Courtesy: Medical Miracles, from Readers Digest 1981.
November.
From the frontiers of science and the far horizons of
personal courage, these stories of medical triumphs and miracles will reaffirm
your faith in the awesome powers of the human spirit. Dramatic victories and
human triumphs.
Selected and edited by the editors of Readers Digest
The doors of the intensive-care unit (ICU) at the University
of Alabama Hospital in Birmingham swing wide and a new patient—male, 42—is
rushed in. He has just spent 67 minutes
“on the pump” (heart-lung machine) while surgeons replaced a section of damaged
coronary artery.
In a kind of controlled frenzy, eight doctors, nurses and
technicians join in a flashing ballet of arms, reaching across one another in a
seemingly aimless tangle, attaching electrical leads, placing tubes and
bottles, pushing buttons. In five
minutes, the patient is hooked up to instruments that will monitor, second by
second, four vital blood pressures via catheters placed inside his heart and
arteries during surgery. Tubes from his
chest lead to a bottle on an automatic scale that weighs blood drainage; a
similar device measure urine output.
All these data are fed into a computer that has been
programmed to continuously monitor and compare key factors in the patient’s
condition, and measure them against a program of symptoms selected by the
surgeon. To do this, it must make 50 to
100 complex computations every 120 seconds.
The results are displayed on a television screen. A nurse or doctor can “ask the machine by
means of buttons below the screen how the patient is doing, and get a visual
report of any of his vital signs, calculated at five-minute of half-hour
intervals since he entered the ICU.
The computer, however, does much more than merely monitors
the patient’s condition. It can
recommend treatment and even actually treat the patient. If he isn’t putting out enough urine, the
screen signals, “Give a dose of 15-percent mannitol.” And when detects an internal blood loss, a
pump infuses precisely measured amounts into a vein. This infusion is repeated every two minutes
whenever is necessary. Should the
machine’s supply he used up, it flashes: “need more blood.”
Since the system was started, in 1966, it has been used for
about 14,000 open-heart-surgery patients.
Dr. john W. Kirklin, the surgical chief who created the computer
programs our of his experiences at that time with some 8000 open-heart
operations, estimates that the computer has helped to save the lives of
countless critically ill patients. It
can do this because it monitors every sign that the surgeon orders, forgets
nothing, never get tired and makes no mistakes.
The computerized ‘nurse” was developed to meet a specific
need. University Hospital serfes as the
open-heart-surgery referral center for the Southeast states, a region with a
perennial shortage of skilled nurses and technicians. To meet the rising demand for open-heart
operation, the hospital would have needed additional personnel and
intensive-care spares that were simply not available.
The computer had relieved the problem. With a new ICU, the hospital has increased
its heart operations from 150 a year to over 1800. Under manual care, patients spend three to
five days recovering from surgery. With
the computer’s help, the average adult open-heart patient usually is out of
intensive care in 16 to 24 hours.
“Before we had the computer,” says nurse Sharon Shaw, “we
would barely finish one set of exams before having to start the next. There was no time to talk to frightened and
disoriented patients coming out of surgery.
Now we can claim and measure them; it helps them get better so much
faster.”
Of course, nurses watch the computer’s TV screen constantly,
for there are, deliberately, no warning bells of lights. If anything happens to the computer, nurses
must be alert to take over, even though it has a 99 percent success rate. And while computerized ICU care costs perhaps
$40 extra per day per patient, it eliminates about two days of intensive
care—than saving about $450 per patient.
Computers have thus far moved slowly into medicine, braked
by the profession’s conservatism, by a fear of malpractice wits that might
result from handling over life-and-death decisions to machinery and, perhaps,
by some resentment toward an automated challenge to doctors’ expertise. But the climate is changing as computers
prove just how helpful they can be.
For example, computers are now used routinely to select from
among perhaps 20,000 different patterns of radiation treatment the handful
likely to produce the best results for a particular patient, an almost
impossibly tedious task for a human.
They can “read” electrocardiograms (EKGs)—ordinarily a time consuming
job—in only a minute to determine whether they are normal or not. Since about 40 million EKGs had to be read in
1973 alone, the potential time saving is enormous.
