VOLUME II
Symptom
DF:\\NvRRtMT_SOURCE: Elisabeth VanBuren Tyler, M.D.
REALTIME NvRRtMT TRANS-
LATION/EDITING BY: T’lLeq’tomn, Tenth Order, Senior Compiler.
FOR USE OF: Peter Cory, Tenth Order, WWyhr Läaq of Earth.
SUBJECT: Project Armageddon.
FILE TO: DataField Historical Archives.
"Doctor Elisabeth! Doctor Elisabeth . . . !” The voice was that of little Tran, almost certainly: shrill, childlike.
And urgent.
I glanced up, my concentration momentarily broken. Ng, conscientious to a fault, interpreted the motion as a cue once again to sponge from my forehead the accumulated beads of “glow” constantly and rapidly brought forth by the steaming heat of the equatorial Cambodian jungle.
(One of Mother’s most strongly held convictions while I was growing up was that ladies glowed, gentlemen perspired—but only horses, the very lowest-caste ruffians, and/or non-Bostonians [which latter two characterizations were in her view effectively synonymous] ever sweat.)
Without visible hesitation, my fingers resumed the delicate, technically complex, life-and-death dance of open-heart surgery, but under my surgical mask I frowned thoughtfully:
Young as she was, Tran had absorbed her limited medical-technician training quickly, and she took her responsibilities seriously. She knew I was in the middle of an especially difficult pediatric heart-valve repair, for which I, a mere GP/pediatric surgeon approaching retirement age, possessing little formal training in cardiovascular surgery (I’d scrubbed and assisted on a total of possibly three dozen in my entire career to that point), was not remotely qualified to perform alone.
Unfortunately, deep in the jungle, faced with necessity, such distinctions tended blur: The boy's mother had brought him in comatose, completely unresponsive, mere hours from death. (Why did these sweet, gentle people always wait so long!) Under the circumstances, one selected from among a list of guaranteed unworkable alternatives—but was expected to accomplish the impossible anyway. In this case the only alternative was watching the kid die as we began the trek toward civilization—as if any of Cambodia's military-government-run, big-city hospitals would have admitted him even if he'd survived the journey. . .
In any event, Tran knew the potential consequences of distracting me at such a moment. I wondered what could be so important.
I was not kept in doubt for long: “Soldiers come . . . !”
∆ ∆ ∆
My surgical mask failed to absorb a muttered observation which, during their lifetimes, would have caused Mother’s hand to flutter decorously over her heart and Father’s brow to furrow in sternly proper, elegantly patrician disapproval. Unscheduled visits by military detachments were neither rare nor particularly unexpected; certainly not to me—not after having been ejected from seven “developing” countries in three years under virtually identical circumstances . . .
Increasingly, it seemed, right-wing host regimes (as well as the inevitable rebels who opposed them) were coming to view the ninety- to ninety-five-percent reduction in local maternal and/or child mortality which invariably attended establishment of one of our little U.N. neonatology, obstetrics, and pediatrics clinics as a deliberate affront to their own enlightened social policies and healthcare capabilities.
Which, at least from my perspective, they were intended to be—especially their social policies: By now, government leaders in general, and in particular those in charge of the more economically disadvantaged, socially deprived (i.e., corrupt) countries (together with those dedicated to toppling them), had earned their way to the very apex of my personal list of people never sufficiently to be despised.
The leaders of these various factions always seemed able to afford weapons and ammunition in quantities adequate to “protect” their people (the same long-suffering civilian population inevitably was claimed by all contenders) from the soul-blighting contamination represented by exposure to, and/or government by, those espousing the wrong ideology/religion/parentage, et cetera; which “protection” invariably left said civilian population homeless, starving, disease-ridden refugees—a point somehow overlooked by would-be rebel saviors and righteous defenders of the status quo alike.
But in any event, providing decent food, shelter, and medical care thereafter (or beforehand, for that matter) seemed to constitute a separate, much more difficult (if somehow less interesting) challenge. . . .
∆ ∆ ∆
I muttered further imprecations into my mask and inclined my head in Ng’s direction once again to have my forehead sponged before the steadily mounting flood spilled over into the operative field.
Doubtless these soldiers, like those who had so frequently preceded them (government forces and rebels alike) were here to order us, once again, to limit our services to women and children holding political views of which their faction approved, and would warn us most sternly to have nothing to do with those in any way associated with the “other” side.
Such confrontations had become routine by now; and, in the tiny portion of my mind not occupied with the utterly precise surgery in which I was engaged, I found myself reviewing the earnest, slightly-puzzled-but-eager-to-please diplomatic tone which had proved effective on so many prior similar occasions:
Of course we understood the political necessities which lay behind such orders. Nothing would please us more than to be able to comply with them. We would never violate governmental (or rebel, depending upon the identity of our visitors) directives. Certainly not knowingly . . .
Oh, but there lay the core of the problem: The stated loyalties of a parent were hardly a reliable test. It seemed likely that a woman, concerned about the progress of her pregnancy, or the well-being of her living but obviously sick child or children, might not be entirely candid when questioned about her political affiliation, once it became known that only one faction was entitled to treatment.
Besides, who could say who might end up with the support of children we treated, if they were allowed to reach adulthood? Had not the revolution sundered families? Were not fathers pitted against sons, brothers against brothers?
