The thought enters my mind unobtrusively, fleetingly.
Is this all just a dream?
No. It can’t be. It’s too real.
I have performed a procedure and there has been a complication.
A disastrous complication.
I can feel my heart race, and my sweat beading on my brow.
Oh no. 1/
Is this all just a dream?
No. It can’t be. It’s too real.
I have performed a procedure and there has been a complication.
A disastrous complication.
I can feel my heart race, and my sweat beading on my brow.
Oh no. 1/
I can hear the insistent beeping of the alarms in the room.
The nurse’s voice is taut with worry, “Blood pressure dropping, respiratory and heart rates climbing.”
I know what’s coming. The phrase from the textbooks pops into my head.
“Impending cardiopulmonary collapse.” 2/
The nurse’s voice is taut with worry, “Blood pressure dropping, respiratory and heart rates climbing.”
I know what’s coming. The phrase from the textbooks pops into my head.
“Impending cardiopulmonary collapse.” 2/
One of the potential complications of placing a large bore venous catheter in the internal jugular vein is going too deep and puncturing the lung.
I need to decompress the thorax immediately.
I ask the nurse to grab the critical care fellow ASAP, and call for a STAT X-ray. 3/
I need to decompress the thorax immediately.
I ask the nurse to grab the critical care fellow ASAP, and call for a STAT X-ray. 3/
The fellow is there within a few moments, calm and collected.
She asks me to retrace my steps, tell her what happened.
Agreeing with my diagnosis, she asks for a chest tube kit.
In the mean time she hands me a 16 gauge needle and I square it up with the mid-clavicular line. 4/
She asks me to retrace my steps, tell her what happened.
Agreeing with my diagnosis, she asks for a chest tube kit.
In the mean time she hands me a 16 gauge needle and I square it up with the mid-clavicular line. 4/
In that particular moment, the thought returns. Something about the needle triggers it.
A creeping doubt.
Am I dreaming?
With a sinking feeling I lower the drape covering the patient’s face.
There’s no face.
Just a blank space where the face should be.
I gasp in shock. 5/
A creeping doubt.
Am I dreaming?
With a sinking feeling I lower the drape covering the patient’s face.
There’s no face.
Just a blank space where the face should be.
I gasp in shock. 5/
I wake up with a hard jolt. Sweat trickles down the back of my neck.
No procedure. No pneumothorax.
Just a dream.
The instructor’s voice crackles through the intercom disapprovingly, “That’s the third time you’ve terminated that sleep module. What was it this time?” 6/
No procedure. No pneumothorax.
Just a dream.
The instructor’s voice crackles through the intercom disapprovingly, “That’s the third time you’ve terminated that sleep module. What was it this time?” 6/
I exhale, “The needle. I was about to decompress the lung, and the needle shook a little in my hands. Like Jello. It wobbled. Needles don’t do that.”
The instructor sighs, “That’s unfortunate, things were going smoothly.”
I quirk a brow, “What?! I collapsed the lung!” 7/
The instructor sighs, “That’s unfortunate, things were going smoothly.”
I quirk a brow, “What?! I collapsed the lung!” 7/
The instructor’s voice is calm, “Yes. The complication was the point. You don’t really know how to handle a procedure until you know how to handle its complications. That module is impossible to pass without collapsing the lung.”
She pauses, then speaks, “Get some rest.” 8/
She pauses, then speaks, “Get some rest.” 8/
I nod. Sinking back into bed.
The intercom goes silent.
Dream instruction is the latest form of teaching we get in med school.
Dreams uploaded into the brain for an entirely realistic and safe simulation.
Except when the dreamer senses the dream, then it falls apart. 9/
The intercom goes silent.
Dream instruction is the latest form of teaching we get in med school.
Dreams uploaded into the brain for an entirely realistic and safe simulation.
Except when the dreamer senses the dream, then it falls apart. 9/
There have been rumors of students trapped in dreams.
Nightmares from which they can only be awakened by direct cerebral implants and stimuli.
They’re only rumors. Or so they tell me.
I yawn. Enough. I’m too tired for thoughts, or for dreams.
Sleep crashes over me. 10/
Nightmares from which they can only be awakened by direct cerebral implants and stimuli.
They’re only rumors. Or so they tell me.
I yawn. Enough. I’m too tired for thoughts, or for dreams.
Sleep crashes over me. 10/
The next morning I run into Sara on my way to class.
Sara is my friend, and fellow med student.
