Q&A: Willy Fischler, theorist and flight paramedic

About 15 years ago, theoretical physicist Willy Fischler revisited his lifelong interest in medicine. In 2009, at age 60, he earned certification as a paramedic, and last summer he became a flight paramedic.

Fischler continues to supervise graduate students and do research at the University of Texas (UT) at Austin, where he has been on the physics faculty since 1983. He also spends about three weekends each month treating critically injured or sick patients in the air as they are transported to hospitals that have beds or specialists available that they can’t get close to home. “COVID has made the demand nonstop,” he says.

Physics and paramedic work are mostly decoupled for Fischler. “It’s two worlds,” he says. Still, he adds that “maybe my experience in the emergency world has made me a bit more patient, a bit more compassionate, toward students.”

PT: Tell us a bit about your early life.

FISCHLER: I grew up in Antwerp, Belgium. When I was finishing high school, in 1967, the Six-Day War broke out in Israel. I grew up in a Jewish community, a community that was pretty much decimated by the Nazis. My grandparents died in Auschwitz. At the time of that war, I thought this could be the end of Israel, and it should not happen. I needed to be there. When the war started, I went to Israel with a group of volunteers. We replaced people on a kibbutz who had left to fight. I spent three months working in irrigation of citrus groves.

When I returned to Belgium, I had only a short time to decide what to do. Someone told me that for medicine I’d have to memorize all the bones in the body. I didn’t want to do that. Engineering didn’t seem right. Math was too abstract. I went for physics. I attended the Free University of Brussels.

PT: Describe your research.

FISCHLER: In graduate school I joined a theory group headed by Robert Brout and François Englert. I defended my PhD thesis in March 1976—I was already a postdoc at CERN. My focus has varied over the years. Early on, it was mostly particle physics—phenomenology and field theory. Years ago I fell in love with cosmology. And these days I work mostly on questions surrounding quantum gravity, a subject we are far from understanding.

PT: What brought you to the US?

FISCHLER: From CERN I applied for a second postdoc. I didn’t get an offer until May, which was very late. I thought I’d have to drop out of the field. But I finally got an offer from Los Alamos National Laboratory in New Mexico.

I was a student during the Vietnam War, and I was not eager to go to the US. I loved Europe. Still, things are much easier in terms of bureaucracy in the US than in Europe. While I was at Los Alamos I lived in Santa Fe and commuted with Geoffrey West [a particle theorist and former president of the Santa Fe Institute who works on a scientific model of cities]. I very much enjoyed the time I spent in New Mexico.

PT: How did you end up at UT Austin?

FISCHLER: I first took a job as an assistant professor at the University of Pennsylvania. After a couple of years, I had to take a leave when I was called back by the Belgian army. There was still a mandatory draft. I appealed, because there was a rule that if two brothers had been in the army, the third brother was excused. My younger brother had done the army; my second brother was in medical school and had not done the army. But my father had been in the Resistance during the Second World War, and that counted too. After going all the way to Belgium’s supreme military court, my appeal was rejected. The court said, yes, your father was in the Resistance, but he never obtained an official card attesting that he had been a Resistance fighter. One day in the spring of 1981, I received a ticket from Sabena, the Belgian airline, straight to Brussels. I did a year in the Belgian army. Then I went back to Penn for one more year.

After that, Steven Weinberg approached me. He had just gone to UT in 1982, and he was building a theory group. He was given three tenured faculty positions, and he invited me to apply. That year at Penn, two assistant professors, Paul Steinhardt and I, were vying for tenure. Steinhardt got it. I was told I would get tenure the next year. Still, I was a little ticked off. And I was intrigued by Weinberg’s offer. I accepted and joined UT in the fall of 1983.

PT: Did you like working with Weinberg?

FISCHLER: We talked physics, but we never collaborated. Steve was not easy. He was extremely focused. He wanted a group that had the intellectual capacity to do physics, whatever the subject, but he didn’t want a group that was focused on his work.

In that way, it was wonderful. Being around Steve was stimulating. The level of his scientific demand was very high. He didn’t tolerate bullshit. He pushed one to be really precise. Besides me, he hired Joe Polchinski and Vadim Kaplunovsky.

PT: How did you get into emergency health?

FISCHLER: Over the years, I occasionally considered going to medical school. But I always got scared. Then, one winter, I was alone—it was after I got divorced and my son was with his mom. I remembered that in Belgium people volunteered in hospitals over Christmas and New Year’s. So I called a hospital to see if they needed volunteers.

They told me, “That’s not how it works. You have to come in, take a class.” So a few weeks later I did that. I first became a volunteer in the post-anesthesia care unit at the local children’s hospital. I would go early in the morning two or three times a week, before going to UT. It was not technical—I helped with the kids, got things for the nurses. . . . I liked it, and I became close to a couple of the nurses.

PT: And then you moved on to become a paramedic, and then a flight medic?

