I was getting big, scratchin’ 300 pounds, so I thought I should probably lose some weight. I saw an ad for a new doctors’ office in town, so I thought, “What the hell?” I don’t much care for doctors, hadn’t been to one in years besides my cardiologist, but my insurance through work had just kicked in (first time I’d had good coverage in a while) so I figured it couldn’t hurt.
When I walk into the clinic the first thing I notice is the
smell. Smells good, clean, homey. My eyes adjust to the room, and the next
thing I notice is that every single person is holding one of them fancy
tablets. They’re all wearing headphones,
mumbling, making smudges on the flat surfaces with rubber tip pens. I walk up to the window to check in and the
nurse (the only person back there behind the glass) hands me one too, with a
bracelet that she asks me to slip on my left wrist.
I do, and she explains, “The bracelet will measure your
vital signs. Our practice is participating in a pilot program to test new
interactive medical software. The tablet is running an app that will guide you
through the medical history and personal information gathering process, but
should you need any help I’ll be more than happy to assist you!”
I grunt, sit down, and am surprised by how comfy the seat is.
Plenty of room, even for my fat ass. I
don’t know how to use these gadgets very well, and I worry about making a fool
of myself. I push my thumb in the box,
and the app starts up. It asks me if
I’ve got a smartphone, I click yeah. It tells me to bump my smartphone to the
tablet, so I do, and the icon floats from the tablet on to my phone. The pop-up says , “I have located most of the
information I need from your phone. May
I use it?” I click sure and it brings
up a form for my personal information, most of it already filled out including
my meds, pharmacy, allergies, as well as my name, address, where I work,
insurance information, even my picture!
It freaks me out. I guess I was
worried for the wrong reason. That was too easy! But at least I didn’t
have to type it all. So much for privacy.
After I finish with that page a questionnaire comes up. It asks me to use a gauge to measure how
strongly I agree or disagree with the following statements:
• I am healthy (Yeah
no)
• I want to be healthy (That’s
better)
Next is some legal mumbo jumbo. Usually I just click
“accept” but the tablet’s got eye motion trackers, won’t let me scroll unless I
read it. Goddamn lawyers.
At the end of that page it asks:
“Would you like to know the results of all the tests that will be run today, or only those that are
pertinent to your treatment plan?”
That’s easy. Less is
more. What are they gonna do with the rest of it? I wonder.
Now it asks me to fill in the blank:
“A doctor should______”
I cough a little. How
the hell should I know? Isn’t he the one
went to school for eight years? it tells me that’s an invalid answer. No shit. So I put “Listen.” Not sure where that came
from, but it sounds good. The app does
some fireworks, then the tablet goes transparent (just uses the camera I
suppose to show the room in front of me), and some arrows point towards the
direction of the far wall, where I see a big TV with my first name two spots
from the top, and the status bar says I should be in to see the Doc in about
fifteen minutes. Not too shabby for such a stripped down outfit.
The fifteen minutes seem like five, and the nurse calls me
back. She looks too young to have gone
to nursing school. She takes the gizmos and says “All your vital signs are
normal except your blood pressure, which is high.”
“How high?” I ask.
“170 over 100,” she
says. She shows me a curve, and I see a
line in the red danger zone which marks where mine is. She asks me how I’m feeling, and if my chest hurts.
I say, “I’m fine,” a little put off.
She leads me to the room and says she needs to take some
blood, and my heart starts to go bump.
All of a sudden I remember why I avoid doctors. I curse under my breath, roll up my sleeve
and she turns around with a fat pen, giggles, and says, “All I need is a naked
fingertip.” She takes my hand and says, “Just a little pinch.” I feel a shock
on my finger. Reminds me of how my
grandpa used to check his sugar. She turns away.
“That’s it?” I ask.
She turns back around, nods, says the Doc will be in shortly, and
bounces her cute lil’ rear out of there.
I look around the room.
