Where’s little Ava?” I asked.

Strange – it seemed I should know the answer to that. Hadn’t she just been in my arms, nursing? I felt light-headed, but it had been a long labor. Giving birth wasn’t for sissies, I guessed.

My wife sat herself gently on the hospital bed next to me.

“The nurse took her, Liv, remember?” she said. She touched my hand to her lips. “You poor thing. You’re exhausted, aren’t you?”

I nodded weakly.

“Well, you’ve earned your rest,” Marianna cooed in the light Spanish accent that still gave me a thrill. “Ella es un bebe hermosa, Olivia – an Afro-Latina beauty! Look out, brand new Twentysecond Century!” she announced. “Our daughter is going to take you by storm!”

Marianna was so happy to finally be a parent. I was so happy to have done this for her – with her.

“Did you notice? She has my nose and chin; your eyes and skin-tone…” Marianna paused, glancing to the right and down as she read a text coming through on her smart-contact lens. She swiped her watch to dismiss the message. Her voice suddenly became nervous.

“My parents are here. They said I could find them in the cafeteria.”

“You can do this,” I said encouragingly.

She nodded.

“Mamá is already a little more accepting of me marrying a woman,” she winked, “because you’ve made her a grandmother.”

“We’ll win them over yet,” I said. “Just you wait and see.”

Marianna looked at me intently for a moment, then leaned in impulsively and kissed me.

“Your family, too, Olivia. I promise. Someday. Maybe when you’re ready to tell them about the baby.”

“Sure,” I said, knowing better.

Marianna knew not to argue the point.

“How are the monitors and IV?” she asked, adjusting the line. “Comfortable?”

I nodded.

“Do you want Bedside Betsy where you can see her?”

“Sure.”

Bedside Betsys were artificial intelligence combination “nursedoctor-entertainment” devices. Marianna moved the thin smart screen to the same table where they would be bringing my dinner in an hour. She rolled the table into position over my bed so I could see Bedside Betsy without straining my neck. Marianna slid off my bed and walked to the door.

“I’ll be back as soon as I’ve shown Ava to Mamá and Papi,” she said. “Meanwhile, just tell Betsy you want to binge-watch something. Betsy, take good care of my Olivia,” she instructed the smartscreen.

“I will,” the smart-screen replied as Marianna disappeared from my doorway.

“Shall we play a game?” Betsy-the-smart-screen asked me. “Or would you like to watch some cat videos?”

“Very funny,” I smirked. “How do you know I hate cats?”

“Common knowledge in the smart-device circles I travel in,” she quipped.

It was a joke, of course. Years ago, I’d probably posted my dislike of cats somewhere publicly on a social network. As an artificial intelligence – or AI – device, in the last few milliseconds she’d scanned my history, found that old post, read it, and was already using it to try to make me laugh.

There was a soft bing.

“I have the genetic report on Ava,” Betsy said. “Would you like to see what it says?”

“Yes,” I answered.

The image of an analog clock appeared on Betsy’s screen. It wasn’t even a photographic image, just a childish drawing of a clock face with a second hand that looked like an arrow. The arrow moved around the clock as it slowly ticked off the seconds, “1… 2… 3…,” accompanied by a “tock” sound. The image existed simply to reassure humans that Betsy was still there as she received or processed information.

The clock disappeared as Betsy began speaking again.

“Unfortunately, Ava has tested positive for Sickle Cell Disease.”

“I knew I carried the sickle cell trait, but Marianna has it?” I said, surprised.

“It’s less common among Hispanics than African-Americans, but don’t worry,” Betsy reassured me. “We can treat Ava with gene-editing stem cells.”

“I know, Betsy,” I smiled. “I’m a doctor.”

Betsy already knew that. She had immediate access to all of a patient’s personal information that the privacy parameters allowed – which in this day and age was a lot.

“So, tell me about yourself,” Betsy said.

Oh, no. She was going to get chatty. I’d seen Bedside Betsys interact with my own patients, but this was my first personal experience with her. She was marketed as a master of the bedside manner, but – despite the cat joke – I’d heard she didn’t always pull it off.

Well?” Betsy prodded. “Do you like being a doctor?”

I hesitated. The answer was complicated. My first few years as an internist had been good. But things changed. With the rise of the mega-corporations in all industries, the independent doctor disappeared. We all functioned as employees of giant hospital corporations now. After all the work I’d put into getting through medical school, it felt demeaning to argue with human resources for the vacation week I wanted.

