Machine Of Death Part 3

At night he dreamed of them, low and tawny, their eyes luminous in the charcoal African dusk. He welcomed them to him like he might a lover, inviting them in to the limits of his light, inviting them to feed.

"Come, beautiful ones," he whispered to them as they circled close. "Come."

Story by Jeffrey Wells Ill.u.s.tration by Christopher Hastings

DESPAIR.

THEY DIED ANYWAY. Of course they did, that's what those little cards are good for. The security guards here have a league table of the most impressive death predictions reported in the UK press: "The Cool List," they call it. They got me to phone the doctor whose machine predicted that an eighty-three-year-old bedridden Cardiff woman would die of STUNT PLANE CRASH. I used to feel sick looking at the list, because for a moment a bit inside me would laugh in wonder at the improbabilities written there, and then the moment would pa.s.s and I would begin to imagine the Cessna tumbling from the sky, falling down, down, down onto a slate roof under which an old lady was sleeping. The top of the list at the moment is SOLAR FLARE. I have no idea how that one will turn out.

The first one came in twenty-one hours ago, just as I'd started my shift. In the early morning the emergency waiting room was intolerably bright, and I squinted out of the windows-clean enough at midday, but blindingly dirty against the low sun. The call that the ambulance was coming in had been taken by the guy who'd just gone off shift, and I didn't really know what to expect. In theory there is supposed to be some kind of chain of responsibility to keep us all prepared, but in practice, doctors have long shifts and want to go home more than they want to tell you that a middle-aged man is coming in suffering from severe pain and pa.s.sing blood in his urine.

This is the procedure now: A vehicle comes into the bay, paramedics pull a body out on an unfolding trolley, and a nurse meets them and asks them for the card. Sometimes she smiles, and you know that this one might well walk out of the hospital. Sometimes she gets a stony look on her face and you know that her eyes have flicked across to the patient to see who's going to die. Sometimes-rarely, but sometimes-she frowns. As Nurse Kealing did with that first one.

We doctors don't like to look at the cards. Once upon a time all doctors sounded like Hawkeye Pierce. Death was our enemy, and if you can't point to your enemy, your crusade is n.o.ble. You are fighting against the odds, s.n.a.t.c.hing a few more years, months, weeks of life for your patients, defeating your endless foe. But of course, we don't fight that fight anymore. We fight a stiff piece of card, and we know that ultimately we are going to lose. What could be more ignominious than to be defeated by a few grams of wood pulp?

I examined the patient. Late forties, according to the driving license that the paramedics had found, but looking like he might be in his thirties. I had seen people like him at the speed-dating evening the previous Friday, divorcees taking their shot while they still had the time, boring and desperate. He could so easily have been there, and as I directed him to be moved into a nearby observation room I suddenly felt sorry for them. They were alive, and they deserved their chance at a little happiness.

"Marianne," Nurse Kealing said, by my elbow. The other doctors don't like to be called by their first name, but I let the nurses do it because it endears me to them, and they don't complain as much when I land them with paperwork that I should really be doing myself (which I do shamelessly).

"What's the verdict?" I asked her.

"I...uh..." She held out the card to me, and I know that I recoiled, because I haven't touched a card other than my own in five years. "You'd better look for yourself."

I stared at the card without reaching for it, and Nurse Kealing flipped it up so that I could see.

TESTS.

"s.h.i.t." I ran back to the doors that lead to the ambulance parking area. The two paramedics that had brought in my patient were trying to manoeuvre out past another ambulance, and as I cleared the doors the driver spotted me and leant on his horn in an effort to scare the other vehicle out of the way. I was too fast for them, though, ducking around the accidental roadblock and intercepting one ambulance as it swerved around the back of the other. They screeched to a halt a few feet in front of me, and I strode over and pulled open the door.

"Before you ask, we didn't do any tests!" The paramedic in the pa.s.senger seat cried. The driver, who looked afraid for his life (and in truth I felt myself like pulling him out of his seat and beating him), cringed away from me and nodded.

