Space tourism companies set their own health standards, and these differ a lot from the usual rules for air travelers. The requirements keep changing as companies get more experience flying civilians.
When companies screen space tourists, they care most about cardiovascular health. The launch pushes your body through 3-4 Gs, which is a lot for your heart and blood vessels.
They want your blood pressure stable without risky meds. If you’ve got uncontrolled hypertension, you’ll need to get it sorted before you can fly.
They check for:
Age doesn’t automatically disqualify anyone. Companies look at your overall health, not just your birthdate.
Bone health is a big deal because microgravity can really mess with your skeleton. If you have severe osteoporosis, especially for longer trips, you might not pass the screening.
Mental health matters, too. Anxiety and claustrophobia can get worse in a cramped spacecraft, so they screen for that.
You’ll need to show you can move around, since emergencies might require you to act fast inside the cabin.
Medical rules for regular flights mostly focus on infectious diseases and emergencies that need quick treatment. Space tourism looks at how your body handles wild environmental changes.
Airplanes keep their cabins at the equivalent of 6,000-8,000 feet. Spacecraft can have pure oxygen or change pressure fast—pretty different.
If there’s an emergency on a plane, you can land somewhere in a few hours. Not so in space. There’s no pulling over.
Flight attendants know basic first aid and planes have some medical gear. Most spacecraft lean on automated systems and don’t pack much medical equipment.
Some major differences:
Space motion sickness is super common—about 70% of people feel it. It barely happens on regular flights but is almost expected in space.
At first, companies copied NASA’s astronaut requirements, but those were way too strict for would-be tourists.
Now, the Aerospace Medical Association writes guidelines just for tourists, not astronauts. They know tourists are willing to take on more risk.
Virgin Galactic and Blue Origin set up their own screening rules to fit their vehicles. Each company tries to keep things safe but also wants to let more people fly.
As time goes on and more civilians fly, companies relax some rules. They started out super cautious, but real-world experience lets them loosen up a bit.
Lately, companies have:
The FAA mostly just wants to see your informed consent. They leave the real screening up to the companies and their doctors.
As the industry grows worldwide, countries might set their own medical rules for launches from their soil.
Space tourism companies make passengers go through full medical evaluations before they let anyone fly. They focus on your heart, your risk for motion sickness, and whether you can handle the G-forces.
Aerospace medicine doctors handle the clearance process, since they get what spaceflight does to people. It starts with a detailed questionnaire about your health, surgeries, meds, and long-term conditions.
Physical exams zero in on the systems most affected by spaceflight. Cardiovascular tests come first, since launch Gs stress your heart and blood flow. Doctors look for heart disease, high blood pressure, and circulation issues.
Neurological tests make sure you can act fast if there’s an emergency. They also check your vision and hearing so you can follow instructions and communicate.
Main things they look at:
You need to do this screening within six months of your flight. If you have chronic issues like diabetes or heart disease, you’ll probably need extra sign-off from a specialist.
You’ve got to hand over your medical records going back several years. That means hospital files, surgery reports, and a list of all your meds with doses. Missing info can slow down your approval.
Lab tests look for hidden problems. Blood work checks for things like diabetes, kidney issues, and infections. Heart tests might include EKGs and stress tests.
Depending on your age and health, you might need more in-depth tests. Older folks usually get more heart checks. If you’ve struggled with motion sickness before, you might need balance and vestibular testing.
You’ll need to provide:
You’ll also sign informed consent forms that spell out the risks and confirm you know there’s no ER up there.
The FAA oversees commercial spaceflight but keeps medical requirements light. Right now, they just want your informed consent, not a list of health standards, so companies and their doctors decide who qualifies.
The Aerospace Medical Association gives clinical advice through its Commercial Spaceflight Working Group. They use aviation medicine experience and new data from space tourism to help doctors make clearance calls.
Each company—Virgin Galactic, Blue Origin, SpaceX—writes its own screening rules based on their spacecraft and missions.
NASA’s rules for commercial crew flights are stricter, but they give companies a baseline for safety expectations.
Aerospace medicine doctors have to balance safety with letting more people fly. As more civilians go to space, the guidelines keep changing based on real experiences.
Space travel puts your body through some serious changes right away. Microgravity moves fluids around in minutes, forcing your heart and bones to adjust to a place they weren’t really designed for.
