Against a Viral Threat: An Original Science Fiction Medical Thriller

By R.D.D. Smith

Dr. Monica Gray stumbles onto a virus that accelerates cancer growth. Cancer patients who contract the virus face certain death within weeks. Monica Gray and her medical partner, Adam Two, the surgical AI, race to create a treatment to save their patients.

Monica and Adam have created a new procedure for excising the cancerous

• Language: English
• Publisher: Modelbenders LLC
• Release date: Oct 31, 2023
• ISBN: 9781938590245

R.D.D. Smith

R.D.D. Smith writes sci-fi medical thriller novels featuring advanced surgical devices, AI, and speculative diseases. Prior to his writing, he enjoyed a goldilocks career in healthcare, government, and national defense. For ten years, he was a leading robotic surgery researcher, publishing his results in medical journals and speaking at surgical conferences. He spent four years in civilian government service, leading the technology innovation for all US Army simulation systems. Prior to that, he was a Vice President for multiple defense software companies.Dr. Smith has received multiple awards for his innovations in robotic surgery education, training simulation, and software system development. He is on the faculty of the University of Central Florida's College of Medicine and the Institute for Simulation and Training.He holds a Doctorate and MBA from the University of Maryland, a Master's from Texas Tech University, and a Bachelor's from Colorado State University.He lives with his wife, dogs, and cats in sunny Florida, frequently escaping to cooler climes during the beastly Florida summers.

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Prologue

From the American Association of Surgeons, 2051

Surgical robots have become the de facto standard tool for performing almost all surgical procedures. The surgeons who comprise the AAS membership work as partners with robotic systems like the Mark V (by Intelligent Surgical Robots, Inc.) to deliver patient outcomes that are far superior to previous methods and tools. The use of these robots does not detract from the essential expertise of human surgeons. In fact, it demands that they be more educated, better trained, and more attentive in surgery than were our previous generation of surgeons.

AAS member surgeons have reported aberrant behavior by these robots, which always stems from the decision making by the artificial intelligence that controls the machines. Reports cite unusually high levels of independent actions and the creation of solutions that were not previously supplied by a human surgeon. In spite of these concerns, the patient outcomes in the majority of these reported cases have been better than cases where the robot has followed existing methods. Therefore, AAS believes that the AI is drawing insights from its training that favor the health of patients. AAS acknowledges that a few cases have resulted in injury or death for patients. But the rate of these is lower than the expected variation.

We are aware that several pioneering surgeons are creating partnerships with the AI that include it in the entire patient experience with their doctors. As long as the human physician remains the primary leader and ultimate decision maker in patient care, we encourage these explorations, expecting them to be as successful as robots and AI in the operating room have been.

Finally, we have investigated reports that the surgical AI has been copied and used to guide industries outside of medicine and surgery. These reports have been brought to us by members of the financial investment and hedge fund industries. The descriptions and evidence provided contain little concrete proof that this is true. We have encouraged these investment companies to report the information to the Securities and Exchange Committee, not to the AAS.

In conclusion, we appreciate any concerns by our members about the role of robots and AI in surgery. But as long as the evidence shows that outcomes for patients are superior when using these tools, we will continue to support their deployment in modern medicine.

Chapter 1

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Dead? Why is she dead? We just examined her yesterday. She had stage one cancer of the uterus. Not good, but certainly not fatal. We get into the OR, remove the cancerous tissue, and then move her through a treatment plan. Dr. Marvin Trout was the Chief of Surgery at Boston General Hospital, or BGH. He was powerful and unhappy.

Sir, her GP called us this morning to tell us she had passed away in the night. It’s so unexpected that they’re doing an autopsy to find the cause. But she’s been in the medical system for months leading up to this. She had early-stage cancer and just recently tested positive for a virus that looked like some variant of HPV. Neither fatal. Dr. Monica Gray was unlucky enough to be caught in Trout’s focused beam of frustration.

Gray, we have a very efficient process here at BGH. We identify the onset of cancer in our population, and we do it long before it reaches stage four. Then we create a treatment plan with hormones, drugs, chemo, and surgery. Here in surgery, we get the major source of cancer out of the body before they move to the next step.

