by Tom Clancy
“What’s most disturbing, however,” Kealty was saying now, “is what Ryan said about his appointments to the Supreme Court. It’s pretty clear he wants to turn the clock back on a lot of things. Litmus tests on issues like abortion, appointing only strict-constructionists. It makes you wonder if he wants to overturn affirmative action, and heaven knows what else. Unfortunately, we find ourselves in a situation where the sitting President will exercise immense power, particularly in the courts. And Ryan just doesn’t know how, Barry. He doesn’t, and what we learned today about what he wants to do—well, it’s just plain frightening, isn’t it?”
“Am I on a different planet, Arnie?” Jack demanded. “I didn’t say ‘litmus test.’ A reporter did. I didn’t say ‘strict-constructionist.’ A reporter did.”
“Jack, it isn’t what you say. It’s what people hear.”
“Just how much damage do you think President Ryan could do, then?” Barry asked on the TV. Arnie shook his head in admiration. Kealty had seduced him right out of his shorts, right on live television, and Barry had responded perfectly, framing the question to show that he still called Ryan the President, but then asking the question in a form that would shake people’s faith in him. It was no wonder that Ed was so good with the ladies, was it? And the average viewer would never grasp the subtlety with which he’d pulled Barry’s drawers off. What a pro.
“In a situation like this, with the government decapitated? It could take years to fix what he might break,” Kealty said with the grave concern of a trusted family physician. “Not because he’s an evil person. He certainly is not. But because he simply doesn’t know how to execute the office of President of the United States. He just doesn’t, Barry.”
“We’ll be back after these messages from our cable operators,” Barry told the camera. Arnie had heard enough, and didn’t need to see the commercials. He lifted the controller and clicked the TV off.
“Mr. President, I wasn’t worried before, but I’m worried now.” He paused for a moment. “Tomorrow you will see some editorials in a few of the major papers agreeing that a judicial commission is necessary, and you’ll have no choice but to let it go forward.”
“Wait a minute. The law doesn’t say that—”
“The law doesn’t say anything, remember? And even if it did, there’s no Supreme Court to decide. We’re in a democracy, Jack. The will of the people will decide who’s the President. The will of the people will be swayed by what the media says, and you’ll never be as good at working the media as Ed is.”
“Look, Arnie, he resigned. I got confirmed by the Congress as VP, Roger got killed, and I became President, and that’s the fucking law! And I have to abide by the law. I swore an oath to do that, and I will. I never wanted this fucking job, but I’ve never run away from anything in my life, either, and I’ll be damned if I’ll run away from this!” There was one other thing. Ryan despised Edward Kealty. Didn’t like his political views, didn’t like his Harvard hauteur, didn’t like his private life, damned sure didn’t like his treatment of women. “You know what he is, Arnie?” Ryan snarled.
“Yes, I do. He’s a pimp, a hustler, a con man. He has no convictions at all. He’s never even practiced law, but he’s helped write thousands of them. He’s not a doctor, but he’s established national health policy. He’s been a professional politician his whole life, always on the public payroll. He’s never generated a product or a service in the private sector of the economy, but he’s spent his life deciding how high the taxes should be, and how that money should be spent. The only black people he ever met as a kid were the maids who picked up his bedroom, but he’s a champion of minority rights. He’s a hypocrite. He’s a charlatan. And he’s going to win unless you get your shit together, Mr. President,” Arnie said, pouring dry ice over Ryan’s fiery temper. “Because he knows how to play the game, and you don’t.”
THE PATIENT, THE records said, had taken a trip to the Far East back in October, and in Bangkok had indulged himself in the sexual services for which that country was well known. Pierre Alexandre, then a captain assigned to a military hospital in the tropical country, had once indulged in them himself. His conscience didn’t trouble him about it. He’d been young and foolish, as people of that age were supposed to be. But that had been before AIDS. He’d been the guy to tell the patient, male, Caucasian, thirty-six, that he had HIV antibodies in his blood, that he could not have unprotected sex with his wife, and that his wife should have her blood tested at once. Oh, she was pregnant? Immediately, right away. Tomorrow if possible.
Alexandre felt rather like a judge. It wasn’t the first time he’d delivered news like this, and damned sure it wouldn’t be the last, but at least when a judge pronounced a sentence of death it was for a serious crime, and there was an appeals process. This poor bastard was guilty of nothing more than being a man twelve time-zones from home, probably drunk and lonely. Maybe he’d had an argument over the phone with his wife. Maybe she’d been pregnant then, and he wasn’t getting any. Maybe it had just been the exotic locations, and Alex remembered well how seductive those childlike Thai girls could be, and what the hell, who’d ever know? Now a lot of people would, and there was no appeals process. That could change, Dr. Alexandre thought. He had just told the patient that. You couldn’t take their hope away. That’s what oncologists had told their patients for two generations. That hope was real, was true, wasn’t it? There were some smart people working on this one—Alexandre was one of them—and the breakthrough could happen tomorrow, for all he knew. Or it could take a hundred years. The patient, on the form card, had ten.
“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 SURGEON’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 SURGEON 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.
SHE 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 fo
r his part thanked Allah that he’d spent the last decade in laboratories, else he might have succumbed to the same human weaknesses.
BADRAYN 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.
“YOU’RE JACKSON?” 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.
