Authors: James Gunn
As the chest cavity was closed, the new heart began squeezing powerfully, forcing the blood through the healthy new arteries.
Cassner would have had a good excuse for turning the more routine job over to the assistant, but he completed the arterial job before he turned away toward the dressing room. . . . That's what the scoffers forgot, Flowers thoughtâwhat a man got for his money: the skill, the drugs, the instruments. Twenty years earlier, without modern medicine, the man on the operating table would have died.
That man wasn't too healthy. If he were any less healthy, he'd be dead. Now he was good for five to ten years more.
“That's nothing,” Mock said. “I saw Smith-Johnson save a five-month fetus and I had to wonder: Why?”
Flowers looked scornful. He knew why: It was because life was sacred, any life, all life. That's what a doctor bowed down to.
“Sometimes in the night,” Mock said distantly, “I can hear their voices wailing, muffled by the incubators, all the premies that were too weak to live, that nature wanted to be rid of, and we savedâfor blindness and disease and perpetual care. Oh, Cassner's good, but I wonder: How much did the operation cost?”
“How should I know?”
“Why don't you find out?”
Flowers shivered in the darkness, although the room was hot, and pushed his hands into his pockets. He touched his belt buckle.
He started, and wondered why he hadn't thought of it before. He pushed the alarm button hastily.
It was a chance, and any chance was worth trying. He supposed that the hijackers had turned off the ambulance motor when they parked it.
Flowers sank back against the wall, remembering how he had gone to the business office. They had taken down his name, but they had shown him the statement. The old man had put down a $200,000 deposit. The business office had figured it pretty shrewdly. The total bill was only a few hundred less.
He glanced down the Debit column with its four- and five-digit numbers:
Operating Room: $40,000
Well, why not? The heart machine alone had cost $5,000,000, and that microsurgery had been the marvel of the Middle West when it had been constructed and equipped. Someone had to pay for it.
After that was the room fee, anesthesia, laboratory fees, X-ray, tissue exam, EKG-EEG-BMR fee, drugs and dressings, and, most prominently, the prices for new organs and arteries:
New Arteries (1 set): $30,000
New Heart (1): $50,000
Some poor devil of a defaulter had paid his bill.
Flowers sat in the concrete cell and told himself that a medic shouldn't have to weigh questions of relative value. So the operation had cost the old man $30,000 to $40,000 for each year of life it promised him. It was worth itâfrom the old man's viewpoint. Was there another viewpoint? Was someone else footing the bill?
Society, maybe. Was it worth it to society? Maybe not. The old man was a consumer now, eating up and using up what he had been smart enough or strong enough or ruthless enough to have produced when he was younger.
So maybe it wasn't worth it to society.
That was a brutal, inhuman viewpoint. That was the reason nobody wanted society to be the judge of what was worthwhile. Medicine had been fighting that possibility for centuries; on that point the AMA was immovable.
A man had an inalienable right to the doctor of his choice and the medical treatment he could afford.
Of course, of course. It illustrated the danger of looking at the problem all backward, as Hal Mock might. The knowledge was there; the skill was there; the equipment was there. If it wasn't used, it would be an outrageous waste.
But maybe, he thought sharply, the mistake came earlier, in developing the knowledge, the skill, and the equipment in the first place. That was when society footed the bill.
Society puts a price on everything. In every era there are limited quantities of intelligence, energy, and what people collectively inherit from the thought and labor of the past, capital. Society's value system determines how these assets are distributed among a thousand different enterprises.
It was like a budget: so much for food, so much for shelter, so much for clothing, education, research, entertainment; so much for the doctor.
What was more valuable than good health? Nothing, said society. Without it, all is worthless.
What did Mock mean when he said we can be too healthy?
Was there an optimum beyond which medicine consumed more than it produced in benefits? And was there a point past that at which medicine became a monster, devouring the society that produced it?
Maybe the cost of living could be too high. Maybe a society could be too healthy, like a hypochondriac, spending itself into bankruptcy in a vain effort to cure small or fancied ills.