"You'd better not have," I snarled, and slammed the door shut.

We could barely do anything without the tests, of course. For two hours after he was brought in we watched my patient get weaker and weaker. He pa.s.sed blood in his urine, but we were too scared to take even that for a.n.a.lysis. That is what the machines have done to us: they've left us second-guessing reality. We gave him an a.n.a.lgesic to keep him as comfortable as possible, but we all knew that we were not dealing with something that would pa.s.s if we treated the obvious symptoms. Something was wrong with him-injury, possibly, more likely a viral or bacterial infection-something that would kill him. But if we tried to discover what was wrong and he died, we would be outside the NHS rules. Clause 14 of the revised patients' charter: Medical staff or hospital trust employees will take no action likely to hasten or lead to a predicted death.

"Realistically," Nurse Kealing argued, "there's no way that testing the blood in his urine can kill him, surely?"

"You know what those f.u.c.king machines are like," Doctor Jamison said, shaking his head. "You could trip while carrying the test results back in and stab the poor b.a.s.t.a.r.d with a needle." He leaned down and reached for the sheet covering our patient.

"What are you doing?" I asked sharply.

"Nothing."

"It doesn't look like nothing," I told him.

"I'm taking a look, all right? A look, not a f.u.c.king test, a look!" I stepped back, and he peered under the sheet at the patient's back. After a few seconds, he stood up again. "Kidneys rather than bladder, definitely."

"So it's going to kill him," I said.

"Yes," he said, in a quiet flat voice.

The second and third ones came in almost together, although I didn't know about the second one until much later. I found out about the third one from Doctor France, who saw me standing at the vending machine in the lobby. I was deciding whether to have a Crunchy or a packet of Nik Naks, and had been trapped in that decision-making process for three minutes. Perhaps I wanted to make a difference to something, however trivial.

"h.e.l.lo Marianne," he said. "Are you doing anything tomorrow night?"

"Going out with my boyfriend," I lied. I don't have a boyfriend. I occasionally f.u.c.k one of our security guards in the supply closet an ex-policeman who was fired because his card read SHOT. The Northampshire police force have one of the lowest reported incidents of gun crime in the UK, and it would have been a terrible public relations blow to have a policeman shot on duty. I like him because he keeps himself in shape, and because he has an ex-wife and a child who take up all the emotional energy that he would otherwise spend developing feelings for me.

Doctor France flinched. Perhaps he knows, I thought.

"Anyway," he said, plastering on a smile. "I've got something a bit interesting, thought you might enjoy wrestling with a little problem. We've got a young woman in with blood in her urine, probably simple urinary tract infection." An ice sheet spread out from my spine. "Thing is, her card says..."

"TESTS," I interrupted him.

He looked at me quizzically.

"How did you know?"

Patient Two was in a room at the other end of the ward, being treated by one of the junior doctors. Patients Four and Five we found by calling the emergency admissions at Kettering, and Patient Six, a thin middle-aged woman in old clothes, came in a few hours later. I could see instantly that she could understand the way things were headed, because she was arguing strenuously in Italian with her husband and in somewhat less eloquent English with the two grown-up daughters that accompanied them. She wanted to go home, and she must have understood what we did, that her devoted family's wish to help might be the death of her.

We gave her painkillers and I talked to them, individually and as a group. But for bad timing I think she would have persuaded them to let her go home, but about a quarter of an hour after they arrived, I noticed that she was beginning to fade somewhat, and five minutes later she fell unconscious. At that point we had to give her the same care we were giving the others, and we moved all four of the local patients into the same ward. Doctors France and Jamison argued endlessly with me over the treatments we could give, but all of our arguments came to nothing.

Without knowing the cause of the distress, any actions we took were more likely to be harmful than helpful (and more likely still to have no effect at all other than to waste time).

