Category Archives: The Future of Medicine

The Great Lawsuit Rush of 2049

The Future, or Something Very Similar

“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.”
“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.”
“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.”
“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.”

The Future, or Something Remarkably Like It

Grandpa Reminisces

“Why yes, Jimmy, that is a picture of your old grandpa. That’s your grandma next to me and your Uncle Mark on the right. I’m the one in the white coat…third from the left. That picture was taken at my law school graduation, man, I guess it must have been forty years ago. Maybe five years after the end of the Burger Wars so it had to have been May of 2062. Not that the war ever really ended. Most of the McDonald’s forces retreated to Canada and then the ones that weren’t incinerated in the fire raids on Winnipeg just sorted of melted into the tundra where they continued to raid across the border for another ten years or so. It was pretty hairy going to a Taco Bell up there, let me tell you.”

“In fact, the last Mickie hold-out only just surrendered a few years back. Maybe you remember seeing him on the holo-news in his scruffy beard and tattered clown uniform? Apparently he never got the word that the war was over. There was a big reconcilliation ceremony for him up in Yellow Knife. It was pretty touching. They dug up some old fry-cook who had fought against him in his sector and they both sat down and ate a Whopper.

“Then they found out that he was actually ‘Commandant Ronald,’ the commander of the Indianapolis concentration camps and he was hanged for war crimes. Life’s kind of funny that way.”

“So anyhow, yeah, I was a lawyer. I had the diploma and white coat to prove it. Lawyers used to wear white coats, you understand, although most of them don’t today. We originally got the idea from the doctors…oh, wait a minute…I’ve told you about doctors, right? Not too many people know about them now. About the only doctor you probably could have seen was the one they had stuffed and mounted over at the Museum of the 20th Century. Unfortunately they took down that display five or six years ago after parents complained it was scaring their children.

“It’s hard to believe that vast herds of doctors once roamed the country. No, it’s true. They were everywhere. Almost every town had at least a couple sticking their noses into other people’s business or lording it over the rest of us with their high-falutin’, fancy-schmancy educations and their huge, multisyllablic words that they used to confuse us. But they’re all gone now. They were our natural prey after all, and I guess we sort of hunted them to extinction…which was a shame because once they were gone lawyers turned on each other and it became something of a feeding frenzy. Seems like everybody and his brother was suing his lawyer. It wasn’t fair. I had to quit the legal profession because I couldn’t afford my malpractice insurance. Here we were trying to help people collect the damages they deserved and then some slick mercenary lawyer sues us because we made a few mistakes in an otherwise air-tight case. As if I really can know every single precedent in the history of American Jurisprudence.”

“Hell, I can’t even keep track of all the ammendments to the Constitution. I kind of lost count after the the 56th Ammendment (the Right to Keep or Hold the Pickles which as you probably learned in school was one of the causes of the Burger Wars) so I think it was a little unfair to expect lawyers to never make a mistake. Nobody’s perfect. And our clients weren’t exactly helping us either. You can tell them a hundred times what to say and how to say it but put them in front of a jury and they start running their mouths indiscriminantly. I just don’t see how I should have been held responsible for my clients if they were non-compliant.”

“So anyways, I was a lawyer. I decided against Primary Law because even then it didn’t pay that much. There’s not too much money in mortages, deeds, and other low-level stuff; things that could be handled by a notary or other mid-level legal provider. I did a residency in Emergency Law and for a while did pretty well at it. The Emergency Legal Departments were booming back then especially after the government mandated legal representation at all doctor-patient encouters. Man! Those were the glory days! We knew it couldn’t last because as more and more doctors were driven out of business we eventually had to start suing actors and there just wasn’t any money in that.”

“You heard me right. We tried to sue actors. Not just any actors you understand but only the ones that were hired by the hospitals to improve their customer satisfaction scores (an unfortunate and unintended consequence of the 53rd Ammendment). It seems that hospital administrators…yes, Jimmy, a hospital was a big warehouse for sick people…realized that people were happier being treated by a doctor who looked and acted like a doctor. You know, all smarmy and paternalistic like in those movies that I know you kids have hidden in your rooms. A real doctor, although perfectly competent, represented a significant risk of having his unpolished personality interfere with the business of the hospital which even back then had become making the patient happy. But then that was the problem with doctors to begin with. They were always assigning blame and relaying bad news.”

