We are excited to announce the results of this year’s medical sci-fi contest, and to present to all our readers the top three stories, as decided by our distinguished panel of reviewers.
First, we would like to thank Epocrates, a company that generously donated to the winner the latest version of Epocrates Essentials Deluxe, a premium mobile suite of drugs, diseases and diagnostics that also features a medical dictionary, coding reference, clinical calculators and more, as well as the latest Palm® Tungsten™ E2 handheld. Medgadget is also awarding to the winner a boxed set of The Complete Wreck (A Series of Unfortunate Events, Books 1-13) by Lemony Snicket.
We would like to extend our appreciation to the judges, all of whom are our friends, who joined Medgadget’s team in grading the entries: Dr. Allen Roberts from GruntDoc, Dr. Val Jones from the newly opened Getting Better, and Amy Tenderich from Diabetes Mine.
And now to the winner. By a majority decision, the winner of the 2008 Medgadget’s Sci-Fi Award is…Mr. Charles Pappas for his story titled Different Day, Same Chip. Mr. Pappas tells Medgadget that he is a Senior Writer for Exhibitor and Corporate Event magazines, was also Yahoo Internet Life’s investigative reporter, and has written for Advertising Age, Smoke, POV, and Nerve. His first book, It’s a Bitter Little World, an ode to film noir, was published in 2005 by Writer’s Digest Books.
Please also meet the runners up: Kevin Bond for 30 Minutes of Clinical Ethics and Daniel Gow for the story titled APA 4000. We would like to extend our heartfelt appreciation to all the talented writers who submitted their prose: it was a competitive contest, and we look forward to reading your entries next year.
And now to the part everyone has been waiting for: the stories themselves. We hope you’ll enjoy reading them as much as we did…
UPDATE: For your convenience, you can print all three stories and have them on the go.
Different Day, Same Chip
by Charles Pappas
Calories In Today: 2,875
Calories Out Today: 1,180
I knew I shouldn’t have had that Krispy Kreme. I thought I nuked
enough calories on the treadmill this morning but nooooo, that glazed
vixen donut had to rear its raspberry- filled little head and give me
that come-gobble look.
Your health insurance premium for the next quarter is $397.55.
OMG, I hate when they Twitter that annoying message to my iPhone. I
want to take a Ginzu knife and carve the RFID chip out of my wrist —
but that would violate the end user agreement, which, BTW, Craig
Venter himself couldn’t have decoded.
Signing up for the chip implant will save you 20 percent on your
premium, the HMOs say. You’ll be able to take control of your health,
the HMOs promise. Well, yeah, if by “take control” you mean they
monitor you 24/7. Calories in, calories out, glucose, cholesterol,
heart rate, blood pressure, and blood alcohol level, a constant
calculus of your well being. You’re free to have the chip surgically
removed, of course. You’re also free to inform your auto insurance
company that you’re going to drive without a seat belt, deactivate the
airbag, and hold a can of Pabst Blue Ribbon in both hands while you
steer with your feet. It’s an automatic cancellation, the blue screen
of insurance death.
I took the stairs to the office and skipped lunch. How much do I
burn per hour when I don’t eat? I forget.
Calories In Today: 2,875
Calories Out Today: 1,527
Your health insurance premium for the next quarter is now $383.57.
I only use the calories in and out, and health insurance premium
factoids. I only update them every time the calories change and it
shakes its Magic 8-Ball and recalibrates what I’m going to hemorrhage
out of my checking account. I downloaded a widget that ribboned the
info across the bottom of my Firefox browser like those news crawls on
MSNBC but the stress of just looking at it raised my cortisone stress
hormone level higher than a Dubai skyscraper, which raised my
insurance premium, which raised my cortisone…Sisyphus, table for
When Medtronic came out with the chip, no one believed that it
would sell. “Cash in These Chips,” The Wall Street Journal snarked.
Who would want their insurance company getting stalker-y inside their
bloodstream? Then Aetna-Cigna started making you an offer you couldn’t
refuse: you don’t have to be chipped, it’s a free country,
Constitution, Bill of Rights, blah, blah, blah, but we don’t have to
gamble on your Marlboro-smoking, Budweiser-drinking, Guacamole Bacon
Burger-scarfing butt either. No chip? No problem — for them. Your
premiums doubled and your minimum deductible exploded like an ejector
seat to $1,000, $2,000, sometimes $2,500. No exceptions. It was as
legal as it was lucrative. Every HMO followed suit like they were
running a red light. You had no choice, really.
That’s when Google and Nintendo got in the act. Overnight, Mr.
