Alan E. Nourse - The Bladerunner (14 page)

The sign on the door said
HOSPITAL ADMINISTRATION,
and below it:
KATHERINE DURHAM, M.D.
Beneath the name was the single word
PRIVATE.
At the secretary's nod Doc opened the door and

stepped into a large, simply furnished office. The room was bright and airy, with large windows looking out across the city from their thirty-fourth-story vantage point. Now mid-afternoon sunlight was slanting across the city, throwing the mile upon mile of high-rise offices and residential complexes into sharp relief, bristling like dragons' teeth. At a desk near the windows Dr. Katie Durham stood up, smiling. "Come in, John, and relax," she said pleasantly. "Sorry about earlier. I'm afraid I lost my temper. Bad move, I'm told. I seem to be doing it more and more these days."

She was a small, striking woman with auburn hair swept severely back from her forehead, wide-set green eyes that could look inviting or frigid depending on the circumstances, and with finely chiseled features that held a freshness that belied her thirty-six years. In the operating room her trim figure had been lost in the bulky surgical gown, but now it was set off to advantage in the blue and white uniform with the white physician's jacket she wore.

Doc smiled and sat down across the desk from her. "I probably wasn't the soul of politeness myself," he said, "but that's the way it is with surgeons. Cardiac transplants just naturally make me nervous. But that's not why you wanted to see me."

"No, not really." Katie leaned back, regarding him somberly. "John, how long have you been working with Health Control now?"

He looked at her. "How long has the Department been organized? Eighteen, nineteen years? You've got it all there in my record." He pointed to the thick manila folder on her desk.

"Yes, you have quite a record." She leafed through the folder in silence. "You came to Hospital Number Seven in the spring of ninety-five, just after the Eugenics Control Program was initiated. That makes you one of the original staff here. And before that you were in general practice with a group in Pittsburgh."

"That's right."

"And there was trouble there, I understand."

"The Health Riots were especially bad there," Doc said. "The clinic was fire-bombed, one of my partners killed—"

"And you had a wife and child involved?"

"A wife and a baby daughter . . . but that came later. Once they were gone there was no reason to stay there any longer. I came East, worked at the old Philadelphia General while Number Seven was being built and then came here. Surgical residency, then a staff appointment . . . well, it's all there on the record."

"Well, those were certainly bad years for you. Weren't you pleased with the new health legislation that put an end to the riots?"

"Pleased?" Doc hesitated. "I suppose so, in a way. Health care had to be brought under control somehow, and anything was better than the total chaos during the riots. Sure, I was glad to see the new administration doing something to change things, but I wasn't happy to see them jump head-first into an obviously premature, untested experiment."

"You mean the Heinz-Lafferty Eugenics Control program?"

"That's right. The basic theory seemed to make sense, but there were a thousand variables that had never even had preliminary checks run when the government took the whole system and pushed it through. It was no wonder there was trouble; they were just begging for trouble."

"Like what?"

"Well, the Naturist movement, for one thing. You were probably too young to remember the fuss they put up. They not only opposed the mandatory sterilization to qualify for medical care, they opposed medical care of any sort for anybody. Of course, the government thought the Naturists would just fall apart as soon as the Health Control program got working, but they didn't. They kept protesting, and they've gotten stronger every year."

Katie Durham looked up. "Yes, we've been having trouble down on the street every night for the last month."

"Well, just wait a few more weeks, until a few more really wild-eyed people join that crowd, then there's really going to be trouble."

"I can't argue that," Katie said soberly, "and I don't see any solution, either. But let's not get sidetracked on the Naturists. What other troubles do you think the Health Control program brought about?"

"Well, hell, Katie . . . look around you," Doc said angrily. "The biggest hole in the wall was the passive resistance. They should have foreseen how many people would fight against mandatory sterilization . . . and find a way around it. Essentially the whole program was a bid to bribe people into submitting to sterilization as the price of health care, and a whole segment of the population wouldn't bribe. God knows how many people have turned to the underground, they must number in the millions. It's a lousy brand of medicine,
nobody
can do good surgery on a kitchen table, but doctors and patients alike are into it because it's the only sane way to resist the government's program."

"Look, nobody can deny that the government's program was premature," Katie said.
"Nobody
likes all of it, not me or anybody else, but surely it's better than what was going on before."

"I'm not so sure," Doc said slowly. "If it is, then why all this problem getting new doctors in training? Medical schools are closing their doors for lack of students. Look at the staff of this hospital: every week another two or three doctors are leaving, and nobody's coming in to replace them. And the ones left are being worked into the ground."

"Exactly," Katie said. "And that's why the computerization program is so vitally important. It's got to be carried through as swiftly and efficiently as possible. That's one of my main jobs here: to computerize the hospital on all fronts, and try to iron out any snags along the way. Well, for the most part it's been going far better than we ever dreamed. The only real problems are the doctors that are fighting us, and that's why I asked you to come here this afternoon."

Doc spread his hands. "Look, if you're talking about that first case this morning,
everybody
was confused, including myself. I don't know why the computer set Mabel Turner up as a transplant case, you know yourself that diagnostic codes can get scrambled up easily enough. And as for that robot transplant case I just finished, the machine was obviously trapped in a feedback loop, two conflicting sets of directives, and it could have kept on vacillating until the patient died on the table. I
had
to step in on that one."

Dr. Katie Durham looked at him and shook her head. "I'm sorry, John, but it won't wash. Not this time."

"What do you meant it won't wash?"

"I mean I won't buy it anymore. You're lying. I've bought your excuses and explanations before, time and again, when you've had 'problems' on your cases, but no more. You've been letting it get so flagrant that
everybody
knows something strange is going on. Your own pantograph operator has gotten so confused he can't even guess what's going to happen next in a case of yours. He's been in here asking for a transfer five times in the past month. Your whole pantograph program is in a shambles, and the poor man doesn't understand what's wrong. He's blaming himself for the lousy results since he can't imagine who or what else could be to blame. Well, I know who's to blame, and it's not him."

Doc sat up in his chair. "Katie, I know I've said some pretty strong things about the pantograph program in the past, I've never really cared much for it. But you can't seriously claim that I've been deliberately sabotaging the program—"

"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."