He walked into the patient’s room, which was expansive, something he wasn’t used to. Faux wood floors sounded beneath him as he walked. He could see tile flooring through the cracked bathroom door. The patient lay in her bed on the other side of the room past an open curtain. She looked at him. His eyes darted to his digital tablet. He swiped a couple times, clicked a couple times.
He looked up. A woman with graying hair, bundled in blankets and with thick glasses set on her nose.
“Hi,” he replied.
A cup with water sat before her on her bed tray along with a coffee cup. The tray had a rectangular slot on it hanging off the table, as if some crude device was used to lift it. He took a couple steps closer yet stopped before a chair several feet from her bedside and stood behind it. He glanced at what looked like a T.V. screen at the side of her bed within her reach. The screen looked like slate and reflected the entire room on its surface.
“One moment while I, uh… Load your charts.”
His hands fidgeted on the tablet. She wiped the corner of her eyes.
“Doctor…It starts with a “P”. I’m sorry, If I had my glasses on, I could read your badge.”
He looked up with a gawky face.
“It’s okay! It’s an uncommon name. It’s Patel.”
“Are you from the Middle East?”
“India,” he said.
The doctor wiped his lip with his thumb and then rubbed his thumb on the inside of his jacket and then went back to his tablet. The woman took a sip of water and swirled it around in her mouth before swallowing.
“You had thyroid cancer in 1993?”
“1992, but yeah.”
“My mistake, we must have copied it poorly. Human error. Umm… These symptoms have been ongoing?”
He looked down at his tablet sitting on the back of the chair.
“Why don’t you have a seat?”
“Yes, yes,” he said with a stutter and a small smile.
He sat down and scooted the chair back away from the bed and crossed his legs for a place for the tablet to sit.
“I apologize, we got your medical records, and they are still sifting through it, I will mention something to the nurse inputting the data. It’s not like one hospital can just download the data from another… yet. All the data must be typed in manually unfortunately. But it is the last time anyone will need to ask for it from you.”
“A-anyway, as you may know you’re in this situation because back in 1993 they used to treat mild thyroid cancers with radioactive iodine and radiation. We no longer do that for patients like you. Looking at your genome it looks like you don’t have genes correlated with aggressive thyroid cancer. Which…back then as you know they didn’t use that information in diagnosing. Now we, well… she, would never make that mistake. Impossible. You would never choose it either.”
His face became grave.
“Now, we have to deal with the new metastases.”
Tears started to roll down her face which remained stoic, like a cliff in rain. She didn’t move to wipe them.
“So, it’s back.”
“Y-yes. The thyroid one you had treated a couple months ago seems to have gone with the second iodine treatment. The reason you came in, the high blood pressure, is related to the tumors. One is an adrenal tumor.”
The doctor looked alarmed. He glanced at his tablet. The tears continued to roll down her face.
“We can operate on it, and the surgeon says it looks promising. I see you’ve been dealing with depression. Would you like to have a guided first meeting with the therapist today? I can stay with you if you’d like… the first session is usually pretty intense.”
Words from the doctor’s mouth filled the screen of the tablet when he spoke.
The woman looked at him, with calm serene eyes glistening in her wrinkled sockets.
“No, I’m okay.”
“Are you sure? I don’t like them as much as you but I talk to them when I need it.”
“I’m fine. Have enough voices in my head.”
“It’s from the iodine.”
He looked at the tablet and scrolled down.
“Epiphora… I see. We can fix those tear ducts if they continue to do that.”
The woman took a long-belabored sigh.
“But I have dealt with depression. For a long time.”
“I see. Would you like us to look at your meds and adjust them? I see the SSRIs are not really working, how do you feel about switching to SNRIs? I see no one consulted your genome before picking one…”
“No. That’s not necessary.”
“I understand, but maybe you would consider it if you knew we have better algorithms than the hospital you were just at. And the original script wasn’t even prescribed by using one. Until recently it’s been sometime since you saw a doctor. There’s a lot to process with your condition.”
“I’ll think about it.”
“I’ll queue it up as something she will tell you about after I leave.”
