by Dale Brown
“As much as I like blowing things up, Texas,” Patrick responded, “I think we should get a look first. If those craters are really decoys, they’re the best I’ve ever seen, which means—”
“They’re probably not Iranian,” Luger said. “You thinking maybe the Russians?”
“I think Moscow would like nothing better than to help Mohtaz destroy Buzhazi’s army and station a few brigades there as his reward,” Patrick said.
“You think that’s what Zevitin wants to do?”
“An American-friendly state in Iran would be completely unacceptable,” Patrick said. “Mohtaz is a nutcase, but if Zevitin can convince him to allow Russian troops into Iran to help defeat Buzhazi’s army—or for any other reason such as defending against American aggression—Zevitin will be able to send in troops to counterbalance American domination in the region. At the very least, he can put pressure on President Gardner to back away from supporting former Soviet bloc countries that are drifting into the American sphere of influence.”
“All that geopolitical stuff makes my head hurt, Muck,” Dave said with mock weariness. Patrick could see Dave’s attention diverted away from the videoconference camera. “I have the first draft of the plan ready—I’ll upload it to you,” he said, entering instructions into his computer.
“Okay, Muck, here’s the preliminary status reports,” Luger went on moments later. “We have two Black Stallion spaceplanes available within four hours along with their dedicated tankers and enough fuel and supplies for orbital missions, and three available in seven hours if we cancel some training sorties. Macomber says he can get loaded up in time to launch. How do you want to build the air tasking order?”
Patrick made fast mental calculations, working the timing backward from when he wanted the Black Stallion off the ground and out of Persian airspace. “I’d sure like to have decoys, backups, more intel, and more rehearsals for Whack and the ground forces, but my primary concern is getting a good look at that base soon without the Revolutionary Guards being alerted,” he said. “I’ll see if I can get approval for two Studs to go in right away. If we launch in four hours, we’ll be over the objective by midnight to one A.M. local time—let’s call it two A.M. to be safe. We recon for one hour max, blast off before civil sunrise, refuel somewhere over western Afghanistan, and head home.”
“The ‘Duty Officer’ is spitting out the preliminary guesstimate for the air tasking order,” Luger said. The “Duty Officer” was the central computer system based at the High-Technology Aerospace Weapons Center that tied in all of the various departments and laboratories around the world and could be securely accessed by any member of HAWC anywhere in the world—or, in the case of Armstrong Space Station, around it. “The biggest question mark we have right now is the KC-77 tanker support for the exfiltration aerial refueling. Our closest XR-A9-dedicated tanker is at Al Dhafra Air Base in the United Arab Emirates, which is two hours’ flight time to the closest possible refueling point over Afghanistan. If everything worked absolutely perfectly—they loaded the tanker without mishap, got all the diplomatic and air traffic clearances in a timely manner, et cetera—they’d make a possible rendezvous spot over western Afghanistan just as the Black Stallion goes bingo fuel.”
“And when was the last time we ever had a mission go completely flawless?”
“I don’t recall that ever happening,” Luger reassured him. “There are several emergency landing sites in that area we can use, but they are very close to the Iranian border, and we would need a lot of ground support to secure the base until fuel arrived. We can move recovery teams into Afghanistan to assist in case the Stud has to make an emergency landing, or we can push the mission back a couple days…”
“Let’s push ahead with this plan,” Patrick said. “We’ll present it as is and bring in as many contingency assets as we can—hopefully we won’t need any of them.”
“You got it, Muck,” Dave said. “I need to…stand by, Patrick…I have a call from your flight surgeon at Walter Reed. He wants to talk with you.”
“Plug me in, and stay on the line.”
“Roger that. Stand by…” A moment later the video image split in two, with Dave on the left side and the image of a rather young-looking man in Navy Work Uniform camouflage blue digital fatigues, typical of all military personnel in the United States since the American Holocaust. “Go ahead, Captain, the general is on the line, secure.”
“General McLanahan?”
