Many people have been asking me about the jury trial I spent most of the last two weeks on. Two weeks of being able to say only "I'm on a jury trial", especially as the trial was pretty intense, was challenging. Interestingly enough, this particular trial was trying out the use of computing technology in a way they hadn't done before so we were guinea pigs. What was most interesting to me was that the technology itself wasn't particularly unusual or radical, but the people in the court were using it for the first time and I got to see how they chose to use it, what worked and didn't work, how it contributed (or not) to the trial process, and how everyone (jurors, judge, lawyers, witnesses, plaintiffs, defendant) reacted to it. There was a tech guy in charge and I wasn't supposed to talk to him (or anyone else). I wanted to find him after the trial was over and pick his brains but he had vanished by the time we were out of deliberations. Too bad.
The trial was a messy complex personal injury lawsuit (now I am allowed to say anything I want). The "facts" were not at all clear. Enormous sums of money were at stake and people's lives on all sides hung in part, in great part, on the credibility of witnesses and the technology they worked with.
A key issue was whether or not one of the plaintiffs had suffered a particular back injury, and what options (surgical or otherwise) were warranted if he had. Spinal injuries are very complex, more than I ever could have imagined. Surgery can involve pulling out all your innards and laying them...somewhere... in order to get access to the spine. Ew. We the jury heard DAYS of testimony from doctors and surgeons about the spine and soft tissue injuries and viewed shot after shot of digital imaging tests including MRIs, X-Rays, Discograms... The courtroom set up a system whereby there was a giant screen TV in front of the jury box; the judge had a monitor, the witness on the stand had a monitor, the plaintiff and lawyer tables had their own monitors and there was a tech guy in the back controlling who could see what and when. Sometimes control was given over to either of the lawyers. Cables ran around across the floor.
Sometimes they wanted all of us to see a Discogram image for example (a somewhat controversial procedure where they stick 8 inch long needles into your spine and ask if it hurts). Other times they wanted all of us to watch a 3D MRI or a simple document display (usually of endless spreadsheets of mind numbing medical or financial data). The images were pretty interesting actually, especially as I have done research into digital image use in medicine and now got to see it put to use in a legal setting. Other times they wanted the witness to see something along with the judge and lawyers but not the jury. Basically, pick your combination, and at some point in the trial any given subset of people were supposed to see it.
Sounds easy right? By the end of the trial they more or less had it down. Here are some interesting highlights of their learning curve from a usability perspective in the juror box.
The giant TV was on a stand about 6 feet high. Hard to move, trailed a long cable and had to be shoved around the room without tripping over other cables. One of the lawyers tripped on a cable early on. (not badly, but it threw him momentarily off stride). The TV blocked some of the jury from seeing the witnesses (not good) and blocked the judge from seeing some of the jurors (not good). We paused while they figured out where to best put the TV. The lawyers and judge could not see what displayed on the juror TV without walking around in front of it. This led to some early significant "oops" moments. For example, one witness was looking at his screen (along with the lawyers and judge at theirs) describing in great detail something about the spine and we jurors were completely in the dark about what was being referred to. Eventually they figured this out and some time was taken to figure out why the connection wasn't working. We started over again.
In another case, the plaintiffs' lawyer thought we were all looking at some emotionally laden photographs the witness was describing, however we couldn't see them. There were quite a few photographs and it went on a while. It turned out that our not being able to see the photographs was a good thing because the lawyer hadn't requested and obtained permission to show them as exhibits (not good). Near the end one picture momentarily flashed on the screen. Our generally genial judge looked rather annoyed when all this came to light moments later. A backroom huddle between the judge and the lawyers took place and I suspect some strong words were exchanged. In the end we saw none of the photographs and ignored the one we had seen. Had we been shown all those photos which were eventually ruled as inadmissible I suspect there would have been some truly severe backroom lecturing by the judge. As it was, both lawyers were pissed off from what I could tell from their faces, though nary another word was spoken on the matter.
Then there was the witness whose monitor on the stand stopped working and was asked to come down to the big TV. He stood smack in front of it, back to the audience (ever had a teacher do that? :) and had to be gently and repeatedly asked by the lawyer to move out of the way so we could see what he was talking about. The lawyer actually helped him move at one point.