“It was always, ‘You’re too fat’, or, ‘You need to stop smoking,’ or ‘You’ve got cancer.’ People just don’t like that kind of negativity. They want postitive thinking. An upbeat prognosis. A physician that will be a team player and work with them, not against them, to make them feel good about themselves.”

“By that time the medical schools (sort of like our medical community colleges except they were four years long instead of twelve weeks like they are today) had come to rely on standardized patients to train doctors. Somebody, I think it was at Hopkins, had a Eureka moment and realized that what patients really wanted were standardized doctors, not real ones. Oh sure, they had some real doctors in the hospital at first but they kept them in the back rooms where they gave suggestions to the actors by radio. Clinics, however, were entirely staffed by actors by the mid-2000s and except for surgeons who lingered on for a few more years, by 2060 there was probably not a practicing doctor West of the Mississippi.”

“I mean, people started dropping like flies but the patient satisfaction scores were incredible. There is just something about a distinguished looking actor playing the role of a grave, caring healer that puts people in a good mood…even if their relative did just die a horrible and entirely preventable death. He cares, man, and that’s all that’s important. The good actors even used big medical words which added to the effect. The so-so actors used to make up words but nobody knew the difference so it was fine.”

“Eventually the drama programs at most universities exploded in popularity and it was the fondest hope of many a mother that their son or daughter would become an actor playing a doctor.”

Kingdom Come

I could count the openings in the radiator grill of the truck that killed me and as I lost conciousness I noted with satisfaction that it was a good old-fashioned International Harvester of a kind that I had seen thousands of times but never from that close.

And then the cool darkness closed around me and I slept.

After what seemed like years I was awakened by a faint white light in the distance. I saw someone beckoning to me from the light which became brighter as it drew closer and I was afraid. Afraid to leave the comfortable darkness. Afraid of the long swim to the light which now burned with a cold incandescent fire.

“Come into the light,” said the voice and as I rose towards it I recognized the speaker.

“Uncle Jedidiah?” I said, “Is that you?”

“None other,” said the voice as he extended his hand to pull me firmly out of the darkness.

“I haven’t seen you in forty years,” I said in wonder, “Since you died, I mean. Aren’t you dead?.”

“Oh, I’m dead, as dead as a doornail. I’m sorry to be the one to break it to you but so are you.”

“I figured as much,” I said, “Where am I? Is this heaven?”

“Not quite,” Replied Uncle Jedidiah, “You’re in the Purgatory Room.”

“Purgatory Department!” corrected a winged creature carrying a flaming sword, “It’s a department, not a room.”

“Uh, right…anyway, you’re in the Purgatory Department waiting to be admitted to Heaven,” said Uncle jedidiah, “And I’m afraid it’s going to be a while.”

“You mean you’ve been waiting for forty years? What gives, Uncle? I remember you were a pretty good Catholic, went to mass every week, said your prayers. Even the priest thought you were a pretty righteous guy. If anybody could get to heaven quickly surely it would be you.”

“Oh, I did all right when I was alive,” said Uncle Jedidiah looking down modestly and pretending to examine his fingernails, “I ate a little meat on Friday and cursed a little. I wasn’t perfect you know.”

“Yeah, but surely a couple of Hail Marys and a few Our Fathers could have covered it,” I was incredulous, “Fifty years? Come on now. What chance do I have?”

“Well, it’s not exactly merit-based anymore now that they’ve gone to a Single Penance system so your chances are as good as anybody else’s.”

“Single Penance? What’s that?” I asked.

“It’s new. Instead of being responsible for your own sins, somebody repents for you so you don’t have to do it yourself. It’s supposed to ensure equal access to Heaven for the under-repentant,” Said Uncle Jedidiah.

“So that explains the wait.”

“At first it wasn’t too bad,” said Uncle Jedidiah leading me around a group of bikers eating vending machine locusts and honey, “They started with the Protestants which was all right, I guess. I mean I could see the rationale for that. But then they decided to start letting in the Hindus and the Moslems. I don’t have to tell you the penance problems that posed.”

Uncle Jedidiah motioned me to a place at the end of a line which stretched for miles.

“Pretty much anybody can get in now,” He continued,”You really have to have committed some kind of major crime against humanity not to…which explains why the Back Street Boys might not make it. But pretty much no matter what you do somebody else will do your penance. About the only people they don’t let in are the Methodists, for obvious reasons, but other than that it really makes no difference what you have done.”

