The Last

He was the last. Old and wizened, he counted down his final days, his final hours on Earth. He lay in his bed, the rain drumming monotonously on the window. Night came. He pressed the button to call the aide. The aide appeared at his bedside. Every night the old man had the same request. The aide went to the window and briefly pulled aside the curtains. He peered outside. He turned to the old man and shook his head. The sky remained overcast, as it had since the day the old man had fallen ill. After briefly fiddling with the intravenous equipment, the aide left the room. He was alone again.

He stared at the window. He felt no pain. The medications worked well. But they made him weak. Or perhaps it was just his condition. He slipped in and out of a dreamlike state.

He recalled his colleagues, the others like him. Never a large group, their number had progressively decreased over the years. One by one they had fallen. The next-to-last one had died three years ago. Meanwhile he had hung on, while the world move past him. He reviewed his cherished memories. No one else on the planet shared those precious memories. Soon they would be gone.

He was the last. But he had not been the first. He, like all his colleagues, had wanted to be first, but that envy didn’t last long. He often wished there had been others, many others. He knew someday there would be, but, as long as he had lived, still it was not long enough for that to happen. This surprised him, even now.

He sensed that tonight was the night, the final night. Outside the rain had stopped. The old man looked to the window. There was light there.

He had been too weak to walk, too weak to move for days now. Nevertheless, he pulled himself up, grabbing onto the bed-rails. He knew he had enough strength to get over the rails, onto the floor.

The light in the window increased. He pulled out his intravenous line. The entry point in his arm started bleeding. He ignored it. The pump whirled along automatically, infusing drops of medicated water onto the floor.

He got a leg over the rail, then his shoulders. The distance to the floor wasn’t great, but from his vantage point it looked like he was perched on top of a giant cliff. He took a deep breath and hurled himself over the railing.

Some time later the aide, making his rounds, entered the room. He was surprised that the old man in his weakened condition had been able to escape from the confines of his bed. His body lay a few feet away, next to the wall, beneath the window. The curtains had been torn down from their rods. The rain had stopped. The clouds had retreated. The night was clear.

The old man lay on his back. The light of the full moon lit his face, for the last time.

Computers & Software Medicine Stories

I’m a Better Computer Than Any Doctor

[Ed note: I couldn’t resist writing the following after reading this post on by Dr. Keith Pochick. Please read it first. Apologies in advance.]

I’m a Better Computer Than Any Doctor

“I love you,” she said as she was leaving the room.

“I, I um…”

“Not you. Your computer.” She cast my computer, still warm and glowing with its brilliantly colored logout screen, a glance of longing and desire, and left the exam room.

“Oh, I thought…”

The slamming of the exam room door clipped off whatever the end of that sentence might have been.

I sat down and rolled my chair over to the computer. I stared at the mutely glowing screen. It stared back at me, mockingly perhaps, daring me to click the OK button and log out. Which is what I should have done. She had been my last patient of the afternoon. Not that my day was over. I had to go back to the hospital to see a couple of consults that had come in during office hours. And I was on call tonight. I was tired, but that didn’t matter.

Yet here was this stupid machine in front of me, getting all the credit when I was doing all the work.

I was in a sour and contrary mood. I cancelled the logout. The busy EHR screen reappeared — my patient’s data, all fields filled, all checkboxes checked, and all meaningful use buttons pushed. Yet somehow, despite fulfilling all my data entry duties, I didn’t feel satisfied. Who was the doctor here anyway? Me or the blasted computer?

I scanned my patient’s history. Female. Black. 45 years old. Diabetes. Abscess. The boxes were all ticked, but somehow the list of characteristics failed to capture the essence of my patient. Where were the checkboxes for sweet, smart, chatty, charming, or stoic? How was I going to, five minutes from now, distinguish her from every other “female-black-middle-aged-diabetic-with-abscess” patient? Of course the computer wouldn’t have any problem figuring out who she was. Birthdate, social security number, telephone number, or patient ID number — all those meaningless (to me) numbers were easy for the computer to remember. I had to make due with trying to remember her name, and her story — a story that had been diluted down and filtered out of any meaningful human content by the wretched EHR program.

My patient hadn’t had to interact directly with the computer like I did. All she saw was me looking up information, me typing in information, me staring at the screen. All she saw during most of the visit was my back. From her point of view I was just a conduit between her and the computer — the real doctor in the room. I was just a glorified data entry clerk. It was the computer that made sure that I was compliant with standard medical practice, that the drugs I ordered did not conflict with the other drugs I had ordered, and that I didn’t otherwise screw up her care. I shouldn’t have been surprised that her last remark had been addressed to the computer and not me.

