His code number was flashing intermittently on the paging system when he walked into the Hospital just before seven next morning, and a light blinking on his mail box indicated a message was there. In the box he found copies of two new patient admission slips bearing his name as attending physician — one for a Will Hardy, aged forty-eight, the other for Robert Hardy, aged twelve. According to the slips, father and son had arrived at the hospital by ambulance shortly after midnight and had been admitted to an isolation ward by the emergency room intern who had first seen them. In each case the admitting diagnosis was acute meningitis.
So the Hardys had come back, after all. Doc tucked the notices in his pocket, and made his way across the hospital lobby to the doctor’s lounge. Here he picked up a telephone to answer his page, sipping coffee and munching a doughnut as he dialed his code. Two calls were in for him, one from 14 West, the isolation ward where the Hardys were admitted, and one from Katie Durham. He rang the isolation ward first. The desk nurse there, dressed in isolation gown and mask, looked relieved when she saw him on the screen. “Did you get slips on your two new patients, Doctor? They both look very sick, and we’ll need some orders on them.”
“Okay, I’ll be up right away,” Doc said. He rang off, started to ring Katie Durham’s office, and then put the phone down. He was early, and Katie could wait. Finishing his coffee, he left the lounge and jumped on a west-wing jitney. Ten minutes later he was slipping into an isolation gown and mask in the dressing room of 14 West.
“I’m glad you got here,” the nurse was saying as she led him down the corridor to a six-bed wardroom at the end. “The intern has gotten routine studies started and ordered up IV’s, but we need continuation orders for the Viricidin, and something for pain and fever.”
“Any sign of convulsions?” Doc asked.
“Not yet, but if they go like some of the others, that could begin any time, and then the ones we’ve had have just gone right on out.”
“Well, we may be in time.” He stepped into the room and saw the two Hardys in beds at the far side. An intern was adjusting an IV on the older man. Doc crossed the room, frowning. Will Hardy was obviously far sicker than when Doc had last seen him thirty-six hours before, but he managed a feeble wave of his hand. “Hi, Doc. I should have done what you said. This neck’s really getting me now.”
“How’s the boy?” Doc said, looking across at the sleeping figure in the other bed.
“Better than me,” Hardy said. “His stiff neck didn’t start until after dinner last night.”
“Well, let’s take a look at you.” Carefully, painstakingly, Doc examined the older man, checking heart and lungs, extremities, neurological signs. Then he took the chart from the intern, nodded in satisfaction. “Okay, things seem to be under control here. You’ll both need continuous IV’s, and we’re going to keep you loaded up with medicines. You’re going to have to be here awhile, I’m afraid, and you’re to do everything the nurse tells you — no nonsense whatever, understand?”
“Don’t worry, I’ll behave.”
“You’d better. Now what about your wife?”
“I’m not sure. They kept her in the emergency room for some tests and shots, I think.”
“Well, I’ll check,” Doc said. “She didn’t get the Shanghai flu when the rest of you did; she may be all right with just immunizations. I’ll check back with you tonight. Meanwhile get some rest.”
Back at the nurse’s desk Doc wrote examination notes on the charts, together with additional orders. “Keep a close eye on them,” he told the nurse. “They should have come in two nights ago, but there may still be time.”
“I hope so. Sometimes these Naturist people just don’t use good sense.”
“It isn’t just the Naturists that are in trouble,” Doc said. “You’re going to have a floor full of sick people here before this is over, unless I miss my guess.” He finished his notes and handed her the chart. “Page me if you need me,” he said.
By eight o’clock the hospital was alive with early-morning activity, with elevators and jitneys full. Back in his street clothes, Doc made his way up to Katie Durham’s office. In the reception room her secretary looked up from the two telephones she was handling simultaneously and sighed. “There you are! Dr. Durham is about climbing the walls.”
“What’s the trouble?”
“They don’t tell me the trouble, but it’s like a convention in there, computer people in and out all night. They called me in at five o’clock to handle the phone, and I don’t think Dr. Durham got home at all.”
Katie’s head appeared at the door. “Will you try paging John Long again, urgent? Oh, he’s here.” She looked weary and shaken, and there was no mistaking her relief at Doc’s presence. “John, did you ever call it! You have no idea. Come on in, we’re finally making some sense out of these figures.”
Doc followed her into her office, then stopped dead. The place was in chaos. Two large tables in the middle of the room were heaped high with papers, with computer print-outs cascading to the floor on all sides. Dr. Lerner and two other people from Records were huddled over one pile of papers, speaking into small microphones, and a technician was punching colored pins into a city map draped the length of one wall. Across the room by the window, separate from all the activity, was a short, balding man with wire-rim glasses and a small mustache. “John, you must have met Mason Turnbull, Chief of the Eastern Division of the Department of Health Control?”
“Oh, we’ve met,” Doc said. “He ran that four-day conference on the robot-training program last year, remember? Look, if I’m interrupting something — ”
“Not at all,” Turnbull said. “On the contrary, we’ve been waiting for you for some time.”
Doc’s face darkened, and he turned to Katie. “Look, I had an appointment with you this morning. What’s he doing here?”
“I called him at two o’clock A.M., that’s what he’s doing here. John, we’ve got trouble on our hands, we aren’t worrying about the robot-training program right now.”
“Well, I warn you, Katie, I’ve been thinking about it and I won’t even discuss my work with this man without a lawyer on hand.”
“That won’t be necessary this morning,” Turnbull said. “Not that there isn’t plenty to discuss. We’ve been watching your program very closely, Dr. Long, and we’re not pleased with what we see.”
“Then you just don’t comprehend the problems involved,” Doc said.