“Charley,” he asked Brand one day, “what percentage of the national income went into medicine last year?”
“Therapy, education, research, production, or construction?”
“Everything.”
“Let's seeâfifteen point six, ten point one, twelve point nine, five point two, eight point sevenâthat'sâwhat does that add up to?”
“Fifty-two point five,” said Flowers.
In the darkness of the concrete room, he repeated the figure to himself. “Nonsense,” he muttered.
It was a relief from thought to discover that the recorder was running. He had only to press the playback stud to discover the identities of his captors.
He pressed the stud and listened, engrossed, to the voices of Leah and Russ and himself. . . . But before the tape reached Leah's frightened cry, the door swung open and a blinding light dazzled his eyes.
He stabbed the recorder into silence and cursed silently. He had lost his chance.
“Who are you?” he demanded.
“Police officers,” said a harsh voice. “Didn't you send out an alarm?”
“Get that light out of my eyes,” Flowers said suspiciously. “Let me see you.”
“Sure.”
The light turned away, splashed against dark trousers, lighter tunics, glittered on badges, exposed faces, caps.
One of the two officers looked familiar; surely that
was the sergeant to whom he had turned over the shover.
“Well, Medic,” the sergeant said, “we meet again, eh? Come on, we'd better get out of here.”
“Certainly, but where's the ambulance? Did you find it? Did you catch the hijackers? Did youâ”
“Hold it.” The sergeant chuckled. “We ain't got time for everything now. The hijackers might come back, eh, Dan?”
“You bet,” said Dan.
They went down long marble corridors, echoing with their footsteps, opening before them as the flashlight moved forward into the darkness. They reached a wide hall. On each side were three sets of heavy brass doors, one set standing open. Behind it was an elevator. Flowers followed the officers into the car. The sergeant pushed a button. They started up with a jerk. The elevator creaked and rattled and wheezed until Flowers wondered whether it would ever make it. That was the sound he had heard in the concrete room, he thought. He leaned back wearily against the ornate brasswork of the wall and thought,
I'm lucky.
In his moment of safety he found time to wonder about Leah. Was the blind girl all right? Surely she hadn't been hurt. And her fatherâwhat was familiar about his face?
It reminded him of a picture, of the time he had wandered through the hall of past presidents in the courthouse headquarters of the county medical society. There were dozens of the portraits, all done in dark oils, all with their solemn faces and their stern eyes that seemed
to watch him as he passed, as if to say, “We received the great Aesculapian tradition intact, unblemished; we hand it down to you, unchanged. Live up to it if you can.”
It was a pretty grim business, Flowers thought, this presidency of the county medical society. No occasion for laughter.
No, that was wrong. One of them had worn a ghost of a smile, the vague possibility around the painted lips that they once had smiled, that they did not take this matter quite as seriously as the painter.
He had bent over, curiously, to read the name on the tarnished brass plate fastened to the bottom of the frame, but he had forgotten it. He bent again, in imagination, trying to read the memory engraved on his brain. He visualized it, getting closer, clearer. He read the name:
DR. RUSSELL PEARCE
President, 1972â1983
Russell Pearceâof course, how could he forget? Discoverer of
elixir vitae,
developer of the synthesis which bore his name, dying now of senescence in a rotting house in the middle of the city.
Dr. Russell PearceâRussâLeah's father.
The door opened in front of them. Hesitantly Flowers stepped out into the hall. It was almost identical with the one below.
To the left were tall windows opening on a graying night. “Where are we?” Flowers asked fretfully.
“City Hall,” said the sergeant. “Come on.”
“What am I doing in City Hall? I'm not going anywhere until you answer my questions.”
“Hear that, Dan? He ain't going anywhere. Ain't that the truth? Go tell Coke we're here.”
The other officer, big and sullen-faced, slipped through a pair of glass doors at the other end of the hall. The sergeant grinned and ostentatiously adjusted a pistol in the holster at his side.
That one, Flowers thought with a shudder, wouldn't be loaded with anesthetic slivers. “You've got no right to keep me here against my will.”
