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The Library of Congress has cataloged the paperback edition: Smith, Roger D. Surgeon in the Mirror, The / Roger D. Smith–1st ed.
1 Medical Thriller, 2 Science Fiction, 3 Fiction
I Roger D Smith II Title
Paperback ISBN 978-1-938590-16-0
eBook ISBN 978-1-938590-17-7
Fiction by R.D.D. Smith
Robotic Surgeon Series
The Surgeon in the Mirror Against a Viral Threat* Savior of the War Torn*
Nonfiction by
Roger D. Smith
Chief Technology Officer
Thinking About Innovation
In the Footsteps of Franklin Advice Written on the Back of a Business Card Patterns of Strength
*Coming in 2024
Prologue
Surgical robots are mechanical and electronic devices that assist a human surgeon in performing procedures that have proven difficult with traditional surgical tools. The first crude versions of these were used on a human patient in 1998. By 2000, much more reliable machines were available and began to proliferate through the healthcare systems around the world. The best of these machines could improve the fidelity, dexterity, and stability of the surgeon’s hand, while also magnifying the surgical field to improve visibility of the tissue. Until 2033, these robots were entirely driven by human decisions and movements. The human surgeon looked at the surgical field and used their judgment on how to proceed. In 2033, Intelligent Surgical Robotics Inc. (ISR) introduced the Mark III robot that used sensors and specialized AI to perform a few specific actions like knot tying, cauterization, and suction. But a human surgeon still performed most of the procedure, using the robot to fine tune their movements and magnify their vision.
In 2047, ISR introduced the Mark V model of the robot that was powered by a revolutionary new AI that had been trained on millions of surgical videos and the entire world’s library of medical textbooks and journal papers. This robot was able to perform any previously seen surgery with more precision and finesse than a human surgeon could match. The new generation of human surgeons became assistants to the robot, being called on only when a situation arose that had not been recorded in previous videos and trained into the robot’s AI. The number of these original situations diminished every year, pushing the human surgeon further and further into the background.
But in 2050, ISR made major modifications to the AI to make the robot smarter and more autonomous …
Part I BEFORE
Chapter 1 Learning Surgery
“No, Monica! You are missing the stitch! The needle has to enter at a perpendicular angle! Yours is way off. That won’t heal right. Mr. Brown here is counting on you to put him back together better than he was when he walked in. Atkins had little patience for these clumsy new surgical fellows.
They all thought robotic surgery was going to be easy. Because they held the controls of a multimillion-dollar robot, they thought the machine could correct their sloppy technique. Becoming a competent surgeon still took years of intense practice.
“Dr. Atkins, I’m trying,” Monica snapped. “But the robot won’t do what I want it to do. It’s fighting me.”
“I hear that lame excuse every day. The Mark V robot is not fighting you. It magnifies exactly what you’re doing. All it does is make your bad technique look even worse. You need to develop finesse. You’re not trying to butcher a hog here. You’re taking out a man’s prostate. If you screw this up, Mr. Brown there on the table will be broken for the rest of his life. He will become intimately familiar with the concepts of incontinence and impotence. But no pressure.”
Monica had come to Miami following medical school in Atlanta and a residency in Arlington, Virginia. She was much more comfortable in a city than in a cornfield. She had not done all this work to practice medicine in a cornfield. The larger the hospital, the more patients she could help. More patients meant fewer little girls with broken hearts and no fathers to hold them.
She said to herself, “Control your breathing, control your thinking, control your performance.” Her yoga instructor always said that good performance began with good breathing. Center your breath, calm your mind.
Atkins continued to comment, “Ok, that’s better. Now let’s work on the rest of the anastomosis. This time with better technique. We can always have the robot do it automatically, but that will do nothing for your skills.” He was usually critical like this. It was his normal behavior with all the surgical fellows.
Monica brought the newly severed neck of the bladder down to meet the open end of the urethra. She was closing the gap where the prostate had been moments before she had removed it. The prostate sat between the bladder and the urethra, which then ran down through the penis, delivering both urine and semen, depending on the man’s interests. She could feel the resistance of the tissue as she pulled the two pieces together. Atkins always made it look effortless. But you were stretching resilient human tissue to fill a four-millimeter gap. That tissue may be soft, but it was not very elastic.