One time the judge's monitor stopped working and they tried to swap it out with the witness monitor which was a few feet away. The cord wasn't long enough. Our very cheerful and friendly judge disappeared under his bench - one moment he was there and the next moment he was gone. I had glanced away at the tech guy and when I looked back - no judge. Huh? Moments later he popped up, in black robe, happily holding a cable and cheerfully announcing he had figured it out. It was an amusing moment in another wise not at all happy trial situation. We appreciated every rare light moment that came our way.
There was the first tech guy (not the one referred to above) who fell asleep sitting at his little table at the back of the courtroom. The lawyers had been in the habit of requesting him to do something without turning around and it was only when there was no response that we all noticed the poor guy snoozing. Probably bored to tears by all the talk of the T4, L4-L5 spinal disks, protuding jelly globs of spinal material, endless lists of complicated drugs that I had never heard of (and hope to heck never to have to take after hearing about their side effects) and the gorey details of spinal disk replacement vs. disk fusion vs. inserting tubes around the spine full of pain medication....(there was more but I'll stop). After that we got the second tech guy.
I was pleasantly impressed with the grace and patience with which all the court personnel handled the technical experiment. It must have interfered with their usual mode of doing business and caused them to do some cognitive context switching when they least wanted to. From a juror perspective I wonder how they conducted such a trial before? All those complex digital images, some rotating and zooming. The computing setup was very effective in presenting the information under discussion and made it quite clear why there was lack of medical agreement on various procedures and possible outcomes. One variable at least was made less abstract and easier to evaluate in our deliberations.
As a passing note, I want to comment that this experience, in spite of the time it took up and the emotional stress it induced for all the jurors (we compared notes extensively afterwards) was absolutely worth it. My perspective on our trial system has risen significantly - everyone took it very seriously, worked hard together and we did our very best in deliberations. It was a fair process. If you haven't been on a jury trial I suggest you take advantage of it when given the opportunity.
Showing posts with label digital imaging. Show all posts
Showing posts with label digital imaging. Show all posts
Thursday, July 28, 2011
Friday, March 4, 2011
Zen and the Art of CT Scan Investigation
"Because we put emphasis on some particular point, we always have trouble. We should accept things just as they are". (Zen Mind, Beginner's Mind p. 120)
Yesterday I described my "plan" for learning first hand about the digital imaging equipment I have been studying for one of my projects. My plan turned out to be easier said than done - this was definitely not Grey's Anatomy. The staff were politely but determinedly cycling people in and out of the CT room as fast as they possibly could. Before I even had my bag picked up off the counter and had found my necklace they had wheeled the next guy in.
My attempts to be politely inquisitive met with only modest success. I started with a simple question "Is it blue?" Ok, probably not quite so inane (I hope), but the idea was to ask a very friendly and innocent sounding question (although a real question) about whether or not the contrast IV liquid was colored. How else might one get contrast? I was imagining all these colorful images on the imaging machines, because I have seen so many of them in my research. Very high resolution pictures of multicolored body parts with swoops and curves. Sometimes rotatable in 3D and able to be zoomed in and out and entered and exited in fly-by mode. So I figured blue was a likely color, not occurring naturally in the body - at least as far as I know.
The tech looked at me like I was a bit loony and I had to explain that I wanted to know how this liquid was going to provide the contrast to enable the CT scan to better read my head. I said I had an interest in digital imaging equipment in medicine - now trying another approach. She still wasn't interested in my line of inquiry. Eventually I managed to get the information that no, it was not colored, it worked by expanding the blood vessels so that they would stand out better. By the time I had gotten that far I had been jabbed and was being injected and she was out of there. So much for asking about the CT machine. It was 4:45 pm on a Friday and they probably just wanted to go home.
When I first walked in the room I had realized the people (at least 3) sitting behind the glass wall were back there to protect themselves from the radiation I was about to get blasted with and it was going to be impossible to ask them about their viewing equipment and software or to ask to see my scan. Rats. Foiled again.
However, another opportunity presented itself. Shortly after the first tech left, another one came in and said he was there to check the IV because sometimes it didn't ... do something or other right. Whatever it was, it sounded a bit fishy to me. Anyway, he was a bit more talkative and didn't give me any funny looks. He stood there for a minute or two seeming to stare at nothing much and suddenly ... I started getting really warm and it felt like liquid was flowing all over starting at shoulder level and migrating all the way down to my toes. Not only that, it felt like a lot of liquid was pooling in all sorts of strange places. So I said "What is it doing?" And he asked if I was getting warm, said that was normal, did I feel ok otherwise and that's all he said. He continued staring calmly at apparently nothing for another few moments. So I contemplated warmness and expanding blood vessels and wondered if I'd soon be leaking out of previously unknown pores. Then they told me (for the second time) I had to close my eyes. Darn it. No more watching what was going on.
