Tom Clancy - Executive Orders

"E-Strain," Alexandre explained with a nod. "America is mostly B-Strain. Same thing in Africa."

"What's the difference?" Cathy answered.

"B-Strain is pretty hard to get. It mainly requires direct contact of blood products. That happens with IV drug users who share needles or through sexual contact, but mainly it's still homosexuals who have tissue lesions either from tearing or more conventional venereal diseases."

"You forgot bad luck, but that's only one percent or so." Alexandre picked up the thread. "It's starting to look as though E-Strain—that cropped up in Thailand—well, that it makes the heterosexual jump a lot more easily than B. It's evidently a heartier version of our old friend."

"Has CDC quantified that yet?" Cathy asked.

"No, they need a few more months, least that's what I heard a couple weeks ago."

"How bad?" Altman asked. Working with SURGEON was turning into an educational experience.

"Ralph Forster went over five years ago to see how bad things were. Know the story, Alex?"

"Not all of it, just the bottom line."

"Ralph flew over on a government ticket, official trip and all that, and first thing happens off the plane, the Thai official meets him at customs, walks him to the car and says, 'Want some girls for tonight? That's when he knew there was a real problem."

"I believe it," Alex said, remembering when he would have smiled and nodded. This time he managed not to shudder. "The numbers are grim. Mr. Altman, right now, nearly a third of the kids inducted into the Thai army are HIV positive. Mainly E-Strain." The implications of that number were unmistakable.

"A third? A third of them?"

"Up from twenty-five percent when Ralph flew over. That's a hard number, okay?"

"But that means—"

"It might mean in fifty years, no more Thailand," Cathy announced in a matter-of-fact voice that masked her inner horror. "When I was going to school here, I thought oncology was the place to be for the supersmart ones" — she pointed for Altman's benefit—"Marty, Bert, Curt, and Louise, those guys in the corner over there. I didn't think I could take it, take the stress, so I cut up eyeballs and fix 'em. I was wrong. We're going to beat cancer. But these damned viruses, I don't know."

"The solution, Cathy, is in understanding the precise interactions between the gene strings in the virus and the host cell, and it shouldn't be all that hard. Viruses are such tiny little sunzabitches. They can only do so many things, not like the interaction of the entire human genome at conception. Once we figure that one out, we can defeat all the little bastards." Alexandre, like most research docs, was an optimist.

"So, researching the human cell?" Altman asked, interested in learning this. Alexandre shook his head.

"A lot smaller than that. We're into the genome now. It's like taking a strange machine apart, every step you're trying to figure what the individual parts do, and sooner or later you got all the parts loose, and you know where they all go, and then you figure out what they all do in a systematic way. That's what we're doing now."

"You know what it's going to come down to?" Cathy suggested with a question, then answered it: "Mathematics."

"That's what Gus says down at Atlanta."

"Math? Wait a minute," Altman objected.

"At the most basic level, the human genetic code is composed of four amino acids, labeled A, C, G and T. How those letters—the acids, I mean—are strung together determines everything," Alex explained. "Different character sequences mean different things and interact in different ways, and probably Gus is right: the interactions are mathematically defined. The genetic code really is a code. It can be cracked, and it can be understood." Probably someone will assign a mathematical value to them… complex polynomials… he thought. Was that important?

"Just nobody smart enough to do it has come along yet," Cathy Ryan observed. "That's the home-run ball, Roy. Someday, somebody is going to step up to the plate, and put that one over the fence, and it will give us the key to defeating all human diseases. All of them. Every single one. The pot of gold at the end of that rainbow is medical immortality—and who knows, maybe human immortality."

"Put us all out of business, especially you, Cathy. One of the first things they'll edit out of the human genome is myopia, and diabetes and that—"

"It'll unemploy you before it unemploys me, Professor," Cathy said with an impish smile. "I'm a surgeon, remember? I'll still have trauma to fix. But sooner or later, you're going to win your battle."

But would it be in time for this morning's E-Strain patient? Alex wondered. Probably not. Probably not.

SHE WAS CURSING them now, mainly in French, but Flemish also. The army medics didn't understand either language. Moudi spoke the former well enough to know that, vile as the imprecations were, they were not the product of a lucid mind. The brain was now being affected, and Jean Baptiste was unable to converse even with her God. Her heart was under attack, finally, and that gave the doctor hope that Death would come for her and show some belated mercy for a woman who deserved far more than she had received from life. Maybe delirium was a blessing for her. Maybe her soul was detached from her body. Maybe in not knowing where she was, who she was, what was wrong, the pain didn't touch her anymore, not in the places that mattered. It was an illusion the doctor needed, but if what he saw was mercy, it was a ghastly variety of it.

The patient's face was a mass of rashes now, almost as though she'd been brutally beaten, her pale skin like an opaque window onto misplaced blood. He couldn't decide if her eyes were still working. There was bleeding both on the surface and the interior of each, and if she could still see, it wouldn't last much longer. They'd almost lost her half an hour earlier, occasioning his rush to the treatment room to see her choking on aspirated vomit and the medics trying both to clear her airway and keep their gloves intact. The restraints that held her in place, coated though they were with smooth plastic, had abraded away her skin, causing more bleeding and more pain. The tissues of her vascular system were breaking down as well, and the IV leaked as much out on the bed as went into the arms and legs, all of the fluids as deadly as the most toxic poison. Now the medical corpsmen were truly frightened even of touching the patient, gloves or not, suits or not. Moudi saw that they'd gotten a plastic bucket and filled it with dilute iodine, and as he watched, one of them dipped his gloves into it, shaking them off but not drying them, so that if he touched her there would be a chemical barrier against the pathogens that might leap at him from her body. Such precautions weren't necessary—the gloves were thick—but he could hardly blame the men for their fear. At the turning of the hour, the new shift arrived, and the old one left. One of them looked back on his way out the door, praying with silent lips that Allah would take the woman before he had to come back in eight hours. Outside the room, an Iranian army doctor similarly dressed in plastic would lead the men to the disinfection area, where their suits would be sprayed before they took them off, and then their bodies, while the suits were burned to ashes in the downstairs incinerator. Moudi had no doubts that the procedures would be followed to the letter—no, they would be exceeded in every detail, and even then the medics would be afraid for days to come.

Had he possessed a deadly weapon right then and there, he might have used it on her, and to hell with the consequences. A large injection of air might have worked a few hours before, causing a fatal embolism, but the breakdown of her vascular system was such that he couldn't even be sure of that. It was her strength that made the ordeal so terrible. Small though she was, she'd worked forty years of long hours, and earned surprisingly good health as a result. The body which had sustained her courageous soul for so long would not give up the battle, futile as it was.