A Complete Diagnosis

A story very loosely based on Matthew Eight and Nine

By Bob Freye
 

“A man walked into a critical care facility with one arm pressed tight against his chest. The nurse evaluated the type and degree of the injury and processed the patient for insurance and medical history before handing the case off to an ER physician. After a preliminary analysis, the diagnosis in layman’s terms was a simple fracture of the arm, about halfway between the wrist and elbow. It looked like a clean break, with no sign of unnaturally severe damage to surrounding tissue.”

Doctor Alan Demming paused to take a sip of water from the glass that sat in front of him on the lectern.

“The physician communicated her preliminary diagnosis to the patient,” he continued, “along with a complete disclaimer to protect herself in case of any later legal action.”

He paused again to accommodate the chuckling that rippled through the room, crowded with notable surgeons and their hospital administrators. 

“The patient asked if, at the end of treatment—which would include surgery, followed by therapy—the patient asked if, at the end of that time, he would be able to play the piano.”

The crowd rustled uncomfortably.

“With no apparent sign of any debilitating effects, the physician felt safe to assure the man that he would, in all likelihood, be able to play the piano after a sufficient time of recovery.”

Dr. Demming stared out over the audience as he brought the well-worn anecdote to it’s conclusion.

“’That’s funny,’ the man said. ‘I never could play piano before.’”

As the crowd broke into laughter, Demming took another sip from the water glass. You can’t beat an old joke, he thought. And it didn’t hurt to serve too much wine before the lecture.

When the noise subsided enough to be heard again, he came to the point of his message.

“Diagnosis has always been a difficult task for the physician, especially when the patient gives incorrect or incomplete information. But now, Glaxwell Industries has taken the guesswork out of diagnosis with their newest breakthrough, the M-I-R-slash-I-R, or as we like to call it, the MIR/IR line of magnetically-imaged-radiation-and-infra-red scanners.”

Someone flashed a large picture of a white metal doughnut on the screen behind Dr. Demming. That was MIR/IR, the next step beyond CAT scan and MRI. As he described the function of the machine, other slides flashed on the screen behind the lectern, showing smiling technicians and confident patients, all interacting with the mechanical marvel that was Glaxwell’s new MIR/IR.

“No longer will the process of diagnosis fail at the weak point of patient involvement. The images provided by the MIR/IR are so comprehensive that they provide a single point of diagnosis for every patient, regardless of the mode of treatment.”

The crowd broke into admiring applause, due in part to the brightness of the images on the screen and in part to the absolute decadence of the meal that Glaxwell had just served. The corporation deserved some respect for that, if for nothing else.

And there was good reason to be impressed with the presentation. New equipment meant new reasons for people to come to the hospital, and new ways to bill them for their trouble.

Miles Wofford was already figuring profit and expenses in his head. After twenty years of medical advances, Miles had grown adept at figuring how a new machine would impact the patient, and how to market the technology successfully. He had a rough idea of what Glaxwell expected as a cost for the machine, and his mind was running ahead to figure cost to the patient, insurance company markup, staffing overhead, and he resulting return to the institution, from which he would take a percentage for his trouble.

In addition to his pay, he would also rake off another slice of the profits under another budget heading, something vague and difficult to track, like all his previous embezzlements. That’s what made him so good at his job. He was so personally involved in the outcome of every decision. 

Dr. Bernard Roston had a different motive, something less illegal. He needed a project, something new to take up all his time and fuel his need for challenge. To Bernie, the MIR/IR was a new reason to stay at the hospital well past his normal shift. It would make him feel important again, and it would keep him away from his children and his wife, who were too loud and too demanding and too unimpressed with him. No, the MIR/IR would be good for him, Bernie thought.

Demming took another sip of water and watched the crowd. They were in a good mood. That made his job easier. He knew that this machine would be at the top of every hospital’s capital budget for the next year. 

“And so in summary,” he said, “the MIR/IR stands as the next milestone in diagnostic tools, one that will revolutionize the work and will in the process make many of the hospital’s current staff unnecessary.”

The muttering of the crowd suddenly took on a slightly hostile tone.

