"One night he upped and left. Vanished without a trace. No one's heard from him since."
"Okay," Quinn said. "I'll stay. But not too long."
"All right!" Tim said, making room for her beside him. "Where were we?"
It was some sort of tradition. No one knew how it got started, but it had been going as long as anyone could remember. The floating bull session, wandering from room to room, from floor to floor, changing personnel from night to night, hibernating during class hours and sleep time, but reawakening every night after dinner to pick up where it had left off.
Quinn rarely got involved in the sessions; she had too much work to do, always seemed just on the verge of—but never quite—catching up. But when she did sit in, the topic almost always gravitated toward Dr. Alston's lectures. Like tonight.
"I was up," Judy Trachtenberg said. "I was just saying that if rationing of medical services is inevitable, maybe the elderly should be put at the ends of the waiting lists."
"Sure," Tim said. "I can just see you telling your grandmother she can't have that hip operation because she's over 75."
"So, I'd find away to squeeze her in," Judy said with an expressive shrug.
Her casual attitude offended Quinn. As much as she wanted to avoid getting mired in one of these endless conversations, she had to speak.
"Either you believe in what you're proposing or you don't," she said. "You can't say this is how we're going to do it, these are the rules and they apply to everyone equally—except my friends and family."
Judy laughed. "Quinn, where have you been for the past thousand years? This is the way the world works. What you know is nowhere near as important as who you know."
Quinn felt herself reddening but pressed on.
"But then you run into the corruption of the magnitude of old USSR-style Communism, where the size of your apartment and the amount of meat on your plate depended on how buddy-buddy you were with the local commissar. I don't think that kind of system is the answer."
"Well, we need some kind of system," Judy said. "Like a national health insurance program that will keep costs down so we can distribute the services as broadly as possible."
"And end up like the Brits?" Tim said. "No thanks. Their system is broke and they're already rationing care to the elderly. A million people on waiting lists. Nobody over 55 gets dialysis. Chemotherapy and coronary bypasses are strictly rationed too. That's pretty cold. That kind of system seems to insure that everyone gets some health care but no one gets great health care. And I'm one hundred per cent against rationing."
"So am I," Judy said. "But since I don't plan to practice in Shangri-La, what do we do when we can't treat everybody on demand?"
"Do it on a need basis," Tim said. "The guy whose heart has the worst coronary arteries and is just about to quit gets first spot on the list, and the next worst gets second, and so on."
Quinn said, "But what about the guy who's far down the list with only one bad coronary artery, but his angina's bad enough to keep him from running his fork lift? Does he have to wait till he's in cardiogenic shock before he gets some help?"
"If he gets worse, we move him up the list."
"In other words, under your system people will have to get sicker before they can get well?"
Tim scratched his head, his expression troubled. "You know, I never looked at it like that."
"Okay, Quinn," Judy said. "Now that you've shot everything down, what's your solution to the mess?"
"The coming mess," Quinn said. "Dr. Alston talks like it's already here, but it's not. And with the way medical knowledge and technology are advancing, the entire practice of medicine could be revolutionized by 2011. It might be nothing like what we see today. We'll have new resources, new methods of delivery, we might be able to handle —"
"You can't count on that," Judy said.
"Technological growth is exponential," Quinn said. "As the base broadens—"
"You still can't count on it."
Quinn sighed. Judy was right. No matter what happened, the Medicare population was going to double in the next thirty to forty years, but medical resources weren't going to double with them.
She had a sudden vision of the future. She found herself in the worn-down and rusted-out body of an elderly woman, seventy-six years old, with a failing heart, gallstones, and arthritis, trudging from specialist to specialist, clinic to clinic, hospital to hospital, trying to find relief, and being told repeatedly that none of her conditions met the established criteria that would allow immediate medical intervention, so she'd have to wait her turn.
True enough, perhaps, on paper. True enough according to the numbers the medical facilities had used to encode her diagnoses for the government computers.
True enough: Her heart failure had been gauged as Grade II, which meant the old pump was failing, its reserve low enough to make a breathless chore of walking a single block, but still pumping well enough to keep her from being completely incapacitated; Grade II heart failure warranted only a limited work-up and certainly not aggressive therapy.
True enough: Her Grade II gallbladder disease did not trigger attacks of sufficient severity to yellow her skin or generate enough unremitting pain to warrant emergency surgery, but her rattling gallstones did cause her daily abdominal distress and incessant belching, and she lived in constant fear of another attack, so much so that each meal had become a form of gastric Russian roulette.
True enough: The Grade III arthritis in her hip elicited a bolt of pain whenever she went up or down a stair, and her spine was arthritic enough to cause it to stiffen like a rusty gate whenever she sat or reclined for more than fifteen minutes, which made rising from a chair or getting out of bed each morning an excruciating ordeal; but her symptoms—when adjusted for age—did not code severe enough (you needed Grade V) under the federal guidelines to warrant hip surgery or even one of the newer, more potent anti-inflammatory medications that were in such short supply; she'd have to make do with the older, more tried-and-true (and lower-priced) generics.
All true enough—when each condition was considered one at a time. If she had been afflicted with just the arthritis, or merely the gallstones, or simply the heart failure, she could have handled it. And she even might have coped fairly well with a combination of any two of them.
But all three?
The triple whammy was slowly doing her in, melting her days into exhausted blurs, nibbling away at her quality of life to the point where she'd begun to wonder whether life was worth living any longer.
Why wasn't there a code for the quality of life? Why couldn't the computers add up a person's Grade II's and Grade III's and send up a red flag that said Help when they reached a certain critical number—regardless of age?
Was that what it was going to be like? Number-coded doctors treating the number-coded diseases afflicting number-coded patients? There had to be another way.
But what?
"Quinn?" It was Tim's voice. "Yo, Quinn. Where are you? Come back to us."
Quinn shook herself. "I'm, uh, thinking," she said.
"Good," Tim said. "I thought you were in a trance. Come up with anything?"
"No," she said. "No solution. Sooner or later the politicians and bureaucrats are going to take over completely. They can control the funds and the distribution of their so-called resources—and they'll consider us 'resources' too—but they can't control the delivery of compassion, can they?"
Judy groaned but Tim cut her off with a karate-chop wave of his hand.
Tim nodded. "You said it. The empty suits will try to get into the hospital charts, into the operating rooms, into the office records, even into the examining rooms." He tapped his chest. "They'll even try to get in here, and believe me, plenty of times they'll succeed, but they can't get a piece of that special chemistry that happens between a doctor and a patient unless we let them. And part of that chemistry is compassion. Empathy."