Christmas 2012: Tomorrow’s World

Case report of E.T.—The Extra-Terrestrial

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8127 (Published 18 December 2012)
Cite this as: BMJ 2012;345:e8127
  1. Gregory Scott, clinical research fellow1,
  2. Edward Presswood, core medical training doctor2
  1. 1Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
  2. 2Barnet and Chase Farm Hospitals NHS Trust, Chase Farm Hospital, Enfield, UK
  1. Correspondence to: G Scott gregory.scott99{at}imperial.ac.uk

Gregory Scott and Edward Presswood present the intriguing case of ET and provide advice for those who have a medical close encounter with an extraterrestrial

In his 1982 film, E.T.–The Extra-Terrestrial, Steven Spielberg documented the short period when an alien named ET was stranded in a suburban region of North America.1 The film portrays the special relationship between ET and an alienated young schoolboy, Elliott. Previous work has looked at the cinematic importance of the film, but there has hitherto been no serious medical account of ET, despite the depiction of various pathophysiological states and detailed footage of ET’s medical care.

Based on an analysis of available footage, and disregarding the film’s emotional distractions,2 we report the medical case of ET. We describe his anatomy and pathophysiology, examine his medical care, and shed light on his glowing digits and luminous heart.

Case presentation

ET is an alien botanist and explorer who became unwell after being abandoned during an expedition to a forest in North America. Nothing is known of ET’s medical history, but his selection for interplanetary exploration suggests he was previously fit and well.

ET is a bilaterian tetrapod, sharing many of the physical characteristics of primates. Given that ET’s species evolved on a remote planet, the similarities are a striking example of convergent evolution.3 ET’s age is unclear. He is presumed to be male, although his external genitalia have never been observed. He weighs 35 lb (15.75 kg) and is about 4ft 6 in (1.35 m) tall, a measurement that varies because of his extensible cervical spine. Despite having the mass of a 4 year old boy,4 ET has a body habitus associated with increased cardiovascular risk.5

ET’s upper limbs are similar to the vertebrate pentadactyl limb, although he has only three fingers and an opposable thumb. The first finger of his right hand is grossly elongated at the terminal phalanx, with a drumstick appearance consistent with stage four clubbing. This finger has a remarkable ability to fluoresce with a red candescence. This may be a form of bioluminescence similar to that seen in Lampyris noctiluca, the common glow-worm. The same phenomenon is seen in his thorax and is associated with translucency of the chest wall. These periods of illumination serendipitously reveal aspects of ET’s cardiac anatomy, the appearances of which are consistent with dextrocardia, with a single ventricle and juxtaposition of the right atrial appendage.6 7 This unusual configuration, although rather beautiful, may well signify a cardiovascular system ill equipped to compensate for haemodynamic stress.

ET’s lower limbs are very short, with the appearance of lymphoedema. He has a Trendelenberg gait and severely limited walking speed. ET’s impaired mobility may explain why he did not originally make it back to his spacecraft. He may have pre-existing joint pathology, comparable to Perthe’s disease in childhood. This possibility, combined with other concerns about ET’s premorbid status (box 1), suggests he may have undergone inadequate physical screening for interplanetary space exploration.

Box 1 ET’s premorbid conditions*

  • Bilateral lower limb joint pathology, possible Perthe’s disease

  • Lower limb lymphoedema

  • Centripetal adiposity, possible metabolic syndrome

  • Unidigital clubbing

  • Congenital dextrocardia, with a single ventricle and juxtaposition of the right atrial appendage

  • Functional acetaldehyde dehydrogenase deficiency

  • *Based on analysis of available footage.2

ET’s linguistic faculties are impressive. While at first making only primitive vocalisations, within days he showed a grasp of spoken English. His grammatical understanding was initially flawed (“ET home phone”), but he quickly learnt the subject-verb-object structure (“ET phone home”), a feat that takes human children years to acquire. Incidentally, this syntax is something that Master Yoda refused to adopt,8 despite his advanced age (“When 900 years old you reach, look as good you will not”).9

ET’s newfound and haphazard Western diet may have led to profound malnutrition, contributing to his deterioration. His carefree attitude to nutrition may also explain his centripetal adiposity. Interestingly, ET rapidly developed features of alcohol intoxication (disorientation, disinhibition, and ataxia) after consuming one can of American beer. Such a dramatic reaction suggests that ET has a deficiency of the enzyme acetaldehyde dehydrogenase. This could result from a lack of exposure to ethanol during his evolutionary past, as is seen in some humans of East Asian ancestry.10

ET’s illness and treatment

ET became unwell in the days after arriving on Earth. He was found stranded in a stream after a failed attempt to phone home via a makeshift telecommunication device. He came to medical attention after he was returned to Elliott’s home and parental assistance was sought. ET was found lying on the bathroom floor; he was very unwell, pale, tachypnoeic, and delirious.

