The Next Horizon

By Kevin Tankersley

First Surgeon General for the U.S. Space Force on the Changing Landscape of Medicine

Pictured: Photos by Breanne Johnson

TWhen students visit “Sparky” Matthews’ office on the first floor of the Baylor Sciences Building, they often find themselves looking at all the stuff instead of paying attention to the conversation.

“Oh, my goodness. I’ve got different favorites for different reasons,” Matthews replied when asked to pick out his most cherished artifact.

On one shelf are the gas mask and canteen his Uncle Gentry used in World War I. On the wall is a print signed by four of the original Tuskegee Airmen who visited Matthews’ unit when it was stationed in Iraq. The staff leaning up in the corner? It’s made from bloodwood, the only tree wood that doesn’t float due to its density. Matthews picked that up during a humanitarian mission in Peru. He also has on display his flight helmets from his time in the Air Force, photos of him with his mentor, Dr. Bill Hillis, a physician and researcher who worked at Baylor for more than 30 years.

And then there are the ceramic busts lined up on the top shelf of a bookcase. There’s Homer Simpson — a family joke — next to Hippocrates, the father of medicine, who is wearing a surgical cap from The Space Surgery Association. The last four are who Matthews describes as “the essential men of the last three centuries: George Washington, Abraham Lincoln, Ronald Reagan and Winston Churchill.

Without Washington, “the entire world would be different,” Matthews said. Lincoln is the essential man of the 19th century, and Reagan and Churchill share the title for the 20th century.

“The world would be different if it wasn’t for Reagan and Margaret Thatcher and Pope John Paul II,” he said. “And we would all be speaking German if it wasn’t for Winston Churchill, because he literally stood alone against the Nazi invasion of England.

Everyone else wanted to capitulate. And he stood alone saying, ‘No, we have to resist,’ and that made all the difference in the world.”

Matthews said his students call his office “the Sparky Museum,” and he doesn’t disagree.

“It’s hard to say a favorite because these are the totems of my whole life,” he said. “I mean, my whole life can be told through the story of everything that’s in this room.”

Dr. Walter M. “Sparky” Matthews, 53, is a clinical professor in the Honors Program at Baylor and the Honors Program pre-medical mentor. He graduated from Baylor in 1992 with a bachelor’s in biology and holds master’s degrees from the University of Texas Health Science Center and the National War College and earned his medical degree from the Baylor College of Medicine. He served in the U.S. Air Force for 28 years, retiring as a colonel, and was the first surgeon general of the United States Space Force.

“I can’t remember ever wanting to do anything but be a physician, ever since I wanted to be anything,” he said. “Other kids wanted to be a policeman, a fireman, an astronaut. I wanted to be a doctor.”

While he had designs on entering the medical field, it was a conversation with his mentor Hillis that pointed him toward the military.

“He grabbed me as I was leaving class one day and said, ‘You ought to go talk to the Air Force recruiter that’s on campus today. I think that’d be a good fit for you,’” Matthews said. He eventually enrolled in the Health Professions Scholarship Program in the Air Force, which paid for medical school but also required an enlistment commitment.

“I figured I’d serve four years after residency and go into civilian life,” he said. “I decided to stay until it wasn’t fun anymore. And that took 28 years.”

In his fourth year of medical school, Matthews enrolled in an aerospace medicine course, and “fell in love with flying,” eventually becoming a flight surgeon, working closely with Air Force pilots and crew members.
“The job of a flight surgeon is to be as much like a pilot as you possibly can be,” he said. “We dress like them. I did more medicine on a bar stool in the squadron bar than I did in my in my exam room.

So, I was with them. I worked with them.

I flew with them. I played with them.

I deployed with them. I lived in the same neighborhoods they did. And so, they saw me as one of their own. That’s one of the big reasons flight surgeons fly.”

Matthews earned the moniker “Sparky” during his first week as a flight doctor.

“That’s my call sign from the Air Force. And you never get a call sign from doing something cool. It’s doing something stupid,” he said.

