The Doctor's Paradox

Before the hospital’s staff could administer anaesthetic to the screaming patient they had to confirm his contract would cover the cost, so when the doctor entered the room the patient had only been strapped down to the table in order to stifle his thrashing. The straps dug into his papery skin, blood oozing from his ripped flesh.

“Let me go,” the patient begged. “Let me go, I want to go home...”

The patient struggled despite the obvious emaciation of his body. His atrophied muscles flexed and pulled under a thin veneer of skin. With the patient’s body so depleted, the doctor imagined that he could discover what was causing the man so much pain just by touch, no expensive x-rays required. However, he could perform that sort of exploratory work and then still decline to operate on the patient, so he ordered the x-ray.

A young woman stood in the corner of the operating room, looking almost as if she thought that by standing very still she could disappear into the white wall. Considering that she wasn't wearing the hospital's approved whites or blues, she had to be the relative who had brought the patient in. The doctor asked, “Did you notice anything out of the ordinary?”

The relative replied, “No. No, I don’t think so.” But there was shame in her eyes, and she didn’t quite meet the doctor’s gaze. “He’s been in a lot of pain,” the relative said. “That’s why--”

“I can see that. Nurse, give him something.”

The nurse responded in a cautious tone. “His contract...”

The doctor waved the comment away. They could take the cost of the painkillers out of the doctor's pay if it would stop the patient's screaming. And, when he thought neither the relative nor the patient would overhear, he whispered, “Whatever’s cheapest today. Just do it, dammit.”

"I don't think he'll swallow anything we give him."

"Then give him a syringe. Just shut him up now." As long as the screaming continued, the doctor wouldn't be able to evaluate the contract in a cool state of mind, and ultimately it was those cool decisions that earned him his pay.

The nurse left and returned with a vial. Two orderlies held the patient down long enough for the syringe of opaque fluid to penetrate the patient's throat. Within moments, the patient’s moaning went from desperate screams to the hum of a child trapped in a nightmare.

After running through the usual questions with the relative, confirming that the patient had appeared to be in normal health until the sudden onset of painful cramps in his gut, the doctor dismissed her from the room. He brought up the patient’s contract, careful to avoid reading the man’s name. Of course he was legally allowed to know the patient’s identity, but the less he knew about anyone from this whole world, the easier it was to sleep when he returned to his home at the end of his shift. He knew he’d developed a certain notoriety around the hospital because even after working there for a decade he’d made a careful practice of learning no one’s name. Early performance reviews emphasised a marked lack of bedside manner but praised his complete dedication to efficiency. Considering that the hospital was still paying him a decade and a half later, it was clear that the efficiency outweighed any of the issues that might arise from employing a doctor who refused to operate even on a last-name basis with anyone in the building.

“Sir?” the nurse said. “The x-ray’s ready.”

The image showed a lump in the patient’s small intestine. A long thread wound off of a bulky head, looking absurdly like an oversized sperm-cell caught in the man’s guts. However, this monstrous sperm-cell was made out of metal.

The doctor glanced down to the barely conscious man still wiggling on the table. “Just what did you eat?”

The patient giggled. “They won’t find me now.”

Summoning all of the authority of his office, the doctor repeated, “What did you eat?”

“The tracker.” The patient whispered like a child sharing his very first secret. “They won’t find me, because my stomach acid will deactivate the tracker.”

The doctor could easily file away the relative’s shame into a familiar cabinet in his mind. Whoever she was to the patient--he would work very hard to ensure that he never found out exactly what bond connected them--she had watched the patient slipped into a delusional paranoia. In all likelihood, the patient's contract contained no budget for psychiatric evaluation, so the relative pretended not to notice the delusion as it grew like mold.

“They won’t find me now, not with the tracker deactivated.”

“What was the tracker?” the doctor asked.

The patient’s grin faded. “Mother’s locket. Shaped like a heart. They had to hide the tracker in something I wouldn't destroy, didn’t they? They thought they pulled one over on me. They thought if they hid it in there, they’d get me. But I knew what to do. Stomach acid. Deactivates the tracker... but the locket... I’ll just need to wipe it down, that’s all. Just need to wipe it down.” The patient’s breaths came slower than they had since the doctor entered the operating room. His eyes shut like snow sliding off a roof in spring. He even seemed peaceful.