Anastomosis was one of the most difficult parts of the procedure. It was like sewing two ends of a garden hose together. The ends had to meet perfectly and be pulled snug, so they were water tight when healed. To accomplish this, the needle had to be inserted through the inside of one end of the hose, come out and then go in and out again at the other end. If you did this well eight times around the ring of the hose, you were likely to get a good seal. If you messed up even one of those stitches, you might close the urethra and shut off the flow of urine. Then you had to start over again with tissue that had puncture holes in it.
Atkins was wrapping up, “Listen Monica, there’s a big difference between a surgeon and a physician. Until now, you have been a physician. Now you are becoming a surgeon. Do you know what that means?”
Monica nodded vaguely, “Yes. Basically, it is the difference between knowing and doing.”
“That’s right. Physicians know everything about medicine. They can examine a patient, take their history, and map out a treatment plan. But they do not actually do anything themselves. A surgeon is hands-on. You have to know what needs to be done, and then you actually have to do it with your own hands. Your talent must reside in both your brain and in your hands.”
Atkins was reciting the credo that separated the two different classes of doctors.
He continued, “You came to us with outstanding test scores and great evaluations of your interactions with patients. Now you’re going to have to translate that knowledge into a genuine talent with advanced surgical equipment. Right now, your hands are just not as talented as your mind, and you need to fix that.”
At the end of their discussion, Atkins ordered her to spend more time on the simulator. He wanted her to repeat surgical maneuvers over and over until they became second nature. The simulator challenged her with all the little skills that she needed to master. Each of these was some foundational part of a larger procedure, but in the simulator, you could not injure, maim, or kill a patient. Mastering small skills opened the door to exercises that challenged you with full prostatectomies, hysterectomies, and dozens of other common procedures, each with a unique twist waiting to trip you up.
The simulator also scored her performance every second, so it could compare her to the most experienced surgeons and her own classmates. These scores contributed significantly to everyone’s standing in the program, which determined whether they ended up in New York or Iowa.
Like most surgeons and fellows, she had spent very little time with that simulator because it was not thrilling, like real surgery. No one got into medicine so they could play video games on human tissue. They were here
to heal real people. Her scores on the few exercises she had done were mediocre. That meant she was not excelling in the program and was far behind the leaders in the class. Discouraging. Unacceptable. Atkins told her she was not coming back to the OR until he saw some improvements in her simulator skills. So, she could not avoid the virtual torture device any longer. The simulator was not an actual patient, but it could equip her to help the next Mr. Brown, just as she wished the surgeon had helped her father nearly two decades earlier.
had been embarrassing. But the code, the robot, and the company had come a long way since then.
Janice and the rest of the team were much younger. They thoroughly understood the AI code and had given it capabilities that would have been science fiction when Sudhir was doing their job. Working with them had kept him technically sharp, while he helped them understand what an ISR customer needed in a robot.
Sudhir continued, “When we reach the 99.9% accuracy and reliability level of the AI in performing a procedure, I think we can dial up its confidence. That means it is doing the right thing but doing it twice as fast as it was in the previous version. The hospitals are loving it.”
Janice would not be silenced by her boss. “Of course, they love it. They can double their daily caseloads and double their profits using the same number of installed robots. What’s not to like? But the robot is almost out of control. It needs to have a more balanced level of confidence and caution. You can’t have Confidence running the show all the time. You have to let Caution play in with questions and concerns,” Janice countered. Her blood pressure was rising, as it often did when others tampered with her AI code. The code technically belonged to ISR, the product of dozens of bright engineers, but she had been the senior engineer on this part of the Mark V surgical robot for several years. That made it all ‘her code.’