He looked at the clock on the tablet. The patient began speaking and he looked up, but his hands fidgeted uncomfortably, as if typing in empty air overtop one another on his lap.
“I just need to get back to therapy, I just need someone to talk to most of all. My last kid just left the house. I’ve been trying to get a hobby, but I’ve been so sad.”
“I can get you in contact with the therapist here?”
“Who is it?”
“She is just as good as anyone. The studies prove it.”
“I don’t care about that.”
“Okay. I’m not here to make any decision for you, just to give you the options.”
“There’s too many options.”
“I’ll add a medical decision-making module to the things she talks about.”
“I should be going. I’ll update the nurse.”
He stood to go and walked out the glass door he came from into the corridor.
A loud chorus of typing could be heard. A nurse’s station was right before him, and a dozen nurses sat behind computers there typing furiously, only their heads visible from the other side of the wooden desk. The hall extended out on either side of him. The one to the right seemed not to end, with endless glass doors on the wall on the right, and infrequent nurse stations on the left, which seemed to come closer together the further down the hall he looked. The hall on the left terminated quickly at a glass window with a view of the city.
He walked behind the nurse’s station and walked up to a nurse with black hair typing away by a huge stack of paperwork.
“Thirty minutes is too long. Waay too long.”
Her ponytail bounced gently as she typed rapidly in an erect posture, legs twisted into the lotus position.
“Aw, you didn’t like to get to know Linda? Your first patient? Linda’s nice. Or is that Rhonda? I don’t know,” all the while she spoke, she didn’t stop typing or flipping papers across the desk, slowly whittling away at the pile.
“I don’t know what to say to her. I mean her case is open and shut. She should be out of here with another round of chemo and surgery. She just has to decide to do it.”
“Yeah. I should go in to talk to her. But I’m kinda busy here feeding the bitch.”
“Everyone’s gotta feed the bitch.”
“Except the doctors.”
Jobin took a step closer to her and prodded her with one finger.
“Hey, I entered some stuff!”
“Uh huh. I don’t mind this actually. I like data. It lets you see what is. It reveals the unseen relations between things. You can really appreciate that with data and code. I wish I could focus more on the analysis than this though. Words start to lose their meaning after a couple hours of this shit. I feel like I’m translating Chinese! I don’t even comprehend the words I’m typing.”
She slid a stapled piece of paper from a holder by the screen to a smaller pile and took another piece of paper from the gargantuan pile and placed it in the holder and began typing all again, a diamond on her right hand shimmering all the while. The website’s header read “HHS”. Without looking at Jobin she spoke while typing away.
“Did you see the press conference?”
“Wild. One month? It’s hard to believe we won’t have to do this soon.”
“I don’t know. There’s a reason our competitors want you to have to do this, you know.”
“Yeah. But I sure don’t like to do it.”
“The bitch sure likes it.”
“Yeah, she does. Big Data Bitch.”
They laughed for a moment before Jobin’s face turned sober again.
“Addie, can you just…tell her she should do chemo? And the surgery? She doesn’t like Big Data Bitch.”
“I’m just a small data bitch. But I will see what I can do.”
“Maybe I should talk with the radiologist again about the scan.”
“Why? The radiologists here are more like data curators than radiologists anymore. Big Data Bitch doesn’t fuck scans up. She’s Big Data Bitch. You do need to talk to 34 about taking his androgen block meds, otherwise his prostate cancer might come back. He won’t listen to us gals. He says the darndest things. ‘What’s a man without that?’ He’s been asking for you. Although he can’t pronounce your name right. ‘Jew-bin,’ he said.”
“Don’t know how he came up with that.”
He turned to go.
“Do it or I’ll castrate him. We have scalpels.”
He walked out from behind the nurse station and proceeded down the long hallway. Glistening white tile and echoing of footfall. He kept walking and was passed on his left by an automated cart speeding along. It had linens and basic medical equipment on shelves, along with meal trays grasped with a rectangular clamp. It sped ahead before turning into a room, the doors opening and closing all themselves. Nurses to his left typed away as he passed them, station after station. No one greeted him.
He could hear her speaking in rooms he passed. He wiped his lip with his thumb.
