The Bladerunner

by Alan E Nourse

  “No, not really.” Katie leaned back, regarding him somberly. “John, how long have you been working with Health Control now?”

  He looked at her. “How long has the Department been organized? Eighteen, nineteen years? You’ve got it all there in my record.” He pointed to the thick manila folder on her desk.

  “Yes, you have quite a record.” She leafed through the folder in silence. “You came to Hospital Number Seven in the spring of ninety-five, just after the Eugenics Control Program was initiated. That makes you one of the original staff here. And before that you were in general practice with a group in Pittsburgh.”

  “That’s right.”

  “And there was trouble there, I understand.”

  “The Health Riots were especially bad there,” Doc said. “The clinic was fire-bombed, one of my partners killed — ”

  “And you had a wife and child involved?”

  “A wife and a baby daughter … but that came later. Once they were gone there was no reason to stay there any longer. I came East, worked at the old Philadelphia General while Number Seven was being built and then came here. Surgical residency, then a staff appointment … well, it’s all there on the record.”

  “Well, those were certainly bad years for you. Weren’t you pleased with the new health legislation that put an end to the riots?”

  “Pleased?” Doc hesitated. “I suppose so, in a way. Health care had to be brought under control somehow, and anything was better than the total chaos during the riots. Sure, I was glad to see the new administration doing something to change things, but I wasn’t happy to see them jump head-first into an obviously premature, untested experiment.”

  “You mean the Heinz-Lafferty Eugenics Control program?”

  “That’s right. The basic theory seemed to make sense, but there were a thousand variables that had never even had preliminary checks run when the government took the whole system and pushed it through. It was no wonder there was trouble; they were just begging for trouble.”

  “Like what?”

  “Well, the Naturist movement, for one thing. You were probably too young to remember the fuss they put up. They not only opposed the mandatory sterilization to qualify for medical care, they opposed medical care of any sort for anybody. Of course, the government thought the Naturists would just fall apart as soon as the Health Control program got working, but they didn’t. They kept protesting, and they’ve gotten stronger every year.”

  Katie Durham looked up. “Yes, we’ve been having trouble down on the street every night for the last month.”

  “Well, just wait a few more weeks, until a few more really wild-eyed people join that crowd, then there’s really going to be trouble.”

  “I can’t argue that,” Katie said soberly, “and I don’t see any solution, either. But let’s not get sidetracked on the Naturists. What other troubles do you think the Health Control program brought about?”

  “Well, hell, Katie … look around you,” Doc said angrily. “The biggest hole in the wall was the passive resistance. They should have foreseen how many people would fight against mandatory sterilization … and find a way around it. Essentially the whole program was a bid to bribe people into submitting to sterilization as the price of health care, and a whole segment of the population wouldn’t bribe. God knows how many people have turned to the underground, they must number in the millions. It’s a lousy brand of medicine, nobody can do good surgery on a kitchen table, but doctors and patients alike are into it because it’s the only sane way to resist the government’s program.”

  “Look, nobody can deny that the government’s program was premature,” Katie said. “Nobody likes all of it, not me or anybody else, but surely it’s better than what was going on before.”

  “I’m not so sure,” Doc said slowly. “If it is, then why all this problem getting new doctors in training? Medical schools are closing their doors for lack of students. Look at the staff of this hospital: every week another two or three doctors are leaving, and nobody’s coming in to replace them. And the ones left are being worked into the ground.”

  “Exactly,” Katie said. “And that’s why the computerization program is so vitally important. It’s got to be carried through as swiftly and efficiently as possible. That’s one of my main jobs here: to computerize the hospital on all fronts, and try to iron out any snags along the way. Well, for the most part it’s been going far better than we ever dreamed. The only real problems are the doctors that are fighting us, and that’s why I asked you to come here this afternoon.”

  Doc spread his hands. “Look, if you’re talking about that first case this morning, everybody was confused, including myself. I don’t know why the computer set Mabel Turner up as a transplant case, you know yourself that diagnostic codes can get scrambled up easily enough. And as for that robot transplant case I just finished, the machine was obviously trapped in a feedback loop, two conflicting sets of directives, and it could have kept on vacillating until the patient died on the table. I had to step in on that one.”

  Dr. Katie Durham looked at him and shook her head. “I’m sorry, John, but it won’t wash. Not this time.”

  “What do you meant it won’t wash?”

  “I mean I won’t buy it anymore. You’re lying. I’ve bought your excuses and explanations before, time and again, when you’ve had ‘problems’ on your cases, but no more. You’ve been letting it get so flagrant that everybody knows something strange is going on. Your own pantograph operator has gotten so confused he can’t even guess what’s going to happen next in a case of yours. He’s been in here asking for a transfer five times in the past month. Your whole pantograph program is in a shambles, and the poor man doesn’t understand what’s wrong. He’s blaming himself for the lousy results since he can’t imagine who or what else could be to blame. Well, I know who’s to blame, and it’s not him.”