To put a face and a name on the Caution vs. Confidence balance, she had casually named them Laurel and Hardy, after the ancient comedy duo that her parents had made her watch as a child. Oliver Hardy was the fat, bossy leader who always thought he knew what to do when they were in trouble— confidence. Stan Laurel was the skinny, whining sidekick, forever worried about getting into trouble—caution. She wanted Oliver to be confidently proposing the best next move in surgery. But she also wanted Stan to worry about making mistakes, measuring the risks, and suggesting caution. Together, they controlled an AI that balanced risks and rewards. Though she was the senior engineer for the AI, Sudhir still out ranked her. He also had oversight of more programmers. He could, and did, assign
“Very simple. Given the range we are talking about, those are the only prime number pairs. That means that no multiplicative combination of conditions will land right on the balanced edge, creating confusion about where control should go. The Bayesian splits will just be one additional safeguard against a deadlock of control.”
“Clever girl!” Sudhir replied, imitating the big game hunter from a classic dinosaur movie. “I think that actually has some merit.” Just as Sudhir was complimenting her, he realized he had used the last words of the hunter before the raptor devoured him. This clever girl may just be clever enough to take his job someday.
Curtis cleared his throat. “So, we are telling the world that our AI is 70% confident in what it is doing, but 30% uncertain and worried?”
“71 and 29,” Janice corrected.
Sudhir stepped in. “Well, that is a common misunderstanding of how AI works. But it is how the general public thinks about it.”
“Not to mention the general public’s lawyers,” Curtis added.
“All true. But computers, with or without AI, have to make decisions with quantified gates. That may mean a simple binary if-then-else statement, a Bayesian decision tree, maximizing a utility function, or tracing a neural network. All of them can be expressed as numerical decisions just like your 70-30 split.”
“71-29,” interjected the Raptor.
“Stop that!” Sudhir was trying to bring peace.
Curtis, “Ok, but I am just pointing out that we need a good laymen’s explanation for setting a decision point. Something that makes more sense to a patient and a lawyer than the nice mathematical properties of prime numbers.”
Sudhir was happy to find a taker for this problem. “Agreed! So that is now your job. Whatever the numbers are that allow us to balance Confidence and Caution, you work out the public facing explanation for it.”
“Thanks a lot. I have loads of free time to work on that.” Curtis was great at his job, but not as decisive or dynamic as Janice, which is why he would
always end up working for her.
“Someone from public relations and technical writing will help you with how to express it. You just give them the core concept to work with.”
“Will do,” Curtis sighed. He was supposed to be doing engineering and computer programming, not working on ad copy.
Sudhir turned to Janice, “Now, Clever Girl, you get to work on how best to balance the two. If 71-29 really is an advantage, you will have a journal paper on your hands. It’s a clever idea. Let’s see how it works out in practice.” He realized too late that he had implied that Janice was a ravenous dinosaur from an old movie. He hoped she did not catch the reference.
Janice nodded. “That sounds great. And, just to be clear, don’t call me a raptor. Or a girl. Certain negative connotations which might have to be discussed with the HR department.”
Sudhir sighed, he had been caught, “Fine. No disrespect intended. I genuinely meant it as a compliment.”
Chapter 3 The Prestige of Surgeons
Samuel Newman, democratic Senator from the state of Georgia, had sought the best surgeon and the best hospital for his prostate surgery. His own physician had pointed him to Richard Atkins at the GCRS in Miami, Florida. Though it would be a black mark for him to patronize the medical services of a neighboring state, rather than his Georgia home, he was determined to put his health above his political ambitions. Under the guise of visiting family in Florida, he had checked in to the GCRS under an assumed name. Hopefully, he would be in and out before the media or the political grapevine knew where he had gone. Only the most senior administrators and the surgeon at the hospital knew who he really was. Today was his day.
“Kevin, can you pass me a new suture?” came the clear voice of authority from the speaker on the robot. Kevin was one of the most experienced Physician’s Assistants on the floor. He had already loaded and inserted two more sutures; he only had to extend them into view.
The surgical instruments were dancing gracefully from the bladder neck to the severed end of the urethra. Every step of the procedure had been textbook flawless to this point. The robot had automatically adjusted some
Back in the OR, Dr. Atkins was seated at the surgeon’s console, ready to step in if the robot needed help. He said, “That looks really nice. You residents watching the feed get a good look at that. That’s what you want to do one day—if you’re lucky.” There were always a few residents or fellows in the room and several more watching the streaming feed, just as Monica was. Though Atkins always spoke to these beginnings with confidence, even he felt a little threatened by the beautiful job the machine was doing without his help.
