Expanded Universe

SPINOFF

On 2 July 1979 I received a letter calling me to testify July 19th before a joint session of the House Select Committee on Aging (Honorable Claude Pepper, M.C., Chairman) and the House Committee on Science and Technology (Honorable Don Fuqua, M.C., Chairman) - subject: Applications of Space Technology for the Elderly and the Handicapped.

I stared at that letter with all the enthusiasm of a bridegroom handed a summons for jury duty. Space technology? Yeah, sure, I was gung - ho for space technology, space travel, spaceships, space exploration, space colonies - anything about space, always have been.

But "applications of space technology for the elderly and the handicapped"? Why not bee culture? Or Estonian folk dancing? Or the three - toed salamander? Tantric Yoga?

I faced up to the problem the way any married man does: "Honey? How do I get out of this?"

"Come clean," she advised me. "Tell them bluntly that you know nothing about the subject. Shall I write a letter for you to sign?"

"It's not that simple."

"Certainly it is. We don't want to go to Washington. In July? Let's not be silly."

"You don't have to go."

"You don't think I'd let you go alone, do you? After the time and trouble I've spent keeping you alive? Then let you drop dead on a Washington sidewalk? Hmmph! You go - I go."

Some hours later I said, "Let's sum it up. We both know that any Congressional committee hearing, no matter how the call reads, has as its real subject 'Money' - who gets it and how much. And we know that the space program is in bad trouble. This joint session may not help - it looks as if it would take a miracle to save the space program - but it might help. Some, maybe. The only trouble is that I don't know anything about the subject I'm supposed to discuss."

"So you've said, about twenty times."

"I don't know anything about it today. But on July 19th I'm going to be a fully - qualified Expert Witness."

"So I told you, two hours ago."

Ginny and I have our own Baker Street Irregulars. Whether the subject be Chaucer or chalk, pulsars or poisons, we either know the man who knows the most about it, or we know a man who knows the man who knows the most. Within twenty - four hours we had a couple of dozen 1f 1ft% f {$// public - spirited citizens helping us. Seventy - two hours, and information started to trickle in - within a week it was a flood and I was starting to draft my written testimony.

I completed my draft and immediately discarded it; galley proofs had arrived of TECHNOLOGIES FOR THE HANDICAPPED AND THE AGED by Trudy E. Bell, NASA July 1979. This brochure was to be submitted by Dr. Frosch, Administrator of NASA, as his testimony at the same hearing. Trudy Bell had done a beautiful job - one that made 95% of what I had written totally unnecessary.

So I started over.

What follows is condensed and abridged from both my written presentation and my oral testimony:

"Honorable Chairman, ladies, and gentlemen - "Happy New Year!

"Indeed a happy New Year beginning the 11th year in the Age of Space, greatest era of our race - the greatest! - despite gasoline shortages, pollution, overpopulation, inflation, wars and threats of war. 'These too shall pass' - but the stars abide.

"Our race will spread out through space - unlimited room, unlimited energy, unlimited wealth. This is certain.

"But I am not certain that the working language will be English. The people of the United States seem to have suffered a loss of nerve. However, I am limited by the call to a discussion of 'spin-offs' from our space program useful to the aged and the handicapped.

"In all scientific research, the researcher may or may not find what he is looking for - indeed, his hypothesis may be demolished - but he is certain to learn something new... which may be and often is more important than what he had hoped to learn.

"This is the Principle of Serendipity. It is so invariant that it can be considered an empirically established natural law.

"In space research we always try to do more with less, because today the pay load is tightly limited in size and in weight. This means endless research and development to make everything smaller, lighter, foolproof, and fail - proof. It works out that almost everything developed for space can be used in therapy

and thereby benefits both the elderly and the handicapped, the two groups requiring the most therapy of all sorts.

"When you reach old age - say 70 and up - it approaches certainty that you will be in some way handicapped. Not necessarily a wheelchair or crutches or a white cane - most handicaps do not show. So all of us are customers for space spin-offs - if not today, then soon.

Witness holds up NASA brochure. "There is no need for me to discuss applications that NASA has already described. But this I must say: NASA's presentation is extremely modest; it cites only 46 applications - whereas there are hundreds. Often one bit of research results in 2nd, 3rd, and 4th generations; each generation usually has multiple applications - spin-offs have spin-offs, branching out like a tree. To get a feeling for this, think of the endless applications of Lee DeForest's vacuum tube, Dr. Shockley's transistor.

"Here is a way to spot space - research spin-offs: If it involves microminiaturization of any sort, minicomputers, miniaturized long - life power sources, highly reliable micro switches, remotely - controlled manipulators, image enhancers, small and sophisticated robotics or cybernetics, then, no matter where you find the item, at a critical point in its development it was part of our space program.

