by James Gunn
If he was a hijacker, if he had wanted the drugs and the instruments, why had he bothered to bring along the medic?
Flowers went through his pockets—futilely. The coat and the jacket underneath were empty. They had taken the needle gun.
He would hide behind the door, he decided. When it opened—he could tell from the hinges on this side that it opened inward—he would be behind it. He had fists. He was big enough; maybe he was strong enough. He would have a good chance of taking the hijackers by surprise.
Meanwhile, he sat in the dark silence, remembering the dream he had wakened from. It had seemed to him that he was a little boy again, and his father was talking to him in the grown-up fashion he had affected with his son. It had always embarrassed Flowers, even when he was very young.
“Ben,” his father said, “there may be more important things than medicine, but you can’t be sure of any of them.” He put his hand on the boy’s shoulder. It was heavy and Ben wanted to shrug it off, but he didn’t dare.
“It’s different with medicine. You deal with life, and life is always important. You’ll feel it every day, because every day you’ll have a personal fight with death, you’ll beat him back a foot, surrender a few inches, and come back to the battle. Because life is sacred, Ben. No matter how mean it is or crippled, it’s sacred. That’s what we bow down to, Ben. It’s the only thing worth worshipping.”
“I know, Dad,” Flowers said, his voice high and a little frantic. “I want to be a doctor. I want to—”
“Then bow down, boy. Bow down!”
But why should he think of Leah’s father? Why should the memory of something that had probably never happened make him think of Russ?
Was it what the dying man had said: “Some empty time . . .”
What time could be emptier than this?
Too many doctors and not enough healers! That’s what the old man had said. Absurd. It was like so many meaningless phrases that seem portentous because of their vagueness. It reminded him of arguments with other medics.
In the darkness the hospital incense seemed to drift to him—anesthetic and alcohol. The good smells. The reverent smells. Anyone who criticized medicine just didn’t know what he was talking about.
He remembered standing by the dormitory’s bullet-proof window, staring out at the block of houses being razed to make room for the two new wings, geriatrics and the premature section of obstetrics. It seemed to him that the twin processes of destruction and construction never stopped. Somewhere on the Center’s periphery there were always new wings growing over the old ruins.
How many square blocks did the Center’s walls enclose? Forty? Forty-five? He had forgotten.
He must have said it aloud, because Charley Brand answered from his desk. “Sixty and three-fourths.” Brand was a strange person, an accretion of miscellaneous information waiting to be mined, a memory bank awaiting only the proper question. But he lacked something; he was cold and mechanical; he couldn’t synthesize.
“Why?” asked Hal Mock.
“No reason,” Flowers said, vaguely irritated. “I went on a call a few days ago—into the city.”
“ ‘Thus conscience doth make cowards of us all,’ ” Brand quoted, not looking up from the desk where he flipped the frames in the viewer, one every second. Mechanical, mechanical.
“What does that mean?” Flowers snapped.
“Sometimes,” Mock mused, “I wish something would happen to a few medics in our class. Like getting sick—not seriously, you understand—or breaking a leg. The school can only graduate so many, you know. It has a quota. But we’re all so healthy, so careful. It’s disgusting.” He brooded over it. “Think of it. Seven years of torture, grinding my brains to a sharp point, and the prize depends on the right answers to a few stupid questions. It makes me sick to think about it.”
Brand shifted uneasily and changed the subject. “What are you going to specialize in, Ben? After you graduate.”
“I don’t know,” Flowers said. “I haven’t thought about it.”
“I have,” said Brand. “Psychiatry.”
“Why be a head-shrinker?” Mock asked scornfully.
“Simple economics,” Brand said. “The incidence of mental disease in this country is sixty-five point three percent. Almost two out of every three persons needs the services of a psychiatrist during his lifetime. On top of that are the neuroses and the stress diseases like stomach cramps, rheumatoid arthritis, asthma, duodenal ulcers, hypertension, heart disease, ulcerative colitis. And life doesn’t get any simpler. You can’t beat those figures.”