While he was a student at Baylor, Matthews was training as an EMT and gained some experience after working a couple of mass casualty incidents on Interstate 35.

Three days into his first week as a flight surgeon, he took part in a training exercise where the scenario replicated the aftermath of a plane crashing into military base housing. He approached the plane’s pilot, still strapped into his ejection seat, who was on a piece of playground equipment. Matthews gripped the pilot’s helmet to stabilize his neck and did not notice an extension cord that was draped across the pilot’s chest.

“That simulated a live power line for the exercise, so as soon as I touched him, the evaluator said, ‘That’s it. You’re dead. You’re electrocuted. You touched a body with live powerline,’” Matthews said. “They killed me off, they strapped me onto a lifter and carried me into the clinic on their shoulders like a hunting trophy. And for weeks after that, people called me Sparky. They passed me in the hallway and go, ‘Bzzt,’ and I hated it. I tried to scrape it off. And the harder I scraped, the harder it stuck. So, I eventually just had to embrace it. It fits my personality, so it’s OK.”

The hardest part of being a flight surgeon, Matthews said, is telling a pilot that he or she can’t fly, whether that means being grounded for a week or so to recover from a minor illness or injury, or never flying again due to a tumor in the ear canal that causes “one-sided deafness,” or because of a cardiac arrhythmia, which means there’s an abnormality in the electrical conduction of the heart. Matthews faced both of those situations in his time as a flight surgeon.

“Being a pilot and being a physician are very, very similar, because flying is not what a pilot does. It’s who they are. Being a pilot is an identity,” he said. “Being a physician is an identity as well. It’s not what you do, it’s who you are. So, I’m not telling this pilot, ‘You can’t do this anymore.’ I’m telling them, ‘You’re not who you have always been. You have to find a new identity.’ That’s tough to do.”

Matthews spent most of the last 15 years of his career in leadership and not working as a clinical physician. He held senior leadership positions mentoring junior officers and junior commanders, helping them advance in their careers.

And six months before he retired, Matthews was appointed surgeon general of the U.S. Space Force, a branch of the military whose “domain of warfare” is “everything from 100 miles above the Earth to the edge of the universe.” The Air Force oversees the first 100 miles.

And what defines the “edge of the universe”?

“We don’t know,” he said. “We don’t know and that’s what makes it so exciting.

A unit from the Army or Marines entering a new area will have a pretty good idea of the topography of the land, Matthews said. And the Navy knows what all is going on with the surface of the oceans, and a lot about what happens undersea as well, though a great deal of that is still unexplored. But space,” he said, “is a different matter altogether.”

“We just don’t know what we don’t know, and we will eventually find out a lot of the things that we don’t know about space over time,” Matthews said. “And that’s a tremendously exciting organization and function to be a part of, to accompany the explorers that are going to go out and see the things that no one has ever seen before, to touch things and go places that no human has ever seen or touched or been there before. To be a part of that is enormously exciting.”

In the first staff meeting with General John W. “Jay” Raymond, chief of space operations for the Space Force, the directors of all the units were asked to share what they thought their role would be within the force.

“I talked about how, for the last 70 years, space medicine has been preparing astronauts to go to space and then recovering them when they come back,” Matthews said. “But when we have long-duration space missions, and when we go to other planets, the moon and Mars, we’re going to have to know how to practice medicine in space. We have to figure out how to do that.”

When NASA establishes a permanent presence on the moon and Mars — and Matthews said that’s “when, not if” — “the security of those installations will be done by the Space Force.”

Once NASA has an installation on the moon, that will serve as the launching pad for the mission to Mars, Matthews said.

“We’re going to have to do things like accumulate fuel, and accumulate logistics, supplies, different things like that, and have living quarters for the industrial workers that will do all of that work to put everything together,” he said. “That’s most likely going to be on the surface of the moon. If we do that, we will likely have at least a caretaker force there for good.”

