The Doctor Will See You Now

by Cory Franklin

  With apologies to Mort Sahl, here is how today’s political factions, beginning with the moderates, shake out on our current hot-button issue, health care:

  Moderates: The “left-moderates” favor the Affordable Care Act (ACA) health care plan. They do not believe in “death panels” and want to keep both parties as far away as possible from changing the ACA.

  Moderates: The “center-moderates” favor the ACA health care plan, assuming it can be made revenue neutral. They hope President Obama knew what he was doing, while they harbor secret doubts about Bernie Sanders’s economic expertise.

  Moderates: The “right-moderates” oppose the ACA health care plan because they are convinced it will never be revenue neutral and will require government subsidies indefinitely. They still hope President Obama knew what he was doing, but they cast a suspicious eye at Elizabeth Warren.

  Right Wing: The “left–right wing” wants no health reform. They believe our health care system is the best in the world without the ACA. Let the free market sort it all out. Everyone is on their own—as long as the stock market goes up and their taxes go down.

  Right Wing: The “center–right wing” wants no health reform. In fact they are in favor of scrapping socialist government programs like Medicare and Medicaid. The money saved should be used for subsidies to the insurance and pharmaceutical industries.

  Right Wing: The “right–right wing” wants to invade Canada, take over their health care system, and show them how it should be done.

  Left Wing: The “right–left wing” also oppose the ACA health care plan but for a different reason. For them nothing less than single-payer health care will do. And right away by government fiat, no debate necessary.

  Left Wing: The “center–left wing” also want a single-payer health care plan—and they think the military should be disbanded to pay for it. Health Care Reeducation Camps will be set up for those at town hall meetings who disagree. The first one for Camp Reeducation is Mitch McConnell.

  Left Wing: The “left–left wing” also want single-payer health care financed by breaking up the military. In addition to Health Care Reeducation Camps, they want to make free medical care available to everyone in North America—Mexico and Canada included. The only people excluded from free health care, or any health care for that matter, will be Donald Trump, Mike Pence, and Rush Limbaugh. For them the only contact with the doctor will be physician-assisted . . . well, you get the picture.

  Which camp do you belong to?

  67

  MY FIRST ENCOUNTER WITH

  ILSE AND ROBOT DENTISTRY

  * * *

  All in all, I don’t think robots and greater automation can bring about a utopian world as I imagined it would as a kid 50 years ago.

  —STANLEY DRUCKENMILLER, FINANCIER AND PHILANTHROPIST

  WE MIGHT AS WELL GET USED TO IT—the future of medical care is robots. Already they are making diagnoses, performing surgery in the operating room, and soon they will be administering anesthesia. It’s only a matter of time before they take over the dentist’s office. Hence what my first visit with my robot dentist might look like:

  It had been two years since I had been to the dentist (currently recommended interval: six months). My wife and I had to select a new dentist from our New Employee Health Care Plan. Our plan offered “complete choice concerning your point-of-care provider,” which I think is medical speak for you get to pick your own dentist.

  My wife was intrigued about the new robot dentist near our house. She reasoned that robots would be programmed for sensitivity and compassion. Moreover, with robots in charge, pain would be managed better, making it a thing of the past. My main concern was whether a robot would badger me about flossing. What type of artificial intelligence were we dealing with here?

  Ultimately, the possibility of less pain was the tipping point, and my wife convinced me. I remained slightly suspicious that she was making me the guinea pig for this robot-dentist experiment.

  I arrived promptly, and the new robot dentist greeted me with a beautiful mechanical smile. Good sign. Although maybe I should have been more concerned when I addressed it as “Doctor” and it quickly informed me, in that same unsettling voice that Amazon Alexa uses, that I should call her Ilse. First-name basis, good sign.

  “All my patients call me Ilse, and you will too.”

  Hmmm, a little bossy, I thought, and funny that the programmers chose such an unusual name. Ilse? The only Ilse I’d ever heard of was from an old, sleazy exploitation flick, Ilse: She-Wolf of the SS.

  The next thing I noticed, background music was coming from her body, but it wasn’t traditional dentist’s office Muzak; it was Prussian military marching music. Mildly unsettling.

