Alan E. Nourse - The Bladerunner (11 page)

As a tentative working program, the Heinz-Lafferty proposal was carefully worked out—but their work was far from complete. A hundred details of the plan remained to be tested—the impact of the proposal on religious convictions, the attitudes the doctors might take, above all the attitude of the general public, all had to be studied in meticulous detail. A dozen more years of work were needed to crystallize the plan into sound policy, and neither Heinz nor Lafferty had any idea that the federal government might ever try to implement such a program before that vital work was done. But they had not counted on the sheer desperation of the government at the precise time that their preliminary studies were completed. Faced with an economic and political crisis, with the spreading Health Riots and threatened social disintegration, the aged President and his aged Congress were aghast at any program which sought to limit medical care in any way whatever. But an ambitious and liberal young opposition saw in the proposals the makings of a revolutionary reform program. Even as the incumbent administration floundered, the opposition broadcast the Heinz-Lafferty proposals as a panacea for the future, and in 1996 a frightened and riot-weary electorate bought the package in a landslide vote of historic proportions. Within sixty days after inauguration the tentative, untested Heinz-Lafferty proposals had been written into law, and for better or for worse the nation moved down a murky road of social and medical revolution.

No one at the time could see the end of that road, least of all Heinz and Lafferty, who shouted themselves hoarse warning that their work was incomplete, or the new President, to whom aoing something seemed synonymous with improving something. Yet as the fledgling program was instituted, the stage was set for the emergence of a strange and extralegal medical black market, existing solely to thwart the law. It was into this world of underground medicine that Billy Gimp, with his shadowy personal history, his youthful ambition and his half-repaired club foot, found work as a bladerunner—a procurer of illegal surgical supplies; and it was in this same underground world that men like Dr. John Long and multitudes of his professional colleagues set about with dogged determination to defeat a system they considered intolerable to the ideals and training of physicians anywhere, any time. And now, some eighteen years later, the network was tightening and the struggle reached a new level of ferocity, with no end in sight.

Ill

DOCTOR LONG! DOCTOR JOHN LONG!
The paging speaker on Doc's office wall broke into his reverie. With a sigh, he reached for the phone switch. "Doctor Long? This is Miss Rupert on Nine North. We're about to give Mabel Turner her preoperative medication. Did you want to see her before your surgery?"

"Oh, yes, of course. I'll be right there." Doc checked his watch and saw that he had just an hour's leeway before he was due in the operating suites. As he had expected, the computer had designated Mabel Turner as his first case this morning, to be performed with a full neuropantograph hookup to trace and record his every move, his every surgical decision from beginning of the case to the end. And in this case Doc was ready and waiting for them with a large measure of undisguised glee. It would be a case to be remembered. For weeks now Doc had been carefully planting erroneous data in the computer record of Mabel Turner's case history—a false lead here, a manufactured response there, a subtly incorrect clinical summary from one hospital visit, a totally erroneous electrocardiograph interpretation from another visit—in short, a craftily designed patchwork of misinformation and half truths about the patient's clinical course, all concocted for the sole purpose of misleading the computer into a slightly erroneous diagnosis, prognosis, and plan for treatment.

And it had worked. As a result of his efforts, Mabel Turner had been identified by the computer as a high-risk, desperately ill cardiac case, candidate for an immediate heart transplant—precisely the kind of case that Dr. Katie Durham and the other medical directors of the hospital so eagerly wanted him to perform with a full neuropantograph hookup, a case involving multiple difficult, perhaps even life-and-death, surgical decisions to be made from opening to closing. Now Doc smiled to himself in satisfaction. With the case finally scheduled, despite his formal, almost ritual, objection to the neuropantograph hookup filed with Dr. Durham, there could be no backing out without extreme embarrassment in high places. For all their claims and contentions, Health Control authorities were really not all that certain of the reliability of their computerized diagnosis and prognosis systems, so that the error could as well have arisen in their system as in Doc's machinations, and only a time-consuming and costly retrospective analysis would spot the difference. And now that they were boxed in, the case would give him a splendid opportunity to play hob with the neuropantograph, first confusing it thoroughly at the discrepancy between the procedure scheduled and the procedure he intended to do, and then almost certainly sending it into a paralyzing feedback crisis when he, as surgeon-in-charge, changed the projected procedure entirely.

And change the case he would, for he had no intention of performing a cardiac transplant on Mabel Turner this morning or any other time. He had never intended to.

Walking down the corridor from his office, Doc nodded to the occasional intern or resident who hurried by, then paused to wait at the northside elevator bank. Moments later the elevator dropped him off on the ninth floor, devoted exclusively to pre- and postoperative patients, and he hopped a jitney moving briskly down the main central corridor, passing wing after wing of perpendicular ward corridors. Hospital No. 7 was loudly acclaimed by Health Control authorities as one of the most modern and best designed of all the new federal Hospitals built in the last decade, with each patient bed within comfortable view of an outside window, with holo-TV stages with multiple projectors in each room so that each of four different patients could watch a different program projected on the same holography stage at the same time without any overlapping or interference of the images. With its thirty-eight stories, and thirty-six wings branching from the main central corridor, the hospital housed four thousand patient beds and, as usual, was filled to within 10 percent of capacity at all times. What was more, internal hospital transit was so efficient that a doctor could, if necessary, travel from the main lobby to the farthest end of the top-floor main corridor in no more than fifteen minutes of travel time, a significant improvement over some of the earlier pentagonal and hexagonal hospital designs in which just finding a patient's bed might well consume an hour of a doctor's time.

Mabel Turner had already received the first stage of her preoperative medication and when Doc finally reached her room, the small, chipper middle-aged woman was relaxed and a little drowsy, but still alert. Doc greeted her like an old friend, which indeed she was, a patient that Doc had been following closely in the outpatient clinics for nearly three years before the decision for surgery had to be taken. Now he rolled the bed into an upright position and carefully checked out the woman's vital signs, read the nurse's notes on her chart, then began his final pre-op examination. "No fever," he said. "That's fine. I warned you not to get a cold at the last minute. Blood pressure . . . well, that's behaving. Let's just listen to you breathe." Finally he finished and smiled at her. "You're in good shape," he said. "I don't think there'll be any problem."

"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-panelled 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."