There were no messages from Billy on Doc’s apartment phone, however, and no messages waiting in his box at Hospital No. 7 when he arrived there at a little after 7:00 in the morning. There had been little rest when he had reached home; after an hour or so of fitful dozing, intermixed with unpleasant dreams, he had gotten up, showered, and then read surgical journals before taking a ground-cab to the Hospital. Now as he flipped the IN sign by his name at the call desk and walked across the lobby he felt raw-eyed and groggy. Pushing through the lines of patients already queuing up for the 8:00 outpatient clinics or morning admissions, he made his way to the staff canteen behind the banks of elevators and found coffee and doughnuts, the only breakfast he ever ate. Armed with a full cannister of coffee, he took an elevator to the twenty-eighth floor, hopped a jitney to the north wing, and a few moments later was letting himself into the welcome solitude and privacy of his own Hospital office.
Sitting down behind his desk, he activated his computer console and studied his day’s schedule as it appeared automatically on the screen. Fortunately it was an easy day, starting at 9:00 with the Mabel Turner heart case in the neuropantograph recording suite, then monitoring an emergency appendectomy that had been slipped into the schedule at the last minute, to be done by a pantograph-programmed robot, and ending with a cardiac transplant originally planned for noon but now rescheduled for 1:00. Pouring himself more coffee, he knew he should be using the available time to review the charts of the two heart patients; but after a half-hearted attempt to become interested, he cleared the console screen in disgust and sat back to stare out the window at the gray dawn.
He had counted on word from Billy by now, and the absence of any message at all was alarming. Breaking a long-standing agreement that they not communicate with each other directly in the Hospital, Doc called the operator to page Molly Barret in the Operating Suites on 17 Central. A moment later Molly appeared on the screen, looking as weary as Doc felt. “Word from Billy?” she said. “No, nothing. Haven’t you heard from him yet? Doc, I’m worried.”
“So am I,” he said. “But I don’t dare try calling him until I know he’s clear.” He looked at her. “Did you check Records for those figures on meningitis?”
“Yes,” the girl said, “and that’s another funny thing. They wouldn’t give me the data.”
“Wouldn’t give it to you?”
“That’s right. They said it was Hospital-classified, and I’d have to have a special authorization code from the Administrator. I wasn’t sure what you’d want to do, so I cancelled the request. I hope that was right.”
“Yes, that was certainly right. But classified? Molly, there’s something very strange going on. Didn’t they say anything else?”
“Not a thing.”
“Well, all right, listen. I’ll be in surgery most of the day, but if you hear anything from Billy, anything at all, leave me word on my office tape. I need to reach him as soon as I possibly can. And Molly — don’t worry a lot. There’s really not much they can do to him, the way I see it, and Billy’s been on this griddle before. Hell make out all right.” Doc rang off then, wishing he felt as confident as he had tried to sound.
Classified. Doc poured himself some more coffee and sat back in his recliner, frowning. All she had asked for was a statistical rundown from Medical Records on any and all cases of meningitis admitted to Hospital No. 7 in the past month — the type of infection, sex of the patients, age curves, pattern of symptoms, duration of illness, other medical history or contributing factors, a complete biomathematical profile of the sort that any doctor might need for any type of illness he might be treating. The Hospital’s Medical Records department filled hundreds of such requests each day, searching out statistical profiles as routinely as they recorded blood counts and X-ray reports; it was a basic part of modern medicine’s technological weaponry, and for such a profile to be Hospital-classified and withheld from review was virtually unheard of. Of course, he could go to the Hospital Administrator for authorization — but the less of Dr. Katie Durham’s attention he drew right now, he decided, the better he liked it.
He pulled a pipe out of his desk, filled and lighted it. There was another way to do it, too. He could pull the admission rosters for each separate day during the last month, pick out the patients with admitting diagnoses of acute meninigitis, and pull their records one by one, compiling a statistical profile as he went. But such a procedure could take days, maybe weeks, of his time, and deep in his mind was a sense of urgency that told him that days or weeks might be too long.