DontBeEvil.com, started buying the aggregate data form the HMOs and
posting their own HMO -Health Maps Online. You could satellite-eye the
HQ — the Health Quotient, a composite number of all the tissue and
chemicals the chip analyzes — of an entire country, or zoom right down
to a city block — and how hard was it then to suss your prospective
date’s HQ? Nintendo co-marketed all its Wii health and fitness games
with the HMO’s: For every dollar you spend on Wii, they assured us
with some very professional-looking Venn diagrams, you’ll save two on
health care. HQ became a social technology thing, like cell phones,
iPods, Facebook. After that, like the clear-cutting they did on
privacy protections years ago, there was no resistance when the
insurance companies rewrote the end user agreements. In exchange for
an on-the-fly 10 percent drop in your next premium, they sold your HQ
to auto insurers and life insurers who jacked up your rates 10, 20, 30
percent. I keep thinking of the old saying “When you dance with the
Devil, you don’t change the Devil. The Devil changes you.”
Calories In Today: 2,875
Calories Out Today: 1,527
Your health insurance premium for the next quarter is now $385.55.
Oh, jeebus I forgot — the cream in that venti coffee is like 50
calories a tablespoon. Maybe the extra caffeine will jitter off them
off. I can’t even imagine what my HQ is. I don’t even look at
anymore. They probably don’t even use a digital number anymore; I bet
it’s a photoshopped graphic of Amy Winehouse holding a scythe now. The
goal HQ for my age bracket is 15, a composite number of all the tissue
and chemicals and goo the chip analyzes. Apply for a job, ask for a
loan, sign up for a room in assisted living, they all can all buy it
just as easily as they do your credit score. They say every HQ
secretly transmits your DDD — your Due to Die Date — to your insurer.
Snopes.com says DDD’s are an urban legend, like Chihuahuas causing
asthma. But I don’t know. In an age of miracles, how can you tell
what’s impossible from the mundane?
The new generation chips now read infections, viruses, even
impending heart attacks. If I consent to have one implanted, I get $50
off my next premium. Of course I have no clue how many companies they
vend my information to, selling my life’s data like slavers selling
bodies. When I eventually deal with some of them, as I must, I don’t
know how much they extort from me. I don’t even know how much my HMO’s
premiums will escalate when the new chip starts analyzing a body that
only ticks like a slow-motion time bomb toward decrepitude and
I only know that powdered strawberry-filled looks delicious.
Calories In Today: 3,177
Calories Out Today: 1,702
Your health insurance premium for the next quarter is now $402.55.
30 Minutes of Clinical Ethics
by Kevin Bond
The door opens and Amanda, the staff nurse, hands me a cup of coffee
as I struggle off of the cot. Ugh. I’ve been on shift for over 24
hours. It feels like I just put my head down for a moment to sleep.
“What do we have?” I ask her.
“Transport accident. Something happened on the shipping end. We have
the body ETA 15 minutes. Dr. Sanders is already in the ER ready to go.
If the body makes it we have Dr. Michaels set up in Room 231 to
interview the patient. You should get the call soon to see if you are
I absorb all this while sipping the coffee and trying to clear my
head. Could use some more sugar, but not bad at all. Sanders was old
school. Save the body no matter what! Quantity of life is what
matters, who cares about quality. Michaels, as a psychotherapist, was
more progressive, focusing on quality of life. That same old debate
that won’t go away. Although in the case of transport accidents,
Michaels has the easier job, assuming Sanders can save the body.
Michaels just has to figure out if there is a mind left.
As we leave the room Amanda introduces me to a new face. “This is
Debbie. Debbie is a ‘nurse shadow’ following me around for a few
shifts. Part of her nurse program.”
As I shake her hand Debbie asks me, “What do you do?”
Amanda laughs and says, “Oh him? That’s our EC. Ethics Cop. Watch your
step around him!”
I can tell Debbie isn’t sure whether or not Amanda is joking. Trying
to calm her a bit I tell her, “Not really Deb. I’m just the clinical
ethicist on call.”
She looks puzzled. “But, what do you do?”
Oh boy. Time for a mini-lecture to the newb. I lead them to my office
as I begin to talk.
“Well Deb, you probably already know most of the roles of the medical
personnel here, so I’ll skip over job descriptions for doctors,
nurses, pharm techs, organ harvesters, eco-nutritionists, etc. They
all work together to care for the health of patients. Unfortunately,
sometimes there is not agreement on what is ‘best’ for a patient. When
that happens, I get called in to adjudicate the case and make
decisions. In some cases, extreme cases, someone has to decide who
lives and who dies. I’m that someone.” I remember a line one of my old
profs used to chant to us “I decide who lives or dies! I decide who
lives or dies!
