Under the Knife

“Becoming the puck meant fundamentally changing our way of thinking,” Montgomery said. “Surgeons have been doing things essentially the same way for over 150 years. But we are about to change all of that. Forever.”

On the screen, the picture of the surgeons transitioned into one of a sleek aircraft cockpit with high-tech digital control panels. Two pilots, both men, one black, one white, sporting multistriped epaulets affixed to white dress shirts with the sleeves rolled up, were turned in their seats toward the camera, flashing thumbs-ups signs with virile, affable charisma.

“Automation. That’s our puck, folks! To automate an operation the same way one would automate a plane flight. Autopilots use computer-controlled systems to mechanize the finely coordinated movements of an airplane and guide it safely through all aspects of its flight. Takeoff.” Below the pilots appeared a smaller picture frame in which a video clip showed a passenger jet soundlessly lifting off from a runway. “Flight.” The takeoff picture transmogrified into a view of the same jet cruising at high altitude among sun-dappled clouds. “Landing.” The jet glided in for a routine landing on a different runway.

“Autopilots fly tens of thousands of us around the world every day. They flew many of you here today. Why, then, not auto-surgeons? Machines that perform the surgeries for us, the same way autopilots fly our planes?”

“But surgery is an art!” thundered a man in the front row. He had a shock of white hair, stooped neck, and haughty bearing. He had no microphone, but the acoustics were exceptional, and Sebastian could hear him quite well from his seat in the back. “A machine can’t do what a surgeon does! We are human beings, laying hands on other human beings! A machine can’t do that! We are artists!”

Montgomery nodded in a way that communicated both agreement and polite dissent. “Yes, Dr. Linton. We surgeons are indeed artists. And you, sir, are a master. We have, all of us, benefited from your pioneering work. There is no doubt, sir, that you have forgotten more about the art of surgery than I could possibly ever hope to learn.”

Linton bobbed his snowcapped head in regal concurrence, accepting Montgomery’s compliment as the pope would a kiss to his ring.

Sebastian wanted to laugh out loud.

Jesus Christ but was this Montgomery guy slick.

“But,” Montgomery continued, “surgery is also a science, Dr. Linton. Why not combine the science and the art? Why not have surgeons program machines to execute the same tasks they otherwise would, but without the imperfections of the human condition? To map out every nick of the scalpel and tie of the suture, then have machines perform them?”

“Bahhh!” Linton exclaimed, pawing at the air in the manner of a baseball fan dismissing a bad call by an umpire.

“Your skepticism is completely understandable, Dr. Linton. But if I may—”

“No, sir, you may not!” Linton tilted his chin up and sniffed through cavernous nostrils guarded by thick white hairs. “I would remind you that we lay hands on people, Doctor. Every stitch I threw, in every single operation I ever performed, was perfect. Because it had to be, Doctor. No machine can do that!” He snorted. The white nostril hairs cowered.

Montgomery smiled indulgently and spread his hands wide. “But if I may, sir: Does not aviation also deal in matters of life and death? We place our lives in the hands of autopilots every time we board a commercial flight. As you did, sir, when you flew here from Boston.”

“Bahhh.” Linton discovered a spot on the auditorium wall off to the right of the stage on which to fix his sullen gaze.

Montgomery gestured to the image of the grinning pilots in their gleaming, computerized cockpit. “Whether it’s a commercial flight or a combat mission, any pilot these days will tell you that automation has become essential. Computers haven’t replaced pilots—they’ve only taken over certain aspects of flying. Made it more precise. Safer. Our auto-surgeon functions much like an autopilot. The surgeon designs a surgical plan and programs it into the auto surgeon. The auto-surgeon then executes the plan under the surgeon’s supervision, much like the flight plan for a plane. We believe that most of the steps for basic operations—like removing an appendix—can be automated.”

“An autopilot has direct connections to the controls of the airplane,” the woman from the Wall Street Journal interrupted from her seat near the front. “How does a computer perform an operation on a person?”

Definitely a smart chick.

Montgomery was unruffled. He grinned. “Ms.… Grant. Correct?”

She nodded.

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