“Nobody doubts your sincerity, Dr. Schwartz.” The President’s voice reflected his respect for the physician. “Unfortunately, there was no way to accurately predict the future, and at this point our argument is academic. Having been briefed on the current situation, I assume that the discovery of the material in the post offices leaves no doubt in your mind that this is indeed a deliberate attack on us.”
“No, Mr. President,” Schwartz responded. “There’s no doubt about it. Any ideas as to who our adversaries are?”
Mark McKitridge opened a folder and quickly glanced at the top sheet. “We’ve looked at all possibilities. Any of a dozen or so nations could be the one, but we can’t pinpoint which with the presently available information. We’ve also looked at the overall international situation. The only change over the past several weeks seems to be a possible blowup in the Middle East, but I doubt that concerns us.” He closed the folder.
“Dr. Schwartz.” The President’s mood had obviously changed. He spoke firmly, but with a certain strain in his voice. “What I am about to say is not to leave this room. I have chosen to confide in you because I wish you to understand clearly the urgency of your work. I know the difficulties you are facing, and I realize that giving you a deadline to come up with an answer will not make it any easier. Under the present circumstances, however, I have no choice. I can give you only five more days. By that time you must be able to tell the government that you are satisfied that you are well on your way to identifying the microorganism responsible and can make a judgment as to whether or not it is treatable. If you cannot do this at the end of the five days, you will, of course, continue your work; but then I will be forced to take certain actions to insure the safety of the country.
“I think it is only fair and proper to inform you what will be done if this epidemic cannot be brought under control. The Joint Chiefs, the National Security Council and the Cabinet support me in this decision. We all feel that any prolonged delay will do us irreparable harm. The nation may panic. If it does, we may not be able to administer a cure even if you can come up with one. We all feel that five days is a reasonable time for you to evaluate the medical situation; beyond that time, we might not be able to keep things under control.
“Mark, will you please continue?” The President motioned to General McKitridge, indicating that he had the floor. The general opened a red folder that had the words “Top Secret” stamped clearly across the cover.
“Gentlemen, the following is an outline only. I need not take up your time with the details. It applies to the eighteen nations listed.” He pointed to a typewritten sheet before him. His voice was not that of the Mark McKitridge they had known for the past twenty-four hours. This was the general, the professional soldier, who had returned to the world he knew best. The time had run out for niceties, the polite interplay between gentlemen.
ten
General McKitridge continued: “In three days, seventy-two hours from midnight tonight, the President will send an official note to the heads of state of these eighteen nations. He will inform them that we are presently being attacked with a biological weapon by an unknown adversary who has chosen to disregard the Geneva Convention. He will also inform them that we are ready to arbitrate the differences which may have led to this attack if the responsible party will inform us within forty-eight hours of receipt of his message of the identity of this agent and the treatment for the disease which it causes. If at the end of the forty-eight hours we have received no reply, an automatic state of war shall exist; and without further consultation we will utilize nuclear weapons to destroy them. All of them! The complete list of the eighteen nations will be provided to each of the heads of state so that they may mutually consult. In addition, should any further attack be made on this country during the waiting period, a state of war shall exist immediately with all of these nations. In other words, we will not waste the time to find out which one attacked us.
“Gentlemen, we have armed our entire nuclear attack force. We are not bluffing. We are prepared to institute full mobilization for a national emergency in forty-eight hours.” Mark McKitridge looked at each of his listeners to be certain they grasped the meaning of his words. Then he closed the folder and sat down.
The silence was oppressive.
“Madness. Sheer madness.” Max Schwartz spoke with little overt emotion. “We have become a race of madmen who are bent on destroying ourselves. Perhaps it is better that we do not survive.”
Alex Kahn looked at him. It took him some time to realize that this man who always asked the questions that needed to be asked, who always had the answers when no one else did, had no more to say. What else could be said? He was frightened as he never had been before.
Finally, to break the silence, he asked, “How did you come up with that list of eighteen countries?”
“We always have a target preference list ready in case of a surprise attack,” the general replied. “This is prepared by computer from analyzed information. In simple terms, it’s a list of potential enemies. We can’t take a chance this time. If we don’t know our enemy, they all must go.”
“And if it happens to be a friend,” asked Alex, “who no longer wishes to be friendly? Or do we keep a few friends on the list, too?”
“Cold as it may sound, Alex, if our enemy is not on the list, we’ll know it and we’ll get him next time.”
“If there is a next time.” Alex was shocked at the cold, impersonal attitude toward wiping out millions of people. They were talking about a nuclear blow that could destroy mankind, not the odds in a bingo game.
The President interrupted him before he could speak further.
“I know this has come as a shock to you. I would like to add a comment or two before leaving.
“I’m playing your game, Dr. Schwartz. I’m praying that a show of brute strength will get us the answer if you can’t come up with one first. I’m not bluffing, though. I am willing to wait the five days—no longer; then we will go to war. I know it sounds like madness; but I, too, cherish our way of life. Even if it means wiping out half the world to preserve it. I pray you find the answer first. I pray we never need to push the button. If we do, only history will be our judge. Good luck.”
