All but eight of the red spots vanish when I filter by workplace. But one of them is much, much bigger, flashing malignant crimson. “They all work for the same employer?”
Andy stares at the screen. “That’s odd. Where is it?”
“Let me check.” Huh. “It’s an office cleaning agency in the East End.” I frown. “Twelve cases in one month.” Another seven outside it, sprinkled across the rest of London. “That tears it, doesn’t it?”
“Yes, I should say so.” Andy stares at the screen. He looks worried. “If it was evenly spread over the whole of London it’d only be a three-sigma spike, but just in one employer in the East End? I think you may be looking at five sigmas.” He’s thinking what I’m thinking: ten extra cases in a quarter million people in one month corresponds to about thirty thousand extra cases a year in the UK as a whole. That’s not just a signal in the noise; it’d be fighting it out with lung cancer and heart attacks as a leading cause of death. “You need to pull those patients’ records so we can double-check that it’s not a database error. Then we need to get a neurology consultant on board who’s cleared for K syndrome so we can rerun the post-mortem examinations.” He falls silent.
“Then what?”
“If we’re lucky, it’s just Mad Cow Disease going nuclear under us. Or some hideous new epidemic getting started. If not, if it’s actually K syndrome, the shit hits the fan.” He reaches into his jacket pocket with a slightly shaky hand and pulls out an electronic cigarette case. “Looks like your ten-percenter just exploded, Bob.” He raises the cigarette to his lips and takes a puff: the tip glows blue. Blue LEDs are the color of progress, the color of the twenty-first century. “Better find out where those cleaners were working, then pull an action plan together. I think you’re about to come to the attention of important people.”
• • •
I AM NOT A MEDICAL STATISTICIAN. I MEAN, I CAN SORT OF follow a chi-squared regression and I know my standard deviation from my T-test, but I don’t do that stuff for a living. Nor am I a medical informatics guy. For all I know, I fucked up big-time with my SUS trawl. So, first I swear Andy to silence (with an embargo time limit of forty-eight hours). Then I write a very anodyne memo that kinda-sorta explains what I’ve been doing, and send it to my HR admin person and all my various managers, tagged as low priority and with a not entirely misleading subject line. Hopefully that means they’ll ignore it for a while. Finally, my ass covered, I shut my office door and do a quick change. Clark Kent uses telephone booths to ditch his suit in favor of the Superman underwear; I do it in reverse. These days I keep a set of office drag on a hangar on the back of my door, against those rare occasions when I have to go somewhere and look invisible in a suit-wearing managerial kind of way.
Like this afternoon. Because I need to visit a hospital and see a man about a brain.
The Laundry has an institutional aversion to loose ends—and especially to the existence of civilians who have, through whatever means, become aware of our work. For many years, if you had the misfortune to be a witness to the uncanny you’d inevitably end up working within the organization. However, since the 1980s the efflorescence of computational systems throughout our society has exposed so many people to the fringes of magic (I use the word cautiously, in the context of Arthur C. Clarke’s famous aphorism, “any sufficiently advanced technology is indistinguishable from magic”) that we simply can’t stick them all in an office and have them keep tabs on one another. Nor would it even be a good idea to try. We need people on the outside, in every walk of life, bound to silence by a geas, but available when we need specialist consultancy—and also able to contact us if they stumble on something inexplicable. Butcher, baker, candlestick-maker . . . also, experts in biblical apocrypha and brain lesions.
(Other people, accidental witnesses who don’t understand what they’ve seen, are bound to silence and then released—subject to monitoring. Or, if their services are no longer required by the admin side of the organization and they have no special skills, or are card-carrying members of the awkward squad, they can be bound to silence and allowed to quietly reenter civilian life. It’s only the core staff—practitioners, executives, and agents like me—who have no exit options.)