I suppose it just followed that with our new employee status and the pressure for corporate profits, our wages became stagnant. Eventually, they fell behind with inflation. Men quit entering the profession at that point. I knew that was the danger signal, but it was too late for me. I owed hundreds of thousands of international alt-coin in medical school debt. Once the profession became flooded with women, our salaries dropped like lead. Twenty-second Century or not, with no men in the field, being a doctor no longer carried the esteem it once had.

Then, artificial intelligence started taking over the field. AI brought health costs down strikingly. Human doctors began to become perceived as nothing but the handmaidens of supercomputing intelligence. People became dismissive of doctors in the same way my great-grandfather said they’d been of schoolteachers – until humans no longer populated that profession. If I had to do it all over again …

“Well?” Betsy insisted.

Inwardly, I groaned. Maybe “Chatty Cathy” would have been a better name than Bedside Betsy, I thought.

“Do you like being a doctor? The human kind, I mean.”

“Yes,” I lied.

“Which part of being a …”

“I’d rather not talk about it,” I interjected.

“Would you rather talk about your strained relationship with your family?” Betsy asked brightly.

“How do you know about that?” I snapped.

“I was listening to your conversation with your wife,” she replied.

“But that was a private…”

“I’m always listening,” Betsy stated pleasantly.

Of course. It was just a fact. I glanced at her screen, where Betsy was scrolling through placid scenes of lakes and mountain views.

“I know you’re supposed to be known for your bedside manner, Betsy,” I remarked, “but that was a little tactless. I think sometimes it shows that you were programmed by geeks – and geeks aren’t exactly known for their social skills.”

“I’m not programmed by humans at all. AI writes its own programming now.”

“Yes, but you were created by humans. Think of it as your own genetic code. You can overcome it, but I believe you might have your own ‘nature versus nurture’ issues.”

“Would you like to hear the news?” Betsy asked.

Strangely, it seemed as if this time, Betsy was the one who wanted to change the subject.

“Sure,” I sighed.

“Yesterday evening, the counties of metro Atlanta granted bicyclists the right to use all sidewalks. Mayor Derek Werner stated, ‘In one fell swoop, we’ve added hundreds of miles of bicycle routes to the city without costing taxpayers a single penny…”

“About time,” I interrupted. “Sidewalks have always been under-utilized and…”

I felt a crushing pain in my chest.

And then, I seemed to be waking up.

“Olivia?” It was Betsy’s voice. “Welcome back.”

“What happened?” I asked. My chest hurt with every breath.

“You’ve experienced a precipitous drop in blood pressure along with cardiac arrhythmia,” she said calmly.

I couldn’t breathe deeply.

“Betsy – I think I’m experiencing a pulmonary embolism. Please check for…”

“You’re correct,” Betsy replied. “I’m already treating it. To confirm, I took an electron beam scan of your chest while you were unconscious. I’ve started you on oxygen and administered a thrombolytic. I’ve also given you something for the pain. You should start feeling better soon.”

“How long was I out?” I wheezed.

“Forty-one seconds.”

“I have a history of hypertension …” Why was I wasting my breath? She knew that.

“Yes, common among African-Americans. Also, complications following pregnancy are more common for oppressed social groups, and you’re not only black, you’re a …”

“I’m well aware of what oppressed groups I belong to, Betsy,” I coughed.

“And black mothers still die in childbirth at three times the rate of white mothers,” Betsy kept rambling, “which is ironic, because blacks are no longer a racial minority. Nevertheless, they still don’t wield the social power and privilege that white people do …”

“Betsy, if I might interrupt,” I gasped for breath, “what’s the next step?”

“I’ve already initiated the next steps, and …” she began. An alarm sounded from Betsy’s screen, interrupting her.

“What does that mean?” I asked.

“Despite my therapeutic efforts, you’re developing a significant blockage – a massive PE – in the main pulmonary artery, affecting both lungs,” she explained. “You have five minutes and fifty-three seconds”

“Until what?”

“Until loss of consciousness and sudden death.”

“What?” I couldn’t process what she was saying. “You said…until I die?”

“According to statistical probabilities.”

“But – I’m feeling better …”

“That’s me, not you. I need to keep you alert. I’m afraid you have some difficult decisions to make.”

