What infectious disease management may be like in 2039

Finished morning rounds a bit early today. Why not get the e-progress reports done before noon? While turning on my iDoc, I review each patient in my mind.

Patient Jonathan Storkes, bed A2507…Aug. 12, 2039. Eleven fifteen hours. Post-infusion day 2. Physical exam. Speaking now slowly to the iDoc. “Insert vitals. Liver temperature 97.6º F. Rash resolved. Infection panel improving, now 2/10. Impression: 7-year-old boy with recurrent HHV-15, p.i. day 2, recovery at 64th percentile. Plan: Step one, stop nutrafeeds. Step two, discontinue abdominal temps. Step 3, re-expand white cells cryopreserve prior to discharge.” A click, and a pleasant beep announces that the note is already uploaded to GlobalChart.

A few more e-progress reports dictated, and I head back to my office. I lay down on the bed to catch my breath (at 63, I should be doing better than that, I reprimand myself). The TV panel on the ceiling powers on.

“This is your local channel with a summary for you. During a ceremony in Congress, legislators commemorated the 30th Anniversary of the Recovery Act. Economic analysts anticipate that in three years, the Treasury’s checkbook will be zeroed for the first time in five decades. In other news, about 40,000 nursing home residents signed up for Keith Richards’ teleconcert yesterday …”

The cafeteria menu is displayed in the screen showing my preferences. But what if today I want to be surprised? After all, aren’t all those meals disguised nutrafeeds? I remind myself to set my preferences to allow for 25% randomness. But I feel so tired now.

I think about my first patient of the morning, Jonathan Storkes. Years ago, if he’d had methicillin-resistant Staphylococcus aureus (remember that? Hah! The old times ...), we would have put him on antibiotics. Had we known better! The rapid spread of white blood cell autotransfusion practices in the early 2020s, coupled with the replacement of the labor-intensive culture and susceptibility techniques for newer laser identification methods, completely revolutionized anti-infective therapy. Nowadays, a 3-mL blood specimen collected 24 hours after birth is submitted to the lab and placed in a "tutor" cartridge.

Genomic sequence is stored in GlobalChart, while cells undergo microbial training to recognize all organisms reported to date. Blood is flowed through microcircuits of precoated-antigen presenting surfaces. T-cells are instructed and expanded, T-regs are finetuned, and B-cells are allowed to proliferate to synthesize the appropriate antibodies — old fashioned, sturdy technology. After that, cells are aliquoted and cryopreserved. A fraction is made available for prompt use. Hospitals now bank their patients’ WBC aliquots.

If you are out of town, thanks to a tiny GPS-equipped subcutaneous microchip, an aliquot would be automatically transferred to the closest infusion center to you anywhere in the world. It was about time for Jonathan to have WBC pools re-expanded.

The iDoc wakes me up with two incoming new consultations. Time to move.