Alan E. Nourse - The Bladerunner

by Alan E Nourse

  Doc followed her into her office, then stopped dead. The place was in chaos. Two large tables in the middle of the room were heaped high with papers, with computer print-outs cascading to the floor on all sides. Dr. Ler-ner and two other people from Records were huddled over one pile of papers, speaking into small microphones, and a technician was punching colored pins into a city map draped the length of one wall. Across the room by the window, separate from all the activity, was a short, balding man with wire-rim glasses and a small mustache. "John, you must have met Mason Turnbull, Chief of the Eastern Division of the Department of Health Control?"

  "Oh, we've met," Doc said. "He ran that four-day conference on the robot-training program last year, remember? Look, if I'm interrupting something—"

  "Not at all," Turnbull said. "On the contrary, we've been waiting for you for some time."

  Doc's face darkened, and he turned to Katie. "Look,

  I had an appointment with you this morning. What's he doing here?"

  "I called him at two o'clock a.m., that's what he's doing here. John, we've got trouble on our hands, we aren't worrying about the robot-training program right now."

  "Well, I warn you, Katie, I've been thinking about it and I won't even discuss my work with this man without a lawyer on hand."

  "That won't be necessary this morning," Turnbull said. "Not that there isn't plenty to discuss. We've been watching your program very closely, Dr. Long, and we're not pleased with what we see."

  "Then you just don't comprehend the problems involved," Doc said.

  "Perhaps not, but other surgeons seem to be solving these problems splendidly. We're getting very curious to know why you can't. However, that's not the issue just now. Dr. Durham called me last night with some alarming information on these meningitis cases, and I understand you're involved."

  "He put us onto it," Katie said, "and it was none too soon, either." She took a thick sheaf of papers from one of the tables. "We knew we'd had a sharp surge of admissions of patients with viral meningitis in the past two or three weeks, and of course had the usual epidemiological studies started—it was obviously highly virulent, with a high mortality rate. We also have had a staggering increase in outpatients coming in for treatment for the Shanghai flu. None of them very ill, but as you know, people who are qualified for Health Control care tend to come in for every sniffle. Well, Dr. Long suggested that the meningitis might be a late sequel of the Shanghai flu in people who had bypassed treatment for one reason or another, and that's what we set out to track down."

  She sighed and tossed the papers on the table. "We only have preliminary figures at this point, but the pattern is already clear: the Shanghai flu and the meningitis are two stages in the same disease, and if the lab people succeed in isolating and identifying the agents, they're going to find the same virus involved in each stage. So far they haven't had any luck pinning it down."

  "The Shanghai virus is elusive; we can confirm that," Mason Turnbull said, "and the flu it causes certainly seems mild—a low-grade fever, headache, sore muscles for a couple of days, nothing much more. Our lab people are convinced it's one of these cyclic mutant flu strains that turn up every few years, but nobody's actually isolated the virus yet. This one appeared in Shanghai about four months ago, and just hit over here in the last two months. Highly infectious, but not particularly hard on the victims, except for babies and older people. We do have immune serum now for protective vaccination, and the virus is sensitive to most of the antiviral antibiotics. Ordinarily something like this would pass through and burn itself out in a few weeks. But a virulent meningitis complication is something else altogether."

  "It wouldn't be bad if everybody who got the initial flu were treated—or vaccinated ahead of time," Katie said. "The frightening thing is that that's not happening, according to our figures. The very mildness of the initial flu is a trap, because the symptoms clear up in a day or two, and people think it's all over until the trouble turns up some days later. I don't know why the time lag—• maybe it takes that long for the virus to travel to the central nervous system and get entrenched in the meningeal membranes lining the brain and spinal cord—but once the meningitis starts it moves like lightning: raging fever, agonizing stiff neck, violent headache, then convulsions and death all in a matter of forty-eight hours unless treatment is started in time. But there isn't any question that it's related to untreated Shanghai flu earlier. People who have treatment for the initial flu don't get it—we haven't turned up a single case. Neither do people who've gotten the flu shots early enough to prevent the flu. All the meningitis cases we've seen have been people who had the flu and rode it out without treatment."

  "And the admissions curve?" the Health Control man said.

  "YouTl have to see it to believe it," Katie Durham said. "Forty-three new meningitis admissions in the last twenty-four hours alone, every single one of them with untreated Shanghai flu a week or so earlier. Thirty-eight cases the day before, thirty-two the day before that. Over a hundred new cases in three days in this Hospital alone, and no sign of it peaking out. Here's the graph for the last week—look it over and see what you think."

  The Health Control man peered at the graph, grim-faced, with Doc looking over his shoulder. "The trouble is," Katie went on, "the really scary part doesn't show up on that graph. Of all the thousands of outpatients we've treated for the Shanghai flu in the last two months, in effect protecting them from the meningitis, ninety-nine point eight percent were patients who were already qualified for Health Control care anyway under the Eugenics Control laws—they'd already been through the sterilization procedure at some previous time, so that wasn't an impediment for them. Only two tenths of one percent—two people out of every thousand—had been alarmed enough about the Shanghai flu itself to submit to sterilization in order to obtain treatment."

