The Future, or Something Very Similar
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“No, I don’t have a spleen, Jimmy. Hardly anybody from my generation does. Or a second kidney, a gall bladder or any other of those useless organs that nobody knows the purpose of. In fact, the Nurse Practitioner Assistant over at Bowel, Bile, and Beyond said that he probably only sees three or four gallbladders a year. He’s not even sure what the gallbladder is for although he thinks it’s part of the immune system or something. He’s the manager, you understand. They send them to a pretty intensive six-week course so he knows what he’s talking about. ”

“But anyway, most of us had all those things removed. Why? Well, let me backtrack a little. Now don’t roll your eye at me. It’s an interesting story and I know they don’t teach you much about these things in holoschool. Even in my day sensitivity training, sexual awareness, and learning our recycling catechisms took up most of the day so we didn’t learn too much history. Oh sure, we learned about Martin Luther King signing the Declaration of Independence and about how the United States lured the Japanese to their destruction at the Little Big Horn but, you know, learning to put condoms on bananas is serious business and important things like that took up a lot of our time.”
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“So you kids know that your old grandpa was a lawyer, right? I went to law school and everything, oh, must have been nearly forty years ago, right after the Burger Wars. Man, those were the days! Not much business for lawyers nowadays of course but things were booming back then. Most of it was in medical malpractice, suing doctors I mean. It’s hard to believe but at that time vast herds of doctors, the law profession’s natural prey, still roamed the country raising huge clouds of paperwork wherever they passed.”
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“They’re all gone now…the doctors I mean…you remember me telling you about doctors, right? Like I said, I know they don’t teach you much about them now in school but at one time doctors, or ‘Physicians’ as they were also called, were completely responsible for everybody’s medical treatment. That’s right Jimmy, back then there were no Cath-in-the Boxes or Tumor Marts. If you got sick you had to go see some pompous, over-educated doctor who asked you a lot of embarrassing questions and then threw a bunch of big words at you before trying to force you to do things you didn’t want to do. It was pretty insulting. I mean, seriously, if I have a history of rectal bleeding, what business was that of my doctor’s, especially if all I was seeing him for was some tummy pain? But that’s what you get when you give somebody from seven to twelve years of training…they get a little big-headed and think they know better. Arrogant bastards. Believe me, nobody shed any tears when the last one was hunted down. Give me a guy with a few weeks of superficial training any day of the week. At least we can talk on the same level and if he doesn’t know something, he can just shrug his shoulders and say, ‘I dunno’ Man,’ not call in even more doctors to ask even more embarrassing questions.”

“So I was a lawyer and business was good at first. I was doing all the usual things. I got my start as a court-appointed malpractice attorney and, after the fire department decided that we were tailgating the ambulances a little too closely for safety, even spent a few years riding shotgun with the paramedics (It’s a lot easier handing the patients and family your card if you’re the first one on the scene, let me tell you).”

The big money, however, was in the hospitals so after a few years of little stuff; you know, the usual ‘If-we-settle-for-a-couple-of-grand-will-your-patient-let-us-exam-him’ things, I started taking on big cases. You gotta’ understand that it was a no-lose situation for us. After the passage of the 58th amendment which emancipated citizens from personal responsibility, what had previously only been assumed became law and doctors had prima facie responsibility for all bad outcomes, non-compliance, and bad habits of their patients. Heart attack from smoking hover-crack? It was the doctor’s fault for not motivating you to quit. Contract a case of HyperAIDS? Hey, the doctor should have warned you about contaminated gerbils and got you into to a clean gerbil exchange program. Eat too many Big Macs…well yeah, I know they’re illegal now but this was before the war and everybody was eating them (before we knew what those sinister clown-faced Mickies were putting in them)…blame the doctor for your high cholesterol. And win in court…big time. The money just kept rolling in, that is, until the doctors got smart and started fighting back.”

“I mean, nobody said they weren’t intelligent. I know your cousin Billy who runs the Colectomatron down at Spleens n’ Things isn’t the shiniest nickel in the kitty but things were different back then. A GED might be all you need for an exciting career in the medical profession today but back then medical professionals were in the top percentile for intelligence in the country. Now, don’t laugh Ricky, it’s true. Billy might not be able to think his way out of paper bag but at one time medical schools only took the cream of the crop, kind of like the interior design schools do today.”

“Apparently a bunch of doctors got together and decided that, since they were taking a beating on missed diagnosis (that’s where the super-genius doctors fail to spot a diagnosis even though, as it has a one in a million chance of occurring, it is fairly common) the only solution was to start working-up and treating everybody for everything all the time. The logistics of this seemed daunting but as a lot of pioneering work had already been done by a group of doctors in a specialty that they used to call ‘Emergency Medicine’ (yes, Jimmy, kind of like Quickie Med but actually a lot slower), the solution presented itself fairly quickly. To start, the doctors installed big CT scanners at all of the entrances to the hospital, usually hidden behind fake plants or Joint Commission decrees, and scanned everybody who came in the door. They were still missing a lot of things so, initially with modified airport baggage handling equipment, every patient who came to the hospital was sedated, placed on a conveyor belt and routed to the appropriate diagnosis and treatment area depending on the chief complaint. At first there was some differentiation. If you had a cold, for example, all you got was a chest xray and intravenous antibiotics before being deposited at the exit three days later. Eventually, however, as liability increased the lines merged and everybody got the works.”