ET was moved to a temporary medical facility. He became critically ill, shocked, and hypoxic. Various investigations and treatment measures were undertaken (box 2). Despite aggressive management, ET had a ventricular fibrillation cardiac arrest. Chest compressions were started at a rate of 60/min. Bag mask ventilation was applied. A direct current shock was delivered. Intravenous lidocaine and noradrenaline (epinephrine) were administered. There was no return of circulation, however, and the resuscitation attempt was abandoned.

Box 2 ET’s medical details*

Acute medical problems
  • Malnutrition

  • Hypothermia

  • Delirium

  • Atrial flutter

  • Shock

  • Possible pulmonary embolism

  • Ventricular fibrillation cardiac arrest

  • Resurrection

  • Frontal lobe hypoxic brain injury

Examination
  • Respiratory rate 12 breaths/min

  • Oxygen saturation 82% on air

  • Electrocardiography (saw-tooth baseline)

  • Electroencephalography (initially synchronous with Elliott’s)

  • Normal reflexes

  • Hypothermia

Investigations
  • Blood pH 7.03 (acidosis)

  • Magnesium 0.3 mg/dL (normal range in humans 1.5-2.3; 1 mg/dL=0.41 mmol/L) (low)

  • Ejection fraction 20% (low)

  • Serum electrophoresis

  • Blood cultures

  • Skin biopsy

  • DNA analysis (six nucleotides)

Treatment
  • 5 L oxygen/min via nasal cannula

  • Intravenous cannulation and fluid

  • Broad spectrum antibiotics including gentamicin

  • *See the film: 01:18:24 to 01:29:49.

The management of the arrest was in keeping with the standards of the time, but the immediate outcome might have been better if modern resuscitation guidelines had been followed.11 12 The differences would include faster chest compressions (100-120/min) and greater emphasis on minimising delay to defibrillation. Lidocaine is no longer first line treatment, and it may have been ineffective in the presence of hypomagnesaemia.11 A systematic approach to the reversible causes of the arrest (using the mnemonic “4H’s and 4T’s”) might have improved the outcome. His hypovolaemia, hypoxia, and hypothermia were treated, but surprisingly he was not given magnesium to correct the hypomagnesaemia. Tension pneumothorax or tamponade were not suspected. Toxins are a possibility given ET’s new diet and his recent trips to the forest. A coronary thrombosis is also possible given ET’s cardiovascular risk profile. It is disappointing that the diagnosis of a massive pulmonary embolism was overlooked, given his recent long haul flight.

Recovery

After his death, ET’s body lay in a freezer compartment. Elliott was allowed to say farewell. Remarkably, ET came back to life and repeatedly chanted “ET phone home.” This verbal perseveration suggests frontal lobe damage resulting from a hypoxic brain injury that was not ameliorated by the cooling process. Nevertheless, ET made an exceptional functional recovery, balancing in the basket of Elliott’s bicycle and performing feats of telekinesis en route to the site of his eventual departure.

Conclusions

We are able to draw some conclusions about the care of extraterrestrials. The following points should be borne in mind in any close encounter:

  • Earth’s environment and our diet are unlikely to be optimal for sustaining extraterrestrial life. Even simple medical interventions, such as oxygen and fluid resuscitation, require careful consideration.

  • A collateral history is paramount in extraterrestrial cases. That said, an accurate medical history is a challenge to obtain from the records even for earthly life forms registered with a general practitioner. Obtaining a collateral history for an extraterrestrial, especially on a Friday afternoon, will probably be almost as challenging.

  • Any extraterrestrial who has succeeded in travelling to Earth is likely to be intellectually superior to most humans, even neurologists. This will provide a contrast for Earth based doctors, who are used to feeling superior to their patients. Usefully, involving the extraterrestrial patient in medical decision making represents not only exemplary ethical treatment, but will probably result in a more favourable outcome.

  • If you are involved in the treatment of an extraterrestrial, do ensure that this experience is fully reflected in your revalidation portfolio.

We realise that most doctors will not need specialist skills in extraterrestrial medicine: in his or her career, the average GP will see no cases of ET illness. Nevertheless, we suggest that specialists be trained in this branch of medicine, because such alien encounters are likely to be more common with the explosion in space travel.

Notes

Cite this as: BMJ 2012;345:e8127

Footnotes

  • Thanks to Frank Cross for his comments on drafts of the paper.

  • Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

References

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