Once you hit weightlessness, your body changes fast. Fluids shift from your legs up to your head and chest.
That’s why most people get puffy faces and stuffy noses. Your kidneys react, and you’ll probably need to pee more in the first few hours.
Your inner ear can’t figure out which way is up, so you might feel dizzy or disoriented.
Microgravity causes:
Your nervous system has to work harder to keep your blood pressure and heart rate steady. These changes can make you tired, especially on longer trips.
Research shows even a short time in weightlessness shifts hormone levels and how your cells work.
Your heart works extra hard during launch—3-4 Gs push your blood down, and your body gets pressed into the seat.
In space, the heart quickly gets used to the lighter workload. You lose blood volume because your body doesn’t need to fight gravity anymore.
Bones start losing calcium right away. Without gravity, your skeleton weakens.
Muscles shrink fast, too, since they aren’t pushing against anything. That hits both your big muscles and the ones in your blood vessels.
What happens to your heart:
Your bones and muscles take the biggest hit. Bones lose minerals, and muscles waste away if you’re not working them.
Most people adapt to weightlessness in a day or two. Your inner ear slowly figures out how to work without gravity.
About 70% of first-timers get space motion sickness. It’s usually worst on day one, then starts to fade.
Your brain rewires itself to rely more on your eyes and muscles to keep you oriented.
How adaptation usually goes:
You start using your vision and muscle feedback more to figure out where you are. That helps with the nausea and confusion.
How fast you adapt depends on your age, fitness, and whether you’ve had motion sickness before. Some folks feel fine in hours, others need a few days.
Space motion sickness hits most space travelers—anywhere from 60% to 80%—in the first couple days in microgravity. It’s by far the most common problem for space tourists. Other in-flight risks include heart changes, bone loss, and vision issues that can affect your experience.
Most people feel space motion sickness within hours of reaching microgravity on SpaceX, Blue Origin, or Virgin Galactic flights. The inner ear gets confused when it doesn’t match what your eyes see in weightlessness.
Symptoms you might get:
About 70% of astronauts go through this in their first three days in space. Some barely notice it, while others feel pretty awful.
On suborbital flights, you might just get a quick wave of it during the weightlessness phase. Longer, orbital trips bring a higher chance of symptoms since it usually peaks within those first few days.
Pharmaceutical options can help manage space motion sickness before symptoms spiral out of control. Anti-nausea meds like scopolamine patches or promethazine tablets usually offer solid relief for most space tourists.
Pre-flight training programs now include motion desensitization. These programs use spinning chairs and virtual reality to get passengers used to the odd motion patterns they’ll face in spacecraft.
Non-pharmaceutical approaches include:
Commercial space companies brief passengers on handling motion sickness during training. Flight attendants on board carry basic medical kits and know how to help folks having a rough time.
Suborbital flights don’t leave a lot of room for mid-flight treatment because they’re over so quickly. Most of the real prep happens before launch, not during the flight.
Space tourists end up facing way more radiation than regular air travelers. Once you leave Earth’s protective bubble, exposure jumps dramatically. Cosmic rays and solar particles bring real health risks, so doctors have to check people out carefully before they go.
Radiation exposure really depends on the type of flight. Suborbital passengers get a quick dose of cosmic radiation after leaving the magnetosphere. Virgin Galactic and Blue Origin flights expose folks to radiation levels about 100 times higher than commercial jets.
Orbital flights are a whole different story. SpaceX Dragon trips to the International Space Station give passengers daily radiation doses equal to a few chest X-rays. The longer you’re up there, the more it adds up.
Immediate effects might include nausea or feeling wiped out, especially for sensitive people. Most space tourists on short flights don’t notice any acute symptoms from radiation exposure.
Long-term cancer risks climb with higher doses and longer missions. NASA’s research shows that astronauts have higher cancer rates after long stints in space. Space tourists spending several days in orbit rack up enough exposure that doctors have to take it seriously during medical checks.
Pregnant women can’t participate in space tourism because of radiation risks to unborn babies. Companies require pregnancy tests before flight and don’t allow expecting mothers to fly.
Spacecraft design makes a big difference in radiation protection. SpaceX Dragon capsules include radiation shielding in the heat shields and crew area. Blue Origin’s New Shepard uses thicker aluminum walls to cut down on cosmic rays during suborbital flights.
