Not This Kind of Doctor

So Doctor Who isn’t exactly the best example of a space doctor…at least not the kind we are going to need here in the next hundred years. We will need a way to have a doctor with us wherever we go though…but how can we do that if there are small groups of humans spread across hundreds of stations and millions of miles apart? It isn’t exactly feasible to have every 50th person be a doctor. Lets look at a couple solutions to this problem that are rooted in technology available today.

The Fun Part

June 1, 2063
Swift Crater Settlement, Deimos, 9,300km from Martian surface

Greg wasn’t thrilled about this….after all this was his daughter’s life. Why should he trust it to a glorified autopilot system? Wasn’t there another way?

When Greg was a kid back on Earth his grandma had a heart attack and because of complications he wasn’t old enough to understand at the time; she had to have surgery with her doctor remotely performing the procedure.

Why couldn’t Emma just have that done?

There were doctors on both the Gateway in Lunar orbit, and on the Aldrin Cyclers…why couldn’t they do the surgery remotely?

All these automated systems were scary…weren’t autonomous cars still having accidents and killing people back on Earth? It wasn’t like these machines were perfect. And what happens if something goes wrong?

Why did Aquafina not think it was important to have a doctor at the water extraction plant nearby? This was a company settlement after all – shouldn’t the company have brought along a doctor instead of this jumble of robot limbs? Surely it couldn’t have been cheaper.

Greg had been told about some executive travelling out to Mars on one of the cyclers being evacuated via medical transport back to Earth itself for his treatment…how could he get that but Emma be stuck with this…this…thing…

Maybe he was worrying too much…after all…there wasn’t really any other option for her. A medical transport might take six months to get her back to Earth, and from what the remote diagnosis had said, her internal bleeding was really really bad.

Maybe he should just trust the machine…maybe he could just rest while she was in there…maybe…but probably not…

The Real Deal

So Greg is going through a problem that we are all going to face at some point when we get to space…where do we get medical care. One solution is to just use the tele-medicine that is starting to become feasible here on Earth. However that isn’t going to work for precise procedures like surgery. Oh sure it will probably be fine for routine procedures, but not the sort of things that require delicate maneuvering, or real-time feedback.

Lets look at what the problem is with using tele-medicine, and possible solutions to that, which we are likely to implement over the next 100 years in space.

Tele-Surgery’s Downside

According to medical researchers in 2018, the ideal amount of latency between doctor and patient during a tele-surgery procedure is 100 milliseconds, and not more than 300 milliseconds. With light traveling 300 km in a millisecond, that means a doctor needs to be within 30,000km (~19,800 miles) and 90,000km (~60,000 miles).

Ok enough nerd shit. What that means for our purposes is that you have to be really really f’ing close…at least in space terms. There are currently satellites in geosynchronous orbits that would be in the middle of the safety band, and that is assuming there is literally no lag on the part of the computer.

A lot of remote surgery now is done with doctors in the same room, rather than separated by thousands of miles

For medical procedures, the distance the signal has to travel is going to be less of a factor than the ability of the systems on both ends to translate the intentions of a doctor into action.

But What Does This Mean?

So in practical terms this means ships traveling between stations, planets, asteroids and just about anything else, will have to carry their own medical support. Stations in close proximity however will likely be able to share doctors, so long as there is adequate medical facilities on each for the patient to actually undergo surgery.

Right now the shift towards telesurgery and telemedicine on earth is allowing relatively scarce doctors to perform risky and delicate procedures for longer, and from greater distances. Absent a change in our ability to communicate (e.g. being able to communicate faster than light), we are going to be forced to move beyond current telemedicine ideas.

SO what will we do?

So if we are limited by the speed of light in how much a surgeon can do remotely, and if we are currently limited in our number of skilled surgeons, what will future generations have to do in order to cope with needing medical care while they are days or even weeks away from an actual medical facility?

I see three possible options…but i’m sure there are others (comment below if you can think of any). The three are ordered by their feasibility (based on currently available tech, and our current accepted medical practice).

Solution 1: SEMI-AUTONOMOUS SURGEONS (ALSO KNOWN AS ROBOTS WITH SCALPELS)

The first, and most likely solution to our space doctor and distance problem is to take current tele-surgery systems and make them just a bit more autonomous. Think the difference between your vacuum and my Roomba. Instead of a doctor needing to actually operate the remote surgical system in real time, he can have his robot avatar do pre-programmed procedures based on the patients needs. This may look like the doctor arranging a sequence of tasks for the robot hands to undertake, with safety parameters that automatically kick in (kind of like how a Roomba will stop rather than run itself down the stairs).

