Saturday, April 23, 2011

Dystopian Nightmare v2.5

 A Healthcare Odyssey

His silver hair ruffles from the sudden disquieting breeze that blows through the street stirring up the settled dust. He smoothes his hair instinctively as he closes the door to his 2012 model Porsche designed Hybrid vehicle. There aren’t too many of those around anymore. The door shuts with a distinct muted thud. He admires the preserved state of this antique.

He walks to open the shuttered iron door. A low frequency siren wails from the corner of the office. He uses his thumb on the scanner to quiet it. He turns the light on. It is a single, overhead fluorescent lamp that flickers into existence.

The room is unevenly lit. The books in the closed wall cabinet, line the narrow office space wall on one side. There is a comfortable armchair, a small desk with a caduceus made of ceramic on one side of the table with a blotter and an old-fashioned ink pen in a holder on top on the other side. The opposite wall of this space is filled with photos and a single MD diploma from a little known university hospital dating back to 2010. The office space although narrow is furnished in modern style with clean lines and open spaces.

He picks out a book from his collection and sets it down next to the armchair. It is a compendium of medical differential diagnoses. As he turns the first page, the door opens and a 40-something person walks in.

“Good morning doctor.” The woman entering the office smiles at him with the greeting..
“Good Morning Vee,” He says and goes back to perusing the book.
“Mr. Stemp will be here shortly, he called yesterday.” She says her face turned away at her tiny desk perched close to the entrance door with its straight-backed chair.
“Thank you Vee.” He replies and no sooner, the door opens and in walks the Mr. Stemp.
“Hello Ms. Vee,” he says and unburdens himself with his issued card and other documents.
“Charlie, how are you!” the doctor shakes the other’s hand. Charlie is Charlie Stemp a 69 year-old man, muscle-bound with strength, who walks with an erect posture filled with pride and dignity..
“Doc you’ve got to help me. I feel fine, but they tell me that I have this heart problem that will take a month or two to confirm and then they will consider treatment.” He shakes his head, “And the problem is…”
“The problem is that in a month you will turn 70 and be ineligible for any treatment. Right?”
“Yeaes.” He exclaims.
“You know Charlie, 70 years is the age limit for any treatment for a chronic condition.”
“Yes. But I am not there yet and I want to nip it in the bud, if I can before then.”
“Ok. Lets see what you have.” The doctor scans the papers one at a time that Charlie has brought with him.

After the doctor completes the physical examination in the side room, he sits back down at his desk with his head bent over the papers in thought. What seems like a long time to Charlie, the doctor finally looks up into his expectant eyes and says, “Maybe I can help you.” Charlie’s face breaks out into a smile.
The doctor looks at the gash on his arm. It is partially healed but the beginnings of infection seem all too likely.
“Charlie, you should have gone to the emergency room for this.”
“No doc. You know they take credits off my health care card every time. Imagine, if I really need the care and no credit left. What am I going to do?”
“This could get infected and besides after next month all your credits are set to expire anyway?”
“I know, but one has to preserve every bit in this world for as long and I figured you can take a look at it. Besides, going to the emergency room is a nightmare. You have to register your name and it can take a whole day to get processed and then wait to be called. There are people lined up against the wall in the hallway and others camping outside the hospital just to get entrance.” He paused, “I don’t have to tell you that they have these mobile vans that carry patients that are not qualified back to their homes without treatment if they are deemed ineligible.” Charlie’s eyes are wide with anxiety.

The doctor opens the thick metal vault next to his desk by placing his thumb on the scan surface. There are no buttons or knobs. The door opens. The doctor pulls out a pad, makes some notation on the electronic pad and has Charlie sign beneath his name. And the treatment is rendered.

“Doc, thank you so much. You know I will pay all your bills as soon as I can earn some credits. Don’t you?”
“Yes Charlie. I know that.”
“Hey doc is that 40 year old antique car out there, yours?”
“Yes Charlie.”
“How would you like two gallons of unleaded gas for it.”
“At the going rate, all I can afford is two gallons a week just to keep it running.”
“I’ve got the gas in a drum at home. It is of no use to me. You can have it.” Charlie offers.
“Thanks Charlie, and I will take off equivalent amount from your owned amount.”
“No doc. This has nothing to do with the bill. Besides you don’t want to get the GS mafia against you, do you?”
“You’re right. Thanks for the offer Charlie”
“It is amazing how far I have fallen doc. Eighteen years ago, I was the poster child of a Biotech firm and its CEO. Seven implants, two ocular, one olfactory, two auditory and two muscle boosting implant devices. GS takes over the firm under some national security pretext and throws me in the trash heap. Now they are just waiting for me to die so they can take out these implants and do some data mining from my experiences. Hell they will have to try harder to rid of me.”
“Charlie, it seems you and I have both out-served our purposes. It is just a matter of time before they look at me too. It seems that once you have outspent your designated budget and out lived your mandate…” the doctor doesn’t finish his thought.
“Well they are not going to psychologically force me to add my name to the rash of 70+ year-olds committing suicide. No! No! I intend to make them miserable with my existence.” Charlie clenches his fist and heads for the door.

After Charlie leaves, the doctor settles into his armchair and his eyes take in the growing traffic outside. The shuttered Hardware Store on the opposite side of the street a stark reminder of the good old days. The shop next to it is a tailoring store with some reasonable business, but it opens only two days a week. Next to that is a shuttered café with the “Moonlight Coffee” sign hanging precariously off the roof overhang. Behind this dilapidation rises the silver megalith. The building almost 100 stories high is the tallest building this side of the Mississippi. It is the GS Headquarters.

