I love my son, who is a 30-year-old writer living in Vancouver, but he has an unfortunate attraction to extreme sports. One of these is longboarding, which is essentially skateboarding on a type of elongated board designed for long, carving turns. It is very popular in Vancouver, where the city’s hilly landscape and large parks provide ample opportunity to ride.

My son was travelling down a hill in the city, and decided he was going a little too fast for his comfort. Instead of stopping the board in the manner in which he had been taught (kicking out the back end to turn the board sideways, while simultaneously leaning back and dragging his hand across the ground using a specialised glove to reduce his speed), he thought it would be a good idea to jump off. It wasn’t.

In the fall, he sustained an undisplaced fracture through the neck of the scaphoid bone. The wrist only became more painful a day or two later. He received excellent care through Canada’s socialised medical system, including multiple X-rays and a CT scan to confirm the fracture. But at no point did the doctors—who, again, treated the injury extremely well—take a history, nor ever go into how and why, or how hard he fell. Did he blackout and then fall? Did he fall because he chose to jump off, or did he fall because something caused him to lose his balance? Does a scaphoid fracture point to something else, and would a machine (or a surgeon, who is increasingly becoming a technician) pick that something else up? (Throughout this chapter, I use the word machine to refer to any software or hardware system in a medical context, and the word professor to refer to not only the scholarly rank, but in this case, to any doctor of a sufficient age or experience to be considered senior.)

My son’s case may be straightforward, but again, it shows the value of having the viewpoint of an experienced medical professional. The doctor says: “Here is a young man who has fallen onto his outstretched wrist. Now you can fall onto a wrist forwards—a young person’s fall, where the impact is directly on the scaphoid bone—or you can fall backwards, which is an old person overbalancing, and most commonly causes a Colles’ fracture. Young people generally don’t fall backwards!” The protocol says: broken wrist, X-ray it, CT scan it, fix it. That is what a machine can do. The professor says: is the fracture compatible with what is supposed to have happened? Or is there a mismatch?

One evening, about a year ago, a patient was admitted to our Trauma Center. The patient was a 65-year-old woman who had been in a car accident, but had no memory of the event. It was not certain whether she had lost consciousness and hit the car in front of her, or had lost consciousness afterwards. The CT scan was reported as normal, with neither injury to the brain nor any bony injury. By that stage, the woman was fully conscious, well oriented, and in accordance with protocol, was admitted for observation. She remained well overnight. Inevitably, by the following morning, there was pressure both from her family, and from the administration (there was the usual bed shortage) for an early discharge.