Alan E. Nourse - The Bladerunner

by Alan E Nourse

  "That's precisely what I claim, in so many words." Katie opened a desk drawer and drew out another folder. "I'm sorry, John, but it's no good. I couldn't really believe it myself until I started really digging into past cases and found that I'd opened a can of worms. All the simple cases—vein strippings and things like that—went fine, but every time there was a major lung or cardiovascular case, something always went wrong. I've checked out a hundred case records, and with every one it's the same story. Faulty input data, scrambled-up case histories, distorted diagnostic load, contradictory laboratory findings—you name it and it's there. In three different stages of a single patient's workup you'd have recorded three conflicting items in the history, all mutually exclusive items which could do nothing but sabotage the computer's evaluations."

  "Look, Katie, everybody makes mistakes once in a while—"

  "Yes, once in a while. But the same sort of mistakes repeated time after time in case after case? No. Those 'mistakes' were on purpose. And it didn't stop with your pantograph programming cases. The robot cases you monitored also went haywire time after time so that you had to step in and take over. So more than faulty diagnostic data was getting into the machines, the surgical technique data was also faulty. I admit that had me stumped for a while. I couldn't see how faulty technique was getting into the machines when the pantograph programming was coming straight from your own performances in the operating room. I couldn't see how you could be unconsciously making errors. So I started reviewing the actual neuropantograph records of individual cases. And I found out you were making surgical errors purposely to throw off the pantograph—and getting away with it!" She pulled a sheaf of papers from the folder and shoved them into Doc's hands. "I couldn't believe it, but it was all there. Nobody but a fantastically skillful surgeon could ever have pulled it off, but you managed. You were quick enough and skillful enough to make deliberate errors, purposeful faulty operative judgments with the patient right under your hands, and get away with it time after time. You'd meet a crisis one way at one time and a totally different way another time, and then create the crisis in still another case so you could use a different method of bailing out. It was no wonder your machines weren't getting their surgical techniques programmed straight—you were playing games with them from the very beginning, deliberately building false judgments and judgmental conflicts right into your normal operating procedure. Very deadly games, I might add. You took some fantastic risks and you were just incredibly lucky time after time, but you got away with it, and you figured that nobody would ever take the time to go back and try to reconstruct what you'd been doing all this time. Well, on that one you were wrong. As you say, it's all right there on the record —the whole fantastic story."

  For a long moment Doc leafed through the bundle of papers. Finally he set them back on the desk. "Well," he said softly, "it looks as if you've been pretty thorough."

  "I've been thorough, all right," Katie said. "It's taken me weeks to put it all together, but it's all here. This data shows that you've been systematically sabotaging your part of the pantograph program for months, probably for years. I don't know how long, just yet, I haven't gone back that far, but I will if I have to."

  Doc shook his head. Walking over to the office windows, he stared down in silence at the darkening city. "Don't waste any more time digging," he said finally.

  •It's been six years, maybe seven—almost since the beginning of the program. I've hated this robot-training program right from the start At first I fought it in the open with everything I had, argued against it, wrote position papers, supported legal actions, sat through so many committee meetings it makes me sick to think about it; and then one day it dawned on me that not one person in all Health Control was even listening. They were going to jam that program through no matter what anybody thought about it. I wasn't even given a choice about participating in it; I was assigned. So I decided then that there was more than one way to resist it. You could assign me to a pantograph program, but you couldn't make it work out right—and I could make it work out wrong."

  "John, / didn't assign you. Health Control assigned you, the orders came right from the top. I just work here. My job is to administer their robot-training program and get it working, along with a thousand other jobs I have to do around this hospital at the same time. Maybe I don't like the robot-training program all that much myself. You hate it because you don't believe a robot operator can ever be programmed thoroughly enough to substitute for the critical judgment and skill of a human surgeon, even using the neuropantograph. Well, I'm not so sure that I think so either, but I've got no choice but to try. I'm convinced that at least part of the program can work. We know the robot operators can handle relatively simple surgery, and that one single surgeon coud effectively monitor a dozen appendectomies at the same time. But for really complex surgery we need expert input and full cooperation."