  "Well, what would you expect?" Doc exploded. "An apparently minor, two-day illness—people who are resisting the eugenics qualifications would hardly change their minds because of a mild case of flu! This is exactly the kind of illness they'd try to ride out without treatment. But what about the other side of the coin? How many of the meningitis patients have been qualified for care?"

  Katie Durham tossed the graphs down and looked up at the Health Control man. "Practically none," she said. "I could hardly believe it, but those are the figures—and that's why I called you at two in the morning. Nine out of ten are unqualified, and they're waiting to the bitter end before they come in for help. A good third are beyond hope by the time they get here; they're dead before we can even get treatment started. Lord knows how many just don't get here at all." She sat down at her desk and spread her hands hopelessly. "That's the pattern our figures show, Mr. Turnbull, and frankly, I'm terrified. The Eugenics Control laws are working, all right, altogether too well. People who won't submit to Health Control qualifications are trying to ride out an apparently minor illness that later turns out to be something quite different—when it's too late, of course. There are still some holes in our data, some unanswered questions. We don't really know yet how many of these untreated flu patients actually come down with the meningitis, maybe it's only a small percent, but if our preliminary projections are anywhere near accurate, this city could be knee deep in corpses within another few weeks."

  There was a long silence in the room. Then Mason Turnbull cleared his throat. "Thirty percent," he said finally.

  "Thirty percent what?"

  "Thirty percent of the untreated flu patients will develop the meningitis," Turnbull said. "Those are the latest figures we've been able to come up with. And if you are alarmed by the implications, Dr. Durham, I can assure you that we are too. If the figure were five percent instead of thirty percent we would still have a dangerous underground epidemic on our hands. At thirty percent, we're facing a perfectly appalling medical disaster, with virtually all the potential victims out of reach of legal medical care. And to be perfectly frank, the Department of Health Control has its back
against the wall. We don't know what to do to stop it."

  X

  "I think," Mason Turnbull said, "that the time has come to lay cards on the table. The real reason I'm here right now is not because you called me last night, Dr. Durham; in point of fact, I've been expecting your call for several days now, and had planned to be here today anyway. Nor did I ask for Dr. Long to be here in order to pressure him on account of his robot-training fiasco. We certainly regard that as important, but not nearly as important as this critical problem that we're facing right now. I'm really here on an extremely confidential basis to ask Dr. Long for some rather extraordinary help. It's a kind of help that I can't legally ask for at all, but it's help that we very desperately need."

  The computer team had departed with piles of paper in their hands, and the office was empty except for Turnbull, Katie and Doc. The little man from Health Control took a seat facing the two doctors, filled an enormous briar pipe and lit it. "First of all, Dr. Durham, let me confirm that your computer analysis of this meningitis situation is perfectly sound, and every bit as frightening as you have indicated. It's not a local thing —your figures are very close to those from other east coast Hospitals, and things appear to be even worse in the west. In our offices we've been aware of the problem for about ten days now, and so far we can see no way —no way—that we can stop this thing in terms of any of our present Health Control programs." He spread his hands. "As you point out, it's a crisis that the Eugenics Control laws have actually created by encouraging unqualified people not to seek medical help for a minor illness. Yet the Eugenics Control programs provide us with no means whatsoever to fight the epidemic that's now developing."

  "But there's always been a threat of an epidemic getting out of hand," Doc interposed. "You Health Control people have known that right from the start; you've just chosen to ignore it."

  "That's not quite right," Turnbull said. "We just never anticipated anything on quite this scale, that's all. Minor epidemics we could handle. If anything, they fit right into the program, caused more people to get themselves qualified for care, and of course we've always had an escape valve for those who wouldn't . . ."

  "Escape valve?"

  "Underground medicine," the little man said. "The illegal medical practice that some eighty percent of all doctors, including yourself, Dr. Long, have been engaged in ever since the Eugenics Control laws were enacted. The kind of medical moonlighting that we have been continually denouncing and prosecuting all these years. Well, that's been necessary for public consumption. The truth is that from the very first the Department of Health Control has deliberately permitted medical moonlighting to evolve to whatever level it was needed for the very specific purpose of making the Eugenics Control program practicable at all."

  Doc stared at the little man. "Did you say permitted?"

  "That is what I said. Of course, I also said that this meeting is confidential, and if I were to be quoted outside this room, I would deny under oath that I made any such statement." Turnbull sighed and relighted his pipe. "Look, Doctor, Health Control has always been torn between the ideal and the practical. The Eugenics Control laws were aimed at certain long-term, idealized goals: control of a disastrous population spiral, the reduction of health care demands to a manageable level, and the long-term improvement in general health by weeding out certain health-destructive factors from the nation's gene pool. And already our studies show evidence of progress toward those goals. Last year saw the first decline in annual birthrate in the past forty years. Even with more people qualifying for Health Control care every year, the total demand for medical services—and the cost of providing them—has begun to level out after fifty straight years of increase. It's too early to see clear genetic gains just yet, but our medical actuaries are certain we're on the right track. In order to secure these gains, however, we've had to be practical. Hardly anybody really likes the sterilization requirement, even when they concede that it's necessary, and our control has been very fragile—we've been walking a knife-edge right from the first. We've had to have underground medicine as an escape valve, to provide emergency medical care to those who just wouldn't buy the sterilization. It's had to be completely illegal and subrosa. We've had to keep it under constant attack as far as the public was concerned, but we've had to have it to keep Eugenics Control afloat. It's been tricky going, a very difficult balancing act, but it's been working. It's been meeting our health care needs to a reasonable degree, and achieving our long-term goals at the same time. And under normal, ordinary circumstances there's no reason it shouldn't keep on working."

