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Last week I had the chance to mentor a newly certified ADCO trainee - the NASA process is called "Hot On-The-Job-Training", or Hot OJT. What makes it "hot" you ask? Well, essentially I am hands off - he is sitting at the console, working all the plan reviews and updates, making calls to other flight controllers and to the flight director, reacting to anomalies and preparing material for the shift handover. My job is to act as the fault tolerance - a backup ADCO of sorts.

Tuesday was his last official day and by Wednesday morning he was in the backroom sending commands to ISS in preparation for the docking of a three-person Soyuz.

Controlling ISS during the 61S Soyuz docking!

The beauty of this system is the gradual buildup in responsibility. There is a subtle shift from student, to subject matter expert, to fresh operations trainee to advanced trainee and finally to certification and real-time operations flight controller - the process takes two years on average and is considered by many to be enough specialized training to qualify for a Master's degree. After that there is another round of training and simulations to become a Specialist...hoofty!

It's safe to say NASA has perfected this type of training much better than Type 1 Diabetes (ha). At NASA we are evaluated during each simulation using the "Flight Controller Performance Criteria" - a set of categories with associated grades. Everyone - from backroom support to Flight Directors are graded on this same scale. It may sound intimidating but it's actually a great way to zero in on skills that need more work, and while still subjective, its an attempt to make everything less so.

When juxtaposed with the training regime following a T1D diagnosis, there really is no comparison.

From the first moment - T1D is "Hot OJT" - real people, real injections, real faulty pancreases. It's like trying to fly the ISS while reading the book on how to do it, all while troubleshooting anomalies and preparing for dockings. And unlike a shift in mission control, there is no handover to the next flight controller - it's you, on console, 24/7/365 for, well, basically ever. We all know how incredibly complicated ISS is, but I would venture to say that the human body is even more complicated - there are no straight forward users guides or flight rules or recommendations or constraints - you're operating mostly on gut feel with some SWAGs thrown in for good measure. Overall it's a completely different approach to training and operating.

T1D is always on-the-job training, sometimes literally, on-the-freaking-job.

An interesting thought experiment - imagine you could take the same approach to T1D as a NASA flight controller. Imagine having time to build up the skills and knowledge, practice injections and carb counting, get feedback on your performance. Then, when you have proven your ability to manage, problem solve and react, the diagnosis day comes. Somehow I don't think it would make anything any better - in fact, it feels so much worse. And even with all the training and practice and simulations and examinations, there are still things that you can only learn "on-the-job". As Flight Controllers, we have all made a less-than-perfect call to the Flight Director, and as T1Ds we have all forgot a bolus or ran out of test strips. And those feelings? Like the one when your blood sugar is low or high, or when a vehicle is just a few feet away from the docking port - well, those feelings just can't be replicated outside of the actual environment.

For better or worse T1D is an on-the-job disease.


  1. In a way I sort of had that. My mom was DX'd when I was 3-4 and I watched her do it for 14 years. Sometimes with me by her side and other times pouring regular coke in her mouth when she was low. Then when I was 16I was DX'd. I suggest doing it that way for anyone who has to do something like this.


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