The Clean Room / Producing Surgery on the Internet

“The Clean Room” is a column by David Serlin on science and technology.

In Richard Fleischer’s 1966 film Fantastic Voyage, an elite crew of medical technicians—including the buxom but brainy Cora Peterson (Raquel Welch)—is shrunken down to microscopic size and climbs aboard the Proteus, a nano-sized submarine. The crew’s mission: to use a modified laser to destroy a blood clot on the brain of a dying scientist who holds important Cold War military secrets. Navigating their way through the dark, dangerous world of multicellular marauders and bacterial invaders, the crew of the Proteus spends a good amount of time on-screen peering out the windows in awe of the human body’s oceanic interior. Just after comple­ting their assignment, and with valuable seconds ticking away, the crew of the Proteus is attacked by white blood cells. The survivors exit the body by riding out through a tear duct, cushioned in the saline safety of a single teardrop.

For all its retrospective camp value, Fantastic Voyage is also a fascinating cultural hybrid, the talented offspring of postwar American cinema and postwar American science. By the mid-1960s, the distinction between cinematic representations of the body’s interior, and representations of the body generated by a new repertoire of visualizing medical technologies, was an increasingly arbitrary one. In 1965, the year before Fantastic Voyage was released, Lennart Nilsson published the first microphotographs of fetuses in utero in Life magazine. These interior shots of fetuses were medically “accurate”; yet, seen floating in soft and dramatic lighting, they seemed both transcendent and inhuman, not unlike the images of the ür-infant that would close Stanley Kubrick’s 2001: A Space Odyssey a few years later. Fleischer’s film also tapped into widespread enthusiasms during the late 1950s and early 1960s for new diagnostic technologies such as ultrasound, echocardiography, electroencephalography, and computer-assisted x-ray scanning techniques, which paved the way for computer-aided tomography (CAT) and magnetic resonance imaging (MRI) technologies in the 1970s and 1980s.

Fleischer was fearless about his artistic vision. The film’s opening credits offer a utopian manifesto, couched in the futuristic lingo of Cold War scientific prowess, which predicts a time when travel through both outer and inner space would be commonplace:

This film will take you where no one has ever been before; no eye witness has actually seen what you are about to see. But in this world of ours where going to the moon will soon be upon us and where the most incredible things are happening all around us, someday, perhaps tomorrow, the fantastic events you are about to see can and will take place.

It was not that Fleischer and his colleagues believed that they were depicting the “real” body. Instead, they believed that their film served as a state-of-the-art cinematic dress rehearsal for visualizing technologies and medical advances that lay just around the corner. The rhetorical lure of medical “realism” was such that it affirmed science’s ability—consequences be damned—to penetrate the unfathomable depths of the human body. Yet, even in 1960s cinema, special effects like those in Fleischer’s film were still artful creations of imperfect human animators, and not the cold digital products offered by industrial light and magic. As a result, Fantastic Voyage is a highly theatrical presentation of a human-created inner world: a final frontier, the dreamy stage sets and evocative props of which trump even the most realistic depictions of the body generated by modern medical media. The film’s aesthetic sense bears a charming naiveté, not unlike Georges Méliès’s beautiful images of the man in the moon made some 60 years earlier.

Fantastic Voyage had clearly imbibed a broad range of cultural influences: from Soviet-inspired espionage narratives, to the radical body manipulation found in Weird Science tales of the 1950s, to the military-industrial fetish for high-tech gadgetry featured in the early James Bond films. But by the mid-1960s, the increased blurring of realistic and symbolic representations of the body in medical and cultural media suggested that there was no longer any concrete division between these two worlds. In this sense, Fleischer’s wide-eyed optimism was neither naïve nor unfounded; Fantastic Voyage operated in an public environment where hyper-realistic medicalized images were used increasingly in everyday contexts, from cinema to television to the avant-garde. Artists in the late 1960s and early 1970s as diverse as Marina Abramovic, Chris Burden, and Carolee Schneeman staged performances that mirrored this rapid diffusion of cinematic/medical images, offering violent public acts on their own bodies that were both highly realistic (as well as graphic) as well as highly symbolic. Such performances ultimately inspired a generation of artists to make profound and disturbing statements about the subjective uses—and institutional abuses—committed against the physical body in often quasi-medicalized contexts. In the case of Annie Sprinkle, even low-tech medical equipment such as a vaginal speculum unveiled and collapsed altogether the artificial distinctions between medical practice and artistic practice.