  "You could train more surgeons," Doc said.

  "That's no answer. You know how hard it is to recruit new medical students, and it's getting worse every year. Health Control knows that too. We have to find some way that fewer doctors can supervise more work.

  It's the only possible solution, and the robot-training program is absolutely essential to it."

  "But you can't make robots do research. Health Control's research programs are all going down the tube too. There hasn't been a really major medical breakthrough in the last twenty years. Thousands of incompleted research programs have just stopped dead. That's another thing that's wrong with Health Control's program."

  "Well, I can't touch that part," Katie said bitterly. "That's got to be someone else's headache. I've got trouble enough with the robot-training program here at Hospital Number Seven. And the Health Control people have been crowding me. Every week I have a Health Control supervisor down here checking progress, and they're getting very tense; the program isn't moving fast enough. Last week I spent a whole day on the carpet with the Secretary of Health Control himself. He wanted to know why we were six months behind our projected goals, and I couldn't tell him—without landing Dr. John Long in a pile of trouble. As it is, I can't bluff for you much longer. I'm going to have to pinpoint my trouble areas in so many words, and that could mean you'd be facing a full-blown Health Control investigation."

  Doc shrugged. "So what can they do? I haven't broken any laws in your program. The worst they could do would be to give me a bad mark on my promotion record."

  "John, you just don't know what they could do! With this data they could prove malpractice, criminal negligence, grossly unethical medical practices. They could revoke your license, strip you of all your medical credentials, block you from working in any hospital or clinic anywhere in the country." She hesitated, looking up at him. "And that might not be all. When Health Control decides to go after somebody, they dig in deep. They might not stop with your hospital work, they might look at everything you do—where you spend your time, who

  you associate with, where your phone calls come from, what taxi trips you take, everything. If a man should happen to have something to hide, he could find himself in real trouble."

  Doc looked up sharply. "Just what do you mean, something to hide?"

  Katie spread her hands. "All I know is the rumors I hear," she said. "If nothing else, you're a dissident, and Health Control wants dissidents under control. In particular they want control over the key men, the professional leaders, the top experts in their fields—like you, for instance. If they catch men like that moonlighting, they're inclined to make public examples of them."

  "So now I'm moonlighting?"

  "I don't know. Are you?"

  "If I were I sure wouldn't tell you about it."

  "I might be the safest person you could tell," Katie said quietly. "I can tell you one thing, though. If you are, you're leaving a trail. And if Health Control wants to pick it up, sooner or later they will. There's no way to cover your tracks completely, they can always find something."

&nbs
p; There was a long silence in the room. After a moment Katie joined Doc at the window. The sky was almost dark now and the city lights, normally dazzling, were muted by a light powdering of snow that had been falling. "You've got a great view here," Doc said softly.

  "One of the perquisites of my job," Katie said. "With your wits and skill you could have one too. You could be Chief of Surgery in this place in another few years. And then, if you still hated the system so much, you'd be in a position to get things changed legally, from the top down."

  "I don't know," Doc said. "In a few more years there may not be much left to salvage."

  "You don't really believe that, John."

  "Maybe not—but then maybe I do. The thing that started out a stream has turned into a flood. The Heinz-Lafferty formula could have been modified to be workable, if they'd only taken enough time to approach it slowly. But they didn't, and now it's going more and more wrong every year. Your robot-training program won't save it; that's just a drop in a leaky bucket. And you can't see the flood coming because you're so solidly on the government's side."

  "Could you believe that I might also be on your side?" Katie said. "I don't want to fight you. More than anything, I'm afraid for you. There's been too much interest in you and your work here. Health Control has been asking too many questions about you. And there are far too many rumors. I'm afraid you're walking into grave trouble and don't even know you're being watched."