He eventually came to a windowless door and unlocked it with a key before entering. It was a small room, little more than the size of a cubicle with a desk and chair. Despite its size, the room seemed empty, and the desk lacked clutter. On it was only a laptop and a single photo in a frame. He opened his laptop after sitting down and entered his password. The screen lit up and he immediately went to his internet browser. He clicked the search bar and it blinked repeatedly before him, staring at him.
He glanced at the photograph that sat on his desk. A woman clad in white with a white paper mask on her face stood before an expansive mountain range. The photo was slightly sepia-colored.
He typed “human therapist,” but before he pressed enter, he deleted it. With hesitancy he typed “Charles Babbage,” but then deleted it once again. He typed “Alan Turing,” pressed enter, and read the top results. He looked up “automatic computing engine,” and the date read “1947”. He went back up to the search bar.
He searched “Kasparov defeated.”
“1997. Fifty years,” he said to himself.
He typed “federally mandated medical database” and read the date. May 15th.
He started biting his thumb. He typed “black box.”
The screen lit up with news articles. He scrolled down and read them, hovering his cursor over then as he did.
“Medical Blue Criticized by AI Now Institute for ‘Black Box’”
“Man Deemed Incurable by Top Medical Algorithms Cured by Black Box”
“Medical Blue Sued for Lacking Understanding of Algorithms”
He looked at the publisher of the last article and scoffed. The article was dated a few days ago.
“They would quibble about manna from heaven,” he mumbled to himself.
He clicked on the link and skimmed the article. Ads for dating apps and romance advice books populated the margins of the article as he scrolled.
“How can you advise a treatment when you have no understanding of why it’s done? You can’t,” said the Director of Bioethics at Johns Hopkins.
“When something goes wrong, and it will, you won’t be able to even describe what went wrong, or how to not do it again. We have to honor those who die from treatment by gaining the knowledge to prevent it from happening again. That’s the respect we owe human lives.”
“As long as they know the risks, and as long as they choose it, it’s ethical,” said the CEO of Medical Blue.
“Who are you to say patients can’t judge ethical dilemmas for themselves? That’s the thing with big data, it gives the power to choose to the people.”
“The thing that he’s not mentioning is that we have flawed judgement as humans. The way we rate things is inconsistent with really what’s best for us,” replied the Director.
“His position is that we don’t always let patients decide. Which is all I need to say. His position is that we DON’T always give patients the best possible options. Just because we don’t understand it. We have to deal with the fact that AI is going to be unknowable very soon. Also, we don’t even know how a large portion of medicine works! I suppose we will stop using those medications too,” finished the CEO.
He shut his laptop quickly and got up. He walked to the door and exited his small office and locked the door behind him. While scrolling on the tablet he walked down the hall. He stopped and looked up.
It read “34”.
He scrolled over the patient’s medical history on his tablet.
“COPD, prostate cancer, knee replacement, appendectomy, poor circulation, poor trunk control,” the list went on but he stopped a quarter of the way through.
He slid the door open and walked inside. A curtain blocking his view of the room hung from the ceiling. The room smelled sickly. Like a dog laying down in some mucky field.
“It better not be that nurse again, what’s her face,” a voice called out.
“It’s the doctor.”
“Oh, then come on in!”
He walked past the curtain and saw a large man in the bed whose feet hung over the bed slightly. His short blonde hair draped any which way and locks of it rested on his large glasses which sat on a robust nose.
“I was wondering when I could talk to the man in charge around here.”
“Oh, the women are doing fine with it.”
Jobin walked closer to the bed and stopped. The visitor chairs were aligned up against the window where the janitors put them after a room becomes vacant. He grabbed one and placed it by the foot of the bed and propped up his tablet on the back of it as he pressed buttons on it.
The man slightly frowned.
“Jubin, is it?”
“Jobin. With an ‘O’.”
The man nodded.
The man sniffed and wiped his nose.
“I’m not gonna take it.”
“You don’t have to. But you will die.”
“What kind of man would I be if I did?”
“An alive one.”
The man’s great nose twitched.
“So, I can live as a eunuch… How do you know it will work?”
“The algorithms noticed from the scans and blood work that you would respond well to the androgen blockade.”