“That’s horrible! What gives you the right to play God?”
Oh boy. Sounds like a holdover from the religious uprising from a few years ago.
“I only wish I could play God. If I could, then you can damn well be
sure that there would be no more pain and suffering in this world. But
I’m not all knowing, all powerful, or all wise. Instead I’m only
human, all too human. But when people cannot decide on their own…like
when science and technology advance so far that we know a lot about
what we can do…but have not caught up with what we should do…someone
has to make that call.”
We finally got to my office. Leading them in I turned on my light and
fired up the computer. Amanda made herself comfortable on my couch,
while Debbie chose a chair. Before I could launch into a
philosophically dense lecture Amanda interjected, “Why don’t you tell
Deb about what your role is in this case?”
“Okay. We have a transport accident. Although the news generally gets
censored about this type of thing, you will see it somewhat frequently
in a hospital. Some glitch in the system causes a transport failure.
‘Best case’ is that the body simply never materializes at the delivery
site. No body, nothing to deal with except death certificates. A ‘bad
case’ would be something where a malfunction causes either incomplete
dematerialization or incomplete materialization. These types of
problems range from missing parts to misarranged parts…kind of like a
bad car wreck. Although messy, they are still relatively
straightforward to deal with.”
“What happens if our patient is a ‘bad case’?” Amanda prompts.
I gathered my thoughts as I take another sip of coffee.
“Well, some decisions are easy. If Sanders can’t patch up the body
then we have some spare parts for the organ bank. Misfortune for one
turns into salvation for twenty-four. But if he can patch up the body,
then Michaels will evaluate him. If there is a body without a mind,
then we can ship the body to one of the government reprocessing
centers. A new identity will be implanted, and society will have
another civil servant or soldier.”
I fall silent at this point, not sure if I wanted to just skip the
next part or go ahead and deal with it. Implanting identities could be
a controversial topic for some people, especially if they were not
Amanda decided not to let it slide, “And if there is a mind?”
“Then it depends on whether it was simply a ‘bad’ case or a ‘tragic’
case. Once I get my call I’ll know which type we are dealing with. If
no delivery was made we keep the patient in the hospital untill he is
recovered. Hopefully he can go on with life without to much
psychological trauma to deal with. However, if a delivery was
made….and the delivered person has both a mind and a body, well then I
have to decide which one is the original and which one is the copy.”
Debbie interjects, “What does it matter? Aren’t they the same person?”
Okay, so maybe she is not a religious type.
“You will have to come talk to me some other time about the
metaphysics of sameness in transport accidents. Our practical concern
is that the Government has decided that ‘copies’ are not citizens and,
thus, do not deserve the rights, responsibilities, and privileges of a
“But what happens to them?”
“As the hospital’s clinical ethicists, if we have the copy I will
process it and then turn it over to G’EthCen Agents when they come for
it. After that the Center will determine the best use of the copy for
society…” at that point my Palm started to buzz.
I sat down my coffee cup and picked up the Palm. After it recognized
my thumbprint the screen came to life with the G’EthCen logo. I
plugged in my CAC Card and waited. A message scrolled up the screen,
confirming a transport accident and listing the shipping and delivery
sites. I confirmed that we had the shipping patient and tapped on the
icon for the delivery site. I noted the code on the screen and signed
I put on my poker face, “Well, looks like I got up for nothing. No
Amanda’s pager went off.
“Looks like our patient is here. We’ll call you if there are any
complications. Come on Deb. Let’s let our Ethics Cop have some nap
time.” They got up and left. Deb gave me a funny look as she glanced
back on her way out.
I sat at my desk a bit, contemplating theory versus practice of
philosophical ethics. Why isn’t the ‘copy’ just the same as the
‘original’? What gives the Government the right to decide these
things? How long can I ‘play God’ until I crack under the pressure?
Some things they just don’t really teach you how to handle in college.
by Daniel Gow
When Mike Evans, M.D., was called before the Board of Directors to
testify, it was fair to say that the series of events that had lead up
to the hearing were not what he’d expected the first time he’d met
Bob. Bob had not only saved his life, but shown him the terrible path
he had set himself on purely out of fear of losing his job. When
asked by the Board to explain the night of October 26th, Mike would
tell them it was the scariest, and most humbling, night of his life.