“Perhaps not, but other surgeons seem to be solving these problems splendidly. We’re getting very curious to know why you can’t. However, that’s not the issue just now. Dr. Durham called me last night with some alarming information on these meningitis cases, and I understand you’re involved.”
“He put us onto it,” Katie said, “and it was none too soon, either.” She took a thick sheaf of papers from one of the tables. “We knew we’d had a sharp surge of admissions of patients with viral meningitis in the past two or three weeks, and of course had the usual epidemiological studies started — it was obviously highly virulent, with a high mortality rate. We also have had a staggering increase in outpatients coming in for treatment for the Shanghai flu. None of them very ill, but as you know, people who are qualified for Health Control care tend to come in for every sniffle. Well, Dr. Long suggested that the meningitis might be a late sequel of the Shanghai flu in people who had bypassed treatment for one reason or another, and that’s what we set out to track down.”
She sighed and tossed the papers on the table. “We only have preliminary figures at this point, but the pattern is already clear: the Shanghai flu and the meningitis are two stages in the same disease, and if the lab people succeed in isolating and identifying the agents, they’re going to find the same virus involved in each stage. So far they haven’t had any luck pinning it down.”
“The Shanghai virus is elusive; we can confirm that,” Mason Turnbull said, “and the flu it causes certainly seems mild — a low-grade fever, headache, sore muscles for a couple of days, nothing much more. Our lab people are convinced it’s one of these cyclic mutant flu strains that turn up every few years, but nobody’s actually isolated the virus yet. This one appeared in Shanghai about four months ago, and just hit over here in the last two months. Highly infectious, but not particularly hard on the victims, except for babies and older people. We do have immune serum now for protective vaccination, and the virus is sensitive to most of the antiviral antibiotics. Ordinarily something like this would pass through and burn itself out in a few weeks. But a virulent meningitis complication is something else altogether.”
“It wouldn’t be bad if everybody who got the initial flu were treated — or vaccinated ahead of time,” Katie said. “The frightening thing is that that’s not happening, according to our figures. The very mildness of the initial flu is a trap, because the symptoms clear up in a day or two, and people think it’s all over until the trouble turns up some days later. I don’t know why the time lag — maybe it takes that long for the virus to travel to the central nervous system and get entrenched in the meningeal membranes lining the brain and spinal cord — but once the meningitis starts it moves like lightning: raging fever, agonizing stiff neck, violent headache, then convulsions and death all in a matter of forty-eight hours unless treatment is started in time. But there isn’t any question that it’s related to untreated Shanghai flu earlier. People who have treatment for the initial flu don’t get it — we haven’t turned up a single case. Neither do people who’ve gotten the flu shots early enough to prevent the flu. All the meningitis cases we’ve seen have been people who had the flu and rode it out without treatment.”
“And the admissions curve?” the Health Control man said.
“You’ll have to see it to believe it,” Katie Durham said. “Forty-three new meningitis admissions in the last twenty-four hours alone, every single one of them with untreated Shanghai flu a week or so earlier. Thirty-eight cases the day before, thirty-two the day before that. Over a hundred new cases in three days in this Hospital alone, and no sign of it peaking out. Here’s the graph for the last week — look it over and see what you think.”
The Health Control man peered at the graph, grim-faced, with Doc looking over his shoulder. “The trouble is,” Katie went on, “the really scary part doesn’t show up on that graph. Of all the thousands of outpatients we’ve treated for the Shanghai flu in the last two months, in effect protecting them from the meningitis, ninety-nine point eight percent were patients who were already qualified for Health Control care anyway under the Eugenics Control laws — they’d already been through the sterilization procedure at some previous time, so that wasn’t an impediment for them. Only two tenths of one percent — two people out of every thousand — had been alarmed enough about the Shanghai flu itself to submit to sterilization in order to obtain treatment.”
“Well, what would you expect?” Doc exploded. “An apparently minor, two-day illness — people who are resisting the eugenics qualifications would hardly change their minds because of a mild case of flu! This is exactly the kind of illness they’d try to ride out without treatment. But what about the other side of the coin? How many of the meningitis patients have been qualified for care?”
Katie Durham tossed the graphs down and looked up at the Health Control man. “Practically none,” she said. “I could hardly believe it, but those are the figures — and that’s why I called you at two in the morning. Nine out of ten are unqualified, and they’re waiting to the bitter end before they come in for help. A good third are beyond hope by the time they get here; they’re dead before we can even get treatment started. Lord knows how many just don’t get here at all.” She sat down at her desk and spread her hands hopelessly. “That’s the pattern our figures show, Mr. Turnbull, and frankly, I’m terrified. The Eugenics Control laws are working, all right, altogether too well. People who won’t submit to Health Control qualifications are trying to ride out an apparently minor illness that later turns out to be something quite different — when it’s too late, of course. There are still some holes in our data, some unanswered questions. We don’t really know yet how many of these untreated flu patients actually come down with the meningitis, maybe it’s only a small percent, but if our preliminary projections are anywhere near accurate, this city could be knee deep in corpses within another few weeks.”
There was a long silence in the room. Then Mason Turnbull cleared his throat. “Thirty percent,” he said finally.
“Thirty percent what?”
“Thirty percent of the untreated flu patients will develop the meningitis,” Turnbull said. “Those are the latest figures we’ve been able to come up with. And if you are alarmed by the implications, Dr. Durham, I can assure you that we are too. If the figure were five percent instead of thirty percent we would still have a dangerous underground epidemic on our hands. At thirty percent, we’re facing a perfectly appalling medical disaster, with virtually all the potential victims out of reach of legal medical care. And to be perfectly frank, the Department of Health Control has its back against the wall. We don’t know what to do to stop it.”