Incision

By Blake Chapman

There was a ringing in his ears. He heard a voice but paid it no mind.

“Doctor?”

The ringing persisted.

“Dr. Howie?”

It wasn’t until one of the operating room assistants grabbed his shoulder that Dr. Howie snapped out of his daydream and the ringing in his ears subsided, only to be replaced by the beeps and clicks of various medical machines. Dr. Howie was all but focused on the patient splayed out on the table in front of him. While his junior medical student assistants scurried around and executed their tasks, second year surgical resident Dr. Howie stood very still and stared at the charts of the patient’s vitals, pretending to know what they meant.

He sat down at the desk in the corner to think. The only people familiar with Dr. Howie’s situation were those who overheard the private discussions he’d had with his tutors throughout his time at medical school. Other than them, Dr. Howie had kept his academic life private from everybody, and for good reason.

“That’s not your own work,” his tutors would say. “Keeping this up will not prepare you for the real world. Real lives will be in your hands in that room.” It was a concept that Howie was able to grasp, but not entirely. It was the seriousness that seemed to elude him. The easiest solution for Dr. Howie was not to focus on his studies and learn the content of his courses, but to find another AI chatbot to tell him what the answers were to whatever was assigned that week. Since AI technology became increasingly undetectable, he was caught by his tutors less frequently. He discovered a lot about AI during his tenure at medical school, the most notable piece of information being that the more one asked an AI to be more specific with its answer, the less accurate it became. This is the very reason why he would run his answers through multiple AIs before submitting his work. An outsider would’ve thought he was a genius. Maybe he was, maybe he wasn’t. There was no way for even him to know.

In the operating room, grand lights shone brightly on the faces of confused assistants and medical students. The glare made the computer screens hard to read, not that it mattered. Dr. Howie was spending his time staring at the empty white of his notes, contemplating what he was going to do with this patient.

“Appendectomy – Urgent” he said to himself, his nose about an inch away from the screen as he read. This was his very first solo-surgery, and this was the only note that he thought to scribble in the patient’s file. Throughout the beginning of his residency, Dr. Howie was always able to stay invisible, or at most, do only what the head doctor told him to do. Now he was the head doctor, and completely alone.

“Dr. Howie, I’m administering the anaesthetic now,” the anaesthesiologist in the corner chirped at him, not angrily, but hastily, as the extra-long prep time that Dr. Howie had requested was not being used for preparation.

“Y-Yes,” Dr. Howie said, attempting to look confident and professional. “That’s good. Keep doing that. I’ll be over in a second. This one looks challenging.”

“An appendectomy, Doctor? Needs to happen fast, maybe, but not challenging. At least not for a doctor like you,” the anaesthesiologist was smirking, possibly flirtatiously, but Dr. Howie wasn’t able to pay attention at the moment. His head swirled with an infinite number of outcomes, each one worse than the last, and not one of them ending in a successful surgery.

Dr. Howie got up from the computer, and the squeak of his shoes seemed to draw all attention to him. In reality, nobody noticed. He slowly approached the patient and his eyes shot around the operating room, noticing every trivial detail on the walls. Scuffs. Marks. Handwashing signs. Informational posters. None of this information was relevant to him, but he needed somewhere to focus his hyperactive nervousness. His phone was glued his sweaty palm which was in his pocket. If he was going to do this surgery and save his patient’s life, he was going to do it the only way he knew how. He turned his back to the table and concealed his phone behind his chest so that no assistant or student could see what he was doing. They wouldn’t question him anyway; as a resident, he must know what he was doing. He opened the most used app on his phone: Chat GPT.

How to do an appendectomy. It was a strange feeling typing that into his phone. The trembling of his hands and pooling of sweat on the screen of his phone only made him more aware of what he was typing. A medical doctor asking an AI how to do a surgery. That’s who Dr. Howie was.

He noticed that Chat GPT had only given him a basic summary of what an appendectomy was. He’d been in medical school long enough to know that he should be looking for some more scientific sounding words. Make it more surgical is what Dr. Howie typed into his phone next. He found that it still did not sound surgical enough, even after his request.

Even more surgical.

Finally, Dr. Howie noticed enough uses of the word “incision,” as well as the names of various medical instruments, for him to justify using this outline. He took a screenshot of the AI’s statement’s and loaded it into the “photos” application on his watch. Now, with the tap of his trembling finger, he had the entire procedure displayed on the 2-inch screen that was attached to his wrist.

“Alright,” Dr. Howie said while looking at the anesthesiologist. “Scalpel, please.” The anesthesiologist lifted her eyebrow and delivered a look of confusion.

“Sorry,” Dr. Howie replied to the look on her face. He spun his head around, looking for a medical student to make eye contact with. He found one who looked eagerly back at him.

“Scalpel?” he questioned. The student swiftly grabbed the scalpel from the tray located right in front of him and handed it to him. As he made the first incision, he knew there was no going back.

On paper, Chat GPT had only ever done him good.

. . .

As most doctors do, Dr. Howie spent the last part of his shift recording and charting the events of the day.

Time of death: 14:25

Cause of death: ____

Dr. Howie didn’t know what to put for that one. He sat in silence and watched the little black bar blink at him while he thought. Anybody who was present during the surgery would have filled the empty line with “Dr. Howie” instantly, but it couldn’t have been his fault. Why did they let me do that? It was a simple question, but one that Dr. Howie could not find an answer to. It couldn’t have been his fault. Shouldn’t the Board have known about his lack of qualifications? Why didn’t anyone in the operating room say anything? What was he supposed to put on that empty line? While trying to think of an answer, Dr. Howie’s mind flashed to the memory of the patient’s parents and the looks of disbelief on their faces while he told them of their child’s passing during what was supposed to be a routine surgery.

“There wasn’t anything I could do,” Dr. Howie repeatedly told them. Any questions asked were met with a deafening silence.

He left the line blank.

The next day, his phone began to ring. The news had gotten out. He may have had longer if he hadn’t left his watch on his desk the night of the surgery, or if one of the student assistants present for the surgery hadn’t found it while doing some private investigating into Dr. Howie after that mess of an operation. It would be a matter of hours before his history with plagiarism and use of AI were common knowledge around the hospital. The moment his career had started, it was over. In his apartment, he stared at his computer screen and the line he left blank on his charts. The document was shared with all the staff, and he could see that 45 others were viewing it at the same time as him. He closed the document and opened up a web browser. He knew at this moment that he had one option. Into the search bar, he typed:

Chat GPT.

He clicked the first link and, after being prompted by a blinking line, typed:

Write me a letter of resignation.