On Her Majesty's hospital service

The doctor pulled into the hospital parking lot in her Aston Martin DBS. She flashed a perfect smile at the new valet and introduced herself. “I am Spond, Dr. Jane Spond, pager number 00007.” He let her park in the CEO's private spot. She gracefully leapt from the vehicle, her white coat immaculately pressed. Inside, she was ushered into Dr. N's office. She helped herself to a can of Ensure, shaken, not stirred, from the snack cabinet.

Dr. N was a grumpy no-nonsense administrator and got straight to the point. “Spond, you've got to stop this Dr. Nope character before he does irreparable harm to the health system. You'll be working with a new intern, Dr. Golytely. Now head down to supply management and find P.”

Spond found P in the basement, where he ran the supply chain. Spond picked up an otoscope, and a laser beam shot from it, burning a hole in the wall inches from P's head. “Careful,” yelled P. “I've got some special equipment for you, Spond. Please try to return it in one piece. First, here's a pager. It will emit a high-pitched squeal only audible to younger, more acoustically sensitive people, briefly immobilizing them. This tongue depressor is made of Kevlar. This surgical mask also doubles as a gas mask. Most important to your mission is this gold stethoscope. It has knockout gas in one earpiece and a memory stick with a deadly computer virus stored in the bell.”

Spond and Golytely headed for their target, the Institute for Healthcare Anarchy. Spond instructed Golytely to wait outside and page her at 3 p.m. As Spond walked into the building, she was met by an aggressive woman who introduced herself as Dr. Evenjob and told Spond to follow her. As they walked down the hallway, Evenjob pulled a guaiac card from her pocket, and threw it like a Frisbee. It sliced through a vase and embedded in the wall. Spond got the message; she would follow without a fight. Evenjob not too gently shoved Spond into a big server complex, staffed with adolescent programmers, all dressed alike, clacking away on their keyboards.

From behind a desk strode the formidable Dr. Nope. “Welcome, Dr. Spond, pager number 00007. I have been expecting you. Yes, I already know all about you. You are 42, 5′ 10″, with three crowns and 40/20 vision in your right eye. You've had an appendectomy and a hemorrhoidectomy. By the way, that mole that was biopsied and came back benign? It wasn't.”

Dr. Nope grinned evilly. “I suppose you want to know what this is all about, Spond, and since you won't live to tell, I'll explain. Years ago I was the medical director for an HMO. We were wildly successful and had the highest rating of any organization. But then the board of directors discovered that I was manipulating our quality data. Instead of praising me, they fired me. The short-sighted fools!

“I then founded the Dark Quality Web. Medical groups from around the country come to me to subtly massage their data. You think the hospital ranked #1 in quality did it by better patient care? Guess again. When the competition is getting too close, I just alter their DRGs a little. Voilà, the expected mortality plummets and so does their national ranking! It's virtually impossible to trace.

“With my crack team of hackers, I've developed a new computer prion and implanted it in every electronic medical record in the United States. In the first trial run we searched for all hospital deaths and applied for credit cards in their names. On our second trial, we ‘admitted’ those same deceased seniors to a hospital in Baltimore, all with the same diagnosis and a one-day inpatient stay, triggering an Office of Inspector General audit.

“Now I am ready for my crowning achievement. I will enter the medical record of every patient in the United States. I will submit charges to both governmental and private insurers for high-cost care for every person in the country. By the time anyone has realized, I'll have transferred the funds offshore and shorted the stock of every major insurer. The U.S. health care system will crash, and I'll be fabulously wealthy.”

Dr. Nope laughed maniacally and turned to his lackey: “Kill Spond!”

Spond glanced at the clock. It was 3 p.m. Her pager went off. The high-pitched tone blasted from the device. Although it was too high for Spond, Evenjob, and Nope to hear, all the young workers fell to the floor, hands over their ears. Dr. Evenjob pulled a deadly card from her pocket and flicked it at Spond's face, but Spond grabbed her reinforced tongue depressor and batted the card back at her enemy, embedding it in Evenjob's forehead.

Spond pulled her stethoscope from her neck. After covering her face with the surgical mask, she unscrewed the right earpiece, releasing the knockout gas. Once everyone else was unconscious, she unscrewed the bell, removed the memory stick loaded with the SHUTDOWN virus, and plugged it into the desk computer. The servers started to ominously hum as they overloaded.

Spond ran from the room and outside, where Dr. Golytely was behind the wheel of the car.

Another successful mission complete.

Thanks to Amindra Arora, MB, BChir, for his Bondian suggestions and to Ian Fleming for the inspiration.