The Bladerunner

by Alan E Nourse

  “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 years 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.”

  “And what exactly does that mean?”

  Turnbull sighed. “Doctor, we have studied every conceivable angle, and we keep coming up with the same answer. If these people can’t be treated legally in the Health Control framework, they’re going to have to be provided with treatment illegally. Somehow these unqualified people have to be contacted, by way of rumor, the underground medical grapevine, by any means we can think of — but somehow — and made to understand that they can and must get treatment for the Shanghai flu on a subrosa basis if they can’t qualify for Health Control care. Health Control has got to be out of it; the government can’t formally change its policy. But Health Control facilities can help. The outpatient clinics can provide the vaccinations and Viricidin shots and just look the other way as far as qualifications are concerned — on an unofficial basis — but unqualified people have got to get the word. If the doctors practicing underground medicine can get the word to their patients fast enough, on an underground basis, we might have a chance to defuse this thing.”

  For a long moment there was silence in the room. Then Doc spread his hands. “Mr. Turnbull, you’re still asking for the impossible. How are you going to recruit doctors to go along with this sort of illegal program? How do you tell who’s practicing underground medicine and who isn’t? Who’s going to believe you’re sincere in asking this kind of help? You know what a doctor faces when he’s convicted of underground practice — heavy fines, punitive surveillance, loss of his medical license, maybe even prison time. Who do you think is going to admit to underground practice just because you Health Control people all of a sudden want them to?”

  “Suppose no admission were necessary,” Turnbull said.

  “What do you mean?”

  “Precisely what I said,” Turnbull replied. “Look, Dr. Long, if we’re going to put our cards on the table, let’s do so.” He reached down and pulled a large manilla folder form his briefcase. “I have a folder of data here — a dossier, if you will — dealing with certain legally unsanctioned medical activities of one Dr. John Long, Chief of Cardiovascular Surgery at Health Control Hospital Number Seven, and incidentally, an active practitioner of underground medicine for a period of over ten years. The data in this file goes back to the year 2007, although the early notes are very sketchy. Health Control didn’t have its intelligence program very well organized at that time; we had all kinds of problems with local police authorities, and our surveillance techniques were still pretty crude. But in recent years we have done far better. We have been using surveillance techniques so effective and sophisticated that you have never even heard of them, much less had any way to avoid them. And with them, we have been following your activities. In fact, you might just be a little startled to know how very closely we’ve been following your activities.”

  Doc was sitting up straight now, peering intently at the little Health Control man. “Just how closely, for example?”

  “All right, our records show that for the past four years you have been working with a medical supplies man — a so-called bladerunner — whose name and background are obscure but who is commonly known as ‘Billy Gimp.’ He has a crippled foot, I believe, with first stage of surgical repair accomplished in early childhood. You’ve also had the help of a surgical nurse named Barret off and on for almost six years — an excellent girl, it seems, who thinks that the Eugenics Control laws are a travesty, and who has been involved in a couple of ‘Nurses’ Crusades’ here at Hospital Number Seven, agitating for legal repeal — but that’s neither here nor there. In the past several months, with the aid of the girl and the bladerunner, you’ve been accelerating your underground activity quite sharply, several surgical cases a week, ranging from routine procedures to some rather technically difficult cases, including at least two gall bladder resections, right? Yes. Our last note, dated night before last, indicates that you performed tonsillectomies on the children of a family named Merriman in an apartment complex in the Trenton Sector, and that as you left the place your bladerunner was apprehended in a police ambush while you made an escape via heli-cab. The boy was interrogated, submitted to computer-court hearing, filed an appeal, and was released under continuous transponder surveillance. Last evening you saw the boy, and since your visit and that of another as-yet-unidentified person, the transponder has been inactive — hasn’t moved as much as five feet on the grid. In our experience, that probably means that the transponder has already been muffled and replaced with a stationary phony, although, of course, we can’t be sure of that yet. We could resolve the question easily enough, but there’s no need. The only reason for planting that transponder was to be very certain that we had either you or the boy quite firmly under our thumbs at this particular point in time. For the moment we’re quite content to let the boy go where he wants to go, undetected.” Turnbull set the folder down on the desk. “Dr. Long, I could go on and on with this, but what’s the point? When I said that Health Control has permitted underground medical practice to flourish, I meant just that We have all the data we need to stop it if it served our purposes to do so. We know the doctors involved, their bladerunners, their sources of medical supplies; but we have also been aware of the thin margin of acceptance for our Health Control programs during this transition period. To clamp down on the underground practitioners would close a very necessary escape valve, far too risky at this point.”

