“Sometimes I shut down for a few milliseconds and reorganize my files. That’s kind of what people do when they sleep, but I do it a lot faster. Hmm, Linda, have you had any swelling in your feet or ankles?”
“Sure, after I’ve been sitting in a chair or standing for a while. Isn’t that normal? Maybe my body still thinks I’m pregnant?” There was more than a note of sadness in her voice, Thorny thought.
“Hmm, I wouldn’t think so, those hormones should be out of your system by now. You said something about a stomach ache?”
“Yes, sometimes after I eat.”
“Oh. Thank goodness I don’t have to eat the food here!” Angel joked and they all laughed.
“Can you show me where it hurts?” Angel continued to ask questions for the next five minutes. Finally, she finished with “Any other problems, anything else you want to tell me?”
Linda squinted for a second. “Nothing that I can think of.”
“If you do think of anything else, let me know. Right now, I’d like to do a physical examination. Is that OK?”
“Sure.”
Thorny rose out of his chair. “Let me step out so you can put on a gown—”
Linda laughed. “That’s OK Dr. Thorny, you’ve seen everything before anyway.”
Thorny watched Angel do a brief but thorough examination—one that was far more thorough, he reflected, with her built-in sensors than he could have done with only a stethoscope and the few basic instruments in the room. They fed a blood sample into the office wall terminal, ran a saliva slide under its microscope, and had Linda step up and down Thorny’s battered old kiddie steps wearing a cellular cuff.
After Angel finished, she spoke to Linda.
“Linda, do you mind if we have you sit outside in the waiting area for a few minutes? I need to talk to Dr. Benson while we wait for the lab results.”
For a second Thorny was afraid Linda was going to ask, “Why? What did you find wrong?” But instead she smiled back and said, “Sure.” He walked her out and she settled down with a smile to a coverless magazine that looked like a relic from the twentieth century, and probably was.
Back in the examining room, Thorny asked. “What do you think?”
“I’m worried. Her symptoms suggested at least mild congestive heart failure, and my examination confirmed it. She’s definitely retaining too much fluid—in her lungs, liver—everywhere. So I did a complete diagnostic check on her implant.
“Fortunately, there were no large blood clots inside the chambers, or on its valves. But it’s still not working as well as it should. The Model 4 Rockwell is rated for a peak cardiac output of 4.9 liters per minute, but hers is down to 2.8. There have been some reports in the past few months that smaller units like the Models 4 and 5 may lose efficiency much sooner than they’re supposed to owing to problems in the semipermeable membranes used for oxygen transfer. The recent article in—”
“I’ll take your word for it, Angel.”
They sat silently for a few minutes. Angel’s programmed knowledge of the pathophysiology of congestive heart failure, Thorny knew, was more exhaustive than his—but the basic points were simple. When a human heart began to fail, the body retained water. With a little extra fluid, the heart’s reflexes made it beat more forcefully, and for a while the person did better.
But if the body kept too much of it, the excess fluid actually made the heart work less efficiently. Then fluid leaked out into the lungs, replacing the air that was supposed to be there—and the person very gradually began to drown. When not enough blood and oxygen got to the rest of the body, the kidneys and other organs eventually failed too.
Linda’s mechanical heart had none of a human one’s reflexes. In her any extra fluid was “too much”—and, if it got worse, could kill her.
Angel’s face became very serious and professional. “What did Dr. Creighton think?”
Thorny grunted. “Dr. Creighton thought everything was ‘fine.’ ”
Angel looked puzzled. “But what about her symptoms and—”
“Angel,” Thorny snorted, “Dr. Creighton doesn’t even know that there are any symptoms because he didn’t listen to Linda. So he didn’t bother to examine her, didn’t check her unit, or even order blood tests. Why go to all that expense if everything’s fine?
“I don’t understand. Why didn’t Dr. Creighton listen? Why didn’t he want me to see her?”
Thorny sighed. “I don’t know, Angel. For the first, you have to have a lot of self-confidence to do what Elvis does; it’s hard to absorb contrary data if you think you already know everything. Nor does it help to need to impress people so much that you can’t admit you need any other input. For the second,” Thorny shrugged, “maybe he sees himself as John Henry racing the steam hammer.
“Hell, I’m the one who should feel threatened. You’d make a great G.P., Angel. I may call myself a G.P., but really there’s been no such thing as a general practitioner for almost two centuries.” Actually, to be technical about it, he really hadn’t been a “G.P.” for a long time himself; he’d gone back and completed a family practice residency five years after he’d finished his internship, even done an extra two years of obstetrics—and a year with the army in Zaire back in oh seven had left him with a lot of surgical experience he’d rather not have had. But, as a slightly pugnacious “badge of honor”—especially around some of his more snobbish colleagues—Thorny still liked to call himself a “G.P.”
“Back then, if a physician knew how to saw off a limb and deliver a baby—if they had a supply of morphine, calomel, foxglove, and maybe a few anemic leeches—they could do just about everything that could be done for patients. But as the ‘science’ part of medicine grew, no one doctor could know or do everything anymore—so some, and nowadays most, became ‘specialists.’ ”
Thorny exhaled deeply. “And now we’ve come full circle. With your programming, and a little more experience, you can be a ‘general practitioner,’ in the literal sense. Potentially, not only will you be able to do everything I can, or Creighton can, or any other specialist can—but you’ll be able to do it better. Someday, instead of you being my assistant, we poor human doctors will be assisting you!”
Angel looked concerned. “I don’t want to threaten anyone. I just want to be their friend.”
“Progress, Angel. As long as I’ve been around, there’s been a kind of de facto hierarchy among doctors, with ‘specialists’ like Creighton at the top of the pyramid, and ‘generalists’ like me a lot closer to the base. I think Creighton knows that if you succeed, his prestige is going to suffer. The bottom line, though, is that the kind of advance you represent is going to help patients—and that’s a lot more important than bruised egos.”
“Don’t worry, Dr. Benson. As long as I’m around, you’ll always have a job with me.”
“That,” he laughed, “makes me feel so much better.”
Angel started to laugh too, then froze for a second. “Linda’s test results are in the hospital computer.” She recited a long list of lab values.
“Well?” Thorny knew all too well what they meant, and it wasn’t good. But he wanted to hear Angel’s interpretation; diagnostics were one of the first and most successful uses of cybernetics in medicine, providing everything was in the database.
“The low serum sodium and elevated liver enzymes are worrisome, but her BUN of 83 and her creatinine of 4.1 are very alarming. They were only 20 and 1.2 when she was discharged from the hospital.” Angel paused. “If this goes on, she’s going to lose her kidneys—and that won’t help her implant either. I think she’s going to need a real heart much sooner than we expected.”