"Examples:

"Image enhancer: This magic gadget runs an x - ray or fluoroscope picture through a special computer, does things to it, then puts it back onto the screen. Or stores it for replay. Or both. It can sharpen the contrast, take out 'noise,' remove part of the picture that gets in the way of what you need to see, and do other Wizard - of - Oz stunts.

"This is the wonder toy that took extremely weak digital code signals and turned them into those beautiful, sharp, true - color photographs from the surface of Mars in the Viking program and also brought us the Voyager photographs of Jupiter and its moons.

"I first saw one in 1977 at the Medical School of the University of Arizona - saw them put a long catheter up through a dog's body in order to inject an x - ray opaque dye into its brain. This does not hurt the dog. More about this later - "I did not know what an image enhancer was until

I saw one demonstrated and did not learn until this year that it came from our space program. Possibly the doctor did not know. M.D.'s can use instruments with no notion that they derive from space research and a patient usually knows as little about it as did that dog.

"The most ironical thing about our space program is that there are thousands of people alive today who would be dead were it not for some item derived from space research - but are blissfully unaware of the fact - and complain about 'wasting all that money on stupid, useless space stunts when we have so many really important problems to solve right here on Earth.'

"' - all that money - '!

"That sort of thinking would have kept Columbus at home.

"NASA's annual budget wouldn't carry H.E.W. ten days. The entire 10 years of the Moon program works out to slightly less than five cents per citizen per day.

"Would you like to be a wheelchair case caught by a hurricane such as that one that failed to swing east and instead hit the Texas and Louisiana coast? That storm was tracked by weather satellite; there was ample warning for anyone who would heed it - plenty of time to evacuate not only wheelchair cases but bed patients.

"A similar storm hit Bangladesh a while back; it too was tracked by satellite. But Bangladesh lacks means to warn its people; many thousands were killed. Here in the United States it would take real effort to miss a hurricane warning; even houses with no plumbing have television.

"Weather satellites are not spin-off; they are space program. But they must be listed because bad weather of any sort is much rougher on the aged and the handicapped than it is on the young and able - bodied.

"Portable kidney machine: If a person's kidneys fail, he must 'go on the machine' or die. 'The machine' is a fate so grim that the suicide rate is high. Miniaturization has made it possible to build portable kidney machines. This not only lets the patient lead a fairly normal life, travel and so forth, but also his blood is cleaned steadily as with a normal kidney; he is no longer cumulatively poisoned by his own toxins between his assigned days or nights 'on the machine.'

"This is new. A few have already made the switch but all kidney victims can expect it soon. The suicide rate has dropped markedly - life is again worth living; hope has been restored.

"Computerized - Axial Tomography, or CAT, or 'brain scan': They strap you to a table, fasten your skull firmly, duck behind a barrier, and punch a button - then an automatic x - ray machine takes endless pictures, a tiny slice at a time. A special computer synthesizes each series of slices into a picture; a couple of dozen such pictures show the brain in three - dimensional, fine detail, a layer at a time.

"Doppler Ultrasound Stethoscope: another microminiaturization spin-off. This instrument is to an ordinary stethoscope as a Rolls Royce is to a Model - T Ford."

Witness stands up, turns from side to side. "Look at me, please! I'll never be Mr. America; I'll never take part in the Olympics. I've climbed my last mountain.

"But I'm here, I'm alive, I'm functioning.

"Fourteen months ago my brain was dull - normal and getting worse, slipping toward 'human vegetable.' I slept 16 hours a day and wasn't worth a hoot the other 8 hours.

"Were it not for the skill of Dr. Norman Chater, plus certain spin-offs from the space program, today I would either be a human vegetable or, if lucky, dead of cerebral stroke.

"My father was not lucky; from a similar disorder it took him years to die - miserable years. He died before the operation that saved me had been invented, long before there was medical spin-off from space technology.

"Am I elderly? I'm 72.1 suffered from a disorder typical of old age, almost never found in the young.

"Am I handicapped? Yes, but my handicaps do not interfere with my work - or my joy in life. Over forty years ago the Navy handed me a piece of paper that pronounced me totally and permanently disabled. I never believed it. That piece of paper wore out; I did not.

"Mrs. Heinlein and I spent 1976 and - 77 on blood drives all over this nation. We crisscrossed the country so many times we lost track. It was worthwhile; we recruited several thousand new blood donors - but it was very strenuous. By the end of '77 we badly needed a rest, so we took a sea voyage. She and I were walking the beach on Moorea, Tahiti, when I turned my head to look at a mountain peak - and something happened.

