Behold, I am Become Number

 

 

 

When Robert Oppenheimer, architect of the atomic bomb, reflected back on his work, he said, ‘Behold I am become death, the destroyer of worlds.’ He was quoting the Hindu scripture, the Bhagavad Gita.

Please excuse me for borrowing from something much more weighty than what I’m about to say, but I was reminded of this when was doing some paperwork for hospital credentials.

‘Behold, I am become numbers.’

For those not in medicine, credentialing is the process by which we present our qualifications, our ‘credentials’ to the hospital and they verify our identities and certify that we are fit to be physicians. It’s important, I’ll grant that. There are some morons, liars and cheats that sneak around in medicine, and the process is meant to weed them out for the safety of patients. (And obviously for purposes of billing, which is usually an entirely different set of forms.)

However, the whole process is becoming increasingly, and painfully, numerical.

What numbers am I to the system? Obviously, I am a birthday, an address, a phone number. I was once an MCAT score, a GPA and assorted graduation years. I am a board score and board certification number. I am an NPI number (National Practitioner Identifier). I am a CAQH number (Council for Affordable Quality Healthcare). These mysterious numbers are essential to working in the modern US healthcare system.

I am a taxpayer identification code. I am an employee identification number. I am a business owner, so I am a business tax identification number. I am a state medical license number. I am a Drug Enforcement Agency number. I am a state controlled substances registration number.

I am the years I have worked and the two months I have not worked in 30 years. I am the length of time I have lived at each location and the length of time I have worked in each job. I am the years I have been married and the children we had together.

I am the financial terms of my malpractice insurance. I am the cost of my health, home and auto insurance. I am the value of my life insurance.

I am a series of metrics. I am a patient satisfaction score. I am the number of charts in my medical records ‘basket.’ I am the number of patients I can move through my department in a shift. I am a number based on the speed with which I see those patients, the speed with which I treat them and discharge them, the length of time they are in my emergency department and the rate at which they return the next day or week. I am how long it takes to treat a heart attack, stroke or sepsis.

From birth I been a Social Security number. When I am sick I am a medical record number. Before long I will be a Medicare number.

I am a credit score, I am a bank account and routing number. I am a loan number. I am a retirement account.

My paperwork for the hospital is populated with these numbers and probably with some others I have already forgotten.

I am confident that my profession is not the only one. We are a world of numbers, more and more numbers. Modern life in its complexity does not lend itself to the kindness of names, or the process of knowing a person, as a person.

I don’t know all of the numbers that everyone else is consigned to in life but this numerical transmogrification is hardly isolated to the medical world. I mean, there are things common to all of us, of course. GPA, SAT and ACT scores, ASVAB scores, Medicaid number, WICC number, mortgage interest rates, drivers license numbers and license plate numbers.

We are voter ID numbers, poll number and political party statistics. We are census numbers used to make policy.

Now there are even carbon use scores and carbon credits. And in China (and eventually here I suspect) there are ‘social credit scores’ that determine if one is a good citizen or bad and thus deserving of privileges or punishment.

Every job, every profession has numerical codes that are affixed to its practitioners. Every citizen is continually reduced to more and more numbers.

We are all of us, with increasing passion and speed, being digitized so that we are evolving into pure, manageable, manipulable data.

In the Bible, in 2 Samuel 24 and 1 Chronicles 21, King David takes a census of his people. His action results in God’s wrath. It’s not clear what the problem was; maybe pride. Or maybe it was a message about the danger of reducing people to lists and numbers.

It could be that this was also part of the warning that St. John gave us when he wrote Revelations on the Isle of Patmos and assigned the Beast a specific number, living as he did in an era when a name or mark or digital code applied worldwide for commerce would have had no precedent.

You may be atheist or agnostic and may consider the Bible fantasy if you wish. I do not, but I understand. And I think that even if it is fiction it is a remarkable series of stories with critical messages for us down the long ages of human folly.

‘Careful with the numbers,’ God seems to be saying.

We might even ask, what is AI, if not a series of powerful binary numerical codes, that if unfettered could rule us all?

We are become numbers, more and more every day, and with every new requirement for a new identifier or a new form.

I fear our oppressors will be numbers as well. Cold, heartless numbers.

And we will long for the simple elegance of our beautiful, antiquated names.