Fictions

by Nancy Kress

  “I think the system stinks. The insurance companies should never have been allowed to deny health coverage on the basis of genescans for potential disease, and employers should never have been allowed to keep costs down by health-based hiring. If this were a civilized country, we’d have national health care by now!”

  The Hispanic had stared back at him, blank-faced.

  “Some of us are trying to do better,” Jesse said.

  It was the same thing Mike—Dr. Michael Cassidy—had said to Jesse and Anne at the end of a long drunken evening celebrating the half-way point in all their residencies. Although, in retrospect, it seemed to Jesse that Mike hadn’t drunk very much. Nor had he actually said very much outright. It was all implication, probing masked as casual philosophy. But Anne had understood, and refused instantly. “God, Mike, you could be dismissed from the hospital! The regulations forbid residents from exposing the hospital to the threat of an uninsured malpractice suit. There’s no money.”

  Mike had smiled and twirled his glass between fingers as long as a pianist’s. “Doctors are free to treat whomever they wish, at their own risk, even uninsurables. Carter v. Sunderland.”

  “Not while a hospital is paying their malpractice insurance as residents, if the hospital exercises its right to so forbid. Janisson v. Lechchevko.”

  Mike laughed easily. “Then forget it, both of you. It’s just conversation.”

  Anne said, “But do you personally risk—”

  “It’s not right,” Jesse cut in—couldn’t she see that Mike wouldn’t want to incriminate himself on a thing like this?—“that so much of the population can’t get insurance. Every year they add more genescan pre-tendency barriers, and the poor slobs haven’t even got the diseases yet!”

  His voice had risen. Anne glanced nervously around the bar. Her profile was lovely, a serene curving line that reminded Jesse of those Korean screens in the expensive shops on Commonwealth Avenue. And she had lovely legs, lovely breasts, lovely everything. Maybe, he’d thought, now that they were neighbors in the Morningside Enclave . . .

  “Another round,” Mike had answered.

  Unlike the father of the burned baby, who never had answered Jesse at all. To cover his slight embarrassment—the mother had been so effusive—Jesse gazed around the cramped apartment. On the wall were photographs in cheap plastic frames of people with masses of black hair, all lying in bed. Jesse had read about this: It was a sort of mute, powerless protest. The subjects had all been photographed on their death beds. One of them was a beautiful girl, her eyes closed and her hand flung lightly over her head, as if asleep. The Hispanic followed Jesse’s gaze and lowered his eyes.

  “Nice,” Jesse said. “Good photos. I didn’t know you people were so good with a camera.”

  Still nothing.

  Later, it occurred to Jesse that maybe the guy hadn’t understood English.

  The subway stopped with a long screech of equipment too old, too poorly maintained. There was no money. Boston, like the rest of the country, was broke. For a second Jesse thought the brakes weren’t going to catch at all and his heart skipped, but Kenny showed no emotion and so Jesse tried not to, either. The car finally stopped. Kenny rose and Jesse followed him.

  They were somewhere in Dorchester. Three men walked quickly towards them and Jesse’s right hand crept towards his pocket. “This him?” one said to Kenny.

  “Yeah,” Kenny said. “Dr. Randall,” and Jesse relaxed.

  It made sense, really. Two men walking through this neighborhood probably wasn’t a good idea. Five was better. Mike’s organization must know what it was doing.

  The men walked quickly. The neighborhood was better than Jesse had imagined: small row houses, every third or fourth one with a bit of frozen lawn in the front. A few even had flowerboxes. But the windows were all barred, and over all hung the grey fog, the dank cold, the pervasive smell of garbage.

  The house they entered had no flowerbox. The steel front door, triple-locked, opened directly into a living room furnished with a sagging sofa, a TV, and an ancient daybed whose foamcast headboard flaked like dandruff. On the daybed lay a child, her eyes bright with fever.

  Sofa, TV, headboard vanished. Jesse felt his professional self take over, a sensation as clean and fresh as plunging into cool water. He knelt by the bed and smiled. The girl, who looked about nine or ten, didn’t smile back. She had a long, sallow, sullen face, but the long brown hair on the pillow was beautiful: clean, lustrous, and well-tended.

