Class began just after 9:30 with a short meet-up at Crave Coffeehouse, a converted church on Caroline street and a few blocks east of Grand in St. Louis. After procuring much-needed caffeine from the small coffee bar on one side of the spacious chapel, we took our seats around a number of pushed-together tables near the center of the floor, and introduced ourselves to Dr. Joseph Walline, who would lead us through that day's class.
It was difficult to hear each other from opposite ends of our makeshift banquet table, owing to the echoing quality of the chapel, but we ultimately succeeded in making the necessary introductions, and we learned about Dr. Walline's responsibilities at the Saint Louis University Hospital. As Assistant Program Director, Dr. Walline is responsible for running the medical student residency program and therefore turning medical students into capable ER doctors. A short nota bene at the beginning of our discussion: if you ever need visit the emergency room, try your best to become gravely ill or injured in the morning around 8am (when the ER is relatively quiet), and avoid the month of July, as that's when brand new residents start. Personally, I'm looking forward to breaking my leg in late May, just after breakfast.
Shortly after introductions, the class walked over to SLU Hospital's emergency room, which was eerily quiet. Dr. Walline guided us into a side room, where we learned about the uses of sonography in emergency situations. He told us how sonography used to be mostly the turf of specialists, but with improved technology and mobility, gradually sonogram machines became portable enough for use in the ER.
A student asked about the timing of widespread sonography use by ER technicians, and whether or not there was a bit of a power struggle regarding which medical professionals had the authority or expertise necessary to conduct and read sonograms. It was acknowledged that medical professionals sometimes feel a need to "defend their turf," as in most large bureaucracies, but that generally attitudes have relaxed, and the use of ultrasound by ER techs is not controversial. This lack of continued conflict over sonography in emergency rooms is in part due to the different way that the technology is employed here: while most public perceptions of sonograms are heavily founded in pregnancy and learning the biological sex of the fetus, the greatest use of the machines here is in the search for signs of internal bleeding, and other "yes/no" questions with urgent implications. More detailed uses in obstetrics includes interpretation of less straightforward information than the presence or lack of internal hemorrhaging or the location of a vein for an IV placement, and obstetricians usually don't have to act on the information they have with the same level of immediacy.
The advances in technology that allowed for bedside ultrasound machines, it was pointed out, have also recently led to the development of even more mobile contraptions, such as a cell-phone based sonogram. Dick discussed how these kinds of inventions have led to both the mobilization and commercialization of ultrasound, noting that Tom Cruise bought a full-sized machine when he and Katie Holmes were expecting their first child. Professor Song questioned whether or not these advances would eventually allow laypeople to buy sonogram machines, and wondered what the "end" goal of such extreme miniaturization of technology is. The relationship between this potential commercialization and the normalization of ultrasound discussed in the Erikson article (regarding the history of the fetus in Germany) was pointed out by Sierra.
Dr. Walline had commented earlier that while it was nice that ultrasound technology has gotten so small, it would be more advantageous if someone could develop a machine that was capable of holding its own probe, to facilitate easier IV placements. I asked, if the patient is capable and willing, why they might not be able to assist in holding the probe, and Dr. Walline explained that ultrasound probes cannot be used statically, but instead must be "swept" a bit to provide better information, and further, that ultrasound really only provides a 2-dimensional image. This lack of dimension prompted Professor Song to interject that then "you don't know if you're seeing what you think you are," highlighting the way that this technology is not as objective a representation of internal structures as we might think it is. It can skew our perception and lead to unfounded overconfidence.
Dick brought up a conversation he had with the developer of the highly mobile cell-phone ultrasound technology, quoting him as saying, "Imagine a future where you could go to your doctor and they would no longer need to touch you." This lack of connection was echoed later on by other sentiments regarding how ultrasound technology can lead to a kind of disconnect with patients, where the machine acts as a sort of non-human second opinion. We also discussed how sonograms have come to be used in obstetrics as a sort of comfort for worried mothers, in spite of the recommendation against unnecessary exposure.
Thereafter, we moved to an adjoining section where a machine was reserved for our use. In spite of my excellent health, I somehow wound up on a bed in the emergency room; ostensibly because I was the only one readily willing to sacrifice the comfort of having a clothed midriff in order for our class to look at some human insides. I can't really complain, however, since I got to spend the remainder of class laying down while everyone else stood, and I got to take home a picture of my kidney.
Once my abdomen was properly exposed and covered with cold conductive ultrasound goo, Dr. Walline was able to confirm that I had the standard internal organs, including a heart (which was thankfully not three sizes too small), and after giving a tour of my intestines, asked if anyone else would like to try their hand at seeing inside of a human.
I thought it was really intriguing that that only male student in the course willing to engage with the ultrasound (and also with me) was the one I live with, and that despite my voiced consent to being prodded with the ultrasound probe for the sake of education, not as many students wanted to attempt ultrasonography as I had expected. I thought that this spoke a bit to the "intimate" interactions that medicine and ultrasounds create. Really, what's more intimate than literally looking inside of someone?
After printing a picture of my kidney, Dr. Walline excused me from the bed, and I got to observe with the rest of the class while he demonstrated the method used to find veins for IV placement on another student.
Class ended with a short discussion regarding the skills that are no longer being taught due to the ubiquitous use of ultrasound, and we wondered what other skills might disappear in the future.
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