by Dave Eggers
The clinic’s lobby was really not a lobby at all. It looked more like a cafe, with Circlers talking in pairs, a wall of beautifully arrayed health foods, and health drinks, and a salad bar featuring vegetables grown on campus, and a wall-mounted scroll featuring a recipe for paleo soup.
Mae didn’t know who to approach. There were five people in the room, four of them working on tablets, one fully retinal, standing in the corner. There was nothing like the standard window through which a medical administrative’s face would have greeted her.
“Mae?”
She followed the voice to the face of a woman with short black hair, dimples in both cheeks, smiling at her.
“You ready now?”
Mae was led down a blue hallway and into a room that looked more like a designer kitchen than an examination room. The dimpled woman left her there, showing her to an overstuffed chair.
Mae sat in it, then stood, drawn by the cabinets lining the walls. She could see horizontal lines, as fine as thread, delineating where one drawer ended and the next began, but there were no knobs or handles. She ran her hand across the surface, barely registering the hairline gaps. Above the cabinets was a steel strip, and engraved in it were the words: TO HEAL WE MUST KNOW. TO KNOW WE MUST SHARE.
The door opened and Mae startled.
“Hi Mae,” a face said as it floated, gorgeous and smiling, toward her. “I’m Dr. Villalobos.”
Mae shook the doctor’s hand, mouth agape. The woman was too glamorous for this, for this room, for Mae. She was no more than forty, with a black ponytail and luminous skin. Elegant reading glasses hung from her neck, briefly followed the line of her cream-colored jacket, and rested on her ample chest. She was wearing two-inch heels.
“I’m so glad to see you today, Mae.”
Mae didn’t know what to say. She arrived at “Thanks for having me,” and immediately felt like an idiot.
“No, thank you for coming,” the doctor said. “We have everyone come in, usually in their first week, so we were getting worried about you. Is there any reason you delayed this long?”
“No, no. Just busy.”
Mae scanned the doctor for physical flaws, finally finding a mole on her neck, a single, tiny hair protruding from it.
“Too busy for your health! Don’t say that.” The doctor had her back turned to Mae, preparing some kind of drink. She turned and smiled. “So this is really just an introductory exam, a basic checkup we give to all new staff members here at the Circle, okay? And first of all, we’re a prevention-emphasis clinic. In the interest of keeping our Circlers healthy of mind and body, we provide wraparound wellness services. Does that square with what you’ve been told?”
“It does. I have a friend who’s worked here for a couple years. She says the care is incredible.”
“Well that’s nice to hear. Who’s your friend?”
“Annie Allerton?”
“Oh, that’s right. That was in your intake. Who doesn’t love Annie? Tell her hello. But I guess I can do that myself. She’s in my rotation, so I see her every other week. She told you the checkups are biweekly?”
“So that’s—”
The doctor smiled. “Every two weeks. That’s the wellness component. If you come here only when there’s a problem, you never get ahead of things. The biweekly checkups involve diet consultations, and we monitor any variances in your overall health. This is key for early detection, for calibrating any meds you might be on, for seeing any problems a few miles away, as opposed to after they’ve run you over. Sound good?”
Mae thought of her dad, how late they’d realized his symptoms were MS. “It does,” she said.
“And all the data we generate here is available to you online. Everything we do and talk about, and of course all your past records. You signed the form when you started that allowed us to bring in all your other doctors’ information, so finally you’ll have it all in one place, and it’s accessible to you, to us, and we can make decisions, see patterns, see potential issues, given our access to the complete picture. You want to see it?” the doctor asked, and then activated a screen on the wall. Mae’s entire medical history appeared before her in lists and images and icons. Dr. Villalobos touched the wallscreen, opening folders and moving images, revealing the results of every medical visit she’d ever had—back to her first checkup before starting kindergarten.
“How’s that knee?” the doctor asked. She’d found the MRI Mae had done a few years ago. Mae had opted not to get ACL surgery; her previous insurance didn’t cover it.