  Doc gazed at the woman for a long moment. Then he took a deep breath. "Okay, maybe you are on my side. And maybe you're right that I'm walking into trouble without knowing it. I appreciate the warning. But that's nothing compared to the kind of trouble you and your Health Control bosses could be walking into right here in this hospital."

  Katie looked up. "What kind of trouble?"

  "Perfectly legitimate, necessary medical work that gets out of hand. You're barely able to limp along and handle the patients that you've got coming in here during normal times. What would you do if a real medical disaster struck?"

  For a moment a shadow crossed Katie Durham's face. Then she said, "Aren't you maybe borrowing trouble, John?"

  "Not exactly. How many cases of meningitis has the hospital admitted in the course of the last week?"

  "Far too many, I admit. We've had to convert three whole wards for isolation care. But that's not what you could call a disaster."

  "Then why does the computer have a security lid on the meningitis data?"

  Katie gave him an odd look. "That's just temporary until we can establish a baseline for analysis. Right now our people are breaking down the data we have, plotting incidence curves, comparing case histories to find common denominators—the works. Until that's finished we try to cut off any extraneous data searches. Look, I won't say we're not worried. This is a new strain of meningitis, we aren't even sure what's causing it, and cases have been increasing sharply. We don't know yet whether it's really an epidemic pattern, or just a chance clustering of cases that we're seeing. But whatever it is, Viricidin seems to stop it if we get treatment started early, and the lab has an immune globulin to protect people who've been exposed. It certainly isn't out of control. In fact, it wouldn't be any strain at all except that it's turning up right on the heels of this Shanghai flu epidemic."

  Something clicked in Doc's mind. "My God," he said softly. "Shanghai flu."

  "Well, yes. All our outpatient clinics have been loaded down treating that for the last six weeks."

  "Treating all the cases that come in, you mean," Doc said. "As for the thousands that didn't come in—" He broke off, pulled a note pad from his pocket and scribbled down a name. "Katie, check something out for me. See if anyone named Hardy was admitted here last night or this morning. An infectious case, isolation ward."

  Katie Durham looked at the name, then picked up the telephone and spoke into it for a moment. She waited, impatiently tapping her fingers on the desk. Presently the computer print-out beside the telephone began clicking. She picked up the print-out tape, frowning. "Is that all you have on it?" she said into the phone. "Nothing more? And this was at six a.m.? No ... no thanks, that's all I need right now."

  She set the phone down very slowly and turned to face Doc. "This Hardy family," she said. "They brought a boy to the hospital, early this morning. But he wasn't admitted. He was dead on arrival."

  The fact that he had been half-expecting it all day did not lessen the impact. Doc picked up the computer print-out tape, stared at it for a moment, and shook his head with a sigh. "As fast as that," he said bitterly. "I was afraid of it. What about an autopsy?"

  "The father refused permission. Lab did take a throat culture and blood studies, though, and a spinal tap. They supported the history—a viral meningitis. There were traces of Viricidin in his bloodstream, too; he'd been treated by somebody, probably just not soon enough."

  "And what about the rest of the family?" Doc asked.

  "He was brought in by the father and a younger boy. They were obviously Naturists, and they refused examinations."

  Doc winced. "They'll be back," he said, "probably just like the boy. Katie, something's going on here that's very bad, and I don't think you and your Health Control people here are even beginning to grasp it."

  "But we know there's a bad infection on the move. We're treating it, and I told you we've got the computers working on the epidemic problems."

  "You mean you've started off on a big, sprawling, time-consuming analytic study that's going to take six weeks or more to complete, and I don't think you've got six weeks. If what I suspect is true, this hospital and the whole damned city could be buried in bodies in six weeks."

  "What do you think is happening?"