Not long after, a bit of whirring and movement later, we were finished. The second guy came back and told me he had also been out there to make sure I didn't start vomiting! Now that explained all the questions about food and drug allergies and the "no eating for 4 hours prior" requirement and why he had so quietly stood there and asked me ever so casually if I felt ok!
"When we inhale the air comes into the inner world, when we exhale the air goes to the outer world...actually there is just one world...our throat is like a swinging door" (p. 29)
So while I felt like I might be developing new porousness I also concentrated on not moving my head because I had been told that if I moved my head or opened my eyes we'd have to do it all over again (meaning I get zapped with lots more x-rays). This was a hard task being the patient/researcher!
More so because I have a head cold and my sinuses are blocked and my nose wants to run and I periodically want to sneeze and...you know...all those things that go with having a nasty head cold and are exaggerated when lying on your back where it can all congeal into one gloppy spot in your head.
So I breathed...in...out...in......out......do not sniffle......in.......out.....do not worry about what is going on in your nose.... or the back of your throat...in...out... zen. Getting into the zen of it all. Or as Spock would have said "I became one with the CT machine". In goes the breath, out goes the breath.
I do have one clear success to report from the original "plan". It was very very easy to ask for a copy of my scan. Back at the front desk I checked off about 3 boxes on a sheet of paper and was told I could either wait 30 minutes or they'd mail it to me. Figuring it would be more than 30 minutes I opted for the mail route. They said it would go out Monday! No one batted an eye at my request! So, hopefully soon, I will have my own digital copy of my head scan.
Wait a minute. Not "hopefully".
"Perhaps". Non-attachment.
Yesterday I described my "plan" for learning first hand about the digital imaging equipment I have been studying for one of my projects. My plan turned out to be easier said than done - this was definitely not Grey's Anatomy. The staff were politely but determinedly cycling people in and out of the CT room as fast as they possibly could. Before I even had my bag picked up off the counter and had found my necklace they had wheeled the next guy in.
My attempts to be politely inquisitive met with only modest success. I started with a simple question "Is it blue?" Ok, probably not quite so inane (I hope), but the idea was to ask a very friendly and innocent sounding question (although a real question) about whether or not the contrast IV liquid was colored. How else might one get contrast? I was imagining all these colorful images on the imaging machines, because I have seen so many of them in my research. Very high resolution pictures of multicolored body parts with swoops and curves. Sometimes rotatable in 3D and able to be zoomed in and out and entered and exited in fly-by mode. So I figured blue was a likely color, not occurring naturally in the body - at least as far as I know.
The tech looked at me like I was a bit loony and I had to explain that I wanted to know how this liquid was going to provide the contrast to enable the CT scan to better read my head. I said I had an interest in digital imaging equipment in medicine - now trying another approach. She still wasn't interested in my line of inquiry. Eventually I managed to get the information that no, it was not colored, it worked by expanding the blood vessels so that they would stand out better. By the time I had gotten that far I had been jabbed and was being injected and she was out of there. So much for asking about the CT machine. It was 4:45 pm on a Friday and they probably just wanted to go home.
When I first walked in the room I had realized the people (at least 3) sitting behind the glass wall were back there to protect themselves from the radiation I was about to get blasted with and it was going to be impossible to ask them about their viewing equipment and software or to ask to see my scan. Rats. Foiled again.
However, another opportunity presented itself. Shortly after the first tech left, another one came in and said he was there to check the IV because sometimes it didn't ... do something or other right. Whatever it was, it sounded a bit fishy to me. Anyway, he was a bit more talkative and didn't give me any funny looks. He stood there for a minute or two seeming to stare at nothing much and suddenly ... I started getting really warm and it felt like liquid was flowing all over starting at shoulder level and migrating all the way down to my toes. Not only that, it felt like a lot of liquid was pooling in all sorts of strange places. So I said "What is it doing?" And he asked if I was getting warm, said that was normal, did I feel ok otherwise and that's all he said. He continued staring calmly at apparently nothing for another few moments. So I contemplated warmness and expanding blood vessels and wondered if I'd soon be leaking out of previously unknown pores. Then they told me (for the second time) I had to close my eyes. Darn it. No more watching what was going on.