And once there are personnel on the moon and Mars permanently, there’s going to be a need for medical care, especially on Mars. Say an astronaut breaks a leg while working on the moon, Matthews said. Getting the break fixed could be done in the medical facility there, but the person would need to return to Earth for rehabilitation. That trip would take two to three days.

If the same incident occurred on Mars, however, it would take a space ambulance from Earth six to nine months to reach the patient, and then the same amount of time to return. That’s not feasible.

“That means that once we get to Mars, it has to be something really, really bad to send them all the way back to Earth,” Matthews said. “We can’t just stabilize them on Mars, we’re gonna have to be able to get them back to duty on Mars, which means we will need an OR, an ICU, inpatient holding facilities, physical medicine, rehabilitation, all of the things that you would have in a small hospital.”

And any small hospital is going to need supplies: surgical instruments, IV bags, bandages, medications.

“Those are consumables,” Matthews said. “You use them, and then you’ve got to do something with them or replace them.”

The answer to that, he said, is 3D printing. Surgical instruments could be 3D printed in a sterile environment, which eliminates the need for an autoclave to sterilize instruments. And, he said, the ability to print medications means there’s no need for a pharmacy.

“Every medication is just a molecular structure,” he said. “You have a 3D molecular printer where you could print a molecule of penicillin, and then do that a million times and aggregate that into a pill or to an IV bag. What if I could get rid of the pharmacy and print the medications as I needed?”

That technology currently exists, as does the ability to print red blood cells, which is already being done and is undergoing FDA evaluation.

“That’s a really exciting concept, and it’s not a matter of if we can do that. It’s when we’re going to do it,” Matthews said. “Because we’ve already figured out how to do it. We just have to scale it and take it from theory to actual practice.”

Matthews said establishing a permanent presence on the moon and Mars is the next logical step in a timeline that can be traced back to when Greek sailors first set sail in the Aegean Sea and includes Christopher Columbus and the Wright brothers:

“Why do we think that we won’t be able to go past our solar system, when every other explorer throughout the history of man has not been able to conceive of the next step? We will eventually do that. We’re only limited by ourselves. If we stop, then we’ve got no one to blame but ourselves. And we will have betrayed the spirit of exploration that has existed for tens of thousands of years.”

Sparky Matthews and his wife Monica have been married for 30 years. They wed on Dec. 19, 1993, at First Baptist Church of Waco. They met at Baylor and married during Matthews’ time in medical school. Monica graduated with a degree in early childhood education and taught elementary school for a few years, “then decided that if she kept teaching other people’s children, she’d never want any of her own,” Matthews said.

Monica kept things running the three times Matthews was deployed, with his final deployment — to Afghanistan — lasting 13 months.

“When I was a commander, she was kind of like the mom for my unit,” Matthews said. “She would manage the spouses’ group. Whenever somebody had a baby within the squadron or the group, she would organize the meal train and different things like that. And now that we’re back here, she serves very much the same function.”

Matthews is director of the Hillis Scholars Program at Baylor, and they have family dinners each week. And the honors section of Matthews’ history of medicine class takes part in a book club that he and Monica host at their house in Twin Rivers three times a semester. They’re members of First Woodway Baptist Church.

In addition to the history of medicine class, Matthews also teaches pathophysiology — the introduction to human disease — as well as a first-year seminar class for pre-med Honors College students on “what it’s like to be a physician.”

“It’s introducing them to the culture of medicine,” he explained.

They have two daughters, both of whom graduated with degrees in theatre performance from Baylor. Kaelyn, the older daughter, also graduated from Truett Seminary and is a youth pastor at Columbia Baptist Church in Falls Church, Virginia, which the family attended when Matthews was working in Washington, D.C. “She was a member of that youth group, and now she’s the pastor for that youth group,” he said.

Their younger daughter, Brooke, works in the insurance industry in Dallas and is also involved in the theater world, with her eyes set on Broadway.

“I have no doubt, knowing her force of will and talent, she’s going to make it,” Matthews said.