On Presence Without Touch, and the Future of American Healthcare
By Michael Cummins, Editor, September 23, 2025
Angela had delayed this moment for months, but her body no longer allowed delay. The cramps had worsened, the weight loss grown alarming, the exhaustion pressed down like gravity. She parked between a Dollar Tree and a vape shop, the August sun glazing the asphalt where weeds pushed through cracks and carts drifted like forgotten ships. For a long moment she stayed behind the wheel, staring at the storefront. The faint outline of an old Payless sign still clung to the stucco, ghostly letters half-scraped away. In its place, glowing faintly in turquoise, were two words: Diagnostic Pod.
What had finally broken her was the memory of Dr. Evans, her old primary-care physician, patting her hand and saying, “Stress, Angela. It’s just stress.” His exam had lasted three minutes, punctuated by a buzzing pager and a rushed exit. That had been two years ago. Now, in the face of what felt like a body in revolt, the antiseptic pod seemed less like a last resort than the only reliable option. She stepped out of her car, pulling on the familiar mask of composure that had carried her through classrooms and staff meetings.
The doors slid open with a hiss. The space was dim, quiet, unnervingly antiseptic. Ten glowing capsules lined the floor, each shaped like a half-egg with a seam for a door. They hummed softly, more like appliances than instruments of medicine. A digital fish tank flickered on one wall, its coral reef looping every twenty minutes. The air smelled of synthetic lavender layered over bleach, reassurance by way of chemistry.
A voice, blue and bodiless, asked for her universal health card. She slid the plastic into the slot, watched the green light pulse, and felt the door of Pod 7 unlock with a sigh. The chair inside was gray vinyl, cool against her palms. A headset rested on the arm, waiting. She lowered herself carefully, fitted the goggles over her face, and the world dissolved into a meadow. Grass bent in a wind she could not feel; a bird flitted at the edge of her vision. The scan began—silent, invisible, a non-touching touch that somehow felt more invasive than a stethoscope.
Within minutes, the verdict arrived: an eighty-three-per-cent probability of Crohn’s disease. Biologics recommended, prognosis guarded. The voice that delivered it was calm, as if announcing a boarding group. Angela exhaled, the sound a faint gust in the sealed pod, and pressed her hands into her lap. Then the meadow shifted. Across from her appeared a woman in a white coat, rendered in startling fidelity. Her expression was sympathetic, her gestures precise. She spoke with warmth, as though she were really there. Angela tried to listen, but part of her mind wandered to the strangeness of it all. Was she speaking to a machine? Was someone behind the light, or was the figure entirely synthetic?
The hologram nodded, paused, answered each question with patience. Angela asked about travel, about meals with colleagues, about explaining illness to her students. Every answer was careful and clear. For the first time in years she felt she had been given time—thirty uninterrupted minutes, more than any doctor had ever offered. And yet, as the figure folded her hands and dissolved into pixels, the uncertainty remained. Who, if anyone, had just been in the room with her?
The pods had not appeared all at once. Their origin story was familiar: crisis, collapse, the promise of technological salvation. In the late 2020s, rural hospitals closed at an unprecedented pace. Insurers staggered under costs, and bipartisan outrage built in Congress. Emergency rooms overflowed while millions delayed care. A coalition of tech firms and health systems pitched a moonshot: retrofit America’s empty retail landscape with portable diagnostic pods, modular units that could be installed in days.
In one Ohio town, the last community hospital shuttered in 2029. A month later, a pod opened in the hollowed husk of a Blockbuster. The mayor cut a ribbon, the local paper ran a photo of the turquoise sign glowing against cracked asphalt, and residents lined up to swipe their cards. An elderly man emerged first, clutching a printout that looked like a grocery receipt. “It says I have to follow up,” he told a reporter. “But who do I follow up with?”
The government, desperate for an answer, subsidized the rollout nationwide. By 2033, more than sixty thousand pods had been installed. Ninety-seven per cent of Americans lived within ten miles of one. The universal health card became not only a key to the pods but a symbol of national solidarity, the closest the country had come to universal care.
