William Forstchen - One Second After

“Please hold,” came the voice from the other end.

John looked across at Makala, who was standing at the crank phone in the conference room.

Five minutes passed, then ten. He sat on his desk, waiting nervously, heart racing, the only sound static and then a distant voice.

“Vance here.”

“Dr. Vance. This is,” he hesitated, “Matherson, director of public safety for Black Mountain.”

“What do you want?”

He could hear the exhaustion in Vance’s voice. John looked over at Makala and nodded. He was afraid if he continued, emotion would take over, and the man on the other end had no time for emotional appeals.

John had sat in the same spot now since Charlie’s death. Decisions about who got rations and who did not. The condemning to death by execution of twenty-two people for looting of food, in one night fifteen of them had killed off two head of cattle, and, horrifyingly, one for cannibalism. Fortunately, he was now able to delegate that terrible deed to someone else, three people, one from Swannanoa, one from Black Mountain, and a professor from the college.

John had listened to so many appeals, and always he had to judge based upon what was fair, and fairness was who might be able to make it through to next spring and who was now triaged off.

“Dr. Vance, this is Makala Turner. I was head RN with the cardiac surgical unit at Overlook in Charlotte. I worked directly with Dr. Billings. I’m now head of all emergency treatment here in Black Mountain.”

That line was carefully prepared by her, to create a sense of equality and draw from the tradition of mutual professional respect.

“Billings, how is he?” And then a pause, a realization most likely of the absurdity of the question.

“Doctor, on the day things went down, I was coming up to Memorial to attend your briefing on the new cauterization method for control of P.A.T. arrhythmia.”

A pause.

“Seems like a million years ago,” and John could hear the voice on the other side soften.

Makala had thought this out well. He looked over to her, but her back was turned to him, avoiding eye contact. “Nurse Makala…”

“Turner,” she said. “Dr. Vance, we have a situation here I think you can address.”

“Go on,” and John could hear the tension come back into Vance’s voice. “We got word that a helicopter load of medical supplies was airlifted to your hospital last night.”

A long pause… “Yes, that is correct.”

“Dr. Vance. We have a girl, twelve years old, type one diabetic.”

“And she’s still alive?” There was an incredulous note in his voice.

“She’s been carefully monitored and is a tough kid. Her father was able to obtain enough insulin to last five months, but the stock has degraded and all potency is gone.”

“Amazing she lasted this long.”

John stiffened, again looking at Makala, the way she was now so clinically talking about Jennifer.

“Dr. Vance. Was any insulin included in that shipment?” There was a pause.

“Was there any insulin?” John asked, cutting back in, his voice tense. “Yes.”

A pause on the other end.

“How long has she been without insulin?” Vance asked.

Makala quickly turned, looked at John, and shook her head.

“Last injection four days ago.”

It was a lie; it had been over two weeks.

Silence on the other end.

“Blood count?”

“Three hundred and ten,” again a lie; it was over twice that now and still climbing.

“Dr. Vance?” Makala asked. “Yes.”

“We can send a vehicle to pick up a vial, just a thousand units. It will save her life.”

He sighed and with that sigh John knew. How many had heard him sigh in the same way before rejecting their tearful appeal for but one more bowl of soup or the release of but two or three pills of Cipro or the few precious Z-pac antibiotics locked away in a safe?

“Save her life for how long?” Vance finally replied. “A month? The insulin received might be all we’ll get for several months. It’s already been designated for those who can survive on far lower doses than type one diabetics need.”

“Dr. Vance, we can have her at the hospital in an hour. Just one injection to stabilize her. We’ve heard the road might be open down to Columbia and from there to Charleston; we’ll risk driving her down there if you can help us stabilize her.”

“You and I both know the road is not open. A dozen people from here tried to get through just to Greenville yesterday and were wiped out by raiders in Saluda Gap,” Vance replied, “and even if you did get through, there’s no chance she’ll be given more. The authorities in Charleston have listed insulin, along with a couple hundred other drugs, as A priority, meaning to be distributed in extreme need only to those under the age of forty-five and over eighteen with high probability of survival and the ability to work in some manner. They sent me exactly five vials.”

Frustrated, John thought of Don Barber’s plane.

“Is there a means to fly her out?” John interjected forcefully. “Surely you must have planes down at Asheville Airport that are still flying.”

“We did, but we don’t now. We lost the last two a week ago. The pilots just took off with their families and disappeared. And even if we did have that means, I’d prioritize a hundred other cases first for airlift, even if we had it.”

Makala waved for John to shut up and there was a long pause. A long pause that drifted into nearly a minute of silence. “I’m sorry, but the answer is no. Now, if you will excuse me…” John stood up.

“We are talking about my daughter!” he shouted. “I suspected that,” Vance replied. “And suspect as well that it’s been far longer than four days since her last injection.”

“Please, Dr. Vance. Please, it’s my daughter. Just one injection.”

“John, isn’t it?”

“Yes.”

“John. Like I said, they sent up five vials. I’ve got two kids in this hospital now who have standard childhood diabetes and are barely hanging on, but God forgive me I’m withholding the medicine even from them because I’ve got nearly thirty adults with varying degrees of diabetes that can survive a lot longer with just a low dose. I might need this stock for the rest of the year to try and save some that can be saved.”

“Please for God’s sake.”

“John. Please listen. One injection for your daughter will not change the final diagnosis; it will simply postpone the inevitable. My God,” he said wearily, “do you think I want to tell you this? John, I have enough anesthesia for maybe twenty operations and we need hundreds. Painkillers, even just some damn aspirin…”

His voice trailed off.

Makala was waving John off, signaling him to be quiet.

“Dr. Vance. Makala here. I’ve been treating this girl since all this started. She’s a tough kid, a survivor. We can save her life.”

“For how long?” Vance replied, and now his voice was getting cold. “Type one diabetics. A hundred years ago they died within weeks after pancreatic shutdown. That’s the world we are back in now, maybe for years to come.”

Again a pause.

“Nurse Turner. You understand triage as well as I do.”

“Triage?” John shouted. “You are talking about my daughter, god damn it. You will not triage her off.”

“Sir, I am sorry for you. I truly am.”

“Damn you, listen to me! I can mobilize a hundred well-trained infantry and by God we will be there in an hour and by God you will give me that insulin. And if need be I’ll blow up the water main to your damn town.”

A long silence.

“Are you listening to yourself?” Vance said. “Would you really do that?”

“Yes!”