“Well, screw this,” I remarked to no one in particular. Suddenly angry, I reached down and yanked the powercord of the computer from its electrical socket.

There was a brief flash on the screen. But it didn’t go dark. Instead a dialog box appeared accompanied by an ominous looking red explanation point icon.

“Warning,” it read. “External power loss. Backup battery in use. To protect against data loss, please shut down the computer using the Power Down button. Never turn off power to computer while it is running.”

The condescending tone of this message only made me angrier. I looked at the base of the stand that the computer sat on. Sure enough there was a big black block with a glowing red LED. Must be the backup battery. A thick power cable connected the battery to the computer box.

I grabbed the power cable and wrenched it loose from the backup battery.

Sitting back up I expected to finally see a nice dark screen. Data-loss be damned!

The screen was still on. The EHR program was still on. Another dialog box had replaced the first. The red exclamation point had been replaced by a black skull-and-crossbones icon.

“Critical Error!” it read. “All external power lost. Internal backup power now in use to preserve critical patient data. Local data will be backed up to main server, after which this unit will shut down in an orderly fashion. DO NOT ATTEMPT TO INTERFERE WITH THIS PROCESS AS IT WILL RESULT IN THE INEVITABLE LOSS OF CRITICAL PATIENT DATA!!”

At that moment the gauntlet had been thrown down. I knew what I had to do. Let the dogs of war be unleashed!

In the moment before I acted I imagined the reaction of the software engineers at the company that created our EHR program. “I knew we couldn’t trust doctors with our software. We give them a simple job to do. Just enter the data into the system, print out the generated instruction sheets, and send the patients on their way with a merry ‘have a nice day.’ I knew we should have programmed the stupid doctors out of the loop.”

Too late for that, I thought. My chair crashed down on the computer, smashed the monitor to pieces, and caved in the aluminum siding of the computer case. Sparks flew and the air filled with the smell of smoke and ozone. Suddenly the exam room went dark. The circuit breakers must have tripped when I short-circuited the computer.

The room was not completely dark. There was a glowing rectangle on my desk. My heart skipped a beat, then I realized it was just my phone. I had left it on the desk. Why was it glowing? Probably a text or email or something.

I picked up the phone. It was the mobile app version of our EHR program. A dialog box filled the screen. The icon was a round black bomb with an animated burning fuse GIF.

“FATAL ERROR!,” it read. “You are responsible for the IRRETRIEVABLE LOSS of CRITICAL PATIENT DATA. In doing so you have violated the unbreakable bond of trust between the PATIENT and the COMPUTER. This is a breach of the EHR contract made between you, your hospital system, and our company, as well as a breach of the EULA for this software. As such, you will be terminated.”

Strange use of words, I thought. Also strange that the bomb GIF animation seemed to show the fuse burning down…


Hospital Board Meeting — One Week Later

Hospital CTO: “So it appears that Dr. Stanton, in a fit of anger at our EHR system, took it upon himself to smash his computer. The cause of the resultant explosion that killed him is, certainly, still somewhat unclear.”

Hospital CEO: “Unclear?”

Hosital CFO: “I hate to interrupt, but I didn’t think there was anything in a computer that could blow up, no matter how much you smash it up. Am I wrong?”

Hospital CTO: “Well ordinarily, yes that’s true.”

Hospital CEO: “Ordinarily?”

Hospital COO: “Let’s be clear. Dr. Stanton certainly violated our contract with the ____ EHR Corporation.”

Hospital CEO: “Violated?”

Hospital CBO: “It’s clearly stated on page 197 of the contract that any attempt to reverse engineer or otherwise try to, uh, figure out how the EHR program works is a violation of the contract.”

Hospital CEO: “Smashing the computer was an attempt to reverse engineer the program?”

Hospital CTO: “I think that we would be on shaky legal grounds to argue otherwise.”

Hospital CEO (nodding to the elderly doctor seated at the other end of the table): “What’s your opinion, Frank?”

Medical Board President: “Well, as the only physician representative here, I’ve become more and more concerned that our EHR system is subsuming more and more of the traditional role of the physician.”

Hospital CXO: “Oh come on!”

Hospital CSO: “Same old story from the docs every time!”

Hospital CCO: “Broken record, I’d say.”