  “But you have clamped down,” Doc protested. “What about all the arrests, convictions, fines we’re hearing about?”

  “Oh, a few showcase convictions have been necessary. After all, it is illegal, and we’ve had to demonstrate that the Health Control programs can’t just be ignored. But mostly we’ve only bothered the most flagrant offenders. As long as we’ve known which doctors were involved there’s been no need for widespread action. We’ve felt that once the transition period was over and the Eugenics Control laws were more widely accepted we could then phase out the underground practice a little at a time without resorting to legal action at all — just a little pressure in the right places at the right time.”

  Doc picked up the folder bearing his name and medical identification number, leafed through it for a moment. “And you mean to say you have this kind of file on every doctor engaged in underground practice?” he said increduously.

  “No, no, nothing that exhaustive. We’ve only kept records on the leaders, the activists in the underground — the ones we thought might really give us trouble one way or another. There’s been no need to keep tabs on the others. We figured if we ever had to crack down, these key men would be the ones to stop, and most of the others would just quietly pull out without any other urging.”

  “I see.” Doc sat silent for a long moment. Then he looked up at the little Health Control man. “Mr. Turnbull, why are you telling me all this?”

  “I suppose I’m trying to convince you that we aren’t entirely the monsters you make us out to be,” Turnbull said. “We know more about underground practice than anyone suspects, but by and large we’ve kept our hands off because it’s served a useful, necessary purpose. We’re not indifferent to the needs and feelings of the people who oppose Eugenics Control, we never have been. And now, with this crisis on our hands, we can’t just sit by. We need the underground network now, need it badly, but we haven’t time to convince every underground doctor of that, and we can’t publicly back off from the Eugenics Control laws. That’s why we desperately need you, and other key underground men, to get the word spread and get help to these unprotected people fast.”

  “But what can I do, realistically?” Doc said. “Sure, I could contact a dozen or so other doctors and
try to enlist them, maybe contact a thousand patients one way or another, but that’s not even a drop in the bucket.”

  “I know that,” Turnbull said. “By yourself you’d be almost as helpless as we are. You just don’t have the breadth of contact with the underground that we need right now — but you know someone who does. What we need now is a pyramid effect, a chain-letter effect, with the warning spreading out throughout the whole vast net of underground medical workers and their contacts, with each one of them contacting twenty more. We’ve got to get a wildfire underground rumor spreading fast, within the next twenty-four hours, if possible. Well, you can’t do it yourself, Doctor, but there’s one person who can do it for you if you can beg, bribe, or bludgeon him into it — one person you know with absolutely impeccable underground connections who could get the word spreading far and wide.”

  “You mean my bladerunner,” Doc said quietly.

  “I mean your bladerunner,” Mason Turnbull replied.

  XI

  It was not until later, as he was making his way back down to his office, that Doc began to realize the full magnitude of the risk he had been asked to take — the risk to himself and, more particularly, to Billy Gimp. There had been no record made of the meeting with Mason Turnbull, no demonstrable evidence that it had occurred at all, except for Katie Durham’s presence. There had been no promises made, no guarantees of immunity, no real assurance that Doc’s cooperation, or Billy’s, might not be met with harassment, redoubled surveillance or both. For all he could prove, it might be nothing but an elaborate scheme to entrap them, a move on the part of Health Control to put them out of action once and for all. The best Doc had to go on was his own certain knowledge that the exploding epidemic was terribly, frighteningly real (there was no doubting that) and Mason Turnbull’s unsupported word that Doc’s and Billy’s cooperation with Health Control in fighting it would not soon be forgotten. Nor were there any suggestions that Health Control might be considering any basic reforms in the Eugenics Control program if this crisis could be overcome — nothing but Doc’s growing conviction that the Department of Health Control would finally read the handwriting on the wall and recognize the grave, recurrent danger of similar epidemics in the future. Conceivably — just conceivably — they might learn something from the crisis and be impelled to begin modifying the disastrously rigid program that currently existed. But precisely how he was supposed to get such a tenuous possibility across to Billy Gimp in any convincing way and recruit him for the underground task that had to be done, Doc was far from certain.