  “It’s her belly,” said one of the men who had met them at the subway. Jesse glanced up at the note in his voice, and realized that he must be the child’s father. The man’s hand trembled as he pulled the sheet from the girl’s lower body. Her abdomen was swollen and tender.

  “How long has she been this way?”

  “Since yesterday,” Kenny said, when the father didn’t answer.

  “Nausea? Vomiting?”

  “Yeah. She can’t keep nothing down.”

  Jesse’s hands palpated gently. The girl screamed.

  Appendicitis. He just hoped to hell peritonitis hadn’t set in. He didn’t want to deal with peritonitis.

  “Bring in all the lamps you have, with the brightest watt bulbs. Boil water—” He looked up. The room was very cold. “Does the stove work?”

  The father nodded. He looked pale. Jesse smiled and said, “I don’t think it’s anything we can’t cure, with a little luck here.” The man didn’t answer.

  Jesse opened his bag, his mind racing. Laser knife, sterile clamps, scaramine—he could do it even without nursing assistance provided there was no peritonitis. But only if . . . The girl moaned and turned her face away. There were tears in her eyes. Jesse looked at the man with the same long, sallow face and brown hair. “You her father?”

  The man nodded.

  “I need to see her genescan.”

  The man clenched both fists at his side. Oh, God, if he didn’t have the official printout . . . Sometimes, Jesse had read, uninsurables burned them. One woman, furious at the paper that would forever keep her out of the middle class, had mailed hers, smeared with feces, and packaged with a plasticene explosive, to the President. There had been headlines, columns, petitions . . . and nothing had changed. A country fighting for its very economic survival didn’t hesitate to expend front-line troops. If there was no genescan for this child, Jesse couldn’t use scaramine, that miracle immune-system booster, to which about 15% of the population had a fatal reaction. Without scaramine, under these operating conditions, the chances of post-operation infection were considerably higher. If she couldn’t take scaramine . . .

  The father handed Jesse the laminated print-out, with the deeply-embossed seal in the upper corner. Jesse scanned it quickly. The necessary RB antioncogene on the eleventh chromosome was present. The girl was not potentially allergic to scaramine. Her name was Rosamund.

  “Okay, Rose,” Jesse said gently. “I’m going to help you. In just a little while you’re going to feel so much better . . .” He slipped the needle with anesthetic into her arm. She jumped and screamed, but within a minute she was out.

  Jesse stripped away the bedclothes, despite the cold, and told the men how to boil them. He spread betadine over her distended abdomen and poised the laser knife to cut.

  The hallmark of his parents’ life had been caution. Don’t fall, now! Drive carefully! Don’t talk to strangers! Born during the Depression—the other one—they invested only in Treasury bonds and their own one-sixth acre of suburban real estate. When the marching in Selma and Washington had turned to killing in Detroit and Kent State, they shook their heads sagely: See? We said so. No good comes of getting involved in things that don’t concern you. Jesse’s father had held the same job for thirty years; his mother considered it immoral to buy anything not on sale. They waited until she was over 40 to have Jesse, their only child.

  At 16, Jesse had despised them; at 24, pitied them; at 28, his present age, loved them with a despairing gra
titude not completely free of contempt. They had missed so much, dared so little. They lived now in Florida, retired and happy and smug. “The pension”—they called it that, as if it were a famous diamond or a well-loved estate—was inflated by Collapse prices into providing a one-bedroom bungalow with beige carpets and a pool. In the pool’s placid, artificially blue waters, the Carlsons beheld chlorined visions of triumph. “Even after we retired,” Jesse’s mother told him proudly, “we didn’t have to go backwards.”

  “That’s what comes from thrift, son,” his father always added. “And hard work. No reason these deadbeats today couldn’t do the same thing.”

  Jesse looked around their tiny yard at the plastic ducks lined up like headstones, the fanatically trimmed hedge, the blue-and-white striped awning, and his arms made curious beating motions, as if they were lashed to his side. “Nice, Mom. Nice.”