Finally, disgusted, he activated his console and called for the admission roster of new patients admitted to the Hospital from the previous midnight on. When the list appeared on his screen, he went through it carefully, name by name. Just as he feared, no Hardy was listed on the roster, although four other patients with tentative diagnoses of acute meningitis had been admitted during the night and confined to the Hospital’s isolation wards. Along with the roster was a flagged notice directing all Hospital personnel to report to the Public Health and Immunology Department on 8 West for gamma globulin shots as short-term protection against an unclassified viral meningitis diagnosed in “several admitted patients,” and a long notice from Immunology describing efforts to prepare a multi-valent vaccine against all currently active strains of viral meningitis in the eastern sector of the country. Doc coded in a request for a print-out of the notices to be placed in his box. Then, never entirely trusting the computer-compiled admissions roster, Doc called the Admitting Office and asked them to check for a Hardy on the night’s admission cards.
After a five-minute wait, Admitting came back and said no, no Hardy had been admitted. Doc flipped off the console and sat back with a sigh of defeat. It had been too much to expect, after all. He had been hoping against hope that the fact that the Hardys had violated their Naturist convictions to the extent of calling in a doctor in the first place might have led them to follow his urgings and have the boy admitted. Yet he could also see how impossible, how unthinkable, this might be for them, considering the fanatical zeal with which the whole Naturist movement, from Randall the Martyr on down, hated and despised doctors and medical care in general, and treatment in government Hospitals in particular. This was no lipservice dedication, and never had been; from the very first the Naturists had followed the tenets and teachings of Randall Morganson with a single-minded devotion more reminiscent of fixed religious conviction than of mere social or ethical policies.
In fact, Doc reflected, the really surprising thing was that the Hardys had decided to call a doctor at all, for the Naturist movement had always been marked more by zeal than by judgment. Randall the Martyr was as much alive today as he was before his death some twenty years before, and the cult of fanatics he had founded and led had continued to grow with each passing year despite all the government’s efforts by force or by guile to silence its voice. It had been Randall Morganson who had led the movement through the bloody Health Riots of ‘94, flailing mobs of people into mindless, incandescent frenzy and sending them out to break into hospitals, burn down clinics and drive doctors and nurses into the streets for angry public confrontations, whippings, or worse. His capture, of course, had been inevitable; some said he was purposely daring the authorities to stop him, forcing them to move against him, knowing that his incarceration would merely fan the flames of violence and determination among his followers. Nor was the man without his own deep-seated personal conviction that the Naturist way was the only way, as events later proved. Whatever else he may have been, Randall the Martyr was no fraud. Perhaps it was mere coincidence — or ironic fate — that it was while he was waiting trial during the heat of the riots that he developed the first symptoms of the disease that was destined to kill him as swiftly as flames or gas chamber: the ravenous appetite, the unquenchable thirst and the increased urination that marked the onset of acute diabetes mellitus.
Physicians later concluded that Randall Morganson, at the age of twenty-seven, was suffering the belated onset of the virulent, fast-moving juvenile form of the disease, uncontrollable without vigorous medical intervention — and Randall flatly rejected medical aid of any kind. Throughout the rapid, downward course of his illness, his condition was followed daily by every newspaper in the country, and his flushed face, thinning cheeks and overbright eyes became familiar fare on every household TV screen. When his trial was accelerated by a government fearful that he might die before he could be convicted, no one was surprised that he was rescued from the courtroom at gunpoint by a squadron of his Naturist followers, all wearing the half-shaven head and beard that Randall himself had worn as a symbol since accidentally burning off half his hair escaping from a fiercely burning clinic building he and his lieutenants had fire-bombed. And from the day of his escape onward, the course of Randall Morganson’s illness in a hideaway in Mexico remained a front-page newspaper story: the encroaching blindness, the episodes of diabetic coma staved off by rigorous dietary control, the gangrene of the extremities, the kidney failure, survived, some said, only by the overwhelming power of the man’s will alone, and finally the ultimate martyrdom in a diabetic coma so profound that no measures whatever, medical or otherwise, could have reversed it.
