Scene 1

On the eleventh floor of the Centennial Tower of an elite outpatient Orthopedic Surgery Center, Division of Amputations. The Chair is pacing nervously up and down the hallway outside his office. The intern approaches him as his back is turned. He is looking out the window thoughtfully.

Intern: Boss are you ready to scrub in?

Chair: Don’t sneak up on me.

Intern: Sorry.

Chair: How are we doing on Podiatrists?

Intern: What do you mean?

Chair: In the amputation clinic. Are we fully staffed?

Intern: Actually, Sir, you’re supposed to scrub in and supervise.

Chair: Can ChatGPT do it?

Intern: ChatGPT is an AI-language model. It can’t perform diabetic amputations.

Chair: Not even the pinky toe?

Intern: Sir it’s a computer.

Chair: We put computers on the moon, son. In a few years, computers will perform open heart surgery.

Intern: The C-Suite already approved credentialing for nurse practitioners to do that.

Chair: I see. That cuts the cost of bypass surgery by 60%. With those savings, it probably doesn’t make sense to hire a bunch of engineers to train a computer.

Intern: Sir the OR nurse texted me. They’re ready for that BKA in Room 9.

Chair. So they are.. (gazes down, squints his eyes menacingly).

Cut-scene: Now they’re in the OR with the patient asleep and prepped by the staff for the amputation. The intern is crouched down, the podiatrist is crouched down behind him, and the Chair is crouched down behind the podiatrist with his MacBook open on the instrument cart.

Intern: Sir we’re ready, can I start sawing the leg off?

Chair: Go slow, I’m describing everything you do to ChatGPT.

Podiatrist: Yea.. go real slow. (Creepily)

Intern: Do you need to sit this close to me?

Podiatrist: I took an oath for this. Are you de-valuing my oath? Because right now I’m feeling a little de-valued.

Chair: Would you guys knock it off? We have 3 more cases after this.

*Sawwing noises*

*Thought bubble* With orthopedic bone-saw noises in the background, the Chair leans back in his OR stool and envisions a pitch-meeting with the hospital CEO. AI will save this company Billions. The residents are essentially free-labor, other than having to deal with Medicare, and the morons in the GME office. We can work ChatGPT into the ground without tracking duty-hours. I’ll get an award for this. Maybe a bonus. Maybe they’ll forget about the med student I flew down to Cabo.

OR Nurse: Wrapping up in here, Doc.

Intern: All in a day’s work (pulls off gloves, making satisfying snap sound).

Podiatrist: I’ll take it from here. (Puts on loops).

*The intern steps away from the Gurney and starts dictating his Op Note. The podiatrist is cleaning the wound. 5 minutes later the OR alarm sounds.

Anesthesia: Everybody stop. It’s a code red.

Intern: Fire?

Anesthesia: No the other code red. The patient’s pressures are dropping. He must be bleeding out through something.

Intern: Something?

Chair: It’s the popliteal artery. What have you done?

Podiatrist: I was working on the other side and the knife was too sharp.

Intern: You’re attempted a second amputation on the other side?

Anesthesia: What side?

Intern: The right side? That’s a perfectly good leg.

Podiatrist: What side?

Chair: Did anyone look at the damn chart? Stop everything now. (Looks at Anesthesia) We need you to intubate and give pressers.

Anesthesia: Sorry no can do. Tell you what - I can page my Staff.

Intern: What do you mean? This patient is dying.

Anesthesia: Technically I’m still a Nurse Anesthetist until July.

Chair: Where the fuck is my Anesthesiologist.

Podiatrist: This is getting too intense (runs out of the OR).

Intern: (to OR nurse) 2x units of blood, STAT.

Chair: Has he been cross-matched?

Anesthesia: I played la crosse in high school. Cross-matches were a blast.

Intern: You don’t know what his blood type is? (Looks at OR Nurse) See if they have O.

Chair: I’m getting this all coded into ChatGPT.

Intern: Someone give me a tourniquet.

*Scuffling noises* Camera Fades..

Transition: The outpatient surgery lobby area where families are waiting. There are plants in the corner and a little Japanese waterfall. The secretary is filing her nails while watching Hunger Games on her iPhone. The podiatrist walks out, confidently, wearing loops and a long white-coat.

Podiatrist: We have achieved hemostasis.

Secretary: Why are you in the lobby?

Podiatrist: Ma’am I have a responsibility to these families.

Secretary: Where’s the Intern? What’s going on?

Cut-scene: Back in the OR, the intern is furiously clamping the gushing artery.

Intern: I think I got it. Can someone page Vascular Surgery stat?

Vascular: (saunters into the OR, beeper going off) Rolando’s my name, vein clinic is my game.

Nurse: How’d you get here so fast?

Rolando: We vascular surgeons jog everywhere. Plus I heard the Chairman was operating today.

Chair: We had a sentinel event. The patient started bleeding, the podiatrist went AWOL, and my Intern saved the day.

Rolando: Right on. Why do you have your MacBook in the OR?

Intern: He’s recording everything into ChatGPT, so that one day the computer will teach a robot how to do below-the-knee amputations.

Nurse: It’ll be a major cost savings to the healthcare system.

Rolando: Sounds like they got you drinking the Kool-Aid too (leans over and takes over suturing from the Intern).

Chair: This is all experimental right now. Plus it’s gotta get through the FDA and everything - you know how that is.

Rolando: FDA? Right. Them's the rules (quietly humming and sewing).

Intern: The FDA is up on this stuff. How do you think they got Ipilimumab approved?

Rolando: Ip-who?

Podiatrist: Ip.. the kung fu guy?

Intern: No the oncology drug.

Nurse: You mean the FDA just asked ChatGPT whether or not it should approve the drug?