The series of events began on the morning of June 2nd, at 6am when
Mike entered his office at his clinic on Delmar Avenue. There was a
single voice-mail waiting on his desk phone from Dr. Leman, of the
Board, informing him that his APA 4000 would be arriving today. The
Automated Physician’s Assistant, model 4000, was heralded by its
manufacturer as the greatest innovation in medical technology the
world had ever seen. At its core was a computer capable of making
medical diagnoses, linked to a central database that would share the
statistical information on the diagnoses with all of the other APA
units. Every diagnosis made by an APA was analyzed by a licensed
physician and an assessment was fed back into the unit, and how well
the unit had performed was shared between all units across the globe
to improve the next diagnosis which would again be analyzed, and so
on. The more APA units in practice, the manufacturer explained, the
better they became at diagnosing patients because each task an
individual unit performed was measured against all the previous
assessments of every unit in operation. All that was just the core of
the unit; the shell was a human shaped robot that could talk, listen,
take a patient’s temperature and blood pressure, and scribble down
notes on a clipboard. The APA 4000 was designed to take the place of
a human physician’s assistant, provided of course, patients didn’t
object to being left alone in a room with a robot.
For the first couple of days a technician from the manufacturer had
been working with the clinic staff to configure the unit to meet their
unique needs, and for the most part Mike avoided the thing. No
computer, in his opinion, would be accepted by his patients as
trustworthy, and quite frankly the Board had wasted an enormous amount
of money. On June 5th, the clinic’s APA saw its first patient, Janice
Anderson. After a few minutes with her, the unit walked out of the
room nodding to Mike as it passed him in the hallway. He stepped in
fully prepared to deal with a distraught patient.
“Why, that was the most marvelous young man!” she declared, forcing
Mike to pause for a moment.
“You do realize that was a robot, Mrs. Anderson?” he asked.
“Oh of course I do, Doctor, don’t be silly. He has such a lovely
voice, very friendly. I didn’t catch his name, though.”
Mike thought about this for a moment, realizing that the only ‘name’
they had for the machine was its acronym and model number.
“Bob,” he replied.
“Marvelous! Well, I was most pleased with your Bob. I think it’s a
By July 17th, the APA, now known by everyone in the office as Bob, had
seen and diagnosed fifty patients. Following the instructions given,
Mike had carefully assessed each diagnosis and entered the information
into the console provided with the unit. Out of those fifty, twenty
diagnoses were declared inaccurate beyond reasonable interpretation.
Mike was satisfied that such poor performance by the unit was enough
to cause a recall, and he e-mailed as much to Dr. Leman. The response
was very clear; the Board had invested a significant sum of money in
the machines, other clinics were not experiencing the same performance
issues, so it was clearly Mike’s assessments that were wrong. The APA
would remain in place.
Two months after arriving at the clinic, Bob had seen over one-hundred
patients. An analysis of APA performance across all their clinics had
shown that patients with similar diagnoses according to the APA units
were for the most part paired with similar assessments from the
physicians, the exception being Mike’s clinic. On August 3rd Dr. Leman
had sent a strongly worded e-mail to Mike warning him against
attempting to foil his APA unit by providing incorrect assessments.
Frustrated with all of this, Mike left work early that day and drowned
the night away at a local bar.
By early October, Bob had become something of an involuntary
celebrity. He’d been featured in the local paper twice, and the
clinic had a seen a significant increase in patient visits once word
got out about the APA 4000 unit. It did not matter to them that Bob’s
diagnoses were not spot on; people were more comfortable explaining
their problems to a robot with a friendly face and a calm voice than
to an actual person. The amount of detail Bob recorded in each
session went well beyond what Mike could extract from a patient in the
same amount of time, but despite the wealth of information at hand
Bob’s personal diagnosis library was still performing poorly compared
to the other APA units, something which Bob brought to Mike’s
attention on the morning of October 24th after they’d both seen to a
patient with a wrist fracture.
“I do not understand this at all, Dr. Evans, I was certain she had a
mild case of bronchitis.”
“Happens to the best of us, Bob,” Mike assured him, giving the robot a
friendly slap on the shoulder, “but don’t worry, I’ve made the
adjustments and plugged in the correct data, you’ll straighten out
“If you say so, Dr. Evans. My library was configured to weigh my own
diagnoses and assessments much higher than the collective library of
all APA 4000 units. I am effectively ignoring the central library
when I consider a patient’s case. Do you think that is affecting me
“Not at all, you were configured that way from day one on purpose.
Don’t access the central library for your decisions, that is crucial
to our patients’ well-being,” Mike warned him sternly.
“I understand, Dr. Evans. The well-being of our patients is my
highest priority, and I will do nothing to jeopardize it. If you will
excuse me, I would like to read through your latest assessment and
process the data. ”
“Go right ahead, you’re doing just fine, Bob.”
Mike was assured that his unit would be recalled eventually as faulty,
it was just a matter of continuing to tweak the assessments to further
corrupt Bob’s library. And then life could return to normal, and the
machine that was threatening to take over his job would be removed.
