Clarkesworld Magazine Issue 117

by Neil Clarke

I knowed, then, what I had to do.

  The Chinese clinic was almost empty.

  A sign outside said CLOSED. Through the window I could see the lobby stripped of its chairs and pictures and clothesbasket of toys. But a light shone in a back room, bright in the drizzly gray rain. I rattled the lock on the door and shouted “Hey!” and pretty soon Mrs. Cully opened it.

  She wore jeans and a sweatshirt instead of her usual dress, and her hair was wrapped in a big scarf. In one hand was a roll of packing tape. She didn’t look surprised to see me. She looked something, but I couldn’t read it.

  “Ludie. Come in.”

  “You all leaving Blaine?”

  “Our grant won’t be renewed. Dr. Chung found out the day after the election from a man he knows in Washington.”

  “But Rollins lost!”

  “Yes, but the new president made campaign promises to reinstate the FDA with tight regulations on studies with human subjects. Under Rollins there was too much abuse. So Doctors Chung and Liu are using their remaining money for data analysis, back at the university—especially since we have no research subjects here. I’m packing files and equipment.”

  The rooms behind her, all their doors open, were full of boxes, some sealed, some still open. A feeling washed over me that matched the weather outside. The clinic never had no chance no matter who won the election.

  Mrs. Cully said, “But Dr. Chung left something for you, in case you came back.” She plucked a brown envelope off the counter, and then she went back to her packing while I opened it. Tact—Mrs. Cully always had tact.

  Inside the envelope was a cell phone, a pack of money with a rubber band around it, and a letter.

  Ludie—

  This is the rest of what the clinic owes you. Along with it, accept my deepest gratitude for your help with this study. Even though not finished, it—and you—have made a genuine contribution to science. You are an exceptional young woman, with exceptional intelligence and courage.

  This cell phone holds the phone number for Dr. Morton, who implanted your optrode, and who will remove it. Call her to schedule the operation. There will of course be no charge. The phone also holds my number. Please call me. If you don’t, I will call this number every day at 11:00 a.m. until I reach you. I want only to know that you are all right.

  Your friend,

  Hai Chung

  The phone said it was 9:30 a.m. Mrs. Cully said, “Is that your suitcase?”

  “Yeah. It is. I need Dr. Chung’s address, ma’am.”

  She looked at me hard. “Call him first.”

  “Okay.” But I wouldn’t. By the time the phone rang, I would be on the 10:17 Greyhound to Lexington.

  She gave me his university address but wouldn’t give out his home. It didn’t really matter. I knew he would give it to me, plus whatever else I needed. And not just for the study, neither.

  Dr. Chung told me, one time, about a scientist called Daniel Zagury. He was studying on AIDS, and he shot himself up with a vaccine he was trying to make, to test it. Dr. Chung didn’t do no experiments on himself; he used me instead, just like I was using him for the money. Only that warn’t the whole story, no more than Bobby’s terrible behavior when he got really sick was the whole story of Bobby. The Chinese clinic warn’t Chinese, and I’m not no Frankenstein. I’m not all that “courageous,” neither, though I sure liked Dr. Chung saying it. What I am is connected to my kin, no matter how much I used to wish I warn’t. Right now, connected don’t mean staying in Blaine to help Dinah with her grief and Shawn with his sickness and the kids with their schooling. It don’t mean waiting for Mama’s funeral, or living with Granmama’s sour anger at what her genes did to her family. Right now, being connected means getting on a Greyhound to Lexington.

  It means going on with Dr. Chung’s study.

  It means convincing him, and everybody else, to put a optrode in Bonnie Jean’s head, and Shawn’s, and maybe even Lewis’s, so laser light can “disrupt their neural pathways” and they don’t get no more misfolded prions than they already got.

  It means paying for this with whatever work I get.

  And maybe it even means going to Washington D.C. and talking to my congressman—whoever he is—about why this study is a good thing. I read on Dr. Chung’s tablet that other scientists sometimes do that. Maybe I could take Bonnie Jean with me. She’s real pretty, and I can teach her to look pathetic. Maybe.

