Michael placed the coffee cup in the slot and pressed the button. Dark liquid spouted out from the nozzle and started turbulently filling the cup. He sighed a deep sigh and scrunched his eyes up tight. This was the 9th hour of his 12-hour shift. Gulping down the coffee, he walked slowly by the patient-Bot rooms that were his wards for the evening. First up was Amelia Jones – the elderly lady who SRGY-2245 had diagnosed in the ED and performed an emergent bedside appendectomy on. Next was Preston Felton – the man whose family had brought in saying he was confused who was now receiving ceftriaxone for a UTI from one of MEDDR-911’s ports while through another port cooed a calming lullaby that Michael could hear accompanying Mr. Felton’s soft snores. Then was Raj Sharma, the cardiogenic shock patient that CARDS-4777 had performed a bedside echo on, dropped a Swan-Ganz catheter into, and was now infusing milrinone and bumex into, precisely titrating the rates of both every 30 seconds.
Each of the patients had been diagnosed and treated in a matter of minutes. And now, Michael, who had been an internist for almost 33 years, played the role of a glorified babysitter, checking in on each patient a few times a shift to make sure that no other orders were needed. He was the only human on the Pavilion side of the hospital tonight – the Bots could perform dressing changes, infuse medications, and draw labs, all with the ease of his favorite nurse with whom he had worked with while in training – but with none of her cheer – Michael thought to himself. The Bots had indeed solved the nursing shortage that had long plagued the healthcare system.
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A new patient had popped up on the list – Iris Lisbon, age, 28. Michael crumpled his coffee cup, tossed it in the bin, and hurried down to the Pavilion Bay. The bay was whirring with activity as he walked into the room. MEDDR-911 swiveled around a hospital bed, with one metal arm placing EKG leads, another drawing blood samples and plating them methodically on slides that were being slid underneath a microscope, and a third performing a full body PET-CT. A panel in the room flashed a list of phrases “PMHX IRON DEFICIENCY ANEMIA; FEVERS X 3 DAYS, PAINFUL GUMS x 7 DAYS, FATIGUE X 60 DAYS, BRUISING X 60 DAYS.”
On the bed, lay an extremely pale, skinny-looking girl with her eyes squeezed shut in discomfort. Michael approached the girl and raised his hand, “Hi Ms. Lisbon, my name is Dr. Atifa. This is one of the medicine Bots, it’s working on figuring out what’s going on with you right now.”
Iris fluttered her eyes open and smiled, “Hello Dr. Atifa, sorry to be meeting you like this. Do you need to ask me any questions?”
Michael smiled too, “Looks like the Bot already has. I’m more here as a supervisor to MEDDR-911. Can I get you anything?”
Iris responded, “I just want to know what’s going on. I’ve been feeling so tired and dizzy for a while but today I couldn’t even get up out of bed so my roommate brought me in.”
Michael and Iris talked for a few minutes. She worked at an antique furniture store. She had gone to college and studied Art History and had been drawn to the mahogany cabinets with satinwood inlay of the Dutch Masters. One day she would own her own store, but for now she was in charge of the grunt work for the store. “They call me Wax on, Wax off,” she laughed.
All the while, Michael thought to himself – this is definitely something that’s been going on for a while. He bit the inside of his cheek. At that same moment, a beeping came from MEDDR-911 and it emitted a spool of paper.
“Excuse me, I’ll be right back,” Michael said to Iris and took the paper outside the bay.
The paper read, “DEFINITIVE DIAGNOSIS: AML C/B SYMPTOMATIC HYPERLEUKOCYTOSIS WBC 142 x 109/L. TREATMENT: HYDROXYUREA, URGENT LEUKAPHERESIS
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Michael sat on a plastic stool in the corner of Room 411. He glanced up at the hospital advertisement poster on the door of the room. “Efficiency. Precision. Compassionate Care.” it read with a collection of different Bots pictured below. As quick as MEDDR-911 had been to diagnose and initiate treatment, it had been no match for the leukocyte plugs of Iris’s microcirculation that persisted even after several days of treatments. Her friends had presumably been by earlier that day – there were vases filled with freshly-cut orchids and balloons bouncing up and down off the ceiling. But visiting hours had ended a long time ago and Michael was now the only other person in Room 411. The Bots had already shuffled around, after Iris’s prognosis became more obvious, MEDDR-911 had been swapped out for PALL-007, a Bot that was tasked with monitoring patients’ vitals and administering morphine. Giving-Tree-1800, the organ procurement Bot, had also been by earlier today.
PALL-007 swiveled into the room to perform another assessment of Iris. The Bot checked on her respiratory rate and injected something into her IV.
Michael felt Iris stirring. He was unable to come within 5 feet of her due to infection prevention regulations but he evaluated her figure – wan and skeletal with cooling blankets covering her every surface that purplish bruises did not already cover. He sat upright, his fatigue forgotten, at the 5-foot mark. Her breathing grew faster and faster. And then, in a matter of moments, she was gone. PALL-007 entered and began the necessary order of operations.
Michael stumbled out of the room and let out a guttural moan that echoed down the empty hallway. “Efficiency.” A pure sadness that had been lingering deep inside now reared its head. “Precision.” He felt a release as anger, anguish, Iris’s face, the faces of the other patients on the ward washed over the folds and corners of his brain and heart. “Compassionate Care.”
--Alisha P. Maity, MD, Internal Medicine, PGY-3, Lankenau Medical Center, Wynnewood, PA