But pods did not remain confined to the architecture of decline. They began migrating into other spaces. Libraries tucked them between the stacks, their hum softened by the smell of paper. Schools installed them in faculty lounges, where algebra prep sat beside diagnostics. Angela sometimes imagined one appearing near the vending machine at her own school, students ducking in between classes to get checked, their health as much a part of the curriculum as history. Train stations wedged pods between ticket kiosks and vending machines, so commuters emerged with a boarding pass in one hand and a diagnosis in the other. Civic centers placed them beside passport counters and voter registration booths, medicine stamped with the same authority as citizenship. Some towns placed them in church basements, next to folding tables and hymnals, as if confession and diagnosis were twin sacraments. Mobile pods, mounted on trucks, rumbled into flood zones and fire-scorched valleys, a doctor on wheels beaming into places where hospitals had never stood.
Each site shifted the meaning. In the strip mall, the pod felt like triage in a theater of decline. In libraries, it became a secular cathedral, knowledge and healing side by side. In parks, where pilot programs placed pods beneath trees, the meadow inside mirrored the meadow outside. Presence reframed by architecture.
Most patients never asked whether the hologram was real. The system didn’t volunteer the answer. For some, the ambiguity was part of the reassurance—better to believe in presence than to question it. But behind many of those avatars were physicians working from home, their voices traveling through fiber optics, their empathy rendered in pixels. Often they were women who had left hospital shifts to raise children, care for aging parents, or escape burnout. Medicine redistributed: a clinic in a kitchen, a consultation conducted while soup simmered on a stove. Presence could be performed, but it could also be remote, refracted through circumstance.
Medicine had always relied on ritual as much as knowledge. Galen wore robes that conferred cosmic authority, aligning the body with stars and humors. William Osler at Johns Hopkins taught that listening to a patient was as diagnostic as a stethoscope. Richard Cabot, at Massachusetts General, turned diagnosis into public theater, staging case conferences where information unfolded like a chess match until the autopsy delivered the truth. Each era clothed authority differently. The pod was simply the latest garment: light projected where flesh once sat.
But what was the difference between presence and the performance of presence? Abraham Verghese has argued that the physical exam—the hand on the pulse, the stethoscope on the chest—is an irreplaceable ritual, a way of telling the patient, you are not alone. Atul Gawande has emphasized the importance of conversation and choice, of weighing what is meaningful as well as what is possible. The pods simulated both—empathy and explanation—but without touch. Patients felt attended to, but only through performance.
Not everyone accepted them. Some still drove hours to see a “real” doctor, refusing to let a headset mediate their vulnerability. Civil-liberties groups warned that the universal health card functioned as a tracking device, linking diagnoses to employment and credit. A lawsuit alleged that pod data was quietly sold to insurers, who raised premiums for patients flagged as high-risk. Yet the vast majority swiped their cards and reclined in the chair. They emerged into strip-mall lots, or civic centers, or church basements, clutching their diagnoses like shopping bags, relieved to have been heard, unsettled by what was missing.
The meadow flickered, the hologram folded her hands, and the pod door sighed open. Angela stepped out into fluorescent quiet, past the Dollar Tree displays of plastic pumpkins. She slid into her car, the printout of her diagnosis buried in her purse between coupons and receipts. For the first time in years she felt she had been given time—thirty uninterrupted minutes, more than any human doctor had ever granted her. And yet, as she gripped the steering wheel, her eyes blurred. She had spoken with someone who looked and sounded like a doctor, who stayed longer than any doctor she had ever met. But had anyone really been there?
A week later, Angela received a follow-up message on her health-card portal. It confirmed her treatment plan and carried a single additional line: Your consultation was conducted by Dr. Elena Reyes, gastroenterologist, New Mexico. Angela read it twice. She had spoken to someone after all—someone who had paused between answers to check on a sleeping toddler in the next room, someone who had chosen medicine again, in a new form. Presence had been there all along, just refracted through distance and light.
Angela left the laptop open, the screen still glowing on the table. The light filled the room, a presence both real and not, lingering like a question without end.
THIS ESSAY WAS WRITTEN AND EDITED UTILIZING AI