"I balanced on my left leg and said, 'Darling, I'm terribly sorry but I think I've had a stroke. Something happened inside my head and now I'm seeing double and my right side feels paralyzed.'

"Mrs. Heinlein half carried me, half dragged me, back to the landing - got me back aboard.

"A shipmate friend, Dr. Armando Fortuna, diagnosed what had happened: a transient ischemic attack, not a stroke. When we reached California, this was confirmed by tests. However a TIA is frequently a prelude to a stroke.

"Remember that spin-off, computerized - axial tomography? That was done to me to rule out brain tumor. No tumor. The neurologist my physician had called in started me on medication to thin my blood as the clinical picture indicated constriction in blood flow to my brain. This treatment was to continue for six months.

But in only two months I was failing so rapidly that I was shipped to the University of California Medical School at San Francisco for further diagnosis. Remember the image enhancer and that dog at the University of Arizona? I said that dog was not hurt. They did it to me, with no anesthesia; it did not hurt.

"The catheter goes in down here" - witness points at his right groin - "and goes all the way up and into the aortal arch above the heart. There three very large arteries lead up toward the brain; the catheter was used to shoot x - ray - opaque dye into each, in succession. The procedure took over two hours ... but I was never bored because the image enhancer included closed - circuit television of the fluoroscopy with the screen right up here" - witness indicates a spot just above and to the left of his head - "above me, where the radiologist and his team, and the patient - I - could see it.

"How many people ever get a chance to watch their own hearts beat? Utterly fascinating! I could see my heart beating, see my diaphragm rise and fall, see my lungs expand and contract, see the dye go up into my brain... see the network of blood vessels in my brain suddenly spring into sharp relief. It was worth the trip!

"They spotted what was wrong; my left internal carotid was totally blocked. So the left half of my brain was starved for oxygen, as it was receiving only what leaked over from the right side or from the vertebrals where the network interconnected, principally at the Circle of Willis under the brain.

"But this is your speech center" - witness touches left side of skull above ear - " your word processor, the place where a writer does all his work. No wonder I was dopey - could not write, could not study, could not read anything difficult.

"My left internal carotid is still blocked; the stoppage is too high up for surgery. So they sent me to Dr. Chater at Franklin Hospital, who moved my left superficial temporal artery to feed the left side of my brain. This operation is pictured on pages 62 and 63 of the April 1978 Scientific American, so Twill omit grisly details; if surgery interests you, you can look them up there.

"The procedure is this: Scalp the patient from the left eyebrow, going high and curving down to a spot behind the left ear back of the mastoid. Cut away from the scalp the temporal artery. Saw a circular hole in the skull above the ear. Go inside the brain into the Sylvian fissure, find its main artery, join the two arteries, end to side. The left anterior lobe of my brain is now served by the left external carotid via this roundabout bypass. Dr. Chater did the hookup under a microscope with sutures so fine the naked eye can't see them.

"Check by Doppler ultrasound to make sure the bypass works, then close the hole in the skull with a plate that has a groove in it for the moved artery. Sew back the scalp - go to lunch. The surgeon has been operating for four hours; he's hungry. (The patient is not.)

"They placed me in a cardiac intensive - care room. When I woke, I found in my room a big screen with dancing lights all over it. Those curves meant nothing to me but were clear as print to the T.C. nurses and to my doctors - such things as EKG, blood pressure, respiration, temperature, brain waves, I don't know what all. The thing was so sensitive that my slightest movement caused one of the curves to spike.

"I mention this gadget because I was not wired to it. "Another space - technology spin-off: This is the way Dr. Berry monitored our astronauts whenever they were out in space.

"Colonel Berry had to have remote monitoring for his astronaut patients. For me it may not have been utterly necessary. But it did mean that I was not cluttered with dozens of wires like a fly caught in a web; the microminiaturized sensors were so small and unobtrusive that I never noticed them - yet the nurses had the full picture every minute, every second.

"Another advantage of telemetered remote monitoring is that more than one terminal can display the signals. My wife tells me that there was one at the nursing supervisor's station. Dr. Chater may have had a terminal in his offices - I don't know. But there can't be any difficulty in remoting a hundred yards or so when the technology was developed for remoting from Luna to Houston, almost a quarter of a million miles.

"Space spin-off in postoperative care: a Doppler ultrasound stethoscope is an impressive example of microminiaturization. It is enormously more sensitive than an acoustic stethoscope; the gain can be controlled, and, because of its Doppler nature, fluid flow volume and direction can be inferred by a skilled operator. Being ultrasound at extremely high frequency, it is highly directional; an acoustic stethoscope is not.