The President stood up, turned and left. General McKitridge and Roger Bergen followed him. After a minute, all the others except Alex Kahn and Max Schwartz left, too.
The two physicians sat in silence for almost an hour. The long shadows of sunset filled the room with an eerie glow. Alex watched the face of the older man sitting across from him. For a fleeting moment he had the premonition that the sun was setting on Max Schwartz, that the President’s words had heralded the end of his career. Alex felt a sudden warmth and closeness to this man who now no longer seemed the distant symbol of the ultimate success in medicine. Now he seemed to be just a man—a man with the same feelings, the same fears, the same disappointments as Alex himself. How tragic it must be for him to have devoted his life to saving the lives of others, when to fail now would result in loss of life incomparable in magnitude to what he had worked to preserve.
Perhaps Max Schwartz was right. It was madness—a madness so great that the human mind could not comprehend its scope or its purpose.
eleven
Max Schwartz was alone in the small, dimly lit room that served as his sleeping quarters. It was sparsely furnished with a cot, an old wooden desk, a chair, and a metal gooseneck lamp that provided the only source of light.
He sat at the desk, browsing through the pile of mail that Betty, his secretary, had forwarded. Always on his frequent trips to lecture or attend meetings she sent his mail to the places on his itinerary where it was sure to reach him. This time, to keep his whereabouts unknown, he had arranged for her to deliver it to the Boston Army Base; it was forwarded from there courtesy of the U.S. Army after undergoing thorough decontamination. Isolated by the secrecy surrounding his present work, he found the letters a comforting reminder that everyday li
fe still went on in the real world beyond the wire fences.
As usual, Betty had divided the mail into two neat packages, one containing personal letters and those requiring his immediate attention, the other, the many reprints of scientific articles he had requested from all over the world—reprints which over the years had filled rows of metal filing cabinets in a small room behind his office at the hospital.
None of the personal mail was of particular interest, so he began to read the titles of each of the reprints, separating them into two piles. The larger pile contained articles merely to be filed under a designated subject heading that he penned in red in the upper right-hand corner of the paper. The smaller pile consisted of papers of particular interest that he would read before they were filed. He set aside articles on streptococcal exotoxins, septic shock, a review of bacterial meningitis, and several papers concerning the first clinical trials of new antibiotics.
An article entitled “The Induction and Characteristics of Staphylococcal Mutants” caught his eye because he could not recall either reading or requesting it. The author was Ahmed Machdi. Like many reprints he received, it was personally signed. He read the handwritten words beneath the author’s name: “To my good friend, Max Schwartz. Please accept this gift with my sincerest admiration and compliments. My best wishes for a long and healthy life.” He was puzzled. It was an unusual note for a scientist. Besides, he was no “good friend” of Ahmed Machdi. He was familiar with the man’s work in the field of bacterial metabolism; they had even met once as students in London many years before. But this greeting was hardly that of a casual acquaintance. He shrugged and started to put it down when his eye caught the date. The article had not yet been published. This was a preprint, a Xeroxed copy of an article yet to be published; authors occasionally sent these to colleagues who might be interested in the subject. He looked at the title again, especially at the words “Staphylococcal Mutants.” He suddenly remembered Alex Kahn’s words: “I think we’re dealing with an unusual species of 80/81,” and he wondered. He underlined the title several times in red and looked down at the bottom of the page to see where the work had been done. He could still hear the words of General McKitridge: “The only change over the past several weeks seems to be a possible blowup in the Middle East…”
“This could be it!” Max Schwartz said aloud. He grabbed the article. He had to see Alex.
The pain in his chest hit him as he stood up. It was a crushing, heavy pain, as if a ton of weight had been dropped on his breastbone. It radiated up into his neck and to his left shoulder and down the inner aspect of his left arm. He knew what it was.
He felt nauseated, faint, and short of breath, and he could feel cold sweat erupting on his forehead. The room began to spin. He lost consciousness before he hit the floor. The article was still clutched in his hand.
Alex Kahn had gone to the Fort’s library. He was convinced that he had to investigate further his own theory that they were dealing with an unusual strain of staph 80/81.
He was familiar with clinical staphylococcal infections and had done some research on one of the staphylococcal toxins, but he had a working knowledge of only the common strains of this microorganism. He had spent two hours going through textbooks of microbiology and the recent literature and had been able to find almost nothing except a reference to the use of staphylococcal mutants in studies of bacterial respiration; the author was A. Machdi, a name he did not recognize. He made a mental note to read the paper later. As he was gathering up his belongings, a military policeman burst into the library’s main reading room and shouted his name.
Alex turned to him and said quietly, as if to remind him that he was in a library, “I’m Dr. Kahn.”
“Dr. Kahn,” the man was still shouting and obviously out of breath, “we were making our usual night check, and we found Dr. Schwartz—on the floor of his room—unconscious! We’ve taken him to the base hospital. I think you’d better come right away. I’ve got a jeep outside, sir.”
Alex Kahn just stood there silently and stared at the soldier. Mechanically, he put down his papers and followed him to the waiting jeep.