“How are you, Captain Summers?” Patrick asked. U.S. Navy Captain Alfred Summers was the chief of cardiovascular surgery at Walter Reed National Military Medical Center and the man in charge of Patrick’s case.
“I saw your interview this morning,” the surgeon said testily, “and with all due respect, General, I was wondering where you got your medical degree from?”
“You have some problems with what I told the interviewer, I take it?”
“You made it sound like long-QT syndrome can be cured by taking a couple aspirin, sir,” Summers complained. “It’s not as easy as that, and I don’t want my staff blamed in case your request to remain on flight status is denied.”
“Blamed by whom, Captain?”
“Frankly, sir, by the great majority of Americans who think you are a national treasure that should not be sidelined for any reason whatsoever,” the physician responded. “I’m sure you know what I mean. In short, sir, long-QT syndrome is an automatic denial of flight privileges—there’s no appeal process.”
“My staff has been researching the condition, Captain, as well as the medical histories of several astronauts who have been disqualified from space duties but still retained flight status, and they tell me that the condition is not life-threatening and might not be serious enough to warrant a denial of—”
“As your doctor and the leading expert on this condition in the United States, General, let me set it straight for you if I may,” Summers interjected. “The syndrome was most likely caused by what we call myocardial stretch, where severe G-forces deform the heart muscles and nerves and create electrical abnormalities. The syndrome has obviously lain dormant for your entire life until you flew into space, and then it hit full force. It’s interesting to me that you obviously experienced some symptoms during some or perhaps all of your space flights, but then it lay dormant again until you had a mere videoconference confrontation—I’d guess it was equally as stressing as flying in space, or maybe just stressful enough to provide the trigger for another full-blown episode.”
“The White House and Pentagon can do that, Doctor,” Patrick said.
“No doubt, sir,” Summers agreed. “But do you not see the danger in this condition, General? The stress of that simple videoconference episode, combined with your repeated trips into orbit, sparked electrical interruptions that eventually created an arrhythmia. It was so severe that it created cardiac fibrillation, or irregular heartbeat, a true heat ‘flutter,’ which like a cavitating pump means that not enough blood gets circulated to the brain even though the heart hasn’t stopped. It goes without saying, sir, that any stressor now can bring on another episode, and without constant monitoring we have absolutely no way of knowing when or how severe it would be. Allowing you to stay on flight status would jeopardize every mission and every piece of hardware under your control.”
“I assume you were going to add, ‘not to mention your life,’ eh, Captain?” Patrick added.
“I assume we’re all thinking of your welfare first, sir—I could be mistaken about that,” Summers said dryly. “Your life is at risk every minute you spend up there. I cannot stress that too strongly.”
“I get it, I get it, Doctor,” Patrick said. “Let’s move on past the dire warnings now. What’s the treatment for this condition?”
“‘Treatment?’ You mean, other than avoiding stress at all costs?” Summers asked with obvious exasperation. He sighed audibly. “Well, we can try beta blockers and careful monitoring to see if any electrical abnormalities crop up
again, but this course of treatment is recommended only for non-syncopic patients—someone who has never passed out before from the condition. In your case, sir, I would strongly recommend an ICD—implantable cardioverter-defibrillator.”
“You mean, a pacemaker?”
“ICDs are much more than just a pacemaker, sir,” Summers said. “In your case, an ICD would perform three functions: carefully monitor your cardiac condition, shock your heart in case of fibrillation, and supply corrective signals to restore normal rhythm in case of any tachycardia, hypocardia, or arrhythmia. Units nowadays are smaller, less obtrusive, more reliable, and can monitor and report on a wide variety of bodily functions. They are extremely effective in correcting and preventing cardiac electrical abnormalities.”
“Then it doesn’t affect my flight status, right?”
