Medicine and the pager#
by Arthur Fielder, MD, Moose Jaw, Saskatchewan, Canada, October 2017Introduction#
When Herman Maurer asked me to possibly contribute a bit on how computers have changed my professon as family doctor (MD) in a more or less rural area (on the outskirts of Moose Jaw Moose Jaw ) I was not sure I would be able to oblige. As general medical practitioner in a small community, and now retired for some 8 years, my use of computers was more or less restricted to simple administrative tasks, certainly not worth mentioning to a wider audience.Still, I did not want to let Herman down: We were close friends for an interesting part of my life, and when I decided to stop our friendship it was due to a misunderstanding as it turned out later. We have met only few times after we have renewed our friendship, but good friends we still are. Let me briefly tell the (strange?) story of our friendship, and then turn to some small medical points were computers were involved.
Friendship and misunderstanding#
I was well on the way in my study of medicine at the College of Medicine in Saskatoon, but took off for some practical experience as was demanded by our study program, going to Pasqua hospital in Regina April 1963. While hunting for a furnished room to rent, I stayed at the Regina YMCA. Only minutes of my checking in, a young computer scientist also checked in, coming for an extended summer job from the University of Calgary. He was to work for the computer center of the government as junior member in an expert team to set up the data infra-structure for the free medicare program the government had promised in the election campaign. The concept behind this medicare program (50 years before Obama introduced something similar in the US!) was that all persons resident in Saskatchewan would have free medical treatment.To avoid misuse of the system (like a dentist charging for the extraction of a tooth that did not exist any more) it was necessary to collect and electronically store precise medical data on all people in the province. At this time this was a more than major task, and the young computer scientist from Calgary (Herman Maurer as you have guessed) was to help a bit with the project.
Anyway, both of us were looking for furnished rooms with a kitchenette. We ended up finding two that looked good, and Herman left me to choose. I took the one quite close to the hospital, Herman the one under a roof in downtown, separated from the government buildings he would work in by the nice park around the lake and the bridge over its outlet. We became good friends. However, in July 1963 Herman told me that his room was not air-conditioned and got too hot, and the walk through the park had become too bothersome because of the many mosquitos. Herman moved into a floor of an old villa quite close to the government buildings. I was sure his "explanations" were just excuses---but excuses for what? When I found out that he had moved into the headquarter of the Sakatchewan communist party, I decided that a communist was not good company for me. I made sure not to meet him any more.
I found out only years later (in 1967) that my conclusions were all wrong. Herman smiled when heared my story then. We have been on excellent terms again after this, ever since. Hermann will tell you his part as appendix to my story, to keep you in suspense till then 
So let me tell you now three short episodes were computers did influence my life.
Integrating patient information#
Canada is a rather mobile society. Hence many persons moved to Sakskatchewan whose medical record was not yet in the main data-base. When treating such persons doctors were oblidged to help collect health data related to the patient, and evidence of residency in Saskatchewan. The amount of work required for this was much higher than anticipated. It took years to reduce the efforts for all involved. This proved to me that even the best team is not able to fathom all consequences of a really big programming undertaking.Radiation therapy#
Radiation therapy for tumors is quite old. When I started medical practice and patients were diagnosed with some tumor (cancer), mainly brachytherapy was used, i.e. a radiating substance was placed (surgically) in or near the tumor, often using a technique called "afterloading": typically, a hollow tube is placed surgically in the organ to be treated, and the radiating sources are loaded into the tube as second step.For the patient it would be more desirable to use external beam radiation, i.e. sending a beam from a source outside the body to the tumor at issue. However, his radiation will also pass through cells one does not want to destroy, making a safe application difficult. It was in the sixties when, using computers, three or more weak external beams from different positions would be used, the direction calculated in such a fashion that beams would meet in the tumor, and only their combined strength would be able to kill cells.
Pager#
Pager technology has been around since the fifties: Small devices could be activated by radio signals to typically emit a peep, alerting the person to go to the nearest phone to find out why one is receiving an alert. Many versions of pagers have been developed. In the eighties, when I was was already married but (I have to admit) had a girl friend once in a while, I had a pager that had three different sounds, telling me whether my wife wanted me to call back, or my hospital, or my girlfriend.Cell phones seemed to be the end to all pagers. However, some are still in use. One reason is that in some places cell phone reception is on purpose shielded against (to avoid interference with other electronic equipment, like in high-tech hospital environments). However, the radio signals a pager requries are on other frequencies and weaker, hence do not pose a problem.
Recently, pagers are experiencing a revival. In catastrophic situations (like terrorist attacks) many people have to be warned. The cell phone network can easily collapse in such cases. The pager communication network, sending only a few bits, is much more relialbe stable!
Appendix by Herman Maurer#
It was a strange experience for me in 1963: I moved from my indeed very hot under the roof room accross the lake to the nice cool appartment near my place of work. And Arthur was not avaibable any more. True, he was now more remote, but with his car just a few minutes more. I was a bit baffled, may be hurt, but my work on the project mentioned did keep me very busy, including weekends.I had no idea that the villa was the HQ of the communist party. I did wonder, why I was invited to numerous parties downstairs and I was very naive: I should have noticed some remarks or events. Like when this guy I knew from my work who suddenly rushed to me: "Herman, I did not know you are one of us!". Anyway, I left Regina without knowing that I had stayed in an empty floor of the communist HQ of Saskatchewan.
However, when in 1966 I tried to enter the United States I was first not allowed in! I was seriously questioned: "Why had you lived in the HQ of Sasketchewan's communists?" Only then I realized what had happend! The border officers were kind enough to give me a copy of the long interrogation, and when I mailed this to Arthur, who was by then starting as doctor in Moose Jaw, he drove all the way to Calgary (six hours) and we had a handshake and a good laugh over my then favorit beer, "Lethbridge Lager".
(Thanks Arthur for digging up this story!!!)
