One of the interesting things about spending time in hospitals is the technology. I found the MRI fairly incredible, a giant magnet aligns the nuclei of cells, then a radio frequency is applied which causes alterations in the rotation of the magnetic fields, and this can be detected to create a three dimensional image of the interior of your body. My latest MRI came back as a DVD, and I could manipulate the view and magnification to observe any point within my brain on my home computer.
Pretty amazing stuff, when you consider that the non invasive diagnostic tools for multiple sclerosis involved submerging the patient in hot water to see if the symptoms worsened. My diagnosis took a few weeks, I met others who had been witting years. Technology didn’t actually save their lives, it prevented their suicides. Being told “it’s all in your mind” takes a lot out of a person.
When Emma had cancer I saw all sorts of technology. The simplest was a “port”. Because chemo and other therapies can wear out your veins, a tube can be inserted into a large vein (the Jugular in this case) and routed to a port in your chest. A special needle (Huber needle) is used to pierce the port to apply chemo. At one point, Emma was receiving chemo twenty four hours a day. there was a cassette with the drugs that pumped them into her day and night for a week. Sleeping around the tubes and cassette was not easy, but we got through it. My biggest worry was that she would wake in the night and head to the toilet, yanking the external tubing, that never happened.
Endoscopy, the practice of putting a tube down your throat (or up your rectum) is surprisingly complex. This isn’t just a camera, there are different tips for collecting specimens, blades, brushes, positive and negative pressure fluid to clean the path. What amazed me was the path the scope can take. They were able to place an endoscope down her throat, and work it down to her pancreas. I’ve gone over the anatomy, and I just don’t see that path.
I was amazed with the DEXA scan, a low level x-ray that can determine bone density (I have osteoporosis). Just a little scanner passes over your body and the density in critical areas can be analyzed.
Prior to her surgery Emma underwent a couple of PET cans. This is really amazing Star Trek stuff. The Positron Emission Tomography scan is an incredible mixture of technologies. The most amazing to me is the computation. In Emma’s case, four different “dyes” or positron-emitting radionuclides were used. each is attracted to a different substance within the body. As the “dye” goes through beta decay, a positron (which is an anti particle) is emitted, which then interacts with an electron, annihilating it. The annihilation produces two gamma photons, traveling in opposite directions. When two photons reach the scanner simultaneously, the point at which they were created is calculated, and the point of the positron emission is calculated from that. Millions of photons are detected, and a three dimensional view of actual functioning organisms is revealed. PET scans can see into your brain, and detect which sections respond to different stimuli. Everything about this is cool.
There’s a procedure called CardioVascular and Interventional Radiology (CVIR), or just VIR when the heart is not involved, in which a probe is inserted to clear a vein, or any vessel (in Emma’s case they were working on the biliary tree). Guided by a scan, the probe is simply pushed through the tissue. sounds rather barbaric, and oddly cloaked in secrecy. They don’t talk about it, and the people who do it are radiologists. Had we actually known what it consisted of we might have been put off, but then surviving is a carrot almost anyone will chase.
One procedure we did skip was a lung needle biopsy. There was a question about nodules in Emma’s lungs, repeated scans had determined they were scar tissue and not tumors, but the question kept nagging one doctor who wanted to do a needle biopsy. The needle in this case is about a foot long (I know, it’s the diameter that matters, right?) and is guided to the nodule by CT scan. Keep in mind that this cannot be done in the CT scanner, so the patient has to hold her breath and not move from the time of the scan to the placement of the needle. With that information you can figure out that the patient must be fully conscious. We felt there was adequate data showing the nodules to be benign, and skipped the procedure.
All the advances in imaging allow innovations in treatments, but technology can never take the place of the doctors who implement it. No machine can replace the wisdom of a compassionate physician.