They sped past the parade ground, the Post Exchange, the Administration Building, the theater, and turned right toward the base hospital. The cool night air blowing in Alex’s face cleared away some of the numbness. His first thought was that Max Schwartz had caught the disease, and his numbness changed to fear. “It can’t be!” Alex wasn’t sure if he had spoken aloud. He looked at the driver who showed no sign that he had heard; he repeated the words to himself. He would always remember his first thought. “Now the buck-passing will stop with me. There’s no one else.”
With a screech of brakes and a jolt, the jeep came to a halt. Alex looked up. The small white sign was clearly visible under the bare light bulb above it: HOSPITAL.
Alex sat on the edge of the bed and looked at the sweating ashen face partially covered by the plastic oxygen mask.
It was not pneumonia. There was no fever, no hemorrhagic rash, no trickle of blood from the mouth. The coils of electrocardiogram paper strewn on the floor told the story. Max Schwartz had had a massive myocardial infarction—severe damage or death of heart muscle due to inadequate blood supply—a massive heart attack. The prognosis was poor. Despite the administration of morphine, oxygen, digitalis, and drugs to reduce the irritability of the heart muscle and thereby the irregular cardiac rhythm, Max Schwartz was dying, and Alex Kahn knew it. He had placed him on a cardiac monitor to observe the beat-to-beat rhythm of the heart. He had a pacemaker nearby in case the heart should stop and a defibrillator to electrically stop fatal cardiac arrhythmia if they should develop. The Chief of Cardiology was on his way from Walter Reed by helicopter.
Alex sat and watched the man who had helped him gain all the knowledge he was now using.
He remembered Max Schwartz’s words the night he had lost his first patient, a three-year-old girl, from overwhelming bacterial meningitis. He had been sitting on the edge of the bed then, too, unwilling to leave her side. Max Schwartz had sat down beside him and had put his arm around the young intern. Alex never forgot Max’s soft voice or the words.
“Alex, let’s go. There are other patients, son. The hardest lesson to learn is to accept death. You have to relearn it every time you lose a patient. I still do. Each death is just a reminder that medicine has come only so far. You can try hard, but you can’t save them all. Some will just die—as if they’re meant to die. Our job is to take care of the living.”
Alex remembered how Max Schwartz had led him out of the room. To Alex, those few minutes were Max Schwartz’s greatest.
The breathing became more labored. Alex felt the weak pulse; it was grossly irregular and thready. Max Schwartz continued to die. It was as he had said, “Some will just die—as if they’re meant to die.” Perhaps it was an instinct, perhaps it was because he had come to know the great man so well, but Alex knew Max Schwartz was meant to die—to die in this small fort buried in the hills of western Maryland. He would die as he had lived—battling for the lives of others. But how ironic that in the midst of this great epidemic he should die of a common heart attack.
Alex looked at the gray face, motionless except for an occasional jerk caused by agonal gasps for breath; even these were becoming less frequent. He listened to the quiet around him; only the hissing of the oxygen as it flowed from the outlet in the wall through the plastic tubing and into the plastic mask disturbed the silence. The room was cold and bare and lonely.
In these few moments when Max Schwartz was about to cross the threshold of death, Alex Kahn fought with the age-old question that plagued a doctor each time one of his patients began to die. It was a simple question, but one each physician had to accept the awesome burden of answering for his patient. When does life end and death begin?
When he was an intern, Alex Kahn believed that it was a doctor’s job—no, his sacred responsibility—to preserve life for every precious second. Only God could tak
e away what He had given. As long as there was breath and heartbeat, there was life. And even if spontaneous breathing stopped and the heart ceased to beat autonomously, progress and science had provided the electrical and mechanical means to maintain these life processes. With artificial aids, a doctor could keep his patient’s body free from decay as long as he had the knowledge and experience to turn the right dials.
At first the justification for it all lay in the rationalization that where there was life, there was hope. But when time and time again hope proved false, and as he matured as a physician, Alex began to see that life was living, not just existing; he began to learn that the definition of living belonged to the patient alone—not to the doctor. He saw families forget what had been good and real about loved ones—all they remembered were the endless days of watching and waiting in a hospital room. When death finally came, they left with only the image of a body operating mechanically with tubes and pipes and wires—the good memories lost in the heartbreaking agony of slow death.
He could find no absolute answer to the problem of distinguishing between preserving life and prolonging death. Each case had to be balanced with understanding and pity and mercy for the dying and for those who had to go on living. Some answers satisfied him; others remained to haunt him and plague his soul and conscience.
Max Schwartz died ten minutes later. He never regained consciousness. Alex Kahn let him die as he would have wished—with dignity. The young doctor had known all along that he would not use the pacemaker or the defibrillator or the respirator or anything else. It had been a losing battle from the start; and at the end he had done what Max wanted. “Alex, when I die, I hope my doctor isn’t some overzealous son of a bitch who’ll stick a tube in every orifice and an electrode on every square inch of my body. I hope my doctor is a simple man who can recognize death when it comes to me, and will let me die in peace and with dignity.” Alex allowed him this right.
The 11th Plague Page 10