Virgin Galactic’s SpaceShipTwo doesn’t have much radiation shielding. Its lightweight build and big windows don’t help, but since the flight is so short, it’s not a huge issue for them.
Medical screening protocols now ask about previous exposure to radiation. Doctors want to know about past medical imaging, cancer treatments, or jobs that involved radiation. Passengers who’ve had a lot of exposure might not get cleared to fly.
Space weather monitoring helps keep tourists safe from solar storms. Ground control teams track solar flares and can hold off launches if radiation levels spike. SpaceX works with NASA’s Space Weather Prediction Center to make sure the timing’s right.
Some space tourists on longer trips carry personal radiation monitors. These dosimeters track exposure and help medical teams figure out post-flight risks.
Suborbital flights put passengers through intense G-forces during launch and reentry. The short flight time creates its own set of medical challenges compared to longer orbital missions.
Suborbital flights hit passengers with 3-6 Gs during launch and reentry. These forces squeeze the cardiovascular system and can put stress on the spine and joints.
People with heart conditions are at the highest risk here. Coronary artery disease, irregular heartbeats, or previous heart attacks can keep someone grounded. Blood pressure meds can also affect how the body handles G-forces.
Spinal injuries and chronic back problems are a big deal. The compression during Virgin Galactic flights can aggravate disc or vertebrae issues. Passengers need to prove they can hold the right position during high-G moments.
Pregnancy is an automatic no-go for suborbital flights. The risks to fetal development are unknown. Operators require a negative pregnancy test before giving the green light.
Virgin Galactic and others usually turn away people who’ve had recent surgeries, especially abdominal or heart procedures. Healing tissues just can’t handle the stress of launch and reentry.
Suborbital flights last around 90 minutes, with only 3-5 minutes of weightlessness. This short window changes the medical concerns compared to longer orbital trips.
Passengers go through rapid shifts from high G-forces to zero gravity. Motion sickness hits up to 60% of space travelers, but the quick weightless period limits how bad it gets.
Claustrophobia can become a real problem during the tight ascent phase. Passengers must stay strapped in during the most intense parts. People with severe anxiety might struggle with the confined space.
Age limits vary, but most companies allow passengers from 18-75 years old. Virgin Galactic has even flown folks in their seventies, though older people get more thorough medical checks.
Bone density and muscle loss aren’t big issues for suborbital flights due to the short time in zero gravity. Still, passengers have to show they can move well enough to get out fast in an emergency.
Orbital missions demand much stricter medical screening than suborbital flights. Longer exposure to microgravity and radiation means added health risks and specialized monitoring protocols.
Orbital flights put passengers in microgravity for days or weeks, not just minutes. That causes medical challenges you just don’t see on quick suborbital hops.
Bone density really matters after 72 hours in space. Passengers can lose 1-2% of bone mass per month in microgravity. Anyone with osteoporosis faces serious fracture risks.
Cardiovascular conditioning has to be top-notch for orbital missions. The heart needs to handle big fluid shifts the whole time you’re up there. People with heart disease, high blood pressure, or circulation issues go through extra cardiac testing.
Radiation exposure jumps up dramatically for orbital flights. Passengers get 100 times more radiation than on Earth with each orbit. Cancer survivors and pregnant women usually can’t go on these longer trips.
Space motion sickness hits about 70% of orbital passengers in the first couple of days. Unlike suborbital flights, nausea can last for days in orbit.
Screening includes blood tests, bone scans, and stress tests. Passengers need to show they can handle emergencies even if they’re feeling dizzy or sick.
The International Space Station is the main spot for civilian orbital flights. NASA and the Russian space agency have built up medical protocols over decades of astronaut missions.
SpaceX Dragon capsules take paying passengers to the station through NASA’s commercial crew program. These trips require meeting modified astronaut medical standards.
Station-specific medical considerations include:
NASA makes all station visitors complete medical training modules. Passengers learn to use basic equipment and spot signs of serious health problems in zero gravity.
The station’s medical bay has defibrillators, oxygen, and emergency meds, but surgery is out of the question. Any real emergency means heading back to Earth.
Russian protocols add more requirements. Soyuz spacecraft act as backup escape pods, so passengers have to fit into Russian seats and suits.
Getting cleared for orbital flights is much tougher than for suborbital trips. The longer duration and higher risks mean you need astronaut-level health.
