In which a lot of people get drugged and poisoned,
A small delta-wing craft approaches a heavily industrialized planet with an advanced aerostat station. This is a bustling, but incredibly dingy hospital, and the trader from the delta-wing walks through a scanner with the kind of routine acceptance at a full-body scan for horrifying diseases that one gets when the clerks at a bookstore miss one of the antitheft tags and you have to share an awkward look with the security guard that says ‘we good here?’ The trader, Garb, is more of a con man, and he has the Doctors mobile emitter on offer, and the Doctor is not expecting to be here. The Doctor initially refuses to be part of this theft, but under threats to his programmatic integrity and, more pressingly, in the face of fresh wounded, he is a Doctor. He is, apalled by the lack of Federation medical technology, but shoulders aside the locals to render what aid is possible anyway.
Harry and Tom picked a terrible day to play hocky, if the Doctor’s been stolen. And yet here he is… and yet not. He’s been replaced with a very poor copy and a replicated chassis of his mobile emitter. The program running is from a ‘training file’ which is evidently how there was room for the program but there’s never been room to keep a backup or even differentials off the base from the protected backup recovery drive or anything. In the aftermath of the security incident, Janeway starts going over some future safeguards that can be taken and orders the search to be started.
The Doctor is revolutionizing the local surgical techniques, but he’s of course trying to trick his way to a comms unit out of the fresh resident. The resident points the Doctor towards the Allocator, a computer that runs the hospital. There’s also a patient who wants to be a doctor, assuming he lives long enough to become one. He won’t, as he’s in the final stage of a ‘chromoviral’ infection. He hasn’t been given any of the treatment because he’s got low TC levels, and at that moment the floor admin comes to let the Doctor know that he’s being transferred to level Blue, where the Allocator has determind the patients who need him the most are. In contrast to the squalor of his previous assignment, level Blue looks like a proper Federation-quality hospital – private alcoves for beds, clean sparkly uniforms. Level blue is where it is ‘most critical that he provide excellent care.’
Imagine being created for a utopian socialized medicine plan where there is basically no such thing as scarcity and the only limiting factor to who you can cure is whether science has gone that far, and then being dropped in the middle of the HMO garbage wastelands of the 1990s.
These patients have a higher TC (treatment coefficient) assigned by the Allocator, which is why they get preferential treatment. It is derived from… well basically it’s their credit check, except it factors in ‘importance to society’ rather than anything so reductive and crass as mere money. This is a beurocratic triage that the administrator provide as contractors for the locals, the Denali population. Doctor Dysik is the chief of medicine, a Denali whose people were on the brink of extinction before the hospital platform arrived.
Gar, the guy who stole the Doctor, had enough foresight to set a false warp trail, but he traded them a substance with a short enough half-life that it had to come from nearby, so first up: Guesses what Voyager is using it for? I mean, maybe it’s tabile when alloyed into something, or perhaps they replicator can just take it apart for use later. Though, if that were the case I’d expect a lot fewer depictions of cargo bays over the years. Finding a lead, Voyager heads to the mining colony where Gar acquired the iridium – stole it, in fact. Janeway agrees to give him back the iridium (they must not have needed it so badly) in exchange for the lead, and so the fetch quest begins.
As the COM and the Doctor pat each other on the backs, it is made clear that medicine desperately needed for red-level patients is freely available to Blue-level patients for minor cosmetic and low-level preventive treatments. Such is the power of a high TC. The Doctor goes back to Red to get the kid his treatment by any means necessary – perhaps by adding more data to the kid’s bio to raise his TC. The system, however, is proof against such blatant lies.
The Doctor’s next plan is to increase the dosage for other patients and smuggle it down to other levels. This works, at least for one dose. While Voyager tracks down Gar’s trail through several nodes, a process that makes Janeway join the illustrious ranks of Starfleet Captains That Have Had To Pretend At Relationships With Their Crew For Increasingly Ridiculous Reasons, the viral kid has started his recovery and is terrified that the Powers that Be will find out that the Doctor bent the rules. When he’s assured (falsely) that everything was above-board, the Doctor gets sucked into expanding his scheme. The red-level doctor won’t help, but the patient kid will, which allows the Doctor to give him some practical training, shaming the red-level doctor into helping.
