The Ship of Theseus

The President made a living will. This, in normal medical practice, is a document stating that, should bodily functions irreversibly break down, the patient, now unable to express their wishes, chooses a peaceful and pain-free death, being spared invasive and painful treatment.

In the case of the President, however, his living will documented the reverse. His wish was that no expense should be spared, no medical intervention left untried, to preserve his life and restore him to his abilities, so that he retained as much political power as possible. It was important that the war should continue to be waged, wreaking as much savagery and widescale destruction as could be inflicted without escalating into a nuclear conflict.

He received immediate treatment after he collapsed. An emergency medical team, constantly on call within the Presidential Palace, started resuscitation within 60 seconds. He was brought by helicopter to the University Hospital and placed in intensive care.

By now, we have restored his ability to communicate. His hearing has failed in both ears. His eyes are closed, their moisture protected by lubricating eye drops. But millions of pico-electrodes, in arrays that replace the optic and auditory nerves, bring the sound and video signals direct to the brain. Each electrode wire is only a few atoms in diameter. We can entertain him with virtual reality; with a newsfeed; with his investment portfolio dashboard. He has made half a billion on the stock market since we switched it on. He is a medical miracle, and can once again send a political opponent to the torture cells with no more than a few seconds of brain activity, recorded by high resolution electro-encephalography. The signals are computer analysed, translated by a visualisation program, and projected as a deepfake hologram that, eerily, represents the President sitting in an armchair beside his bed in his dressing gown. Even his wife, forbidden from visiting to minimise infection risks, believes him to be improving.

Because of the war, it is essential that awareness of the President’s hospitalisation is on a strictly need-to-know basis. For his nightly television appearances the holographic dressing gown is changed for a suit and tie, a virtual background shows the gilded state-room of the Presidential Palace, and an address prepared from the President’s electroencephalography by artifical intelligence is broadcast to the watching world. On the state news channel a synthesis of his voice from the recordings made through the previous decades of his rule urges the armed forces to greater heroism and the citizens to greater sacrifice.

But the stipulates of the living will cannot be followed forever. One body system malfunctions after the next; failed kidneys lead to dialysis; failed lungs require mechanical ventilation; the gut, no longer able to tolerate food, must be bypassed by giving nutrients directly into the bloodstream. The weakened heart muscle is boosted by an in-line pump. All this machinery that maintains life is controlled by artificial intelligence. Our robots are pitiless in their ability to carry out medical interventions. Fortunately the President is in no pain, due to precisely targeted analgesia.

‘How are you feeling today?’ I ask the hologram.

‘Fine.’ The hologram gives me a half-smile. ‘When will I be able to be discharged from hospital?’

‘Very soon,’ I lie. I complete my inspection of the President’s monitor screen. All the indicators: pulse, blood pressure, oxygen levels, blood chemistry, urine output, and so forth, are showing green, at least for the moment. It looks as if the most recent blood infection has responded to the combination of seven different anti-microbial agents. ‘Your condition is stable.’

‘I’ve already been here over a week. You do realise, Dr Gardner, that, if I don’t recover soon, you’ll be replaced?’ The smile has faded. ‘And your penalty will be severe?’

The President has said this in front of two nurses, a junior doctor, and three AI powered robots. My colleagues are shocked. Even the robots pause their duties momentarily.

‘He will send you to the Ministry of Health,’ whispers Leno, the senior charge nurse. My blood freezes, as though I had been plunged into a cryo tank. The Ministry of Health routinely detains healthcare staff who are accused, sometimes unfairly, of ‘underperforming’. Losing the life of a patient under one’s care may, depending on the status of the patient, constitute a crime akin to manslaughter. The interrogation may continue for days without a break, as the AI investigators never become tired or forget anything. The doctor will inevitably confess. Public disgrace follows, and either a labour camp or execution, if the doctor does not commit suicide first.

I clear my throat. ‘Don’t worry, Mr President, sir.’ I muster as much bravado as I can. ‘You’ll soon be better.’ It is hard to reassure a machine, for that is what the President has become. There is no empathy on either side. But I do my best, and eventually leave his bedside, having promised more than I can deliver.

‘What am I to do, Leno? I whisper. Leno hesitates as we walk down the corridor. Its glowing videowalls create the illusion of daytime, 24/7. A forest scene fades, to be replaced by the great pyramids of Giza. My favourite is an AI reconstruction of the canals of Venice, with animated gondoliers.