  “You know it,” she said, and winked roguishly. Jesse had looked away before she could see his embarrassment. Boston had loomed large in his mind, compelling and vivid hectic as an exotic disease.

  There was no peritonitis. Jesse sliced free the spoiled bit of tissue that had been Rosamund’s appendix. As he closed with quick, sure movements, he heard a click. A camera. He couldn’t look away, but out of sudden rush of euphoria he said to whoever was taking the picture, “Not one for the gallery this time. This one’s going to live.”

  When the incision was closed, Jesse administered a massive dose of scaramine. Carefully he instructed Kenny and the girl’s father about the medication, the little girl’s diet, the procedures to maintain asepsis which, since they were bound to be inadequate, made the scaramine so necessary. “I’m on duty the next thirty-six hours at the hospital. I’ll return Wednesday night, you’ll either have to come get me or give me the address, I’ll take a taxi and—”

  The father drew in a quick, shaky breath like a sob. Jesse turned to him. “She’s got a strong fighting chance, this procedure isn’t—” A woman exploded from a back room, shrieking.

  “No, no, noooooo . . .” She tried to throw herself on the patient. Jesse lunged for her, but Kenny was quicker. He grabbed her around the waist, pinning her arms to her sides. She fought him, wailing and screaming, as he dragged her back through the door. “Murderer, baby killer, nooooooo—”

  “My wife,” the father finally said. “She doesn’t . . . doesn’t understand.”

  Probably doctors were devils to her, Jesse thought. Gods who denied people the healing they could have offered. Poor bastards. He felt a surge of quiet pride that he could teach them different.

  The father went on looking at Rosamund, now sleeping peacefully. Jesse couldn’t see the other man’s eyes.

  Back home at the apartment, he popped open a beer. He felt fine. Was it too late to call Anne? It was—the computer clock said 2:00 A.M. She’d already be sacked out. In seven more hours his own 36-hour rotation started, but he couldn’t sleep.

  He sat down at the computer. The machine hadn’t moved to surround his empty square after all. It must have something else in mind. Smiling, sipping at his beer, Jesse sat down to match wits with the Korean computer in the ancient Japanese game in the waning Boston night.

  Two days later, he went back to check on Rosamund. The rowhouse was deserted, boards nailed diagonally across the window. Jesse’s heart began to pound. He was afraid to ask information of the neighbors; men in dark clothes kept going in and out of the house next door, their eyes cold. Jesse went back to the hospital and waited. He couldn’t think what else to do.

  Four rotations later the deputy sheriff waited for him outside the building, unable to pass the security monitors until Jesse came home.

  COMMONWEALTH OF MASSACHUSETTS

  SUFFOLK COUNTY SUPERIOR COURT

  To Jesse Robert Randall of Morningside Security Enclave, Building 16, Apartment 3C, Boston, within our county of Suffolk. Whereas Steven & Rose Gocek of Boston within our County of Suffolk has begun an action of Tort against you returnable in the Superior Court holden at Boston within our County of Suffolk on October 18, 2004, in which action damages are claimed in the sum of $2,000,000—as follows:

  TORT AND/OR CONTRACT FOR MALPRACTICE

  as will more fully appear from the declaration to be filed in said Court when and if said action is entered therein:

  WE COMMAND YOU, if you intend to make any defense of said action, that on said date or within such further time as the law allows you cause your written appearance to be entered and your written answer or other lawful pleadings to be filed in the office of the Clerk of the Court to which said writ is returnable, and that you defend against said action according to law.

  Hereof fail not at your peril, as otherwise said judgment may be entered against you in said action without further notice.

  Witness, Lawrence F. Monastersky, Esquire, at Boston, the fourth day of March in the year of our Lord two thousand four.

  Alice P. McCarren

  Clerk

  Jesse looked up from the paper. The deputy sheriff, a soft-bodied man with small, light eyes, looked steadily back.

  “But what . . . what happened?”

  The deputy looked out over Jesse’s left shoulder, a gesture meaning he wasn’t officially saying what he was saying. “The kid died. The one they say you treated.”