Age limits tighten up for orbital missions. While suborbital flights can include people over 70, orbital trips usually stick to ages 18-65.
Medication restrictions are stricter in orbit. Lots of prescription drugs act differently in microgravity or can’t be used safely on long flights.
Suborbital passengers need basic cardiovascular health and some motion sickness prep. Orbital tourists face in-depth testing like:
Training requirements are way more intense for orbital flights. Suborbital tourists train for 2-3 days. Orbital passengers spend weeks or months on medical monitoring, emergency drills, and physical conditioning.
Liability changes a lot for orbital missions. Emergencies on suborbital flights last minutes, but in orbit, you might have to wait days before you can get home.
Space tourism companies take mental health seriously. The tight spacecraft environment and being cut off from Earth bring their own psychological challenges. Medical checks now include screening for claustrophobia, anxiety, and the ability to stay calm if something goes wrong in a small space.
Commercial spacecraft don’t give you much personal space. Virgin Galactic’s SpaceShipTwo cabin is just 7 feet wide and 12 feet long for six passengers and two pilots.
Blue Origin’s New Shepard is a bit roomier, but movement is still restricted during the 11-minute flight. Passengers can’t get out of their seats during launch or reentry.
Space tourism companies screen for:
Cramped quarters can make stress worse. People who get anxious in elevators or small rooms often have a harder time in spacecraft. Companies suggest parabolic flights to see if folks can handle it.
Emergencies get tougher in tight spaces. If someone gets sick or panics, it affects everyone. Medical teams can’t easily help during the critical parts of the flight.
Training covers breathing exercises and mental prep strategies. Passengers practice managing claustrophobia before the real thing.
Mental health checks look at how passengers handle stress and surprises. Space tourism companies use questionnaires and sometimes interviews with aerospace medicine experts.
Doctors look for untreated depression, severe anxiety, or panic disorders that could get worse in space. Even short suborbital flights can trigger unexpected emotions.
Key psychological factors include:
Passengers on anxiety meds get extra attention. Some drugs don’t mix well with motion sickness meds or make people too drowsy during launch.
Screening helps weed out anyone who might freeze up or ignore safety instructions. In a spacecraft, you really need everyone to react quickly if something goes wrong.
Companies sometimes look at family mental health history too. If a passenger has close relatives with severe mental illness, they may need extra screening—especially for longer orbital flights where isolation can hit harder.
Some medical conditions flat-out block people from space travel, while others just need a careful review by aerospace medicine specialists.
Fitness thresholds and age expectations shift a lot between suborbital and orbital missions.
Space tourism companies stick to strict exclusion lists for conditions that could create immediate safety issues during flight.
Unstable heart disease always lands at the top of those lists, since launch acceleration can spark cardiac events in vulnerable folks.
If you have active cancer, most programs will turn you away. The extra radiation in space just adds to cancer risks and messes with ongoing treatments.
Severe osteoporosis makes bones more likely to break during high-G phases. Medical teams really focus on bone density scans, especially for anyone over 50.
Uncontrolled diabetes is another big risk. Blood sugar swings can get dangerous fast when medical help is limited in space.
People with major psychiatric conditions who need medication usually can’t go. The stress of spaceflight can trigger episodes in those who are susceptible.
If you’ve had surgery in the last six months, you’ll need special clearance. Medical teams want to see full recovery and stability before they let you fly.
There aren’t official age limits for space tourists, but if you’re over 65, expect a tougher medical evaluation.
The oldest space tourist made the trip at 82, so clearly, age alone isn’t a dealbreaker.
Cardiovascular fitness standards get stricter as passengers get older. Older folks go through stress testing and a thorough cardiac check before getting the green light.
Young passengers under 18 face a different set of hurdles. Most companies require adult consent and a pediatric aerospace medicine evaluation.
Kids’ bodies just react differently to spaceflight stresses.
Physical mobility standards depend on the spacecraft design. You’ll need to show you can move around by yourself in the cabin and handle emergency procedures solo.
Space tourists must have enough strength to manage their body weight during re-entry. Medical teams check functional fitness based on the specific craft you’ll be flying in.
Some issues that would disqualify professional astronauts might get a pass for space tourists on shorter trips.
The length and complexity of the mission set the acceptable risk for civilian passengers.
