Royal Children’s Hospital – Melbourne, Australia (Winter 2016)
In the Star Wars galaxy far, far away, technological progress had long ago dispensed with people in the care of the injured and sick. Of course this was a good thing, as people make mistakes and mistakes are costly. Costly, not just in a financial sense, but to the victim, too. Reliance on medical machines was also beneficial in terms of restructuring a health care system that would no longer have to rely on physicians. Moreover there had also had evolved a whole cadre of administrators just to manage the physicians, and these people were quite unsuited to the real business of medicine, fixing the sick in a technically correct way.
In the Star Wars story, medical droids had replaced people. From the fragments presented to us in the Star Wars stories, we can see how futuristic medicine worked. The sick or injured could report (or be brought) to a medical centre. The person’s details and complete medical record were scanned from the wireless enabled digital information chip inserted in the right forearm. (A second, back up chip could be found under the skin in the small of the back, in case of amputation of the arm. This is relevant to the story that follows). Once scanned in, the person was now a patient. Voice-enabled technology allowed the triage droid to interpret the medical history given by the patient through digital selection of key words, ignoring most of the unnecessary verbalisation from the patient who still thought he was a person. The patient could then be separated from the helper and conveyed to the correct location for treatment.
At the treatment station the appropriate digital treatment laser discs were inserted (by another machine) into the required droids. Droids were like R2D2, but broadly manufactured into medical and surgical ones, equipped with specialised tools for the job (eg robotic arms for surgery etc..). The digital information was built on treatment protocols based on clinical practice guidelines developed over millennia. These guidelines had gradually replaced individualisation of care when people were involved in health, minimising mistakes and improving efficiency. The process of delivery of health care had become so efficient and practically automated that it was really a small transition to the fully automated system that existed in the Star Wars story. Correct care. No mistakes.
To see how efficient the system was, let’s follow the near death experience of the Jedi knight Anakin Skywalker. His medical story goes back a bit. Anakin was a slave when he was discovered by Jedi knight Qui-Gon Jinn. Filled with ambition and “strong in the force,” the eight-year-old Skywalker was taken in to be trained as a Jedi Knight. Suffering the limitations of personhood, Skywalker’s background and emotionless training resulted in a young man consumed by anger, narcissistic tendencies, and self-doubt. Not even marriage to a beautiful woman or impending fatherhood (of the future Luke Skywalker and Princess Leia) could temper his path to self-destruction. (With hindsight, and a little sensitivity to his plight, it was obvious that what he needed was psychological help. Had that been available, who knows what the future might have been). Returning to the medical story, Skywalker’s confusion led to a fight with his former mentor, Obi Wan Kenobe. In the ensuing battle, Skywalker was seriously wounded, losing his right arm to a light-sabre slash and falling into a lava pit, sustaining near total burns.
Anakin Skywalker was brought to the medical centre. His identity was determined by the chip in his back, not destroyed by the lava burn. His airway was secured by a tracheostomy and breathing supported by a ventilator (later converted to a backpack to allow mobility, but explains the breathy quality to his later voice). Skin cells were cultured from the few remaining ones on his body, growing in sheets and grafted back on. Even with that technology the appearance was grotesque. He never looked at himself in a mirror again, and always went about in public fully covered, even his face. His right arm was replaced by a prosthetic limb, connected to the nerves in the humeral stump, and fully functional. Maybe even better than the original. The physical rehabilitation was long and painful but the medical droids put Skywalker back together. Technically. Accurately. No mistakes. But it was not possible to deal with his human failings and in the person-less medical system, not possible to psychologically support the adjustment to his altered circumstances. Still, he was back together and able to assume his new life as Darth Vader.
John Massie is a pediatric respiratory physician at the Royal Children’s Hospital in Melbourne, Australia and a member of the RCH clinical ethics committee. He is a Clinical Associate Professor at the University of Melbourne and Research Fellow at the Murdoch Children’s Research Institute.