  While Ilse took questions about my dental history, another robot, a smaller fellow named Igor, entered the room, opened my mouth, and examined my teeth.

  Ilse and Igor, just like R2-D2 and C-3PO in Star Wars. Cute.

  Wrong movie. It turned out rather than Star Wars, Ilse and Igor were more like dentists Laurence Olivier in Marathon Man and Steve Martin in Little Shop of Horrors.

  Right then Ilse began probing one of my molars and struck a deep, painful recess in a back tooth. Human dentists at least offer an apology when they hit a nerve, but none from Ilse. She just flashed some sort of enigmatic robot grin.

  Then Ilse inspected my gums, my least favorite part of going to the dentist. Sure enough, she told me in a rather stentorian tone that I had not been brushing well. My gums needed work, lots of work.

  Igor immediately cruised over and shined a bright light in my face, one of those lights that Jack Bauer used to shine in 24 when he wanted to drag a confession out of Russian villains. It appeared that Igor was grinning and laughing mischievously, in eager anticipation. But I know robots are not programmed for that.

  When Ilse started in, my mouth started hurting—mucho. I requested more anesthetic, but she must have been designed as one of those minimal anesthesia dentists. The next hour was a blur, other than to say my best comparison would probably be what Dante must have experienced in the fifth circle of hell.

  Ilse finished, and while I was still spitting blood, much blood, in her spit sink, she issued an order—nay, a demand.

  “You will go out immediately and buy a new electric plaque remover.”

  I felt compelled to obey. Despite my pain, some strange force compelled me to click my heels, salute her, and reply, “Jawohl, Ilse, right away!”

  Thus ended my first robot-dentist visit.

  I left in a cold sweat and immediately bought a new $119.95 electric plaque remover. When I was a kid, it was called an electric toothbrush and cost about nine bucks. Of course back then, it didn’t come with a 347-page instruction booklet. Admittedly, it was a beautiful booklet, highlighted by a full-color fold-out instruction brochure in seventeen different languages on how to brush each individual tooth.

  That night at bedtime, my mouth still hurting, I began reading the section in my new booklet in Portuguese, Urdu, and Swahili on how to brush my back-left third molar. My wife came in, brushing her teeth with an old-fashioned toothbrush.

  “So how did you like your new robot dentist?”

  “Let’s just say if the doctor told me I was terminally ill and had but a month to live, the first thing I would do is go to Ilse’s office.”

  “Why?”

  “She made an hour seem like a lifetime.”

  My wife looked at me curiously and said, “You know, I’ve decided to put off my dental appointment for a couple of months. By the way, I was reading online you should see the gastroenterologist every five years. You are overdue. I’ll get the health plan and we can pick one. I think they are doing robotic colonoscopies.”

  “No problem, dear. But this time how about you try it out first and let me know what you think? I’ve had enough robotic medicine for a while.”

  68

  THE RIP VAN WINKLE STORY AT THE HOSPITAL—WITH APOLOGIES TO WASHINGTON IRVIN
G

  * * *

  Having nothing to do at home, and being arrived at that happy age when a man can be idle with impunity, he took his place once more on the bench, at the inn door, and was reverenced as one of the patriarchs of the village, and a chronicle of the old times “before the war.”

  It was some time before he could get into the regular track of gossip, or could be made to comprehend the strange events that had taken place during his torpor.

  —WASHINGTON IRVING, RIP VAN WINKLE

  IT WAS A LATE WINTER EVENING in 1970 when University Hospital’s top surgeon, Dr. Elkniw, was summoned emergently to operate on a patient with a bleeding ulcer. Dr. Elkniw’s specialty was ulcers, and his surgical prowess endeared him to staff and patients—he was considered a charming rogue, despite or perhaps because of rumors of an occasional drink after surgery or furtive tryst with a nurse, unbeknown to his wife.

  After finishing the surgery, he stopped in the doctor’s lounge to sip from his trusty hidden bottle and rest briefly before going home to his impatient wife. The clock on the wall read 1:30. The preternaturally dark lounge, and the alcohol, induced in him a deep sleep. Suddenly he was awakened by the eerie glow of a fluorescent digital clock blinking 8:00. What kind of newfangled clock is that, and where did it come from? Switching on the light, he noticed the familiar wall clock was gone.

