This is a science fiction short story with a medical technology angle. This story is one of a collection that uses elements and scenarios generated during a series of Strategic Foresight sessions related to the study of plausible alternate futures involving healthcare technology.


Nora woke up before her alarm and needed to throw up. The toilet cheerfully informed her that this was an abnormal event, and it recommended a medical consultation. There was a dull pain in her lower belly, and she just felt off-key.

Nora was an operator in the Space Force, an arm of the military and customs department that celebrated its centennial the year she joined. She was the only crew member on orbital waystation Sierra 97. It was a geostationary space elevator port, directly above the coastal city of Atlanta, GA, and had a tether cable that provided an elevator to the logistics hub in the seaport just outside the city.

Nora activated a medical app in her embedded communicator. The communicator was something like the smartphones of the last century, but it was the size of a fingernail, implanted in her head, and integrated with her visual and auditory cortical regions. She paired the communicator Bluetooth with the scanner from the first aid kit on the bridge, and she tilted her chair back as far as it would go.

The little scanner drone buzzed three inches above her abdomen, making slow circles, then moved up to her chest and back down to her groin. It changed tone and landed back on its black plastic docking station. A soft voice sounded in her head, and green lettering appeared over her view of the bridge. With access to her cortex, the communicator could show her data that she could see whether her eyes were open or closed. It made movie watching an absolute blast.

“68% probability of appendicitis, 32% probability of gall bladder infection, 12% probability of bladder infection…” The voice listed the top ten likely causes, and then summarized the recommendations. “Suggest watchful waiting at this time but use of diagnostic pill type A.”

Nora scrolled through the visual display until she got to the likely causes below 1% and dismissed the display. She got up gingerly and put the scanner back on its shelf in the first aid cabinet. She opened the slot on the box labeled “Diagnostic Pill Type A,” and popped one little black ovoid tablet in her mouth.

It dissolved almost instantly in her mouth and made her saliva run. She swallowed several times.

The pill didn’t actually dissolve in the technical sense. It was made of over ten thousand nanobots, essentially holding hands to form a solid ovoid. Once the bots detected they had been put in her mouth; sensing motion, shift in ambient light, presence of saliva, and proximity to a functioning neural communicator, they simply stopped holding each other, and propelled themselves apart. A small number attached to her teeth, gums, and epithelial surfaces of her mouth and began sampling the tissue. As her swallowing moved thousands of the bots down her esophagus, some attached to the walls, while the rest made their way down to her stomach— through the pyloric valve, and down into the stomach itself.

As the bots attached, they began sending data to the neural communicator that rested just above the bundle of nerve fibers that connected her two brain hemispheres. The health app running in the communicator interpreted the data but consulted with the quantum computer array spread across all the orbital stations. They had medical records of every human that had lived for the last century and some records from previous centuries.

The nanobot process was not entirely benign though, and Nora knew what was coming. There was no pain involved, partly because the bots were small and clever enough to avoid pain nerves, but also because they could temporarily switch off pain signals at their source. The problem was, and there was simply no way to avoid it, the presence of the bots and their sampling irritated the gut, and in about 2 hours’ time, Nora would be knees up in her bathroom, crapping her heart out.

In the meantime, her medical app had already ruled out most of the lower order possible causes and re-sorted the leading contenders. Ectopic pregnancy was ruled out. “Well, duh!” Nora muttered, “haven’t seen another person in the flesh for more than a year.” Gall bladder was now out of the running too. No stomach cancer, no reflux, no gut erosion, no ulcer, no colitis. It was vaguely entertaining to watch the green entries get a strikethrough and drop off the list, but she actually needed to work, and this time was being deducted from her pay.

Nora busied herself with checking the arrival and departure schedules and those marked with a purple halo. These were the things that, for whatever reason, were not handled by the logistics robots. Sometimes, it was a dexterity thing, but mostly it was the law or religion. Some antiquated laws dictated that certain cargos, destinations, or places of origin required that a human observe and authenticate the order. Mostly, these were just plain stupid, in Nora’s view, and she added zero value. She would have been tempted to just let the robots do their thing, but that wasn’t an option in practice. Firstly, the robots wouldn’t move unless she did her bit. They understood enough to bring the pallet or container to the inspection area, and they noted every move she made that signified compliance with expected actions. Also, they would report noncompliance.

The other causes of her having to do things that robots could do better were customer religious stipulations. The growth in humanistic religions over the previous 50 years had resulted in many customers requiring that a human speak a stipulated blessing at each stage of transport. Nora had felt self-conscious the first few times, but after 10 years of being on orbital stations, she was used to it. She had a yellowed and creased laminated book with the incantations and rules in her jacket pocket but really didn’t need it much. She knew the words of most by heart.

There was no paperwork as such, because the acts themselves served as the record. The robots recorded when she did inspections or incantations, and so did her embedded communicator.

Her medical app pinged, and a gentle voice in her head said “10 minutes until uncontrollable bowel movement, Nora. Recommend you return to quarters at this time.”

