Sunday, February 13, 2011

Little Black PACS Station

Cyril Kornbluth, one of the most beloved Science Fiction writers of the '50's, died of a heart attack at the rather young age of 34. Perhaps his most famous work was the short story, "The Little Black Bag":
"The Little Black Bag" was first televised as a live act on the television show "Tales of Tomorrow" on May 30, 1952. It was later adapted for television by the BBC in 1969 for its Out of the Unknown series. In 1970, the same story was adapted by Rod Serling for an episode of his Night Gallery series. This dramatization starred Burgess Meredith as the alcoholic Dr. Full, who has lost his license and become a derelict. He finds a bag containing advanced medical technology from the future, which, after an unsuccessful attempt to pawn it, he uses benevolently — reclaiming his career and redeeming his soul...but not that of the guttersnipe he takes in as his receptionist/assistant.
The text is available at Gutenberg Project Canada. Here are the 1952 (Tales of Tomorrow) and the 1970 (Night Gallery) adaptations:

Gotta love Dr. Fullbright's persistent cigarette in the 1952 episode, and the different interpretations of the "guttersnipe" in both clips.

With all due respect and gratitude to Cyril, may I present my own (per)version of the story, The Little Black PACS Station:

Dr. David Fullerbrush was a radiologist, although he was not a particularly good at it. Which probably explained why he was working for ImagingTemps, the least-respected locums agency in the country. His current assignment was equally admirable, covering general radiology at the county hospital in Teaneck, New Jersey.

The job wasn't that bad, all things considered, for a 62-year-old who had finally learned to read CT scans five years before, and couldn't begin to differentiate a bleed on an MRI of the brain from a normal thalamus. This was, in fact, how he found himself working for ImagingTemps. It seems that he declared a growing opacity on chest radiographs a "normal cardiac silhouette" for five years running, a finding which didn't quite agree with the autopsy results of a cantaloupe-sized tumor. IT's policy, fortunately, was "don't ask, don't tell, don't check credentials," and they were usually on time with Dr. Fullerbrush's salary. He did end up working some colorful inner-city gigs, and he never stayed at any one site long enough for him to hurt too many patients.

Teaneck County was the sort of place that you might not want to visit at the wrong time of day. In fact, most of the physicians and staff wouldn't go out the door after twilight, as it was considerably safer to stay inside until dawn. It was the hospital of choice for the local knife-and-gun club, and when one of their members rolled into the ED, it was a certainty that friends of the patient would shortly inspire a member of one of the rival clubs to make a similar visit.

Having graduated from film to PACS only a few years before, Teaneck County was ahead of many of Dr. Fullerbrush's placements. The system, a bargain from Typical Electronics, actually did work, although it tended to choke on the 5,000 slice whole-body/head/total spine/triple extremity CT with head-to-toe CTA that was de regeur for all trauma patients. Fortunately, Dr. Fullerbrush was familiar with this piece of equipment, as TE was rather ubiquitous in the sort of hospitals he frequented.

But one night, about two weeks into his tenure, he entered the dingy reading room and found all the stations filled by the other ImagingTemps employees doing time in Teaneck. They barely acknowledged him, as they were trying desperately to read at least one part of an exam before their station crashed. David looked around, shrugged, and strode past his colleagues and into an alcove hidden in a far corner, hoping to find a place to sit and doze. In the darkened room, there was indeed a worn but serviceable chair, and he plopped down in it with a sigh of relief. But before he could drift off into the safety (more for Fullerbrush's patients than for him) of slumber, he spotted a faint glow on the battered desk in front of him. He sat up a bit straighter in the chair, and the glow came into focus. It was a monitor of sorts, although nothing like David had ever seen before. It was solid black, rather like a brick of black glass, and it had no markings or other identifying features. Save for the glow, which was an iridescent shade of violet.


Startled, David looked around. There was no one in his alcove, certainly no one who could have spoken in the soft feminine voice that seemed to originate from a spot near his own corpus callosum.


"Who, me?"

"Thank you. Voice print registered, Dr. David Fullerbrush session now active."

"Ummm, OK..." Fullerbrush had dealt with Speech Recognition at those hospitals which placed a higher value on saving the cost of transcriptionists than on accurate reports, but this didn't quite fit the template.

"Would you like to interpret the next patient, Dr. Fullerbrush?" requested the ethereal voice.

"OK, sure, whatever..." replied the wary rad.

"Thank you. Next patient is Ralph Rococo, 39 year old male, status post gunshot wound to the buttocks. Presenting image now."

And with that, the purple glow from the little black slab swirled around a bit, and settled into a three-dimensional, rather solid appearing rendition of a human torso. David sat back, utterly devoid of any thought as to what to do with this apparition. He brought his hands to his face, hoping to rub his eyes and make the image disappear completely. As he did so, however, the floating image twirled around, and the surface melted away on the side facing him, revealing the organs and blood vessels beneath. The more he moved, the more he found he could manipulate the ghostly form.

"Would you like to begin dictation?"