I’m on my way out of the office today to visit a Dr. Wills at the National Hospital for Neurology and Neurosurgery, which is part of the sprawling complex of medical institutions around Great Ormond Street. Dr. Wills works with the National Prion Clinic and is part of a research group at University College’s Department of Neurodegenerative Diseases, which is a long-winded way of saying that if anyone has spotted the spike and knows what’s going on, Dr. Wills is probably your man. (Or woman, because all it says in our contact database is “Dr. F. P. Wills, UCLH, MRC Prion Research Unit—cleared per OSA(3).”)
This person is our go-to expert on Krantzberg syndrome and I don’t even get a recognition mugshot or a potted biography? Great.
• • •
LET ME TELL YOU A BIT MORE ABOUT K SYNDROME: BECAUSE everything is better with early-onset dementia.
Magic—the collection of practices that enable us to mess around with the computational ultrastructure of reality—has been around for thousands of years. We’re not entirely sure how it works. One theory holds that computational processes involving observers can influence quantum systems up to the macroscopic level via entanglement. Or, from another angle, we reach out into an infinity of parallel universes and pull rabbits out of the hat—rabbits with too many tentacles, that do what we tell them to. Either way, thinking or cogitating or reasoning or singing or just plain looking at stuff the wrong way can make things happen in the physical universe.
So, yes, magic works—although the do-it-in-your-head variety is notoriously hard to master, like solving three-dimensional cryptic crosswords in multiple languages. But if magic has always worked, why are successful magicians so rare in the historical record? It turns out that the limiting factor is not just the difficulty of the job: it’s the medical side effects.
Now for a brief diversion:
In the 1950s, Australian medics in Papua New Guinea discovered a perplexing new disease among the women and children of the Fore tribe. The victims would be overtaken by a sudden weakness and muscle pains: they’d succumb to violent shivering, lose the ability to stand up, and eventually die. The disease, known as Kuru, was infectious, although no actual agent was detected until the 1980s. The Fore practiced cannibalism as part of the funeral rites: the bereaved would consume parts of the body of the deceased to return their life force to the community. Men took the choice cuts, muscle from arms and legs: they mostly dodged the bullet. But the women and children ate the leftovers . . . including the brain. If you examined the brain of a Kuru victim with a microscope, you would see odd spongy holes scattered throughout the cerebral cortex; hence the term spongiform encephalopathy.
The disease agent in Kuru turns out to be a prion, a malformed version of a naturally occurring protein that catalyses conversion of normal protein molecules into the pathogenic state. It’s a truly weird and scary corner of medical research, because the diseases caused by prions—such as Creutzfeldt-Jakob disease and Fatal Familial Insomnia—kill horribly, first taking the victim’s mind and then their ability to move. Not to mention new variant CJD, also known as Mad Cow Disease.
Now, back to the subject on hand: ritual magicians who perform too many invocations in their head tend to develop a package of symptoms after a while which eerily resembles Kuru. It starts with tremors, unsteady gait, slurred speech, and confusion. Then they become unable to walk, suffer from ataxia and uncontrollable tremors, and show signs of emotional instability. They become depressed, but may suffer from fits of maniacal laughter. In the final stages, they lose all muscular control, can’t sit, or swallow, or speak, become unresponsive to their surroundings . . . and from start to finish it can take between three months and three years.
Krant
zberg syndrome is a horrible way to die.
Krantzberg syndrome is probably also the only spongiform encephalopathy that is not a prion disease. (I say “probably” because there are relatively few cases of it in the first place, which makes it very hard to investigate.) However, prion proteins appear to be absent in K syndrome, and extracts from K syndrome brains don’t cause symptoms in other organisms that they’ve been tested on. (For obvious reasons, nobody’s been able to perform the most important test—on other humans.)
The best theory to account for K syndrome is that ritual magic is intentionally designed to attract extradimensional critters—and not just big ones. There seems to be some variety of microscopically small, dumb eaters that materialize inside the gray matter of the practitioner while they are in the process of carrying out some sort of invocation, take a tiny bite, and disappear again. Brain parasites from beyond spacetime, in other words. The brain is a resilient piece of squishware, but if the K-parasites chew enough tiny holes in the headmeat, its owner will eventually succumb to a dementia-like illness. Furthermore, once the eaters have found a tasty lump of brains to chow down on they keep at it. So the disease is progressive, vile, and fatal if unchecked.