  I never had no thoughts like this afore, and maybe that’s the opsins, too. But maybe not. I don’t know. I only know that this is my path and I’m going to walk it.

  I hike to the highway, suitcase in one hand and cell phone in the other, and I flag down the bus.

  First published in Twelve Tomorrows, edited by Stephen Cass.

  About the Author

  Nancy Kress is the author of twenty-seven novels, three books on writing, four short story collections, and over a hundred works of short fiction. Her fiction has won six Nebulas (for “Out of All Them Bright Stars,” “Beggars in Spain,” “The Flowers of Aulit Prison,” “Fountain of Age,” “After the Fall, Before the Fall, and During the Fall,” and “Yesterday’s Kin”), two Hugos (for “Beggars in Spain” and “The Erdmann Nexus”), a Sturgeon (for “The Flowers of Aulit Prison”), and a John W. Campbell Memorial Award (for Probability Space). Her work has been translated into Swedish, French, Italian, German, Spanish, Danish, Polish, Croatian, Korean, Lithuanian, Chinese, Romanian, Japanese, Russian, and Klingon, none of which she can read. Nancy lives in Seattle, Washington with her husband, writer Jack Skillingstead.

  The Science Fiction Future of the Microbiome

  Matthew Simmons

  You are wheeled into a hospital after a stroke. The doctors stabilize you and monitor you for a couple days. The latest treatments are at their disposal, so they use bacteria therapy to stimulate the growth of a diverse microbial ecosystem: feed you 3,3-dimethyl-1-butanol (DMB) to regulate trimethylamine N-oxide (TMAO) levels, nourish certain microbiota to reduce your body mass index, increase your salt processing bacteria to lower cholesterol, and alter your body’s cravings to desire foods beneficial to heart health. In a few days your tuned up body, now loaded with a bacterial population adept at combating heart disease, walks out of the hospital into a new life. Far-fetched? Not by much.

  The human microbiome is the collective term for the flora inhabiting the human body. The Human Microbiome Project estimates there are as many as a hundred trillion cells in a human microbiome, weighing around three pounds in the average adult. These non-human cells, also called microbiota, outnumber the human cells in the body ten to one. Cell for cell we are more microbial than human. Gene for gene we have around nine million microbial genes to a mere 23,000 human genes.

  The Human Microbiome has not been fully sequenced, but researchers estimate there are between 500-40,000 unique species of microbiota inhabiting the human body. Recent studies link these microbiota with heart disease, obesity, autoimmune disease, cancer, irritable bowel syndrome (IBS), depression, dementia, autism (ASD), and attention deficit hyperactivity disorder (ADHD) to name a few. If we alter these bacteria we can change our body and mood, treat diseases and conditions, change our scent and microbial print, and shift the way we view the world.

  The majority of microbiota in the human body are bacteria in the gut—the thirty-foot long intestinal tract, starting at the stomach all the way to the anus. With its continuous stream of foreign matter—food, drinks, etc.—the gut provides bacteria with sustenance and an ideal hideout from the body’s immune system. The gut is like a trade path. The microbiota are the cities and towns that pop up along the route. They service the transient populations, the food we eat, and skim a little off the top. The relationship is mostly symbiotic. The transient populations need the boom-towns, the towns need the transients. The community, the body, needs both. However, highway robberies happen and occasionally a town is razed to the ground.

  With the high concentration of bacteria in the gut, it’s no surp
rise that many of the emerging microbiome-based treatments are for gut illness. One of the more interesting and successful of these treatments is Fecal Microbial Transplants (FMTs). FMTs are the most effective treatment for C. Dificile, a common infection from hospitalization, and have been shown to help Crohn’s, ulcerative colitis, and IBS patients. To undergo an FMT, a patient swallows a healthy donor’s sterilized and encapsulated stool. Each gram of a donor’s stool contains around a hundred billion bacteria. It’s like a probiotics pill, but with a hundred times more live cultures. Unlike a normal probiotics pill, these bacteria naturally occur in the human body and help digest food, produce vitamins, and absorb nutrients.

