipassana ashram because he felt a need to ponder his future and because “they feed you, and it’s free!” After much thought and rice, he decided to become an actor. He spent the next four years as “a starving artist, literally,” and then he heard about a study here at FARU. When he finished, he returned to acting, joining a New Hampshire theater troupe doing “children’s Macbeth,” the very thought of which alarms me. When the chance came to re-up at FARU, he took it. These days he’s weighing wildly diverging career options: joining the Houston police force, opening a coin-op laundry, enrolling in Navy officer candidate school, starting a landscaping business, and becoming a motivational speaker. He is having, as he puts it, “a quarter-life crisis.”
According to FARU manager Joe Neigut, 30 percent of the people who sign on to bed-rest studies say they are doing so not only for money, but to be a part of the space effort. As Leon says, “It’s as close as I’m going to get to being an astronaut.” At the very least, the association with spaceflight puts a luster on the undertaking. Knowing this, the staff entreat astronauts to write thank-you messages on 8-by-10 glossies. Every now and then, an astronaut drops by to deliver them in person. Aaron got an in-person visit but does not recall the man’s name. Tim received an autographed photo of Peggy Whitson. (“A total BAMF* astronaut,” he called her.)
Tim is back from the kitchen. There is no extra food for me, and that’s okay. “Did I miss anything?”
“Yuh,” Aaron says. “I moved to the left a bit.”
THE BIGGEST SKELETON at Johnson Space Center belongs to John Charles. Charles is 6 feet 7. When he was ten, he knew he wanted to be an astronaut. His skeleton, as though aware of its fate in space, sabotaged Charles’s dreams by growing past the astronaut height cutoff. Charles got his Ph.D. in physiology and went to work for NASA. It is his job to do what he can to protect the bodies and bones of astronauts.
Charles and I spoke one recent afternoon in the Lyndon B. Johnson Meeting Room in the public affairs building at Johnson’s namesake, the Johnson Space Center. A chaperone from the Public Affairs Office sat quietly in the corner, as though Charles and I might otherwise leap into each other’s arms there amid the plaques and signed proclamations of the Johnson era. Charles must put the public affairs people on edge. He is known for speaking his mind freely and sits high enough on the ladder of command not to worry too much about the consequences.
As on Earth, weight-bearing exercise is the best way to hang on to your bone. In zero gravity, of course, you have to create your weight. The problematic and expensive way to do this is to outfit the space station with a rotating room, a huge, inhabitable centrifuge that spins astronauts outward toward the walls, creating artificial gravity. (Keir Dullea can been seen jogging on one in 2001: A Space Odyssey.) The funky and affordable alternative is to mimic weight by pulling astronauts’ bodies down into a treadmill belt as they jog. Typically this involves a harness and bungee cords and much cursing and chafing. It is not tremendously effective. Bone loss researcher Tom Lang says this kind of device pulls exercisers against the belt with about 70 percent of their bodyweight, a scenario that still translates to “massive bone loss.”
It’s unclear how much exercise helps. “Exercise is probably better than not exercising in space,” says Charles, “but we don’t know how much better, because we’ve never done the experiment.” No one wants to expose a control group to the sort of bone loss that could result from doing no exercise at all. “If you have hundreds of astronauts who’ve done different levels, you can pool them into groups and see that this group did slightly less and it had this effect, and this group used a treadmill, not a bike, and it had that effect. But we don’t have those large numbers. We have one person that used a bicycle and not a treadmill, one person that used a bike and then changed to a treadmill, and the first is a female in her forties and the second is a male in his sixties. All we can do is a sort of grouped average. The grouped average says that we have countermeasures that still are not protecting astronauts as much as we would like them to be protected.” According to Lang, astronauts are coming home from six-month space station stints with 15 to 20 percent less bone than they had when they left.
FARU has lately run a study on vibration as a means of preventing bone loss. Subjects exercised while pulled by elastic cords into a vibrating plate installed at the foot of their bed. It’s the same kind of vibrating plate you see advertised on the Internet with promises to build bone and muscle, trim fat, flatten bellies. I was surprised to find them here. So was John Charles. When I asked him about vibration as a bone-loss countermeasure, he said, “It’s over with. It’s not working.” The FARU consent form notes that the investigator has a “relationship” with the vibration machine. He helped invent it.