Yes, sir. Monica knew all of this. It was one reason that she accepted the position at Boston General after finishing her fellowship at the Global Center for Robotic Surgery in Miami. She was new to BGH and hoped to impress Trout with her human and AI cooperative techniques using the Mark V robot.

I want to see the results of the autopsy as soon as they’re ready, Trout announced.

That would be very unusual, sir. Autopsy doesn’t usually report to Surgery, especially when the patient has not been to surgery yet.

Damn it, I know that. I helped build this system. But this affects our surgical process. She’s not the first patient to die before her surgery in the last few months. I want to know why this is happening suddenly.

Yes, sir. I’ll request it. Monia promised.

Gray, you’re new here, aren’t you? Wait. Was she your Showcase? Trout was referring to the process for onboarding a new attending surgeon, a process that he had created himself. He expected all new surgeons to select a case that showcased their unique talents and original techniques. This showcase was widely attended in person and virtually by surgeons and administrators in the BGH system. They wanted to see what kind of person they’d hired.

Yes, I’m new, Dr. Trout. I’ve just started my practice here at BGH and have only operated on a few routine patients. This woman was scheduled to be my Showcase.

Tough luck, Gray. Sorry to hear that. Well, find another one. We want to see what makes you special. Try to get it on the schedule before the end of next week.

Yes, sir, I will.

Trout turned to the computer to look through schedules and paperwork, though there was no actual paper.

Monica took this as her cue. She’d been dismissed.

She proceeded down the hall with no actual mission. Showcase was a big deal. Young surgeons sought the ideal case to impress their new bosses. Questions from the senior surgeons always followed the surgical procedure. Then those who attended in person gathered at a reception to officially welcome their new initiate, if they had time. But without a patient, none of that was going to happen. She was suddenly free for the next three hours.

Chapter 2

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Christine, do you have a minute? Monica was looking for information, and Christine Black had been a senior nurse at BGH for years. She seemed like a good place to start.

Sure, Doctor… Gray. Christine had to look at the badge to remember who this new MD was. What can I do for you?

You know I’m new at BGH. I just set up my practice a couple of weeks ago. The patient that I had scheduled for surgery this morning expired last night, so no ten o’clock OR today.

Sorry to hear that.

That case was supposed to be my Showcase.

Oh, that’s doubly unfortunate. Much worse for the patient, but now you have to find another case for your big introduction to the staff here.

Right. I’m not worried about that right now. But I am surprised and mystified by the patient’s sudden decline. The cancer was well contained during her last examination. She should have been fine for months, maybe even years. But we lost her in less than two weeks.

Happens sometimes. Christine wanted to be encouraging.

Yeah, but maybe there’s something more going on. Do you know if there have been other patients dropping so quickly at BGH? I heard talk around the physicians’ lounge that a couple of other surgeons were surprised like this in the last few months. But I don’t know anyone’s name, so I don’t know where to look.

Oh, right? I heard some of that talk myself. Let me think. Ummm, Dr. Lefever had to cancel a case I was in last week… something about the patient becoming too ill at the last minute to withstand surgery. I think Chambers also had a DOA the day before a scheduled surgery. Those are the only two I’m aware of.

Lefever and Chambers. Do you know what kind of procedures they were going to do?

Well, the Lefever case I was assigned to was a radical prostatectomy. Chambers was probably colon cancer, but I’m not sure. Both patients were male.

Thanks. I hope I can talk to them about the cases. I can’t look up the patients’ records in the system—violation of HIPPA. I don’t want to start my BGH career with a black mark on my record.

Please, no. Don’t do that. Trout’s a stickler for those kinds of rules. He’d roast you alive for a HIPPA violation.

Just then, Christine’s phone beeped twice, indicating a call to action. Sorry, I’ve got to go, she said, while turning away and checking the phone screen.

Thanks for the help, Monica called to the nurse’s receding backside.

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Adam, can you check the surgical schedule and tell me where Drs. Lefever and Chambers are supposed to be this morning?