  Doc sat up in his chair. “Katie, I know I’ve said some pretty strong things about the pantograph program in the past, I’ve never really cared much for it. But you can’t seriously claim that I’ve been deliberately sabotaging the program — ”

  “That’s precisely what I claim, in so many words.” Katie opened a desk drawer and drew out another folder. “I’m sorry, John, but it’s no good. I couldn’t really believe it myself until I started really digging into past cases and found that I’d opened a can of worms. All the simple cases — vein strippings and things like that — went fine, but every time there was a major lung or cardiovascular case, something always went wrong. I’ve checked out a hundred case records, and with every one it’s the same story. Faulty input data, scrambled-up case histories, distorted diagnostic load, contradictory laboratory findings — you name it and it’s there. In three different stages of a single patient’s workup you’d have recorded three conflicting items in the history, all mutually exclusive items which could do nothing but sabotage the computer’s evaluations.”

  “Look, Katie, everybody makes mistakes once in a while — ”

  “Yes, once in a while. But the same sort of mistakes repeated time after time in case after case? No. Those ‘mistakes’ were on purpose. And it didn’t stop with your pantograph programming cases. The robot cases you monitored also went haywire time after time so that you had to step in and take over. So more than faulty diagnostic data was getting into the machines, the surgical technique data was also faulty. I admit that had me stumped for a while. I couldn’t see how faulty technique was getting into the machines when the pantograph programming was coming straight from your own performances in the operating room. I couldn’t see how you could be unconsciously making errors. So I started reviewing the actual neuropantograph records of individual cases. And I found out you were making surgical errors purposely to throw off the pantograph — and getting away with it!” She pulled a sheaf of papers from the folder and shoved them into Doc’s hands. “I couldn’t believe it, but it was all there. Nobody but a fantastically skillful surgeon could ever have pulled
it off, but you managed. You were quick enough and skillful enough to make deliberate errors, purposeful faulty operative judgments with the patient right under your hands, and get away with it time after time. You’d meet a crisis one way at one time and a totally different way another time, and then create the crisis in still another case so you could use a different method of bailing out. It was no wonder your machines weren’t getting their surgical techniques programmed straight — you were playing games with them from the very beginning, deliberately building false judgments and judgmental conflicts right into your normal operating procedure. Very deadly games, I might add. You took some fantastic risks and you were just incredibly lucky time after time, but you got away with it, and you figured that nobody would ever take the time to go back and try to reconstruct what you’d been doing all this time. Well, on that one you were wrong. As you say, it’s all right there on the record — the whole fantastic story.”

  For a long moment Doc leafed through the bundle of papers. Finally he set them back on the desk. “Well,” he said softly, “it looks as if you’ve been pretty thorough.”

  “I’ve been thorough, all right,” Katie said. “It’s taken me weeks to put it all together, but it’s all here. This data shows that you’ve been systematically sabotaging your part of the pantograph program for months, probably for years. I don’t know how long, just yet, I haven’t gone back that far, but I will if I have to.”

  Doc shook his head. Walking over to the office windows, he stared down in silence at the darkening city. “Don’t waste any more time digging,” he said finally. “It’s been six years, maybe seven — almost since the beginning of the program. I’ve hated this robot-training program right from the start. At first I fought it in the open with everying I had, argued against it, wrote position papers, supported legal actions, sat through so many committee meetings it makes me sick to think about it; and then one day it dawned on me that not one person in all Health Control was even listening. They were going to jam that program through no matter what anybody thought about it. I wasn’t even given a choice about participating in it; I was assigned. So I decided then that there was more than one way to resist it. You could assign me to a pantograph program, but you couldn’t make it work out right — and I could make it work out wrong.”

  “John, I didn’t assign you. Health Control assigned you, the orders came right from the top. I just work here. My job is to administer their robot-training program and get it working, along with a thousand other jobs I have to do around this hospital at the same time. Maybe I don’t like the robot-training program all that much myself. You hate it because you don’t believe a robot operator can ever be programmed thoroughly enough to substitute for the critical judgment and skill of a human surgeon, even using the neuropantograph. Well, I’m not so sure that I think so either, but I’ve got no choice but to try. I’m convinced that at least part of the program can work. We know the robot operators can handle relatively simple surgery, and that one single surgeon coud effectively monitor a dozen appendectomies at the same time. But for really complex surgery we need expert input and full cooperation.”

  “You could train more surgeons,” Doc said.

  “That’s no answer. You know how hard it is to recruit new medical students, and it’s getting worse every year. Health Control knows that too. We have to find some way that fewer doctors can supervise more work. It’s the only possible solution, and the robot-training program is absolutely essential to it.”

  “But you can’t make robots do research. Health Control’s research programs are all going down the tube too. There hasn’t been a really major medical breakthrough in the last twenty years. Thousands of incompleted research programs have just stopped dead. That’s another thing that’s wrong with Health Control’s program.”