She reassures me, “It’s ok. That dream tech is still a prototype. I went through four cycles on the ‘breaking bad news’ dream and woke up early every time.”
I feel better. 11/
Sara is my friend, and fellow med student.
She reassures me, “It’s ok. That dream tech is still a prototype. I went through four cycles on the ‘breaking bad news’ dream and woke up early every time.”
I feel better. 11/
Med school nowadays isn’t how it used to be.
I read about how students in the past took entrance exams, licensing exams, and board exams.
These exams were never once shown to correlate with any meaningful clinical outcome.
Our medical system doesn’t have exams anymore. 12/
I read about how students in the past took entrance exams, licensing exams, and board exams.
These exams were never once shown to correlate with any meaningful clinical outcome.
Our medical system doesn’t have exams anymore. 12/
The Voigt-Kampff testing methodologies in the early 2040s led to a wave of new individualized assessments.
At any given moment there are dozens of ways in which my progress is being assessed relative to myself, and no one else.
We don’t compete with each other anymore. 13/
At any given moment there are dozens of ways in which my progress is being assessed relative to myself, and no one else.
We don’t compete with each other anymore. 13/
Sara and I are attending a conference today, as part of our “history and humanity” growth module.
We could, in theory, experience this as a VR lesson.
But there’s something about being there in person. So few of our experiences are “real” anymore.
We cherish reality. 14/
We could, in theory, experience this as a VR lesson.
But there’s something about being there in person. So few of our experiences are “real” anymore.
We cherish reality. 14/
The conference is taking place at a hotel downtown.
Sara, myself, and about a dozen students from my school have chosen to go in person.
Before setting out together, we all activate our nanomasks. Our ID badges glow green.
Even if we forgot, they’d auto-activate for us. 15/
Sara, myself, and about a dozen students from my school have chosen to go in person.
Before setting out together, we all activate our nanomasks. Our ID badges glow green.
Even if we forgot, they’d auto-activate for us. 15/
The hotel lobby greets us with an icy blast of air-conditioning. My gaze is drawn upwards to the giant banner hung up.
“COVID-19: ECHOES FROM THE PAST, 2060.”
This should be interesting, after all, it’s where everything began.
An old man makes his way to the main hall. 16/
“COVID-19: ECHOES FROM THE PAST, 2060.”
This should be interesting, after all, it’s where everything began.
An old man makes his way to the main hall. 16/
I enter the conference hall. Social distancing is the norm, my colleagues spread out instinctively.
Of course, we are some of the few here in person. Most seats are taken by remote stations, and disembodied floating faces glance at me as I walk past.
The talk begins. 17/
Of course, we are some of the few here in person. Most seats are taken by remote stations, and disembodied floating faces glance at me as I walk past.
The talk begins. 17/
“The American Aberrancy.” I settle down in my seat to listen.
Each presenter tells me things we already know. A part of me is getting impatient.
Then an elderly man takes the stage. The same man I saw walking across the lobby.
I sit up, interested in what he might say. 18/
Each presenter tells me things we already know. A part of me is getting impatient.
Then an elderly man takes the stage. The same man I saw walking across the lobby.
I sit up, interested in what he might say. 18/
He talks about what it was like. And the more I hear, the angrier I get.
Seriously? I mean I understand they didn’t have nanotechnology or real-time viral tracing, but ... seriously?
As he speaks, my anger slowly gives way to something else.
Sadness.
Such needless loss. 19/
Seriously? I mean I understand they didn’t have nanotechnology or real-time viral tracing, but ... seriously?
As he speaks, my anger slowly gives way to something else.
Sadness.
Such needless loss. 19/
After the lecture ends I head back out to the lobby with Sara. I feel sick.
Sara excuses herself for a moment, and runs across the lobby.
I see her approach the elderly man who spoke to us. They have a conversation. I can’t hear their words.
He seems wistful. She nods. 20/
Sara excuses herself for a moment, and runs across the lobby.
I see her approach the elderly man who spoke to us. They have a conversation. I can’t hear their words.
He seems wistful. She nods. 20/
Later that evening, I ask Sara what she asked him.
She won’t tell me. She says it isn’t important.
But I can see something in her eyes.
The realization of a deep and terrible truth.
I walk beside her in silence, and imagine each step a chance to atone for past mistakes.
She won’t tell me. She says it isn’t important.
But I can see something in her eyes.
The realization of a deep and terrible truth.
I walk beside her in silence, and imagine each step a chance to atone for past mistakes.
(For the companion piece to this thread, visit the link below.)