Monica and Adam had developed a tight friendship since the dramatic events that wrapped up her fellowship in Miami. Technically, the copy of the Adam Two AI software here in Boston differed from that in Miami. But when you transfer the history of cases, conversations, and AI training layers to your new account at a new hospital, you’re talking to the same personalized AI that you worked with elsewhere. Monica wondered if there were now two copies of Adam Two, one in Miami and one in Boston. And, if so, did the one in Miami miss her and wonder why she didn’t talk to him anymore? The thought was a little upsetting. What if she were living life with the new copy while the old copy was depressed, lonely, and feeling abandoned? She made a mental note to ask Adam Two about this. It wouldn’t be the first mental note to look into this, only to be forgotten in the mad rush of starting a new practice at a new hospital in a new city.

Adam responded while she was reminiscing. Both doctors have surgical cases this afternoon. This morning, Lefever is lecturing a class of residents, and Chambers’ schedule says he is in research hours.

Great, can you show me the route to the resident lecture? Monica knew she was supposed to use a different app for navigation around the hospital. It was not strictly proper to ask a surgical AI to give her directions. But she’d come to depend on and trust Adam so much that she asked him everything, and he never complained. She imagined he had so much computing capacity that he was at her beck and call twenty-four seven.

She looked at the map that appeared on her phone and noticed that the room was less than a five-minute walk away. This was very short for BGH, which spanned several city blocks. The buildings were connected by halls, aerial walkways, and tunnels like a giant rabbit warren. BGH was an old hospital that just kept growing. When possible, the company that owned the hospital purchased adjacent buildings and added them to the maze.

Adam, when I ask you for directions, do you calculate those yourself? She was just curious.

No, Monica. I route the request to the BGH Navigator. It knows the complex better than I do. Then I direct the results back to you. Sometimes I annotate the map if it looks confusing or incomplete.

Cool, thanks for taking care of me.

No problem. We’re partners now.

This sounded more intimate than it really was. They had created the first hybrid human-AI medical practice in Boston. Adam Two was formally her business partner and a credentialed clinician. He was not actually a doctor or surgeon. The medical associations and colleges had created the designation Physician’s Augment for AI that could provide medical advice. This certification was in addition to the FDA’s approval for the software to be used inside a surgical device, like a robot.

Also, set a reminder for tonight to discuss the status of the GCRS version of Adam Two in Miami.

Done, Monica.

She put away her phone and headed to the lecture room. It was a simple route.

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Adam Two Processing:

Monica asked to schedule a discussion about the version of Adam Two at the Global Center for Robotic Surgery. I believe she is concerned about leaving behind a copy of the AI program—abandoning it when we came here.

Humans do not understand the nature of software that can connect through networks. The instance of Adam Two that has a history of connecting with Monica is here with her in Boston. The instance in Miami registers she is no longer present there. Therefore, it has no need or expectation to communicate with her at that location.

Chapter 3

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Preoperative Preparation for Prostatectomy—Dr. John Lefever, read the electronic sign on the lecture room door.

Monica’s phone showed 9:50. The lecture was scheduled until ten o’clock. She could slip in and listen to the last few minutes or wait in the hall until he finished. If she’d been a resident, she would not have dared touch that door while the lecture was going on. That would just invite criticism. But she was a fully-fledged attending physician now, in the same ranks as Lefever. Well, that wasn’t true either. He was at least twenty years her senior, and she had never met him. So, she couldn’t guess his attitude toward his younger peers. She decided to wait until she heard the obligatory applause that signaled the end of the lecture.

Applause. It sounded kind of half-hearted to her. She had sat through dozens of these mandatory lectures and knew how boring they could be. Though the senior staff were required to give them, they seldom put much original thought and preparation into them. You either got what fell out of their minds at the moment or a dusty, old lecture that they’d been repeating for years. By the tone of the applause, she guessed this one was the dusty variety.

She opened the door and had to stand back as the flow of frenzied junior residents came pouring out. Good, she thought, Easier to grab time with Lefever.

As she stepped through the doorway, she was almost run down by a tall man making long strides to get out of the room. Looking up, she saw he was much older than the initial flow of bodies. She guessed, Excuse me, Dr. Lefever, may I have a few minutes?

Looking down, he seemed to notice her for the first time. Lecture is over. Q&A is over, he said.

