NHS 50
Your NHS
Looking Ahead
healthsmart 2010
healthsmart 2010

About Healthsmart 2010
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5


A Tale of Life, Death and Healthcare in the Information Age

'Chapter 3 - Night Shift'

It was a beautiful sunny spring morning in Rockhampton, Queensland, when Tetsuo Hashimoto checked into the Dai Ichi Orthopaedic Clinic, part of the Goshu retirement resort. He was looking forward to receiving his new hip-joint and getting back to the golf course for the summer.

His surgeon was feeling a lot less chipper. In Smolensk, Russia, it was nearly midnight and Anna Ryumin was still only halfway through her day's caseload. Losing sleep was an occupational hazard when most of her patients were in the Pacific Rim.

Consideration for the patient's time-zone always came first; old folks especially were likely to develop unexpected complications if operated on at four in the morning.

Dying, for example.

Anna yawned and stretched herself, settled into her swivel chair in front of a wrap-around video screen, adjusted her tele-presence headset, and clicked the "surgeon ready" button on the display. A cheery tanned face appeared in a corner of the screen.

- G'day, doc, I'm Phil at the DaiIchi. We're all standing by.

It was the anaesthetist who, although Hashimoto-San would never know, was the only fully qualified physician on the clinic's premises. The other members of staff were surgical assistants, Japanese-speaking nurses and physiotherapists - and of course a technician to maintain the clinic's state-of-the-art robotic imaging and surgical equipment.

Hashimoto-San would certainly never know that the surgeon supervising his operation was so far away; the clinic's promotional Web video clips gave the impression that it employed exclusively East Asian staff. There was certainly no mention of Russians, especially at a time when Japan and Russia were supporting opposite sides in the Manchurian war.

But, as usual, the global information economy had found a way of outflanking the old sensibilities of "nation states". The DaiIchi Clinic had contracted out orthopaedic services to a US-based surgical robotics firm. It, in turn, hired expertise from wherever it was able to find professionals with qualifications that its insurers would approve.

Anna Ryumin, employed by day as a senior orthopaedic surgeon in her home city's central hospital (a "disease palace" dating back to the Soviet era), was one of the best.

Anna muted the automatic translation facility in her headset, and greeted the anaesthetist in accented English. She wanted to practice the language in preparation for her big trip to London that autumn, to visit her friend Bonnie Henderson. It would be a good time to go, after the terrible news about Bonnie's father; she would have to send some flowers or something.

Hashimoto-San's operation was routine, but one requiring the highest standards of precision. At the age of 91, the obsessive golfer had worn out two previous artificial joints in his right hip.

The first had been implanted in Japan back in the 1980s (he couldn't remember exactly and his administrative record, like many in Japan, had fallen victim to the millenium computer bug) and a second one in 1995 when cement holding the original one in place had given out.

The second implant had done sterling service, but was now playing up as the brittle bone surrounding it crumbled with old age.

The solution was to remove the artificial joint from the top of the femur, delicately remodel the cavity, removing all traces of old cement, and fit a custom-made titanium-ceramic replacement directly to the bone. With a good enough fit, it would need no cement and probably outlast its owner. Precision was vital, so virtually every step of the operation would be carried out by robots.

Comparative rarities at the turn of the millenium, robots were now taking over much surgical handiwork. Their advantages were most obvious in routine orthopaedic work where, linked with the latest 3D imaging devices, they could work with 10 times the precision of even the steadiest human hand. And they turned out to be vastly less prone to error.

Luckily for Anna Ryumin and her colleagues, robots could not yet replace human surgeons entirely. Although everyone told stories of robots carrying out complex operations tended only by nursing and technical staff, in any reputable clinic a surgeon had to be in attendance, whether locally or remotely (operating theatres were no place for messy and infection-spreading human beings) or perhaps in the next continent.

Anna considered herself much more than a machine-minder. She had already read through the data concerning Hashimoto-San sent by his referring physician and approved a protocol for the procedure from the menu in her decision-support system.

She confirmed with the technician that the new hip-joint, machined precisely to measurements taken from a CT scan, had arrived on site. Then, after checking again with the anaesthetist, and glancing over the life-signs parameters displayed on her screen, she pressed "proceed" for the operation to begin.

The unconscious Hashimoto-San, clamped rigidly on a mobile operating table, was automatically wheeled into the sterile area, where a laser instantly made a neat incision.

Anna watched automatically, flipping between exterior views and three-dimensional scans, as the robot arms went to work with their milling tools, lasers and viewing probes. With no further need to talk to the team in Rockhampton, she switched on the sound system which her son Nikolai had interfaced - highly unofficially - with her headset.

She usually worked to the sound of Italian opera, but today, in preparation for her holiday, she had downloaded an obscure British work of old comic songs. She had a full, deep voice, and enjoyed singing along, her Russian accent adding resonance to the English words.
"I am the Lord High Executioner," she boomed, as the robot commenced drilling to the consternation of the surgical team listening in Australia. She'd fogotten to turn her microphone off.

Phil the anaesthetist laughed out loud at the expression on his technician's face.

- Don't worry, mate. They're all stark crackers, these surgeons. So you'd be if you spent all day in front of a computer screen.

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