  "Except that we don't have normal, ordinary circumstances anymore," Katie Durham said.

  "Exactly," Turnbull said. "Two months ago this Shanghai flu turned up, and we suddenly found ourselves facing a completely unpredictable situation. Oh, we've had flu epidemics before, but never anything like this meningitis. The people who have been qualified for health care have had no problem. They've come in for treatment that both stops the flu and protects them from the meningitis, all at the same time. As soon as we started broadcasting warnings about the flu epidemic, those people flocked into the Hospitals and Clinics in droves. But there is a vast reservoir of people, as much as forty percent of the entire population, who had resisted Eugenics Control and have thus never qualified for health care. Of course some of these people—the Naturists, for example—resist any kind of health intervention. It's a religious thing with them, a matter of deep-seated conviction, and there's no way in the world we can reach them. They're going to wait until it's too late before they look for help, and that's going to be that. They're doing what they think they have to, and there's nobody except themselves to blame. But the vast majority of unqualified people aren't Naturists. They're just ordinary, reasonably healthy people who haven't liked the Eugenics Control laws and have been gambling on just riding out most minor illnesses. When they've been faced with serious illness, they've relied on underground doctors to take care of them. And for the most part, it's worked. The underground medicine hasn't been as good as Health Control care, it's involved more risk and poorer follow-up, but at least it's provided some kind of coverage for these people, under ordinary circumstances. The trouble is, this particular virus we're dealing with is by no means ordinary; it's lethal unless it's hit hard and early. And all those people who have been relying on underground medicine are completely unprotected."

  Doc stood up and walked to the window. "Why don't you simply declare an exemption in this case?" he said. "Declare an emergency, announce that the Shanghai flu has been found to be deadly dangerous, and that treatment is exempt from the sterilization requirement, that anyone can come in for Health Control treatment whether they can qualify or not. After all, you're talking about mass mortality—thousands, maybe millions, of dead people if this thing isn't stopped. Why not just take it out of the Eugenics Control program altogether?"

  "That was the first approach we considered, and the answer is that we can't. We've checked every possible angle, and our computers come up with the same thing: it would shatter the entire Health Control program. Well, think about what would happen if we published a broadside like that, Doctor. Here we have millions of people who have submitted to sterilization, like it or not, in order to qualify for health care because that was the law, the permanent Health Control policy of the nation. What do you think would happen if we suddenly told those people that now, when the chips were down, we were going to treat people who had never qualified themselves right alongside all those that had?"

  "You'd have a lot of angry people," Doc conceded.

  "We'd have an uprising that would make the Health Riots of ninety-four look like a Sunday outing. Well, we just can't do it, not like that. Flawed as the Eugenics. Control program may be, we're committed to it. We can't just turn it on and off like a light. With the commitment we have, any change in the Eugenics Control program—any change at all— is going to have to come gradually, a bit at a time, with months or y
ears of public preparation. Any sudden switch in policy would be lethal."

  "Then suppose you don't offer any exemptions—just tell the people what the true situation is and urge them to come in and qualify for care."

  "And imply that the government is willing to sit around and watch multitudes die if they don't? I can see you're not long on public relations. The only way we've gotten as far as we have has been by presenting health care qualification as a matter of free choice, and even at that we look like a pretty stone-hearted crew in the public eye. Harden that image any more, and we'd have lynch mobs marching through Washington, and they'd be after you as well as us. There's another problem, too: a vast number of people resent the Eugenics Control program, even though they've qualified for health care. They feel it has violated their privacy, robbed them of their prerogative to decide about children. I admit we're to blame for that, the way we've implemented the program has always been far too heavy-handed, but that's the way many people feel. And because they resent us, they don't trust us. If we were to publish warnings without lifting qualification rules, there would be millions of unqualified people who just wouldn't believe us. They'd suspect a trick to coerce them into qualifying, and they'd back off in droves. They wouldn't believe us until it was too late."

  The little Health Control man tapped out his pipe and laid it in the ashtray. Katie and Doc looked at each other. Finally Doc cleared his throat. "To sum it up rather bluntly," he said, "all you want is the impossible. You want all these unqualified people to come in for care when the virus strikes, but you have no way to provide them with care, or even make them believe you when you tell them they need it."

  "That puts it about right," Turnbull said. "We have no way to provide them with care. No way within the Health Control program, that is. No legal way."