The Bladerunner

by Alan E Nourse

  “And you’re planning to do just one artery?” the woman queried.

  Doc frowned. “Let me hedge … okay? Your angina has been getting progressively worse even with the care you’ve been taking of yourself, and the angiograms showed that you have definite blockage of at least two of the three coronary artery branches. We’ll use your splenic artery — you don’t need that anymore anyway — for a graft to bypass at least one of the blockages, but if I can get away with doing two, I’d like to do it. And if the third shows signs of impairment, I may do that one too, assuming we get good flow from the first one or two.”

  The woman sighed. “It’ll be good to have it over with, after all this time.”

  “It’s been a long wait, hasn’t it? But we had to be sure that it was necessary, absolutely necessary, before we made up our minds. Then the trick was to get you scheduled before you got into irreparable trouble.” He chuckled. “The computer still thinks you’re going to have a whole-heart transplant. We’re going to fool it all the way.”

  “You don’t like that computer, do you?” Mabel Turner said.

  “Not for sour apples, I don’t. But you don’t need to worry. I’m so used to the pantograph connection that it doesn’t bother me, and I suspect the computer is going to sign out long before we get down to serious business. And above all, in that operating room, I’m the boss.”

  The woman smiled. “Okay, Boss,” she said. “So I’ll see you … tonight?”

  “At least by then. I’ll be seeing you sooner, you just won’t know it.” He nodded as a nurse came in with a hypodermic syringe, second stage of Mabel Turner’s premedication, and he took the opportunity to bow out.

  Ten minutes later he was in the Cardiac Operating Suite #4, his customary place of work. In the dressing room he slipped out of his street clothes and into the green operating pajamas, laced shoe-covers onto his feet, and poured another cup of coffee. Then he found an empty dictating booth, dialed in Mabel Turner’s name and chart spool number and, when the signal light blinked on, began to dictate his preoperative physical examination, preoperative diagnosis, and operative prognosis on the patient, who was even now being moved into the operating suite.

  His dictation made a thoroughgoing jumble of the computerized history of Mabel Turner. Through painstaking and subtle selection of data previously supplied, the computer had been compelled to conclude that the patient was suffering from massive and intractable congestive heart failure, incipient kidney failure, uncontrollable hypertension, and a life prognosis of six days plus or minus ten hours unless a cardiac transplant could be performed to supply her with a new, young, and healthy heart to maintain the excessive burden. Extensive tissue typing had been performed; hypoimmune globulins and anergens had been readied in the serum bank to help lower the patient’s tissue rejection threshold to manageable levels; the heart bank had been searched for an organ of the precise immunological type necessary, and the organ finally selected had already been thawed and perfused with plasma in readiness for the operation. Meanwhile, the neuropantograph receiver hookup had been made ready and waiting for Doc’s entry into the operating room, and the vast array of electronic computer-observers and computer-copiers charged with transmitting neuropantograph images into solid-state circuit impulses stood ready with a sort of ghoulish mechanical anticipation for the opening stroke of the scalpel.

  And it was all a fraud. Mabel Turner did not have congestive heart failure, nor did she have kidney failure, nor hypertension, nor was she a valid candidate for a cardiac transplant. What Mabel Turner really had was a history of progressively severe episodes of heart pain whenever she exerted herself, as a result of the gradual plugging up of the coronary arteries supplying her heart with calcified fatty deposits, the result of long-standing atherosclerosis. The surgery for which she was really a candidate was a simple, almost basic, operation in which segments of no-longer-needed splenic artery would be taken and grafted in to bypass the clogged coronary arteries in order — if all went well — to supply her starving heart muscle with a new and refreshing supply of freshly oxygenated blood. And that, of course, was the procedure that Doc was really going to do, with the neuropantograph receiver searching his brain second by second, and the adjoining computers becoming increasingly puzzled, confused, confounded —