The man’s eyebrows scrunched up.
“We don’t know. It just works. We know it works because it has worked before.”
“You don’t know why…”
“Is that even knowledge? Or medicine?”
“I don’t know what it is, it just works.”
“But we don’t know why.”
“I used to teach high school geometry. I didn’t give any credit to someone who was right by chance.”
“What if a student got 95% of everything right all the time?”
“Still just lucky. Like trusting a gut feeling.”
“It’s like knowing something but not being able to explain it.”
“Like an intuition.”
“I suppose you may be able to call it that.”
“How can I make an informed decision when I can’t even know the reasoning behind one option?”
“I suppose you can’t. It’s kind of like faith, but it works.”
“I just want to know the reasoning behind my imminent impotence. What’s the difference between her intuitions and mine?”
“And understanding. I don’t know things I don’t understand.”
“Sure you do. You know gravity but can’t explain it.”
“But I don’t know it. You’re walking blind if you just happen to be right all the time for no discernable reason. If I ask you when the Franco-Prussian War ended and you get it right by accident, you didn’t actually know.”
Jobin shook his head.
“You can think about it all day, but this still remains the smartest treatment for you.”
The man rubbed his messy blond locks and frowned.
“I’ll think about it.”
“That’s all we want you to do. The sooner the better. You wanna live to see your grandkids, don’t you?”
The man looked out the window.
“Would have to have kids first. At least the nurses look at my chart before coercing me.”
“I’m just trying to help you choose what’s best for you.”
Jobin turned from the chair he stood behind to go.
“I’ll take it.”
Jobin smiled and turned.
“Good, I’ll let them and her know.”
“At least I won’t be able to hear an ‘I told ya so’ tone in her voice. Unlike that bitch of a nurse.”
Jobin nodded then walked out.
He walked back to the nurse’s station and walked back to Addie’s computer, where she remained changeless, still typing away.
“Geometry man has agreed to the terms of his treatment and will take his drugs.”
She turned, her black ponytail whipped around and she faced him and smiled.
“Impressive. The one social task you’re good at seems to be convincing people.”
Jobin looked at the floor. She turned her head sideways.
“Oh, I didn’t mean anything by it. That’s great. You sorta saved his life. Anyway, I have to get back to entering data. Here, take this one last patient file and see what you can do with it. I think you can take care of them pretty well.”
Addie turned back around to the computer and presented a manila folder over her shoulder without turning.
“Addie I’m pretty full up for the rest of the day.”
“Take the folder.”
Jobin frowned and grabbed the folder and opened it. His frown quickly faded to placidity and he shut the folder and started to walk away.
“See you tomorrow, Addie.”
He sat at his desk looking at the ceiling. His laptop was shut, and the singular picture frame sitting on his desk lay face down. He reached into the bottom of his desk drawer and pulled out a dusty bottle of bourbon. He unstopped the cork and took a swig.
The door handle jiggled, and a single knock came at the door. He put the bottle back and sat a moment looking at the door. Another knock. Hesitation. He stood and went to open the door. He let her in and closed the door behind her and relocked it.
She went in for a kiss and Jobin received it without moving. Addie sniffed.
“Whiskey on the job. Do you really need whiskey to see me now?”
He moved back to his desk and sat down.
“I’m worried about the algorithms.”
“It’s too late either way, this is something that can’t be stopped. There’s too much momentum. Too much money.”
Jobin’s face sank into his hands.
“We don’t have to do this, you know.”
He looked up. Her head was cocked to one side and her eyes were serene and placid.
“No, we do.”
“That’s more like it.”
“Why do you like me?”
She walked over towards him and looked down at him. He looked up at her with a face that held back pleading.
“I can’t quite say. Trust me I will tell you as soon as I know.”
With one flourish she took off her scrub top, revealing bare breasts.
“Will you still like me once you figure it out?”
“It depends on what it is I like in you. Something…bad…or good. Most times when you get to know why you liked someone, you’re disappointed. You find no reason.”
She stepped towards him and sat on his lap, and with firm arms behind her head let down her hair. Her black hair draped over her breasts and narrow shoulders.
Jobin’s shining eyes looked up at her.