The Federal Aviation Administration (FAA) leads the way in regulating medical requirements for space tourists, while international groups try to create unified standards.
Right now, the main focus is on operator licensing and passenger informed consent, but the rules keep evolving to address health criteria for commercial spaceflight.
The FAA’s Office of Commercial Space Transportation handles medical oversight for American space tourism.
They require operators like SpaceX, Blue Origin, and Virgin Galactic to use medical screening for everyone who flies.
The FAA tells commercial space companies to set up health assessment protocols that catch conditions that could put participants at risk during launch, weightlessness, and reentry.
Key FAA medical oversight responsibilities include:
Licensing operators with solid medical screening programs
Reviewing emergency response plans
Making sure informed consent forms address health risks
Tracking safety incidents related to health
International coordination happens through groups like the International Civil Aviation Organization and the United Nations Office for Outer Space Affairs.
They’re working to line up medical standards across different countries’ space tourism programs.
The Commercial Space Launch Act gives the Department of Transportation authority over medical aspects of commercial spaceflight.
They review operator medical training and emergency equipment requirements for tourist flights.
At the moment, the rules lean heavily on informed consent, not specific medical restrictions.
The FAA wants companies to tell passengers about health risks, but doesn’t require detailed medical exams for everyone.
Originally, a “learning period” for commercial space transportation kept strict medical rules off the table until 2023.
That deadline got pushed back, giving the industry more time to figure out evidence-based standards from real-world flights.
Current regulatory requirements include:
Medical emergency equipment on board
Crew medical training certification
Participant health disclosure forms
Post-flight medical incident reporting
Future rules will probably introduce standardized medical clearance procedures.
The FAA plans to bring in specific cardiovascular, neurological, and psychological screening based on data from current flights.
Regulations are moving toward mandatory pre-flight medical assessments.
These checks will look at whether participants can handle acceleration, tight spaces, and emergencies during spaceflight.
Medical standards for commercial space travel keep changing fast as new tech comes out and the industry works to open space to more people.
Advanced screening and adaptive protocols will change how doctors evaluate space flight participants for different missions.
The Aerospace Medical Association Commercial Spaceflight Working Group is building mission-specific medical protocols for different types of space travel.
They get that suborbital flights need different health checks than orbital or long-duration missions.
Metabolomic markers will let doctors spot who might be sensitive to space environments.
By looking at how your body processes chemicals, they could predict who’s at risk from radiation or microgravity.
Artificial intelligence will pull together health factors to make personal risk profiles.
These tools will weigh things like age, medical history, and genetics to match people with the safest mission type.
Real-time health monitoring will be the new normal. Wearables will track vitals, stress, and other health signals during the flight.
Mission profiles will shape medical requirements.
Mars trips, for example, bring five different environments with their own risks—from intense launch phases to safer subsurface habitats.
Each one needs its own health prep.
Astronaut medical standards keep a lot of people out who could probably handle commercial space travel just fine.
The industry is shifting toward less restrictive requirements, as long as safety for space flight participants stays front and center.
Age restrictions may loosen up a lot. Astronaut data is all from healthy adults, but space tourism could include kids and seniors with the right medical oversight and mission tweaks.
Case-by-case evaluations will start to replace blanket disqualifications.
Controlled diabetes or mild heart conditions might not keep someone grounded, depending on the mission.
The FAA hasn’t set specific medical disqualifiers for space tourists, which gives the industry flexibility while things are still developing.
That way, rules don’t end up too strict too soon.
Short suborbital flights might only need a basic medical questionnaire instead of a full physical.
The +3 Gz loads on these flights are manageable for a lot of people with minor health issues.
Space motion sickness hits up to 85% of participants, but it’s rarely a big safety problem.
Better meds and prep will help more people enjoy the ride, even if they get queasy.
Space tourism medical requirements change by company and mission type.
Suborbital flights usually just need basic health screenings, but orbital missions call for more detailed checks.
Most companies care most about cardiovascular health, motion sickness risk, and whether you can handle the G-forces during launch and reentry.
Space tourism companies ask passengers to fill out medical questionnaires and go through physical exams.
They focus on your heart, bone density, and neurological health.
Most suborbital flights expect fitness similar to airline travel.
Passengers need to handle 3-4 times normal gravity during launch and quick shifts to weightlessness.