There were six prostatectomy procedures occurring at this very moment, each with its own assisting surgeon and a single senior mentor overseeing all of them. The Global Center for Robotic Surgery, or GCRS, was the busiest practice in the country for this procedure. Patients traveled from all over the world to have their cases performed by the most experienced surgeons and the most advanced robotic systems ever invented. Today was actually a slow day. GRCS had the facilities and staff to perform as many as ten procedures at the same time.
Atkins turned to old Anil Patel. “The robot is doing a great job. I don’t think it is going to need me on this one.”
“Or the next one, or the one after that.” Patel grinned. He had played an important role in creating this robot. But he was glad that his operating career had happened during the sweet spot, when robots needed humans to drive them. He pitied Atkins, and Reubens, and Cooper, and all the other really fine surgeons at GCRS who seldom performed surgery the way he had thousands of times in the past.
“Thanks. That makes my day look a lot better,” Atkins was frowning.
When the center opened several decades ago, it was just a single surgeon and two robots. Dr. Anil Patel had performed over 20,000 cases during his career, most of them at this center. As the decades passed and the population aged, the demand for the procedure exploded, so this hospital needed more surgeons and more robots. The old Talos robots had been state-of-the-art in the beginning. They augmented the movements and vision of the human surgeon. But even those machines could not keep up with the demand for
Even his grandfather, who had practiced before robots existed, did more with his hands in a single day than Atkins did in a month. He had listened to his father and grandfather debating each other for his entire life. Not discussing, always debating. They were both certain that they had lived through the best time in medicine and had made more valuable contributions than the other. Every discussion was a competition with them. They had practiced during a time when the surgeon was the most prestigious role in the medical profession. They needed both their brains and their hands to deliver care to patients, as opposed to mere physicians who worked primarily from deep knowledge but did little hands-on work. These surgeons had also wielded power over their hospital systems. They generated so much revenue that the administrators, the desk bureaucrats, had to listen to them and deliver generous compensation packages and perks.
Atkins still enjoyed much of that prestige, but he knew it would not last much longer. Thoughts of the inevitable transition created a vague depression as he contemplated his future and that of the next generation that he was training.
Prior to starting this case, the Mark V’s artificial intelligence had matched the patient’s anatomy and data to 423 previously performed cases, all with similar characteristics. Each of those contained less than a 3% variation from the patient on the table. They had similar sized prostates, similar tumor patterns, similar physiologies, similar life habits, and similar previous treatments. As the AI guided the instruments from one step to the next, from one piece to tissue to the next, it was constantly comparing the response of tissue to all 423 of those cases. When the situation changed, the AI shifted its guidance from an action in case #123 to something more appropriate that it found in case #422. These shifts guided the instruments along the most successful path for the unique anatomy and the response from this patient.
Atkins was sometimes taken by surprise when the robot shifted from one angle of approach to another. He could usually see the tissue response that
had prompted it, but the robot decided so quickly that he was still processing the information when the robot had already acted on it.
This adaptive ability was a very long way from the one-size-fits-all approach of AI two decades ago, when it was first added to the Mark III version of the robot. Back then, the robot knew how to perform just a few steps of a procedure. The human surgeon had to activate each step or create a scripted sequence of them. It was safe and useful, but not impressive by today’s standards. Now, each procedure was broken into thousands of smaller segments and matched to previous cases hundreds of times a second. As a result, each patient received a personalized procedure that was not exactly like any that had been done before. Each of the thousands of segments may have come directly from a previous procedure, but they had never been put together in exactly this sequence with exactly this scaling. It customized each procedure for the specific patient on the table. It was like having a suit made by the most talented, meticulous, and experienced tailor on London’s Savile Row. The suit was unique from all other suits in the world. The Mark V engineers even claimed that the robot put patients back together better than nature had designed them. A very bold claim by the nerds, one which was not shared by the surgeons or the patients.
