We are data druggies.
We spend our days like desperate junkies crawling the carpet, sifting through the shaggy strands of patient histories with shaky fingers in search of facts. Every word our patients utter we feed to the never-ending demands of the electronic chart.
We find a fact and we enter it. The database grows. Someone somewhere adds another question we are supposed to ask our patients. We get back on our hands and knees. We start sifting once again.
Have you been to the continent of Africa in the last twenty-one days? Click. Do you or a loved one feel threatened at home? Click. How was your experience today? Click.
In the background the blood pressure cuff inflates, the quiet hiss filling the room. The monitor beeps along with the patient’s pulse, each ding another penny tossed into the ever-growing bank of patient data.
The data does not lie, we are told. The more data we enter, the better the patient encounter can be captured. The better captured, the better it can be used to guide us to provide care, as if we are blind from darkness and the data in the chart is light itself.
I sign up for my next patient. Fussy baby. Normal vitals. Vaccinations up to date. No red flags triggered in triage.
Proceed, the computer tells me.
I step into the room.
A baby boy lies on the gurney. He is pink and warm with little toes and fingers. When he sees me he wiggles chubby arms and legs in the air while cooing at the bright lights above, drooling and squealing. His delight at being alive and in this world is so strong it ignites the center of the room like a tiny sun. I sit down at the bedside and push on his round belly. He squeals.
I smile and look up at the parents. A mother and a father in their late twenties sit on the other side of the bed, engrossed in their phones.
The mother turns away from me in her chair, staring at her phone and holds up her index finger. I recognize the new universal gesture that tells me to wait- she is busy on her phone with something else.
I shrug. I examine the baby. He is so happy to be alive, to be here, to exist. Every moment is a gift and he still knows it.
I look over at his sibling- an older sister, five maybe. She sits sliding her index finger back and forth on an iPad in between quick sips of a supersized Coke. Her eyes are blank, lost in the screen before her. I watch as she absentmindedly picks up a few fries from the grease stained bag of McDonald’s next to her. She stuffs them in her mouth without missing a beat.
I pick up the baby. The parents still do not look up. The sister I don’t think even knows I am in the room. The baby boy scans around twisting and turning his oversized head. Curious eyes search the space around him, trying to interface with something, anything. I watch as his pupils dilate a tiny bit as they focus on my face. His eyes lock on to mine. I smile. “Hey, little buddy,” I say quietly. He smiles back with a toothless grin and clear drool runs down his chin over my hand and onto his belly.
I finish my exam. He is fine. I hold him on my hip while I wait for the parents to finish what they are doing. I can see Dad is playing a game on his phone. He is trying to slice pieces of fruit tossed across the screen. Strawberries spin in red bunches, bananas burst in yellow bombs, pineapples pop in showers of stars. I cannot blame him for not looking up. It is hard even for me to look away from such a screen.
I look to his mother. She rests her chin in one hand and stares at her phone in the other. She is scrolling endlessly through Facebook with a dull expression on her face, ironically enough looking at other people’s babies.
“Has your son been sick?” I ask.
Mom looks up. “He cries all the time. Of course, he is not crying now since we finally brought him in.” She hesitates, rolling her eyes for emphasis, and then continues. “Day and night he yells. He’s too young to keep himself entertained like this one,” she nods her head at her oldest child playing on the iPad. As if on cue the daughter slurps her Coke without looking up.
“Does he stop crying if you hold him?” I ask.
Mom stares at me for a moment but then her phone buzzes, interrupting us. Someone is texting her. She looks back down at her phone and types as she speaks. “Yeah, he stops crying if I hold him but I can’t hold a baby twenty four hours a day.”
I stand there quietly as she laughs at a picture on her phone. Someone has texted her a cat dressed as a pirate. She types back a response, leaving me standing with her baby still on my hip.
I turn to the computer and click through the boxes. Exam normal. No distress. No signs of infection. The computer auto populates the premade exam and template for healthy babies. I click a couple more boxes and wait. I click complete.
Much to my dismay, the computer accepts this patient encounter as is.
There are no red flags.
Chart Complete, the screen flashes.
The baby and I stare at each other, both trying to make sense of the world we now live in.
How can there be no red flags? I ask myself. Everything in this room feels wrong to me.
I think back through my head. Did I fail to enter some critical piece of data? I can’t think of one. Maybe it’s some kind of user interface problem with the computer. I pause, staring at the screen. Then it hits me. Maybe that itself is the problem. Maybe there is too much interfacing- interfacing between humans and computers.
I ponder that.
Computers are not going to go away nor would I want them to. But it is clear the irresistible glow of screens has taken us over and in the process has taken us out of our very own lives.
Maybe someday someone will invent a user interface that will remind us to stay in the present, to stay alert, to stay awake to the moments of this life before they pass us by. But it’s not here yet.
The baby boy suddenly grabs the stethoscope hanging around my neck, interrupting my thoughts. He yanks the black plastic tubing with surprising strength, almost as if he is trying to pull me close to tell me something. I lean in just a tiny bit.
He smiles again and babbles.
And then I understand what he is trying to tell me.
A user interface already exists that is made to keep us present, to keep us alert, and to keep us awake to the moments of this life.
That user interface is a human face.
We just have to look up from our screens to see it.
Philip Allen Green is an ED physician based in Walla, Walla Washington.