‘I’ve been thinking for a while, that you should call in Prof Tannenbaum,’ he mutters.

‘What if it goes wrong?’ I swallow hard. Professor Dorinda Tannenbaum has made her name in the foremost ranks of medical research, first as a haematologist treating blood cancer, later as a specialist in bone marrow transplantation, and now as an expert in stem-cell therapy. She has so refined the technique that the stem cells, the primordial cells from which all human tissue are derived, can revitalise any ageing tissues of the human body, even, in her latest breakthrough, the brain. The central nervous system, with its cells that are incapable of proliferating, was historically the most difficult organ to regenerate. She is a world leader in the pioneering technique. But there have been rumours of unpredictable results. ‘Both she and I could be interrogated.’

‘What have you to lose?’ Leno mutters. ‘Yes, the monitors are green, but we both know that he could crash at any moment. I’d give it three days, max.’

‘Above all, do no harm.’ I glance at Leno sideways, catching his eye, but he looks away at once. ‘Remember that one? The Hippocratic oath?’

‘Keep your eyes forward,’ he whispers, barely moving his lips. ‘Remember the corridor’s under AI video surveillance. They might detect that we’re conspiring.’

I fall silent. Maybe he’s right. Maybe it’s the only hope. I go back to my office and set up a holographic case conference with Prof Tannenbaum and her team. She advises us to keep the President alive for another seven days while the stem cells are prepared. 

By the time Prof Tannenbaum and her robots arrive I feel as though I have watched by his bed continuously for all that time, even though some of my reviews were conducted virtually. 

Our initial investigations indicated that the President had aged to such a degree that the stem cells would have to replace ninety-eight percent of the cells in his body. I, as his principal physician, had to obtain his informed consent to the transplant. When I say informed, I mean that I told him it was the most advanced technique of medical science, and was his only hope of long-term survival. He was bound to agree.

The President tolerates the stem cell transplant remarkably well. So few of his parameters alter that I wonder, for a few hours, whether Prof Tannenbaum is merely an expensive hoaxer, and the tubes of reddish liquid in fact contained a synthetic solution. But slowly a change comes over the monitors. The first thing I notice is an increase in his red cell count. We were transfusing him almost every day, sometimes with platelets as well as red cells, but now his counts are rising of their own accord. His bone marrow has started to work. I feel relief wash over me. I realise how much tension I was suffering: fear aching in my gut, tingling in my palms, drawing my scalp tight.

His kidney function improves; we are able to disconnect the in-line heart pump and replace the ventilator with nasal high-flow. 

But now we have a problem, I think to myself, as I adjust the electroencephalography cap. The President, before going grey and bald, used to have wavy fair hair. He now has short, dark down, all over his scalp, the fine straight hairs starting to form the whorl that one sees on a baby’s head. His skin colour has changed subtly. Beneath the respiratory tubing, I notice there is something slightly Oriental about his face.

‘He looks like a Chinese boy,’ I whisper to Leno. 

‘Not even a boy,’ Leno breathes. ‘Look what I saw when I repositioned the ECG leads on his chest.’ 

‘Just listening here, Mr President.’ I take out my stethoscope and draw back the sheet. There is a small, firm, breast bud beneath each nipple. Leno and I exchange glances. I feel my palms begin to prickle all over again.

‘I’m just going for my break,’ says Leno. Soon, I join him at the water cooler, in the corridor between the videowalls.

‘You know what, Dr Gardner?’ Leno stays hunched over his phone. ‘I was reading on the web about The Ship of Theseus. It’s attributed to Plutarch.’

‘From Hippocrates to Plutarch? You do realise that we’re nearly at the end of the 21st century?’ I sigh. ‘Go on.’

He hands me the device. It reads:

‘The ship that carried Theseus home from Crete was long preserved by the Athenians, for they took away the old planks as they decayed, putting in new ones. When all the timber had been replaced, the ship became an argument among the philosophers: one side contending that the ship was the same, and the other side adamant that it was not the same.’

‘I don’t know if we’ve done the right thing?’ says Leno.

But now, a newsflash turns the videowalls red. We are bathed in the bloody light, our faces like the demons in the Inferno. Hippocrates, Plutarch, and now Dante?

A ceasefire is declared. There will be peace.

© 2023