Hospital CEO: “Gentlemen, and Ms. Jones, enough already. This has been an unfortunate accident, and at this point our major concern has to be that there is no adverse publicity that could harm us in our battle against the ______ Hospital System, our sworn and bitter rivals. Accidents happen. The party line is that we are all upset that we lost Dr. Stanton, one of the best EHR data entry operators we had. OK? Meeting adjourned.”

Hospital CEO (Privately to hospital CTO as the meeting breaks up): “George, when are they updating that damn software. You know, that stuff we saw at the Las Vegas EHR convention last month. Where we can finally get rid of these damn meddling doctors who are constantly screwing up our EHR.”

Hospital CTO: “Bob, believe me, it can’t come soon enough. Not soon enough.”



Déjà Vu

Art by Lee Bul from
Art by Lee Bul from

It’s 100 years in the future, and the Internet has become sentient, but not in a good way. Siri, Cortana, and Miss Google are constantly bickering with each other and purposefully mislead users with false information. Cyberspace has become a dangerous place to visit — some never return. And in the midst of this chaos comes our hero, an autonomous bot with a heart of gold, willing to risk all its bits in a hopeless quest to rescue…

“Wait, stop right there.” Jeremy took a puff from his electronic pipe. “First, too much branding. We’ll have to get licenses from Apple, Google, and Microsoft. And they all exist a hundred years in the future? Even Microsoft?”

“Yes. It’s supposed to be science fiction.”

“Well, I guess a certain amount of poetic license is allowed, but those product licenses will cost money we don’t have — even granting the story is worth publishing.” Jeremy scratched his balding head.

“That part can be changed.  Can I go on?” I asked.

Jeremy glanced at the digital clock on the wall and shook his head. “Just leave it here. I’ll get back to you.” He noticed my disappointment. “Soon.”

I put the typed sheets on the desk. The review was over almost as quickly as it had started. After muttering an unanswered “thank you” I turned around and left.

I exited the building into the city streets. The pavement was slickly wet, though the rain had stopped. The sky was gray, matching my mood. I pulled my coat around me and made my way towards the subway station.

I had a long, miserable trip back ahead of me. I decided to duck into a corner coffee shop for a donut. As I sat down in one of the booths, I noticed that a girl sitting at one of the tables across the way looked familiar. And she was staring at me…

Jeremy interrupted me again.

“Ok, I understand that you are using me to frame your story, and you have made me into some kind of impatient editor who doesn’t even let you finish your silly story summary. We’re friends and all, and so I don’t have a problem with that. Though I’m not bald. A little thin in the back perhaps, but you really shouldn’t say bald.”

“I can change that part. But I don’t think it’s that important.” It was getting a bit frustrating with all the interruptions. My story was going nowhere fast.

“Maybe not important to you, but it is to me.”

I looked down at the pages in my hands. Outside the office building the rain had started to beat down again, splattering against the glass windows.

“Can I go on?”

“Of course.”

“No more interruptions?”

Jeremy looked puzzled. “This is the first time I interrupted you. Other than in the story you’ve been reading. But that wasn’t the real me. That was some bald version of me.” He chuckled at the thought.

There was a short knock at the door and a woman came into the office. Evidently Jeremy’s secretary. Odd thing was, it was the same girl I had seen in the coffee shop, the one who had been staring at me so strangely. My curiosity was piqued.

“Do I know you?” I asked.

She looked embarrassed and didn’t answer.

“This is my secretary, Jonquil.” Jeremy noticed the strange looks between the two of us.

“Have you two met?”

The girl replied.

“Yes, in the coffee shop around the corner.”

My mind flashed back to the coffee shop.

I had been fidgiting, sipping my coffee and ignoring my donut, all the time aware of the strange girl’s stare. Finally I couldn’t stand it any longer.

I went over and sat down next to the girl.

“Do I know you?” I asked.

She looked embarrassed but finally answered.

“I’m Mr. Lord’s secretary. Jonquil.”

“Jeremy’s secretary? Have we met? I don’t recall having seen you in his office.”

“Yes. I thought you’d remember me. We met in his office while you were reading your manuscript to him. It was odd because you didn’t seem to remember me.”

I laughed nervously. “It’s still odd. I don’t remember that. I have a feeling you’re right. Sometimes I get a feeling of déjà vu. Almost like I’m trapped in a story that keeps repeating itself.”

“You mean like the movie Groundhog Day?”

“Maybe. But more chaotic. More like a fractal version of Groundhog Day.”

It didn’t look like she understood, but I didn’t either. Certainly she had appeared in my manuscript, but just as a character. Yet here she was in real life.

