The internet of things to come
By Jamie S. Newman, MD, FACP
My cell phone alarm buzzed for the second time, with a voice now warning me that I would be late for work. I put my pillow over it to dampen the sound. But then, in a show of solidarity with the phone, my mattress became uncomfortably firm and the head of the bed began moving up and down. I got the message and stumbled into the bathroom. But the toilet seat had not self-heated to my desired 74 degrees! It felt ice-cold. It also began to buzz noisily after just a minute.
Illustration by David Rosenman
I got to the kitchen and found that the coffee maker had added milk to my espresso despite my lactose intolerance. The refrigerator door gave me crushed ice instead of cubes. My appliances were annoying me—I needed to get out of there and get to work.
As I backed out of the driveway, my phone reminded me that I had an early meeting with the administrative team, offering some less-than-flattering commentary on the management. I had to hit mute to get some peace.
When I arrived at the hospital, I encountered my brand-new WhiteCoat 20500, hanging neatly in my locker. My cost-focused employer, Physician Overseers Incorporated, had just, somewhat surprisingly, purchased the extremely expensive unit. An attempt to sync it with my other medical tools had glitched previously due to some kind of interface issue, but I'd been assured all would be fine by rounds.
Next to the WhiteCoat was my trusty SuperLitt 2040 Ultra-Scope. It had built-in ultrasound, EKG, and temperature sensors, and it could read electrolyte levels from skin contact. It even held a charge for cardioversion. The Scope had been with me since medical school. Wired to the Electronic Health Over-Record, it automatically entered all findings into what we still quaintly called the medical chart, using the latest ICD-14 terminology.
I wasn't sure what to think about the WhiteCoat. I'd known it was coming for days, and I was reluctant to be the guinea pig. It had similar capabilities to my Scope but was also loaded with a built-in sensor array and a “Therapute” module for dispensing medication to patients by needle or mist. The hospital administrator assured me it was a prototype to improve efficiency, and I would be one of the first to demonstrate its benefits. It did look pretty sharp on me. My phone buzzed, with a text saying “Warning. . .,” but I just shoved it in my new WhiteCoat pocket.
The administrative team meeting went smoothly enough, but I should have suspected something amiss after I saw my first patient. It appeared the older gentleman was suffering from a respiratory infection. He had a cough and fever. The UltraScope confirmed the lung consolidation and elevated temperature, and also an elevation in the serum glucose. But before I could decide on a course of treatment, the WhiteCoat had administered an antibiotic mist, injected insulin from the sleeve-loaded syringe, and put in an order for antipyretics. I appreciated the help, but I did not like the fact that the coat had acted without my approval. It made me feel extraneous. I was angry, but after a few seconds I inexplicably felt calmer.
I pulled my phone from the pocket to check my schedule, but surprisingly it was dead. I was sure I had charged it. I'd have to deal with this later. My WhiteCoat reminded me that I was running behind.
The morning rounds continued. I would make my diagnosis with my UltraScope, and the WhiteCoat would react before I even could consider my options. I would get mad, but then suddenly relax. In fact, the day seemed drift by in a pleasant fog. My UltraScope beeped and flashed in a pattern I had never seen before, which usually would have upset me, but I had my new WhiteCoat, so all would be fine.
The last patient of the day was complex. She was over 112 years old with lung cancer, kidney and heart failure, and crippling arthritis. She was not the oldest or sickest patient I had ever cared for and she loved to talk. This would take time, but it was worth it—I loved geriatric patients. I placed the UltraScope in my ears and softly laid the sensor on her parchment-thin skin. I felt the head of the UltraScope warm gently to match her temperature, but it was obvious that the lovely old woman was near her end, and in quite a bit of discomfort. I read the empathetic output from the Scope, and I planned to discuss her goals of care, but before I could, a warm mist sprayed from the sleeve of the Coat. The patient took a deep inhalation and became unresponsive. A comfort care order appeared in her record. The Scope ominously beeped.
I knew what happened was wrong on so many levels. The WhiteCoat had just made a major (and cost-effective) decision that I did not agree with for this patient, and I was barely reacting to what was a terrible event. The air smelled odd and I felt numb and detached from what was happening around me.
As I tried to put my UltraScope in the WhiteCoat pocket, it began to strobe and vibrate. It seemed to writhe like a snake as I tried to shove it in. Giving up, I hung it across my shoulders in the time-honored fashion. As I did, the Scope began emitting a loud series of beeps. The unit coffee pot started to bubble. Suddenly hot coffee splashed across the front of the WhiteCoat, soaking it. I felt a sharp jolt of electricity across my chest and saw that my UltraScope had discharged 200 joules. The WhiteCoat started to smoke and, in a flash of smoke, went lifeless.
I'm not sure how the UltraScope and I got to my car. On the drive home, roof down, my head began to finally clear. I couldn't put my finger on it, but my Scope seemed happy. The next morning, the toilet seat was warm, the ice cubes were perfect, and my alarm let me snooze an extra 20 minutes.
Dr. Newman is a hospitalist at Mayo Clinic in Rochester, Minn., and the editorial advisor and humor columnist for ACP Hospitalist.
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