Unchecked? Well, yes: we can stop it progressing by putting the victim inside a locked-down protective ward. This is a huge step forward over, say, Kuru or CJD. What’s more, if we isolate the patient for long enough the eaters lose interest and go away; but the victim isn’t going to be casting any spells ever again. (If they’re lucky they’ll still be able to talk coherently and tie their own shoelaces.) It’s a health and safety nightmare.
Especially for me, because when I’m wearing one of my more recently acquired hats (trainee necromancer) I’m all about the jamming-with-magic–in–my–head thing. My relationship with K syndrome is like that of a forty-a-day smoker with basal-cell carcinoma: not so much a matter of if as of when.
Which is why I am not looking forward to my visit with Dr. Wills.
• • •
“EXCUSE ME, IS THIS THE ENTRANCE TO THE DEPARTMENT OF Neurodegenerative Disease?”
“I have an appointment in the Prion Research Unit . . . ?”
“Hi, I’m here to see Dr. Wills?”
“How do I get to Dr. Wills’s office . . . ?”
I’m lost in a twisty maze of whitewashed corridors, surrounded by glass-fronted cabinets stuffed full of photocopied notices on every side (not to mention a scattering of conference-surplus posters with excessively enlarged cross-sections of gruesomely diseased brains, just for variety). I’ve been wandering in circles for ten minutes now and I’m just beginning to despair of finding my destination. Trish booked me a slot with the doctor for 3:30 p.m., but I’m running a quarter of an hour late. I find myself flagging down an irritated-looking researcher who clearly thinks she has better things to do than give directions to visiting admin people.
“I’m not in,” she snaps. “I’m running late for a meeting.”
I do a double take. “Are you Dr. Wills?”
“Yes, and I’m running late.” She begins to walk away. “If it’s about the facilities audit it’ll have to wait—”
I haul out my warrant card. “I’m not from admin.”
Wills turns back towards me. “Hey, I’m supposed to be meeting you in room 2006. What are you doing here?”
“Nobody told me about a meeting room. Where’s room 2006?”
“Oh for—” She stops. “Hmm.” She has a way of tilting her head and narrowing her eyes as she assimilates new information that reminds me of Mo. The straw-blonde hair and slightly watery eyes behind thick lenses are very different, though. “Well, as you’re here, would you rather use my office?”
I shrug. “If it’s private.” I put the warrant card away. “As I said, nobody mentioned a meeting room.”
“Mack, our departmental receptionist, said he’d sorted it out.”
“Well, it never got passed on to my end.” Yet another detail that fell through the cracks. “Your office isn’t shared, is it?”
“Yes, but Barry’s teaching today.” She eyes me cautiously. “Why?”
“What I want to talk about isn’t for public consumption, I’m afraid.” I shrug self-effacingly, trying to take the sting out of my brusque approach. “I need to pick your brain on the subject of a delicate matter.”
Dr. Wills’s office is surprisingly spacious. It’s what we jokingly refer to as an Ark Special in the Laundry: it’s actually sized for two people, with two desks, two workstations, two of everything. I take the visitor’s seat across from her—one that is clearly accustomed to regular visitors, for it is free of clutter and situated in a clear patch of floor. She shuts the door behind us: I appreciate the gesture. “What can I do for the Laundry today?” she asks.
I take a deep breath. “You’ve worked with us before, I gather. On K syndrome.”
“Krantzberg-Gödel Spongiform Encephalopathy. Yes?” She waits for me to nod.
“That’s it. Um. Tell me, for epidemiological purposes, speaking hypothetically”—I’m making a hash of this; I force myself to get a grip—“suppose there was a significant outbreak of K syndrome in the UK, am I right in thinking that the first thing we’d know about it would be a spike in cases of CJD being diagnosed by post-mortem examination?”