“Can’t we just repent ourselves and eliminate the wait?” I asked taking a number from a brazen tripod which gleamed with a holy luster.

“Well, of course not,” said Uncle Jedidiah looking puzzled, “That wouldn’t be fair, now would it? That would give people who were responsible and self-disciplined an unfair advantage compared to, oh, let’s say pedophiles. Surely we can’t have that.”

“I don’t know Uncle, it sounds good but who’s doing all of the repenting if nobody is expected to do it for themselves?”

“Well, there’s the rub,” said Uncle Jedidiah ruefully,”There is apparently a distinct shortage of pentinents. At first they had the Archangels do it but there are only so many to go around. Then they started using Saints but even they have their limits and I know I don’t have to tell you how long it takes to make one. Eventually they started using mid-levels like Saint Assistants and Saint Practioners.”

“How’s that working?” I asked looking far into the distance at the line ahead of me which wound around pillars of clouds upon which, written in blazing letters of English and Spanish, were admonishments keep all manna in closed containers and to rate your sin on a ten-point scale.

“Here comes one now,” said Uncle Jedidiah, motioning to an officious looking fellow making his way towards us, “Ask him yourself.”

“Hi, I’m your pentinent-providor,” said the fellow, “I’m not actually a saint but I am just as well trained despite the fact that unlike saints who toil and suffer on earth for many years, often enduring martyrdom for their faith, I went to a rigourous two year program which cut out all of the useless stuff.”

A Seraphim, six-winged, rolled his many eyes and shook his head sadly as he flapped by.

My providor shot him a dirty look and just as he opened a book which looked suspiciously like a gold-plated DSM-IV, I felt a slight tingling in my chest like a distant electric shock. Then another which felt stronger. The Purgatory Department started to fade.

“Oh well,” said Uncle Jedidiah, “I guess i’ll be seeing you later. Just some advice. twenty years from now don’t ignore that rectal bleeding. I’m just saying…”

And then I gasped. The pain flooded over me and I was back.

Harvard Medical School, The Not Too Distant Future

Commander of the Devout

Like all good medical students, I await the arrival of the Mother Ship as promised and foretold by the Prophets in whose names we have dedicated our lives. But I have begun to doubt. The world goes on beyond the walls of our medical school. I catch brief glimpses of it over the razor wire that our robed masters say is to protect us from The Deceiver. Sometimes it’s an automobile of an unfamiliar type. Occasionally it’s just a snatch of sound, a few notes from what I once remembered as an ice cream truck although the taste of ice cream eludes me. It is haram, or forbidden, to the disciples and I have not tasted it since my parents handed me to the Guardian at the gates of the adminstration building whose threshold I have not crossed for these many long years.

I was not destined for medical training. Some even doubted my dedication during the selection process. My grades and test scores were good, of course, as are everyone’s who is chosen to follow The Way. And it goes without saying that I had a medical degree from a third world country. Everybody does. It’s considered the bare minimum to prove your dedication to the Prophets. But I never really demonstrated my desire to be a physician, at least not where it counts. I amost cured small pox. I almost implemented a Single Payer System (Peace Be Upon Its Holiness) during one whirlwind summer in Tajikistan. I almost did this and I almost did that, never gaining a foothold, something that could convincingly show my dedication to medicine.

Even my admission novel wasn’t as long or as original as it should have been. I only worked on it for five years and the final product, while servicable and the recipient of several literary prizes was not considered Nobel material.

So I sometimes catch the disapproving glances of my fellow medical students. They whisper that I had some help gaining admission. Perhaps a relative on the admission comittee, maybe a few well placed donations to the High Professors.

“Empathy and Caring” Intones my novice, a first year, breaking me from my reveries.

“For the Underserved, now and forever,” I reply automatically, the words of the ritualistic greeting coming easily to my lips though I no longer believe them.

Even during my first encounter with one of the Holy Underserved, though carefully supervised, the brief glimpse I had of her through the Hippa curtain did not inspire the pure thinking in which I had been instructed. She was incredibly fat and reeked of cigarette smoke. Neither had she bathed in a very long time and she smelled like a piece of rancid cheese. I knew on an intellectual level that this wasn’t her fault. After all, are not the secrets of soap kept from the Underserved? And yet I resented her and fought with all of my training to keep from betraying my revulsion to the Guardians.
My novice looked at me suspiciously. Have I betrayed something on my face? Have I allowed my carefully cutivated external serenity to slip?