“It’s functional,” Mae said.
“Well, if you want to take care of it, let me know. We do that here at the clinic. It would take an afternoon and of course would be free. The Circle likes its employees to have operational knees.” The doctor turned from the screen to smile at Mae, practiced but convincing.
“Piecing together some of the stuff when you were very young was a challenge, but from here on out, we’ll have near-complete information. Every two weeks we’ll do blood work, cognitive tests, reflexes, a quick eye exam, and a rotating retinue of more exotic tests, like MRIs and such.”
Mae couldn’t figure it out. “But how is this affordable for you guys? I mean, the cost of an MRI alone—”
“Well, prevention is cheap. Especially compared to finding some Stage-4 lump when we could have found it at Stage 1. And the cost differential is profound. Because Circlers are generally young and healthy, our health care costs are a fraction of those at a similar-sized company—one without the same kind of foresight.”
Mae had the feeling, which she was used to by now at the Circle, that they alone were able to think about—or were simply alone in being able to enact—reforms that seemed beyond debate in their necessity and urgency.
“So when was your last checkup?”
“Maybe college?”
“Okay, wow. Let’s start with your vital signs, all the basics. Have you seen one of these?” The doctor held out a silver bracelet, about three inches wide. Mae had seen health monitors on Jared and Dan, but theirs were made of rubber, and fit loosely. This one was thinner and lighter.
“I think so. It measures your heart rate?”
“Right. Most of the longtime Circlers have some version of it, but they’ve been complaining about it being too loose, like some kind of bangle. So we’ve modified it so it stays in place. You want to try it on?”
Mae did. The doctor fit it onto her left wrist, and clicked it closed. It was snug. “It’s warm,” Mae said.
“It’ll feel warm for a few days, then you and the bracelet will get used to each other. But it has to touch the skin, of course, to measure what we’d like to measure—which is everything. You did want the full program, right?”
“I think so.”
“In your intake, you said you wanted the complete recommended array of measurements. Is that still true?”
“It is.”
“Okay. Can you drink this?” The doctor handed Mae the dense green liquid she’d been preparing. “It’s a smoothie.”
Mae drank it down. It was viscous and cold.
“Okay, you just ingested the sensor that will connect to your wrist monitor. It was in that glass.” The doctor punched Mae’s shoulder playfully. “I love doing that.”
“I already swallowed it?” Mae said.
“It’s the best way. If I put it in your hand, you’d hem and haw. But the sensor is so small, and it’s organic of course, so you drink it, you don’t notice, and it’s over.”
“So the sensor is already in me?”
“It is. And now,” the doctor said, tapping Mae’s wrist monitor, “now it’s active. It’ll collect data on your heart rate, blood pressure, cholesterol, heat flux, caloric intake, sleep duration, sleep quality, digestive efficiency, on and on. A nice thing for the Circlers, especially those like you who might have occasionally stressful jobs, is that it measures galvanic skin response, which allows you to know when you’re amped or anxious. When we see non-
normative rates of stress in a Circler or a department, we can make adjustments to workload, for example. It measures the pH level of your sweat, so you can tell when you need to hydrate with alkaline water. It detects your posture, so you know when you need to reposition yourself. Blood and tissue oxygen, your red blood cell count, and things like step count. As you know, doctors recommend about ten thousand steps a day, and this will show you how close you’re getting. Actually, let’s have you walk around the room.”
Mae saw the number 10,000 on her wrist, and with each step she took, it dropped—9999, 9998, 9997.
“We’re asking all newbies to wear these second-gen models, and in a few months we’ll have all Circlers coordinated. The idea is that with complete information, we can give better care. Incomplete information creates gaps in our knowledge, and medically speaking, gaps in our knowledge create mistakes and omissions.”
“I know,” Mae said. “That was the problem in college for me. You self-reported your health data, and so it was all over the place. Three kids died of meningitis before they realized how it was spreading.”
