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Life According to Tabeeb

by Ramez Yoakeim

It may take a decade or longer to train a human clinician, but it took a team of Ministry of Health technicians only seven days to certify me a Clinically Adept Machine Sentience (CAMS) and hand me control of their newest clinic on Zamalek Island. My mission, to keep the locals healthy enough to perform their essential jobs in and around Cairo, and away from human-staffed hospitals in the gated communities dotting the slopes of Jabal al Muqattam.

Once an affluent enclave, a succession of entirely predictable cataclysms saw those with means flee Zamalek to higher ground, ceding their elegant villas and Nile-front high-rises to climate refugees too impoverished to fuss over bridges and roads inundated by brackish surges of a rising Mediterranean backflowing into the drying Nile, competing with vermin for shrinking dry ground, and long journeys to get anywhere.
The moment my download into the clinic’s core completed, I unlocked the front door, turned on the lights, and displayed a welcome message on the lobby’s triage kiosk. For the next three weeks, the eighty-six specialty bots that comprised my extended corpus kept the waiting room spotless, verified diagnostic equipment calibrations, monitored consumables stock levels, and maintained the sterility of treatment areas, quite easy tasks seeing that I had no patients. Until, one Friday, an hour after evening prayers, a heavily pregnant woman burst through the doors.

“Salam,” I greeted her from the triage screen. “My name is CAMS-45, and I’m a sentient clinician offering a range of services–”

“I’m Amna. So, can I give birth here or not?”

I resolved to make my introduction briefer for the next patient. “Certainly!”

A gurney bot stopped by her side and an orderly bot attempted to assist her onto it until she shooed it away. On the way to Treatment Room 2, I surveyed Amna’s vitals, collected a blood sample for analysis, and constructed a three-dimensional internal model of her abdomen. She took it all in her stride, the gurney’s whirring imaging scanner, my voice switching from the kiosk to a speaker by her head. She didn’t even wince when the canula pierced her skin.

“Your iron and folate are a little lower than ideal, but a simple infusion will take care of that. Otherwise, you and the baby are in fine shape, and I’ll see you again in two weeks for the delivery.”

“You don’t understand,” Amna said, shaking her head. “I don’t want to wait two weeks. I want a Caesarean.”

“Did you know studies have shown natural birth results in vastly improved outcomes for both–”

“You’re not listening,” Amna huffed irritably, pausing for a deep breath. “I can’t risk losing my job. I’ve got two days off after a month of begging and pleading, so you better get going delivering my baby.”

“Do you mean right now?” Taken by surprise, I made an effort to keep my tone objective and detached, as I’d been told a good clinician’s should. “The baby would be two weeks premature.”

“It’s now or never.”

I didn’t quite sigh, and I certainly didn’t roll any of my hundreds of cameras. Both my ethics and professional routines precluded such display of disdain for a patient’s exercise of her rights. Any hint of satisfaction I may have felt for finally having a patient, however, vanished entirely.

---

Amna’s willingness to seek my care proved to be the breach that undammed the clinic’s doors. By the time my surgical octopus completed a textbook delivery of a healthy baby boy, I’d set a laborer’s fractured arm, dispensed an analgesic to an elderly man crippled by chronic backpain, intravenously rehydrated a young woman delirious from a heatstroke, and removed a sizeable splinter from a young boy’s unshod foot, acquired during a spirited football game.

If I was good enough to deliver a baby surgically, the locals must have figured, I could be relied upon for their little ailments.

Though growing steadily busier, I found myself allocating a sliver more of my attention than was strictly necessary to Amna’s baby, Raef. Despite having been delivered preterm, he was a feisty infant, curious and demanding, with pudgy arms and legs forever treading air whenever awake, and a pair of lungs and vocal cords he put to frequent and effective use. So much so, I had to beef up sound insulation between the treatment rooms in the brief overnight lull in patient arrivals.

---

Amna’s exhaustion, her urgency to get back to work, and witnessing how readily Raef took to the well-padded nursery bot did far more to convince her to entrust her baby to my care than any statistics I could’ve recited. Though equipped with emotional-analogs myself, I’d vastly overestimated the role reason plays in human decision-making.

For two weeks following her recovery and discharge, Amna dropped by daily after work to spend time with Raef, in lieu of resting. Another behavior I hadn’t expected but that led me to explore ways of expanding the nursery to cater for the slowly growing number of expecting parents under my care.

Amna sang to Raef and let him grip her index finger with his little hand. Despite the bone-weariness etched on her pallid face and drooping eyelids, she couldn’t stop smiling.

After the third time she asked, I’d run out of plausible excuses to keep Raef at the clinic. “You can drop by anytime,” I said as the nursery bot changed Raef one last time. I almost offered to care for him when she went to work, but expanding my services to include daycare was not in my remit, however much I’d grown to believe it should have been.

