November 2, 2005
Distributed Healthcare…sometime in the future.
(Disclaimer: I made this up. Telemedicine like this doesn't exist…yet. Nothing contained herein is meant to advise specific treatment of any kind.)
Oh, man, not again, as I fight to awaken. 1:30 am . I just went to bed.
“Daddy, I can't breathe.”
“Oh, Jenny, come here.” I can hear her wheezes and labored breathing from a few feet away. In the dim night light I can see her distress and heaving shoulders. I wonder why asthma is always worse at night? She had been doing so well on the new medications for three or four months. I thought maybe we had it licked. I wonder what happened this time? We've already been to the emergency room 3 times this year. Let's figure this out. Maybe we can avoid that bit of torture tonight. Jenny is only eight. I hate when she is sick.
“Sue.” That's what I named my Supergalactic smart-home central computer server. “Pull up the asthma management protocol. What comes first?”
“The first step is to assess the severity of the attack,” says Sue in her soothing robotic voice with just a hint of Asian accent. Somehow she is not making me feel calm. “Look for signs of labored respiration. Is there use of abdominal or neck muscles.”
“Present,” I answer.
“On a scale of 1 to 10 with 10 the worst, how short of breath does she feel?”
“She says 7 to 8”
“Is there wheezing?”
“Yes, very loud.”
“Place the Respirometer Measuring Module on Jenny.” I put the probe on Jenny's finger and attached the sensor to her chest. Sue continues,” Heart rate 127, respiration 32, loud wheezes on expiration, soft wheezes on inspiration, oxygen saturation 95, temperature 98. Now blow into the spirometer.” Jenny picks up the mouthpiece and blows. “Inadequate effort,” reports Sue. “Try again.” This time Sue reports that the flow is markedly reduced. Jenny really looked sick.
“Use the spacer and albuterol. Give albuterol a series of 8 puffs, one at a time. Have Jenny inhale each one fully and hold her breath for a few seconds” orders Sue. I'm not sure I'll ever get used to being ordered around by a computer, but hey, maybe no ER if this works. “Wait 20 minutes then repeat. After the second series, recheck the spirometry”.
About 30 minutes go by with Sue monitoring all the time and chatting amiably to keep us calm and Jenny blows in the spirometer again. Sue reports,” Airflow is still markedly reduced. I will call the asthma center.” Sue also rattles off Jenny's vital signs. About the same. But I am particularly glad that her oxygen saturation is still 95%.
Within a minute or so, the nurse at the Metro Asthma Center appears on the family room television. “Hi Mr. Dolan. Is it Jenny again? Boy, sleep is short in your house!”
“No kidding, Ms. Blake. I really thought that last gene therapy treatment was going to do the trick”, I wearily respond.
“Please enter your thumb print and Center password so I can download the Module information,” she instructs.
“Oh, my! I can see why you called. She's got a pretty bad attack going here. First, a few more questions. I see from her chart that she is on Prednisone 10 mg every other day, correct?”
“Yes.”
“Is she still taking the Serevent and the Flovent sprays?”
“Yes.”
“Was she sick yesterday? Any fever, allergy symptoms?”
“No she was fine until just now.”
“How about supper?”
“We just had some chicken and vegetables”
“Was it prepared?”
“Yes. Ready to serve from the store.”
“I see from her history she has a sensitivity to MSG. That could be a factor. Hang on a second, I want to get the doctor on the line.”
Damn, I don't remember seeing anything about MSG at the store. If this was back a few years ago before tort reform, I'd be preparing my lawsuit right now. I wonder if Sue is programmed to prepare legal complaint? Pay attention to Jenny.
“Hi, Mr. Dolan and Jenny. Doctor Hackenbush here. How are we doing? Oh, I can see not that great. Hmmm. Ok. Use the spacer with albuterol every 20-30 minutes until your Module indicates either she's had enough or that her asthma is improved. Also, give her 40 mg of Prednisone now and then 20 mg daily starting in the morning. These instructions are being downloaded to your Module .”
“Uh, I don't have enough Prednisone.”
“Not a problem. I just sent the order to the pharmacy. They should have it to you within the half-hour. If she doesn't improve the Module will re-contact us. Or feel free to call back if you have any concerns at all. She should come to the office in the next day or 2 for a check. We'll see what else we can do to prevent these attacks. Good night, Mr. Dolan and Jenny.”
“Good night, doctor.” And with that, they were gone.
“Sue, did you get all that?”
“Yes, sir. We should be fine. I'll wake you up if Jenny has any problems. Good night.”