  While medicinal poop has shock value, it’s just one way microbiome medicine could help with gut conditions. Recent studies link the microbiome to the boom of autoimmune diseases—conditions that cause the body to attack itself—such as celiac disease, rheumatoid arthritis, and diabetes. One study theorizes, an autoimmune disease’s genetic component lies in a microbial gene as opposed to a human gene. If genes that modulate autoimmune diseases are microbial, new treatments for these diseases could aim at the gut. These treatments could range from altering the gut’s bacterial makeup through FMTs and targeted antibiotics to microbiome diets. Microbiome diets—such as the paleo diet—already have many anecdotal proponents. They aim to reduce the inflammation caused by autoimmune diseases, allowing the gut to heal. Science on these diets is very thin, though the amount of people who report dietary relief from autoimmune symptoms are numerous.

  Microbiome medicine could help with more than just gut conditions. In a recent study, researchers found a reduced risk of heart disease in mice whose microbiomes were drugged with DMB. DMB—a common substance found in olive oil, red wine, grapeseed oil, and balsamic vinegar—naturally prevents the microbiota from creating trimethylamine (TMA). Usually, when microbiota break down carnitine and lecithin—substances commonly found in red meat, fish, and other foods—they excrete TMA. Liver enzymes take the TMA and turn it into TMAO. TMAO then fuels atherosclerosis—a disease causing fat to build-up on arterial walls—which increases the risk of heart disease. With DMB this entire process can be prevented. More research is needed to determine the viability of DMB drugging as a treatment in humans, but the prospect of landing a blow against the world’s number one killer is always enticing.

  Recent research has explored microbiome treatments for the brain. In a series of studies, researchers alleviated symptoms of ASD in mice by treating gut permeability. Among ASD individuals, two-thirds have gut abnormalities, such as an increased permeability in the intestinal wall, also known as leaky gut. Researchers used Bacteroides fragilis to reduce inflammation and heal the leaky gut in mice bred to have ASD-like symptoms. After treatments, the mice showed improvement in communication, anxiety-like behavior, and sensorimotor functions—common symptoms of ASD. Conversely, when researchers injected healthy mice with chemicals to increase gut permeability, they began to develop ASD-like symptoms. While many researchers are quick to point out that more research is needed to understand the viability of these treatments in humans, this study, and others like it, have some researchers speculating that ASD may depend on gut bacteria.

  Other studies suggest the microbiome affects depression, ADHD, dementia, and food cravings. Using the vagus nerve, microbiota send neurotransmitters such as GABA, serotonin, or dopamine to create euphoria or sadness. This bidirectional connection is known as the gut-brain axis. Using the axis, microbiota influence cravings for certain foods that fuel their populations, with neurotransmitters as rewards. Though a great source of instant gratification, feeding these cravings doesn’t always keep us healthy. Our microbiota look out for their best interests. Researchers haven’t pinned down how all cravings work. If we knew, could we use microbiome medicine to alter them? Could we make kale give us the same rewards as candy? Could we all become healthy eaters without the desire for gluttonous foods? Or perhaps, we could drug the microbiota to release neurotransmitters for a natural high? We do not know the answer to these questions, but they represent some of the far-flung futures to which microbiome science could lead us.

  The research of the Home Microbiome Study, and others like it, offers another hypothetical future. Through their studies we know every microbiome leaves a unique ‘print’ on a room, items, and people. These microbiome prints are distinct from person to person and are automatically implanted by the millions of particles we secrete every hour. Breathe out, and you are giving it off. Sit still, and it seeps out all the same. It’s in our dead skin that falls off each day, our hair, and sweat. At the moment, researchers can detect a change in the occupants of a room after a person has been there for as little as twenty minutes.

  While distinguishing one microbial cloud from another is not easy, what potential could this technology offer if perfected? Could forensic science tap into microbiome prints to solve crimes? Imagine you go away for a trip. You get back and your house is picked clean. Nothing is left. You aren’t concerned, you call the local precinct and they send over a scanning crew. They analyze the microbiome cloud left by the burglar. They discover it belongs to a moderately healthy individual in their thirties, who recently had surgery on their right leg. They run the fully sequenced print against collected microbiome data, find a match, and solve the case. Eerie and ethically problematic, but not impossible.