The walls are covered in some kind of plastic that doesn’t reflect the
light very well. There are no jars of supplies
on the countertop, no flashlights with old telephone cords hanging on the wall
behind me, no flickering fluorescents above, no obvious sign that I’m in a Doc’s
office. I notice triangular solar panels in all the corners of the ceiling and
another big flat screen on the wall next to me, covered with the same plastic
film. I touch it. Reminds me of petting a sting ray at the aquarium as a kid,
rough one way, smooth (almost slippery) the other. The TV wakes up and starts flashing a
commercial for hand sanitizer, as if to say, “Get your grubby paws off!” On the
counter I notice a box the size of a lunch pail with a rotating holographic
display of a naked man, hands at his sides, palms forward. There’s a rhinestone
glove hanging on the wall next to it. Kinky.
Hope I don’t need a rectal!
The screen is flashing some ad for a local gym. “You callin’
me fat?” I say out loud. The ad is
quickly over and changes to one about life insurance. God, the nerve! A pop-up
says, “The Doctor will see you now.” So I straighten up. The door opens itself and in comes… Not the
guy from the commercial.
“Hello, my name is Dr. Patel,” says a very attractive, dark,
Asian woman wearing a white coat over a tight fitting pinstripe pantsuit.
“Um, I’m Hal.” I respond.
“Hello Hal!” She shakes my hand. Her hand is smooth, but she has a firm grip. She
takes the seat next to the table where I’m sitting and crosses her knees. Her
shoes are worn on the bottom, but still got plenty of rubber left. Made for walking. She’s looking at me.
Her eyes are framed by a thick, black coat of mascara to match her jet black
hair. She’s stunning. Not good for my
heart!
“I had a chance to read your responses from our
questionnaire. Thanks for filling that
out.”
I clear my throat. “Sure.”
“I just have a few more questions before we get started,
OK?”
“Yep.”
“What does ‘good health’ mean to you?”
I stroke my stubbled chin. Strange question. And she
doesn’t seem to be in any hurry, lets me sit there like an idiot for what seems
like forever.
“To… to live to see your grandkids?” I ask with some
hesitation.
“Hum, alright. ‘To live to see your grandkids.’ And what role would you like me to play?”
Again, I’m stumped. Is
this a game? What kind of place is this? I thought doctors were supposed to know what their job was.
“Just keep me alive!”
“I can do that,” she says with a smile. “So let’s get to it.
What brings you in today?”
I shrug, slap my gut. “Ain’t it obvious? I wanna lose some
weight.”
“Alright, you want to lose weight. Let’s write that
down. Computer!”
I reel back as she stands
up, her raised voice still ringin’ in my ears. The flat screen, which had gone the same color
as the wall when she walked in, wakes up in a flash of color and graphics. I
swallow hard. It takes me a second to get my heartbeat back to normal. “Please show me Hal’s medical record.” A face
appears, a balding older man with a grey goatee, thin white hair and glasses.
“Certainly, Doctor. And hello Hal!” the man says as he turns
to me and nods.
“Hal, this is Howard,” says the Shedoc. “Howard is my scribe.
He is an artificial intelligence, an AI, like Siri. He can understand almost any
question or command about your medical record, and I’ll be using his program
during our visit today. Is that alright?”
I nod, not taking my eyes off the AI. He seems to see me
too, and cracks a mischievous little smile. I look away.
“Howard, visit type is preventative health screening, and
chief complaint is ‘I want to lose some weight.’” The face fades, and I see my
words get typed into a large header at the top of the screen and from yards
behind it, in TV land, I see templates rushing up, filling the remaining space.
The doctor motions for me to join her in front of the screen, so I slide off
the table and take a step closer. She reaches out and brushes two templates aside,
they disappear off opposite edges of the screen. Using her pointer finger and
thumb on each hand, she expands two rectangles onto the screen. I realize she’s
not really touching it, just motioning. Then I remember the solar panels on the
ceiling. “They must be motion sensors,”
I think to myself.
“This box,” she points to one at the bottom, “will be our
clipboard, where we’ll keep information temporarily. This,” points to one on
the side “will be our problem list, where we will put your medical concerns
that need to be addressed.” She looks me in the eye as she says this, likes she’s
not at all impressed with this touch-no-touch big screen TV.
