Authors: Morgan Bell
t six-thirty-three A.M. Jamie’s phone erupted with his morning alarm. He tapped the screen until the sound of the drums and horns stopped. He’d been awake twelve minutes before the alarm went off and had, as he did every morning, remained motionless, hoping he might fall back to sleep. He never did. Nor did he get up and do something productive, which was his other urge in those twelve minutes. He would just lie still in the twilight moment between sleep and the world at hand.
Rising, stretching, he surveyed the bed. He was once again its sole occupant. His phone chirped. It informed him that he had emails waiting. He didn’t bother to look to see who they were from. He knew.
He walked down the hall to the kitchen and found his medicine. It was the pill. He took it once a day. He could do without it. But it was the pill that kept his blood pressure down. It kept his heart from racing. It kept the anger from overwhelming him. It made it so that he could read the emails. He took the pill and drank some water. In ten minutes he would be able to read the emails.
Returning to his room he got out his scrubs, found his ID and set out his contacts and his wallet. He went to the adjoining bathroom, shaved, showered, brushed his teeth, dressed and then went to his office to read the emails.
His ex-wife Allie had sent him an email titled “How Does It Feel?” He sighed. She’d sent him that one at least three times before. He scanned it. There was nothing new. He wasn’t a man. He should be ashamed. How did it feel to have some other man raising your kids? The usual crap. With a closing line demanding he contact her, immediately. He moved the email into a file marked “Lawyer” and moved down to the second email. It was from his sister. The header was “I Can’t Believe.” She’d sent him this one before. He scanned it. Family doesn’t understand her. Parents are emotionally indifferent to her. Grandma was a bitch. He deleted that one. He got up from his computer. He made a mental inventory. Took pill. Check. Ex-wife is insane. Check. Sister is insane. Check. The world was the same as it was when he went to bed last night. Check.
He got his car keys and went to work.
“Dr. Baxter, Mr. Tracy called for you,” the practice manager informed him when he arrived.
“Thank you. I’ll call him right back,” Jamie said, and picked up the office phone to talk to the healthcare campus director.
“Dr. Baxter,” Mr. Tracy said, “I need you to cover down on third floor. Dr. Wickham is out today and we are short a doctor.”
Jamie wanted to complain. Third floor was psychiatric outpatient services and he was certified. But he knew better than to complain. “I’ll be down there in ten minutes.”
“Make it five. I’ve already had all of your other case load redistributed so you can jump in down there.”
“Thanks, I’m on my way,” Jamie said, and hung up.
Walking through the annex and riding the conveyor belts that moved staff just slightly faster than walking, Jamie remembered that there’d been a time when you would tell civilian staff and stuffed shirt management to get bent if they did what Mr. Tracy was doing. Now it was the norm. You were a cog not a physician. The bureaucrats and business people told you what to do and… The pill worked well enough. But there were still things that could drive up his blood pressure. So he let it go. He’d not worked third floor in a long time. Dr. Wickham had joined the campus when he sold his practice to the company. The question was, what sort of practice was it? It was psychiatric, Jamie knew that; he had two years residency in psych, but he had never wanted to make it his focus. He switched over as soon as another option opened up and ended up with a general residency. For better or worse, though, the two extra years in psych had gotten him this job and he wasn’t going to screw it up by pitching a fit. No matter how much he wanted to.
“Dr. Locum is doing follow ups. You’re doing interim evaluations,” the med tech informed Jamie when he stepped into the staff area of the clinic.
Again, it grated on Jamie. He remembered the days when there had been civility, decorum, communications. Staff would never say “Yo, get over here, there is work to do.” At least not with the expectation of remaining gainfully employed. Now… The pill was working. He hadn’t yelled or flinched.
“Thanks,” he said, and took the tablet.
The evaluation room was the same as it was on every floor. Seven by seven with a desk, a scanning station for patient ID and insurance data code, a monitor that brought up file records and a printer for the hard copy of the patient’s scrip. When Jamie arrived there was already a patient waiting. His tablet let him know is was Cynthia Thomas, age 35, mother of three, manager for a tech firm and a non-drinker and non-smoker.
