Joseph Rumenapp
Chicago, Illinois, United States

He kicked the scrub sink again—only a trickle. He missed the smell of the iodine in the morning, almost as much as he missed the chill of the operating room itself.

“Don’t bother, Doc,” the scrub nurse chimed behind him. “You won’t be touching sterile anyway.”

He walked into the room with the patient on the table—robotic arms already hovering in position. There was an eerie sound of mechanical breaths whispering in the background. The monotonic voice called from overhead, “Time out. Patient Record Number 13625 opened. Patient prepared for cholecystectomy. Surgeon 12A, please move into position.”

He moved to the control station of the new SurgeTek 3000, sat down, and opened his eyes for the retina scan. “Surgeon 12A verified.”

The old surgeon waited for a moment, looking over at Patient Record Number 13265. He longed for the sensation of the cold scalpel in his hand, a memory from a time long gone when he felt in control, back when he knew his patients’ names and could visualize their anatomies. So many years had passed since he first stepped foot in the cadaver lab of the medical school. Over the course of his long career, he had been through many changes. He adapted to the use of minimally invasive laparoscopic instruments—it was easier for him and safer for the patients. He was an early adopter of the robotic assisted techniques—it was as if those mechanical arms were merely an extension of his own body. But then, the hospital administration invested in this new AI technology. He remembered the first few years when he dictated surgeries at length and in great detail for machine learning, like he once had done for his residents. Initially, he noted, the data was quite convincing. Adverse events plummeted and patient satisfaction scores skyrocketed.

Then, one by one, the anesthesiologists began to disappear. Each adverse event was labeled “human error,” the anesthesiologist was dismissed, and a new update came out for the SurgeTek. Though he had his reservations at first, he knew deep down that the Biofeedback program was impressive. The patient-specific parameters had led to better outcomes, and without the anesthesiologists at the head of the table, he had allowed himself to have complete faith in the new system. But once the latest version, SurgeTek 3000, was acquired, he noticed that slowly the surgeons also began to vanish. Now, he merely sat at the controls while the robot took over. “Alas,” he thought out loud, “it is long since time to retire.”

“Let’s go, Doc! We have four more gallbladders this morning,” the scrub nurse called.

He positioned himself at the controls and looked at the screen. The detail was, indeed, amazing. He never had appreciated the fine detail of human anatomy shown on this new model—not even in his early days of performing actual open laparotomies. He lined up the robotic arms at the cystic duct and initiated the programming sequence. SurgeTek took over. His hands glided, muscles disengaged, as the robotic arms began the all-too-familiar steps of making an incision, cauterizing, and extracting. He had done this thousands of times over his career, but he knew that soon he would perform his last surgery. His mind slipped into a fugue as he recalled the days of a full operating room of young residents and students. He remembered the mesmerized looks on their faces as he worked nimbly in complex anatomical variations or discussed their successes on morning rounds.

Almost as if being startled in the night, he suddenly jolted up, staring at the screen as a drop of blood appeared. “Dammit! It nicked the artery!” He immediately stabilized the robotic arms, taking control, and zooming in to the small tear that was now hemorrhaging quickly. He tried to engage the cauterizer, but he knew instinctively that a more definitive repair would be required. “Load the suture arm and needle driver,” he called to the scrub nurse.

“Doc.”

“I can clamp and repair, but I will need another set of hands.”

“Doc.”

“Call OR 7 to see if they can spare a tech.”

“Doc, look!”

He looked at the scrub nurse and then at the robotic arms, where a red light now flashed. Back on his screen the word “analyzing” blinked repeatedly. He tried to engage the arms, but a clicking sound indicated that he could not overpower them—he was locked out. He could still see blood pouring from the artery.

The Biofeedback machine sounded an alarm, “Hemostasis lost, recalculating.” Helpless, he watched the screen for what seemed like hours. He ran through each step needed to repair the artery in his mind, but he knew it would not matter.

The monotone voice from overhead came back, “Patient Record Number 13265 has been closed.”

Sullenly, he looked over at the surgical nurse, who simply said, “Sorry, Doc.”

The voice continued, “Surgeon 12A, report to central processing immediately. Your license to operate has been terminated.”

The surgeon stood up and walked to the double doors, taking one last glance at Patient Record Number 13265. A dismal hum of the machines hung in the background. The SurgeTek 3000 flashed the word “updating” in a dim blue light. He turned away and walked down the hall one last time, water still trickling into the empty sink.