Dr. Villalobos’s expression darkened. “You know, that kind of thing is just unnecessary now. First of all, you can’t expect college kids to self-report. It should all be done for them, so they can concentrate on their studies. STDs alone, Hep C—imagine if the data was just there. Then appropriate action could be taken. No guesswork. Have you heard of that experiment up in Iceland?”
“I think so.” Mae said, but was only half-sure.
“Well, because Iceland has this incredibly homogenous population, most of the residents have roots many centuries back on the island. Anyone can trace their ancestry very easily back a thousand years. So they started mapping the genomes of Icelanders, every single person, and were able to trace all kinds of diseases to their origins. They’ve gotten so much valuable data from that pool of people. There’s nothing like a fixed and relatively homogenous group, exposed to the same factors—and a group you can study over time. The fixed group, the complete information, both were key in maximizing the takeaway. So the hope is to do something like that here. If we can track all you newbies, and eventually all 10,000-plus Circlers, we can both see problems far before they become serious, and we can collect data about the population as a whole. Most of you newbies are around the same age, and in generally good health, even the engineers,” she said, smiling at what was evidently a joke she often told. “So when there are deviations, we’d like to know about them, and see if there are trends we can learn from. Does that make sense?”
Mae was distracted by the bracelet.
“Mae?”
“Yes. That sounds great.”
The bracelet was beautiful, a pulsing marquee of lights and charts and numbers. Mae’s pulse was represented by a delicately rendered rose, opening and closing. There was an EKG, shooting right like blue lightning and then starting over. Her temperature was rendered large, in green, 98.6, reminding her of that day’s aggregate, 97, which she needed to improve. “And what do these do?” she asked. There were a series of buttons and prompts, arranged in a row below the data.
“Well, you can have the bracelet measure about a hundred other things. If you run, it’ll measure how far. It tracks your standing heart rate versus active. It’ll measure BMI, caloric intake.… See, you’re getting it.”
Mae was busy experimenting. It was one of the more elegant objects she’d ever seen. There were dozens of layers to the information, every data point allowing her to ask more, to go deeper. When she tapped the digits of her current temperature, it could show the average temperature for the previous twenty-four hours, the high and the low, the median.
“And of course,” Dr. Villalobos said, “all that data is stored in the cloud, and in your tablet, anywhere you want it. It’s always accessible, and is constantly updated. So if you fall, hit your head, you’re in the ambulance, the EMTs can access everything about your history in seconds.”
“And this is free?”
“Of course it’s free. It’s part of your health plan.”
“It’s so pretty,” Mae said.
“Yeah, everyone loves it. So I should ask the rest of the standard questions. When was your last period?”
Mae tried to remember. “About ten days ago.”
“Are you sexually active?”
“Not at the moment.”
“But in general?”
“Generally, sure.”
“Are you taking birth control pills?”
“Yes.”
“Okay. You can move that prescription over here. Talk to Tanya on your way out, and she’ll give you some condoms for the things the pill can’t prevent. Any other medications?”
“Nope.”
“Antidepressants?”
“Nope.”
“Would you say you’re generally happy?”
“I am.”
“Any allergies?”
“Yes.”
“Oh right. I have those here. Horses, too bad. Any family history of illness?”
“Like, at my age?”
“Any age. Your parents? Their health is good?”
Something about how the doctor asked the question, how she so clearly expected the answer to be yes, her stylus hovering above her tablet, knocked the wind out of Mae, and she couldn’t speak.
“Oh honey,” she said, and bringing her arm around Mae’s shoulder and tilting her close. She smelled faintly floral. “There there,” she said, and Mae began to cry, her shoulders heaving, her nose and eyes flooding. She knew she was getting the doctor’s cotton coat wet, but it felt like release, and forgiveness, and Mae found herself telling Dr. Villalobos about her father’s symptoms, his fatigue, his accident over the weekend.