“Mrs. Thomas,” Jamie said, looking up from the tablet.
“Ms. Thomas,” she corrected.
Jamie looked at the tablet, saw marital status as married and saw preferred address by care team as “Mrs. Thomas.”
“I’m sorry,” Jamie said, and corrected the information on the tablet.
“No one respects Mrs,” she said.
“I’ve corrected that in your file, Ms. Thomas,” Jamie informed her, and sat on the small hard stool that served as both desk chair and treating physician’s stool. “I’m Dr. Baxter.”
“What is your first name?” she asked.
“Jamie,” he replied.
“Well, Jamie, I want you to know that I’m not at all pleased with the care I’ve been receiving since I started here.”
Jamie scanned her ID and insurance data. The screen informed him that she’d been a patient of Dr. Wickham’ s for five years.
“When you say ‘started here’, do you mean the facility or with Dr. Wickham?” Jamie asked.
“Both,” she retorted.
Jamie reviewed the file and found that she had said these same words at her last interim exam. He also saw that she was being treated for rage.
The monitor scrolled through the narrative of questions he was to ask. Jamie started reading them off aloud to her.
“How have you been handling conflicts in your place of work?” he read.
“Very well, thank you. I work with incompetent idiots. But I manage to remain professional, even when they don’t.”
“How have your relations with family members been since your last visit?”
“My husband is an absolute dunderhead who does not appreciate me. My daughter is married to a cretin and my mother is an ogre.”
“Have there been any incidents where you felt out of control, angry or enraged since your last visit?”
“No. I have felt justifiably perturbed by the failures of people in my personal and professional life and I have informed them of this in no uncertain terms.”
“Have you resorted to the use of profanity or insult to express your point of view at work, home or to other parties?”
“These questions are fucking stupid. Only an asshole would expect to learn anything from the questions you’re asking me. Why the hell do you waste my time?”
Jamie looked at the monitor. It recorded and transcribed the entire interview. Then it gave a summary review that showed the patient’s answers were nearly identical to her last visit. The software diagnostic analysis was, “Patient’s condition unchanged. Continue Pharmaceutical and Behavioral Management.”
A printed fiber scrip slid from the printer. Jamie signed it and handed it to Ms. Thomas.
“Your next appointment is in six weeks,” he told her.
“You could be a little more courteous Jamie. It never hurts to say ‘Thank you,’” she snapped, snatching the scrip from his hand.
He did not say anything. The pill was working.
Jamie saw another seven patients, all being treated for rage. He found, as he had working in the general care clinic, that if he didn’t think about it, he could get through the entire appointment without listening to himself asking the questions the monitor scrolled up for him to read. There had been a time when the questions were asked by the doctor, exercising their own judgment, pursuing their own clinical perceptions of the patient’s presentation. But the 2021 HSA study showed that doctors performed better when forced to follow an algorithm of questions. By the time they did the 2024 study it was determined that the software was more objective at interpreting data and developing clinical profiles and establishing diagnosis. The doctor was still required to read the questions, even though the software recorded all the data and did most of the work. Primarily because software couldn’t have a license to practice medicine and, due to the federal exemption regulation, it also couldn’t be sued.
Looking over the last seven cases, Jamie did, out of idle curiosity, evaluate one pattern that the software seemed to be ignoring. The patients were saying the same thing they had said for more than seven visits. In some cases the pattern went back over twenty visits. Were the patients gaming the software?
A buzzer sounded, letting Jamie know he was exceeding his pre-consult preparation time allocations. He got up and went to the door and said, “Next.”
In the reception area there were more than forty patients waiting. The room was noisy with the sounds of loud conversations, phone calls and furious text messaging. People were commenting on their family, their work, the economy and sports. They were doing so loudly, and without, it seemed to Jamie, listening to anything anyone around them was saying. As this was his experience of people in general, it did not seem unusual. He raised his voice and yelled over the general din, “NEXT!”
A woman in her mid-forties stood up and snapped, “It’s about time!”