“How about geriatrics?” Mock asked slyly. “The incidence of senescence is one hundred percent. That’s the well that never runs dry.”
“Until they bring out the elixir in quantity!”
“They’ll never do that,” Mock said shrewdly. “They know which side—”
Flowers listened intently in the darkness. Was that a noise on the other side of the door? A rattling, clanging sort of noise?
He sprang to his feet, but the noise—if it had been a noise—wasn’t repeated. There was no use taking chances. He felt his way into the corner, behind the door, and leaned against the wall, waiting.
“There’s more to medicine than money,” he repeated softly.
“Sure,” Mock said, “but economic facts are basic. Ignore them and you can’t do an acceptable job at your profession. Look at the income tax rate: It starts at fifty percent. On one hundred thousand a year, it’s eighty percent. How are you going to pay for your bag, your instruments, your library? You can’t practice medicine without them. How are you going to pay your dues in the county medical society, in the AMA, special assessments . . . ?”
“Why are the income taxes so high?” Flowers demanded. “Why are instruments so expensive? Why are a hundred million people without adequate medical facilities, condemned to a lingering death in a sea of carcinogens, unable to afford what the orators call ‘the finest flower of medicine’?”
“It’s the cost of living,” Mock said, curling his lip. “Whatever you want, you have to pay for. Haven’t you figured it out?”
“No,” Flowers said savagely. “What do you mean?”
Mock glanced cautiously behind him. “I’m not that foolish,” he said slyly. “You never know who might be listening. Some medic might have left his recorder turned on inside his desk on the off chance of catching somebody with his ethics down. I’ll say this, though: We can be too healthy!”
“Nuts!” Flowers muttered in the darkness of the concrete cell. He let himself sink down the wall until he reached the floor.
They were all wrong, Mock and Russ and Leah and the rest of them who hinted at dark things. In another age they would have been burned at the stake. He had seen Dr. Cassner refute them brilliantly in a beautiful three-hour display of microsurgical virtuosity.
It began as an ordinary arterial resection and transplant. The overhead shadowless light was searching and cold on the draped body of the old man. The assistant surgeons and nurses worked together with the exquisite precision that is the result of years of training and experience.
The air conditioners murmured persistently, but sweat beaded Cassner’s broad forehead and trickled down beneath his mask before the nurse could mop it away with sterile cotton. But Cassner’s hands never stopped. They were things in motion, disembodied, alive. His fingers manipulated the delicate controls of the surgical machine with a sureness, a dexterity unmatched in this part of the country, perhaps anywhere. Genius is incomparable.
Flowers watched with a hypnotized fascination that made time meaningless. The scalpels sliced through the skin with unerring precision, laying bare the swollen old arteries; deft metal fingers tied them off, snipped them in two, accepted a lyophilized transplant, and grafted the healthy young artery to the stump of the old; the suture machine moved swiftly after, dusting the exposed area with antibiotics, clamping together the edges of the incision, sealing them with a quick, flatten
ing movement. . . .
Cassner’s eyes flickered from the patient on the operating table to the physiological monitor on the wall behind it, absorbing at a single glance the composite picture of the patient’s condition: blood pressure, heartbeat, cardiography, oxygen content, respiration. . . .
The microsurgeon saw the danger first. The operation was, comparatively, a speedy thing, but there were disadvantages. The area involved was large, and even the chlorpromazine-promethazine-Dolosal cocktail and the chilling could not nullify the shock entirely. And the heart was old.
It was impossible to transfer the instruments to the new area swiftly enough. Cassner took the scalpel in his own fingers and opened up the chest cavity with a long, sure stroke. “Heart machine,” he said in his quick, high voice to no one in particular.