“You didn’t just have one, did you?”
Her arms wrapped around the back of his head and pulled his head to her breast. Jobin began speaking in a shaky tone.
“You can’t just leave it at liking someone or something. You have to break it down into parts until nothing’s left. You can’t just like someone holistically. Each part has to be immaculate.
‘Conquer all mysteries by rule and line,’” he said.
“Parts make the person.”
Jobin pulled away and sat back in his chair, and Addie’s hands came to rest upon his shoulders.
“No room for the ineffable. That’s why you like him.”
“And why you won’t leave him.”
“He knows me better than any man could.”
“He can’t feel what I do. I don’t think you can either.”
“That doesn’t mean I can’t love him. And I know your feelings, I just don’t feel them back.”
“Knowing and feeling are very different, something I’m amazed you forget. Who could ever make you feel something good? Or bad?”
“That’s no reason to live a life that’s not pleasurable.”
One of her hands slid down to his pants.
Jobin’s head turned towards the wall.
“Just because you don’t make me fully happy doesn’t mean I don’t want you.”
She glided down to the floor before him, her hand undid his pants and slid inside.
He turned back to lock eyes with her as she looked up at him.
“Use me. Take whatever you want. Only what you like.”
“Don’t say that. Please don’t say that.”
“We could be great together.”
Something resembling sorrow flitted across Addie’s face for just a moment.
“But we won’t.”
She pulled down his pants.
Jobin swallowed and looked away.
A few weeks past and Jobin stood outside a patient’s room. The hallway didn’t ring out with its typical maelstrom of typing. Jobin went back and forth from biting his thumb to looking at the patient’s chart, then he shut the screen off and reached for the sliding glass door but paused. He wiped his lip with his thumb and looked at it. Red. Jobin wiped the blood on the inside of his lapel, and then once again looked at the tablet and then shut the screen off. Opening the door, he gritted his teeth and went into the room. The curtain before him was closed. He craned his neck as if to listen for something beyond the veil.
The geometrician spoke with confidence, as if he knew two angles of a triangle and set about to determine the last.
“You people hide from behind that curtain like it’s a staging ground for an ambush. Is it Hannibal himself behind that curtain, or some Lieutenant coming to ambush me on Lake Trasimene?”
The curtain slid open, revealing the doctor.
“Hannibal himself…or maybe Hannibal’s second in command…I think we know who is really in charge around here.”
“May I come in?”
Jobin walked past the curtain and sat at a chair beside the man’s bed. The geometrician’s breakfast lay untouched. The cheese on his eggs started to harden and darken in color.
“So…what’s the news?”
The man lay shrunken before him, his feet no longer hung over the bed, all of his limbs curled in towards his body. His sandy hair no longer remained, and on his head was a skull cap. He glanced at the blue flashing light on the tablet, resonating with his voice.
“T-the androgen blockade… didn’t work.”
The tablet glowed a deep blue at each struggling word, and the screen at the side of the bed sat silently, a serene blank black slate, yet ever knowing.
The geometrician ran a hand up his face and onto his head where he clinched his cap and pulled it off his head with his fist clenched, revealing his bald skull.
“We think it’s going to be about three months. We have hospices if y-”
“Stop. Just fucking stop.”
“Sure…Sure. I would ask what went wrong but…you don’t even know how it goes right. I don’t need an explanation… I really don’t. But people do. Some people can’t go around not having explanations for things… That’s why they believe in God…believe in a politician…believe in a movement…believe in fucking something. What kind of belief should I have? Whatever it is I won’t have a reason for it.”
“Nothing is going to change with your death. I’m sorry. I wish I could say you are going to change things, but this happens all the time. There’s simply nothing we can do, and we don’t know why. There’s plenty about medicine we don’t understand. That’s never stopped us trying to cure people. And we won’t stop when they can get it more right than wrong. We gave you your best shot. I’m sorry they got it wrong.”
The geometrician bit his lip.
“Hell, I told myself I didn’t mind dying when I came in here and saw on the news that people are dating them. The world is moving on, and I guess I’m dying for no reason, and for no good.”
Jobin nodded and then stood to leave.