Randall the Martyr dead was as much a firebrand as he ever had been while living, and even today he stood revered by the hardcore of Naturist followers who opposed any medical treatment for any form of illness, who attacked the government’s Eugenics Control Program and the Sterilization Clinics as supreme blasphemy, and who died as Randall had died, of infections or other diseases rather than submit to the federalized system of medical care which had finally emerged from the Health Riots. True, there were Naturists who called in underground doctors for care. In some circles they were vilified as unbelievers, but there were others who quietly condoned the practice, claiming that it revealed the corruption of the government’s programs in such bold relief that even the doctors could not live with them. As for Randall Morganson himself, it was in a way a supreme irony that he should have died of untreated diabetes, of all things, for it was an intense scrutiny of the increasing incidence of this ancient disease in the general population that led to the bloody Health Riots of 1994, and ultimately to the very health care programs that the Naturists hated and resisted so fiercely.
Somewhere down the twenty-eighth floor corridor, a loudspeaker paged an intern, and occasional footsteps sounded past the office door; otherwise the place was very quiet. Doc walked to the window, peered down at the vast complex of buildings that composed the Federal Hospital and Medical Center No. 7 and the tier upon tier of Upper City apartment buildings that surrounded it on all sides. A gray winter rain was falling now, and the ground-cabs’ lights were on as they moved up and down the busy thoroughfare fronting on the Hospital. A gray day, precisely the same kind of day some eighteen-odd years ago when the Health Riots in the space of a few brief hours had changed his own life so irrevocably. In a way he was surprised that the bitterness was still there, but probably it would always be there; even after all this time the memory of that horrible night was almost unbearably painful, mental images passing like a fiery tableau: the chanting, furious mob that had materialized without warning outside their quiet surburban home just as his wife had put the baby down and they were preparing for bed; the cutting of phone and computer wires as preparations were made to put the place to torch; the rising flames as four of them smashed the door and dragged him out at gunpoint to the torch-lit gauntlet of jeering, angry faces; his wife and the baby blocked at the door of the burning building by sniper fire until the billowing smoke blotted everything out. The police and fire trucks had come, finally, but as usual in those days, too late and with too little; the hour-long pitched battle that raged leaving half a dozen of the mob dead and a dozen more wounded, and he himself held forcibly in the squad car by a brawny police sergeant as the flaming roof collasped just as the fire hoses got started….
Long ago now, Doc thought, and still the bitterness and pain. It was easy, now, to blame the Naturists, but they were by no means the only ones. In those days the whole country was aflame, and the Naturists only a tiny segment of the rioters. By the late 1980s the health care in the country had reached a point of no return — a point at which something desperate was bound to happen. For over a decade the stage had been set, with full-scale government-subsidized medical insurance providing care not only for the poor, the aged, and the medically handicapped but for everyone else as well. At the same time medical research, with massive federal assistance, had blossomed as never before. The new cancer vaccines, although no cure for malignant diseases, helped immensely to prevent them, while newly discovered drugs prolonged the lives of late-stage cancer victims. With the problem of rejection finally conquered, organ transplants had become commonplace, providing ever-better control of such notorious killers as coronary artery disease and kidney disease. Above all, a greater understanding of bio-feedback mechanisms to counteract physical and emotional stress led to real hope that the aging process could be blocked, and the practice of gene manipulation promised to help increase longevity and avoid genetic proneness to a multitude of diseases. By the early 1980s even the most conservative medical authorities were predicting that an average human life span of 120 years might be achieved by the turn of the century, and more and more young doctors were turning their interest and energies toward research and away from the treatment of individual sick patients.
