TheBakersfieldCalifornian.com

Carolyn Harbaugh didn't feel a thing.

One moment she was making her bed, the next she was on the floor, the right side of her body paralyzed.

Although she was having trouble forming words, she was able to cry out for John, her husband of 47 years.

"I couldn't even talk," she remembered. "I was helpless."

The next hour was like being in a fog. The ambulance ride through the Kern River Canyon, the arrival at Bakersfield Memorial Hospital, the flurry of activity by emergency room staff.

Despite her fear and confusion, it was good to be in the familiar, traditional setting of a metropolitan hospital.

Then the robot came in.

TELEMEDICINE

More than 300 miles away, a neurologist at Mercy Neurological Institute of Greater Sacramento sat at a control panel in front of an array of computer monitors.

Using a swiveling joy stick and a keyboard, he sent wireless commands to a nearly 6-foot-tall robot on wheels that had arrived at Harbaugh's bedside.

A real-time image of the doctor's face filled the large monitor screen that essentially acts as the "head" of the mobile telepresence robot.

He introduced himself to Harbaugh and her husband using the robot's high-quality speakers, swivelled the monitor left and right to take in the room, and using the robot's zoom lenses and sensitive microphones was able to see and hear everything.

"It's the most fantastic thing I have ever seen," Harbaugh later recalled. "It was just like he was standing there with me, taking command of the situation."

Dr. Alan Shatzel, medical director at Mercy Neurological Institute, said examining a patient through the remote-presence technology is the next best thing to being there.

He can zoom in extremely close to look specifically at a patient's pupils. He can check for tell-tale eye movement, and search for clues in the face and voice. He can read vital signs and ask questions.

"We're virtually inside the room," he said. "Which is very helpful to us."

LOST TIME IS LOST BRAIN

The hospital staff at Bakersfield Memorial has nicknamed the robot Caesar -- probably for its commanding presence and the emotional distance it maintains.

Caesar even has a built-in stethoscope and ultrasound device that could allow a doctor across town or across the continent to listen in real time to a patient's heart and lung sounds or view a sonogram of an expectant mother experiencing a high-risk pregnancy.

But it's Memorial's stroke center where Caesar is making his presence known.

Many medical emergencies are time-sensitive, but the effects of a blood clot in the brain are more likely to become tragically irreversible if too much time passes before medical treatment is sought and received.

Dr. Les Burson, medical director of Bakersfield Memorial's emergency department, said Caesar has proved his value time and time again.

"The robot is here 24-seven, 365 days a year," Burson said.

In years past, most neurological consultations were done by phone, Burson said. The symptoms of possible stroke victims were listed over the phone, and the doctor on the other end was expected to make a determination for treatment.

Simply put, the phone consultation was inferior to the telepresence robot, Burson said. And when a living, breathing physician was available to be at bedside, it was often a resident, rather than a neurologist with years of experience.

"When time is of the essence, minutes or tens of minutes can make all the difference," said Michele Shain, director of Memorial's transformational care and specialty programs.

FUTURE OF MEDICINE

Shain said she knows of no other telepresence robots being used in Bakersfield hospitals. But she and others believe it's only a matter of time before that changes.

Kern and many other valley counties have a shortage of physicians, and telemedicine is one way to bring the expertise of medical specialists into local hospitals, without bringing them physically into Kern County.

"This technology maximizes a physician's time to assess and evaluate patients without having to drive all over the place," Shain said.

Sacramento's Shatzel said telemedicine is particularly suited to stroke care, dermatology, critical care and perinatology. It has even proven useful in psychology -- or tele-psych as it's called.

An assessment of physician numbers published in 2009 by the non-partisan California HealthCare Foundation found that Kern County had 67 medical specialists per 100,000 residents in 2008.

The Council on Graduate Medical Education, a research organization funded by the federal Department of Health and Human Services, estimated specialists should number between 85 and 105 per 100,000 to ensure an "adequate supply."

In contrast, San Francisco County had a wealth of specialists, with 265 per 100,000 residents, while Orange County boasted 121 per 100,000.

Kern doesn't have nearly enough physicians to cover the need for specialty care, said Paul Hensler, chief executive of Kern Medical Center, Kern County's public hospital.

Maybe robots are one answer.

SAVING LIVES, SUPERVISING HUMANS

Robots have been used for years by police bomb squads, the military and in industrial applications.

But as the technology has become more affordable, scores of hospitals in the United States have started to use them.

Shatzel said his office in Sacramento contracts with five hospitals, including Bakersfield Memorial, for remote neurological assessment via telemedicine. But many others are expressing interest, he said.

And manufacturers are touting the value of robots in workplaces to enhance communication and even to supervise employees.

But for Shatzel, no area of medicine or business has shown the value of telepresence robots like stroke care.

"Time is brain," he said. And telemedicine saves time.

In Carolyn Harbaugh's case, the quick assessment and diagnosis she received through the "eyes and ears" of Caesar allowed doctors time to effectively use a clot-busting drug called tissue plasminogen activator, or tPA. Within 30 to 45 minutes, feeling and sensation returned to the 67-year-old's right side.

Her powers of speech returned, and after three days, she was back home with her family in Lake Isabella.

"This was dramatic for us," she said.

Indeed, the fear of being mentally aware and yet living trapped within a body where movement and communication have been severely compromised -- or lost completely -- is not unique to Harbaugh. Many stroke patients have said in surveys that such a life may not be worth living, Shain said.

Harbaugh's husband choked up as he talked about his wife's brush with death.

"It's the future," he said, "and it's here now."