Jack Ryan 9 - Executive Orders (46 page)

“You don't look very happy.”

He looked up. “Dr. Ryan.”

“Dr. Alexandre, and I think you know
Roy
.” She gestured at the table with her tray. The dining area was packed today. “Mind?”

He got halfway to his feet. “Please.”

“Bad day?”

“E-Strain case,” was all he had to say.

“HIV,
Thailand
? Over here now?”

“You do read M&M” He managed a smile.

“I have to keep up with my residents. E-Strain? You're sure?” Cathy asked.

“I reran the test myself. He got it in
Thailand
, business trip, he said. Pregnant wife,” Alex added. Professor Ryan grimaced at the addition.

“Not good.”

“AIDS?” Roy Altman asked. The rest of S
URGEON
's detail was spread around the room. They would have preferred that she ate in her office, but Dr. Ryan had explained that this was one of the ways in which
Hopkins
docs kept up with one another, and was for her a regular routine. Today it was infectious disease. Tomorrow pediatrics.

“E-Strain,” Alexandre explained with a nod. “
America
is mostly B-Strain. Same thing in
Africa
.”

“What's the difference?”

Cathy answered. “B-Strain is pretty hard to get. It mainly requires direct contact of blood products. That happens with IV drug users who share needles or through sexual contact, but mainly it's still homosexuals who have tissue lesions either from tearing or more conventional venereal diseases.”

“You forgot bad luck, but that's only one percent or so.” Alexandre picked up the thread. “It's starting to look as though E-Strain—that cropped up in Thailand—well, that it makes the heterosexual jump a lot more easily than B. It's evidently a heartier version of our old friend.”

“Has CDC quantified that yet?” Cathy asked.

“No, they need a few more months, least that's what I heard a couple weeks ago.”

“How bad?” Altman asked. Working with S
URGEON
was turning into an educational experience.

“Ralph Forster went over five years ago to see how bad things were. Know the story, Alex?”

“Not all of it, just the bottom line.”

“Ralph flew over on a government ticket, official trip and all that, and first thing happens off the plane, the Thai official meets him at customs, walks him to the car and says, 'Want some girls for tonight?' That's when he knew there was a real problem.”

“I believe it,” Alex said, remembering when he would have smiled and nodded. This time he managed not to shudder. “The numbers are grim. Mr. Altman, right now, nearly a third of the kids inducted into the Thai army are HIV positive. Mainly E-Strain.” The implications of that number were unmistakable.

“A third? A third of them?”

“Up from twenty-five percent when Ralph flew over. That's a hard number, okay?”

“But that means—”

“It might mean in fifty years, no more
Thailand
,” Cathy announced in a matter-of-fact voice that masked her inner horror. “When I was going to school here, I thought oncology was the place to be for the supersmart ones”—she pointed for Altman's benefit—“Marty, Bert, Curt, and Louise, those guys in the corner over there. I didn't think I could take it, take the stress, so I cut up eyeballs and fix 'em. I was wrong. We're going to beat cancer. But these damned viruses, I don't know.”

“The solution, Cathy, is in understanding the precise interactions between the gene strings in the virus and the host cell, and it shouldn't be all that hard. Viruses are such tiny little sunzabitches. They can only do so many things, not like the interaction of the entire human genome at conception. Once we figure that one out, we can defeat all the little bastards.” Alexandre, like most research docs, was an optimist.

“So, researching the human cell?” Altman asked, interested in learning this. Alexandre shook his head.

“A lot smaller than that. We're into the genome now. It's like taking a strange machine apart, every step you're trying to figure what the individual parts do, and sooner or later you got all the parts loose, and you know where they all go, and then you figure out what they all do in a systematic way. That's what we're doing now.”

“You know what it's going to come down to?” Cathy suggested with a question, then answered it: “Mathematics.”

“That's what Gus says down at
Atlanta
.”

“Math? Wait a minute,” Altman objected.