"It generates a tight beam of ultrasound beyond the range of the human ear. This beam strikes something and bounces back, causing interference beats in the audible range. It behaves much like Doppler radar save that the radiation is ultrasound rather than electromagnetic. Thus it is a non invasive way to explore inside the body without the dangers of x - ray ... and is able to 'see' soft tissues that x - ray can't see.

"Both characteristics make it especially useful for protecting pregnant mothers and unborn babies. I am not departing from the call; babies unborn and newly born, and mothers at term must be classed as 'temporarily but severely handicapped.'

"Doppler ultrasound was used on me before, during, and after surgery.

"After my convalescence I was again examined by computerized axial tomography. No abnormalities - - other than the new plate in my skull.

"This brain surgery is not itself a spin-off from space technology ... but note how repeatedly space spin-offs were used on me before, during, and after surgery. This operation is very touchy; in the whole world only a handful of surgical teams dare attempt it. Of the thousand - odd of these operations to date, worldwide, Dr. Chater has performed more than 300. His mortality rate is far lower than that of any other team any - where. This is a tribute to his skill but part of it comes from his attitude: he always uses the latest, most sophisticated tools available.

"I was far gone; I needed every edge possible. Several things that tipped the odds in my favor are spin-offs from space technology.

"Was it worthwhile? Yes, even if I had died at one of the four critical points - because sinking into senility while one is still bright enough to realize that one's mental powers are steadily failing is a miserable, no-good way to live. Early last year I was just smart enough to realize that I had nothing left to look forward to, nothing whatever. This caused me to be quite willing to 'Go - for - Broke' - get well or die.

"Did it work? I have been out of convalescence about one year, during which I've caught up on two years of technical journals, resumed studying - I have long been convinced that life - long learning helps to keep one young and happy. True or not, both my wife and I do this. At present Tam reviewing symbolic logic, going on into more advanced n - dimensional, non - Euclidean geometries, plus another subject quite new to me: Chinese history.

"But I am working, too; I have completed writing a very long novel and am about halfway through another book.

"I feel that I have proved one of two things: either I have fully recovered.. . or a hole in the head is no handicap to a science - fiction author.

"I must note one spin-off especially important to the aged and the handicapped: spiritual spin-off.

"'Man does not live by bread alone.' Any physician will tell you that the most important factor in getting well is the will to live - contrariwise, a terminal patient dies when he gives up the fight.

"I have been in death row three times. The unfailing support of my wife sustained my will to live.. . so here I am. In addition I have believed firmly in space flight for the past sixty - odd years; this has been a permanent incentive to hang on, hang on! My wife shares this; she decided years back to die on the Moon, not here in the smog and the crowds. Now that I am well again I intend to hang in there, lead a disciplined life, stay alive until we can buy commercial tickets to the Moon ... and spend our last days in low - gravity comfort in the Luna Hilton, six levels down in Luna City.

"Foolishness? Everyone in this room is old enough to know by direct experience that today's foolishness is tomorrow's wisdom. I can remember when 'Get a horse!' was considered the height of wit. As may be, anything that gives one a strong incentive to live can't be entirely foolish.

"I get a flood of mail from my readers; a disproportionate part of it is from the very old and the handicapped. It is impossible to be a fan of my fiction and not be enthusiastic for space travel. Besides, they tell me so, explicitly, in writing.

"Examples:

"A college professor, blind from birth. He's never seen the stars; he's never seen the Moon. The books he reads and rereads - has read to him by his secretary - are about space travel. He went to a lot of trouble to look me up... to discuss our space program.

"A teen - age boy, tied to a wheelchair, who wrote to ask me whether or not he could become an astronautical engineer - some 'friend' had told him that it was a silly ambition for a cripple. I assured him that an engineer did not need legs even on Earth surface, advised him in what courses to take, and referred him to a story by Arthur C. Clarke in which a double amputee, both legs, commands a space station.

"A housewife with epilepsy, grand mal, who doesn't expect ever to be able to go out into space... but finds her greatest interest in life, her major relief from the tedious routine she must follow, in our space program.

"Avery large number of elderly people who wrote to me immediately after the first landing on the Moon, all saying, in effect, that they thanked the Lord that they had been spared long enough to see this great day.

"I could add examples endlessly. Just let me state flatly that my files hold proof that the aged retired, the shut - ins and the disabled of all ages get more spiritual lift out of space flight than does any other definable group of our citizens. For many of them the television screen is their only window on the world; something great and shining and wonderful went out of their lives when the Apollo Moon program ended.

"Even if a space program had no other spin-off, isn't that sort worth 5 a day?"