As recently as the 2020s, a robot like this was purely science fiction. It was not until the early 2030s that the first shadows of such a masterful performance by an AI-guided robot fell across the path of the medical world. That machine had been a child compared to the sleek machine in front of Atkins today.
This morning’s 82-year-old patient with severe prostate cancer had been prepared by human clinicians. The robot was docked to the patient by the OR team. The human assistants loaded all the instruments and disposables. But from that point on, the Mark V was in charge of the procedure.
The robot’s first action was always to “take a walk about”, testing its control of the instruments and scanning the internal anatomy of the patient. With this information, it paused for a long time—in computer terms. Several thousand milliseconds passed while it consulted its memory of
procedures, organizing those with the highest matching scores, and queuing them for use. Then, remaining completely still for another thousand milli‐seconds, it ran an internal simulation of the procedure. Technically, it ran nearly a thousand simulated variations of the procedure to estimate the probable course of this case and to identify the most likely outcomes, both good and bad. For this patient, it predicted 150 unique ending states, most of which would appear identical to the patient and the observing surgeons. It classified only three as negative outcomes, and each occurred at the 0.1% probability level. Should one of these negative outcomes occur, the Mark V would require help from Atkins. In probabilistic terms, this meant that the human would only step in for one case out of every thousand. And that ratio had been falling every year. It left a tiny caseload for Atkins and his colleagues.
John Doe, Male, 82 years old, BMI of 28, cancer in the left lateral lobe, was finished. The OR team was disconnecting the robot and preparing Doe 82 to be rolled out. They had to wake him before leaving the OR. He had to say something, give them a sign he was alive.
“Hello Mr. Doe! How are you feeling? Can you hear me?”
Nothing from Doe 82.
“Mr. Doe!” Rubbing an arm. “Hi there!”
His eyes blinked a few times.
Groggily, “What? Is it over?”
“Yes, sir. You did great. Everything is fine. We are going to roll you to post-op now.”
Out went Doe 82 and in came Doe 76.
Atkins did not get to work on that one. Maybe the next.
Each assisting surgeon had at least one manual case scheduled every week to hone their skills. Initially, those had come from the pool of patients who differed significantly from the cases in the AI’s knowledge base. The robot had not yet learned how to deal with them, so they went to the human surgeons who could consult with each other and apply their more flexible human intuition to the problem. But the AI watched, recorded, and learned
Seeing none, it signaled the OR team and the bot-controller that it had finished and could be extracted.
“Instruments disengaged?” the PA asked.
“Yes, Kevin, instruments disengaged,” the robot answered.
“Unlock the shaft.”
“Retracting.”
As the OR team physically removed the equipment from the patient, the robot was already analyzing its performance and the patient data that it had collected during the procedure. This passed through the network to the cloud servers that held millions of similar case files. This one was tagged for deeper analysis by thousands of computer cores. Any new insights would find their way into the global knowledge base that drove all Mark Vs on the planet. It would include both the positive and negative aspects of the case. The knowledge base was just as interested in fresh problems and mistakes as it was in new successes and innovations.
The experience from this case would spread through the worldwide network of robots in forty-eight hours. This automated learning process was infinitely more efficient than the centuries-old practice of presenting cases at international conferences or mentoring one resident at a time. Every Mark V contained the complete experience of each of its siblings within a few days.
With a thousand robots performing twenty procedures a day, the network could improve its performance by twenty thousand cases every day. In the early days, the AI and the knowledge base learned something new from every case. But now, years after its implementation, the fleet of robots had already seen and done almost everything that could be done. Today, it was more common for the network to find only two or three new pieces of useful information during a typical twenty-four-hour global surgical day.
In fact, the most interesting changes no longer came from the application of known techniques, but from the subtle new ideas that the robots were discovering on their own.
Chapter 4 Thinking Bigger
“Good morning, Janice.” Curtis had just parked his Trek Domane Road bike and was stowing his helmet and clip shoes. At six foot three, he was tall but lanky, exactly the build for an avid cyclist. His blonde hair was always a mess, whether from the helmet or because it just grew like a wild bush.
“Is it? I mean morning.” Janice replied absently. She looked up. Her eyes were red. But her concentration was still intense. She had been deep into the inner workings of the Caution and Confidence personas that guided the AI of the robot. Laurel and Hardy, as she liked to call them.