“The Commander of the Devout wishes to see you, oh my Fourth Year Brother,” says my novice softly, barely concealing his anger to have been assigned a Fourth Year who is fallen from the favor of The Prophets.

“So it shall be done.” I dismiss my novice who scurries away to his empathy prayers and begin the long climb to the chambers of the Dean of Students.

The Commander of the Devout turns from the window and motions for me to sit down.

“I have had complaints,” he says quietly, looking at a thick file laying open on his desk, “Some even question your faith.” The Commander is known for coming quickly to the point. During rounds he once cut short a resident who had only been discussing a patient’s potassium for thirty minutes.

“I serve the Holy Underserved in the wilderness of health care access,” I blurt out, hoping to buy time to collect my thoughts.

The Commander waves his hand inpatiently. “Let us dispense with the scriptures. You obviously don’t believe them, or at least that’s the impression I get from reading your weekly evaluations. Did you not roll your eyes on several occasions during your primary care appreciation meetings? Have you not said to several of your fellow students that you had considering radiology? Don’t deny it. I can produce witnesses if required.”

“I try to think pure thoughts, Emminence, but of late my mind wanders and I wonder what it would be like to have some time to myself, to think of other things besides medicine.”

“Time for yourself? You blaspheme here in my presence? Is it not written that our fathers fled into the wilderness to escape the uncleanliness of the eighty-hour work week?” demands the Commander, making the the warding sign, “Did not the infidels match into dermatology and consort with opthalmologists jeapordizing their very souls and keeping the Pure from the Rendevous With the Primary Care Mothership in the End Times?”

I have never seen the commander so angry.

“Do not fall for the traps of the Deceiver and his Arch-Devil, the Dark Lord of PM&R whose task it is to lead the Faithful astray and deny the Holy Underserved free access to health care and their just absolution from all earthly responsibilities.”

“I have in my hand the results of the match and I could not help but notice you have matched into Emergency Medicine,” the commander spits out the words as if they taste bad, “But I say unto you that even at this late hour it is not too late to withdraw and fall into the welcoming bosom of Family Medicine, the One True Specialty. To sojourn among the unclean, and certainly their are none as unclean as the Emergency Physicians who as they know not empathy and make cruel jests must surely sit at the right hand of the Deceiver as chief among the damned, to sojourn among them is to fall away from grace precipitously and permanentely.”

I shift nervously in my chair. I have been discovered. My involvement in several primary care interest groups and the oaths I have sworn have been in vain. Have I been so transparent? I say nothing.

“Go then,” intones the Commander of the Faithful, “But know now that you are shunned and for any to speak to you is haram.”

Graduation can not come soon enough.

The Future, Or What’s Left of It

Grandpa Remembers

“Man, that was a good dog…grandmother, pass me another piece of the collie. Kids, take it from your old grandpa, store-bought dog is usually pretty good but even General Kang’s Digit Lickin’ Good Seoul Fried Canine can’t compare to your grandmother’s fried collie. It’s just what the doctor ordered.”

“Aw hell, I’m afraid I’m showing my age. I forgot that most of you kids have never even heard of doctors. I know they hardly mention them in the history holograms and the last one must have been hunted down, oh, maybe forty years ago. Just a few miles from here, by the way. The authorities got word that someone was operating an illegal clinic..yes Jimmy, a clinic is kind of like the Spleens n’ Things in the mall except you don’t have to answer a bunch of silly questions before the kid behind the counter hooks up the splenectomatron…and they only had to follow the few old people in town who looked healthy and that was that.”

“He tried to run but his white coat gave him away. Yeah, they used to wear white coats, just like lawyers do today which is where they got the idea. It’s a good trivial pursuit question. They had some half-breed Physician Assistant trackers so he only managed to make it to the next county. You don’t actually see too many Physician Asistants around anymore either even though it’s not illegal to be a Physician Assistant…no really….there’s no law against it but most of them feel safer on their reservations.”

“They had a trial of course, but he wasn’t exactly a model citizen and at that time lot of people still remembered how those doctors with their fancy medical education and their big fancy doctor words used to rub it in our faces that they knew more about our health than we did. The jury delivered a guilty verdict pretty quickly after he was hanged.”