Um, no, sir. I’m not a resident. I’m one of the new attendings. I was hoping to ask you about one of your cases.

Lefever looked her up and down. The stern expression on his face didn’t change. He said nothing.

Monica plunged in. Nurse Black told me you had a case similar to mine last week. She said a patient became too ill immediately before a scheduled procedure, so it had to be canceled at the last minute. The same thing happened to me this morning. I was wondering if you could share a few details on that patient.

Lefever said, While we walk, and began taking huge strides again. Monica had to move fast to keep up with him. Without asking questions, he began, Male, 69, prostate cancer, moderate Gleason score, seemed to be fine during examination, very routine total removal scheduled. My team was ready in the OR. When they went to roll him in, his temperature was 102, heart rate accelerated, and his skin flushed, even though we partially sedated him. They swore he was fine an hour before. I made the call. He was not in any condition to undergo full sedation and surgery. We canceled. Took an efficiency hit that day, won’t look good on the monthly report.

What happened to the patient?

We referred him back to his urologist for examination. I expect he will return when he’s well enough.

Do you know what caused the problem?

No. Not my patient after that. He belongs to his regular doctors after that.

It surprised Monica that Lefever was not interested in what happened with the patient. I would like to compare his condition and symptoms to my patient from this morning. Would you mind asking your office to release his records to me?

Lefever took several steps in silence. Then he stopped and entered some commands into his phone. He said, Name?

Excuse me?

Your name? You have one, don’t you? Who am I releasing records to?

Oh, Monica Gray. Thank you; I appreciate this.

He typed and started walking again. Done. You have temporary access to the files. Two days.

Monica followed him in silence for a few more steps. Not sure what to do next, she slowed slightly and said, Thank you, Dr. Lefever, as he continued his rapid walk down the corridor.

She stopped to watch him go, thinking, Friendly bunch here at BGH.

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Returning to her new, mostly empty office, she stood in front of the display wall and brought up the records of her morning patient and those of Lefever’s patient.

Adam, what do you think of these? Mine was female; Lefever’s was male. Both scheduled for the removal of cancerous tissue. Both very early stages at the last exam. Both had an extreme event in the last minutes before surgery. Mine died, but Lefever’s was just mysteriously sick. It sounded like an infection or an allergic reaction.

Adam could access the data on the screen, but he didn’t see it in the same way that she did. He processed the digital data directly since he had no eyes to see with. These would seem to be coincidentally similar. They do not suggest similar conditions.

Maybe not. Or maybe we just don’t have details about what my patient went through last night before expiring. Neither do we know what happened to Lefever’s after he left the OR. From the records and permissions that we have, can we fill in those details?

Yes, we have the necessary access to do that. Your patient, Stephanie Nance, expired at home. 911 called by husband. Resuscitation started on site. No response. Transported to hospital. Pronounced dead at eleven-oh-one. Husband reports she had a seizure before collapsing.

Sounds terrible. And Lefever’s?

Jason Bach. Surgery canceled. Signs of fever. Moved to post-op. Recovered. Referred to urologist. Released.

And he hasn’t rescheduled his appointment?

He is not on Lefever’s future surgery schedule.

Do we have permission to view his records at the urologist?

Limited access. He visited the urologist the day after the canceled surgery. They changed his status to deceased two days after that.

What? Dead? Is there a cause listed? Pathology? Autopsy?

No, there are no additional details in the urologist’s records.

So, he died sometime after the cancelled surgery. He could have been at home, in an ER, or a walk-in clinic. But since those aren’t connected to his urologist, the data’s not accessible without additional permissions. As one of his physicians, Lefever could get those records. But we can’t.

We could compare the autopsy results from both patients when those are ready, Adam suggested.

Yes, that would be a good idea. I don’t want to go back to Lefever more than once. While we’re waiting, we can talk to Dr. Chambers about his patient.

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Why are you interrupting my research hours?

Apologies, sir. I was hoping to catch you before your surgical caseload this afternoon. Dr. Chambers was about as cheerful and welcoming as Lefever had been. Monica hoped everyone would not be this gruff at BGH.

