George D. LeMaitre
As a youngster I thrilled watching Dr. Frankenstein revive his monster in a musty castle in the darkened, distant hills. Strapped to an operating table and wired to complex gadgets, the monster was zapped with an incredible surge of electricity until life returned. Dials registered expanding electrical current. The mad scientist, with his hunched-back, equally mad assistant Igor, ran back and forth, panicked lest they overlook important switches to be thrown and plugs to be inserted. Timing was critical; life depended upon it.
Scholars talk of the electronic age as if the Ghost of Frankenstein were haunting us. They worry about man being swallowed by his creations. They speak of "technocrats," as if non-thinking humanoids were plotting against us.
Fear of technology is rubbish. It makes life easier, safer, longer. But there is a problem in how it intrudes on the medical scene. To see a modern Frankenstein performance, visit a tertiary hospital's intensive care unit. Observe patients wired to devices.
It is a shocking vision for the novice. Patients are silent, half-opened eyes broadcasting their thoughts. Breathing is controlled by pumps thrusting oxygen into their windpipes. With each discharge a click-click, whooshing sound erupts. The chest is thrown forward. The pump shuts, the chest collapses, click/click, whoosh and another cycle. There are many respirators, a gruesome symphony without a conductor.
There are cardiogram electrodes attached to the patient's chest - BLEEP, BLEEP. These signals represent cardiac function.
The click-whoosh of the respirators and the bleep-bleep of the cardiac monitors are a daily cacophony for the staff. They hear it but barely listen.
A hose issues from the patient's bladder, calibrating urine volume.
Tubes carry fluids into the patient's veins. They stream down from bags hung on steel rods. The patient seems caught behind prison bars.
A hose emanates from the patient's nose, one end in the stomach, the other connected to suction. A clicking sound says juices are flowing.
I have not detailed the ensemble of other stellar attractions. There are dials, wheels and buttons. Frankenstein cannot compare with the haunting reality in one of these hospitals.
The eeriest scene is the nurses, therapists and aids who scurry about like ants under siege. Nurses check flow meters, monitor cardiograms, adjust intravenous fluid rates. They transmit data to a computer, an on-going tally of the patient's condition. Therapists draw blood to determine the concentration of oxygen and carbon dioxide. Aides run errands and answer incessant phone calls.
They always have the well-being of their patients in mind. Unfortunately, they are entangled in the wires and tubes with their patients. The intrusion of technology is not some demonic concept for the social theorist to panic about, and more concrete than what the philosophers surmise. The fear is not that machines will take over. The "gadgets" are like children, drowning out communication by their noisy need for constant attention.
The physician faces the mind-boggling task of evaluating the patient's progress and the efforts of his staff. From my three decades of intensive care experience, I can state this is a greater piece of work than any faced by Dr. Frankenstein or Igor. A human life depends on the physician's judgments, not the super-intelligence of a television doc with stethoscope glamorously dangling around his neck. He or she must analyze data sheets showing blood pressure, pulse, respirations, temperatures, venous pressure, urine output, stomach outputs, cardiac rhythms and laboratory data. He must review scans, electrocardiograms and bacteriological reports. He must allow for human and machine error, multiplied by the size of his staff and the number of gadgets. He must coordinate his efforts with consultants. If there is disagreement, he must match his judgment against his consultants. Add to this the humility engendered by his memories of past personal errors, sometimes lethal, and you sense his turmoil. He also knows the all-wise media folks and lawyers are but an arm's length away. They wait to find errors with their 20/20 retro-spectroscopes.
His eye catches a human being behind the wires, clicking and whooshing. Yes, the patient would like a minute of your time, Doctor. That time has been stolen, hence the fading doctor-patient relationship. Take away the flow sheets, the pulse generators, the therapists, and the electrodes. Put the patient home with a house-call doctor and you have a return of humanism but, probably, a dead patient.
A paradox exists. Increasing technology means increased cures but a lessening of the bond between doctor and patient. Every high-tech refinement demands intricate machines and specialized professionals to operate them. Where once the physician and patient shared a sacred relationship, their intimacy has been shattered by an army of specialists, a boisterous clamor of devices and a stifling stack of paper work.
We demonized Frankenstein. He was the monstrous creation of electricity, a wonderful technology gone astray. This is not to suggest our care units are moving in that direction. Still, the cutting point remains, Frankenstein's dark castle lurks always in those nearby hills. We must never let technology rule. It must remain servant to the patient.
When I suffer a life-threatening illness, I will want an intensive care unit and dedicated nurses, therapists and physicians. Praise be the ICU team and their "intruding gadgets" - save the nice talk for when I am safely home.
Let's keep Frankenstein and Igor at the theater or, better, resting in peace on some distant, darkened hill.
The writer is a Sunset Rock Road resident, surgeon and clinical instructor at Tufts University School of Medicine who wrote the book "Choosing Your Doctor."
