A ghost in the machine

24 June 2018

To my knowledge, I’m one of the very few neurosurgeons that included a short residency in neurology in my neurosurgical training. For those not familiar with the details of these two specialities, neurology is the medical application of clinical neuroscience while neurosurgery is the surgical application of the neurosciences. Traditionally then, neurologists treat predominantly those conditions which require medication while neurosurgeons treat those maladies that may require a surgical intervention. Additionally, neurologists perform the electrophysiological diagnostics which include EEG’s (electro-encephalography – the study of ‘brain waves’) as well as nerve conduction studies and EMG’s (electromyography – the study of the function of nerves, muscles and the interface between the two).

I had always had a leaning towards electrophysiological diagnostics. However the pressures and time constraints of the ‘blood and guts’ world of neurosurgery precluded me from re-learning and incorporating this area of neuroscience into my practice. But in 2017 I resolved to re-connect with this field and incorporate it into my practice. The whole project was dependant on being able to acquire the electronic apparatus (nerve conduction and EMG machine). These machines are pretty pricey ( in the region of $20 000). That’s quite a bit of money to spend on ’testing the water’ as it were. I decided to seek out a second-hand machine, but none were to be found. I then directed my attention to colleagues who may have retired or died. And here I struck oil! One of my older neurology colleagues had died the previous year, quite suddenly. I was quite saddened to hear of this and only got to hear of his death almost a year later. Jamey Flowers and I had shared time in the same clinic several years previously. We’d had a good vibe and in fact I’d taken Jamey flying with me in my flying machine. Shortly thereafter, Jamey had purchased his own plane and became a member of the ‘flying doctors’ fraternity!

The first hurdle to acquiring the machine was locating his widow and/or some family member or friend. Jamey's practice had been wound up and its contents moved out and no one seemed to have any contact or forwarding details. After a month of inquiries we were directed to the assistant of one of the younger neurologists at the said clinic who had the cell number of Jamey’s widow. Finally I was able to make contact in October of 2017. After offering my condolences I inquired whether Jamey’s EMG machine was still available? The response was that she was sure it was among a whole lot of ‘electrical stuff’ in storage, which they were planning to offload on a nearby trash heap. At the first opportunity I dashed over to review the ‘electrical stuff’. Sure enough there among entangled wires, computers and electrical boxes were the components of an EMG machine. I made a deal with the widow that I would take it for myself as is and attempt to resuscitate it. If successful, I would contribute a sum of money to the estate. If unsuccessful, I’d take it and dump it on the nearest trash heap.

After managing to assemble the various components at my home, I called one of the companies that sell these products. The picture was grim. The said EMG machine was thirteen years old; the company that manufactured it was long gone – insolvent and wrapped up; there was no support and no operating manuals available. But there was another major hurdle – Jamey had died with the passwords to the computer and to the program. Nothing had been written down and no one had a clue what the passwords could be. I tried every combination – names, addresses, date of birth. Everything I could think of. On one occasion Jamey’s son called me up and rattled off a couple of names and numbers that he’s dad had written in a notebook. But all to no avail. And despite Googling every possible solution, engaging with communities who’d had similar problems and consulting IT geeks, we came up against a brick wall. This machine was not going to give up its secrets without a fight. But I’m a fighter by nature, actually a terrier, and I was not going to give up. I was now damn obsessed with the machine.

It was at about this point that I began to become very aware of my late colleague Jamey. I don’t think it was just projection. Jamey was taunting me, ‘OK you bloody neurosurgeon. Let’s see what you’re made of. Can you take the punch? Chuckle, chuckle!’

The universe smiled ... just a little. I located the manual online after a month of searching. The description was in Italian but the attachment was the English version of the manual. I downloaded it and printed out the 256 page manual. Great! So I had the comprehensive manual for a machine that refused to progress beyond the Login screen. But the powers that be were slowly coming around in my favor. We were out for dinner with colleagues one night. I described my predicament to my urology buddy. He looked at me with a smirk and said, ‘I’ve got what you need. A gift from the Dark Web!!’.

The following day my buddy sent me a DVD with the instruction – ‘Put it into the DVD reader, push F9 several times and let it do its thing’. I rushed home at the end of the day, went straight to the machine and followed instructions. I got as far as the screen telling me that passwords were being cracked as well as catching a glimpse of the name of the program .... and then nothing! Did I hear Jamey laughing?

Now I was a man possessed. I went straight to my own computer and called up the name of the program on Google. Suddenly all hell broke loose. My anti-viral was screaming warnings at me. There were pop-up screens going nuts all over the place. Shit, I was entering the Dark Web! At that stage I reckoned that I had terminally contaminated my computer. Well what the hell, I thought, let’s go for it. There was the hacking program. It claimed to be able to hack any password on any operating system. Fortunately I was able to transfer the program straight on to a DVD without downloading it on to my hard drive. I was advised thereafter to watch a Youtube-based clip on how to hack, using the program. A woman appeared. In a stern voice she introduced herself: 'HULLO (the 'H' pronounced similarly to when you clear your throat just prior to spitting). My name is Ludimilo. I’m going to teach you how to HACK (another throat clearance of the 'H' and spit)'. I got it. Almost trembling I ran over to the EMG machine, put in the DVD and hit F9... Then I beheld text on the screen that I’ve never seen before and hope to never see again: ‘ Now taking control of RAM. Now taking control of source files - 20% ... 60% .... 100%. Cracking .... cracking.... password number one emerging. Password # 1is ....’

Three passwords were generated in nine minutes and twenty eight seconds! I took out the DVD and re-started the computer. I punched in the three passwords consecutively and ... I was in. The wallpaper on the screen was a picture of Jamey and his kids many years previously. Was that a thumbs up from Jamey?

I spent the next two months doing online courses on EMG and nerve conduction analysis. Using the manual I familiarized myself with all aspects of the machine. Eventually I attained the required proficiency to move the machine into my examining room at the clinic. I made a contribution to Jamey’s estate.

The machine now occupies a proud corner of my examining room. It has added a whole new dimension to my practice. It is undoubtedly a great value-add to the diagnosis of my patients. I’ve come full circle – a neurosurgeon applying clinical neurophysiology in the course of patient evaluation. But every time I see the machine I really feel a touch of pride and jubilation. Shit I did it! The value of the machine is all that I gave it. Without the drive and frustration to make it real, the machine was worthless. It was headed straight for the trash heap. Something in all of this makes me feel warm all over!

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