“How do I know so much about doctors? I’m not proud of it but I once went to the doctor. Don’t act shocked. Everybody was doing it back then. It was a weird time and we were all into some pretty crazy shit. It’s who you went to see when you were sick, for crying out loud. I swear I didn’t respire.”

“Must have been…oh….almost sixty year ago. Your Grandmother and I had just come back from our honeymoon in Paris. Man, I’m showing my age again. Of course it’s not called ‘Paris’ anymore but ‘Al Pareez,’ and I know it’s pretty drab now that the mullahs have taken over but back then, must have been the Spring of 2053, it was still known for its nightlife and vivacious culture. Kind of like Des Moines is today.”

“So anyways we got home and I started to get really bad belly pains. I felt hot, too, and was vomitting all over the place. Your grandmother, who had taken a few electives at the medical community college….”

“Oh, wait, I guess you’ve never heard of those either. Well, fer’ cryin’ out loud, where do you think we got our new doctors after the medical schools were abolished? Rather then wasting four years of your life in school and then up to seven extra years on top of that which is that it took to train somebody to be able to lord it over the rest of us with their oh-so-superior knowledge of physiology and their smug little secret language that nobody else could possibly understand, all you had to do was take a couple of night courses in the area of the body you were interested in. In fact, the “vagina” classes were pretty crowded before people decided that it really wasn’t that exciting…just by itself and not connected to anything…the vagina I mean. Not that I’m straight or anything like that…although there’s nothing wrong with being straight.”

“So your grandmother, who had finished about a month of the three-month Intestine course before she decided to give it up for a more promising career in retail sales, figured it was food poisoning and told me to go to the Emergency Room…no, Billy… wasn’t really a ‘room’ at all. It was usually in the basement of those big hotel-like things they used to keep sick people in. There’s the ruins of one outside of town. You know, next to the big crater where the McDonalds used to be before we finally drove those smiling clown bastards into Canada for good. They called ’em ‘hospitals’ if you must know.”

“Anyways, just take my word for it, that’s just where you went if you got sick all of sudden. To see a doctor, you understand. Your Uncle Mark drove me there. Even back then it was in a pretty rundown part of town. There was the usual group of seedy cardiologists hanging around a scrap-wood fire right outside the entrance. I threw them a couple of bucks even though your Uncle Mark told me that they’d just spend it on old copies of JAMA. He was right, of course, but who am I to judge? It’s not like they were Nephrologists. Now those guys were sad. They used to try to bum syringes so they could check each other’s blood chemistry.”

“After selecting our court-appointed malpractice attorney, we went inside and ‘presented’…that’s genuine doctor talk kids and I’d better not hear you saying it in public… we presented ourselves to the young lady sitting at the counter. Waiting for medical service was technically against the law but it was unavoidable, seeing as our attorny had to inspect all of the hospital’s certifications. Sometimes they tried for a settlement right away and it was not uncommon to walk out of there with a couple of thousand bucks. So while the our lawyer started putting the heat on, your Uncle Mark and I went to the craps tables to kill some time.”

“I was pretty sick so after a few minutes our lawyer motioned to us that the hospital didn’t think he had a case and motioned us to follow him into the Emergency Room. We passed several nurses who held out strange implements and devices but our lawyer was having none of it. We were going to deal with the doctor and nobody else. ‘No sense frying minnows,’ our lawyer explained.”

“We found the doctor in the back and after reading him his rights, our lawyer motioned to us that the consultation could begin. Against my attorny’s advice I waived my HIPAA rights so the doctor didn’t have to wear a blindfold and examine me in a darkened room through a one-way mirror. Hey, usually I’m as ready as the next guy to defend my rights but Panamerican Idol was on the holoscreen that night and I wanted to get home in time to see it. Without saying a word, and as was customary, the doctor heaved his documentation onto the table for our inspection. I saw that his JCAHO ass-wiping proficiency certificate was up to date and that he was in full compliance with all federal diversity requirements including having his prescriptions translated into Klingon. It really was a lot of documents and I wasn’t feeling well so I made a motion that I was willing to accept the documentation as presented and my attorney reluctantly agreed.”