ISR’s engineering center was at a separate campus from the executive, accounting, and marketing functions. Tech companies had a reputation for treating their brain-trust differently from their operational business staff. The programmers and engineers maintained a unique culture, and the company stimulated them with special perks. ISR’s programmers may decide to crack down on a problem and work twenty-four or forty-eight hours straight. They needed a facility where intense work was encouraged and not a burden to the rest of the operation. The human resources department had never worked through the night. Their office areas could shut down at eight pm. The lights went out, the air conditioner throttled
back, security and admin staff went home, and the cleaning crews moved in. It saved a lot of facility expenses every night. But engineering was not on that kind of schedule. Lights, A/C, and computers were necessary well into the night and wee hours of the morning. Security was fully staffed around the clock. Cleaning crews were denied access to an area for days when a big crunch was on.
Given this kind of obsession, the engineers had to look out for each other. Curtis had motivated Janice to stick with a problem a little longer during the last push. But at other times, he had to encourage her to put it down, go home, and let her mind and body recharge. Tech company lore was that the brain-trust only pushed in one direction—toward more work. But, unbalanced, that just led to burnout. They had learned to be just as adamant about pushing each other out the door for rest or rehabilitation.
“How are Laurel and Hardy working out?” Curtis was offering her a coffee while sipping his own.
“Thanks. Mine has been cold for a few hours.” Janice glanced at the remains in the last of her row of matching paper coffee cups. When she turned her head in profile, her features seemed hawkish, but from the front, well balanced and intense. Her brown hair fell to the middle of her back and was restrained in a ponytail most of the time. It was efficient.
Janice had always been intense. The ability to focus for long periods of time complemented her intelligence. Though she was smart enough to compete in the Boston tech ecosystem, she was far from the top tier of raw intelligence. But, when her ability to perform sheer volumes of work was added, her work products could match those of several more intelligent engineers combined. She had sailed through undergraduate classes at MIT, but then who didn’t if they had the credentials to be admitted in the first place. It was not until graduate school that she really had to push herself to the levels of performance that she needed to land this job.
She continued, “I thought it was just a matter of balancing the right amount of Confidence with the right amount of Caution, then applying the core set of fail-safes to override either.”
do throughout their lives, not just the physiology of the body,” Janice suggested.
“I see what you’re saying. What’s the boundary for that kind of curiosity? Almost everything written, filmed, and spoken has a connection to the human condition.” Curtis smiled, “My uncle used that term all the time— the human condition. He thought he was an amateur psychologist.”
Janice was staring into her coffee cup. Red eyes were intense and focused. Curtis knew her well enough to know that she had heard him, even though she showed no outward signs of it. Her mind was mixing his contributions with everything she had been doing all night. The question was whether she was still mentally alert enough to make sense of it, or whether she had passed into the hazy realm where the mind was awake but not really processing. He waited to see where she would come out.
“I think I am done for now.”
“Going home to sleep?”
“No, no. My body has been idle for over twenty-four hours. I am going to run a few miles first. Then sleep.”
Curtis chuckled. “Of course you are. When you’re done, don’t bike home. Call a Lyft. We don’t want to lose all the work that is stored in your head just because you can’t see a car at an intersection.”
“Fine.” Janice headed downstairs to the gym and locker rooms.
As she changed into running clothes, her mind released its grip on the problem, letting it slide to the back of her consciousness. She was looking forward to the shot of endorphins that came from running. Physically unlocking her muscles and forcing them to move together would be a tremendous relief.
After the run, her mind was no longer locked on the Confidence and Caution problem. Physical exertion, outside air, sunlight, gliding through nature—it all pushed the mental reset button.
In the back of the car on the way home, she was dozing off. No pressures were nagging her awake.
Chapter 5 Monica
Monica had come to accept that caffeine fueled all surgeons. The physical, mental, and emotional workload were so extreme that food alone could power no one through the repeated daily grind. She usually awoke every morning, still tired from the previous day’s work.