FISCHLER: I wanted to do more, so that summer I took a basic EMT [emergency medical technician] class at Austin Community College. Then I volunteered with a fire department. We would be called, and I would start the process with a patient—take their blood pressure, listen to their lungs. Usually the firefighters arrive first and do an assessment, and then the paramedics come and take over. Sometimes they need help—carrying a person or disentangling them from a car or from being wedged in a bathroom, for example.

Next I took an intermediate EMT class. With that, I could give shots and start IVs [intravenous therapy], but not much more than that. I decided to become a paramedic, so I could do and interpret EKGs [electrocardiograms] and give drugs. I graduated in June 2009. I was 60. I joined the Marble Falls Area Emergency Medical Services. I worked there as a paid part-time medic for nine years. All along I was teaching and doing research.

As a medic, I volunteered to vaccinate people against COVID-19. On days I was not teaching, I spent several hours at the vaccination center on campus. I probably vaccinated about 3000 people.

Then a friend of mine, Andrew Branco, became a flight nurse. He suggested I become a flight medic. Last summer I spent some months studying to pass my certification. It was the hardest exam I have ever taken.

PT: What do you do as a flight medic?

FISCHLER: Basically what we do is ICU [intensive care unit] work, but in a plane. I do it on weekends, or sometimes on a day I don’t teach. When I have a shift, I drive to San Antonio and meet Andrew or another partner. We check the plane, check that we have everything we need, and practice procedures to stay busy. These days, it doesn’t take long before we get a call. We put on our flight suits, the pilot checks the weather, and then we take off.

Each trip is several hours. We fly to the airport nearest the patient, and then we take an ambulance to wherever the patient is. Then we transfer the patient—and ventilators, pumps, aortic balloon pumps, whatever the patient needs—to the ambulance, drive back to the airport, and then transport the patient to the destination hospital. On a recent shift I didn’t sleep for 27 hours. We got multiple calls. It was nonstop.

Because of COVID, we get more patients. Many places have no beds. Or a facility is not capable of handling the problem.

PT: Tell us about some of the patients you transport.

FISCHLER: It’s all kinds of patients. It could be a high-risk pregnant woman who needs to get to a facility with care for a premature birth and baby. There are patients who have suffered acute strokes, traumatic injury, heart failure, aortic dissection, or who are on ECMO [extracorporeal membrane oxygenation]. We transport patients who are in a coma, basically dead, for organ transplant. Some patients have COVID-19 and need to get to an ICU that has space for them.

PT: How does being a flight paramedic differ from working as a ground-based paramedic?

FISCHLER: It involves more advanced care. In the air, we also have more flexibility than in a hospital ICU. We don’t have time to wait for orders from a doctor, although we do work under written directives of our medical director. That leaves us quite a bit of latitude. Once we have a patient, we do what we think is the best care. If we are not sure, we call our medical director or the doctor at the receiving facility. In an ambulance the work is similar, although usually with less advanced care. But sometimes it’s more stressful because there is less time.

PT: What do you like about the work? I assume you’re not doing it for the money.

FISCHLER: No, I don’t do it for the pay. The pay is abysmal. It’s scandalous how little they pay the medics and flight nurses. I love the team work and helping human beings. Real teamwork—the pilots, flight nurse, and I—is something I don’t have in physics. The stakes in physics are low. No one is dying. Physics is all intellectual, cerebral. In physics I work with students, but it’s not the same. You don’t need to have a heart for physics. In medical work you have to have a heart. You cannot do that work without having compassion.

I love the “band of brothers” atmosphere—we have each other’s backs. In academia it’s not always the case that we have somebody else’s back. It can be quite the opposite. The work is not easy, but it’s rewarding. I will continue as long as my body can take the work.

PT: Does your physics inform your paramedic work in any way? Or vice versa?

FISCHLER: Physics helps a bit, especially in the flight environment, because calculating diffusion of gases, densities, pressures, pressure changes are all easy concepts for me. This can be important for intubating patients, for example, and for hooking them to a ventilator. There are many ways to ventilate a patient—it’s not just turning a knob. There is a lot of juggling. Logical thought is important. The work also requires a solid knowledge of pathophysiology. But there the physics is at the level of the cell.

PT: How have your physics colleagues reacted to your paramedic work?

FISCHLER: I paid a price for it, because a big part of the physics community thought I was out of physics. Before the emergency work, there was no hour, day or night, that I wasn’t thinking physics. So I know some of my colleagues think it’s a shame that I am less invested. They think I’m wasting my talent and time. But I am still publishing.

PT: I am familiar with that attitude among some faculty when it comes to graduate students, but I’m surprised you would encounter it as an established physicist. Also, taking time for other activities can help stimulate ideas.

FISCHLER: I think there is something to that. At times I feel that doing this other work has helped my physics. It opens up some vista I didn’t have. So when I look at a problem, I may handle it better.