I got desperate and handed the details of the patients over to Joe (my occasional tryst)-strictly against hospital policy, because security staff do not generally need access to confidential medical records, or indeed any kind of patient information. I thought he might be able to shed some light on a possible connection between the unfortunate four patients at our hospital-and if he had found one I might have been able to persuade our equivalent numbers at Kettering to hand over the equivalent information about their unfortunates. Despite a bit of help from some old friends of his at the local police station it was all dead ends. The six people lived near each other, but not near enough to form a cl.u.s.ter for the purposes of determining some environmental cause.

There were no common work links, and no social connection. There was a moment of excited hope when he discovered that the serial numbers on the back of two of thecards showed identical mistakes in the printing, but neither of the other two cards showed any similar signs. So two of the patients had been diagnosed by the same machine-probably at roughly the same time-but that was the only connection we could find.

"Almost certainly a coincidence," he told me sadly. "I mean, I'll keep looking if you like, but don't rely on me to turn up anything useful anytime soon."

"Fine," I said, and left him to it. I was grateful to him for trying, for giving me that moment of hope that we might find some way to cheat the machines (if only for today), but I couldn't show it. That wasn't the way it worked between us.

We got the two patients from Kettering transferred over by ambulance-it was easy, no one wanted responsibility for them. Even with all six of the sufferers together we could find out no extra information.

It was Doctor France who finally said it.

"What if we just start," he said quietly.

"We can't."

"We have to do something, what we can't do is just let them die." He shot me a sullen look. "I can't, anyway."

"What's that supposed to mean?"

"Nothing." He shook his head. "Look, I'm tired. I know it's not good, but we have to start some kind of tests. They're not going to last much longer."

"Just one then," Jamison interjected.

"What?"

"You know what those d.a.m.n machines are like. TESTS could mean a completely different thing for everyone here. Maybe only some of them are at risk from the tests we might do. G.o.d, we do tests all the time."

"And people die from them. Even people without cards. If we start," I spoke slowly and calmly, "we know what will happen."

The three of us stood silent, watching the six patients and listening to the muted sounds of bustle and activity coming from the corridor outside the ward. A strange sensation came over me, as though the world were receding-as though I were looking at it through a long tunnel. My hands were hard to move, as though I had slept in the cold, my muscles stiff and unresponsive. With an effort, I walked to the foot of Patient One and read out the details at the top of his chart.

"Brian Felton, 47." I turned it sideways. In the margins of the chart, Nurse Kealing had written in pencil. "Wife and two children," I read aloud.

Replacing the chart, I moved to the next bed.

"Simon Lines, 23. Girlfriend brought him in."

"Janice Greg," said France without looking at the chart. "She's 31, unmarried, a schoolteacher." He turned to the fourth bed, the old woman transferred from Kettering. "Maud Carver, 63. You'd guess from the name, wouldn't you-who calls anyone Maud anymore?" He looked down at the chart again. "Widowed."

Doctor Jamison picked up the fifth and sixth charts, one in each hand. From the left: "Louise Burdon, 28. One kid." From the right: "Emilia Strabbioli, 51. Married, two daughters, one son, one grandson." He put the charts back on their hooks, and we stood back and looked at the six bodies laid out before us.

"Are we really considering this?" Jamison asked.

"No, we can't consider it," I said. The others looked at me. "We have to just do it."

"It can't be Brian or..." France pointed to the fifth one.

"Louise," Jamison supplied. "Or Emilia. No one with children."

"Janice is young," France said. "Simon, too."

They looked at me.

"So we're going to kill Maud because she's the oldest?" I asked.

"She hasn't got any..." France began, but Jamison interrupted him.

"We're not going to kill her at all. We're going to test her."

"And the tests are going to kill her," I nodded. "Have the b.a.l.l.s to admit it."

He sighed, shrugged, and walked over to pick up the chart. "Says here she had a stroke two years ago."

"So? Look, she made it two years, who's to say she won't make it another thirty?"