The venti latte on the table was just the fuel to jumpstart the morning. There would be several more before the day was over. This quick retreat into her favorite café was one luxury that she still squeezed into her day. With her laptop open, she was supposed to be reviewing the day’s patient schedule. But she was scrolling the timeline on her social media feed. She was reliving some of the precious moments that had brought her to Miami and the GCRS.
There was her last boyfriend, Lucien. Had it really been two years since they had broken up? It was not really a formal breakup. Each of them had just been eaten alive by their chosen profession. A surgeon in residency and fellowship just had no time for anyone that was not immediately in front of them. When the work stopped, so did the mind, body, and energy levels. There was no energy left to commute to your lover, engage in enthusiastic conversation, share a meal or a movie, and then climb into bed. Even the
thought of it exhausted her. She was much simpler now. Life consisted of a single switch–work off, sleep on, start again.
Then there were the constant criticisms and corrections. All the new surgeons were terrible at everything. No matter how much you crammed into your brain, your body and your hands still needed years to master the execution of what you knew to do. You had to be a professional brainiac and a professional athlete at the same time.
Worth it? Everyone wondered that constantly. Hundreds of young candidates gave up every year. Eventually their answer to the constantly nagging question came back as, “Fuck no!” Once that happened, it was just a matter of weeks or even hours before they ejected from the program. Sadly, some of them would also eject from a window or inject from a syringe to escape immediately and permanently.
Worth it? Monica’s answer was always, “Absolutely, yes! It is my purpose.”
Dragging the social timeline backward over boyfriends, college trips, and holidays, she could see what she was giving up for this. But then she arrived at her favorite place on the timeline. The months that she relived over and over. The happiest time of her life. She had not known that it would end so abruptly and so permanently.
It began with Princess Cinnamon. The little puppy had filled her heart from the moment she saw it. Brown and white happiness bounding out of the box that her father had brought home. He was late for Monica’s twelfth birthday party. She was surrounded by friends. There were presents, cake, costumes, games, and parents trying to control the chaos.
Parties in late spring were always outside around the swimming pool. By twelve, all the children were certified fish and in no danger of drowning, though parents circled around the edge, certain that their darling would be the first to go.
When her father arrived, she bound out of the pool and rushed to him. “Daddy, you are missing the party!” Then she noticed the box.
“For me?” she squealed.
There were no entries in her social timeline for an entire year after that day.
Was it a day later or a month later? She could never work it out.
They were all sitting at the kitchen table, and mom and dad were trying to explain something to her. She understood nothing they were saying. There were words she did not know. There were vague statements. The only message she got was, “We will go to the hospital tomorrow.”
They all went in the car together. Princess Cinnamon stayed home to wait for them.
It was not until her dad had left them to follow a nurse that she understood this visit was for him. He was never sick. It never occurred to her that he was the one who needed the hospital.
They waited. It was quiet. The snacks were bad. The people around them were sad.
Monica remembered thinking about Cinnamon and whether she was lonely. They should have brought Cinnamon with them.
Her mother was talking to someone in royal blue pajamas. She had watched her mother crumble and sob. Monica did not know what was happening, but it had to be about her dad. When was he coming back?
Her mom sat down sobbing. All Monica heard was, “He’s not coming back.”
After that, everything was a blur. It was like being underwater. She could not see clearly. She could not hear clearly. She could not speak.
It took her weeks to grasp that her dad was not coming home again. There would be no more teasing. There would be no more games.
She spent days on her bed with Princess Cinnamon. Sometimes she cried. Most of the time, she just stared at nothing. Always she held onto Princess Cinnamon.
It took her a few years to understand what cancer was. It took longer to understand that a doctor could save someone. Then she learned some doctors are surgeons, and they can separate a person from their cancer in an
hour. They can save lots of people in a single day. But the bad ones could also kill people.
That was when she knew what she wanted to do.
She got busy learning. Princess Cinnamon had been there with her as she turned herself into a doctor and a surgeon.
Worth it? Yes, absolutely. It was her entire purpose in life. Hundreds of little girls were going to grow up with their fathers because she would save them. They would go home together.
Monica shut the computer. She wiped her eyes. She blew her nose.