It was pumping within thirty seconds, its tubes tied to the aorta and the left atrium. Two minutes later a new heart was in the old chest; Cassner grafted the arteries and veins to it. Ten minutes after the monitor had signaled the heart stoppage, Cassner pulled out the old heart and held it, a dead thing of worn-out muscle. He motioned wearily for his first assistant to inject the digitalis and shock the new heart into action.
As the chest cavity was closed, the new heart began squeezing powerfully, forcing the blood through the healthy new arteries.
Cassner would have had a good excuse for turning the more routine job over to the assistant, but he completed the arterial job before he turned away toward the dressing room. . . . That’s what the scoffers forgot, Flowers thought—what a man got for his money: the skill, the drugs, the instruments. Twenty years earlier, without modern medicine, the man on the operating table would have died.
That man wasn’t too healthy. If he were any less healthy, he’d be dead. Now he was good for five to ten years more.
“That’s nothing,” Mock said. “I saw Smith-Johnson save a five-month fetus and I had to wonder: Why?”
Flowers looked scornful. He knew why: It was because life was sacred, any life, all life. That’s what a doctor bowed down to.
“Sometimes in the night,” Mock said distantly, “I can hear their voices wailing, muffled by the incubators, all the premies that were too weak to live, that nature wanted to be rid of, and we saved—for blindness and disease and perpetual care. Oh, Cassner’s good, but I wonder: How much did the operation cost?”
“How should I know?”
“Why don’t you find out?”
Flowers shivered in the darkness, although the room was hot, and pushed his hands into his pockets. He touched his belt buckle.
He started, and wondered why he hadn’t thought of it before. He pushed the alarm button hastily.
It was a chance, and any chance was worth trying. He supposed that the hijackers had turned off the ambulance motor when they parked it.
Flowers sank back against the wall, remembering how he had gone to the business office. They had taken down his name, but they had shown him the statement. The old man had put down a $200,000 deposit. The business office had figured it pretty shrewdly. The total bill was only a few hundred less.
He glanced down the Debit column with its four- and five-digit numbers:
Operating Room: $40,000
Well, why not? The heart machine alone had cost $5,000,000, and that microsurgery had been the marvel of the Middle West when it had been constructed and equipped. Someone had to pay for it.
After that was the room fee, anesthesia, laboratory fees, X-ray, tissue exam, EKG-EEG-BMR fee, drugs and dressings, and, most prominently, the prices for new organs and arteries:
New Arteries (1 set): $30,000
New Heart (1): $50,000
Some poor devil of a defaulter had paid his bill.
Flowers sat in the concrete cell and told himself that a medic shouldn’t have to weigh questions of relative value. So the operation had cost the old man $30,000 to $40,000 for each year of life it promised him. It was worth it—from the old man’s viewpoint. Was there another viewpoint? Was someone else footing the bill?
Society, maybe. Was it worth it to society? Maybe not. The old man was a consumer now, eating up and using up what he had been smart enough or strong enough or ruthless enough to have produced when he was younger.
So maybe it wasn’t worth it to society.
That was a brutal, inhuman viewpoint. That was the reason nobody wanted society to be the judge of what was worthwhile. Medicine had been fighting that possibility for centuries; on that point the AMA was immovable. A man had an inalienable right to the doctor of his choice and the medical treatment he could afford.
Of course, of course. It illustrated the danger of looking at the problem all backward, as Hal Mock might. The knowledge was there; the skill was there; the equipment was there. If it wasn’t used, it would be an outrageous waste.
But maybe, he thought sharply, the mistake came earlier, in developing the knowledge, the skill, and the equipment in the first place. That was when society footed the bill.
Society puts a price on everything. In every era there are limited quantities of intelligence, energy, and what people collectively inherit from the thought and labor of the past, capital. Society’s value system determines how these assets are distributed among a thousand different enterprises.
It was like a budget: so much for food, so much for shelter, so much for clothing, education, research, entertainment; so much for the doctor.