"Uh, sure. Ummm... Whole body CT is performed without contrast. 3D rendering is obtained." Dr. Fullerbrush, nonplussed as he felt, was not about to lose the reconstruction fees. "Ummm... no acute findings. Signed."

"Dr. Fullerbrush, perhaps you would like to mention the tract of the bullet that has entered the patient's buttocks and severed his right iliac artery and vein?"

And within the floating image, a bright yellow line appeared, presumably showing the path of the projectile. Pooling collections of blood, in neon blue and red, became visible at the level of the vascular injuries.

"Oh, yeah, I was about to take care of that. Please include it in the report," David replied sheepishly, hoping none of his colleagues could hear the exchange between him and the voice in his head.

"Would you like to treat this wound?"

"WHAT? I'm not a surgeon."

"Would you like to treat this wound?"

"Yeah, sure. Why not? I'll just wave my pinkie and everything will be fine!"

"Standard protocol requires only your verbal order. Treatment commencing. Artery regrown. Vein regrown. Muscular and cutaneous damage repaired. Foreign body teleported. Treatment complete."

Dr. Fullerbrush sat back with a mixture of awe and horror. Perhaps he should have attended RSNA at least once in the past few years. Certainly TE couldn't have come up with something like this.

Just then, the ED doc burst into the reading room, yelling at the top of his lungs.

"Basically, I have not been seeing anything of this sort in my long and illustrious career! The unfortunate patient was laying on the stretcher with blood pouring out of the wound in his tremendous backside, and then stopped it did! Right there! The bloody damn entrance wound closed like never it had been there! Unbelievable!"

David cowered in the back room, uncertain of what to do next. The pause seemed to trigger something in the black glass.

"Dr. Fullerbrush, I must perform some brief preventive maintenance. Please stand by."

And with that, the slab went completely dark for a few seconds, and then lit up once again. The purple glow again appeared, but this time, there were words solidifying in the display:

Welcome to MacOSM, copyright MMCCCXI.

MMCCCXI? thought David. 2311? NO! This is impossible! But it's here! My God, the advance in technology! How many people could I save with this? This could make up for all of my old faux pas!

", show me the next patient, please."

"Yes, Dr. Fullerbrush. Next patient is Lilly Blanc, age 57, chief complaint diffuse abdominal pain."

And again, the purple light solidified into a spectral body, floating in the air in front of the desk. This time, David stopped to study the image more carefully. He waved his hands with more precision, and laid bare the peritoneum of the patient. He paused, and gasped. Wrapped around the pancreas was a 7 cm mass, displayed in pulsing, glowing mauve. The ugly lesion insinuated about the celiac and superior mesenteric arteries, clearly an inoperable cancer. Multiple glowing orbs, ranging from marble-sized to larger than a grapefruit, could be easily seen within the liver.

"Um, Miss, computer... can we fix this?"

"Yes, Dr. Fullerbrush. Please verbally request treatment."

"Yes, absolutely! Treat the patient!"

"Yes Dr. Fullerbrush. Treatment commencing. Sequencing neoplasm DNA. Tuning optimal resonant destructive frequency. Ablating tumor now. Regenerating normal pancreas and liver tissue. Treatment complete. Shall I rejuvenate the patient as well?"

"Why not?"

"Commencing rejuvenation sequence. Atherosclerotic changes reversed. Articular cartilage resurfaced. Emphysematous lung damage repaired. Biological age regressed approximately 13.7 years."

"That's INCREDIBLE, David!"

Fullerbrush turned around with a start, and was saddened to see the head of ImagingTemps, Nosi Hachoo, standing behind him, jaw slack with wonder. Hachoo was known to pay unannounced visits to keep his minions in line, and it seemed he had chosen this rather fortuitous moment to appear.

"Hachoo, this is some incredible technology from the future. I don't know how it got here, but it could revolutionize medical care. Just think of how many people we could save with this!" David cried.

"Yes, of course, you save people with it, hack radiologist! You're working for me, and so it's MINE. Can you imagine what people will PAY for us to take care of them?"

"No, Hachoo! You mustn't think like that! This belongs to all of humanity!"

"Great! All of humanity can pay me to watch it for them!" Hachoo chuckled.

With that, Hachoo grabbed for the black slab. David lunged after him, knocked him to the floor.

"Computer!" Fullerbrush yelled. "Delete Nosi Hachoo!"

"I'm sorry, Dave. I'm afraid I can't do that," whispered the soft, feminine voice. "An attempt has been made to commit a homicide with this station. License has now been voided. Have a nice day."

The sides of the slab separated from each other, and floated to the corners of the room, fading to nothingness as they approached the walls. Pinpoints of bright light emanated from the core of the slab, and exploded outward.

"Oh, my God!" David cried, as he slumped to the floor. "It was full of stars!"



Jacques L said...

Good post. I saw that movie on DVD.It's funny how all the technology we saw in the old movies, like cell phone and MRI, is becoming so commonplace today.

Anonymous said...