"Plus," said France carefully, "that's exactly the kind of thing that makes me nervous. Given her stroke, I'd be a bit careful what tests I did on her anyway." He walked over and took the chart away from Jamison, scanned it, then put it back on the hook. Then he turned back to the third patient. I could tell he was thinking something that he didn't like, and I realised what it was going to be. She was his patient, of course, he had been charged with making her well again. "Perhaps we should consider Janice."

Jamison picked up the schoolteacher's chart.

"She's healthy," France continued. "Least likely to have any trouble with the tests, I'd say." He smiled. "Hey, I've just thought of something. She's a teacher, right? Perhaps the stress of grading is what's going to get her! It could be nothing to do with this at all. Of all of them, she's the most likely to survive, right?" He nodded at Jamison and me, trying to convince himself by convincing us.

I ignored his pleading and pointed to my own patient. "Why save Felton?" I asked.

"He has kids."

"He's a s.h.i.t," I spat. "He beats them. He screws around, and he's given his wife the clap."

"Jesus, Marianne!" France slapped my hand down. "He might be able to hear you! That's not funny!"

I saw Jamison's eyes flick down to my balled fists.

"No, wait." He pulled France back by the shoulder.

"She's..." France protested.

"I see what she means," Jamison said, staring past France directly at me. France had believed he was talking to him, of course. "We can't make this decision. We can't just do this based on our prejudices. That's how the cards beat us. They use us against ourselves."

He was wrong, of course, but we had to tell France something to make him listen to sense.

"There's only one thing to do," I told them.

I found the box in the waiting room-there's a little pile of books and toys to keep kids occupied while we talk with the parents. Most of it was for the smaller children, but there was a wooden box of cla.s.sic games that had a backgammon board. I don't suppose it had ever been used. Half of the white counters were missing, but I found most of the red ones and one of the dice, which I scooped up into my pocket and carried back to our ward.

"We make up something to tell the families, of course," I told France and Jamison, then rolled the die on top of the defibrillator cart. I saw two come face up for a moment, two black sockets in a white face, then it was past and the cube came to a rest.

"Five," said France.

"Louise," Jamison corrected him.

They died anyway. Of course they did, that's what those little cards are good for. The first round of tests showed nothing, so we took more blood from Louise. That's when she began to bleed under the skin around where we'd put the needle in. Pretty soon she was convulsing, and then her vitals began to deteriorate and her heart stopped.

While the tests were coming back, Maud stopped breathing. We revived her, but her brain had been without oxygen for too long. When she stopped breathing again, we couldn't bring her back. Nurse Kealing brought the test results back: some viral activity, but sadly not characteristic enough for us to work out what we were dealing with.

The die rolled five again, then two. So we took blood from Simon.

He survived, but we got the same inconclusive results, during which time Brian and Emilia had both gone. We gave the young man antivirals, but his condition deteriorated faster, and he died two hours after Emilia. Finally we watched Janice Greg's heart rate get slower and slower until finally she, too, left us.

We had been watching the six of them for close to a day on and off. France and Jamison looked like corpses themselves, grey-faced and without a hint of emotion. It had drained everything from them-not just the deaths, but what those cards had forced us to do. I left them to it, slipping off quietly to find Joe.

The causes of death were hemorrhagic fever with renal failure, or so the pathologists determined. I didn't feel like anyone was to blame-who could have suspected a hantavirus outbreak in the midlands? No other cases were reported, and the investigators were unable to trace any more connections than we had.

I have Brian's card in my wallet. I keep it next to mine, because that night its prediction came a little bit closer. I take Brian's out when I am alone, and stare at the word. I am still unable to understand what it meant. Was it the tests, I wonder, or the lack of tests? Did the word mean the same thing for all of those six? Did it mean hospital tests, exams, what?

The thoughts run through me like water, ever changing. But there is one I come back to: Who was being tested?

Story by K. M. Lawrence Ill.u.s.tration by Dean Trippe