Chair: Pretty much. And who let him back in?

Large OR Tech: I got it Sir (drags flailing podiatrist by the collar, convulsing).

Scene 2 

A sleepy outpatient Family Medicine Clinic in Chula Vista, CA. The Intern’s brother is Navy Lieutenant Medical Officer who is seeing patients in the local family medicine clinic. It’s a boring gig for him. He is awaiting orders to the Marines. The characters in this clinic include Layla, the communications nurse. Layla is a sweetheart mid-career nurse from the Philippines. Her husband is a retired Navy Chief. They have two kids. Layla manages consults and medication follow-ups for the Clinic. Her cubicle is in the same Pod as the Lieutenant (LT) whom she affectionately refers to as Doc.

Connie is the head front desk scheduler. She determines the appointment times for clinic patients. She is frequently seen eating cupcakes.

Dr. Kay is the retired Navy Commander who sees patients in the next Pod over. She went thirty days without a patient-related incident and is in a celebratory mood.

Dell is the business manager for the clinic. He is an unusually shy tall black guy. He is a retired Navy Chief, unmarried, and socially awkward.

Florence (Flo) is LT’s medical assistant. She comes from a Navy Family and is in the Navy Reserves. She grew up in Chula Vista and knows her way around.

Layla:  Morning Doc.

LT:  Crazy morning.

Layla:  What’s up?

LT:  You know my brother in Houston, the Ortho Resident?

Layla:  Oh yes. He’s so guapo.

LT:  Sure. Anyways, his Dept. Chair let a Podiatrist saw off some guy’s leg.

Dr. Kay:  Was he drug-seeking? I bet he was drug-seeking.

LT:  The Chair? Probably.

Dr. Kay:  No the other guy. Never mind. How many patients am I seeing today?

(Walks up to the Front Desk area to Connie)

Connie:  Twenty. Two of them are disability requests.

LT:  You can request disability?

Dr. Kay:  You can request anything. Last week some kid demanded a cardiology referral.

LT:  Ah yes. Syncope in the post-Google world. You could make a case for a free Plastic Surgery consult too.

Flo:  Free?

Dr. Kay:  Everything here is free. This is government medicine. We just print more money.

Everyone settles into their positions for the day. The medical assistants begin checking in patients at the blood pressure stations. Florence bring back an annual physical for IT. The camera turns to the exam room and takes the viewer inside. The patient’s name is Ignacio. He is a wiry, middle-aged Filipino man in flip-flops and a shaved head.

Ignacio:  Good morning Doc. My neck is killing me. Can you give me something?

LT:  How long has this been going on?

Ignacio:  20-years, Doc. I keep come-backing for the same thing.

LT:  Come-backing?

Flor:  (Cracks the exam room door with a manila file folder labeled: Service Record).

LT:  (Reading) I see you were at Tripler for some time.

Ignacio:  Sure was Doc. They gave me 30% but I need 100%.

LT:  I see you were investigated by NCIS for supply fraud.

Ignacio:  Let me see that paper Doc. (Produces a Nokia burner phone from his pants)

Speaking sub-dialect of Tagalog with pressured speech. Momentarily, the door opens. A stalky Filipina of middle-age enters, wearing a perm and sunglasses. Ignacio hands the folder to the woman, mutters something quickly, then the woman disappears into the hallway.

LT:  What was that about?

Ignacio:  Nothing Doc. She will shred those documents.

Flo:  This is so sketchy.

LT:  Right.. (indifferently). Okay Sir lets do a physical exam and send you down the hall for an X-ray.

Ignacio:  X-ray? Not necessary Doc. Can you send me to MRI?

LT:  Do you have any hardware in your body from prior surgeries?

Ignacio:  You better believe it. Back surgery, knee surgery, the works. Now that you mention it, I also have a plate in my skull.

LT:  Was that from head trauma in Iraq?

Ignacio:  Technically no.

Wife: (Peaks head in the door) It was a port-call in Subic Bay. Dog. Do you need the details?

LT:  That won’t be necessary Ma’am. Its not safe for me to send you to MRI with all the metal alloy in your body.

Ignacio:  Then how will they fix my neck?

LT:  The MRI doesn’t actually fix anything. It is a tool which produces an image of your neck tissues so the surgeon can determine whether or not it is fixable with surgery.

Ignacio:  Really?

LT:  Usually we only send people to MRI after first performing a physical exam. Since you refused a physical exam, and I can’t argue with you, I’m sending you to MRI, which I don’t recommend, and it will probably kill you.

Ignacio:  Then why did I go through all the trouble to call my wife here on a burner phone to shred those documents from Tripler?

LT:  Yes that was unexpected. Nice job on that by the way (High-fives Filipina from the doorway).

Flo:  Yea that was slick. Was she outside the whole time?

Ignacio:  Yea its a game we play. We go from clinic to clinic swindling Doctors. Been quite lucrative for us over the years. You should see my stash of Percocets and durable medical equipment.

LT:  Okay lets wrap up here. (Opens the door, asks for Layla) Layla can we get Mr. Ignacio his Radiology orders printed out?

LT shakes hands with Ignacio and He and Flo exit the room. LT sits down at his computer quietly writing Progress Notes and checking labs.

Dell:  Is that Mr. Ignacio again?

LT:  Oh yea. No big deal.

Dell:  He was here last month and saw Dr. Kay. She stone-walled him. Nicely done Doc.

LT:  I’m documenting everything we talked about, including the metal plate in his head. I’ll probably be out by the time he gets 100% disability.

Dell:  He’ll be disabled by the time he gets through with that MRI.

LT:  That’s messed up, Dell. But yes. Yes he will.