  “Died? Of what? But I went back . . .” He stopped, filled with sudden sickening uncertainty about how much he was admitting.

  The deputy went on staring over his shoulder. “You want my advice, doc? Get yourself a lawyer.”

  Doctor, lawyer, Indian chief, Jesse thought suddenly, inanely. The inanity somehow brought it all home. He was being sued. For malpractice. By an uninsurable. Now. Here. Him, Jesse Randall. Who had been trying only to help.

  “Cold for this time of year,” the deputy remarked. “They’re dying of cold and malnutrition down there, in Roxbury and Dorchester and Southie. Even the goddamn weather can’t give us a break.”

  Jesse couldn’t answer. A wind off the harbor fluttered the paper in his hand.

  “These are the facts,” the lawyer said. He looked tired, a small man in a dusty office lined with second-hand law books. “The hospital purchased malpractice coverage for its staff, including residents. In doing so, it entered into a contract with certain obligations and exclusions for each side. If a specific incident falls under these exclusions, the contract is not in force with regard to that incident. One such exclusion is that residents will not be covered if they treat uninsured persons unless such treatment occurs within the hospital setting or the resident has reasonable grounds to assume that such a person is insured. Those are not the circumstances you described to me.”

  “No,” Jesse said. He had the sensation that the law books were falling off the top shelves, slowly but inexorably, like small green and brown glaciers. Outside, he had the same sensation about the tops of buildings.

  “Therefore, you are not covered by any malpractice insurance. Another set of facts: Over the last five years jury decisions in malpractice cases have averaged 85% in favor of plaintiffs. Insurance companies and legislatures are made up of insurables, Dr. Randall. However, juries are still drawn by lot from the general citizenry. Most of the educated general citizenry finds ways to get out of jury duty. They always did. Juries are likely to be 65% or more uninsurables. It’s the last place the have-nots still wield much real power, and they use it.”

  “You’re saying I’m dead,” Jesse said numbly. “They’ll find me guilty.”

  The little lawyer looked pained. “Not ‘dead,’ Doctor. Convicted—most probably. But conviction isn’t death. Not even professional death. The hospital may or may not dismiss you—they have that right—but you can still finish your training elsewhere. And malpractice suits, however they go, are not of themselves grounds for denial of a medical license. You can still be a doctor.”

  “Treating who?” Jesse cried. He threw up his hands. The books fell slightly faster. “If I’m convicted I’ll have to decl
are bankruptcy—there’s no way I could pay a jury settlement like that! And even if I found another residency at some third-rate hospital in Podunk, no decent practitioner would ever accept me as a partner. I’d have to practice alone, without money to set up more than a hole-in-the corner office among God-knows-who . . . and even that’s assuming I can find a hospital that will let me finish. All because I wanted to help people who are getting shit on!”

  The lawyer took off his glasses and rubbed the lenses thoughtfully with a tissue. “Maybe,” he said, “they’re shitting back.”

  “What?”

  “You haven’t asked about the specific charges, Doctor.”

  “Malpractice! The brat died!”

  The lawyer said, “Of massive scaramine allergic reaction.”

  The anger leeched out of Jesse. He went very quiet.

  “She was allergic to scaramine,” the lawyer said. “You failed to ascertain that. A basic medical question.”

  “I—” The words wouldn’t come out. He saw again the laminated genescan chart, the detailed analysis of chromosome 11. A camera clicking, recording that he was there. The hysterical woman, the mother, exploding from the back room: noooooooooo . . . The father standing frozen, his eyes downcast.

  It wasn’t possible.

  Nobody would kill their own child. Not to discredit one of the fortunate ones, the haves, the insurables, the employables . . . No one would do that.

  The lawyer was watching him carefully, glasses in hand.

  Jesse said, “Dr. Michael Cassidy—” and stopped.

  “Dr. Cassidy what?” the lawyer said.

  But all Jesse could see, suddenly, was the row of plastic ducks in his parents’ Florida yard, lined up as precisely as headstones, garish hideous yellow as they marched undeviatingly wherever it was they were going.

  “No,” Mike Cassidy said. “I didn’t send him.”