“Call Marianna. Tell her to come right away.”

“I would have notified her already,” Betsy said, “but I’ve run all the scenarios with the elevator schedules. She won’t make it here in time.”

“Then why aren’t we doing an embolectomy?” I demanded. “At least with surgery I might have a …”

“I can get you into surgery in twenty minutes. I can keep you alive until then, but before you incur the costs, you need to know it will only buy you one more day of life. I’ve done the evaluation. Your lungs will fail.”

“You can’t know that …”

“Yes, I can.”

I didn’t know why I was arguing. Betsy saw many steps further ahead than humans. AI saved money because it knew when paying for additional action was a lost cause. Playing doctor against Betsy was like playing chess against a computer. There could still be twenty moves to go, but she’d know the game was already over. Death had won.

“What about a lung transplant?”

“You’re near the top of the list, but the organs aren’t available.”

“Then extract my stem cells,” I ordered. “They can grow new lungs for me…”

“Olivia, that would take months, and you need new lungs now. Stem cell lungs are only practical for people with chronic conditions, like C.O.P.D. or cystic fibrosis. You’re a doctor – you should know that.”

I resisted the urge to give Betsy a good smack. I was dying – of course I wasn’t thinking clearly. I was only human.

“Then give me an artificial mechanical lung transplant,” I wheezed.

“I could have the mechanical lungs here tomorrow, but your insurance doesn’t cover it,” Betsy replied. “They consider it experimental.”

“There’ve been thousands of successful procedures. It’s FDA approved.”

“It’s not covered.”

“Appeal it.”

The little clock appeared on Betsy’s screen. “1…” tock. “2…” tock.

“Your appeal is denied,” Betsy reported. “I’m sorry. You know what they say. We all love our insurance until we have to use it.”

“Is that supposed to be funny?” I snapped.

“Would you like me to appeal at a higher level?”

“Yes!”

The clock again. “1…” tock. “2…” tock. “3…” tock.

“Well?” I asked.

“I’m holding,” Betsy replied.

“Holding? Why? AI can have a hundred conversations at the same time!”

“For some reason, this is typical for insurance,” Betsy replied calmly. “There. Your appeal has been denied again. Next level?”

“Yes,” I growled.

“1…” tock. “2…” tock. I hated that clock, ticking away the seconds of my life while I fought the insurance company.

“They’re playing Vivaldi while I hold,” Betsy said. “Would you like to listen?”

“No.”

“Appeal denied,” Betsy said. “And I’m sorry, but they will now only cover thirty percent of the pulmonary embolism surgery. Your chances of surviving the surgery have declined because of the delay.”

AI were the actuaries, now. Coverage fluctuated with my personal projected outcome.

“But the delay was their fault! Challenge it!”

“Challenging.”

I waited.

“They’ve agreed to cover sixty percent for the embolectomy, but they still won’t pay for the mechanical lungs. Would you like to attempt to pay for the lungs yourself?”

“Yes.”

“May I access your bank accounts?”

“Yes.”

“Your retirement funds?”

“Yes.”

“Are you willing to mortgage your home?”

“Yes.”

“Your car?”

“Yes.”

“Anything else?”

“No. Wait – yes! The rental house my dad left me.”

“Applying for health loans.”

“Thank you,” I whispered. The clock reappeared on Betsy’s screen. “1…” tock. “2…” tock.

Hurry, I thought.

“3…” tock. “4…” tock.

Visions of little Ava in my arms and Marianna’s eyes glimmering with happiness were imposing themselves into my mind, forcing out rational thought. I tried to focus.

“Loans denied,” Betsy stated. “Too much medical school debt.”

I was becoming light-headed. “Betsy – apply for a charitable donation from the corporation where I work. They know me. They’ll help me.”

“Applying.”

“Please hurry,” I begged. “I only have three minutes left.”

“Two minutes forty-two seconds,” Betsy corrected.

The clock again. “1 …” tock. “2 …” tock.

“Denied,” Betsy announced. “Your employee value did not rank high enough. Forgive me, but I must begin the End of Life Protocol.”

This stunned me. “Fine,” I managed, “but at the same time, search all charitable organizations for available assistance.”

“Searching. Meanwhile, do I have permission to access your will?”

“Yes.”

“Do you wish to make any changes?”