The Doctor has been caught by the Chief of Medicine, but some quick thinking and the universal truth that ‘making do with less’ in any bureaucratic nightmare-state gets you assigned less next budget period. By using up the budget, you get the same budget next time. And so he’s created a self-perpetuating system. Sadly, thE hits keep coming – once cured, the kid who wAnTs to be a docTor won’t be autHorized for that training and will bE sent to do menial labor – so Raising your TC score isn’t a matter of motIvation or aptitude, but of another bureaucratiC system cHurning against (or more likely, with) the hospital to keep social mobility and mortality in a nice, manageable, predictable stasis.
Subtle, isn’t it. Voyager has located Gar and Chakotay suggests sneaking up on him in a near-light snatch maneuver with high precision. Since you can’t steer at warp without subjecting the ship to potentially-fatal hull stresses, lining up that shot must’ve taken quite a while – either they saw him from far enough away to turn very gradually or they dropped out of warp to line up the shot. Either way, Gar is playing innocent, not that it’s going to do him any good whatsoever.
When it comes time for the Doctor to make his rounds with the kid, it turns out he’s dead, and the Doctor goes straight to the admin, who explains that the kid got a secondary infection and didn’t get any medication because he exceeded his allowance (by living long enough to need a secondary infection to begin with). The Doctor never really got away with his ruse in the first place. All the patients he treated have no more medical budget for the year and are being sent home, and the Doctor is being slaved to the Allocator, which can move him around despite the mobile emitter. Either they have transportation technology or someone forgot that the emitter is a physical object. Also, it’s all down to billable hours.
Tuvok is interrogating Gar, up to threatning a mind meld, when Neelix drops by to make good on his offer to fix things way back earlier in the episode. This is clearly a good-cop-bad-cop thing, only Neelix is the bad cop who just poisoned Gar with horrible volcanic diarrhea so he’ll need to go to the Doctor, in an appropriately ironic con.
The Doctor’s trainee Red-level is fighting back against the System when he’s called up to Blue (the first time he’s seen it or even known about the income inequality he works within) by the Doctor. The plan is to smuggle the mobile emitter (which they’ve remembered is physical in the same scene as they have him bounced across the room for a comedy beat) down to Red in a shielded case to Enact a Plan. Once on Red, the Doctor is caught by the administrator and infects him with acute viral infection and gives him the kid’s low TC score.
So now the Doctor has infected a man in order to heal, which has to violate some constraint of his code. To me, that makes him as sophisticated an AI as Data, in case we were in doubt. Programs break when faced with impossible dilemmas, whereas AIs successfully weigh the constraints of, say, not harming with an ethical duty to prevent greater harm through the use of harm.
Voyager has found the planet, and can tell from here that the Doctor is plugged into the hospital’s computer. Red-doctor has gone to find the Chief of Medicine, who evidently isn’t happy with the way his people have been reduced to statistics. Underneath all that Blue-level superiority, he’s still a doctor. Diplomatic channels are failing with the Allocator program, so Torres has to go directly to unplug the Doctor, but not before he’s extracted from the administrator an agreement to transfer all the infected patients on Red to Blue so they can get their treatment, and with the explicit cooperation of the Chief of Medicine who – if he keeps his job after this – will likely keep up the transfer of medicine if only to ensure an adequate budget buffer.
Once back on board Voyager he asks Seven to give him a diagnostic, but she finds no evidence of abnormalities – and no programmatic basis for his ability to poison someone to save a dozen. Being given a clean bill of health means there’s nothing to repair, but it’s also a reminder that – more than most people – the Doctor’s ethics are directly formed by those who wrote the program, and any moral or ethical failings in his program derive from those who built him. Is his pained look one of regret for his actions, or of someone who knows unequivocally that if he were ever faced with the same choice again, he’d make the same decision.