Not long after, a bit of whirring and movement later, we were finished. The second guy came back and told me he had also been out there to make sure I didn't start vomiting! Now that explained all the questions about food and drug allergies and the "no eating for 4 hours prior" requirement and why he had so quietly stood there and asked me ever so casually if I felt ok!
"When we inhale the air comes into the inner world, when we exhale the air goes to the outer world...actually there is just one world...our throat is like a swinging door" (p. 29)
So while I felt like I might be developing new porousness I also concentrated on not moving my head because I had been told that if I moved my head or opened my eyes we'd have to do it all over again (meaning I get zapped with lots more x-rays). This was a hard task being the patient/researcher!
More so because I have a head cold and my sinuses are blocked and my nose wants to run and I periodically want to sneeze and...you know...all those things that go with having a nasty head cold and are exaggerated when lying on your back where it can all congeal into one gloppy spot in your head.
So I breathed...in...out...in......out......do not sniffle......in.......out.....do not worry about what is going on in your nose.... or the back of your throat...in...out... zen. Getting into the zen of it all. Or as Spock would have said "I became one with the CT machine". In goes the breath, out goes the breath.
I do have one clear success to report from the original "plan". It was very very easy to ask for a copy of my scan. Back at the front desk I checked off about 3 boxes on a sheet of paper and was told I could either wait 30 minutes or they'd mail it to me. Figuring it would be more than 30 minutes I opted for the mail route. They said it would go out Monday! No one batted an eye at my request! So, hopefully soon, I will have my own digital copy of my head scan.
Wait a minute. Not "hopefully".
"Perhaps". Non-attachment.
Thursday, March 3, 2011
A CT Scan as an Opportunity to Get Personal
As those of you know who have been following these postings regularly, I have written frequently about issues related to medicine - from medical informatics to digital imaging. I am working on several projects in this arena and sucking up as much information as I can get. There will be more to come because recently I have been digging into issues related to electronic health records. Fascinating stuff - although reading congressional legislation as officially posted in the Federal Register and elsewhere takes stamina and many lattes.
Tomorrow I am going to conduct a little investigation / experiment because an opportunity fell into my lap. This experiment relates to digital imaging and medical records.
I am going to have a CT scan. Nothing serious (unless they find a screw loose in my head) but they will be injecting me with dye to get a better view of my head - the object of interest. Not one to miss out on an opportunity, I am going to do several things:
I am going to see how much I can talk to the radiology techs about their equipment. Let's hope I get a happy chatty tech.
I am going to see if I can convince them (perhaps by tossing around well placed vocabulary they would not expect your typical patient to have) to let me in on some of their experiences with the imaging and storage systems.
I am going to try and get them to let me look at my scan, although I know from experience that they will clam up completely if I ask any questions about what I'm looking at. Nonetheless I will see how far I can get.
Finally, I am going to ask at the front desk what the procedure is for obtaining a digital copy of my scan. I know that legally my records are mine to ask for. I also know from a few experiences in the past that for some reason it can be very hard to get records. One gets run around in circles and stalled in all sorts of ways. In case any of my current medical personnel are reading this, I rush to note that these previous experiences were at a different medical facility in a different state.
Stay tuned. This could be interesting
Tomorrow I am going to conduct a little investigation / experiment because an opportunity fell into my lap. This experiment relates to digital imaging and medical records.
I am going to have a CT scan. Nothing serious (unless they find a screw loose in my head) but they will be injecting me with dye to get a better view of my head - the object of interest. Not one to miss out on an opportunity, I am going to do several things:
I am going to see how much I can talk to the radiology techs about their equipment. Let's hope I get a happy chatty tech.
I am going to see if I can convince them (perhaps by tossing around well placed vocabulary they would not expect your typical patient to have) to let me in on some of their experiences with the imaging and storage systems.
I am going to try and get them to let me look at my scan, although I know from experience that they will clam up completely if I ask any questions about what I'm looking at. Nonetheless I will see how far I can get.
Finally, I am going to ask at the front desk what the procedure is for obtaining a digital copy of my scan. I know that legally my records are mine to ask for. I also know from a few experiences in the past that for some reason it can be very hard to get records. One gets run around in circles and stalled in all sorts of ways. In case any of my current medical personnel are reading this, I rush to note that these previous experiences were at a different medical facility in a different state.
Stay tuned. This could be interesting
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