“Howard,” the face comes back, “Please populate the problem
list.” The AI turns his face to the other side of the screen, and I see four or
five items appear, words I don’t know with numbers after each one. I don’t dare
interrupt, but she must have read my mind. “These are codes we use in medicine
for billing purposes. This code is for your high blood pressure and this for
your obesity. The others are from past
illnesses and surgeries.”
“Mmhmm,” I mumble. When
she said “your obesity” I felt like somebody punched me in the gut. I never
thought of myself as obese before. My
grandpa, now he was obese! Old man couldn’t get himself off the couch for
the last five years of life. That’s not
me!
“Howard, please show me Hal’s timeline.” The templates and boxes fade, and in appears a
grid with a thick red line across the screen, dotted randomly by points that grow
tentacles with thought bubbles on the ends and fly off in all directions as
they rotate slowly around the red line like a rotisserie.
“There are some pretty large gaps here in your record, Hal,
from the time you were 12 to 18, and here again from age 21 to 30. What can you
tell me about your health during those times?”
I tell her I don’t remember nothin’ from when I was a kid,
except for a broken arm at 15, and that my family didn’t have insurance, and I
spent my twenties in and out of jail…
“In what state were you incarcerated?” interrupts the AI. His
voice squeaks then goes deep, grindy. Startles me.
“Here. Uh, this one.”
“I am searching for your records now.” A pause. “Yes, here
they are.” All of a sudden there are so many dots in my twenties that they run
together. My lifeline looks more like a rolling pin.
“You saw the doctor often in jail?” It wasn’t really a
question.
“Sure. Every week. All there was to do.”
“I understand. In between sentences were you ever
hospitalized or had surgery?” she asks.
I think for a minute. “Yeah, once in ’09. Car crash. ‘Bout broke my
goddamn neck.”
“I have located those records also!” sings the genie in the
TV.
She asks me more questions about my sauce and smokes, about
the meds I take, and digs out of me that this is the first time I’ve been to
see a regular doc in about 5 years.
“All this must seem very strange.” She gestures toward the
screen.
“It’s different.” Too different!
Things change too fast to keep up with nowadays.
“Thank you, Howard. Please update the problem list. We will
now proceed to the physical exam.” The screen returns to the boxes. More red
words and numbers. She smiles and motions with her arm for me to have a seat
back on the table. I sit, glance at the
clock, and realize I’m tired even though I was only standing for 5 minutes. It wasn’t that exciting.
“Are you alright?” she asks.
“I’m fine,” I say, catching my breath.
“Very well.” She goes on, “To begin, I’d like to ask some
general questions about your health in the last week.” She pauses, and I nod
for her to go on. She’s standing close to me now. My eyes are at the level of
her chest, and I realize I’m staring. It’s
hard not to.
“Have you had any fevers, sweats, or chills?”
“No.”
“Unexpected changes in weight?”
“I wish!”
She laughs, just once,
and then she chokes it back. I don’t mind. In fact I want to hear it again. She
puts her hands on my head, and chills run down my neck and chest. It has been so long since somebody touched
me. When I open my eyes, I see her pulling out what looks like a phone from
her coat pocket. She asks me to look directly ahead and a bright light pierces
into my right eye, then my left.
“Have you had any changes in vision?”
“Hum! Now you ask!” Another laugh. When the black dots fade
I see two pictures of red, spidery veins on the screen.
“What are those?”
“Your retinas, and they appear normal except for some new
vessel growth here around the disk, something we call neovascularization, which
is an early sign of diabetes.” I see the
words she just said show up under the images. The last word, diabetes, stands out. That’s what Gramps had. Diabetes.
Obesity. He died in his early sixties, a mess: pissing his pants in front of
the TV, smellin’ like a dumpster. Had a heart attack. Slumped over, like he slept.
The day was half over before we figured it out…
She keeps talking. All I’ve got to say is, “No.” She’s in my
ear now. A picture of my greasy ear drum appears on the TV.
“Can you hear this?” A rumbling sound.