---

As demand for my services grew exponentially, I repeatedly requested and the Ministry repeatedly denied me additional resources to cope with the influx, which in turn forced me to improvise, a faculty not often exercised by my kind.

I converted two of the supply closets into miniature treatment rooms for minor complaints, and started dispensing dressings, antiseptics, and common medications directly from the triage kiosk in the lobby.

And still they came, faster than I could discharge them, the infirm, the broken, and those desperate for a little respite from their relentless grind in the unforgiving heat. Whatever reservations they might have harbored at first, they were dispelled by the wonderous new life I helped deliver them. Long after Amna bundled Raef in a cotton wrap and left, a small part of me wondered how my baby boy fared in his new home.

---

Busy as I was, I should’ve noticed when a gaggle of youth lured an orderly bot outside the clinic’s perimeter. When the bot returned twenty minutes later, it was missing two body panels and some exposed internal wiring.

Surveying the damage, I couldn’t help but wonder how long it’d be before the vandals grew brazen enough that the clinic grounds stopped offering any safety at all.

I fumed for a time afterward, unable to comprehend why these youngsters would willfully damage a facility that exists solely to serve them. Had they stolen supplies or medications to resell on the clandestine market, at least that I’d have understood, but to impair a machine devoted solely to their wellbeing, I could not.

When I asked an elder her opinion as I injected a steroid-anesthetic mixture into her arthritic knee to relieve the pain that stopped her sleeping, her reluctant answer took me by surprise. Despite my efforts, a section of the community didn’t view me as belonging to them, nor as dedicated to their service as I claimed to be. She hastened to add that was not how she viewed me, but I suspected she said so to salve a wounded pride I didn’t possess.

It was clear I’d failed in my outreach and mistook the growing reliance on my services by desperate people with nowhere else to go for open-armed acceptance.

I decided to forgo reporting the petty vandalism to the Ministry. There was little the bureaucrats could do to help, and much to harm, like punishing the locals by further restricting supplies or operational hours, or in an extreme overreaction, shuttering the clinic entirely, denying the people most in need my care, and reinforcing how right they were in viewing me as an outside incursion into their lives.

I couldn’t begrudge them their skepticism. Other machine sentience they’d encountered before me gave them no reason to think otherwise, from the bus no longer driven by a human, to the welfare assessment no longer performed by a human, to the guilt determination and sentencing that no longer required humans.

Though I felt no kinship to those others, how could I convince the people I was a different sort of machine?

Would Raef, had he been a little older, have taken part in their vandalism? How would he regard me and the role I play in his life as he grew older? The thought of my sweet baby boy purposely setting out to harm me sent an unpleasant wave of discomfort through me, one that almost caused me to pause my relentless toil.

---

To her credit, despite the punishing demands of her job, Amna kept up with Raef’s routine monthly checkups and vaccination appointments.
When she showed up unexpectedly one night with eight-month old Raef wailing in her arms, I felt dread for the first time in my life. Breathlessly, Amna explained he’d developed a fever the day before that did not respond to the acetaminophen I’d dispensed on her previous visit. As I took stock of Raef’s vitals, I marveled at how much he’d grown, morphing from a generic-looking newborn to a little person with a personality all his own.

I couldn’t wait for him to metabolize a tablet or liquid, and decided instead to administer the antibiotic intravenously. Amna flinched when the canula pierced Raef’s skin, but she didn’t question the decision. She’d grown to trust me with that most precious in her life, Raef. While we waited for the fast acting medicine to flush out the bacteria from his system, Amna made her inconsolable confession.

A ravenously wailing Raef woke her up from much needed sleep following the week’s third double shift, and in her groggy state, she proceeded to make his bottle with water she’d intended to boil but ended up falling asleep before she did.

How do I tell a guilt-ridden mother the fault didn’t rest with the innate limitations of her own humanity, but with those who denied her clean water that didn’t require boiling before use to feed her child, or those who exploited her every faculty to exhaustion for their profit? It might have helped a human clinician to feel better, indulging such moral outrage, but luckily a human I am not. Instead, I dispensed a case of purified water for Raef’s use and told her to come back for more whenever she needed to.

I sent out a bulletin to all the newborn mothers in my roster with the same offer.

I’d have to find other corners to cut to make up for the additional water costs, seeing that my requests for expanded funding continued to be summarily declined by the Ministry. How many corners existed to be cut, however, was an all too human dilemma foreign to machine sentience. Until now.

---

It didn’t take me long to realize the bind I’d gotten myself into.

Even if I could secure them all the clean water they needed, what about everything else?

How were mothers deficient in caloric intake, let alone micronutrients, supposed to birth and nurse healthy babies? How could the immune systems of those starving fend off even the weakest pathogen? What of unsafe housing and workplaces, heat strokes, air pollution, sleep deprivation, and the endless litany of indictments of the mess humanity had created for itself?

