The Bladerunner

by Alan E Nourse

  “Treating all the cases that come in, you mean,” Doc said. “As for the thousands that didn’t come in — ” He broke off, pulled a note pad from his pocket and scribbled down a name. “Katie, check something out for me. See if anyone named Hardy was admitted here last night or this morning. An infectious case, isolation ward.”

  Katie Durham looked at the name, then picked up the telephone and spoke into it for a moment. She waited, impatiently tapping her fingers on the desk. Presently the computer print-out beside the telephone began clicking. She picked up the print-out tape, frowning. “Is that all you have on it?” she said into the phone. “Nothing more? And this was at six A.M.? No … no thanks, that’s all I need right now.”

  She set the phone down very slowly and turned to face Doc. “This Hardy family,” she said. “They brought a boy to the hospital, early this morning. But he wasn’t admitted. He was dead on arrival.”

  VI

  The fact that he had been half-expecting it all day did not lessen the impact. Doc picked up the computer print-out tape, stared at it for a moment, and shook his head with a sigh. “As fast as that,” he said bitterly. “I was afraid of it. What about an autopsy?”

  “The father refused permission. Lab did take a throat culture and blood studies, though, and a spinal tap. They supported the history — a viral meningitis. There were traces of Viricidin in his bloodstream, too; he’d been treated by somebody, probably just not soon enough.”

  “And what about the rest of the family?” Doc asked.

  “He was brought in by the father and a younger boy. They were obviously Naturists, and they refused examinations.”

  Doc winced. “They’ll be back,” he said, “probably just like the boy. Katie, something’s going on here that’s very bad, and I don’t think you and your Health Control people here are even beginning to grasp it.”

  “But we know there’s a bad infection on the move. We’re treating it, and I told you we’ve got the computers working on the epidemic problems.”

  “You mean you’ve started off on a big, sprawling, time-consuming analytic study that’s going to take six weeks or more to complete, and I don’t think you’ve got six weeks. If what I suspect is true, this hospital and the whole damned city could be buried in bodies in six weeks.”

  “What do you think is happening?”

  Doc sighed. “I’m not sure, but I think you’ve got to find out in one whale of a rush. Look, I was the one that saw that Hardy boy last night in his home. Never mind what I was doing there, I saw him. He was already mortally ill, the full-blown picture of meningitis, but he’d only had those symptoms for forty-eight hours. Before that he’d been just mildly ill for about two weeks — with the Shanghai flu. Not even a bad case, just a mild sore throat, headache, muscle aches, and those symptoms were all getting better spontaneously. Then whammo! A wildfire meningitis, and he’s dead in the course of two days in spite of the treatment I started. Meanwhile, the father and the brother both have had Shanghai flu and have early meningitis symptoms right now, for which they’re refusing examination or treatment.”

  Katie Durham stared at him in confusion. “But John, they’re Naturists. It’s perfectly consistent that they’d refuse treatment.”

  “Especially for something mild, right? Like the Shanghai flu. Well, that’s exactly the point. Suppose this mild flu isn’t just a mild flu. Suppose the virus, once it gets well entrenched, can attack the spine and cause a deadly meningitis. But these people are bypassing early treatment because it just seems like a mild flu. Naturists or whatever, they’re trying to ‘ride it out,’ to use an old Health Control term. And while they ride it out, without knowing there’s a bomb waiting to go off later, they’re also infecting everybody they come in contact with — and by the time they and the ones they infect decide they can’t ride it out any longer, it may be too late to difuse the bomb. Oh, your regular clinic patients are all right. The ones that are eligible come in to the clinic for every sniffle, right? When they get the Shanghai flu. in they come and you slap it down with Viricidin and it stops right there. And you’ve been treating thousands of Shanghai flu cases these past weeks, right? But what about the ones that aren’t eligible?”

  Katie sat down at her desk, frowning. “Yes, I’m beginning to see what you mean. You’re thinking — ”

  “I’m thinking that this city is full of people — not just the Naturists, but thousands upon thousands of common, ordinary, everyday people — who are going to try to ride out a mild case of Shanghai flu just the way they’d ride out a common cold, tens of thousands of people like that who can’t qualify for Health Control care, people who wouldn’t dream of applying for Health Control care for a simple case of flu — considering the eligibility requirements — until it’s too late.”

  “And you’re contending that this meningitis could be a late complication of this particular strain of flu.”

  “Right. And this Shanghai flu epidemic hasn’t even begun to crest yet, we haven’t begun to see the cases we’re going to see when it really gets moving in the population.”

  Katie shook her head. “But, John, this is all pure guesswork. Sure, there’s a flu epidemic moving in, and there’s also a nasty viral meningitis that’s begun turning up. That doesn’t mean the two are related.”

  “But suppose they were.”

  “If they were, it could be a disaster. I’m not sure what it might mean, but you don’t have a shred of evidence.”

  “That’s right, I don’t,” Doc said. “But maybe you do, in the hospital records, and if the two are related, you’ve got to find it out. You’ve got to forget this slow, nitpicking computer study you’ve gotten started and home in on the one critical question you need an answer to right now: how many of your meningitis patients had untreated Shanghai flu to start with, and how many of the flu patients you treated came down with the meningitis anyway. Would that take so long to track down?”

