Apple has introduced me to the uncertainty of being doctored

On a recent Saturday morning, I took my problems to a bar.  The bar was on Boston’s Boylston Street at the end of a row of pubs.  Years ago, during orientation week of medical school, my classmates and I had worked our way methodically down that row.

The bar I headed to on this particular day was the Apple Store Genius Bar.  The “bouncer,” a man with skinny arms and a lanyard, directed me to a counter at the back of the store and introduced me to someone named Genius Jim.

“What can I help you with?” said Genius Jim, and I told him I had two problems.

The first was my phone, which was too slow.  Genius Jim asked to take a look.  He pressed some buttons, then handed the phone back to me.  “You have all these apps running in the background,” he said, flicking through several panels of applications.  Many of them I’d downloaded out of curiosity and opened once: a compass, a cocktail recipe generator, an application that turns things you say (“indigestion”, “Michael Phelps”) into little songs.

Genius Jim’s face was graciously stoic as he made the buttons jiggle and then extinguished them one by one.  I was embarrassed, and not only because he had seen my choice of apps: I’d demanded Genius-caliber help for a problem I could have solved easily on my own.

“What else?” asked Genius Jim.

The second problem was my laptop, which had recently started giving me the “kernel panic.”  This, I’ve gathered, is the Mac equivalent of the blue screen of death.  Now Genius Jim looked concerned.  “I’ll have to run some tests,” he said and asked me to sign a consent form.

I complied, and he disappeared with my laptop, leaving me to wander the store and creepily watch small children play.  An hour later, I returned to the counter.

“Did you back up?” asked Genius Jim, “Because we need to wipe your drive.”

Something had gone awry during the testing process.  Now my laptop was suspended in a technological coma, unresponsive to all stimuli.

Another consent form was produced.  This time, I had questions.  “Do you really have to wipe the drive?” I asked.  “Can’t you just return it to the sub-par condition it was in before?”

No, said Genius Jim.

Seriously? I said.

Seriously, said Genius Jim, looking serious.

I signed the form.

Genius Jim got everything ready.  With his finger hovering above the button that would erase three years’ worth of work, he asked one last time: “Are you sure you want to do this?”

It seemed like a loaded question.  Kind of like having one’s bowel perforated during a colonoscopy, being told surgery would be the only solution, and then getting to choose whether or not to undergo surgery.

After the deed was done, Genius Jim said, “You shouldn’t have any problems now.”

I breathed a sigh of relief.  At least it was over.  At least I could move on.

That’s when my laptop — my blank-faced, factory-setting laptop — gave Genius Jim and me the kernel panic.  This time, it felt less like a blue screen of death than a middle finger.

“That’s strange,” said Genius Jim.

I checked my watch.  It was no longer morning, and next door, the pubs were stirring to life.  I wished I’d taken my problems there instead, or even better, simply kept them to myself.  But it was too late.  I’d sought help, and now there was no turning back.

*

As a medical student, I spend one afternoon a week working in a primary care clinic.  Most of the patients I see are young, healthy women.  They come in with a cough or simple urinary tract infection; they leave with a cough suppressant or antibiotic.  Once every few weeks, an impressive collection of earwax walks through the door, and the office happily mobilizes to perform an irrigation.  Most afternoons, however, pass without incident.

Primary care doctors have one of the most important jobs in medicine: they are patients’ first line of defense.  If something serious comes along, they are the ones who are supposed to find it, flag it, and get the right people involved.

But things that are serious get mixed in with other things — things doctors can’t do anything about, things they could treat easily over the phone, things other trained professionals could handle equally well.  I imagine being a primary care physician must sometimes feel like sorting through a mountain of kidney stones so as not to miss a diamond.

Sitting at the Bar waiting for Genius Jim to fix my computer, it occurred to me that he might feel the same way.  What are Geniuses, after all, if not doctors of technology?  Instead of white coats, they wear lanyards; instead of coughs and UTIs, they fix bugs and RAM.  They, too, have to look out for the big bad thing, even if most of their time is spent dealing with people who have downloaded one too many compasses onto their iPhones.

For everyone’s sake, I had to wonder: wasn’t there a better way?

*

When Genius Jim finally got back to me with an update, it wasn’t a good one.  He was stumped, and he’d consulted two other Geniuses who were also stumped.  “If you’re willing to leave the laptop here for a few hours, we can run some more tests,” said Jim. “Get to the root of the problem.”

I said: “OK.”

To kill time, I went to a cupcake store and looked at some cupcakes. I walked to the river, where some people were falling in love.  When I was about to head back to Boylston Street, my phone rang.

“It’s not ready,” a voice said. “I’m taking over for Jim. The testing won’t be finished by the time the store closes tonight.”

I said: “OK.”

The next morning, my phone rang again.  “Just wanted to update you on the status of your computer,” said yet another voice I didn’t recognize.  “It now works, but in the process of having more testing done, the logic board may have gotten damaged.”

What’s that now?

“We were running some tests to overwhelm the system. We think it may have gotten — overwhelmed.”

To be fixed, he concluded, my computer would need to be shipped to an outside facility.  For a few hundred dollars.

A quick search told me that for a few hundred more, I could get a new laptop.

Had they at least figured out what the original problem was?

No, said Phone Genius, they had not.  But I should rest assured: the outside facility would be able to run more tests.

That’s when I decided to make my laptop Comfort Measures Only.

“Don’t move,” I said, which made no sense.  “I’m coming in.”

*

Looking back, I’d like to imagine that a different series of decisions could have led to a better outcome.  Unfortunately, my imagination doesn’t get far.  When it comes to caring for the sick – whether man or Mac –a good diagnostic system is priceless, but every test has a price.  So where does that leave us?

Sometimes I think back to medical school orientation week and recall the sight of a hundred future doctors descending upon Boylston Street.  That week, the long city blocks seemed to stretch straight into our future.  Not everything appears so straightforward anymore, on Boylston Street or elsewhere.  Medical school has introduced me to the uncertainty of being a doctor; Apple has introduced me to the uncertainty of being doctored.  In the time it’s taken to write this, my laptop has kernel panicked twice.

I’ve taken to pleading with it: Could you please just try to be okay?

Logic doesn’t back me up, but I’m not complaining.  For now, at least, it’s still here.

Rena Xu is a medical student.  Her writing has appeared in The Atlantic and The New England Journal of Medicine.  She can be reached on Twitter @xrayunicorn.

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  • Peter Elias

    Here’s the comment I made on FB: “If you use a computer or smart phone, are a doctor, have seen a doctor, or might ever see a doctor in the future, you should read this. First, though, you should take a few slow breaths, sit down and get comfortable, and practice nodding knowingly while you smile. She has a future as an author and a physician.”

  • http://www.facebook.com/shara.yurkiewicz Shara Yurkiewicz

    This is one of my favorite pieces by a physician-writer ever. Proud to be her classmate!

  • Jerry Yu

    Kernal panics unrelated to software (the genius’ first incorrect differential diagnosis) can be related to a doctor who hopes the deeply confused patient is due to a chemical imbalance only to find that the tox screen and lytes are normal and the patient’s moments of lucid thought are progressively accompanied by long periods of incoherent speech and uncontrolled body spasms. A structural analysis of the hardware will demonstrate an expensive and therefore unrepairable unit. In this analogy an unresectable, slowly progressive tumor that requires a brain transplant, probably not an option in this day. The end is near, but it will be difficult to predict exactly when the final event will occur. Fortunately you have moved beyond denial and are in bargaining phase. Acceptance will come. Black Friday is just around the corner.

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