Some computer programs are phenomenally accurate. A heart program developed by IBM was tested on
1435 EKGs, 1008 of which were abnormal.
The computer was correct 97 percent of the time in classifying cases as
normal of abnormal, and it analyzed with great precision the reasons for the
abnormalities. Another computer, at the
University of Missouri Medical Center, has been programmed to scan X rays and
diagnose rheumatic heart disease. In one
test, the machine was matched against a team of ten radiologists. The computer was 73-percent accurate against
the radiologists’ combined score of 62 percent.
Theoretically at least, there is no limit to the number and
complexity of problems a computer can handle.
For example, a group of pediatric specialists has programmed a computer
to assist in diagnosing more than 3000 significant childhood alignments. The idea is not to replace the doctor, but to
jog his memory, reassure him that he hasn’t overlooked anything and, if
necessary, furnish him with leads to information about disease that he may
never have seen or studied.
Any physician can consult the computer by dialing the
hospital neatest him that has a teletypewriter.
The program can be particularly useful to isolated doctors and hospitals
without access to expert consultants.
Computers are providing to be the means to meet another
growing public demand: that medicine prevent, not merely cure, disease. People are beginning to see health as a basic
right, like education. This means
regular physical checkups for every man, woman and child. Yet there simply aren’t enough doctors or
nurses to accomplish this. The
answer? Computers, linked to automated,
foolproof testing equipment. There are
already hundreds of major Automated Multiphase (handling a verity of different
examinations) Health Testing Units at work in this country, giving complete
physical exams in one to two hours.
I visited three clinics where the units are in use. At one, in Philadelphia, the physical begins
with a typist checking you into the computer with such basic information as
name, address, sex and age. Then the
machine takes over. I put or earphones
and listened to a man’s voice asking me tape-recorded questions about my heath
(the tapes are available in foreign languages, too), and then pressed one of
several buttons: a yellow for “Don’t Know Answer: beige, “Sometimes”; red “No”;
green, “Yes”; a pure white for “Don’t Understand Question”; a blue for “Repeat
Last Question”; and an orange for “Next Question Phase.”
At the French-polyclinic health Evolution Center in New
York, similar queries are flashed on a television screen. This system employs “branching logic.” If the machine asks if you get headaches, and
you punch “no,” it will skip more headache questions and to on to
others—usually about 250 in all. Most
doctors do not have time to take an oral history as complete as this. And patients like the system—the machine does
not hurry them and they can take time to think, or revise their answers.
After your history is taken, you move on to the actual
examination. In the nearing test, for
instance, you are put on earphones, press a button when you hear a sound and
release the button when you stop hearing it.
The results are recorded by the computer and stored in its memory. Blood pressure and EKG are taken
automatically. Technicians take blood
samples and send them to an automated laboratory, where machines can check as
many as 20 different body chemistries on as many as 300 samples per hour—at a
cost of about one-quarter that of manual analysis. When all the tests, including X rays, are completed
and the computer has digested the results, it prints out a chart with your
abnormalities flagged for a physician.
At IBM, where to date 185,000 employees have received such
voluntary health examinations, Dr. John C. Duffy, medical director, says, ‘in
about a third of the cases we discover some medical condition previously
unknown to employee.” Some two and half
percent of all examinations detect conditions that are really serious: diabetes
and silent heart attacks are the most frequent.
One man had a normal printout from his first checkup in
1969, when he had just turned 40. Four
years later, although he felt fine, his second exam reveled serious heart
abnormalities. Cardiologist verified the
computer analysis, and the employee was told to see his own doctor. He underwent open-heart surgery to replace a
damaged aortal valve and clean out blocked arteries, and is now backing at
work. The staff doctor believes that if
the checkup hadn’t uncovered his heart condition, the man would not be alive today.
Employees’ health records remain in the computers’ memory
bank for instant printout and comparison with subsequent examinations, so that
trends can me spotted. This may become
the most important part of the service.
As Gerald Hillman, manager of the IBM medical-system department, says,
“Many doctors now believe that each of us is programmed to get some
disease. It’s like and intercontinental
ballistic missile—if you can spot the trajectory, you may be able to shoot it
down before it his the target.”
