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Note: This was written a year ago. The throat and prostate cancers are currently in remission and I have had time to enjoy the new stents in my right coronary artery. In the last few years I’ve been sonicated, dissected, radiated, biopsied, chemically castrated, spiked with positron emitters, poisoned with platinum, and stented. Yes boys and girls, what a delightful time it has been.
It doesn’t take long in one’s treatment regimen to see that a large industry consisting of diverse technologies has grown around cancer. As one is lead through the maze of corridors and treatment plans, it becomes apparent that the treatment centers are backed by some serious industrial might. As I walk into the cancer center my blood pressure is taken by an automated device, a digital scale takes my weight, and a small device with a light source in it takes my blood oxygen. The staff unlocks the terminal with a fingerprint reader and enters the data into my patient file. The doctor and a dapper young resident soon arrive and consult the terminal. Blood tests are short turnaround and performed on site. The onco-doc and the resident look at the results and divine some kind of conclusion from the numbers.
In nuclear medicine, a local 18F provider produces F18-labeled drugs for daily delivery to the rad labs in small leaden containers. Shortly before delivery a radiochemist quickly isolates the 18F (KF?) and prepares the 18F-glucose that the patient will receive as an injectable from a shielded syringe.
After a bit of resting time to allow the radio-sugar to circulate, the radioactive patient is placed on a motor-driven table that slides into an integrated CT-PET scanner for a bit of tomographic wizardry. A 3D x-ray map of the body is reconstructed from the CT beam data. As soon as the x-ray data is captured, the adjoining PET scanner is switched on and the patient is moved into the sensing zone of the device where gamma rays emissions reveal their location in three dimensions. After the data is collected, it is superimposed on the X-ray CT image to show anatomical locations that indicate an excess accumulation of the glucose. Cancer cells, being immortal and capable of mobility, can reproduce at a higher rate that normal cells. This leads to increased glucose uptake and, accordingly, a greater concentration of radiolabeled deoxyglucose in the cancer cells. A greater concentration of 18F-labeled glucose betrays the location of concentrated cells as they light up in the gamma spectrum.
The pharmaceuticals for chemotherapy are often quite toxic so the nurse who administers the drug is required to don PPE for preparation and administration of the dose. Specialized furniture is provided for the comfort of the patient and family. In the infusion suite of UC Hospital patients lie on recliners within a walled space with a view of the outdoors. Many patients watch familiar television programs as poison drips slowly into their veins. Some patients get sick relatively soon and succumb to fits of vomiting. Others are so strung out from the treatments that they lay there impassively. Worried family and friends strive to manage their own fears while trying to be attentive and positive.
Everywhere in the hospital disposable implements are used. The amount of sterile consumables used by a busy hospital is substantial. Sterile wrappers, clam shell packaging, syringes, IV bags, gauze, tubing, etc. I doubt that the shadows of medical and nursing students ever darken an autoclave anymore.
The breadth of technology and applied science in a hospital is staggering. Microprocessors monitor a wide variety of sensors that then produce digitalized output to either a dedicated screen display or to a nursing station.
The whole system at the hospital is devised to use every available minute of the physicians time. Receptionists verify the patient’s identity and assure the computer that the insurance information is in place. Patients are lined up for entry to the examination rooms.
At a university hospital, physician/professors on duty may have students and residents in tow to observe the great variety of disease states covering a wide range of illnesses. In a recent visit to my head and neck onco-doc, the three polite medical students took turns noodling the scope in my throat to get a thorough look-see. I had all I could do avoid laughing while the students took turns carefully manipulating the slender optical fiber device as it twisted about up through my nasal spaces and emerged below the uvula. The monitor displayed in sharp definition the glistening pinkish tissues in the treatment zone. As before treatment the primary tumor was not visible to the eye.
The industrial cancer business is vast, staffed by highly educated people, data driven and supported by a web of supply chain industries. The extent of the integration of data management is apparent as soon as you check in. Before the appointment is granted your identity and insurance status are verified by the accounting system and copayment is taken. An assistant guides you into a room where digital equipment takes your vital signs and the results are loaded into your patient record on the spot. You wander into another room and the nurse records the purpose of the visit and takes note of your vital signs and history. Soon the doc ambles in, logs into the data system and reviews the information. The appointment begins in earnest.
Those of us in our late 50’s have lived long enough to witness the gradual takeover of electronic and data technology in every aspect of our lives. In the early 1960’s, most of our lives were entirely analog. Television, radio, film, music, automobiles, and general business activities were largely conducted with technology that was fundamentally analog in nature. That is, energy was manipulated or work done via frequency or intensity modulation of electrical properties or by machinery powered by distant turbines. Devices driven by binary math and Boolean logic were around obviously but were only just beginning to enter the consciousness of common folk.
The point is that computer technology has, over a short interval, applied novel decision making or influences on the most intimate elements of our individual existence: The conduct of our wellbeing and how we process the never-ending stream of bewildering sensory input into our consciousness. Applied to the present discussion, health care providers and patients today face a torrent of data in the form of images and measurements that must be wrought into some kind of picture that people can comprehend and use to make plans. Inevitably there are data that, while accurate, are irrelevant to a given issue. And inevitably there are still questions that cannot be answered honestly owing to a fundamental lack of understanding.
For the patient there is a bewildering stream of science-based information and not so sciency information. There is a tendency in people to pay attention to optimistic product testimonials by other afflicted individuals. Magazines and cable television telegraph anecdotal sales pitches at people desperately seeking relief and even a cure. Many people feel the allure of anti-establishment messages promoting dietary plans. There is much talk of anti-oxidant, cleansing and herbal approaches to the treatment of disease states. The fact is, substances which might very well have cancer-preventative properties may be quite useless in the treatment of cancer.