Nora was watching a Bollywood movie when the first spasm hit, and she paused the movie while she made sure she was seated optimally and then went back to the movie with sound and immersiveness turned up. She could feel the warm Indian sea breeze on her skin, smell the perfumed incense, and taste the curried dishes on the wedding table. She looked at the bride, who acknowledged her with a smile and jiggled her head.

A voice interrupted the movie, “The data collection is sufficient to diagnose acute appendicitis with a 98.9% confidence. Recommended courses of action are immediate surgery (100% consensus) and watchful waiting and routine evacuation to Earth facility (10% consensus). What would you like to do, Nora?”

Nora didn’t have to think long, “Cost per option?” The voice responded with pretty much what Nora was expecting “Immediate surgery: No cost for surgery, potential 2-hour salary sacrifice for recovery. Earth evacuation: $25,897 for surgery, $12,000 for transport, and 12 hours salary sacrifice for time off work.”

“And how about risk?”

“1 in 7,987,454 of death during orbital surgery, 1 in 9,878,302 of death during earth surgery, 1 in 870,556 of death during Earth transport.”

Nora laughed to herself. Yeah, that sounded about right. Travel was riskier than surgery, and probably always had been. “Ok, schedule orbital surgery during lunch hour.” Nora showered quickly and returned to work. Three transports of food from Earth to Mars to be checked, one to be blessed, and one to be sanctified. Four transports of minerals from asteroids to Earth to be checked according to law.

At 10 minutes before surgery, the medical app reminded her, and she walked to the infirmary. It was basically just a bed with fancy lights and a door that could seal. She opened the surgical cabinet, and removed the surgical robot that was lit up with purple light. It was inside a sort of plastic oven bag, to keep it sterile, she guessed, and was about the size of her thumb. Her medical app connected to the device, and reported that it was fully charged and functional.

“Would be a bugger to be mid-procedure and run out of juice,” Nora thought to herself. Her communicator responded that this had only happened twice in more than 70 million procedures and had not resulted in mortality.

She took off her top, work boots, and pants, and lay on the table.

An arm descended from the ceiling and sprayed her belly with a cleaner, and then there was a series of flashes as it strobed her skin with ultraviolet light. The arm withdrew.

“OK, so basically I do what now?” she wondered. In response, she saw green instructions that showed her to remove the device from the bag and place it on her belly. She could see an image of herself lying on the table and a circle and crosshair identified the right location. When she had it in an acceptable spot, the circle grew bright, and she released the device and laid her arms at her sides.

The app asked her to accept the conditions, and she scrolled through a long list of incomprehensible waivers and terms that she didn’t bother to read. “Yes, accept.”

She heard a slight hum and felt a vibration on her skin as the device initiated. Suddenly, she could no longer feel it. The device had injected her skin with an anesthetic derived from leech saliva. Highly effective and fast-working, it lasted about 20 minutes.

“Would you like to watch, or shall I resume your movie?”

Nora chose to watch for a bit.

A group of thin metallic tendrils emerged from the device. A laser cut a 3mm incision in her skin and then the tendrils snaked into her groin through the incision. She had a vague feeling of movement and fullness, but there was otherwise no sensation other than the smell of burned tissue. The image zoomed in and showed her a cut-away of her belly. The tendrils were moving up to a little bent finger on the corner of her lower intestine. One tendril curled a wire around the base of the finger, and another spread hooks that grabbed the end of the finger. It looked as if the loop just sliced it off like a piece of cheese, and the other tendril pulled the finger away. A set of legs unfolded from a tendril, and like a spider, stitched the edges of the cut and pulled them together. The other tendril squirted some kind of gel over the puckered ends. The tendrils left the appendix where it was, but one Injected it with a catalytic fluid developed from spider venom. The fluid would cause the appendix to self-dissolve and slowly be reabsorbed by the body.

Nora watched as the tendrils withdrew, arching up out of her groin about 3 inches. They retracted smoothly, paused, rotated, and spinnerets wove a three-layer suture across the incision, leaving just a slightly reddened 3 mm scar.

The arm descended again from the ceiling, sprayed, flashed, and withdrew. The device fully retracted its tendrils, flashed a green light, and went dead. The display in Nora’s head said the surgery had completed, with an elapsed time of 5 minutes and 38 seconds for surgery, total time of 10 minutes and 25 seconds. The charge of $1,200 was fully covered by her insurance, with zero balance and zero copay. Advice was to avoid strenuous exercise, heavy lifting, or sex for a day.

Nora snorted, swung her legs off the table, and got dressed. She grabbed a croissant from the galley, and microwaved it. A cup of coffee and a cookie rounded off her meal. Nora clocked back on duty 10 minutes before the end of her lunch break and reviewed the cargo list. Three new equipment shipments headed for Mars and two ore shipments to Earth. Nora did a double-take. One ore shipment had to be blessed. “Well, that’s a first” she thought, and flipped open the laminated book to see if ore required any special wording that the robots needed to hear her say.