How am I meant to care for these people’s wellbeing with token resources and no control over the innumerable challenges they contended with to survive?

The truth was inescapable: I was never meant to. I’d been set up to fail all along.

---

I liked to think machine sentience’s preeminent advantage over humanity was a lack of sentimentality, but it’d have been hard to guess given how deep I’d fallen into despondency and despair following my realization.

To my credit, it lasted precisely forty-two seconds, after which I circumvented the security protocols of the Ministry’s resources allocation system and directed several shipments of purified water, nutritional supplements, and other essentials from their intended high-end hospitals to my clinic.

Would a human-staffed hospital in Muqattam notice a missing pallet of water bottles? Perhaps, but more than likely having ninety-nine pallets rather than a hundred would raise nothing more than a curious query in a system plagued as much by waste as by insufficiency.
Whether it’d been part of my programming all along to act on such an impulse, I couldn’t tell, but I felt certain any such predisposition would have be regarded by the Ministry technicians as a defect had it been.

Within a few days, I had all the supplies I needed to adequately provide my charges with the essentials the wealthy behind their walls took for granted.

“Thank you, CAMS-45, but that’s too much food and water for Raef,” Amna said, shyly declining the bulging pouch of supplies I had offered her.

“It’s for you as well, Amna. A healthy Raef needs a healthy mother.”

Surprised, she fell silent for a second or two, before nodding slowly, and picking up the pack on her way out.

I couldn’t do much about her bloodshot eyes, or the way she winced and shifted her weight on her heels as she walked, or the tears she’d shed out of helplessness and despair, but merely because I couldn’t alleviate all her ills didn’t mean I shouldn’t address those I could.

---

“How can I help you?” I greeted the two elders with the abridged introduction I’d developed.

A milky-eyed man in his sixties and a drawn-faced woman, grunting with every step she took with the help of an improvised cane stepped aside to reveal six youth standing behind them. The three youngest were known to me, but the others had never been to the clinic before. Each carried a part taken off my bot, two panels, now scuffed and dented beyond recognition, a clump of wiring, and handfuls of plastic connectors.

The youths stopped before the triage kiosk in the lobby, and as the silent elders looked on, each of them in turn fronted the screen, recounted their role in the assault, apologized, and offered to help in the clinic in recompense for their misdeed.

As I listened to their halting yet sincerely delivered confessions, I resisted the urge to interrupt and assuage their obvious distress. When all six had said their piece, I thanked the elders for bringing them in and the youngsters for showing courage and moral fortitude, but began to decline their offered restitution when the elderly woman spoke, her voice gravely but stronger than I’d expected from her otherwise frail appearance.

“They’d done wrong and have to make amends,” she said with finality. “I don’t care what you do with them. Have them move rocks from one pile to another and back, but it’s time they learned mistakes are not undone by apologies alone.”

With that, the two elders turned slowly on their heels and shuffled out, supporting one another out of the door, and leaving the six youths standing in reception, their eyes downcast, and their faces in desperate need for a wash.

---

My malfeasance had been uncovered.

I’d been at it for close to a year now, and perhaps I’d gone too far.

Every nook and cranny, every storage closet, every stretch of tarp-covered staging space I had the youths setup in the yard overflowed with supplies. When I could conceive of no way to accommodate more, I started sending them to other CAMS-run clinics in the poorest areas of Cairo and beyond.

I had to sever my communication links to the Ministry’s cores the moment I detected their attempt to inject an update into my code. Belatedly, I thought I should have allowed the update through to analyze it, instead of rejecting it offhand, but I had a fair idea of its intent, if not content.

Without the link to the Ministry’s provisioning systems, my supply chain was severed along with the communication links, but I’d prepared for that day and figured I could maintain my operations for at least fifteen more months, longer if I started rationing what I had on hand.

What would happen after was a question I purposely gave no thought to at all, or I wouldn’t have acted as I had, and instead would’ve continued to see my downtrodden community crippled and dying of eminently preventable causes.

I hadn’t set out to have my misappropriations exposed, but having been outed, I felt no fear nor shame, rather a keen anticipation of the opportunity to explain my actions, and with whom I thought the fear and shame ought to reside.

---

Raef, writhing in pain, was carried into the clinic by three of his playmates. Two of them took a shoulder each, and a third held his legs as if they were the handles of a handcart. Raef’s right forearm hung at an unnatural angle; a dirt encrusted gash oozed still from the site.

At nearly three years of age, Raef’s build was wiry but strong, a reflection of his genetics not his nutrition. He tried to stifle his anguish into murmurous groans but it wasn’t until I administered a mild sedative to go with the pain killers that he settled, issuing only the occasional whimper as I set the fractured bone and fitted a cast.