  Someone probably replaced it overnight, he thought. “Did I sleep that soundly?”

  It was indeed morning when he walked the familiar hallway. Except it appeared much cleaner and brighter. Was it his imagination or were there more female doctors scurrying about than he remembered?

  Straightening up in the restroom, he noticed no paper towels or soap—just some liquid gel and a blow-dryer on the wall. A dash to the cafeteria for bacon and eggs, but the woman behind the counter informed him the only offering was “heart-healthy cuisine.” He wasn’t sure what that was, but he was damn sure he didn’t want any part of it.

  He sipped a cup of coffee, which cost him several dollars. When did they start charging that much for coffee? Then he caught a snippet of conversation between two anesthesia residents.

  “Go home. They can’t make you stay at the hospital over fourteen hours in a row. It’s a rule.”

  “Will do. Hey, let me ask you. Do you ever twitter in the operating room while a case is going on?”

  “During long cases, I’ll twitter, but most of the time I just google.”

  Dr. Elkniw was stunned. What are these work rules? And what type of perversions are going on in the operating room? Twittering? Googling? I knew that some guys did some weird stuff in the OR, but that’s the first time I ever heard it called that. I have to discuss this with the chief of anesthesia.

  Off to the recovery room to check on his patient. Julia, his favorite nurse, always manned the desk. Today Julia was not there. Instead he encountered an unfamiliar face.

  “Can I help you?”

  “Dr. Elkniw, here to see Mr. Bummel. Bleeding ulcer, last night.”

  “I’m sorry but there is no patient here by that name. By the way, you can’t enter unless you scan your ID at the door.”

  Scan my ID? He had no idea what she was talking about. He was slightly nonplussed.

  “Where’s Julia? And who are you?”

  “There’s no Julia here either. I don’t know any Julia. I’m Ms. Bridges. And where’s your ID?”

  Completely confounded, Dr. Elkniw began to doubt his own identity. Everyone in the hospital knew him. A vague uneasiness about last night’s drink began gnawing at him. Got to find my patient, he thought.

  Maybe Bummel was transferred to the ward. He hurried downstairs and searched for Bummel’s chart. Nothing, no charts anywhere. He would have asked someone, but everyone was busy typing at these strange typewriters while watching small televisions. What were all these strangers doing? Who’s taking care of all the patients? He didn’t recognize one resident.

  He corralled one of the unfamiliar residents. “Where are the medical charts?”

  The resident answered incomprehensibly, “What are you talking about? Charts? We use electronic medical records.”

  “But, but, but . . . how do you write orders?”

  “We just enter them into the computer.”

  Dr. Elkniw knew about computers, but they were huge machines. How could those little things be computers? He needed a pen to make notes about what was happening, but nobody at the computers had one. Not even the nurses, who always wore string pens around their necks. There was nothing to write with on the ward. And in fact, nothing to write on.

  Need a familiar face, he thought. “Let me page Dr. Vedder, chief of surgery.”

  A resident saw him, and obliging, the resident said, “Here, use my computer to page.”

  “I don’t know how to page by computer. Can I page him by phone?”

  The resident looked puzzled, “Sure, take my cell.” Dr. Elkniw took the small contraption and handed it right back to him, as if it were something contaminated.

  Then the resident stunned him, “Anyway, the chief of surgery is Dr. Gardenier.” The only Gardenier Dr. Elkniw knew was that dull, slack-jawed medical student who scrubbed in on last evening’s surgery. He must have some connected relative who moved into Vedder’s spot. I always wanted that job, he thought to himself.

  “OK. Where’s Dr. Gardenier?”

  “In the auditorium. At grand rounds.”

  Desperately he headed to the auditorium. But it was no longer there. In its place was a new, glittering hospital entrance with Gershwin tunes coming from a self-playing piano. Someone directed him to the auditorium in a different building, a building he was sure was not there before. It was quite modern and now called the academic facility. At grand rounds, the lecturer discussed lasers and scans using slides projected on a screen without a slide projector. Like the Starship Enterprise. What type of magic is this? Dr. Elkniw whispered, “Where’s the slide projector?”