Summers rolled his eyes in exasperation, completely frustrated that this three-star general wouldn’t let go of the idea of getting back on flying status. “Sir, as I’m sure you understand, installing an ICD is a disqualifier for all flight duties except under FAA Part 91, and even then you’d be restricted to solo day VFR flights,” he said, taken aback simply by the fact that anyone who had an episode like this man did would even think about flying. “It is, after, all an electrical generator and transmitter that can momentarily cause severe cardiac trauma. I can’t think of any flight crewmember, military or civilian, who’s been allowed to maintain flight status after getting an ICD.”
“But if they’re so good, what’s the problem?” Patrick asked. “If they clear up the abnormalities, I should be good to go.”
“They’re good, much better than in years past, but they’re not foolproof, sir,” Summers said. “About one in ten patients suffer pre-syncopic or syncopic episodes—dizziness, drowsiness, or unconsciousness—when the ICD activates. Three in ten experience enough discomfort to make them stop what they’re doing—truck drivers, for example, will feel startled or uncomfortable enough that they will pull off to the side of the road, or executives in meetings will get up and leave the room. You can’t pull off to the side of the road in a plane, especially a spaceplane. I know how important flying is to you, but it’s not worth—”
“Not worth risking my life?” Patrick interrupted. “Again, Doctor, with all due respect, you’re wrong. Flying is essential to my job as well as an important skill and a source of personal pleasure. I’d be ineffective in my current position.”
“Would you rather be dead, sir?”
Patrick looked away for a moment, but then shook his head determinedly. “What are my other alternatives, Doctor?”
“You don’t have any, General,” Summers said sternly. “We can put you on beta blockers and constant monitoring, but that’s not as effective as an ICD, and you’d still be restricted in flight duties. It’s almost guaranteed that within the next six months you’ll have another long-QT episode, and the odds are greater that you’ll suffer some level of incapacitation, similar or probably more severe than what you experienced before. If you’re in space or at the controls of an aircraft, you’d become an instant hazard to yourself, your fellow crewmembers, innocent persons in your flight path, and your mission.
“General McLanahan, in my expert opinion, your current job or just about any military position I can think of is too stressful for a man in your condition, even if we install an ICD. More than any treatment or device, what you need now is rest. If there is no history of drug abuse or injury, long-QT syndrome is almost always triggered by physical, psychological, and emotional stress. The damage done to your heart by your position, duties, and space flights will last the rest of your life, and as we saw, the stress of just one simple videoconference meeting was enough to trigger a syncoptic episode. Take my advice: Get the ICD installed, retire, and enjoy your son and family.”
“There have to be other options, other treatments,” Patrick said. “I’m not ready to retire. I’ve got important work to do, and maintaining flying status is a big part of it—no, it’s a big part of who I am.”
Summers looked at him for a long moment with a stern and exasperated expression. “Bertrand Russell once wrote, ‘One symptom of an approaching nervous breakdown is the belief that one’s work is terribly important,’” he said, “except in your case, you won’t suffer a nervous breakdown—you’ll be dead.”
“Let’s not get too dramatic here, Captain…”
“Listen to me carefully, General McLanahan: I’m not being dramatic—I’m being as honest and open with you as I can,” Summers said. “It is my opinion that you have suffered unknown but serious damage to your cardiac muscles and myocardium as a result of your space flight that is triggering long-QT episodes that are causing arrhythmia and tachycardia resulting in pre-syncoptic and syncoptic occurrences. Is that undramatic enough for you, sir?”
“Captain—”
“I’m not finished, sir,” Summers interjected. “The likelihood is that even with rest and medication you will suffer another syncoptic event within the next six months, more severe than the last, and without monitoring and immediate medical attention, your chances of survival are twenty percent, at best. With an ICD, your chances of surviving the next six months go up to seventy percent, and after six months you have a ninety percent chance of survival.”
He paused, waiting for an argument, and after a few moments of silence he went on: “Now if you were any other officer, one who didn’t use to date the Vice President of the United States with the Secret Service in tow, I would simply advise you that I will recommend to your commanding officer that you be confined to the hospital for the next six months. I will—”
“Six months!”