  “Well, I can’t touch that part,” Katie said bitterly. “That’s got to be someone else’s headache. I’ve got trouble enough with the robot-training program here at Hospital Number Seven. And the Health Control people have been crowding me. Every week I have a Health Control supervisor down here checking progress, and they’re getting very tense; the program isn’t moving fast enough. Last week I spent a whole day on the carpet with the Secretary of Health Control himself. He wanted to know why we were six months behind our projected goals, and I couldn’t tell him — without landing Dr. John Long in a pile of trouble. As it is, I can’t bluff for you much longer. I’m going to have to pinpoint my trouble areas in so many words, and that could mean you’d be facing a full-blown Health Control investigation.”

  Doc shrugged. “So what can they do? I haven’t broken any laws in your program. The worst they could do would be to give me a bad mark on my promotion record.”

  “John, you just don’t know what they could do! With this data they could prove malpractice, criminal negligence, grossly unethical medical practices. They could revoke your license, strip you of all your medical credentials, block you from working in any hospital or clinic anywhere in the country.” She hesitated, looking up at him. “And that might not be all. When Health Control decides to go after somebody, they dig in deep. They might not stop with your hospital work, they might look at everything you do — where you spend your time, who

  you associate with, where your phone calls come from, what taxi trips you take, everything. If a man should happen to have something to hide, he could find himself in real trouble.”

  Doc looked up sharply. “Just what do you mean, something to hide?”

  Katie spread her hands. “All I know is the rumors I hear,” she said. “If nothing else, you’re a dissident, and Health Control wants dissidents under control. In particular they want control over the key men, the professional leaders, the top experts in their fields — like you, for instance. If they catch men like that moonlighting, they’re inclined to make public examples of them.”

  “So now I’m moonlighting?”

  “I don’t know. Are you?”

  “If I were I sure wouldn’t tell you about it.”

  “I might be the safest person you could tell,” Katie said quietly. “I can tell you one thing, though. If you are, you’re leaving a trail. And if Health Control wants to pick it up, sooner or later they will. There’s no way to cover your tracks completely, they can always find something.”

  There was a long silence in the room. After a moment Katie joined Doc at the window. The sky was almost dark now and the city lights, normally dazzling, were muted by a light powdering of snow that had been falling. “You’ve got a great view here,” Doc said softly.

  “One of the perquisites of my job,” Katie said. “With your wits and skill you could have one too. You could be Chief of Surgery in this place in another few years. And then, if you still hated the system so much, you’d be in a position to get things changed legally, from the top down.”

  “I don’t know,” Doc said. “In a few more years there may not be much left to salvage.”

  “You don’t really believe that, John.”

  “Maybe not — but then maybe I do. The thing that started out a stream has turned into a flood. The Heinz-Lafferty formula could have been modified to be workable, if they’d only taken enough time to approach it slowly. But they didn’t, and now it’s going more and more wrong every year. Your robot-training program won’t save it; that’s just a drop in a leaky bucket. And you can’t see the flood coming because you’re so solidly on the government’s side.”

  “Could you believe that I might also be on your side?” Katie said. “I don’t want to fight you. More than anything, I’m afraid for you. There’s been too much interest in you and your work here. Health Control has been asking too many questions about you. And there are far too many rumors. I’m afraid you’re walking into grave trouble and don’t even know you’re being watched.”

  Doc gazed at the woman for a long moment. Then he took a deep breath. “Okay, maybe you are on my side. And maybe you’re right that I’m walking into trouble without knowin
g it. I appreciate the warning. But that’s nothing compared to the kind of trouble you and your Health Control bosses could be walking into right here in this hospital.”

  Katie looked up. “What kind of trouble?”

  “Perfectly legitimate, necessary medical work that gets out of hand. You’re barely able to limp along and handle the patients that you’ve got coming in here during normal times. What would you do if a real medical disaster struck?”

  For a moment a shadow crossed Katie Durham’s face. Then she said, “Aren’t you maybe borrowing trouble, John?”

  “Not exactly. How many cases of meningitis has the hospital admitted in the course of the last week?”

  “Far too many, I admit. We’ve had to convert three whole wards for isolation care. But that’s not what you could call a disaster.”

  “Then why does the computer have a security lid on the meningitis data?”

  Katie gave him an odd look. “That’s just temporary until we can establish a baseline for analysis. Right now our people are breaking down the data we have, plotting incidence curves, comparing case histories to find common denominators — the works. Until that’s finished we try to cut off any extraneous data searches. Look, I won’t say we’re not worried. This is a new strain of meningitis, we aren’t even sure what’s causing it, and cases have been increasing sharply. We don’t know yet whether it’s really an epidemic pattern, or just a chance clustering of cases that we’re seeing. But whatever it is, Viricidin seems to stop it if we get treatment started early, and the lab has an immune globulin to protect people who’ve been exposed. It certainly isn’t out of control. In fact, it wouldn’t be any strain at all except that it’s turning up right on the heels of this Shanghai flu epidemic.”

  Something clicked in Doc’s mind. “My God,” he said softly. “Shanghai flu.”

  “Well, yes. All our outpatient clinics have been loaded down treating that for the last six weeks.”