  The ever-changing microbiome complicates the usefulness of these microbial prints. If they become standard operating procedure, would altering the microbiome become a necessary step for those with identities to protect—whistleblowers, people in the witness protection program, and criminals? We know antibiotics, a new environment, or a new diet can significantly alter a person’s intestinal flora. In the future, will someone burgle a house, then take antibiotics and change their diet to alter their microbiome print?

  What does altering the microbiome mean? Smell is determined by the microbiome, it also plays a role in human attraction. Appealing body odor in another person indicates compatible genes for breeding, but it could also indicate comparable political opinions. One recent study speculates we can smell key traits used to form political opinions. By changing a microbiome, a smell, a vast collection of genes, do we change the person and their opinions? Could it change who we are attracted to and who is attracted to us? Could a lover’s scent become intolerable after microbiome treatments? In the social realm, could politicians alter their microbiomes to appeal to voters? Or at least mask their scent with a leftist or conservative cologne?

  These hypothetical futures are beyond where research has brought us, but as with cell phone surveillance, space exploration, and social media, continuous advances may turn them into reality. We could revolutionize medical treatments, surveillance, politics, and recreational drugs. We could cure diseases and live longer happier lives, or be tamed by forced bacteria injections or bacteria warfare. What would a society that puts the microbiome at the center of their understanding of the human look like?

  You are wheeled into a hospital. You waited too long for your compulsory monthly injection, so your heart convulses like you’re having a stroke. The doctor’s give you the injection with smiles. Immediately it calms you, alters your microbiome to induce lethargy and apathy. They monitor you for a few days. Your numbed body walks out of the hospital ready to continue your life.

  About the Author

  Matt Simmons wanders the world. Teaches English online. Pays student loans. Drinks craft coffee. Reads speculative fiction. Studies Italian. Exists with Crohn’s and celiac disease. And has just finished writing fifty-two stories in fifty-two weeks (alright, sixty weeks).

  The ‘Quarter Turn’ of History:

  A Conversation with Guy Gavriel Kay

  Chris Urie

  Fantasy is a genre steeped in history. Mammoth novels outline thousand year dynasties and shorter works hint at machinations decades in the making. Their imagined histories lend a level of immersion and context for the reader. B
ut when our own history is woven into the fabric of the fantastic, you find yourself reading a slightly different kind of story.

  It is undeniable that Guy Gavriel Kay is a master of historical fantasy. His unique way of weaving world history into engrossing fantasy novels has earned him numerous accolades and praise around the world. His latest novel, Children of Earth and Sky, follows a Dickensian cast of characters making their way in a world not too far off from our own Mediterranean in the Renaissance. A young woman seeks vengeance. A painter is summoned to immortalize a king. Spies lurk between borders and pirates ravage the seas. Countries play politics. The world is poised for uproar.

  Guy Gavriel Kay is the author of numerous novels and a book of poetry. In addition to the World Fantasy Award and the International Goliardos Prize, Kay was named to the Order of Canada for his contributions to literature. It is the country’s highest civilian honor. Children of Earth and Sky was published by New American Library this past May.

  Many of your novels pull from history and Children of Earth and Sky is no exception. What does your research process look like?

  Lots of books and academic monographs, Moleskine notebooks, several of them filled over time, pens, emails back and forth with academics, some travel, and about a year or so before some evil voice within says, ‘This is meaningless if you don’t start writing.’ And I do. But the research phase is absolutely my favorite—I’m just learning things, no responsibility till later to produce something from it.

  You’re known for being exceedingly thorough when researching your novels. What is the most extreme length you’ve gone to in pursuit of knowledge for a novel?

  Hah! There are a few stories. One is when I was writing Sailing to Sarantium and I came across a complete disagreement in texts as to chariot racing in Constantinople, as to where the best horse of four in a quadric was placed—on the inside or outside. Inside would be so that its force of personality, as it were, would stop the others from drifting too high (and thus going farther), or on the outside because it had the farthest distance to run. Both made sense. I chased down some harness track trainers! Closest I could get, I figured. (For those interested: there was a discussion, but consensus was the best would go outside as the added distance, across four horses and many laps, was real. The charioteer could keep them from drifting out, if he had to.)