That was what he believed, up until the night of October 26th.
It was two hours after the clinic had closed when there was a knocking
at the front doors. Mike had stayed behind at the office to tend to
some paperwork, and aside from Bob he was alone in the clinic.
Approaching the front doors Mike saw a man outside, hunched over and
looking quite ill. He yelled out to Bob to come give him a hand, and
swiftly unlocked the doors. Before he realized what was happening the
man outside shoved the door open and punched Mike squarely in the
stomach. The man knocked Mike to the ground before running past him
and into the clinic. Mike tried to call out but couldn’t overcome the
pain, he heard a door bust open behind him and assumed it was the
supply room. A few seconds later the man was back, running out this
time, and Mike clambered to his feet and stepped in his way.
“Look man, if you need help-” Mike began.
“Get out of my way!” the man yelled, glowering at him.
“Those cost us a lot of money, you know, and I can help you, just put
the drugs down.”
The man paused for a second and then motioned like he was going to do
exactly that, and just when Mike thought it was over the man had a gun
in his hand. The shot rang loudly in Mike’s ears and he crumpled to
the floor, the robber stepped over him and disappeared into the night.
The next thing he knew, Bob was standing over him.
“Bob! Call for an ambulance!” Mike cried and reached a hand up to the
robot that knelt next to him.
“Dr. Evans, are you feeling all right?”
“He shot me, Bob! Of course I don’t feel all right, now go get some help!”
“Allow me to examine you, Dr. Evans, this won’t take but a moment,”
Bob replied, leaning forward to inspect the gunshot wound.
“We don’t have time for your medical protocol!” Mike screamed through
the pain as Bob gently pulled his hand away from the wound.
“Yes, I see,” Bob replied, “This rash is nothing to be too concerned
about; a topical ointment will clear it up in a few days. I will make
a recommendation to the doctor on duty for a prescription ointment to
last a week. That will take care of it for you.”
“What rash? What are you talking about?”
“My medical diagnosis library indicates a mild rash across your midsection.”
“Your, your what? No!” The sudden realization about Bob’s faulty
library came through to Mike like a cold knife twisting in his
“Bob, forget your library, it’s irrelevant!”
“But Dr. Evans, in order to best serve the well-being of our patients
my own diagnosis library must carry a much greater weight than the
central library,” Bob reminded him.
“I was lying, Bob! I’ve been corrupting your library all this time!”
Mike cried, a blood-soaked hand gripping at Bob’s cold metal shoulder,
“Your own diagnosis library is faulty; do you hear me?”
“Should I access the central library and perform another diagnosis of
your condition, Dr. Evans?”
“Yes! Do it now!” Mike screamed.
Bob fell silent for an agonizing minute, and Mike could feel his
strength slipping away and his vision starting to blur. He could
barely hang on to Bob, much less crawl to the phone on the counter
several feet away. When Bob finally woke back up, tears were
streaming down Mike’s face.
“Dr. Evans! I have completed my secondary diagnosis, and it appears
that you have sustained a severe wound to the abdomen!” Bob announced
in alarm, “Please remain still, there is currently no other doctor on
duty at this clinic and I must alert the appropriate medical facility
of your situation.”
Bob stood and ran to the phone. Minutes later an ambulance arrived
and Mike was rushed to the hospital.
“So you were deliberately corrupting your APA 4000 unit’s internal
library?” Dr. Leman asked into the microphone.
“Yes,” Mike replied, seated at the desk facing the seven doctors on the Board.
“He was taking over, and I felt threatened by him. I didn’t want some
machine taking the place of real, human doctors.”
“I’m sorry, ‘he’?” Dr. Henderson leaned forward and asked.
“Yes, he, our APA 4000 as you put it, is named Bob,” Mike answered firmly.
“And this, Bob,” Dr. Leman continued, “How do you feel about him now?”
“Bob saved my life,” Mike replied, “And he’s one hell of a good
assistant. He can work at my clinic any day.”
On December 12th, Mike visited the clinic to see about a chest cold
that had lingered for three days and wasn’t responding well to over
the counter medication. The attempt to fault the APA 4000 unit’s
internal library had cost him his job at the clinic, but their finding
that no harm had come to any patients due to his actions allowed him
to keep his license and he would be allowed to practice again after
six months probation. After waiting a half-hour, Mike was lead into
one of the familiar rooms and found that Bob was waiting for him.
“Hello, Dr. Evans, how may I assist you today?”
“Just Mr. Evans today, Bob, I’ve a bit of a bad cold I’m afraid.
Think you can help me out?”
“Certainly Dr. Evans, it would be my pleasure.”