“Yeah.”
“Tell me when you can no longer hear it.” The pitch goes up,
gets shrill like a dog whistle, then it’s gone.
“Now!”
“Alright.” She does
the other ear. She takes off the little plastic funnel, and says, “Please open
your mouth, stick out your tongue and say ‘Ahh.’” I do much more than that! But
this time, she only smiles. Charm is
wearin’ off. I glance over at the TV again and notice the words are still
churning out. It must be watching her and taking notes.
She asks me to unbutton my shirt. I bite my tongue, and do
as she says. She pulls out a small probe, like a lip balm tube, and says “I’m
going to place this on your chest to listen to your heart and lungs.” She
places it against my chest with her right hand, and stares at the phone in her
left. I hear whooshing—my heartbeat—I see
a dance of blue and red on the small screen. She twists the probe, like she’s
turning a car key, and then moves it around in all directions like she’s
tenderly stabbing me in the heart.
“Any chest pain? Palpitations? Shortness of breath?”
“No.” I lie.
She moves to the other side of my chest, haves me breathe in
and out through my mouth, all the while twisting and turning the probe this way
and that.
“No shortness of breath?”
“Nope.” Not why I came in. Next she holds it up to my neck, one side, the
next.
“Now I’d like to listen to your abdomen.” I start to lie
down, but she stops me. “That won’t be necessary.” She presses the tube into
the center of my gut. I suck in. “Try to relax” she says. She moves it up under
my ribs on either side. I can’t help but tense up. She eases off. Another round
of questions.
“No... No… No…”
“Ok. We’re done with this!” She puts the tube back in her
pocket. I exhale. She starts tapping on the phone and talking without looking
up. “Not long ago these ‘studies’ [she
air quotes] used to be ordered outpatient and would take days, even weeks, to get back to the physician, and
when they did eventually get back to us we didn’t know what to do about it most
of the time.”
“What changed?”
She smiles, puts her phone away, looks me in the eye and
says, “Let me show you.”
She walks over to the box with the naked man on top, puts on
the glove, and walks back. Here we go,
I think to myself and the bumping starts again. But she turns to the TV instead
of askin’ me to bend over. My buttcheeks relax, and I slump with a sigh.
The genie pipes up. “Virtual rendering is complete. Would
you like to view the model now?”
“Yes, thank you Howard.” A 3D image of a torso appears. Looks
familiar, but at least twice as fat as me.
“Please prepare echogenic visceral cross sections of these
regions for the transducer.” She draws a circle with the gloved hand over the
model of my upper belly and my heart. The layer of skin becomes transparent, a
thick layer of yellow fat, then the muscles and bones fade away and I see the
plumbing. I see the same thing floating in the air above the box! She walks
back over to it, reaches into the box with the gloved hand, and I see
fingertips appear inside the hologram fondling the tubes. Her fingertips!
“What the hell is that thing?!” It comes out like a cough.
“This is a force transducer that converts the ultrasound
image obtained during the exam into a model that I can feel using this special
glove. Pretty neat, huh?” I’m speechless. I get it, but I don’t at the same time.
“This method allows me to feel the density of your liver,
the thickness of your coronary arteries, and the amount of fat around your
pancreas without having to cut you open—better for both of us!” She’s not
showing off, she’s genuinely giddy. I can tell this is her favorite part of the
job. It’s almost cute, but then I remember that those are my guts, and seeing her fingers digging and pinching ‘em gives me
the heebie-jeebies.
She turns to me, holds out the glove and says, “Wanna try?”
I feel sick, an acid burp bubbles up and burns through my nose.
“No thanks.”
She shrugs. “Howard, please add the following diagnoses to
the problem list.” The box with the red words comes back. “AFLD, nodular
cirrhosis of the caudate lobe, chronic pancreatitis with fibrosis, metabolic
syndrome, and coronary atherosclerosis of the LAD.” The words tumble onto the
list, each with a number. It’s all Greek
to me.