  In the scrub room Doc prepared for the surgery, then backed through the swinging door into the operating room to receive sterile gown, gloves and mask. Then, sitting on a stool, he waited as a circulating nurse brought the lightweight neuropantograph helmet and placed it over his head. He felt the momentary prickle as the scalp contacts were secured, insuring an uninterrupted pickup of neuro-electric signals from his cerebral cortex throughout the surgery. Glancing up at the glass paneled pantograph control room overhanging the operating theater, Doc saw the pantograph operator working his control panel, testing circuits and contacts in preparation for monitoring the strange human-computer neural hookup that would pick up echoes of each motor impulse and sensory impulse that passed through Doc’s brain and record them as sequences of punched molecules arranged and rearranged like uncountable multitudes of colored lights on a movie marquee in the colloid-filled bank of activated Hunyadi tubes that filled the room adjoining the operating suite. There those patterns of shifting molecules would be held in a colloidal suspension in the depths of the tubes, later to be scanned and impressed into permanent computer memory banks for analysis and, if all went well, ultimate programming into robot guidance units for use in future operations. Someday, it was the fond expectation of the Department of Health Control, enough of such units, working together, would have sufficiently refined the entire cardiac transplant procedure into its basic moves and judgments that robot operators could take over the operating room work, requiring only the monitoring of a living surgeon. And it was this fond expectation that Dr. John Long was determined, at any cost, to thwart.

  Now, as the three resident surgeons who made up the rest of his operating team came into the theater for gowning, Doc saw the operator at the control panel nod, his signal to begin testing his pantograph contact. Nodding back, Doc began a pre-ordered ritual of motion, first lifting his right hand, then his left, right arm, left arm, right shoulder, left shoulder, with the operator nodding encouragingly with each move, then saying into the loudspeaker, “That looks good, Doctor Long, I think you have a good ‘graph contact.”

  “Great,” Doc said sourly. “May the leads short out on you.”

  “Aw, come on, Doctor. Just forget about it, it won’t bother you any. And this should be a dandy case to record, according to the chart.” The operator fed a pack of chart cards into his reader, began flipping through them. His forehead creased in a puzzled frown. “Uh … Doctor … hold it just a second. Something seems to be off here.”

  “Nothing’s off,” Doc said, rising from his stool. “The patient’s ready to go.”

  “But, Doctor, I don’t think you’ve got the right patient — check this ID, will you?”

  A name and code number appeared on the operating room read-out screen. Doc already knew it by heart, but he went through the motions of checking the wristband of the now-anesthetized patient on the operating table. “It checks,” he said. “This is the one.”

  “But the history doesn’t check and neither does your pre-op note. Computer-Central just flashed an alarm up here — ”

  “Nonsense. Computer-Central is just confused.”

  “Well, I’m not so sure. Isn’t this a transplant candidate?”

  “Transplant!” Doc tried to sound indignant. “Not in my book. We’re doing a splenic artery graft and coronary bypass, not a transplant.”

  “Then why has the heart bank got a heart ready?”

  “You’d better ask Computer-Central about that. I didn’t order it up. I think Central’s confused — ”

  “Well, so is the pantograph unit, it’s getting all the wrong signals — ”

  “Too bad, but I can’t help it now. I’ve got surgery t
o do.” Doc nodded to the residents, who had been standing by frowning in perplexity at this exchange, and together they moved to the operating table. Doc raised his eyebrows at Anesthesia, got an answer nod, and began his case, leaving the pantograph operator still spluttering over the loudspeaker.