  Katie Durham bit her lip thoughtfully. “Twenty-four hours, maybe. Maybe less.” She stared at him for a long moment, then picked up her phone with an air of decision. “Will you see if Tim Lerner in the data bank can come up here, Mary? Right now, if possible, it’s urgent.”

  They waited in silence, Doc lost in thought, Katie closing her eyes and rubbing her forehead wearily. Only a few moments later the secretary ushered in a tall, thin young man in a white lab coat and horn-rimmed glasses. “Dr. Durham?”

  “Come in, Tim. Dr. Lerner, this is Dr. John Long, surgical staff. You’ve probably never met. John, Tim is our Chief Records Analyst and heads up the Department of Statistics. Now, then. On this meningitis study you’ve got started, Tim, we need some preliminary data very urgently.” Carefully, she began outlining the problem, the question of relationship between flu victims and the meningitis cases admitted to the hospital. Lerner pulled out a pipe, filled it and lit it as he listened. When she finished he said, “When do you need this?”

  “The sooner the better. Tomorrow morning at the latest.”

  Lerner whistled. “You know that this will all show up anyway when the general study is finished.”

  “That’s far too slow. Set the rest of it aside and get this going fast. Commandeer all the computer time you need. I’ll sign the priority. We want a search on every viral meningitis case diagnosed either in the outpatient clinics or in the hospital in the past six weeks, with a tight résumé of follow-up — what happened to each one of them. Even more important, search their records for any history of general influenza symptoms within two weeks prior to onset of meningeal symptoms. Never mind the lab data, we’ll correlate that later. But tabulate old patients and new patients separately — we need hard figures on how many meningitis victims might have delayed clinic or hospital visits on account of ineligibility. Is that clear?”

  “You mean you want separate figures for former patients and never-treated patients?” Lerner jotted notes on a pad. “Fine, we can do it. I’m not sure we can vouch for statistical significance on th
is kind of run, but with any luck we can get you some sort of a picture.”

  “That’s what we need right now — a preliminary picture. We can pick up details later. But put this through tonight, Tim. It could be critically important.”

  When Dr. Lerner had left, tapping his note pad thoughtfully, Katie turned back to Doc. “Okay, now we’ll see. Personally, I think you’re way out in left field, and this little canter is going to cost the hospital a small fortune in computer time, but we’ll see. Meanwhile, we still haven’t resolved the small problem of Dr. John Long and his part in the robot-training program.”

  “I know,” Doc said.

  “So what answer can you give me?”

  “I just don’t know.”

  “Well, obviously I can’t keep you in the program any longer unless you’re willing to cooperate. And if I can’t keep you on it, I’m going to have to explain why to Health Control, and they’re going to start to probe.”

  “Can you give me twelve hours to answer?”

  “Do you really need twelve hours?”

  “I’ve got to think it through. I’m not sure what I can do. Some time would be a help.”

  “Then take your twelve hours. Check with me in the morning. I should have data on this other thing by then; you can give me your answer then too. And, John, for God’s sake don’t play games with me anymore. Make it the right answer this time.”

  Doc paused at the office door, turned back to her with a smile. “For you, Katie, I’ll try. But if I can’t, it won’t be your fault. I won’t have anybody to blame but myself.”

  VII

  Back in his own office, Doc turned off the lights, leaned back wearily in his chair and clasped his hands behind his head. On his way from Katie’s office he had stopped on the surgical floors, intending to make evening rounds on his morning cases and the patients still hospitalized from surgery earlier in the week. But after seeing Mabel Turner and one other, he had given it up as a bad job and come back to his office, counting oh the resident surgeons to flag him in the event of any trouble. His mind was far too unsettled to concentrate on routine; there were far more pressing decisions to make than what to do about a post-operative fever.

  Now, in the quiet office he thought once again about his confrontation with Katie Durham. Of course, it had been sure to come sooner or later. His methods of obstructing the robot-training program had not always been the most subtle, and he had known that Katie Durham was no dunce. True, he had often enough mulled over excuses he might use when the time came, innocent explanations to account for the failures and missteps, one by one. But when the confrontation finally came, such arguments had obviously been pointless. Katie had done her homework too well; when she had finally faced him, she had an airtight case. He could have delayed and stalled and challenged her figures and insisted on having other pantograph analysts go over her data, but it would only have gained him another few days at best, as well as infuriating Katie at the same time, and there was nothing to be gained by that. Faced with it cold, there had been nothing he could do but accede to her accusations and hope that she might somehow begin to comprehend, maybe even understand, the depth and bitterness of his opposition to the robot-training program and all that it represented in the government’s Health Control program.

  And in a way, she had surprised him. There had been no mistaking her tone and attitude. She had dreaded the confrontation as much as he had, and she clearly had sympathy, even support, for his feelings. But it was also clear the official position she had to take. Like it or not, she would surely blow the whistle on him if he continued to try to sabotage the program. There would be no more games, no more sabotage. He could cooperate, or he could quit the program. It was as simple as that.