  Doc sighed. "I'm not sure, but I think you've got to find out in one whale of a rush. Look, I was the one that saw that Hardy boy last night in his home. Never mind what I was doing there, I saw him. He was already mortally ill, the full-blown picture of meningitis, but he'd only had those symptoms for forty-eight hours. Before that he'd been just mildly ill for about two weeks—with the Shanghai flu. Not even a bad case, just a mild sore throat, headache, muscle aches, and those symptoms were all getting better spontaneously. Then whammo! A wildfire meningitis, and he's dead in the course of two days in spite of the treatment I started. Meanwhile, the father and the brother both have had Shanghai flu and have early meningitis symptoms right now, for which they're refusing examination or treatment."

  Katie Durham stared at him in confusion. "But John, they're Naturists. It's perfectly consistent that they'd refuse treatment."

  "Especially for something mild, right? Like the Shanghai flu. Well, that's exactly the point. Suppose this mild flu isn't just a mild flu. Suppose the virus, once it gets well entrenched, can attack the spine and cause a deadly meningitis. But these people are bypassing early treatment because it just seems like a mild flu. Naturists or whatever, they're trying to 'ride it out,' to use an old Health Control term. And while they ride it out, without knowing there's a bomb waiting to go off later, they're also infecting everybody they come in contact with— and by the time they and the ones they infect decide they can't ride it out any longer, it may be too late to di-fuse the bomb. Oh, your regular clinic patients are all right. The ones that are eligible come in to the clinic for every sniffle, right? When they get the Shanghai flu, in they come and you slap it down with Viricidin and it stops right there. And you've been treating thousands of Shanghai flu cases these past weeks, right? But what about the ones that aren't eligible?"

  Katie sat down at her desk, frowning. "Yes, I'm beginning to see what you mean. You're thinking—"

  "I'm thinking that this city is full of people—not just the Naturists, but thousands upon thousands of common, ordinary, everyday people—who are going to try to ride out a mild case of Shanghai flu just the way they'd ride out a common cold, tens of thousands of people like that who can't qualify for Health Control care, people who wouldn't dream of applying for Health Control care for a simple c
ase of flu—considering the eligibility requirements—until it's too late."

  "And you're contending that this meningitis could be a late complication of this particular strain of flu."

  "Right. And this Shanghai flu epidemic hasn't even begun to crest yet, we haven't begun to see the cases we're going to see when it really gets moving in the population."

  Katie shook her head. "But, John, this is all pure guesswork. Sure, there's a flu epidemic moving in, and there's also a nasty viral meningitis that's begun turning up. That doesn't mean the two are related."

  "But suppose they were."

  "If they were, it could be a disaster. I'm not sure what it might mean, but you don't have a shred of evidence."

  "That's right, I don't," Doc said. "But maybe you do, in the hospital records, and if the two are related, you've got to find it out. You've got to forget this slow, nitpicking computer study you've gotten started and home in on the one critical question you need an answer to right now: how many of your meningitis patients had untreated Shanghai flu to start with, and how many of the flu patients you treated came down with the meningitis anyway. Would that take so long to track down?"

  Katie Durham bit her lip thoughtfully. "Twenty-four hours, maybe. Maybe less." She stared at him for a long moment, then picked up her phone with an air of decision. "Will you see if Tim Lerner in the data bank can come up here, Mary? Right now, if possible, it's urgent."

  They waited in silence, Doc lost in thought, Katie closing her eyes and rubbing her forehead wearily. Only a few moments later the secretary ushered in a tall, thin young man in a white lab coat and horn-rimmed glasses. "Dr. Durham?"

  "Come in, Tim. Dr. Lerner, this is Dr. John Long, surgical staff. You've probably never met. John, Tim is our Chief Records Analyst and heads up the Department of Statistics. Now, then. On this meningitis study you've got started, Tim, we need some preliminary data yery urgently." Carefully, she began outlining the problem, the question of relationship between flu victims and the meningitis cases admitted to the hospital. Lerner pulled out a pipe, filled it and lit it as he listened. When she finished he said, "When do you need this?"