Adam Smith liked it quiet while he was doing his documentation. It seemed wherever or whenever he logged on someone would sit down next to him and want to chat, show him a funny cat video, or consult on a case. The constant interruptions were making internship difficult and the days long. He longed for a quiet space and an open desktop. He had searched the hospital, from obscure office spaces to darkened hallway terminals, but every time he found an isolated spot and began to write an admission history and physical or a daily progress note, he would find someone at his elbow. His resident had no advice, and his co-intern on the service was useless. Every day his frustration grew.
One night on call, Adam tried searching in a closed unit. He traveled down a flight of stairs into an old office space. There, on a dusty wooden desk, was an old PC. He thought it wouldn't work, but when he typed his user name and password, it slowly came to life, with an odd blue-tinged light. His mailbox, the admission board, and even the electronic medical record were there.
In blessed silence, he began his first note, about Mrs. Johnson, an extremely crabby and belligerent woman with cellulitis. Smiling, he typed, “Mrs. Johnson is a pleasant 80-year-old woman who presents with pain and redness in her leg.” He laughed to himself: pleasant, right. Suddenly his pager went off: “Please see Mrs. Johnson, Room 7Dom 555.” He trudged up there expecting a litany of complaints, but when he entered her room she was smiling. She hated to disturb him, but she just wanted to thank him for his kind care and wanted to offer him a home-baked brownie that her daughter had just dropped off. This was odd, Adam thought. Why was she so suddenly pleasant?
He went back to his new favorite spot and began another note. Mr. Jackson had chest pain and an elevated troponin. Dr. Smith was convinced it was unstable angina and possibly an infarct with an abnormal EKG. But instead, as a kind of test, he wrote, “Mr. Jackson is admitted with atypical pain, not likely to be ischemia; troponin and EKG normal.” He ordered a proton-pump inhibitor. Then he went back upstairs and saw Mr. Jackson again. His repeat troponin was normal, as was his EKG. Adam entered the room in time to hear a tremendous belch. Mr. Jackson smiled and said he suddenly felt all better.
That night Adam wrote many admit notes. A patient with a respite admission for metastatic cancer was now in remission, dementia was only a drug reaction, and a severe case of calciphylaxis was merely bug bites. He wondered what else he could do.
Adam also opened his stock portfolio on the old computer. If it worked for his patients, maybe he could do more. Could he write orders for stock purchases for days ago? He sat there thinking of other ways to make money off this discovery. He barely noticed the blue light beginning to turn purple. Could he change the outcome of sporting events? Or even elections?
But before trying this, he had one important task. His co-intern, Moses Jilliard, was useless. He thought about removing him from the program, but then he had a better idea. He wrote an evaluation: “Dr. Jilliard is the best intern in the program. He can do the work of two people. He is well read, caring, and conscientious.” That ought to do it.
The computer was glowing a more reddish hue now, but Adam was just getting warmed up. He would change a lot of things. He'd get likes on dating sites, and perhaps a nice lease on an upscale apartment. He wasn't thinking about patients anymore.
He started an evaluation of himself. “Dr. Smith is perhaps the greatest intern ever to enter our program. His base of knowledge is at an attending's level. His empathy and bedside manner are without reproach. His diagnostic acumen is beyond belief.” But then Adam thought a bit. With a little more time, he could make it much better. So he deleted the file.
The next day, morning rounds were a pleasure for the resident on the medicine service. The patients were all doing so well. For some reason all the other services had two interns and he had only one, but Dr. Jilliard was such a great intern that he didn't miss having a second one on the team.