This system requires some sort of basic medical facilities on most human outposts/ships which can receive commands from whatever doctor is needed. It also necessitates at least a semi-skilled human on each ship/station who can stabilize emergency cases long enough for a signal to get to a doctor and a treatment begun. But with emergency medical technician training being a matter of weeks compared to at least a decade for a surgeon, that seems like a manageable hurdle.

This system would allow skilled doctors to take care the maximum number of patients across the furthest distance, without sacrificing the ‘human in the loop’. Its principle downside is that it will take the longest to get a patient treated. Granted that time may be less than the average ambulance ride is right now, but still, it will take the longest of the three possible future systems.

Solution 2: Chirurgus A Machina (Also Known As A Benevolent Terminator)

Rather than God being in the machine, we could put a doctor in the machine. It may seem a tad far-fetched, but let me break it down.

Surely We Can Make A Nice Version

First off, the human body is just a machine. A complicated one…but a machine nonetheless. With that being the case, we can remove the human in the loop of the semi-autonomous doctors described above. It would just be a matter of training an algorithm with enough data for it to learn all the ways things can go wrong and be taught by expert doctors ways to mitigate those problems. This is very similar to how medical students are taught now. There is a degree of art to medicine still, but much of the training involves showing medical students the different ways things go wrong, and the best ways to fix them.

This would be a resource intensive project up front (making self driving cars might seem like an easy challenge compared to this), but its main benefit is the ability to ‘mass produce’ skilled surgeons. The ability to install this Chirurgus (surgeon) system in every ship or station would enable rapid emergency or non-emergency care for all the squishy monkeys living there.

An obvious downside is the lack of a human in the middle who can reassure us that this robot won’t decide to freeze up at exactly the wrong moment. There are also risks to these machines being hacked, or otherwise re-purposed for nefarious aims.

SOlution 3: Sleep It Off

The final possibility is we just freeze patients until they can reach a doctor. This would be a bit like the stasis pods of just about every science fiction story, but its analogue is currently in use on Earth. We already induce ‘therapeutic hypothermia‘ in patients to prevent brain damage in severe heart attacks. Sure there are currently limitations to how long this can be sustained before it damages the patient, but these hurdles seems eminently overcome-able.

This system would essentially be a merger of current life support systems (which can keep people alive for as long as 2 years) with a bed where a patient could be chilled from both the inside and outside. Chilled liquids would run through IVs into the patient while the bed itself would cool the patient to a ‘storage’ level. The system would need an integrated ventilator or other way to deliver oxygen, and ensure blood continues to circulate.

This whole system would then be shipped to a medical facility by either the space equivalent of UPS or some sort of specialized medical shipping company, allowing human doctors to revive and repair the patient.

The key benefit of this system is it avoid robots all together (assuming you view that as a benefit), and allows for a centralization of medical providers at a relatively small risk to patients. Its principle drawback is that it could take literally years for a patient to get treatment depending on how long it takes for them to get back to a doctor.

Which One Is Most Likely

Because we are silly monkeys at our core, some variant of all three of these will almost certainly see use in space over the next hundred years. We are almost certain to avoid standardizing medical care to one easy-to-use / one-size-fits-all system. The richest among us may opt for specialized, frozen transport to an actual in-person doctor; while automated surgeons provide care to impoverished miners or hospitality workers.

Much will depend on our relationship with automation, and the willingness of the people who venture into the stars to recognize the risks of allowing a robot to operate on us isn’t greater than the risk of even the best surgeon making a mistake. We fundamentally trust those who look and act more like us, so unless we overcome our instinctive bias against robots, we are more likely to rely on systems that allow for humans in the loop.

Next Time

Lets look at some other medical problems in space in the next couple posts. Problems like where do you put the blood in zero-g surgery, or how do you keep blood from accidents/medical procedures from being pulled into air recycling systems and distributed to everyone?

Until then feel free to contact us below if you have thoughts on this or any other post. Check out some of our old posts on other quasi-medical issues (like what to eat; or what our home planet will do to our bodies if we leave her for too long).

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