“I’m sorry for the medical jargon. Basically what I found is
evidence of liver dysfunction, inflammation in your pancreas, and hardening of
the arteries that keep your heart alive. These are all consistent with your
history of alcohol use, a fatty diet, and a family history of diabetes and
heart disease.”
Holy Shit! Is she
talking about me?
“Howard, please
access Hal’s vitals and blood results and combine his Framingham score with the
Seattle heart failure model to compute a 10 year survival curve with a 90%
confidence interval.”
“Certainly Doctor… With no improvement in Hal’s health
status, the natural course of his disease will most likely end in death in the
next ten years; in other words, the probability that Hal will be alive in 10
years with no improvement in his health is approximately 45%. Most likely cause
of death is stroke, second most likely cause of death is heart attack.” She turns to me slowly, and asks, “Do you have any
questions?”
She doesn’t touch me, but I’m in pain. The words slice
through me. I feel numbness replace the ache.
I’m checkin’ out.
My mind is blank. My mouth hangs open. I see nothing.
What?
WHAT?!
I heard what he said. It shouldn’t surprise me. I saw the
whole thing, saw everything she did. It is me they’re talking about. My body!
Right?
The room comes back into focus. I look away from her, to the
box of red words, to the list. A death sentence written in a language I can’t
even read!
I shouldn’t have come.
“How are you feeling right now… emotionally?” Her voice is
quiet. Sounds far away.
“How do I feel?” You
just told me I’m gonna die! How do you think I feel?
I see Gramps, before he got sick—strong, laughing, leaning
over to give Grams a kiss. I remember the look on her face the day we buried
him, the same questioning look she had every day he was sick that seemed to
always ask “why.”
That’s not me. I don’t
wanna die! There’s got to be a way out. There’s always a way out!
“What can I do? What are my options?”
“You want to change?” She’s not smiling. Her look is
challenging, straight in the eyes.
It’s game time. “Yes.”
“What are you willing to do?”
“Anything!”
“Good.” Her lips part and she smiles, big and beautiful.
“Howard, please add another 10 minutes to my visit with Hal. He and I would
like to discuss a treatment plan to improve his chances of survival.”
“By what factor, Doctor?”
“How about we double it? Bring it up to 90%?” She’s asking
me. I jerk my head up and down. She
shouts, “Therapeutic target is 90%!”
“Input received… Accessing decision analysis program Delta
Rho… building individualized decision web for Hal… Rendering is complete!”
“Show me the web Howard.” She is standing stiff, moving
slowly. She puts the glove back on. She is in another world, in TV land. The
status bar at the bottom says COMPLETE and in comes a flashing point, lines
shooting out from it in all directions and branching, more points, more
branches! The image shrinks to make room on the screen for the new branches. One
line veers off to the right, becomes a deep red, then goes out of sight.
Another turns yellow, then goes straight up to the top. The perspective starts to change. I look over
at her and see that she is holding her gloved hand out in front of her like a
priest during a blessing, and she is slowly extending it straight out. As she moves, the view changes. A small flick
of her finger erases an entire branch, the red one.
We get close enough to one of the points to see that it is
labeled, “Immediate intervention: Compatible statin therapy+35% total
cholesterol reduction+ moderate exercise+ compatible diet= 65% 10 year
survival.” She reaches out and the node lights up a bright green.
“This is our approach, Hal, uh, I mean Howard.” She snaps
out of it, turns to me, “Sorry!”
“That’s alright,” I say.
“Well, as you can see these interventions will get you most
of the way there; however, we are still pretty far from our goal of 90%. This
is where you come in. I’m going to put your resolve to the test.”
“I’m listening.”
“Before we go any further, I need to know how committed you
are to making the changes listed here. Howard will build reminders into the
calendar on your phone, he will send you a shopping list every week for your
diet, and he can negotiate with your insurance company to pay for a gym
membership and even reduce your premium if you are following the plan and
losing weight. But, if you don’t, your rates will go up, and they will go up
twice as fast if you start to gain weight! Do we have a deal?”
“You drive a hard bargain!” Got me where it hurts.
“From one to ten, how committed are you to this course of
action?” she asks.