As a young, solo family practitioner in the early 1990s Doc had seen the pattern of chaos developing all too clearly. He had been proud of the sign on his door announcing JOHN F. LONG, M.D., GENERAL MEDICINE even when almost half his practice time was occupied filling out dreary Medicare forms in quadruplicate, seeking to justify to the federal agencies the studies, treatments, and medications he wanted to prescribe for his patients. But already obvious to him was the ever-increasing number of aged patients passing through his doors. At the same time he was more aware than many of the subtle shift of political power to help maintain the aged in physical comfort and good health in their ever-lengthening sunset years. Political leaders clearly recognized the blossoming power of Senior Citizens’ lobbies, and enacted multitudes of costly old-age benefit programs to be financed by taxing the young and producing members of society. At the same time there was a steady loss of interest in population-control programs as the elderly, conservative, status quo attitudes prevailed. Of course it was inevitable that, while health care facilities became more and more widely available to all, the quality of the medical care delivered became increasingly poor, with huge crowds holding the clinics open until late at night, the endless waits to be seen by a doctor — any doctor — and the sad but inescapable depersonalization and computerization of medical care as sick people found it ever more difficult to achieve the close doctor-patient relationships once so important to good, concerned medical care. In response to this, an aging national legislature began a vast shake-up of the federalized health control facilities, seeking to triple the number of doctors, establish more family consulting units and provide more doctor-patient contact — a program which, although theoretically achievable, promised to double once again the already staggering cost of government health care services in the nation.
It couldn’t go on like that, of course. If Doc in his simple office had foreseen a breaking point ahead, the nation’s leaders had foreseen it even more clearly. By late in 1992 several disturbing facts began to surface in the national administration and, by leaks, to an increasingly concerned and frightened public. With all the aging beneficiaries of the medical and geriatric programs, there was an alarming leveling-off of the national economy as an ever-smaller proportion of the population actually produced anything. Younger breadwinners were forced to shoulder the spiraling tax burden, yet the total tax revenues began to fall. Money became scarce, outdated medical equipment was continued in use, necessary hospital repairs were postponed, and new hospital construction rumbled to a halt. Perhaps most frightening of all was a secret economic study commissioned by the President, and then unaccountably leaked to the press, that contended that the whole national health care program, supposedly so well funded, was in fact approaching bankruptcy, and predicted that a massive economic breakdown would occur before the year 2010 unless some way could be found to halt the increase in population growth and curb expenditures on medical programs. With an aging Congress and national administration unable or unwilling to do anything to alter the developing pattern, there was a massive public outcry from the younger citizens, and scare headlines appeared in the news media across the country. One liberal Washington newspaper proclaimed: REPORT PREDICTS DISASTER IN FIFTEEN YEARS; HEALTH SERVICES MAJOR FACTOR, while a large midwestern paper reported COMPUTER SAYS COUNTRY GOING BROKE in two-inch banner headlines. At the same time, sporadic outbursts of violence began to occur, moving in an accelerating spiral into the full-blown national Health Riots of 1994.
It was a time of fear and anguish for the doctors and others involved in health care. Blamed for increasing health care costs, lack of concern, and inhumanity toward their patients, doctors became the scapegoats for an angry and vengeful public, with medical leaders all over the country the victims of public attacks by rioting mobs. An American Medical Association annual convention was mobbed by thousands of angry citizens and was forced to disband in a retreat that became a rout as police and National Guardsmen held back, fearful of involving an entire city in the conflagration. A major New York City hospital was invaded by a mob, the medical and nursing staff slaughtered, and the building set on fire, killing multitudes of aged patients unable to escape the inferno. Across the country, hospitals and clinic buildings were bombed, burned or occupied by renegade bands of reformers — and the cries of the Naturists, who advocated an end to all kinds of professional health care in a back-to-nature-and-home-remedies movement, were heard more and more loudly in the leadership of the rioting mobs. Ultimately the convulsive events involved virtually everyone. The stock market, long uneasy, dropped through the floor in a wave of emotional selling unequaled in sixty years. Labor unions threatened massive general strikes against excessive taxation and old-age benefit programs their workers were forced to support, and as unemployment rose, laborers and executives alike joined in the protest marches and riots aimed at the doctors.
It was in the midst of this accelerating turmoil that a small and mild-mannered man at a Midwestern university dropped a sociological bombshell that was destined to revolutionize the nation’s entire concept of medical care in the space of a few short years.