  It went well. He had worked smoothly with this team of men for months; he knew what he could expect from them, and they knew, by and large, what he would be doing and what he would want them to do. With all his mind concentrated on the work at hand, he forgot the neuropantograph, forgot the increasingly frantic operator in the control booth, concentrated his attention on the feel and function of small, quarter-inch-thick blood vessels carrying blood to a weakened and suffering heart; concentrated on selecting the graft vessel, removing the spleen it served, tying it off and snipping segments of it for preservation in a saline bath. The angiocardiograms had been right, two of the woman’s coronary arteries felt like hardened pipestems near the place where they branched off from the aortic valve to supply the heart muscle, and he could see some evidence of small scars on portions of the heart, confirming the electrocardiograph’s evidence that Mabel Turner had probably had at least one or two minor coronary attacks in the past, even though she had never had a “heart attack” that she recognized as such. Fortunately, the third major coronary artery branch seemed full and open, so only two obstructed branches had to be bypassed. Doc proceeded with the work, suturing in a segment of splenic artery to bypass the worst-blocked vessel, seeing the heart muscle blanch and begin to fibrillate as he clamped and removed the hardened segment, then seeing the muscle darken with blood again as the bypass artery segment was attached in place. As one of the residents used the defibrillator to restore normal heart beat Doc prepared the next segment of splenic artery, totally oblivious to the people around him, to anything around him but the patient and the operating field and the quick sure hands assisting his in their delicate work.

  “Doctor Long! Will you please explain to me just precisely what you are doing to that patient?” It was a woman’s voice, furious over the loudspeaker, and as Doc looked up, he saw a woman in hospital whites in the control booth next to the pantograph operator, staring down at him.

  “Splenic artery bypass of two coronary arteries,” Doc replied. “Why?”

  “The computer thinks you’re murdering her.”

  “Nonsense. She looks pretty pink to me.”

  “She may look pink to you, but your pantograph computer hookup can’t make any sense at all out of the procedure you’re doing. You’re supposed to be doing a transplant, and it’s practically climbing up the wall.”

  Doc paused in his work and looked up at the woman. “Now, Katie, just relax,” he said. “Your computer has gotten confused somehow. All this woman needs is a bypass artery or two, and her heart will be as good as new — what’s that?” He turned to one of the residents. “Yes, of course, get X-ray in here now, so we can document the flow through these two segments. Should be nearly perfect.” He looked up at the control room again. “Sorry, Katie. What was that, now?”

  “I said the computer is not confused,” the woman said. “It is acting on data which you and others have supplied it, and either that data has been deliberately falsified or else you’re performing the wrong procedure on that patient.” Her voice was deliberately paced, and Doc could feel the fury behind the words.

  “Look, Katie, can’t we hash this out a little later? I’ve got this patient open like a watermelon right now, and I really need to concentrate. Forget your computer, the surgery is going fine.”

  “Well, I won’t forget the computer, and neither will you. This sort of thing has gone on just once too often.” Dr. Katie Durham turned to the pantograph operator, checked the controls. “Oh, hell, turn it off, or we’ll have the whole thing paralyzed with feedback. Get this record, as much as you can, to my office, and do it fast. As for you, Dr. Long, I want to see you in my office as soon as you finish here, and I hope you don’t make me issue an official order.”

  “Fine,” Doc said. “Just one thing, though — I’m supposed to monitor a robot case in Number Five operating room when I’m through here. The first is only an appendectomy, but the second is that robot heart transplant you’ve been so eager to schedule. Do you want me to scratch that?”

  “Oh, no, not that.” The woman looked annoyed. “Just come up whenever your schedule is clear.”

  “Fine. For a late lunch, maybe?”

  “No lunch for me, thanks. This isn’t a social engagement.”

  Doc watched as Dr. Durham left the control room, followed shortly by the pantograph operator. A nurse said, “He’s disconnected, Doctor, do you want that helmet off?” and he nodded gratefully and tipped his head down so she could remove it. “Tell them in Number Five that I’ll be through here in half an hour, so they can get set up,” he said.

  By now the radiology department had the special OR X-ray machine set up, so that Doc could inject the dye into Mabel Turner’s newly bypassed coronary arteries. The preoperative plates hung against the wall. In a few moments the post-op plates were hung up beside them, still dripping. Where only a trickle of dye had passed through the two coronary artery branches before the surgery, there was now excellent perfusion of the entire heart muscle through the grafts. Doc sighed and nodded to his residents in satisfaction. “Looks good,” he said. “I think this gal may just do well.”