“My attorney was magnificent. He consulted with me at length before letting me answer any questions and I plead the fifth quite a few times on his advice, especially when it came to my past medical and travel history which he felt was irrelevant. Clearly, as my lawyer stated, the doctor was badgering the patient. But you know, the funny thing was that although we had that poor over-educated bastard on the run, I never got the sense that the doctor disliked me. His contempt for my lawyer was clear even though he tried to hide it but I got the strangest sensation that not only did he know exactly what was making me sick but somewhere, deep down, he wanted to help me. I saw he was older than most doctors and I guess he was ‘old-school’ because there were no beer logos on his white coat of the kind that most doctors had to display to make any money.”

“I told him I needed some antibiotics. He told me I had appendiwhatsities or something like that. And then the magic was gone and I saw that he was just another arrogant relic of the bad old days before they caught on that the customer was always right. We got a court order from a the vending machine back in the waiting room and I made the doctor write my prescription for antibiotics in Klingon just to show him who was in charge.”

“I threw it away, of course. Panabx is my brand of antibiotics and try as I might, even the court order couldn’t get him to prescribe it. Some nonsense about allergies and whatnot. Like, hello, they’re medications. How can anybody be allergic to those?”

“Well, the Panabx did the trix and after a month or so, I’m not clear exactly how long because apparently I was in a coma for a while, I was as good as new. Uncle Mark still bugs me today about the money I owe him for all the Bud Electrolyte he had to buy. I went through liters of it and even if you can get it by the gallon at Cosco, it’s not cheap. Luckily the nice boy next door had taken an elective in high school on Blood and Stuff and he was able to put a line into my vein, or ‘artery’ as they are sometimes called, for the fluid. My vist to the doctor wasn’t a total loss. We never got a settlement, the doctor was too crafty for that, but I did get a nice fifty-dollars-off-your-next-visit coupon which was kind of puzzling because the Single Payer in my town had died a few summers before.”

“Man. That is some good fried dog. Anybody want the last drumstick?”

The End of the World As We Know It

Back to the Future

“So you want to hear how your old Grandpa lost his leg do you? I know what you’re thinking and no, I didn’t lose it in the Burger Wars. You’ve seen my old uniform hanging in the closet but by the time I enlisted…oh..had to have been the Summer of 2057… the war was almost over and what was left of the McDonald’s forces were either surrendering in droves or holding out at isolated food courts in places like Duluth.”

“I’m sure you’ve seen the videos and learned all about it in school. I’m sometimes sorry I missed the action but I guess it was for the best. I’m not sure I had what it takes to kill a man, even if he was one of those bloodthirsty pan-frying monsters. (‘Happy Meal’ my ass.) I remember watching thousands of them being marched to the prisoner of war camps. But you know, other than their yellow and orange uniforms and their Iron Clown insignia they looked pretty much like our boys so maybe they really didn’t commit all of those atrocities.”

“Anyways, I spent my enlistment in the Burger King Reserves guarding a couple of Arby’s and a Wendy’s off of Exit 54. In fact, I never even fired my weapon except for a couple of potshots at a burning Golden Arches in front of a McDonald’s down the road that had taken a direct hit from a lard-seeking cluster bomb.”

“My leg? Oh. Well, one day…must have been twenty years ago…I started having chest pain and figured I needed a doctor…”

“What’s a doctor, you ask? Well, I guess you kids have never heard of doctors. I suppose they don’t mention them much in the history holograms either. Let’s see…Well…Once upon a time if you got sick or injured you went to see a person called a ‘doctor’ who supposedly knew a lot about diseases and how to cure them. These guys went to school for years and years learning a bunch of essentially useless knowledge and then spent the rest of their lives rubbing it in our faces. Not to mention raking in obscene amounts of money. They were replaced by something called a Physician Assistant around thirty years ago.”

“I see some of you remember Physician Assistants or have at least heard your parents talking about them. They’re pretty much gone now, too. Same with Nurse Practitioners. If we weren’t going to let somebody with ten years of medical education strut around there was no way we were going to allow some wanker with only two years to get all big-headed either.”

“My leg? I’m getting to it. Patience.”

“So anyways I started having chest pain and since I wasn’t sure if it was my heart or reflux I thought I’d get it checked out at Cath-in-the-Box.”

“Never go through the hover-through. They fuck you in the the hover-through. If I could do it over again I would have gone in but I was in a hurry. I’m pretty sure they got my order right. It’s pretty hard to yell symptoms into that stupid clown microphone and the questions they asked me were kind of garbled but I figured, hey, it’s a just a heart cath. Their sign says ‘One Billion Stented.’ They do them all the time. It’s not rocket science after all. Just squirting some dye into an artery and inflating a balloon. A monkey could do it.”

