Brad Aiken: Questioning the Tree

It wasn’t such an unusual sight, but it was the first time I’d seen it live, the first time they’d snared one of my own colleagues.

I had just come through the revolving doors that deposit visitors into the opulent lobby of the Metro Towers building like a Pez dispenser, from nine to five every day. Across the white Italian marble floor at the far side of the atrium, camera crews for every major news company lay in wait for something deliciously ominous; had to be, to draw this kind of attention.

An elevator door slid open in front of the throng and floodlights poured into the space revealing a middle-aged man with tightly cropped gray hair twisting away from the brightness. His hands were cuffed behind his back, each arm in the grasp of a uniformed federal officer. As he turned in my direction, the familiarity of his bushy gray eyebrows, ruddy complexion, and paunchy abdominal girth sent a chill up my spine. It was Arnie Hirsch, an old friend who’d joined my practice at the District Thirteen Medical Clinic seven years ago.

A familiar voice behind my right shoulder startled me. “Veered from the answer tree.”

I turned toward my new assistant, Carma Johnson. “What?”

“They got Dr. Hirsch on an answer tree violation. His third one.”

I knew what she meant, of course. We were only allowed to say certain things, specifically scripted responses to questions that were always variations of the same things: What do I have, Doc? Am I going to get better? What’s the treatment? Could the scanner be wrong? We were told from our first day on the job that there was simply too much liability to let us make up our own answers and that any violation of this policy would be considered a federal offense: This was, after all, a government clinic.

I looked at Ms. Johnson. “How do you know?”

“My friend Wanda is his assistant. She just texted me.”

“She the one who turned him in?”

I felt the brief hesitation in her voice. “Nah, not Wanda. She’d never do something like that.”

My attention was drawn back to Arnie as he snapped at a reporter, “And I’d do it again, God dammit . I’m sick of seeing my patients suffer just because I have to listen to some damn machine.”

I knew exactly how he felt. We’d had that conversation over lunch at least a dozen times. The only reason that I had managed to stay out of trouble was because I didn’t have the guts to do what Arnie did. I felt sorry for the poor bastard, but I admired him.

The crowd followed my beleaguered colleague out into the street where a black sedan was waiting. I hated myself for not trying to help, but what could I do?

We stood in the now sparsely populated lobby, staring at the scene on the other side of the picture window by the revolving doors. “Guess we’d better get to work,” I said.

She gave a quick nod and we headed up to the thirty-seventh floor to begin our daily routine. By the time I got into my lab coat and made my way over to the exam room, she had already started the first medscan. Within minutes, a white plinth slid out from the mouth of the giant machine.

“Mornin’, Doc,” Mr. Winthorp greeted me, grabbing the back of his neck as he sat up from the exam table that had just emerged from the tube of the Medtron 3000.

Ms. Johnson looked up from the control monitor on the scanner. “No motion artifacts, Doctor. The report’s coming up now.”

“Thanks.” I looked at my first patient of the day. “Good morning, Mr. Winthorp.” I did not reach out to shake his hand. “I’m Doctor Jenkins.”

He glanced up at the plaque on the wall displaying my diploma, barely legible behind a coat of fading yellow urethane. “Centerville class of 2012, huh?” He looked impressed. “Good school.”

I hadn’t looked at that piece of paper in a long time. “It was .”

“So what are you going to do about my pain?”

I studied the report on the monitor. “The scanner has diagnosed you with a stomach ulcer and entered a prescription into the pharmacy system.”

“Stomach ulcer? I got neck pain, Doc.”

I pulled out my e-pad to consult the company manual and scrolled to the appropriate response grid. “I’m sorry, but the scanner says that your problem is a stomach ulcer. It doesn’t mention anything about your neck.”

“My stomach feels fine.”

I scrolled further. Even though I knew most of the acceptable answers by now, it was best to be cautious, especially with a new assistant hanging on my every word. “Some illnesses have no discernable symptoms,” I quoted.

Winthorp was too busy massaging his neck to notice that I was reading a script. “Okay, maybe I do have an ulcer, but this damn neck pain is what brought me in here, not my stomach.”

“Just the same, if you don’t pick up your prescription, the insurance company will drop you from their plan.”

Mr. Winthorp let out a huff through blowfish cheeks. He knew there was no point in arguing with a medscan. “Okay, but can you just take a look at my neck? It’s killing me.”

The eyebrows on Ms. Johnson’s fresh young face crested noticeably.

“I’m sorry, Mr. Winthorp,” I recited dutifully, “but physical contact is strictly prohibited.”

“Come on, Doc. I won’t tell anyone.”

My demeanor softened. “Now, Mr. Winthorp, you know I can’t do that. I could lose my license.”

He shook his head—with difficulty—and walked out the door.

I felt sorry for the poor sap. There was a time I’d have ignored the rules, taken a look at his neck. But that was before I watched a bunch of my colleagues go bankrupt from lawsuits for doing that sort of thing, or worse yet, get carted off in handcuffs like Arnie Hirsch.

But this was a new world. When I graduated from the prestigious Centerville Medical School thirty-three years ago, I couldn’t have been more proud. Sir William Osler once said, “The transition from layman to physician is the most awesome transition in the universe.” At least that’s what we were told by our first clinical preceptor. And we believed him, thought we were special. After all, we’d gone from sniveling preppies to workaholics whose days were filled with making life-or-death decisions. That kind of thing changes a person. Changes you in ways you can’t see, can’t feel, can’t notice until one day you wake up, look at on old picture of yourself and think, Was I ever really that naive?

But it jades you, too. Rearranges your priorities. Makes it hard to maintain a normal sense of empathy, though most could: It’s what made us good at our profession.

Or used to.

Ms. Johnson looked over my shoulder as I stood in the doorway watching Mr. Winthorp make his way out of the office. “Do you get many like that?” she asked.

“Nah. The scanner usually picks up the right thing: You know, whatever it is that’s causing the symptoms.”

“I can’t believe that guy actually wanted you to touch him.” She shuddered as she spit out the words.

I kept silent. The Board of Medicine was notorious for infiltrating practices with young trainees who were trying to weed out doctors who didn’t follow the rules, and I didn’t know my new assistant all that well yet.

She turned and looked at me. “I mean, I can understand how some of the older people might think that way; it’s what they grew up with. But Winthorp’s only forty-two. Why would he think a doctor could find something that a scanner couldn’t?”

The poor guy was just looking for a little relief and we didn’t give it to him; she had to see that. I wasn’t going to fall for the bait. “Guess some people just long for nostalgia,” I said. “Stories they hear from their parents, an old movie, some viral story running around the Web. There are lots of ways to hear about how things used to be. Some people still believe it was better back then.”