  And as complicated. Because he couldn’t just quit and walk away free to more ordinary hospital duties, that was clear. To refuse to cooperate was to take things out of Katie’s hands. There would be a Health Control investigation to probe what he had been doing to the training program and why. At best Katie might let him continue his own surgical work at the hospital until Health Control was through with him. Or she might ground him altogether pending a Health Control judgment, perhaps even level civil or even criminal charges against him. But whatever she did, it appeared that a Health Control probe would not stop with just his hospital work — and that, above all, had jarred him. Maybe Katie had been bluffing about an in-depth probe of his private life, his associations, his illegal practice, but somehow he didn’t think so. And if she wasn’t bluffing, then his whole career as a legally licensed physician was in jeopardy. A full-blown Health Control probe could ruin him — and expose everybody he was associated with to scrutiny.

  Of course, he did have one other alternative. He could resign from his hospital post completely, give up legal medical practice altogether, and go underground. Plenty of doctors had done just that, and many that Doc knew personally were glad they had taken that route, claiming that anything was better than willingly participating in the hated Health Control program. But for his part, Doc had never been convinced of that. Necessary as it might be, underground medicine at its best was poor medicine, a desperately limited stop-gap measure that could only be justified if there were some hope that it might someday help bring changes in the rigid Health Control system. The underground doctor was working with both hands tied, placing every patient he saw in jeopardy. Certainly it was no long-term solution to the problem of providing medical care for the nation. The only good solution would be a top-to-bottom revision of the way Heinz-Lafferty formulas were applied, a rethinking of the whole government medical program. As it was, where the Heinz-Lafferty formulas failed to meet the medical needs of the people, the peoples’ needs were being twisted to fit the formula, as the government tried desperately to force a vastly imperfect system into perfect function. And the government was stubborn; any revision in the program, any shift of policy whatever, was going to have to be forced upon it, and even then change could only be accomplished one tiny step at a time. Any such changes, however tiny, could only come from doctors working within the system, not from doctors working outside it in totally illegal medical activities.

  It was for this reason that Doc knew he couldn’t go underground completely. He could never hope to force any change if he quit his hospital post. What he could accomplish working within the system was something else again. Maybe nothing, all by himself; he could beat his head on the wall forever, to no avail. But if one with Katie’s power in the system would join him, the result could be different. And if a crisis were to arise, a desperate situation that Health Control could not cope with under the present system….

  He sat there, and suddenly realized that his heart was pounding. He stood up, poured some reheated coffee, then sat back again, sipping it thoughtfully. Throughout history, epidemic illnesses had triggered medical crises. For centuries men had had no defense against such scourges as plague, syphilis, rubella, smallpox. Then immunizations were divised, antibiotics made treatment possible. In recent decades the discovery of potent viral antibiotics had even allowed medicine to contain and stop viral infections among those who had not been immunized. And this was fine — so long as the whole population had medical care available to it. But under the Heinz-Lafferty formula, there were multitudes of people who were purposefully avoiding medical treatment as long as possible. What would happen if a potentially fatal virus infection were spreading across the country, an infection that seemed relatively harmless at first and did not reveal its true nature until the mild early symptoms had run their course and the virus was too well-entrenched in the victim’s body to be quelled or effectively treated? Those who could qualify for Health Control care, those who had accepted sterilization as the legal prerequisite, would be safe as long as they came in for treatment when symptoms were mild. But what about the vast numbers who would try to ride out the early infection? With such an infection the hospitals might only have seen a tiny percentage of all the cases so far, and among
the population at large the infection could be a smouldering brush fire eating its way along the ground, ready to explode into a veritable firestorm when it finally reached a certain critical point. At first concealed, then erupting in fury.

  Slowly Doc stood up and snapped a light on in the darkening office. Katie was right, of course; there wasn’t any proof. Not yet. Tomorrow there might be some answers — and tomorrow he would have to answer Katie, too, tell her where exactly he stood. He sighed, feeling time crowding him on all sides. He needed time — to think, time to come up with a workable answer — and slowly, inexorably, time was running out.

  It was enough to think about, but to top it off there was the nagging worry that had plagued him since the rooftop ambush of the night before — worry about Billy Gimp. His message box had still been empty when he returned to his office. Now he punched out Billy’s home phone number on his computer console, waited impatiently for the relays to close, and blinked down at the same message he had seen twice before that day: this telephone is temporarily out of service if you have a question an operator will come on the line to help you when you hear the — Doc cancelled in disgust. No word from Molly Barret, either, although it was almost six o’clock and she would not ordinarily leave the hospital without leaving a contact number for him. Just as he was about to have her paged, there was a rap on his door and Molly’s head popped in. “Doc! Thank God you’re back. They told me you were in conference with Dr. Durham.”

  Doc nodded. “Most of the afternoon.”

  “Nothing serious, I hope.”

  “Serious enough.” He looked at the girl closely. “You haven’t been aware of any snooping going on around you, have you?”

  Molly frowned. “Not that I know of. Why?”

  “Well, I can’t explain right now. Later, when we have time.” He took a deep breath. “Molly, what about Billy?”

  “That’s why I’m here,” she said. “He called me about an hour ago. A very odd call.”