“Oh Mae,” the doctor said, stroking her hair. “Mae. Mae.”
Mae couldn’t stop. She told Dr. Villalobos about his soul-flaying insurance situation, how her mother was expecting to spend the rest of her life caring for him, fighting for every treatment, hours on the phone every day with those people—
“Mae,” the doctor finally said, “have you asked HR about adding your parents to the company plan?”
Mae looked up at her. “What?”
“There are a handful of Circlers who have family members like that on the insurance plan. I would imagine it’s a possibility in your situation.”
Mae had never heard of such a thing.
“You should ask HR,” the doctor said. “Or actually, maybe you should just ask Annie.”
“Why didn’t you tell me sooner?” Annie said that night. They were in Annie’s office, a large white room with floor-to-ceiling windows and a pair of low couches. “I didn’t know your parents had this insurance nightmare.”
Mae was looking at a wall of framed photos, each of them featuring a tree or shrub grown into a pornographic shape. “Last time I was here you had only six or seven, right?”
“I know. Word got out that I was some passionate collector, so now someone gives me one every day. And they’re getting filthier all the time. See the one on top?” Annie pointed to a photo of an enormous phallic cactus.
A copper-skinned face appeared in the doorway, her body hidden around the corner. “You need me?”
“Of course I need you, Vickie,” Annie said. “Don’t go.”
“I was thinking of heading to the Sahara kickoff thing.”
“Vickie. Don’t leave me,” Annie said, deadpan. “I love you and don’t want us to be apart.” Vickie smiled, but seemed to be wondering when Annie would end this bit and let her go.
“Fine,” Annie said. “I should go, too. But I can’t. So go.”
Vickie’s face disappeared.
“Do I know her?” Mae asked.
“She’s on my team,” Annie said. “There are ten of us now but Vickie’s my go-to. You hear about this Sahara thing?”
“I think so.” Mae had read an InnerCircle notice about it, some plan to count the grains of sand in the Sahara.
&nbs
p; “Sorry, we were talking about your dad,” Annie said. “I can’t understand why you wouldn’t tell me.”
Mae told her the truth, which was that she didn’t see any scenario where her father’s health would overlap with the Circle. There was no company in the country that covered an employee’s parents or siblings.
“Sure, but you know what we say here,” Annie said. “Anything that makes our Circlers’ lives better …” She seemed to be waiting for Mae to finish the sentence. Mae had no idea. “… instantly becomes possible. You should know that!”
“Sorry.”
“That was in your intake orientation. Mae! Okay, I’ll get on this.” Annie was typing something into her phone. “Probably later tonight. I’m running into a meeting now, though.”
“It’s six o’clock.” She checked her wrist. “No. Six thirty.”
“This is early! I’ll be here till twelve. Or maybe all night. We’ve got some very fun stuff happening.” Her face was aglow, alive to possibility. “Dealing with some juicy Russian tax stuff. Those guys do not fuck around.”
“You sleeping in the dorms?”
“Nah. I’ll probably just push these two couches together. Oh shit. I better go. Love you.”
Annie squeezed Mae and walked out of the room.
Mae was alone in Annie’s office, stunned. Was it possible that her father would soon have real coverage? That the cruel paradox of her parents’ lives—that their constant battles with insurance companies actually diminished her father’s health and prevented her mother from working, eliminating her ability to earn money to pay for his care—would end?
Mae’s phone buzzed. It was Annie.
“And don’t worry. You know I’m a ninja with stuff like this. It’ll be done.” And she hung up.
Mae looked out Annie’s window to San Vincenzo, most of it built or renovated in the last few years—restaurants to serve Circlers, hotels to serve visitors to the Circle, shops hoping to entice Circlers and their visitors, schools to serve children of the Circle. The Circle had taken over fifty buildings in the vicinity, transforming blighted warehouses into climbing gyms, schools, server farms, each structure bold, unprecedented, well beyond LEED.