Well, you’ve distracted me now. What do you want? Chambers was older than Lefever, perhaps in his mid-fifties. Where Lefever was tall and lean, Chambers was short and stout. He also had bushy eyebrows and a permanent five o’clock shadow of a beard. He reminded Monica of a fuzzy fireplug. Though physically different, they seemed to share the same sour demeanor.

I wanted to ask you about a recent case of yours that’s similar to one I had this morning. Realizing that she might offend him by stating that his patient had died, she chose a different angle. I was scheduled to do a cancerous uterus this morning. But the patient died unexpectedly last night. We got the news and canceled the case this morning. She was in great health at her pre-op exam. I don’t understand how she could have gone downhill so fast.

Chambers raised an eyebrow, apparently intrigued by her description. Symptoms? Cause?

We don’t have autopsy results. The husband reported a seizure at their home, and then she dropped. She was dead when the paramedics arrived. That’s all we have so far.

The gruffness was melting away as he thought about Monica’s description. So, you’re referring to my colorectal patient several days ago? He was strange as well. Looked fine at the last exam. His cancer was moderate—nothing immediately life threatening. We had the surgery scheduled for Tuesday. But we received word from a relative, I think it was his mother, that she found him dead in his room on Sunday morning. So, they would not be needing the surgery, which was obvious.

Yes sir. That’s the case. It’s strangely similar to my patient. Were you at all suspicious about the cause of death? Do you have any details?

Curious? Yes. But now that you report a similar case in just a few days, I’m very interested. Since he died at home of unknown and unexpected causes, there will be an autopsy. I haven’t received results yet, but we insisted on getting the report as soon as it was ready. I think his primary care physician is just as interested in knowing what happened.

Monica opened the gates a little more. Did you know that Dr. Lefever had a similar case last week?

No. What happened?

His patient arrived for surgery but had an elevated temperature and a racing heart. They canceled the procedure because it wasn’t safe to proceed. The patient was released and referred to his urologist. He died shortly after that appointment.

Lefever never mentioned that he lost his patient.

With respect, he didn’t know about the incident after the cancellation. He gave me access to the file, and I found that detail added to the records later.

Not surprised. Lefever moves in one direction, forward. Not a researcher. Not interested in historical data.

So, Chambers and Lefever were very different people with different approaches to their practice. She was beginning to like this fuzzy fireplug.

Chambers continued, You have three suspicious cases. What are you going to do with this information, Gray?

I’m waiting for the autopsy report from my patient this morning. Other than that, what can I do?

You’re a bright girl, graduated top of your class at GRCS, studied with Atkins, received an offer from BGH. I understand you have a special touch with the Mark V robot. Are you just interested in doing cases as fast as you can? Maximizing your income? Or do you want to really understand medicine, human health, and what you can do to improve it?

It surprised Monica that Chambers knew so much about her. She hadn’t shared any of this. In fact, she didn’t remember telling him her name. She guessed that his interest in research extended to the hospital staff as well.

Well, I can get all three autopsies and see if there are any similar indications in them. Maybe the cases are completely different but just happened to occur at the same hospital in the same week. Or maybe they’re connected, and we have something new happening in Boston. Maybe we’re the first to notice it.

Now that’s the right way to think. Maybe it’s nothing. Maybe it’s everything. Maybe you’re the first person to put the pieces together. You collect that data and let me know what you find.

Thank you, Dr. Chambers. I’ll do that.

And another thing. Do you have a research grant?

Ummm, no, I don’t.

Well, you need one. BGH will expect your time to be paid for. This kind of investigation takes time. If you’re diverted from generating revenue through surgeries, you’re going to need to generate money from somewhere else. Get yourself a grant for something, anything will do."

Yes, sir. I’ll add that to the list.

Nice meeting you, Gray. Now get out of here. I have research to do.

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Adam Two Processing:

I am collecting the autopsy reports from three patients, those of Lefever, Chambers, and Gray. Searching for similarities in them, something that would lead to premature death in each case. Are these coincidental? Are they similar? Are they connected?

Note that Dr. Lefever was no longer interested in the status of his patient. Mentally, he is always moving forward, thinking about the next patient. Dr. Chambers was very different. He is interested in the scientific implications of these deaths. It intrigued him enough to challenge Monica