“At the most basic level, the human genetic code is composed of four amino acids, labeled A, C, G and T. How those letters—the acids, I mean—are strung together determines everything,” Alex explained. “Different character sequences mean different things and interact in different ways, and probably Gus is right: the interactions are mathematically defined. The genetic code really is a code. It can be cracked, and it can be understood.” Probably someone will assign a mathematical value to them. . . complex polynomials . . . he thought. Was that important?

“Just nobody smart enough to do it has come along yet,” Cathy Ryan observed. “That's the home-run ball,
Roy
. Someday, somebody is going to step up to the plate, and put that one over the fence, and it will give us the key to defeating all human diseases. All of them. Every single one. The pot of gold at the end of that rainbow is medical immortality—and who knows, maybe human immortality.”

“Put us all out of business, especially you, Cathy. One of the first things they'll edit out of the human genome is myopia, and diabetes and that—”

“It'll unemploy you before it unemploys me, Professor,” Cathy said with an impish smile. “I'm a surgeon, remember? I'll still have trauma to fix. But sooner or later, you're going to win your battle.”

But would it be in time for this morning's E-Strain patient? Alex wondered. Probably not. Probably not.

S
HE WAS CURSING
them now, mainly in French, but Flemish also. The army medics didn't understand either language. Moudi spoke the former well enough to know that, vile as the imprecations were, they were not the product of a lucid mind. The brain was now being affected, and Jean Baptiste was unable to converse even with her God. Her heart was under attack, finally, and that gave the doctor hope that Death would come for her and show some belated mercy for a woman who deserved far more than she had received from life. Maybe delirium was a blessing for her. Maybe her soul was detached from her body. Maybe in not knowing where she was, who she was, what was wrong, the pain didn't touch her anymore, not in the places that mattered. It was an illusion the doctor needed, but if what he saw was mercy, it was a ghastly variety of it.

The patient's face was a mass of rashes now, almost as though she'd been brutally beaten, her pale skin like an opaque window onto misplaced blood. He couldn't decide if her eyes were still working. There was bleeding both on the surface and the interior of each, and if she could still see, it wouldn't last much longer. They'd almost lost her half an hour earlier, occasioning his rush to the treatment room to see her choking on aspirated vomit and the medics trying both to clear her airway and keep their gloves intact. The restraints that held her in place, coated though they were with smooth plastic, had abraded away her skin, causing more bleeding and more pain. The tissues of her vascular system were breaking down as well, and the IV leaked as much out on the bed as went into the arms and legs, all of the fluids as deadly as the most toxic poison. Now the medical corpsmen were truly frightened even of touching the patient, gloves or not, suits or not. Moudi saw that they'd gotten a plastic bucket and filled it with dilute iodine, and as he watched, one of them dipped his gloves into it, shaking them off but not drying them, so that if he touched her there would be a chemical barrier against the pathogens that might leap at him from her body. Such precautions weren't necessary—the gloves were thick—but he could hardly blame the men for their fear. At the turning of the hour, the new shift arrived, and the old one left. One of them looked back on his way out the door, praying with silent lips that Allah would take the woman before he had to come back in eight hours. Outside the room, an Iranian army doctor similarly dressed in plastic would lead the men to the disinfection area, where their suits would be sprayed before they took them off, and then their bodies, while the suits were burned to ashes in the downstairs incinerator. Moudi had no doubts that the procedures would be followed to the letter—no, they would be exceeded in every detail, and even then the medics would be afraid for days to come.

Had he possessed a deadly weapon right then and there, he might have used it on her, and to hell with the consequences. A large injection of air might have worked a few hours before, causing a fatal embolism, but the breakdown of her vascular system was such that he couldn't even be sure of that. It was her strength that made the ordeal so terrible. Small though she was, she'd worked forty years of long hours, and earned surprisingly good health as a result. The body which had sustained her courageous soul for so long would not give up the battle, futile as it was.

“Come, Moudi, you know better than this,” the director said behind him.

“What do you mean?” he asked without turning.

