The President had never taken a course in government per se, just the usual political-science courses at Boston College in pursuit of his first degree in economics. Mainly he remembered the words of an aristocratic planter, written almost thirty years before his ascension to become the country’s third President: “… Life, Liberty, and the Pursuit of Happiness. That to secure these Rights, Governments are instituted among men, deriving their just Powers from the consent of the governed.” That was the mission statement right there. The Constitution he’d sworn to Preserve, Protect, and Defend was itself designed to preserve, protect, and defend the lives and rights of the people out there, and he wasn’t supposed to be here going over lists of names and places and occupations of people, at least
1083
eighty percent of whom were going to die. They were entitled to their lives. They were entitled to their liberty. They were entitled to the pursuit–by which Jefferson had meant the vocation of, not the chase after–of happiness. Well, somebody was taking lives. Ryan had ordered the suspension of their liberty. Sure as hell not many were happy right now . . .
“Here’s actually a little bit of good news, Mr. President.” Canon handed over the previous day’s election results. It startled Ryan. He’d allowed himself to forget about that. Someone had compiled a list of the winners by profession, and less than half of them were lawyers. Twenty-seven were physicians. Twenty-three were engineers. Nineteen were farmers. Eighteen were teachers. Fourteen were businessmen of one sort or another. Well, that was something, wasn’t it? Now he had about a third of a House of Representatives. How to get them to Washington, he wondered. They could not be impeded from that. The Constitution was explicit on that issue. While Pat Martin might argue that the suspension of interstate travel had never been argued before the high court, the Constitution mandated that members of the Congress could not be stopped from coming to a session except on cause of treason . . . ? Something like that. Jack couldn’t remember exactly, but he knew that congressional immunity was a big deal.
Then a telex machine started chattering. An Army Spec-5 walked over to it.
“FLASH-traffic from State, from Ambassador Williams in India,” he announced.
“Let’s see.” Ryan walked over, too. It wasn’t good news. Neither was the next one from Taipei.
THE PHYSICIANS WERE working four-hour shifts. For every young resident there was a senior staff member. They were largely doing nurses’ work, and though they mainly were doing it well, they also knew that it wouldn’t matter all that much.
It was Cathy’s first time in a space suit. She’d operated on thirty or so AIDS patients for eye complications of
1084
their disease, but that hadn’t been terribly difficult. You used regular gloves, and the only real worry was the number of hands allowed in the surgical field, and for ophthalmic surgery that wasn’t nearly the problem it was for thoracic. You went a little slower, were a little more careful in your movements, but that was it, really. Not now. Now she was in a big, thick plastic bag, wearing a helmet whose clear faceplate often fogged from her breath, looking at patients who were going to die despite the attention of professor-rank physicians.
But they had to try anyway. She was looking down at the local Index Case, the Winnebago dealer whose wife was in the next room. There were two IVs running, one of fluids and electrolytes and morphine, the other of whole blood, both held rigidly in place so as not to damage the steel-vein interface. The only thing they could do was to support. It had once been thought that interferon might help, but that hadn’t worked. Antibiotics didn’t touch viral diseases, a fact which was not widely appreciated. There was nothing else, though a hundred people were now examining options in their labs. No one had ever taken the time with Ebola. CDC, the Army, and a few other labs across the world had done some work, but there hadn’t been the effort devoted to other diseases that raged through “civilized” countries. In America and Europe research priority went to diseases that killed many, or which attracted a lot of political attention, because the allocation of government research money was a political act, and for private funding it tracked with what rich or prominent person had been unlucky. Myasthenia gravis had killed Aristotle Onassis, and the resultant funding, while not fast enough to help the shipping magnate, had made significant progress almost overnight–largely luck, Dr. Ryan knew, but true even so, and a blessing to other victims. The same principle extended to oncology, where the funding for breast cancer, which attacked roughly one woman in ten, far outstripped research in prostate cancer, which afflicted roughly half of the male population. A huge amount went into childhood cancers, which were statistically quite rare–only twelve cases a year per hundred thousand kids–but what was more valuable than a
1085
child? Nobody objected to that; certainly she did not. It came down to minuscule funding for Ebola and other tropical diseases because they didn’t have a high profile in the countries which spent the money. That would change now, but not soon enough for the patients filling up the hospital.
The patient started gagging and turned to his right. Cathy grabbed the plastic trash can–emesis trays were too small and tended to spill–and held it for him. Bile and blood, she saw. Black blood. Dead blood. Blood full of the little crystalline “bricks” of Ebola virus. When he was done, she gave him a water container, the sort with a straw that gave a little bit of water from a squeeze. Just enough to wet his mouth.
“Thanks,” the patient groaned. His skin was pale except in the places where it was blotched from subcutaneous bleeding. Petechiae. Must be Latin, Cathy thought. A dead language’s word to designate the sign of approaching death. He looked at her, and he knew. He had to know. The pain was fighting up against the border of the current morphine dosage, reaching his consciousness in waves, like the battering of a tide against a seawall.
“How am I doing?” he asked.
“Well, you’re pretty sick,” Cathy told him. “But you’re fighting back very well. If you can hang in there long enough, your immune system can beat this thing down, but you have to hang tough for us.” And that wasn’t quite a lie.
“I don’t know you. You a nurse?”
“No, I’m actually a professor.” She smiled at him through the plastic shield.
“Be careful,” he told her. “You really don’t want this. Trust me.” He even managed to smile back in the way that severely afflicted patients did. It nearly tore Cathy’s heart from her chest.
“We’re being careful. Sorry about the suit.” She so needed to touch the man, to show that she really did care, and you couldn’t do that through rubber and plastic, damn it!
“Hurts real bad, Doc.”
“Lie back. Sleep as much as you can. Let me adjust the
1086
morphine for you.” She walked to the other side of the bed to increase the drip, waiting a few minutes before his eyes closed. Then she walked back to the bucket and sprayed it with a harsh chemical disinfectant. The container was already soaked in it, to the point that the chemical had impregnated the plastic, and anything alive that fell into it would quickly be extinguished. Spraying the thirty or so cc’s that he’d brought up was probably unnecessary, but there was no such thing as too many precautions now. A nurse came in and handed over the printout with the newest blood work. The patient’s liver function was nearly off the scale, automatically highlighted by asterisks as though she wouldn’t have noticed. Ebola had a nasty affinity for that organ. Other chemical indicators confirmed the start of systemic necrosis. The internal organs had started to die, the tissues to rot, eaten by the tiny virus strands. It was theoretically possible that his immune system could still summon its energy and launch a counterattack, but that was only theory, one chance in several hundred. Some patients did fight this off. It was in the literature which she and her colleagues had studied over the last twelve hours, and in that case, they were already speculating, if they could isolate the antibodies, they might have something they could use therapeutically.
If—maybe–might–could–possibly.
That wasn’t medicine as she knew it. Certainly it wasn’t the clean, antiseptic medicine she practiced at Wilmer, fixing eyes, restoring and perfecting sight. She thought again about her decision to enter ophthalmology. One of her professors had pressed her hard to look at oncology. She had the brains, she had the curiosity, she had the gift for connecting things, he’d told her. But looking down at this sleeping, dying patient, she knew that, no, she didn’t have the heart to do this every day. Not to lose so many. So did that make her a failure? Cathy Ryan asked herself. With this patient, she had to admit, yes, it did.