After several long seconds of silence, the nurse asked, “Sir?”

The doctor checked the x-ray and the patient’s contract again. The locket had gotten tangled in the man’s insides, becoming the keystone in an intestinal blockage that was no doubt the cause of his pain. Better than nine times of out of ten, someone who swallowed something the size and shape of that locket would simply eject it from their anus along with a bowel movement. This patient had been unlucky, although his obvious malnutrition clearly hadn't helped. Bad luck was also probably the cause of the delusional belief that resulted in him swallowing his mother’s locket.

However, it wasn’t the doctor’s job to adjudicate luck or guilt. It was his job to estimate the cost of the operation and weigh it against the patient’s contract.

According to the documents they had on the patient, he worked on the floor of a large warehouse in a position that required no previous experience and no education. The contract showed that he already had a decade of work ahead of him before the debts he’d already incurred would be paid off. If the doctor were to cut the man open in order to remove that locket and return his digestive tract to working order, it would add another ten years of debts to the company. And the man’s life expectancy was only estimated at 17.23 years. If he operated, the company would likely never see their investment pay off, and enough unsatisfied investments would cause the company to take their contracts elsewhere.

“Who did he think was tracking him?” the nurse asked.

“Who knows,” the doctor murmured, still reading.

Of course, while the patient was sedated, they could bundle more operations onto the first surgery. In doing so, they would extend his life expectancy, but they would also add more debt. Situations like these were becoming annoyingly common, earning the nickname “the Doctor’s Paradox.” By operating, they extended both the debts and the lifespan of their patients. Hospital policy decreed that they could only operate if they were confident that their operations would result in enough working hours to pay off their debts, which meant adding more debts that required more time to pay off, and so on. If they could make someone immortal, they could only do so if the operation would cost eternity-less-one-day in debts.

The contract had all sorts of information on the man. There was the company estimate of how much value he added per hour and how many reliable hours of work he performed per shift. There were details on his purchasing history which contributed to that estimated lifespan, information regarding how much alcohol and sugar he ingested per week. The fuzziest estimates came from the area dedicated to his mental health. He hadn’t received a solid psychiatric evaluation in years, and the company would be very upset if they invested in the patient expecting three more decades of work only to have him hang himself within the week.

“Just wipe it off,” the patient whispered. “Good as new. It's okay, Mom. It's okay.”

The contract gave the company the right to extend his term of service for as long as they needed should unexpected debts be incurred, so legally the doctor required no consent. The man was unhinged, after all, and so his intellectual betters needed to make his decisions for him. Still, the doctor wondered if the patient would beg to have the surgery, or if he would simply take his chances with a cheaper, less invasive operation.

If they had more time, the doctor would begin by administering a stool softener and a diarrhetic to see if the dam of feces would break down. Unfortunately, the patient had clearly been hiding his pain for some time, and now the bulge of built-up waste threatened to rupture his intestines. The doctor cringed at the thought of the patient trying to go about his daily life with a hard lump of shit stuck in his guts. No wonder the contract reported that the patient's job efficiency had declined over recent weeks. Left untreated, the intestinal lining would tear and his feces would mingle with his blood, likely resulting in a deadly case of sepsis.

“Doctor?”

The patient’s face was hollow, and his hair was thin. The doctor could read over the contract again and again if he wanted to, searching for some reason to believe that this patient could eventually pay off his debt. No one in the operating room had the authority to double check his work, so he could perform the operation and then claim it was a mistake later. The only problem would be a small stain on an otherwise impressive record. He’d made a great deal of money for the hospital over the years because he could spot these exact situations, and in a situation like that there was no room for sentimentality.

“Stool softener,” the doctor said. “Painkillers. And an antibiotic just in case.”

They wheeled the patient away to some other room where eventually the numbness of the first painkillers would be diminished, and he would be reunited with his relative, and either the blockage would pass and the man would be fine, or it would not.

As he moved on to his next patient, the doctor reminded himself that regardless of the outcome it wasn’t his fault. It hadn’t been his choice to swallow the damn locket.