“If she were back in the hospital in
Africa
, what would be different? Would they not treat her the same way, taking the same measures to sustain her? The blood, and the IV fluids, and everything else. It would be exactly the same. Her religion does not allow euthanasia. If anything, the care here is better,” he pointed out, correctly, if coldly, then turned away to check the chart. “Five liters. Excellent.”

“We could start—”

“No.” The director shook his head. “When her heart stops, we will drain all her blood. We will remove the liver, kidneys and spleen, and then our real work begins.” “Someone should at least pray for her soul.” “You will, Moudi. You are a fine doctor. You care even for an infidel. You may be proud of that. If it were possible to save her, you would have done so. I know that. You know that. She knows that.”

“What we are doing, to inflict this on—” “On unbelievers,” the director reminded him. “On those who hate our country and our Faith, who spit upon the words of the Prophet. I will even agree that this is a woman of virtue. Allah will be merciful with her, I am sure. You did not choose her fate. Neither did I.” He had to keep Moudi going. The younger man was a brilliant physician. If anything, too good. The director for his part thanked Allah that he'd spent the last decade in laboratories, else he might have succumbed to the same human weaknesses.

B
ADRAYN INSISTED.
This time, three generals. Every seat full, and one of them with two small children strapped in together. They understood now. They had to. He'd explained it to them, pointing to the tower, whose controllers had watched every flight in and out, and who had to know what was going on by now, and arresting them would do little good, as their families would miss them, and if their families were picked up, the neighbors would know, wouldn't they?

Well, yes
, they had agreed.

Just send a damned airliner next time
, he wanted to tell
Tehran
, but no, someone would have objected, here or there, it didn't matter, because no matter what you said, no matter how sensible it was, somebody would object to it. Whether on the Iranian side or the Iraqi, that didn't matter, either. Either way it would get people killed. It certainly would. There was nothing for him to do but wait now, wait and worry. He could have had a few drinks, but he decided against it. He'd had alcohol more than once. All those years in
Lebanon
. As
Bahrain
still was,
Lebanon
had been, and probably would be again, a place where the strict Islamic rules could be violated, and there he had indulged in Western vice along with everyone else. But not now. He might be close to death and, sinner or not, he was a Muslim, and he would face death in the proper way. And so he drank coffee for the most part, staring out the windows from his seat, next to the phone, telling himself that the caffeine was making his hands shake, and nothing else.

“Y
OU
'
RE
J
ACKSON
?” Tony Bretano asked. He'd spent the morning with the acting chiefs. Now it was time for the worker bees.

“Yes, sir, J-3. I guess I'm your operations officer,” Robby replied, taking his seat and not, for once, carrying a bundle of papers and scurrying around like the White Rabbit.

“How bad is it?”

“Well, we're spread pretty thin. We still have two carrier battle-groups in the IO looking after
India
and
Sri Lanka
. We're flying a couple battalions of light infantry to the
Marianas
to reassert control there and supervise the withdrawal of Japanese personnel. That's mainly political, we don't expect any problems. Our forward-deployed air assets have been recalled to CONUS to refit. That aspect of operations against
Japan
went well.”

“You will want me to speed production of the F-22 and restart B-2 production, then? That's what the Air Force said.”

“We just proved that Stealth is one hell of a force-multiplier, Mr. Secretary, and that's a fact. We need all of those we can get.”

“I agree. What about the rest of the force structure?” Bretano asked.

“We're too damned thin for all the commitments we have. If we had to go to
Kuwait
again, for example, like we did in 1991, we can't do it. We literally do not have all that force to project anymore. You know what my job is, sir. I have to figure out how to do the things we have to do. Okay, operations against
Japan
took us as far as we could go, and—”

“Mickey Moore said a lot of nice things about the plan you put together and executed,” the SecDef pointed out.

“General Moore is very kind. Yes, sir, it worked, but we were on a shoestring the whole time, and that's not the way American forces are supposed to go out into harm's way, Mr. Secretary. We're supposed to scare the bejeebers out of people the moment the first private steps off the airplane. I can improvise if I have to, but that's not supposed to be my job. Sooner or later, I goof, or somebody goofs, and we end up with dead people in uniform.”