“Harriet McCormack?” Jamie asked.
“Mrs. McCormack, if you please.”
“Mrs. McCormack,” Jamie corrected himself. This was the eighth time he had had to correct information in the database and each time it was the way the patient was to be addressed.
A loud buzzer sounded in Jamie’s room and a red flash notice went across his screen. “Intake Tech Data Not Completed.”
Jamie hit the system notice key and checked for the error. The report indicated that the data tech had not completed the intake. Absent data: pulse, blood pressure, height, weight, respiration rate, blood oxygenation.
Jamie gritted his teeth. This had only happened a few times. When it did, it was usually because the medical data techs were doing their shift switch. The pill was still working. He’d not torn the monitor from the wall.
“Pardon me,” he said to the patient.
“I don’t know that I will,” she retorted, and got out her panel.
Jamie was fairly sure she was posting unfavorable feedback. There was nothing he could do. Jamie went to the intake bay and found it was unstaffed. “Hello?” he said.
No one answered. Jamie knew if there was a staffing delay due to a shift change there was nothing he could do. The data techs were union and they couldn’t be reported, even for gross dereliction of duty, if the gap was due to a shift change. Jamie looked at the clock. The shift changes shouldn’t happen for another hour. “Hello?” he said again.
“Go away,” a voice responded.
Jamie realized it was coming from the data techs’ break room. He went to the door. It was locked.
“Hello?” he repeated.
“Fuck off,” the voice said.
“Are you the data tech on duty?” he asked.
“What’s it to you?”
“I’m one of the doctors on duty.”
There was a silence and then he heard, “Fuck off!”
Jamie considered his situation. He had no authority over the data techs and clearly this one knew it. He also had a room full of patients to process and without the data tech he couldn’t treat them. His choices were report the data tech negligent and fill out a lot of reports, attend three meetings and risk getting an adverse report on his file, or report the data tech sick and unresponsive. He found a monitor and reported that the data tech was sick and unresponsive, condition: unspecified, location: inaccessible in the data tech break room. An emergency response unit and a data tech union steward would be along in a while.
Jamie looked around the room for the vital unit. He found it was powered down and password protected. He knew it would be a bad idea to take the data on his own. But being behind on treating patients was equally bad as offenses went. Jamie walked back to his exam room to find Mrs. McCormack still texting away furiously.
“We are going to have to do this old school,” he said to her, and took her wrist in his hand.
She said nothing.
Jamie waited several seconds. He dropped her wrist and looked at her.
“My son thinks I’m crazy. He and his wife are trying to have me committed,” she complained.
Jamie checked her other wrist. “I’ll be back,” he said.
“People are unappreciative of what they’ve got in their lives. I know they don’t appreciate me,” she responded, then returned to texting.
Jamie knocked on Dr. Locum’s exam room door. There was no answer. He knocked again. Still no answer. He walked in and found Dr. Locum standing handing a scrip to a patient.
“Just take this down to pharmacy and they will fill your scrip,” he said.
“I’m always shocked at the sort of nonsense people get up to,” the patient said, snatching the scrip from Dr. Locum’s hand and then left.
“Dr. Locum?” Jamie said.
“Next!” Dr. Locum called out.
Another patient shuffled into his office. Dr. Locum scanned the patient’s ID and insurance and then pressed a button. A scrip appeared and he signed it. “Just take this down to pharmacy and they will fill your scrip,” he said.
Jamie went over to Dr. Locum and reached out for Dr. Locum’s wrist. Like Mrs. McCormack’s it was cold and he felt no pulse.
“Patients never appreciate the education, skill and judgment involved in being a doctor,” Dr. Locum complained. Then he called out, “Next!”
Jamie backed away from Dr. Locum. None of this made sense. He didn’t have a lot of experience in the old school techniques, but he knew you should feel a pulse. There was the sound of an alarm. At first he thought it was the abandoned patient alarm being set off by Mrs. McCormack. But he saw people in black uniforms rushing into the clinic. He went over to ask them what was happening.