Demming heard a few words from the front tables.

“How can they replace staff?”

“That won’t go over well.”

“You can’t ask a machine to meet the patient.”

“Oh, come on!” he huffed, dropping his carefully manicured Glaxwell image. “You knew this was coming! We spend half our lives listening to patients who don’t even know what’s wrong with them! This machine will let you get the medical information you need, without all the other twaddle. If you want to spend twenty minutes talking to some old lady about her cats, go ahead. I’ve got better things to do.”

“What about the patient’s feelings?” someone asked. 

“What about them?”

“Where do they fit in all this? Is there still a place for the inclusion of patient interviews in diagnosis?”

“Not any more,” Demming declared.

“But what about their condition, the way they feel, how they view their own situation?” a woman asked from the second row of tables. “Don’t we want to deal with the fears, the loneliness, the isolation of the disease?”

“No,” Demming said. “I’m a doctor. Not a friend.”

That was a true statement. He had no friends. Not here at the dinner, not at Glaxwell, and not at the hospital.  

“But can’t we be caring people?” the woman asked. She would not let this go.  

He almost said, you don’t have time to care. But something stopped him. He reached for the water. That pain was back. It jabbed at his stomach every time he thought of the man that had wasted away in front of his eyes when he was an intern, or his father, or the kid in the pediatric wing.

Forget the water. He still had half a glass of wine next to his plate, not twenty feet away. With his eyes suddenly glazed, he wandered off to get it.

But his message was finding a favorable reception in the audience. Dr. Carla Moon was doodling some figures on a linen napkin, analyzing the cost of an early purchase, while the machine was still prohibitively expensive. She needed something like the MIR/IR. If she had it, she could cut one staff position.

Sign the deal, and Dr. Summers would be gone by the end of the week. Dr. Alicia Summers, with her perky smile in the morning and her chirpy laugh that all the men in the office found so intoxicating. She would have to go. Carla hated her, and she was willing to plunge the clinic into horrible debt just to snuff out the bright light that was Alicia Summers’ career.

Walter McNight got up from his chair and crossed the room to consult with a former partner, Randal Efferidge. They still talked from time to time, and they still held the same dream, to heal the world.

Walter leaned low over the table, almost resting his head on the tablecloth. His back still had that twinge. He would have to check it out, but it was probably just overwork. The doctor would tell him to take it easy, and he couldn’t have that.

Randal stayed seated. His stomach was bothering him. Emma had left him, taking the children with her. He didn’t have time to feel sorry for himself. He was too busy. In fact, when she left, he hadn’t noticed for three days. That wasn’t unusual, he told himself. Anyone who kept busy at work would be a bit preoccupied when they came home. No, three days would be about right.  

Demming returned to the lectern with the wine glass in his hand. This had to be the pinnacle of his profession, the highest point of respectability. To be standing here, among the brightest and the best, the people who would lead the world to a new standard of health, this was an honor.

His throat was dry. He had a little problem with the speech. Glaxwell had provided the words that he would say, but he knew something that they didn’t know. The machine might not work. He had lied on his part of the research. It was a stupid move for someone with his years of education, but the money was too good. And he figured his numbers would be offset by the honest research that everyone else was doing.

Who knows. Maybe there wasn’t any honest research. In the end, Glaxwell had paid him generously for his lies. And here he was, in front of his peers, carrying out the charade that he had begun some five years before, when he changed the first few numbers and told himself that he was doing nothing wrong.

##

A last word:

In Matthew chapter nine, verses one to eight, Jesus heals a man who cannot walk. But before he deals with the man’s legs, Jesus deals with his heart. During the resulting squabble, Jesus makes a point about sin and sickness. He talks about them as if they are the same, just two different problems that everyone will face. And of the two, sin will be the greater plague.

In different words, his argument might sound like this: “Do you want proof that I can forgive sins? Then let me do something that you can all see, something big, something that just doesn’t happen every day.” He turned his back on them and looked down at the poor man lying on his mat. “Get up,” he said. “Pick up that mat that has been your whole world for so long, and go home.”

  
[-] © 2007