Virgin Galactic and Blue Origin use aerospace medicine doctors for reviews.
These physicians check for heart problems, blood pressure issues, and medications that could cause trouble in space.
Orbital missions, like SpaceX Dragon flights to the ISS, require tougher health standards.
Longer exposure to microgravity and radiation means more medical clearance.
Right now, the FAA only asks for informed consent from passengers, not specific medical standards.
So, companies and their medical teams set up their own screening protocols.
Cosmic radiation jumps way up past Earth’s atmosphere.
Suborbital flights last just minutes, so radiation risk stays low.
Space tourists get radiation doses similar to a few chest X-rays on these short flights.
The short time in space keeps exposure at safe levels for most healthy adults.
Orbital flights bring higher radiation worries because of the longer stay.
Passengers might get months’ worth of Earth’s natural background radiation in just a few days.
Pregnant women can’t fly on any space tourism mission due to radiation sensitivity.
Most companies ban spaceflight during pregnancy, no matter the mission length.
Space tourism operators watch solar activity before launches.
If solar radiation spikes, they might delay the flight or tweak the route to keep passengers safer.
There’s no official age cap for space tourists, but companies check older passengers more closely.
Health conditions related to age get extra attention during screening.
The oldest space tourist so far was 90, flying with Blue Origin.
Clearly, age doesn’t automatically disqualify anyone.
Cardiovascular health matters more as you get older.
Older passengers go through extra heart testing to make sure they can handle launch and microgravity.
Bone density is another concern, especially for women after menopause.
Some companies ask for bone scans for passengers past a certain age to check for fracture risk.
Younger passengers usually have fewer restrictions but need parental consent if under 18.
A lot of companies set the minimum age around 18 for safety and liability.
Serious heart problems—like unstable angina, recent heart attacks, or severe arrhythmias—usually disqualify passengers.
Uncontrolled high blood pressure is another red flag.
Active cancer that’s still being treated is a big issue due to radiation and medication risks.
Most companies want a doctor’s note from your oncologist before approving cancer survivors.
Severe osteoporosis raises the risk of fractures during high-G forces.
If your bone density is really low, you might face restrictions depending on severity.
Uncontrolled diabetes, especially if it affects circulation or vision, often leads to disqualification.
Well-managed diabetes might get approval with extra medical documents.
Some mental health conditions and medications get a closer look.
Certain psychiatric drugs don’t mix well with spaceflight or emergency protocols.
Pregnancy disqualifies passengers from all space tourism flights.
If you’ve had recent surgery, you’ll need to wait until you’re fully recovered.
Spacecraft come stocked with medical kits full of emergency supplies and medications.
You’ll find treatments for motion sickness, minor injuries, and heart emergencies.
Crew members get basic medical training to handle common spaceflight health issues.
They learn to spot and respond to motion sickness, cardiac events, and other situations.
Ground-based medical teams keep an eye on flights and can offer real-time advice if something goes wrong.
Communication systems let crew reach doctors any time during the mission.
Most commercial spacecraft carry automated external defibrillators for cardiac emergencies.
Oxygen supplies and pressure suits act as backup life support if cabin systems fail.
These systems protect passengers from decompression or breathing problems.
Flight plans try to lower medical risks by using gradual acceleration and controlled reentry.
Companies avoid unnecessary G-forces that could put extra strain on passengers’ hearts.
Before heading to space, trainers walk passengers through basic emergency response steps and show them how to use essential equipment. They get hands-on practice with safety restraints, oxygen masks, and the communication systems needed in medical situations.
To fight off motion sickness, instructors talk about medication protocols and behavioral tricks that actually help. Passengers take anti-nausea meds and pick up head movement strategies to keep disorientation at bay.
During training, everyone practices emergency descent procedures over and over. They learn how to position their bodies and breathe properly for different reentry scenarios.
Medical emergency simulations throw passengers into realistic situations so they can help crew members if things go sideways. They cover basic first aid, where to find equipment, and how to talk with ground medical teams.
Orientation sessions inside the spacecraft help tourists get familiar with medical kit locations and what’s inside. If a crew member can’t help, passengers know how to find and use emergency medical supplies.
Psychological prep isn’t just an afterthought—it’s a real part of training. Passengers learn stress reduction techniques and decision-making skills to handle panic or anxiety during tough medical situations.