Rupert Heinz was certainly an unlikely candidate for fame of any kind. Doc had met him once, as lecturer at a medical meeting: a shy, tweedy pipe-smoking man who was far happier working out biomathematical formulas in his dusty office at the University of Minnesota than giving lectures — or making headlines. Few doctors even understood clearly just what it was that a biomathematician did, and Heinz himself had trouble explaining — but years of statistical study of the occurrence patterns of certain diseases had led Rupert Heinz to a quietly frightening hypothesis: that the miracles of medical progress in the nineteenth and twentieth centuries might, in some cases, have ultimately led to more human illness, rather than less.
An early study of Heinz’s had dealt with diphtheria, a dangerous throat infection known for centuries as a destroyer, or crippler, of children. Commonplace in the early 1900s, diphtheria had killed as many as one out of every ten of its victims — until widespread vaccination of children in the 1940s and ‘50s had brought the disease almost to a standstill. A medical triumph, it had seemed, until sporadic outbreaks of a more virulent, drug-resistant form of diphtheria began striking adults in the 1970s, with antibiotic treatment now ineffective and the death rate rising to over 60 percent of all victims. Within another ten years widespread epidemics were sweeping the country and mass immunization campaigns were needed to damp the flame of a dreadful disease running wildfire through a population left naked of any natural resistance.
Rupert Heinz had analyzed this pattern and come up with a frightening thesis: that medical intervention in itself had contributed the lion’s share to the massive spread of this virulent infection. Without immunizations earlier in the century, natural resistance would have kept the milder disease under control; now even a massive immunization campaign would be no more than a stop-gap, with horrible future epidemics to be expected as new virulent strains of diphtheria developed in the population. Heinz reported his predictions, almost apologetically, in an obscure scholarly journal, and there they remained, largely unnoticed, as the diphtheria epidemics raged on.
A second study, however, dealt with diabetes, and this time Heinz’s findings could not be ignored. Throughout most of history diabetes had been a relatively uncommon affliction that was uniformly fatal for lack of any effective treatment. As a disease strongly influenced by heredity, the fatal nature of diabetes served as a powerful limitation on its spread. Death often occurred during childhood, and even in adulthood the development of a pregnancy so greatly accelerated the destructive nature of the disease that few children were born of diabetic mothers. For centuries the disease, cause unknown, had remained stable and uncommon, a tragedy for those few who developed symptoms, but with very few of them passing the disease tendency on to their children.
The discovery of insulin in the early 1920s changed all that. For the first time, diabetes could be treated, and more and more victims survived long enough to have diabetes-prone children. By the time of his study in 1993, Rupert Heinz estimated that as many as 40 percent of the nation’s entire population carried at least one part of the complex genetic linkage for diabetes, up from 37 percent just ten years earlier. Looking into the future, Heinz quietly predicted that, as a result of medical intervention in detecting and treating diabetes, as much as 85 percent of the population would be carrying some diabetic factors within another forty years, and that some 42 percent would be actively diabetic. His message was simple and to the point: keep treating diabetes the way it had been treated for three quarters of a century and everybody would be diabetic or diabetes-prone by the late part of the next century.
When news reporters picked up the story and accused Heinz of doom-singing and rabble-rousing, the man merely withdrew, refusing to discuss his work any further. He had evolved complex biomathematical equations predicting the spiraling incidence of the disease; he knew his findings were valid; but he had no solutions to offer. Inevitably his reticence was interpreted to mean that he was concealing something, and soon he was the focus of alarming newspaper headlines: DOOMSDAY SCIENTIST REFUSES COMMENT ON WORK! CAN DIABETES BE STOPPED? TOP EXPERT WON’T TALK! As the storm raged Heinz withdrew still further, extending his studies to mental illness, ulcer disease, hypertension, cancer — the whole spectrum of illness that had been affected by medical intervention over the past centuries. And in each of these areas he found the overall occurrence of these diseases steadily increasing as a direct result of medical interference with age-old natural balances.