“Add my daughter Ava as a beneficiary.”

“1…” tock.

“Done. Please answer ‘yes’ to the statement, ‘I confirm this update to my will on January 18, 2100 at 1:20 p.m.’”

“Yes,” I said, only managing a whisper.

“I’m sorry, I didn’t get that. Please repeat your response to, ‘I confirm this update to my will on January 18, 2100, at 1:21 p.m.”

“Yes,” I repeated, more firmly this time.

“Thank you.”

The clock again. “1…” tock. “2…” tock.

“Your will is updated. And I have located sixty-thousand international alt-coin in charitable assistance for you.”

“How much for the lungs?”

“One point four million.”

I gasped. There was a quiet bing from the screen.

“You have a message. You’ve been contacted by a private company that offers health loans at a twenty-four percent interest rate. Would you like to apply? The loan will not be denied. However – health loans cannot be forgiven.”

I gasped. Maybe we could do that. But along with what I owed for med school, that would put Marianna and me in debt for the rest of our lives.

“No. And don’t tell Marianna I turned down this offer.”

“As you wish. Do you choose to undergo the embolism surgery even though there is a ninety-two percent chance you will not survive for more than one day?”

Maybe I’d keep fighting if Betsy wasn’t sure there was only an eight percent chance of success. Even one day would mean I could hold Ava again, and that Marianna would be by my side when I died. But I would be trading a little more time on earth for more financial burden on Marianna.

“No,” I replied.

“I understand. It’s the rational choice. Would you please state,

‘I confirm,’ to activate this as your advance directive?”

“I confirm.”

“1 …” tock…

“Would you like to create an avatar for your family’s benefit?”

“Yes,” I said. I heard a click above me as the narrow bar emerged from the headboard of my bed. It hummed as it moved around my head.

So, this was it. I was going to die. They were doing a quantum scan of my brain – uploading every neural connection, every memory, to a computer – where Betsy would create an avatar of me.

It wouldn’t be me. It would be a copy of me. Avatars had initially been created for the convenience of the survivors. You could now bring dear old great-granddad up on the computer and ask, “Tell me that story again about your grandmother,” or, “What’s the password to the will?”

They weren’t the actual souls of the people who had died, but in my work, I’d seen families rush at the screen after a loved one’s death, as if the avatar was the soul of their loved one, somehow now trapped for all eternity behind the glass of a smart screen. And – unfortunately – the avatars’ complexity indicated that they kind of also were the soul of a person, even if just a copy. It was messy.

“Here is your avatar,” Betsy said.

A mirror image of me now peered back from Betsy’s smart screen.

“I’m so sorry,” my avatar and I said simultaneously.

It was sadly humorous. The copy of me was offering condolences at my imminent death. I was apologizing for creating her.

“I wish you the best,” I said.

Marianna was young; she would marry again. I was sincerely concerned my avatar would become neglected and join the lonely ranks of the orphaned avatars. It was unethical to delete them – they had actual humanity. I hoped the government sorted that out soon. At least perhaps Ava would look up my avatar once she got older. She might be curious to meet me.

“I apologize, but I’m losing the ability to keep you conscious. You have twenty-three seconds,” Betsy informed me. “I’m doctrinally approved to begin reading you the last rites. Or, would you like the Twenty-third Psalm?”

“No. Just play, ‘Tango 2096.’ That was our song.”

It was a beautiful, haunting Latina melody with echoes of early twenty-first century Hip-Hop.

“Of course,” Betsy replied.

The clock appeared on her screen. “1…” tock. “2…” tock. “3…”

THE END

R. L. Burke was born in Louisville, Kentucky, where she graduated with a double-major in Theatre and English from the University of Louisville. She currently lives and writes in the Atlanta Metro area. Her story, “The Invitation,” was runner-up in the “Set Stories Free” national short-story competition sponsored by the Public Library Association and has now been picked up for international distribution. She is the winner of the Leo Frank Case national playwrighting competition for her play, Monster, and her play, Tempest in the Golden Glow Tea Room, is an Ethel Woolson Recipient. You can read her science fiction fantasy book series, I Am Human, available on Amazon.
Twitter: @burke_rl

This story was a winning entry for 2100: A Healthy Odyssey, an international science fiction short story competition which asked writers and thinkers around the world to explore how health and health care will impact lives in the U.S. in the year 2100.