What was more valuable than good health? Nothing, said society. Without it, all is worthless.
What did Mock mean when he said we can be too healthy?
Was there an optimum beyond which medicine consumed more than it produced in benefits? And was there a point past that at which medicine became a monster, devouring the society that produced it?
Maybe the cost of living could be too high. Maybe a society could be too healthy, like a hypochondriac, spending itself into bankruptcy in a vain effort to cure small or fancied ills.
“Charley,” he asked Brand one day, “what percentage of the national income went into medicine last year?”
“Therapy, education, research, production, or construction?”
“Everything.”
“Let’s see—fifteen point six, ten point one, twelve point nine, five point two, eight point seven—that’s—what does that add up to?”
“Fifty-two point five,” said Flowers.
In the darkness of the concrete room, he repeated the figure to himself. “Nonsense,” he muttered.
It was a relief from thought to discover that the recorder was running. He had only to press the playback stud to discover the identities of his captors.
He pressed the stud and listened, engrossed, to the voices of Leah and Russ and himself. . . . But before the tape reached Leah’s frightened cry, the door swung open and a blinding light dazzled his eyes.
He stabbed the recorder into silence and cursed silently. He had lost his chance.
“Who are you?” he demanded.
“Police officers,” said a harsh voice. “Didn’t you send out an alarm?”
“Get that light out of my eyes,” Flowers said suspiciously. “Let me see you.”
“Sure.”
The light turned away, splashed against dark trousers, lighter tunics, glittered on badges, exposed faces, caps.
One of the two officers looked familiar; surely that was the sergeant to whom he had turned over the shover.
“Well, Medic,” the sergeant said, “we meet again, eh? Come on, we’d better get out of here.”
“Certainly, but where’s the ambulance? Did you find it? Did you catch the hijackers? Did you—”
“Hold it.” The sergeant chuckled. “We ain’t got time for everything now. The hijackers might come back, eh, Dan?”
“You bet,” said Dan.
They went down long marble corridors, echoing with their footsteps, opening before them as the flashlight moved forward into the darkness. They reached a wide hall. On each side were three sets of
heavy brass doors, one set standing open. Behind it was an elevator. Flowers followed the officers into the car. The sergeant pushed a button. They started up with a jerk. The elevator creaked and rattled and wheezed until Flowers wondered whether it would ever make it. That was the sound he had heard in the concrete room, he thought. He leaned back wearily against the ornate brasswork of the wall and thought, I’m lucky.
In his moment of safety he found time to wonder about Leah. Was the blind girl all right? Surely she hadn’t been hurt. And her father—what was familiar about his face?
It reminded him of a picture, of the time he had wandered through the hall of past presidents in the courthouse headquarters of the county medical society. There were dozens of the portraits, all done in dark oils, all with their solemn faces and their stern eyes that seemed to watch him as he passed, as if to say, “We received the great Aesculapian tradition intact, unblemished; we hand it down to you, unchanged. Live up to it if you can.”
It was a pretty grim business, Flowers thought, this presidency of the county medical society. No occasion for laughter.
No, that was wrong. One of them had worn a ghost of a smile, the vague possibility around the painted lips that they once had smiled, that they did not take this matter quite as seriously as the painter.
He had bent over, curiously, to read the name on the tarnished brass plate fastened to the bottom of the frame, but he had forgotten it. He bent again, in imagination, trying to read the memory engraved on his brain. He visualized it, getting closer, clearer. He read the name:
DR. RUSSELL PEARCE
President, 1972–1983
Russell Pearce—of course, how could he forget? Discoverer of elixir vitae, developer of the synthesis which bore his name, dying now of senescence in a rotting house in the middle of the city.
Dr. Russell Pearce—Russ—Leah’s father.
The door opened in front of them. Hesitantly Flowers stepped out into the hall. It was almost identical with the one below.
To the left were tall windows opening on a graying night. “Where are we?” Flowers asked fretfully.