Thirty years later, one would be hard pressed to find medical media that offer a vision of the body that is dramatically different from, or superior to, that rendered in Fantastic Voyage. The widespread use on the Internet of sophisticated imaging technologies—in tandem with super-fast computer servers, web browsers, and Real Player viewers—confirms what Fleischer already knew: in the future, medicine and entertainment will be one and the same. In contemporary medical media, what passes for “realism” no longer borrows from the cinematic but from the much-vaunted (but unpersuasive) realm of digital realism. The National Institutes of Health’s celebrated Visible Human Project—in which the bodies of two anonymous male and female donors (one a doomed prisoner) have been cut into thousands of thin horizontal slices which have been scanned and digitized for public access—provides a compelling view of the body’s interior. But such digital images, while physiologically accurate, have lost their artfulness in favor of digital realism, which gives us something that approximates the human but is, like jazz on a compact disc, not quite human at all. Computer-enhanced medical imaging technologies may appear to offer a precise method for capturing a Kodak moment in the interior life of the body. But even these “precise” images require sensitive technicians who are able to interpret, critique, and challenge every mysterious shadow or pixilated peculiarity that passes across the sterile surface of the camera eye. For all its technical advances, digital medical realism pales in comparison to Fleischer’s vision, an anthropomorphic world of luminous blood platelets and puffy lung tissue resembling the costume shop of a Busby Berkeley production.

One area where the cinematic has not entirely disappeared is in the fast-growing medical sub-genre of online surgery. Many surgical broadcasts on the Internet are not computer-enhanced digital products but are actual analogue videotapes that have been converted for convenience to a digital archive. Because of their modest origins, these films come closest to Fleischer’s vision of a realistic yet cinematically complex inner world. At adoctorinyourhouse.com, viewers can watch archival footage of the gastric bypass operation (originally broadcast live) performed on pop star and former talk show host Carnie Wilson. Wilson’s surgery, promoted as “The Solution” for chronic obesity, was captured for posterity in August 1999 with the help of a tiny, flexible laparoscopic video camera the aperture of which is no larger than the hollow of a drinking straw. When attached to a thin, microfiber cable, the laparoscopic camera enables the surgeon to push the spaghetti-like apparatus through tiny slits made in the skin surface in order both to see the body’s interior and to avoid traumatizing the body through full exploratory surgery. The premier web site devoted to this technology, laparoscop­y.com [link defunct—Eds.], bills itself as a professional arena for students and physicians who want to catch up on the latest advances. More often than not, however, the site traffics in a kind of competitive one-upmanship where one can witness spectacular feats of surgical derring-do. Like their prime-time equivalents RealTV or America’s Funniest Home Videos, the site invites surgeons to send examples of their work and provides detailed instructions on how to convert photographs or films into jpeg or RealPlayer files.

The most cinematically inventive of those laparoscopic operations broadcast on the internet are, surprisingly enough, proctologic in nature, if not in spirit. Perhaps this preponderance of films to watch a nuses by is largely due to the design of the camera itself, which travels well through the body’s more familiar entrances and exits. In laparoscopy.com’s video gallery, for example, viewers move at breakneck speed through the lower intestinal tract in a “3-D colonoscopy.” Whether due to technological constraints, or because they bow to the perceived objectivity of medical “realism” implicit in diagnostic technologies, such films on laparoscopy.com’s roster prefer “authentic,” unmediated action to smoke and mirrors. Yet the eight second, 3-D journey along the smooth, gray-brown lining of the colon walls is clearly modeled on Alice’s descent into the rabbit hole, and not unlike the trip through the secret portal to celebrity consciousness in Being John Malkovich. Such laparoscopic feats are less like Fleischer’s futuristic vision of life under the microscope, and are more like the early cinema, such as the films of Méliès and the Lumière Brothers, as well as other popular visual entertainments from the late nineteenth century. These predominantly silent spectacles were meant to stun the senses, amaze the eye, and transport the viewer to a different world.