“So I get to the window and pay (I think it was 50 bucks which was a lot back then), turn on the radio, stick my leg into the slot and figure I’ll be out of there in five minutes. The pimply-faced kid who took my symptoms is running around putting in arterial sheaths which is not very difficult to do and why they have minimum wage high-school kids doing it. I could tell he was having a little trouble and his “trainee” badge should have tipped me off because by the time he got to me…well…let’s just say his sterile technique left a little to be desired. At least the assistant manager did the actual procedure. He was probably pretty good at it because, as you know, Cath-in-the-Box sends all of their managers to PCI-U for an extensive six-week training course. He maneuvered the C-arm into my car and six minutes later I had a stent in the ‘big artery thing that, like, runs down the front of the heart.’ I felt pretty good and my chest pain was gone so I figured that the a little bit of melted plastic on the dash was a small price to pay. The little “dosimeter” toy that came with the PCI-combo said that my radiation dose was within normal limits and the complementary EKG thingy showed the usual incomprehensible squiggly lines which the assistant manager believed were normal but wasn’t really sure.”

“A couple of days later I notice that my groin was all red and puffy and, to be perfectly honest, I felt like crap. They always stiff you on on the antibiotics at Cath-in-the-Box so I figured I’d get some from the corner Jiffy-mart. A pharmacy, you say? I see we’ve got a budding historian here. Of course I didn’t go to a pharmacy. Even back then they were all gone. As if I needed some over-educated pharmacist with his pricey doctorate-level education and thousands of useless and expensive facts giving me high priced pills with fancy Latin names. No thank you! The last Pharmacist died of old age at Suburbia Village a couple of years ago. (You know, it’s that replica of a small town from the early 2000’s where people dress in period costumes and work at authentic jobs from the turn of the century. Remember how we took you kids there a few Ramadans ago and Jimmy got sick on Slurpees?)”

“So they have a couple of good antibiotics there. I picked Panabx because it has a good blend of antibiotics and I don’t think I’m allergic to any any of them. I like their jingle, too:”

“Panabx, Panabx,
Drip, fever, sepsis got you in a fix?
Need somethin’ that’ll do the trix?
Then you need Panabx!”

“And then they had all of the good-looking topless girls running through the woods. Come on, I’m sure you’ve seen the commercial on the holoscreen. It’s the one set to the tune of that really cool, old Kevin Federline song.”

“Anyways, my leg kept getting redder and redder and I started having alternating chills and fevers. ‘Oh great,’ I said to myself, ‘you’re septic again, just like after your self-service splenectomy over at Organs n’ Things.’ I tried a few more brands of antibiotics but I’m pretty loyal to Panabx so I thought if one dose wouldn’t do the trick, I’d try eight. Your Uncle Scott who’s a professor over at Marshal Mathers University (or M and M) suggested that I might need to get it amputated but he’s a rich frickin’ psychologist. What did he know?”

“Turns out he was right. I staggered over to Home Depot and I’m afraid I might have been a little incoherent from the fever because their little orange aprons looked like the MacDonald’s uniforms and I might have tried to eviscerate a couple of the associates with a cordless laser saw. After they tackled me to the ground and duct-taped my arms to my sides, I sat through a health-improvement seminar taught by a really nice guy named Chip. I bought the Black and Decker Limbzall and your grandma and Uncle Scott held me down while the take-out anesthesia took effect. When I recovered my leg was gone and everybody looked at me like, ‘Dude, you were so acting like a retard.'”

“I wrote a nice letter to Cath-in-the-Box and they refunded my money which was nice of them.”

“Would a doctor have done a better job? Maybe a little better but it’s not worth all of the questions, testing and general screwing around that they used to do to get your money. What my past medical history or whether I smoke has to do with anything is beyond me. They never waste your time with that kind of thing at Cath-in-the-Box or Bile, Bowel, and Beyond which is why medical care is so cheap, quick, and affordable nowadays. If I have another heart attack I’ll probably just get a quick thrombolytic out of the vending machine. They have a whole bunch of them down at the Stroke-o-mat. It’s pretty safe if you just read the friggin’ instructions on the front of the machine.”