Neal Stephenson - Interface

Mary Catherine was trying to make a personal crusade of bring­ing more humanity to the profession. But standing by her stricken father's bedside crying her eyes out was not what she'd had in mind. "Why is he so out of it?" Mel said.

''Stroke is a major shock to the system. His body isn't used to this. Plus, we put him on a number of medications that, taken together, slow him down, make him drowsy. It's good for him to sleep right now."

"Mary Catherine told me that guys of his age, in good shape, shouldn't have strokes." "That's correct," Sipes said. "So why did he have one?"

"Usually stroke happens when you are old and the arteries to your brain are narrowed by deposits. This patient's arteries are in good shape. But a big blood clot got loose in his system." "Damn," Mary Catherine said, "it was the mitral valve prolapse, wasn't it?"

"Probably," Sipes said.

"Whoa, whoa!" Mel said, "what is this? I never heard about this."

"You never heard about it because it's a trivial problem. Most people don't know they have it and don't care." "What is it?"

Mary Catherine said, "It's a defect in the valve between the atrium and the ventricle on the left side of your heart. Makes a whooshing noise. But it has no effect on performance, which is why Dad was able to join the Marines and play football." "Okay," Mel said.

"The reason it makes a whooshing noise is that it creates a pattern of turbulent flow inside the heart," Sipes said. "In some cases, this turbulent flow can develop into a sort of stagnant back-water. It's possible for blood clots to form there. That's probably what happened. A clot formed inside the heart, eventually got large enough to be caught up in the normal flow of blood, and shot up his carotid artery into his brain."

"Jesus," Mel said. He sounded almost disgusted that something so prosaic could fell the Governor. "Why didn't this happen to him twenty years ago?"

"Could have," Sipes said. "It's purely a chance thing. A bolt from the blue."

"Could it happen again?"

"Sure. But we're keeping him on blood thinners at the moment, so it can't happen right now."

Mel stood there nodding at Sipes while he said this. Then Mel kept nodding for a minute or so, just staring off into space.

"I have eight hundred million phone calls to make," Mel said. "Let's get down to business. List for me all of the other human beings in the world who know the information that you just gave me. And I don't want him being wheeled around this hospital for everyone to look at. He stays in this room until we make further arrangements. Okay?"

"Okay, I'll pass that along to the others-"

"Don't bother, I'll do it," Mel said.

It was like the old days in Tuscola, when a hot, portentous afternoon would suddenly turn dark and purple and the air would be torn by tornado sirens and the police cars would cruise up and down the streets warning everyone to take cover. Dad was always there, guiding the kids and the dogs down into the tornado cellar, checking to see that the barbecue and lawn chairs and garbage can lids were stowed away, telling them funny stories while the cellar door above their heads pocked from the impacts of baseball-sized hailstones. Now, something even worse was happening. And Dad was sleeping through it.

And Mom wasn't around anymore. And there was her brother James. But he was just her brother. James wasn't any stronger than she was. Probably less so. Mary Catherine was in charge of the Cozzano family.

Sipes and Mary Catherine ended up in a dark, quiet room in front of a high-powered Calyx computer system with two huge monitors, one color and one black-and-white. It was a system for viewing medical imagery of all kinds - X-rays, CAT scans, and everything else. This hospital had had them for several years already. The hospital where Mary Catherine worked probably wouldn't get one until sometime in the next decade. Mary Catherine had used them before, so as soon as Dr. Sipes set her up with access privileges, she was able to get started.

After a while, Mel somehow tracked her down and sat next to her without saying anything. Something about the darkness of the room made people hush.

Mary Catherine used a trackball and a set of menus and control windows to open up a large color window on the screen. "They put his head in a magnet and baloney-sliced his brain," she said. "Come again?" Mel said. It was funny to see him non-plussed. "Did a series of CAT scans. Had the computer integrate them into a three-dimensional model of Dad's melon, which makes it a lot easier to visualize which parts of his brain got gorked out."

A brain materialized in the window on the computer screen, three-dimensional, rendered in shades of gray. "Is this the way doctors talk?" Mel said, fascinated. "Yes," Mary Catherine said, "when lawyers aren't around, that is. Let me change the palette; we can use a false-color scheme to highlight the bad parts," she said, whipping down another menu.

The brain suddenly bloomed with color. Most of it was now in shades of red and pink, fading down toward white, but small portions of it showed up blue. "When lawyers and family members are present," Mary Catherine said, "we say that the blue parts were damaged by the stroke and have a slim chance of ever recovering their normal function." "And amongst medical colleagues?" "We say that those parts of the brain are toast. Croaked. Kaput.

Not coming back." "I see," Mel said. "Been taking a stroll down memory lane," Mary Catherine said.

"Check this out." She played with the menus for a moment and another window opened up, a huge one filling most of the black-and-white screen. It was a chest X-ray. "See that?" she said, tracing a crooked rib with her fingertip.

"Bears-Packers, 1972," Mel said. "I remember when they carried him off the field. I lost a thousand bucks on that fucking game."

Mary Catherine laughed. "Serves you right," she said. She closed the window with the chest X-ray. Then she used the trackball to rotate the image of the brain back and forth in different ways to reveal selected areas. "This stroked area accounts for the paralysis and this small one here is responsible for his aphasia. In the old days we had to figure this stuff out just by talking to the patient and watching the way he moved."

"I detect from your tone of voice that you think this is all basically superficial crap," Mel said.

Mary Catherine just turned toward him and smiled a little bit.

"I like video games too," Mel said, "but let's talk seriously for a moment here."

"Dad's mixed dominant, which is good," Mary Catherine said.

"Meaning?"

"He does some things with his right hand and others with his left. Neither side of the brain predominates. People like that recover better from strokes."

Mel raised his eyebrows. "That's good news."

"Recovery from this kind of insult is extremely hard to predict. Most people hardly get better at all. Some recover quite well. We may see changes over the course of the next couple of weeks that will tell us which way he's going to go."

"A couple of weeks," Mel said. He was clearly relieved to have a specific number, a time frame to deal with. "You got it."

"Guess what?" Mel said to the Cozzanos the morning after the stroke. It was six a.m. None of them had slept except for the Governor, who was under the influence of various drugs. James Cozzano had arrived shortly after midnight, driving his Miata in from South Bend, Indiana, where he was a graduate student in the political science department. He and Mary Catherine had spent the whole night sitting around in the Executive Mansion, which was nice, but not exactly home. Mary Catherine had tried to sleep in bed and been unable to. She had put on her clothes, sat down in a chair to talk to James, and fallen dead asleep for four hours. James just watched TV. Mel had spent the same time elsewhere, on the telephone, waking people up.