“It was probably horrifically expensive but nobody could say the doctors weren’t being thorough and they didn’t miss too much. I went in one day with a sprained ankle and, after being sedated and passed through the intubation and foley station, I was routed to the Prophylactic Surgery Unit where I had my spleen and all of those other potentially dangerous organs removed before being placed in a full-body cast at the orthopedic pre-processing section. They had immigrant surgeons from Canada and other Third-World countries working on this part of the line and each one did one little part of the procedures as the patient moved by him. After the PSU and the OPS the belt wound around the Antibiotic Holding Area for a fourteen day intravenous course of one of every major class of antibiotics. The doctors eventually added a chemotherapy station ‘just in case’ and everybody got fourteen days of chemotherapy concurrently as well as a (barely) sub-lethal dose of radiation therapy. Upon completion of my infectious disease and cancer prophylaxis I was moved to the imaging section where in rapid succession I was passed through a CT, an MRI, and a PET scanner to make sure nothing had been missed. Finally, I had all my coronary arteries stented and after a quick pass through the lab station for the 3000 or so required tests was topped off with fluids, had my electrolytes replenished, was given a haircut, a shave, a coupon for a day at the spa, weaned from sedation, extubated, and dropped off at my apartment kind of dazed but absolutely as disease free as possible.”

“Eventually they added comprehensive major joint replacement and that was it for the legal profession…or so it seemed. I mean, they checked for everything and did everything you could possible imagine, effectively throwing a brick wall in the path of almost every once-lucrative case. Oh, we tried of course but all the defense had to show was that, while it was regrettable that yer’ stinkin’ granny died, the doctors did everything they could…which was true. No way to argue otherwise. Eventually we tried to get them on the paperwork, you know on the the basis that if it wasn’t documented it didn’t happen, but that’s where those clever bastards really ate our lunch.”

“You see, by that time every doctor was using electronic medical records and their documentation was air-tight. At every processing station of the hospital conveyor the operator pressed a few keys and produced wonderfully complete documentation. I have sneaking suspicion that it was mostly boilerplate but there was no way to tell as the patients were sedated for their whole stay and couldn’t tell you either way what the doctors had done. Sure, the Review of Systems was usually, “Unable to Obtain, Patient Intubated and Sedated” but those mercenary defense attorneys made it sound as if every patient was heroically saved by a dedicated team of doctors even if it was actually mostly cheap Canadian migrant workers doing most of the work.”

“Times were lean, let me tell you. Nobody in the legal profession could find any work. When you get right down to it a lawyer is not really qualified to do much of anything. Eventually roving bands of unemployed lawyers roamed the countryside, terrorizing small towns with nuisance lawsuits against little league teams or shoddy Girl Scout cookies but none of this paid very well and things were starting to look mighty grim, so grim that most of us were thinking of turning to prostitution or other respectable work, that is until an unemployed lawyer named John Sutter made an amazing discovery.”
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“Like most lawyers at that time, Sutter had turned to day labor to keep his BMW from being repossessed and his kids fed. He had been hired to do some demolition on an old, abandoned hospital in Rochester, Minnesota when, on January 24th, 2049, his hammer broke through a basement wall and there, before his eyes, lay acres upon acres of abandoned patient records. Paper charts, I mean, not electronic. Manilla Gold. The good stuff. Thinking quickly, he realized that every single chart represented a patient who was either dead, old, or sick and that, as they predated the assembly line hospital, not only had everything not been done for them but their charts were cornucopias of shoddy documentation, errors of omission, and poorly explained medical decision making. He dug around for a few days before hitting a rich vein of legal gold, the Motherload, in the Oncology section. All he had to do was pull a chart at random, find out if the patient had died, and then sue the doctor for missing something…anything…it didn’t really matter. It didn’t even matter if the doctor was still alive because he could always sue the widow and children out of the doctor’s estate.”

“Of course Sutter tried to keep news of his find secret but soon his fellow attorneys noticed his new suits and fancy dinners at expensive restaurants and it didn’t take long for the news to leak out. Word of the find spread quickly and the great lawsuit rush of 2049 was on! All over the country unemployed lawyers flooded into places like Boston and San Francisco feverishly racing to stake a claim in musty medical records departments and turning what had once been sleepy, decrepit backwaters into overnight boomtowns. The population of Philadelphia, for example, tripled in three months as twenty-thousand lawyers descended like starved locusts.”

“There was tort in them thar’ hills! Pandemonium! Litigation fever swept the nation and all over the country, clerks and bakers abandoned their professions, spent their life savings for mail-order law degrees, and headed to the great litigation fields. Maybe you have seen the holo-pictures of them, standing stiffly by their claims, briefcases held grimly in their hands, ties loosened, and cellphones pressed firmly to one ear. Most of them didn’t strike it rich of course, because although the charts were free for the taking, most lacked the resources to try cases. They usually sold good charts to the big law firms for pennies on the potential dollar who brought them to trial and made the big money. Some of the ‘Forty-niners worked on commission but you had to have a claim to a rich vein of legal ore, say the records of a plastic surgeon, to make it work. Mostly, the ‘Forty-niners returned to their homes after the medical records were played-out, older and wiser but flat busted. If you really wanted to make money the thing to do was to open up an office supply store or trendy coffee shop for the prospectors. Can you believe that some places were charging up to five dollars for a cup of coffee! Insanity!”

“You should have seen it. Creaky little towns like Baltimore took on a wild-west appearance overnight with gambling, illegal Asian fusion restaurants, and latte grandes flowing like water. Every vice known to man could be found except prostitution of course. Apparently the hookers had a little too much self-respect to be associated with lawyers. The fever only lasted a few years. Like I said, even at that time doctors had been hunted almost to extinction and what once seemed like a vast and endless supply of money slowly petered out. The bottom dropped out of the litigation market in the summer of 2052 and that was that. The rush was over leaving nothing but empty designer water bottles strewn over the now-empty streets of medical ghost towns.”

“So that’s kind of why we don’t have spleens. Can’t say that I miss it.”