Of course, it was all only theory, the uncorroborated findings of one man working in a field of science that was inexact at best. For all of the scare headlines, Heinz’s predictions might still have been ignored except for the interest of Charles Lafferty, a young sociologist eager to find a way around the grim pattern that Heinz had forecast. Working at Stanford, Lafferty began collaborating with Heinz to develop certain “solution constructs” that might be used to turn the course of history and prevent or minimize the medical and social disasters that Heinz’s work predicted. Almost immediately the federal government classified this work as top secret and provided money for the development of a practical Eugenics Control program to curb the transmission of genetically linked diseases, even as the Secretary of Health Control and other official spokesmen were publicly scoffing at Heinz’s predictions and denying the implications of his work. But within months Heinz and Lafferty reached a startling and unpalatable conclusion: that a eugenics program alone would not be enough to turn the tide. Even with compulsory sterilization of all victims of diabetes, schizophrenia and a dozen other heredity-connected diseases and the compulsory euthanasia of all identifiably defective babies, the destructive spiral would continue as long as widespread medical intervention continued. Only if all individuals who wished to have medical treatment were first sterilized was there hope that the spiral could be broken.
It was this staggering concept that Heinz and Lafferty finally settled upon as a tentative working approach. Eugenics control — weeding out defective genes — and a diminishment of medical intervention had to be inextricably tied together. Health care, in the form of government-run, tax-supported clinics, hospitals and medical staffs would continue to be available throughout the land, providing a high quality of medical care to every citizen, from cradle to grave, who could qualify. And qualification for that medical care would be simple and easy to achieve: the only requirement for treatment of any ailment would be that the patient first be sterilized. Those who wished to have children would, of course, be free to do so — at the sacrifice of any type of legal medical care. Once such a program was instituted, Heinz and Lafferty predicted, the economic crisis centering on health care delivery would be relieved almost immediately, and the program would show measurable eugenics effects within forty to fifty years. By that time it would also show measurable and beneficial impact on population curves; the population crisis would be over. If the program was ultimately applied on a worldwide basis, Heinz and Lafferty calculated, dependence on health care facilities would diminish to a bare minimum within a few decades and world population figures would ultimately be reduced by two-thirds.
As a tentative working program, the Heinz-Lafferty proposal was carefully worked out — but their work was far from complete. A hundred details of the plan remained to be tested — the impact of the proposal on religious convictions, the attitudes the doctors might take, above all the attitude of the general public, all had to be studied in meticulous detail. A dozen more years of work were needed to crystallize the plan into sound policy, and neither Heinz nor Lafferty had any idea that the federal government might ever try to implement such a program before that vital work was done. But they had not counted on the sheer desperation of the government at the precise time that their preliminary studies were completed. Faced with an economic and political crisis, with the spreading Health Riots and threatened social disintegration, the aged President and his aged Congress were aghast at any program which sought to limit medical care in any way whatever. But an ambitious and liberal young opposition saw in the proposals the makings of a revolutionary reform program. Even as the incumbent administration floundered, the opposition broadcast the Heinz-Lafferty proposals as a panacea for the future, and in 1996 a frightened and riot-weary electorate bought the package in a landslide vote of historic proportions. Within sixty days after inauguration the tentative, untested Heinz-Lafferty proposals had been written into law, and for better or for worse the nation moved down a murky road of social and medical revolution.
No one at the time could see the end of that road, least of all Heinz and Lafferty, who shouted themselves hoarse warning that their work was incomplete, or the new President, to whom doing something seemed synonymous with improving something. Yet as the fledgling program was instituted, the stage was set for the emergence of a strange and extralegal medical black market, existing solely to thwart the law. It was into this world of underground medicine that Billy Gimp, with his shadowy personal history, his youthful ambition and his half-repaired club foot, found work as a bladerunner — a procurer of illegal surgical supplies; and it was in this same underground world that men like Dr. John Long and multitudes of his professional colleagues set about with dogged determination to defeat a system they considered intolerable to the ideals and training of physicians anywhere, any time. And now, some eighteen years later, the network was tightening and the struggle reached a new level of ferocity, with no end in sight.