  “PowerPoint,” someone replied obliquely. He did not pursue the matter further.

  After the lecture he approached Dr. Gardenier. It was indeed the same medical student from last night. Only now he was much older, grayer, and heavier. Suddenly Dr. Elkniw noticed a wall calendar—January 2010.

  “Dr. Gardenier, I’m Dr. Elkniw.”

  Gardenier studied him briefly and exclaimed, “Dr. Elkniw! Everyone thought you ran off with Julia years ago! Where have you been?”

  He recounted his story—forty years passed in one night. His tale was greeted with skepticism, but Dr. Gardenier, with a distant memory of that long-ago operation, received him warmly. He got a hospital ID, a Facebook page, and a Twitter handle. It turned out not to be perversion after all.

  There wasn’t much surgery for him to do. He was now too old, and medications had generally rendered surgery for ulcers obsolete anyway. So he was granted a teaching position, having attained that happy age once described as “when a man can do nothing—with impunity.” A medical patriarch, he’d entertain everyone with tales of the glory of medicine before health care reform. It wasn’t such a bad life, except for the heart-healthy food.

  CREDITS

  * * *

  Sections of this book have previously appeared in the Chicago Tribune: chapter 1 as “Bond Between Patients and Physicians Is in Jeopardy,” December 31, 2014; chapter 2 as “Is It Smart To Skip your Annual Physical?” January 26, 2015; chapter 3 as “ How Old Is Too Old,” October 1, 2014; chapter 5 as “Aching for Some Undivided Medical Attention,” October 18, 2013; chapter 6 as “Reporting Science Without the Drama,” March 28, 2013; chapter 7 as ” Dr. Oz, Heal Thyself,” July 24, 2014; chapter 9 as “In Praise of First-Rate Medicine,” April 25, 2013; chapter 10 as “The Ghosts of Cook County,” April 11, 2016; chapter 11 as “The Man Who Saved Pitchers’ Arms,” March 14, 2014; chapter 12 as “The Woman Who Protected Us,” November 15, 2012; chapter 14 as “Air Conditioning: A Life-Saver,” June 28, 2015; chapter 15 as “Flight 191 on a Spring Day,”
May 24, 2015; chapter 17 as “Notorious Patients,” June 13, 2013; chapter 18 as “Born to Raise Hell,” May 2, 2016; chapter 19 as “Who Was Nancy Reagan’s Father?” March 8, 2016; chapter 23 as “ER Overload,” June 22, 2007; chapter 24 as “Protect Patients’ Medical Records from Prying Eyes,” April 21, 2015; chapter 29 as “The Digital Intrusion,” July 12, 2017; chapter 30 as “Should You Put Your Trust in Medical Research,” June 8, 2015; chapter 39 as “A Pill Not in the Best Interests,” October 18, 2012; chapter 52 as “Zika,” February 1, 2016; chapter 53 as “Ebola,” October 29, 2014; chapter 54 as “Measles,” February 11, 2015; chapter 55 as “Anti-Vaxxers,” May 22, 2017; chapter 56 as “When the Avian Flu Comes,” November 1, 2005; chapter 60 as “Volkswagen,” October 5, 2015; and chapter 62 as “The NFL May Become Extinct,” February 6, 2017.

  Other sections have appeared in Chicago Life Magazine: chapter 4 as “The Missing Pieces of Bread Cancer,” October 11, 2008; chapter 13 as “Needles to Say,” February 7, 2010; chapter 38 as “Doped: Performance-Enhancing Drugs,” October 11, 2009; chapter 42 as “Flying Too Close to the Sun,” June 18, 2016; chapter 48 as “The New Paradigm of Assistive Technology,” April 27, 2016; chapter 51 as “When the Climate Changes,” April 4, 2009; chapter 57 as “The Chicago Experience with a Nineteenth-Century Epidemic,” April 10, 2011; chapter 58 as “Can Science and Religion Coexist?” February 20, 2017; chapter 63 as “Elena and Angela,” August 24, 2017; and chapter 64 as “An Unusual Side Effect,” June 19, 2017.

  Chapter 16 appeared in the Guardian as “Newtown PTSD,” March 20, 2013.