“If there was a—” Her expression could not be more eloquent if I’d asked her how we’d know if there was a minor outbreak of the Black Death: a mixture of pungent disbelief, the barnyard stench of second-guessery, and a high note of oh shit all colliding simultaneously in the back of her mind. It’s enough to freeze anyone’s tongue, so I give her a few seconds before I grin and nod, trying to look like an idiot student in need of tuition. “Please tell me you’re joking? No? Oh fuck.” She slumps back in her chair. “Hang on.” She straightens up again as second, and then third, thoughts line up in a disorderly queue. “This isn’t a joke, is it?”
“I sincerely hope not. I don’t want to waste your time or mine. Look, I know you’d be aware of actual referrals for treatment, patients with active disease and a diagnosis, right?”
“Yes, that’s exactly right! So there can’t be an epidemic without us knowing about it, because—” She stops dead.
“Because it’s a progressive disease, and you’d be seeing them as referrals from wherever they were diagnosed?”
“Yes.” She frowns, perplexed. “Your scenario doesn’t make sense, I’m afraid.”
“Okay. Let me try again. If coroners around the country began recording spongiform lesions in the brains of patients who had died suddenly in the past month, how long would it take you to hear about it?”
“The past month?” She shakes her head. “Then it can’t be K syndrome, Mr. Howard. We get regular updates from the NHS epidemiological tracking database, part of the Secondary Usage Service. K syndrome is rather distinctive. Your typical patient exhibits the symptoms of nvCJD; it’s a strikingly early onset dementia with non-standard signs and presentation, and it’s progressive. More to the point, the patients are also distinctive: mathematicians, philosophers, occultists. Also, they test negative for PrP variants. What you’re talking about is something else—diagnosed only after death, which means the patients went downhill much too rapidly for K syndrome or any prion disease we know about. Do you have any more information about them?”
I finally get to open my briefcase. “This is the output of a query I ran on data extracted from the SUS data warehouse.” I shove the screen shot I took of the geographical scatter plot across her desk. “Twelve cases were diagnosed at post-mortem, all in the past four weeks. The factor they’ve got in common—at least, what I’ve established so far—is that they all worked for an office cleaning agency in Tower Hamlets. I don’t have the individual patient records, but I suspect the shit is going to hit the fan really soon, and I’d like to have some answers to send up the line.” I shove th
e printout of the spreadsheet summary at her: ages, postcodes, other basic anonymized information.
Her eyes flicker across the papers. “This is—I—”
“It’s crazy, isn’t it?” I suggest.
“No! But it’s something new. Hmm. How did you find this?”
I hesitate for a couple of seconds. “I don’t think I can tell you,” I finally say. “Not without prior authorization.”
“Well, if it’s not Krantzberg-Gödel syndrome that makes it even worse.” She shakes her head in unconscious distress. “Mr. Howard, I’m going to have to go and do some digging in order to de-anonymize these patients and confirm that what you’ve found actually exists. Data warehouses tend to accumulate rubbish in the corners . . . I can’t just go pulling these records without justification: there are issues of medical confidentiality here, and respect for the relatives, and so on. On the other hand, I can’t write this off either. Um.” She stares at me until I make eye contact. “I may need some arms discreetly twisted, and unlike you, I don’t have one of those special badges.”
I make a careful judgment call and decide to exceed my lawful authority. Just this once, in order to facilitate the speedy investigation of a major threat—that’s what I’ll tell the Auditors if they haul me onto the carpet. Doing it by the book, I should go and round up a committee or a herd of managers to agree with me first—diffusion of responsibility, it’s called—but I honestly don’t think there’s time for that right now. Thirty thousand deaths a year corresponds to seven hundred a week. (Just sitting on it for the extra day it’d take to convince a committee could result in . . . let’s not go there.) “Whose authorization do you need?” I ask.
“Professor Everett can sign off on the paperwork to pull the patient records, but I’ll need to persuade him in turn that the Department of Health are happy about this.” She bites her lip. “K syndrome is a special case, of course, but this, this is . . .”
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