“Hum… I’d say an eight.”
“Why eight? Why not nine?” She’s puttin’ on the pressure.
“Well, I’ve tried to do this before, and it always starts
off well, but you know how it is… The road to hell…” I look down at my feet,
squeamish, embarrassed, but it’s the truth.
“Alright, why an eight instead of a seven?” she asks it in a
kinder way, almost like she’s impressed.
“Cause it’s what I want. That’s why I came in here.” For the
first time I feel like I can look her in the eye. I’ve laid it all out. I got
nothing left to lose. This is me.
“I know you can do it Hal, and I’m going to do all I can to
help you succeed.” She lays her hand on my shoulder. I feel emotions breaking
to the surface. It’s uncomfortable. I swallow, blink, wipe my nose with the
back of my sleeve. “But there’s something else I need you to do—you’ve got to
give up the tobacco, for good. Let me show you why.”
She turns again to the wall.
“Howard, what are Hal’s chances of survival if he stops smoking as of
today?”
“Including tobacco cessation to decision model… 10 year
survival with current parameters is approximately 90%!” She looks right at me.
She doesn’t say anything. She doesn’t have to. It’s my call.
“I’ll do it.”
“Good! And what about your wife?”
How did she know about
the Mrs.?!
“Er, what about her?”
“Will she support you in this? And by that I mean will she
help you with the diet, exercise program, and most importantly will she stop
smoking, too?” I hadn’t thought of that.
“I don’t know.” I honestly don’t.
“Let’s ask her, shall we? Howard! Please call Hal’s wife for
me, Jane, isn’t it?” She cocks an eyebrow. She’s
relentless!
“Connection is secure.”
The PA crackles, I hear my wife’s ring tone.
“Hello?”
“Mrs. Watson?”
“Yes?”
“Hello, this is Dr. Patel, your husband’s physician.”
“Oh God! Is he alright?”
“Yes, yes. We have just discussed his health and have agreed
on a comprehensive treatment plan to make sure you and he get to enjoy your
grandkids!” She smiles over at me.
“Oh. That’s… that’s great.”
“But Mrs. Watson, I would like to ask if you are willing to
work with Hal and I to make this happen. Can we count on you?”
“What do you mean? Of course I want to help! Why wouldn’t
I?”
“Hal is going to start eating better, exercising, and he is
going quit smoking. And to be successful, he needs our help with those
things—yours and mine. Are you willing to quit smoking as well?”
Silence
“I suppose. I mean… Yes. Of course.”
“Wonderful! I will email you the details, and please feel
free to write back or call with any questions. We are still accepting patients,
and I would be happy to be your physician as well, should you need one.”
“Oh, well, thank you!”
“Goodbye now!”
“Ok, goodbye!”
I laugh out loud! I can’t believe what just happened. Never
in my life have I seen somebody with balls that big! And on a woman to boot!
If I wasn’t a married
man…
“Well Hal, our time is coming to a close. Before I say
goodbye, I just want to quickly summarize our visit today.” She pauses for my
nod. “We put together a timeline of your life and medical history, identified
your major medical concerns, and seeing the real probability that you would not
be around for your grandkids we came up with a plan to improve your
chances—double them—which includes: 1, adding a medication to your
daily regimen to lower your cholesterol; 2, an individualized diet with
automated support; 3, an exercise program and financial incentive to lose
weight; and 4, immediate tobacco cessation. Are you with me?”
Wow! We did all that?
We did, didn't we?
“I’m with you, Doc.”
“Alright, I’d like to see you again in two weeks to follow
up on your progress. And in the meantime, I want you to know that I’m here for
you if you have questions or concerns. The app on your phone will help you
reach me and give you access to everything we discussed today regarding your
treatment plan.”
“Okay.”
“I’ll see you next time!” She shakes my hand. The door opens
itself, and out she goes.
I sit there for another minute, gather my things and step
out into the day. I had forgotten what a beautiful day it was! Or maybe, I just didn't notice it before. I reach for my smokes, then stop.
Wait! What did I just
agree to? What the hell just happened?
