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Patient and writer, one and the same

technofile  by al fasoldt

Columns and commentaries in a life-long dance with technology
 

Simple gray rule


When the patient and the writer are one and the same
 

By Al Fasoldt

Copyright © 1990, The Syracuse Newspapers

Tiny sprays of red and blue danced across the computer screen above my head.

They looked like schools of fish, weaving and darting.

The medical specialist next to me pressed a button on a beige control panel. It looked like a video editing console. In a way, that's just what it was.

Except that the pictures were coming from inside someone's body. They were being taken by sound, not by surgery, and the patient was clearly pleased.

The man who was being examined stretched himself back so he could see the screen himself, and the specialist asked him to shift to the left. She slid a large white probe to another area of his leg.

"Breathe in,'' she said.

The patient inhaled. On the screen overhead, the little blue fish scattered and disappeared. They seemed to be hiding.

"OK, let it out,'' the operator said.

As the patient's lungs relaxed, the blue dots swam back to the center of the stream. He inhaled again, and they slipped out of sight.

The operator pushed a few more buttons and moved the probe another inch or two.

She zoomed the picture so the red and blue streams looked bigger.

Then she began to explain what the pictures on the computer screen meant. I had more than a professional interest in her explanation, and so I listened carefully.

Besides, I wasn't going anywhere. The patient who had limped into the hospital's emergency room delirious with a 104-degree fever was someone I knew all too well. It was me.

I should have been there the day before. That's when a violent circulatory infection knocked me down. But I had put off going to the hospital for both the best and worst of reasons—I'd felt too sick to go.

But the next morning—a Sunday, when doctors' offices were closed—I took the advice of my friends and drove to a hospital.

I chose Crouse Irving Memorial because it was the biggest hospital in Syracuse. Many hours after I had arrived at the emergency room, as I was being admitted for a weeklong stay, I realized from the laundry mark on my hospital smock that I had never made it to Crouse Irving. In my confusion, weakened by the rapidly spreading infection and dazed by the fever, I had stumbled into the hospital at the Health Science Center at Syracuse, just down the street.

It was a stroke of luck. I might never have had my tour of the center's Vascular Lab and my personal look at how ultrasound is making life a lot easier for those who deal with life-and-death struggles.

Like many such medical labs across the country, the ones at the Health Science Center try hard to keep abreast of medical technology. But there are always more gadgets than dollars to pay for them, and so the choices are tough.

But the decision to add a machine that can show pictures of the body's circulatory system without placing anything under the skin can hardly be criticized.

At least not by me. Especially when doctors were searching for blood clots or lymph-system irregularities that could make it harder for me to get better.

Ultrasound has been used for years to make visual images of areas inside the body. It's especially common when doctors want to see how unborn babies are doing inside the mother's womb.

It's about as harmless as listening to bats, so no danger is involved.

But the device in the Vascular Lab has taken ultrasound a few steps further. Unlike older machines, it shows veins and arteries in full color. And the ultrasound probe can even send out signals that are translated into blood-pressure readings—a huge advantage when injuries or swelling make it impossible to use the old-fashioned method.

It was the color screen that attracted me most as I watched the images from inside my leg. The process, called angiodynography, requires an ultrasound sending-and-receiving probe not much bigger than a soda can.

As the nurse operating the machine moved the probe along my skin, it was sending out sound waves at many millions of cycles per second and simultaneously picking up their reflections as the waves bounced off different objects under the surface.

Arteries were making different reflections than veins were, and by using those variations, the computer within the console was making live video pictures out of the echoes. A VCR built into the console was taping everything, too.

I watched the little red and blue fish again. They weren't fish, of course, but tiny pixels on the computer screen. The red ones were ultrasound portraits of blood cells flowing through an artery, and the blue ones were the cells in a companion vein.

As I inhaled, the blood cells in the vein faded away and the screen lost its river of blue. But as I exhaled, the little blue fish rushed out and filled the vein. I was seeing in my own body the lessons of my high-school science class decades before: arteries carry the oxygen-rich blood cells, and veins carry the cells that have been depleted.

The probe checked the rest of my leg, still swollen and sore from the infection. A half-hour later, the nurse was convinced that there were no blood clots or other problems to complicate my recovery.

Not long ago, a vascular test as thorough as mine would have taken longer and would have relied on old techniques. And it would have hurt.

But even more important, at least from the patient's point of view, it would have been a mystery—something doctors and nurses understood and kept to themselves.

Patients, after all, aren't trained to read charts and examine numbers.

But they sure can follow little red and blue fish on a video screen. And that can make everything a lot less frightening.

And even fun.


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