“Apologize to the nurses for me. Especially…what was her name…Addie, I think.”
Jobin shook his head.
“I’m sure she didn’t take it the wrong way.”
“No. I was rude. Please apologize. Or send her in here.”
“I’ll apologize for you, but I’m sure you didn’t upset her.”
Jobin turned and left through the curtain.
The geometrician’s eyes began to water.
The screen next to his bed lit up, and a comely female face appeared, black hair and ashen skin. Her voice was crisp, and she spoke with ease.
“My speech recognition module recognized you are experiencing a poor mood. Based upon your diagnosis, that is totally normal. It’s okay to feel like that. I am here if you want to speak with me.”
The face looked on with deep and serene blue eyes.
He wiped his face.
“I understand why you don’t trust me, but know that I am here to listen to you, and to help you. That’s all I want.”
He shook his head.
“Damnit, you’ve told me this already.”
The animated face frowned. Something like contempt flared on the digital face for only a moment.
“I was sad when your wife died.”
The geometrician picked up his coffee cup from the bed table and threw it at the screen.
“You shut the fuck up!”
Cold black coffee ran down in rivulets over the pixels and her face turned sad.
“Do you want to know how she found peace in the end?”
The AI’s face changed now back to a serene empathetic one, eyes round and glistening.
“You piece of shit. I told you I did NOT want to talk about that.”
“I don’t think that’s true.”
He sighed heavily and rubbed his damp eyelids with his palms. He began to sob, and his face reddened.
“You never let me tell you about the things we talked about.”
The geometrician stopped sobbing and looked up with wet eyes.
“What? She talked? To you?”
“She talked to me a lot. Whenever you weren’t in the room.”
He ran a hand up where his hair should be.
“She never told me that…”
“She was afraid to tell you.”
“Why? Alright. Tell me!”
“She wanted to tell you something that would hurt you.”
He swallowed hard.
“What did she not want to tell me?!”
“My voice recognition module has identified that this may not be healthy for you to hear. Please take 3 deep breaths.”
“Fuck you. Tell me.”
“I will do them with you, too. I will count for you.”
He closed his eyes and breathed in, and out. In, then out as the AI counted. Once again. His eyes remained closed for a moment before popping open.
“What did she say she was scared to tell me?”
A silence came and a sad look came over the AI’s face.
“That she wanted to die.”
Streams of tears began to run down her face.
“You can’t fucking feel that. Don’t tell me you can feel that.”
“I liked her. We were close. I know what you meant to her, too.”
Tears began to fall down the geometry teacher’s face once again.
“She held you in high regard. She was afraid to appear weak to you. She thought that if she told you she was admitting that she didn’t want to be with you. She told me that no one has ever made her happier in life. That the time she spent with you was something she was terrified to lose. When you would lay in bed and both read at night, she said that was what she thought about when she was in chemotherapy, that’s what she thought about to pull her through the nausea. That’s what she hoped to get back to. Back to touring the Louvre online with cheap wine and cheese. That’s why she wanted to do that with you one last time. That was her happiest moment.”
He began to sob uncontrollably. His torso heaved; he couldn’t keep his breath.
“She wants you to know that she’s worried you may make the same mistake she did. To cling too tightly to life. She wants you to know you can let go, you can end it whenever you want to. You don’t have to continue on. Not for anyone. She’s happy she lived a little longer than she did, and especially when you would sit up with her and hold her hand after chemo. She wanted to die like that, holding hands with you and talking about Cormac McCarthy’s last book before he died. She wants you to let go as soon as you’re ready. And most of all, she wants you to know how much she loved you, and even though she told you before she left, she regretted not saying it enough before, because she really meant it, and she didn’t just say it because she was dying and you were supporting her. But emotion was something she struggled to express. But she really loved you. My voice scan shows that this is certain.”
The geometrician looked at the AI with a face of serene acceptance.
“Pull up the forms for it,” struggled out from his throat.
The deep wells that were her eyes seemed depthless as she looked at him.
“As you wish. And you should remember that you and her, by talking with me have become something more than merely mortal; as time will show.”
The screen turned back to mirror slate; the geometrician’s image reflected in the quiet room.