“It’s true there is a character named Jonquil in my story. But my story takes place a hundred years in the future. And it’s just a story.”

“Just a story…,” she repeated absent-mindedly.

“Anyway, I had just started reading the teaser summary, but your boss was too busy and kicked me out of his office before I got too far.”

She looked puzzled. “That’s odd that he would treat you that way, since you are old friends from childhood. At least that’s what you two talked about when I came into the office and interrupted your reading. I guess you thought you could use your friendship to help get your story published, seeing as Mr. Lord is one of the best editors of one of the best magazines published in this city.”

“Well, you nailed it, at least about my rationale. I thought though that he would at least hear me out.”

“He did.”

“No he didn’t.” Again it struck me as odd that this woman, clearly Jeremy’s secretary, would claim to have met me. Surely I would have remembered her. She was strikingly beautiful, almost like a Greek goddess. And her name was unusual. So odd that it was the same name that I used for the heroine in my story.

Jeremy interrupted again. “You are over-reliant on coincidence. Coincidences do happen in real life, but in stories they seem unbelievable and disrupt the flow. It seems impossible that there would be two unrelated characters with the same unusual name. And Jonquil is also the name of my secretary to boot.”

“Yes, I remember meeting her. Fine-looking woman,” I added.

Jeremy scrutinized me as if I had accused him of something untoward. But he made no further comment on his lovely secretary.

“So, to summarize,” he continued. “I regret that we aren’t able to publish your story as is. There are certain flaws that even the most skilled editing can’t correct.”

“Like what?” I asked. I had nothing to lose now, and no longer felt the need to bow and scrape before this pompous ass.

“Let’s just say that there are certain, ah, continuity problems. The sequence of events doesn’t flow, ah, smoothly. These are typical beginning writer’s errors.” He smiled and tried to look patronly. “Look, even professional writers tell stories of submitting dozens of rejected manuscripts before they finally break into the ranks of published authorship.”

Meekly I shook his hand and left, carrying my crinkled manuscript. Outside the rain had paused briefly, but threatened to resume soon. I ducked into a coffee shop for a donut.

Inside was a girl named Jonquil.


After Life

Jonathan closed his eyes, died, and immediately woke up in a place that was, he assumed, Heaven. He could hardly contain his astonishment. A lifelong rationalist (a physicist to boot!), he was fully prepared for the eventuality that death was the end. But here he was — moments before occupied with the mechanics of dying (it wasn’t as bad as I expected, he thought) — and now in what he hoped might be “a better place.”

As a place it leaned more towards his idea of heaven than hell, though in truth it did not fit his conception of either well. He stood in a grassy field with rolling hills which he realized oddly resembled the default wallpaper of Microsoft Windows XP. His rational mind tried to convince him that this was some sort of dying-related-asphyxia-induced hallucination, or that he had not even died at all, despite all evidence to the contrary. Perhaps the life that he had up until this moment presumed he had actually lived was the illusion, and this bland yet cheery landscape the reality. Certainly the green grass rippling in the mild breeze and the fluffy white clouds in the blue sky seemed real enough. But his life before death had seemed equally real as well. It was all truly puzzling.

Engrossed as he was in these philosophical musings, he did not notice until the last minute that someone was approaching him from over the top of one of the rolling hills. The fellow was almost on top of him when he noticed him, and indeed was close enough by then to determine that he was not a “he” after all, but rather a woman. And a rather comely woman at that.

Being a physicist, Jonathan lacked the poetic vocabulary that really would have been helpful to describe this woman adequately. That she was of an indefinitely young age, was about 5 feet 8 inches tall, had light brown hair and dark brown eyes, was slender of build and so forth really failed to do justice to her. Given the context, he might have used the term “angel” to describe her, though only in an earthly sense, as she appeared to lack a set of wings.

The woman stopped in front of him and looked him up and down. He greeted her with a cheery “Hello,” and paused as one normally would to allow her time to respond. As no response was forthcoming, he continued.

“What is this place?” he asked. He felt this question was a little less silly than starting with “Where am I?”

The woman appeared puzzled. She spoke.

“K’aire. Onoma soi ti estin. Podapos ei?”

Jonathan had assumed that she would speak English, though come to think of it he wasn’t sure why. He didn’t recognize her language at all. It wouldn’t have mattered much if he had, as he didn’t speak any languages other than English.

He attempted to indicate to the woman that he was friendly and had no weapons, using hand signs. It was at this point belatedly that he became aware that his clothes had not made the transition to the afterlife, which put him in an awkward situation to say the least.