“Who's keeping you here against your will?” the sergeant asked, surprised. “You want to leave? Go. Of course, you gotta be careful about little accidents on the way, like tripping on the stairs. It's a long way down.”
This degradation of the police power of the city paralyzed Flower's will.
The wizened little man who came back with Dan peered at Flowers speculatively. “He's just a medic,” he said petulantly, his bruised mouth curving down in disappointment.
“You expect us to be choosy?” the sergeant complained.
“Well,” Coke said timidly, “I hope it's all right. Follow me.” He motioned to Flowers.
The medic compressed his lips defiantly. “No!”
The sergeant's hand moved in a blur of speed. It hit Flowers's face, palm open, with a solid, meaty sound. The room reeled; Flowers's knees buckled. Anger burst
over him redly, and he straightened, his arms ready for battle.
Dan stepped forward, grinning, and kicked him in the groin.
The pain blurred everything as Flowers lay curled on the floor, trying to get his breath. Gradually the pain ebbed, and his muscles relaxed enough to let his legs fall away from his belly. Flowers forced himself to his knees on the cold marble floor and struggled up. He found the sergeant's arm around him, helping him stand.
“There now,” the officer said casually, “we're going to be sensible, aren't we?”
Flowers gritted his teeth and did not groan. He let himself be led through swinging glass doors into a large room bisected by a long, darkly polished counter. Against the right wall was a bench. On the bench was a thin, weasel-faced man.
The weasel face smirked at Flowers.
Thyroid,
Flowers thought dazedly. The shover. Free. Laughing. While he was held by the police, in agony.
By the time they reached the heavy walnut door in the right wall, Flowers could walk without crippling pain. “Where are we going?” he got out between clenched teeth.
“The Boss needs a doctor,” Coke said, trotting past him to open the door. Beyond was darkness. “It's about time he should wake up.”
The Boss?
“Who's he?”
The gray little man stared at him incredulously. “John Bone!”
“Coke!” screamed a voice thinned with pain. “Coke! Where are you?”
“Here, Boss!” Coke said in a frightened voice. “Here with a medic!”
He scurried across the room to draw curtains away from tall windows. The smog-smeared light crept across the floor, onto the wide bed with its tumbled covers. A man was sitting upright among them. He was cadaverously thin, his face a blade, his arms and legs mere sticks.
“A medic!” he screamed. “Who wants a medic? I'm dying. I need a doctor!”
“This is all we could get,” Coke said as if he had been born cringing.
“Oh, all right,” Bone said. “He'll have to do.” He swung his feet over the edge of the bed and fitted them into baby-blue mules. “Come on, Medic. Treat me!”
“Where's your contract?” Flowers asked.
“Contract!” Bone screamed. “Who's got a contract? If I had a contract, do you think I'd be hijacking medics?”
“No contract, no treatment.”
The hand hit him on the back of the neck like a club. Flowers sagged and almost fell. Distantly he heard his own voice saying, “That won't do any good.”
When the blackness went away, he was sitting in a chair near the bed. He turned his head painfully. The policemen were standing behind him, one on each side. In the doorway the shover was lurking, watching eagerly. Coke was in front of him. Pacing back and forth between the chair and the window was Bone, his mules clacking
against the marble floor and then clumping on the thick carpeting.
“I want treatment, Medic! Can't you see I'm dying?”
“We're all dying,” Flowers said.
Bone stopped and stared fiercely at Flowers. “Sure. But some of us can put it off longer if we're smart. I'm smart. I want treatment. I can pay. Why shouldn't I have treatment? Why should I be discriminated against? You think nobody ever got treatment who wasn't entitled to it?”
“The only thing I know is that there are ethical standards and I'm bound to them. What difference does it make?” Flowers said defiantly. “You don't need a doctor; you need a psychiatrist. The only disease you've got is hypochondria. Everybody knows that.”
Bone turned to stare at Flowers with dark unreadable eyes. “So,” he said softly. “A hypochondriac, am I? I am not dying, eh? Who is to say? These pains in my belly, they are imaginary? My head is sick? Well, maybe. Come here. I want to show you something.”