GS stands for Geoffery Stoker, a business tycoon aged 45 who inherited it from his father, a wealthy man who became a confidant to the President of the United States. GS enterprises accumulated all its wealth through buying the Nuclear Power plants in the Eastern Seaboard and all the Wind Turbines Farms. GS supplies energy to the entire eastern half of the United States. Mr. Stoker is a very powerful man who wields power through soft toned threats. He has the osmotic desire to absorb all wealth, to fashion the argument as helping others and to mold the facile congress of ideas into a self-propagating financial behemoth. It is no secret that he desires the Western half to add to his collection  He is not driven anywhere. He is flown around town in an electric-state-of-the-art helicopter/mobile. The machine transforms from land-based to flyable state in less than ten minutes, they say. The doctor has heard those tales.

Three hours  and four patients later the sound of muted turbines outside the window, alert him to a black Aviomobile (A flying car – official and very expensive) as it arrives. The gull-wings open and two officials exit the transporter machine and walk towards the entrance door.

The door opens to reveal the two men in silver grey suit, stern features and a no nonsense sense of humor written over their crisp and tanned faces. They are from the Bureau of Finance. The doctor recognizes them from their dress code. A chill runs through his spine.
“Good morning doctor.” The one says in a monotone. “May we review your records today.” A polite statement wrapped in the sternest of tones.
The doctor nods towards his secretary. “Ms. Vee would you please show the gentlemen the logs.”
The door opens and another man walks in and almost immediately turns around and exits the office upon seeing the occupants.
“Mr. Chambers!” Vee cries after him, but the man is already walking down the street. The two men look at each other and then at the secretary.
“May we see Mr. Chambers records also?”
“Sure.” She says and gives then the QD (Quantum Digital) cards. All data is securely stored in a quantum state for encryption purposes. The man scans it into his tablet device. They get up from their chairs from the front of the room and make their way to the doctor.

“Doctor, we find that there was an overuse of four medications prescribed by you to four different individuals for a diagnosis of Asthma. One medication for Arthiritis and one that you prescribed today for a 69 year and 11 month old man with heart failure. These are deviations from standards established by the Office of Health and Management. OHM does not take this lightly. The current penalty for these deviations is a loss of your privileges for one month and a fine of 10,000 Globes (Globes is the global currency now in use across the world).” He pauses for a moment and there is a discernable glee in his voice although it maintains its official monotonous boom. “We also find based on the electronic logs that you vary your time spent with each patient. Some are under the mandatory 45 minutes and others are well over 60 minutes. These violations will reduce your this month’s expected total credit down to 5000 Globes and next month to 1000 Globes.” His face pale and set in its official haughty demeanor remains impassive.

The doctor slumps in the chair, for he knows there is no appeal because the decision is made on a computer algorithm and the data input. How can he convince a non-human insensitive, uncaring, thoughtless, bureaucratic software algorithm designed by heartless human beings the art of medicine.
“And furthermore we find an additional breach of conduct. You sent a patient aged 70 years to the Emergency Room for treatment.” You are aware that patients over 70 must not be sent to the Emergency Room?”
“Yes, I know. But that man was gasping for air. What was I to do?”
“Send him home doctor.” The man replied in his distinctive monotone.
“We have recorded that on your file in the database and the OHM will make a subsequent determination on that in the next 24 hours.” They have not sat down during this conversation and just as they are about to leave, the other one who has not spoken a word, opines, “I will buy your car if you need more credits.”  With that they are gone. Vee looks at the doctor in disbelief. She has tears streaming from her eyes. “I am sorry doctor, it is my fault. I should have flagged their charts.”
“Its not your fault Vee.”

The doctor closes his eyes and within minutes the landscape changes, Outside he can see the Hardware store bustling with activity and the patrons sitting outside in front of the café being tended to by the waitresses wearing white aprons and bright smiles. 

The lampposts have signs of a rally for global integration and free healthcare for all. The rally is planned for 5 PM at the University square. There are people walking in the street in animated discussion. One says to the other, “This GS guy is really a man for the poor people. He wants to help everyone. They say he donated millions of dollars to build a wind farm to give poor people free electricity.”
The other man looks at him and nods his head in agreement. “And I heard that he wants a level playing field for everyone.”
“Yeah. He should run for President” The other one agrees. Cars stream by of all makes and models. Life is brimming with hope.

The doctor wakes up from his short dream and finds two officers of the law standing beside Vee as she cries in anguish, “Please don’t do this. I am a single mother. My child needs me.”  “Don’t worry about your child, Miss, she will be placed in safe custody of the State while you are serving your time.”
The man looks at the doctor, “Doctor, you are requested to come to the local office of the OHM at noon tomorrow.” And they leave.

It is time to leave medicine, he thinks. He has worked for almost fifty years helping the poor and the rich alike. His motivation has always been the health of the patient, something he has ascribed to since the desire of medicine consumed his soul. Now that desire seems to ooze away from the pores of his being. He feels the insidious pressure on his temples. The weight of this burden seems too heavy to carry. It is time.

There is a loud noise that shakes the bed and I sit up sweating from my nightmare. It is still 2011. I look outside from my bedroom door and the street is quiet in the wee hours of the morning. The street lamplight grows weak as the day breaks. The chirping birds dance about the branches of the fully blossomed trees, singing melodies that just sound good. The breeze is building as the sun rises steadily to command its post and soon it will be time for the school busses to roll-by picking up little children and transfer them to their schools and cars driven by their owners looking forward to their days work and the wonder of new spirits ahead that will foster a better future for those little children. The day yawns and spreads its misty golden hue and I close the window gently so as not to awaken anyone in the house. I steal my way down to the kitchen to enjoy the first cup of freshly brewed coffee. The dream of a better future is still alive.

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