Like early cinema, these laparoscopic broadcasts force the viewer to supply his or her own audio soundtrack, often only the sound of one’s own gasping. The RealPlayer movie of endoscopic rectal repair, for example, splices together internal images of the rectum with external shots of the anonymous patient whose exposed lower body is draped in green cotton sheets. In an instructional moment, the external camera records a male surgeon shoving a long, black camera tube through the patient’s colostomy opening (attractively described as a “mucus fistula”) as if he was putting a gasoline pump nozzle directly into his Jaguar’s fuel tank. Watching the penetrative power of the colonoscope reminded me, oddly enough, of neither early cinema nor the “medical gaze” but of the expansive physical exchanges that routinely occur in S/M videos. I thought immediately of Pat Califia’s description of her first experience in the 1970s “handballing” (i.e. fisting) a gay man of her acquaintance. “I got into him easily, I can’t remember how deep,” she recalls in an essay originally published in The Advocate in 1983. “It seemed like miles…. The walls of his gut hugged my hand and forearm, smoother and softer and more fragile than anything I’d ever experienced. I think I cried.”

Califia’s narrative, both for its tactile and emotional resonances, colored my reaction as I watched laparoscopy.com’s un-ironic 90-second film, Foreign Body in the Rectum, which must be seen to be believed. The laparoscopic camera focuses on the action of a tentacle-like hook device that the surgeon manipulates to grasp at a round, greenish-orange object stuck literally in mid-rectum. Like a silent Jacques Cousteau film that savors the aquatic struggle between a squid and a sea urchin, the film keeps the viewer at a remove from the action, though marveling constantly at the why and how of the protagonists. The last twenty seconds of the video are blurred and abstract, like a garbled message transmitted from the lunar surface, which transforms the scene into a wild, neo-psychedelic tumult like that experienced by the crew in Fantastic Voyage. The camera jostles violently as the hook device fights to capture the elusive object. Finally, we see how the hook seizes the obstruction and pulls it expertly from the dark rectal tunnel and into the cold light of day. Without any warning, the on-screen image shifts from the laparoscopic interior to an exterior shot of the hook withdrawing an enormous green and orange dildo from someone’s moderately hairy ass.

The video ends, perhaps as the patient’s doctor visit ended, with a heaving sigh of relief. But whatever explicit story of struggle and fortitude is told by that final exterior shot stands in bold contrast to the highly cinematic images provided by the laparoscopic camera. The close proximity of the tiny camera inside the living body denaturalizes the content of the image and instead creates something amorphous and beautiful, like a Milton Avery landscape. Unlike late nineteenth century cinematic spectacles of oncoming trains or late 20th century CAT scans of the brain, however, this ass-drama tempts us to bring contemporary questions about social practice and sexual identity to an otherwise abstract visual image. Whose ass is this, we wonder, and in what erotic reverie did he—and it is almost certainly a he—lodge the (huge) object of his affection so deep inside of himself? In this sense, Foreign Body in the Rectum eschews the “universal body” typically ascribed to the patient’s medical case history by online surgical broadcasts. The film’s final image demands implicitly that we make a judgment about the patient’s erotic desires that other laparoscopic images simply do not make on the viewer.

Clearly, until we can find a model of representing the body that is free of social context, the beautiful inner world imagined in Fleischer’s Fantastic Voyage will have to stay on hold indefinitely. But there never can be a body free of social context, despite the best intentions of online surgeons, medical imaging technicians, web designers, and universal humanists. Perhaps this is what was so fantastic about the voyage of the Proteus in the first place.