Obviously those promulgating such edicts must already have solved the problem—certainly responsible governmental (or would-be governmental) leaders would never issue orders adversely affecting the well-being of whole blocs of their own people without accompanying those orders with guidelines sufficiently detailed to enable those charged with carrying them out to fulfill their responsibilities.
Therefore, I would ask (always with wide-eyed optimism), would they please share with us their obviously foolproof means of determining the ideology of a mother, child, or fetus? For without that assistance, I would explain (always apologetically, with toe-scuffing embarrassment), we were effectively helpless to follow the directives, however much we might wish to comply. . . .
The word-games which preceded such envoys’ disorderly, inevitably sheepish retreats tended to be repetitious and childish, but I still managed to derive a certain perverse, if not downright vindictive, satisfaction from them.
I was not surprised to be receiving yet another visit from officialdom—whichever side they represented; at this point I didn’t know, and cared even less. Nor was I particularly apprehensive over the fact that the last bunch had departed only two days before.
The real crisis which their presence represented was the fact that today their timing was potentially disastrous: I was up to my elbows in the chest cavity of this four-year-old boy. I had repaired the first of two rheumatically damaged heart valves, but several hours of uncompromisingly delicate work still lay ahead before I could even think of turning the procedure over to my dedicated but only marginally competent, home-grown and locally recruited and trained surgical assistants for final closing.
And while I could, theoretically, interrupt the procedure briefly at this point to deal with yet another episode of official harassment, doing so would involve relying on the questionable alertness, dubious skills, and untested independent judgment of my amateur-status anesthetist (not to mention the reliability of our creaky old, donated heart-lung machine—which, by rights, should have been gathering dust in a museum rather than being relied upon in a life-and-death surgical procedure) to maintain the child for however long it might take to abate whatever nuisance the military had planned, plus the time it would take me to rescrub and don fresh gown, gloves, and mask.
Yes, theoretically I could “take five” at this point. However, the reality of the situation was that, if I stopped now, the prognosis was better than even money that I’d lose this little boy. And I don’t like losing children.
The decision was made much faster than the above makes it appear: “Tell them what I’m doing, and that I’ll talk to them as soon as I’m finished,” I called out to whomever might be listening, and made the first incision to begin repairing the boy’s second defective valve.
“You are finished now, doctor lady,” rasped a harsh voice from the direction of the curtained opening which constituted the door to our makeshift little operating room.
Turning as quickly as was consistent with the delicate status of the procedure, I beheld several heavily armed government soldiers standing just inside the room. At their head was a short, physically slight but obviously well-conditioned, bleak-visaged Cambodian regular army major, whose aspect reflected the humorless, barely restrained ideological fanaticism which I had seen so many times before in these parts. He was smiling—but only with his mouth.
The situation was so startling, the violation of operating-room asepsis protocol so flagrant, the potential consequences to my patient so gross and inexcusable, that for fractions of a second only the doctor in me responded—with an explosion of outrage so intense as to be almost physical.
“Get out!” I hissed, glaring over my mask. Quickly, in what I knew was probably already a futile effort to prevent contamination of the operative site, I pulled a drape cloth over the incision.
“You’re not sterile!” I continued furiously. “Just by walking in here, dressed like that, you may have killed this child. What on Earth do you think you’re doing . . . ?”
“What I am doing is investigating reports of atrocities being committed upon helpless women and children,” the major replied with a smirk. Looking me smugly in the eye, he strutted mincingly across the room to my side. “I am investigating reports of illegal medical experiments. Stories of vivisection and torture.”
Diminutive stature notwithstanding, he brushed me effortlessly to one side and drew back the drape. Long and thoughtfully he stared down at the child’s exposed, partially opened heart.
Pure malice flickered at the edges of his smile. “I see that the reports were, if anything, understated,” he observed with unconcealed relish. “To do such a thing to a small boy . . . Such cruelty is beyond my meager powers to comprehend. You are all under arrest.”
From outside there came the sound of screams and running footsteps, the sudden, unmistakable roar of machine-gun fire—then silence. . . .
Motioning to the heart-lung machine, the major said, “Sergeant, have this torture device prepared for transport to headquarters. It will be needed as evidence.”
Without expression, the noncom stepped forward. For long moments I could only stare in horrified disbelief as he drew a long knife with one hand and gathered a loop of blood-filled tubing against the edge with the other.
Completely without warning (least of all to me), I found myself across the room, beating furiously (with humiliatingly stereotypical geriatric, never mind feminine, futility) on the sergeant’s back with the heels of both fists, shrieking at him to stop. He glanced over his shoulder with a surprised expression.
The major began a short, harsh laugh—which ended abruptly midbark. Momentarily the sergeant looked puzzled; then he slumped bonelessly to the floor.
Ng’s gasp was loud in the nearly palpable silence which had descended upon the operating room. Half a dozen bright crimson stains had begun to spread across the back of the sergeant’s uniform.
Only gradually, I became aware of the old-fashioned, long-handled scalpel still clutched point-down in my fist.
The major stalked unhurriedly across the room, took the instrument from my hand with surprising gentleness, and nudged the fallen soldier with the toe of a mud-covered boot.
There was no response. I could see no hint of respiration. At least two of the stains were proximal to the heart; a third was directly over the aorta. The blood was visibly arterial.
The major raised his eyes to mine. His mouth smiled again. “Better and better,” he approved. “Unprovoked, premeditated murder of a duly authorized servant of the people engaged in the lawful performance of his duties. First torture and forbidden medical experiments, and now this. You have much to answer for. . . .”