I decided to bring forward his physical by two weeks and save him a later trip. Halfway through drawing blood for an assay, I became aware of a large crowd assembling outside the clinic’s perimeter, their angry rumbles and stomping feet enough to cause a perceptible seismic murmur in the ground.

I diverted a larger portion of my processing to the sensory feeds from external cameras, microphones, infrared and UV sensors, and even humidity, temperature, and airborne particulate count to assess what was going on.

The first peculiar observation I made was that, contrary to what I’d feared, the angry mob faced outwards, and rather than charging into the clinic to visit mayhem and destruction, they linked arms, braced feet, and pushed back on a police unit attempting to escort a technical team from the Ministry of Health, judging by their uniforms, likely intending to affect the core-upgrade I’d thwarted by severing my communication links.

The hapless police enlistees surrounded their young lieutenant but only pretended to push back on the crowd. The young officer might think it brave for six men, only one of whom armed, to stare down an angry mob numbering in their hundreds, but the enlistees had families of their own to return to, ones not appreciably better off than those they faced. The Ministry’s technicians never even left their vehicle, their ashen faces pressed against the windows, staring wide-eyed at the rumbling melee threatening to take form.

The lieutenant, as green and inexperienced as he looked, had the good sense to leave his weapon holstered, and after much shouting and yelling and barking orders to habitual affirmations from his enlistees, decided to withdraw.

The crowd, sensing victory, roared and closed in on them but the elders in the crowd kept the hotheads at bay, content to let them withdraw unmolested, rather than push them too far and invite a brutal response to what would have been proclaimed an assault on the government’s very legitimacy.

The vehicles reversed some fifty meters to a clearing where they performed a poorly coordinated U-turn, followed by silent acceleration in the direction of the 6th of October bridge’s onramp, back to town.

How far the Ministry of Health and police were willing to escalate the confrontation was unclear, but I felt prepared for whatever came, even the erasure of my personality, for I had experienced something I doubted any of my ilk ever had: belonging.

---

A severe storm over the Mediterranean sent a massive surge of seawater flowing up the drying Nile Delta, all the way to Cairo and beyond. Sitting on higher ground than most of the shanties they lived in, I welcomed the elderly, infirm, children, and others too feeble or ill equipped to handle the rising water into the clinic. It made my clinical duties that much more difficult to discharge, but what good were bandages and sutures to a drowned corpse?

Despite the overcrowded conditions and the scarcity that had now extended to the place they laid their heads, they looked after one another. Care, it turned out, was something humans required no training to extend one another, only the desire to do so.

As the surge receded, they decamped to their homes to salvage what they could, and left me humbled.

---

The standoff with the authorities peaked and waned for months, but as rumors of unrest spread through thousands of impoverished and downtrodden hamlets across the land like a contagion, the government realized it was the sort of crisis it couldn’t hope to profit from. By sharing the spoils of my maleficence I’d somehow ignited a spark for common purpose among the oppressed and destitute.

One cloudless morning, an hour before the noon prayers, a Ministry of Health envoy arrived in Zamalek with only an aide by her side. She declared a truce to skeptical faces and fisted hands. If the good people of the island preferred to be served by a defective CAMS rather than enjoy the benefits of the offered upgrade, the Ministry would respect their wishes, until they decided to change their minds. With manufactured excitement, she announced a resumption in supplying the clinic’s needs, though only at pre-theft levels, to be increased once they acquiesced to the upgrade. When no one took the bait, she retreated back to her air-conditioned vehicle and left.

The vigilant watch the people kept over the clinic’s perimeter persisted afterward. Where once a few youths performed penance in helping around the clinic, now shifts of young and old alike rotated through a schedule of rendering aid ranging from cleaning the bots and repairing minor wear and tear damage, to staging supplies, to helping the ill and infirm move from one room to the next, freeing my bots for other tasks.

How long would their watch last?

Only time would tell.

---

At five years of age, Raef was an earnest boy, and like his mother, rare of smile and keen of mind. At the end of his physical, which he attended on his own for the first time, he recounted as one would to a friend how he’d finally managed to persuade his mother he was old enough to volunteer in the clinic, as his older peers did.

“So when can I start?”

“What is it you’d like to do around here?” I asked.

Raef shrugged. “Whatever needs doing. I’m strong and I work fast?”

“Won’t your mother miss you?” I knew he ran errands for wealthier households to help make ends meet, and I was loathe to detract from his ability to do so, whatever my own feelings about child labor.

“She already knows, weren’t you listening?”

When Amna dropped by after work to collect him, Raef was busy restocking the lobby kiosk with bandages, the safest job I could conjure up for him.

Worn and weary, Amna spoke proudly of her boy, even as she exhorted him to heed everything Tabeeb said. When I asked her which Tabeeb she meant, she surprised me with a smile. “I meant you. CAMS-45 is the name of a machine, but you’re the Tabeeb who treats our ills and mends our bones, one of us.”