  Doc waited until his residents were well under way with closing the patient’s incision. Then he broke his own scrub, tossing his gown and mask into the disposal unit outside the operating room, and went down the hall to a doctor’s dressing room. Here he found some coffee and began dictating his operative note on Mabel Turner, a narrative account of precisely what he had done in the course of the operation, including why and how. With this chore completed, he checked to see if they were ready for him in No. 5. The circulating nurse there reported that the monitoring crew were just scrubbing for the appendectomy, and that the robot-operator was ready and awaiting activation. For this first case the robot had been programmed from neuropantographs of one of the senior surgical residents; in the second case the machine was programmed from Doc’s own neuropantographs. The first case had been run in first as an emergency, and since Doc had the operating room scheduled for his case, he was assigned to monitor the robot on the appendectomy too.

  Walking down the hall toward the No. 5 operating room, Doc saw Molly Barret emerging from the nurse’s station. She caught his eye, and they stepped to the side of the corridor to confer. “Doc, have you heard anything from Billy?”

  “Not a word. Have you?”

  She shook her head. “Nothing, and when I tried to call I got the same old disconnect signal; he hasn’t reconnected since the bugging yesterday. Doc, I’m really worried.”

  “It’s clumsy, all right,” Doc conceded. “I don’t know how I’m supposed to do that case I have scheduled tonight without any blades.”

  “I’m not worried about your blades, I’m worried about him,” Molly said sharply. “For all you know he may be sitting in jail somewhere, and you complain about inconvenience!”

  Doc looked at her. “Well, he’s not in any jail or we’d have heard about it long since. Anyway, they couldn’t hold him on a misdemeanor charge. He’d either ask for a computer-court hearing on the spot, or he’d go for bail. Either way they’d have to let him go, I think.”

  “But you don’t know.”

  “No, not really.” Doc sighed. “The best we can do at this point is wait for him to call. Check with me this afternoon; if we haven’t heard by then, we’ll have to do some tall figuring. But I’ve got to go now, I’ve got a case to monitor in Number Five.”

  “I know,” Molly said. “You’re also going to have some company, I think.”

  “What do you mean?” Doc said, startled.

  “Dr. Durham is already in there, all scrubbed and gowned.”

  “Oh, oh. Then there is going to be trouble, if she stays for the
second case. Because I’m going to pull the robot off that transplant just as fast as I can find an excuse.”

  Molly shook her head. “Doc, be careful. There’s been talk that she’s been onto you right along, and that she’s going to drop the axe.”

  “I know. She was in the control booth during my last case when the computer almost went into feedback arrest with conflicting priorities. Well, I thought it was a little too quiet around here. But if she’s going to drop the axe, then the sooner the better. Thanks for the warning, anyway.”

  In the scrub room adjacent to No. 5 Doc joined his first resident from the earlier case, and they both scrubbed in silence. As always in a monitoring case, there was a note of tension in the air, utterly unlike the air of quiet anticipation that preceded an ordinary doctor-performed surgical procedure. The use of a pantograph-programmed robot to perform routine surgery was not exactly new anymore, but it was still new enough, and risky enough, that all involved were always extraordinarily nervous. Of course, the robot’s programming was always exceedingly thorough. Drawn from exhaustive computer analysis of hundreds of neuropantograph records of a human surgeon performing the same kind of case, the programming theoretically covered virtually all the judgments and decisions that might conceivably have to be made. Each step in the surgery, no matter how simple or how difficult, had been etched into the robot’s computer memory directly from multiple on-the-spot experiences of the real surgeon. According to Health Control claims, the robot so programmed could, in theory, perform the given surgery with even more skill and elasticity of judgment than the surgeon himself — but nobody was yet quite willing to let a robot-operator proceed unmonitored. Each robot case was closely observed by a human surgical team scrubbed and gowned and ready to step in at any moment the chief surgeon thought necessary. And always, in the minds of the monitoring doctors, there was the dreadful specter of that nightmare case, never yet encountered but always possible, in which the robot-operator would make some death-dealing misjudgment from which a patient’s life could not be salvaged even by the most speedy intervention of the monitoring team.