“I will still advise your commanding officer so,” Summers went on. “Whether you decide to get an ICD installed is your decision. But if you insist on not getting the ICD installed and you are not on 24/7 monitoring, you have virtually no chance of surviving the next six months. None. Do I make myself clear to you, sir?” Patrick momentarily looked like a rapidly deflating balloon, but Dave Luger could see his dejection quickly being replaced with anger—anger at what, he wasn’t quite certain yet. “It appears to me that the final decision is up to you. Good day, General.” And Summers logged out of the videoconference with a rueful shake of his head, certain that the three-star general had no intention of complying with his orders.
Once Summers left the conference, Patrick sat back in his chair, took a deep breath, then stared at the conference room table. “Well, shit,” he breathed after several long moments in silence.
“You okay, Muck?” Dave Luger asked.
“Yeah, I guess so,” Patrick replied, shaking his head in mock puzzlement. “I always thought it was Will Rogers who made that quote about mental breakdowns, not Bertrand Russell.”
Dave laughed—this was the guy he was familiar with, making jokes at a time when most sane men would be on the verge of tears. “I guess Mark Twain was right when he said, ‘It’s not what you know, it’s what you know that ain’t so.’”
“It wasn’t Mark Twain, it was Josh Billings.”
“Who?”
“Never mind,” Patrick said, turning serious again. “Dave, I need to learn everything about long-QT syndrome and treatment for heart arrhythmias before I can make a decision about what I can handle and what I can’t. There are probably a dozen companies doing research on modern ICDs, or whatever the next generation of those things becomes—I should know about the latest advances before I decide to get any old technology installed. Jon Masters probably has an entire lab devoted to treating heart disorders.”
“Excuse me for saying so, buddy, but you just had probably the best heart doc in the country on the line, ready to answer any questions you have, and you pretty much blew him off.”
“He wasn’t ready to help me—he was standing by ready to punch my ticket to a medical retirement,” Patrick said. “I need to handle this in my own way.”
“I’m worried about how much time you have to make this
decision, Patrick,” Dave said. “You heard the doc: most patients who have this condition either start continual monitoring and drugs or get an ICD installed, right away. The others die. I don’t see what other research you need to do on this.”
“I don’t know either, Dave, but it’s the way I always do things: I check them out for myself, using my own sources and methods,” Patrick said. “Summers may be the best heart doc in the military, maybe even the country, but if that’s so, then my own research will tell me that too. But riddle me this, bro: What do guys like Summers do with active-duty cardiac victims who are still alive?”
“They retire them, of course.”
“They retire them,” Patrick echoed, “and then they’re cared for by the Veterans Administration or private doctors paid for in part by the government. Summers is doing what he always does: discharging sick guys and pushing them off to the VA. Most of his patients are so thankful to be alive that they never give retirement a second thought.”
“Aren’t you glad to still be alive, Muck?”
“Of course I am, Dave,” Patrick said, giving his longtime friend a scowl, “but if I’m going to punch out, I’m doing it on my terms, not Summers’. In the meantime, maybe I’ll learn something more about the condition and possible treatments that these docs don’t know, something that will let me keep my flying status. Maybe I’ll—”
“Patrick, I understand flying is important to you,” Luger said sincerely, “but it’s not worth risking your life to—”
“Dave, I risk my life just about every time I go up in a warplane,” Patrick interrupted. “I’m not afraid of losing my life to—”
“The enemy…the outside enemy,” Dave said. “Hey, Patrick, I’m just playing devil’s advocate here—I’m not arguing with you. You do what you want. And I agree: it’s worth risking your life using your skills, training, and instincts to battle an adversary who’s out to destroy the United States of America. But the enemy we’re talking about here is you. You can’t outfly, outguess, or outsmart yourself. You’re not equipped or trained to handle your own body trying to kill you. You should approach this battle like any battle you’ve ever prepared for…”