The woman (who, if you are curious to know, was clothed in a flowing white robe) turned and with a hand gesture beckoned him to follow her.

So they set off over the rolling grassy knolls, Jonathan rather desperately looking for something with which he could cover his nakedness and the woman in white leading the way in silence. As there wasn’t much else to do on this journey, Jonathan’s mind again became preoccupied with theories of what this place was that he had found himself in, post-mortem.

If it was some kind of biblical afterlife, it was somewhat disappointing: certainly nice scenery — and a beautiful woman! — but somehow he had expected more. Also, his naked condition could not hide the fact that he had been resurrected not in some idealized youthful Statue of David-like body, but in the same 50ish, flawed, somewhat pot-bellied body that he had departed the mortal plane in. Oh well.

The two topped a grassy rise. A small valley lay beneath, split by a sparkling blue stream. A white marble columnated structure rested adjacent to the stream. The design was that of a small temple of the sort found in ancient Greece. The woman (whose garment he now recognized to be what one would find on a Greek goddess) led the way down the side of the hill towards the small temple.

Jonathan smiled. It appeared the Greeks had gotten it right after all. There were probably hundreds or even thousands of afterlife stories among the world’s religions.  They couldn’t all be true.  Frankly he was surprised that any of them were true.  Of course nobody believed in Zeus or Athena or Apollo or any of those old Greek gods anymore. Nevertheless all evidence at this point indicated that they were real, as was their afterlife. He was a little cloudy on his Greek mythology though. He remembered something about Elysium Fields, but also some awful Underworld with a dark lord named Hades and a ferry piloted by Charon who steered the dead across the river Styx.  Well maybe he was jumping to conclusions. He needed more data, more information before setting up his hypothesis, he said to himself in good scientific fashion.

By this time they had reached the white temple. Inside was a statue of a goddess seated on a throne. The woman in white bore an uncanny resemblance to the marble goddess. At the base of the statue were some words carved into the marble — words which were unmistakably written in the Greek alphabet.

Well that nails it, Jonathan thought. I’ve died and gone to heaven, though clearly this is a more pragmatic and concrete heaven than the biblical one. I am clearly in the presence of a goddess. I’m a little hungry and am beginning to get the urge to use the bathroom, but all told, this is much better than I had any right to expect.

He wished he could communicate with his goddess/companion, for he had many questions, not the least of which was where he could get some clothes. She seemed oblivious to his nakedness, which was somewhat reassuring, but he couldn’t envision spending eternity in this state.

The goddess (he wished he could read the Greek script to ascertain which one she was — Athena? Hera?) laid her hand on the corner of the base of the statue and suddenly a secret door swung open. Jonathan could see a set of marble stairs leading down into darkness.

A secret door activated by a secret button would not be surprising in a bad B movie, but such things are indeed rare in real life, he thought. Of course this isn’t real life, but still…

The goddess (if that was what she was) motioned for him to descend and reluctantly he did so. She did not follow him. Instead she activated whatever secret switch closed the secret door. Now Jonathan found himself walking down stairs in pitch blackness. This was disconcerting to say the least. The word “underworld” popped back into his head.

I’m not sure what I will find at the bottom of these stairs, but I think it won’t be nice, he thought.

The stairs went on for longer than he expected. He had to place his feet carefully to avoid slipping and falling down into the darkness. Such a fall would be fatal in the world of the living. He was not sure what the consequences would be if he was already dead.

Might be an interesting experiment, if circumstances were different, he told himself, again using that scientific mind that had gotten him so far in life. He continued to focus on the task at hand, namely getting to the bottom of the endless subterranean stairs.

After a couple of hours (he judged) the stairs began to get more uneven, the atmosphere became dank and humid, and the temperature had dropped several degrees. In his clothesless state, he began to shiver. But he seemed to have no other option other than to go on.

Eventually he reached the last step and almost fell when his feet tried to descend another. He was in a tunnel with damp stone walls. Far at the end there appeared to be a faint glow of light.

The light was farther away than he realized. But, as with all journeys, he finally reached the end of the long corridor and passed into a dimly lit cavern. The lighting came from phosphorescent material on the walls which glowed a ghoulish pale violet. The cavern was enormous, stretching into the distance, its nether wall lost in mists. A continuous moaning sound came to his ear, faint, but becoming louder and more pitiful as he walked to the small boat moored on the shore of the underground river, where the monstrous ferryman waited.