Trying to clamp the left branch of the portal vein, I slipped, and the clamp closed tightly on a swollen cyst at the base of the liver, full of grey-white colon cells. It didn’t burst open, but it might have been better if it had; I couldn’t literally see where the contents was squirted, but I could imagine the route very clearly: back as far as the Y-junction of the vein, where the blood flow would carry cancerous cells into the previously unaffected right lobe.
I swore for ten seconds, enraged by my own helplessness. I had none of the emergency tools I was used to: there was no drug I could inject to kill off the spilt cells while they were still more vulnerable than an established tumour, no vaccine on hand to stimulate the immune system into attacking them.
Okwera said, “Tell the parents you found evidence of leakage, so she’ll need to have regular follow-up examinations.”
I glanced at Masika, but he was silent.
“I can’t do that.”
“You don’t want to cause trouble.”
“It was an accident!”
“Don’t tell her, and don’t tell her family.” Okwera regarded me sternly, as if I was contemplating something both dangerous and self-indulgent. “It won’t help anyone if you dive into the shit for this. Not her, not you. Not the hospital. Not the volunteer program.”
The girl’s mother spoke English. I told her there were signs that the cancer might have spread. She wept, and thanked me for my good work.
Masika didn’t say a word about the incident, but by the end of the day I could hardly bear to look at him. When Okwera departed, leaving the two of us alone in the locker room, I said, “In three or four years there’ll be a vaccine. Or even HealthGuard software. It won’t be like this forever.”
He shrugged, embarrassed. “Sure.”
“I’ll raise funds for the research when I get home. Champagne dinners with slides of photogenic patients, if that’s what it takes.” I knew I was making a fool of myself, but I couldn’t shut up. “This isn’t the nineteenth century. We’re not helpless anymore. Anything can be cured, once you understand it.”
Masika eyed me dubiously, as if he was trying to decide whether or not to tell me to save my platitudes for the champagne dinners. Then he said, “We do understand Yeyuka. We have HealthGuard software written for it, ready and waiting to go. But we can’t run it on the machine here. So we don’t need funds for research. What we need is another machine.”
I was speechless for several seconds, trying to make sense of this extraordinary claim. “The hospital’s machine is broken―?”
Masika shook his head. “The software is unlicensed. If we used it on the hospital’s machine, our agreement with HealthGuard would be void. We’d lose the use of the machine entirely.”
I could hardly believe that the necessary research had been completed without a single publication, but I couldn’t believe Masika would lie about it either. “How long can it take HealthGuard to approve the software? When was it submitted to them?”
Masika was beginning to look like he wished he’d kept his mouth shut, but there was no going back now. He admitted warily, “It hasn’t been submitted to them. It can’t be―that’s the whole problem. We need a bootleg machine, a decommissioned model with the satellite link disabled, so we can run the Yeyuka software without their knowledge.”
“Why? Why can’t they find out about it?”
He hesitated. “I don’t know if I can tell you that.”
“Is it illegal? Stolen?” But if it was stolen, why hadn’t the rightful owners licensed the damned thing, so people could use it?
Masika replied icily, “Stolen back. The only part you could call ‘stolen’ was stolen back.” He looked away for a moment, actually struggling for control. Then he said, “Are you sure you want to know the whole story?”
“Yes.”
“Then I’ll have to make a phone call.”
Masika took me to what looked like a boarding house, student accommodation in one of the suburbs close to the campus. He walked briskly, giving me no time to ask questions, or even orient myself in the darkness. I had a feeling he would have liked to have blindfolded me, but it would hardly have made a difference; by the time we arrived I couldn’t have said where we were to the nearest kilometre.
A young woman, maybe nineteen or twenty, opened the door. Masika didn’t introduce us, but I assumed she was the person he’d phoned from the hospital, since she was clearly expecting us. She led us to a ground floor room; someone was playing music upstairs, but there was no one else in sight.
In the room, there was a desk with an old-style keyboard and computer monitor, and an extraordinary device standing on the floor beside it: a rack of electronics the size of a chest of drawers, full of exposed circuit boards, all cooled by a fan half a metre wide.
“What is that?”
The woman grinned. “We modestly call it the Makerere supercomputer. Five hundred and twelve processors, working in parallel. Total cost, fifty thousand shillings.”
That was about fifty dollars. “How―?”
“Recycling. Twenty or thirty years ago, the computer industry ran an elaborate scam: software companies wrote deliberately inefficient programs, to make people buy newer, faster computers all the time―then they made sure that the faster computers needed brand new software to work at all. People threw out perfectly good machines every three or four years, and though some ended up as landfill, millions were saved. There’s been a worldwide market in discarded processors for years, and the slowest now cost about as much as buttons. But all it takes to get some real power out of them is a little ingenuity.”
I stared at the wonderful contraption. “And you wrote the Yeyuka software on this?”
“Absolutely.” She smiled proudly. “First, the software characterises any damaged surface adhesion molecules it finds―there are always a few floating freely in the bloodstream, and their exact shape depends on the strain of Yeyuka, and the particular cells that have been infected. Then drugs are tailor-made to lock on to those damaged adhesion molecules, and kill the infected cells by rupturing their membranes.” As she spoke, she typed on the keyboard, summoning up animations to illustrate each stage of the process. “If we can get this onto a real machine … we’ll be able to cure three people a day.”
Cure. Not just cut them open to delay the inevitable.
“But where did all the raw data come from? The RNA sequencing, the X-ray diffraction studies…?”
The woman’s smile vanished. “An insider at HealthGuard found it in the company archives, and sent it to us over the net.”
“I don’t understand. When did HealthGuard do Yeyuka studies? Why haven’t they published them? Why haven’t they written software themselves?”
She glanced uncertainly at Masika. He said, “HealthGuard’s parent company collected blood from five thousand people in Southern Uganda in 2013. Supposedly to follow up on the effectiveness of their HIV vaccine. What they actually wanted, though, was a large sample of metastasising cells so they could perfect the biggest selling point of the HealthGuard: cancer protection. Yeyuka offered them the cheapest, simplest way to get the data they needed.”
I’d been half expecting something like this since Masika’s comments back in the hospital, but I was still shaken. To collect the data dishonestly was bad enough, but to bury information that was half-way to a cure―just to save paying for what they’d taken―was unspeakable.
I said, “Sue the bastards! Get everyone who had samples taken together for a class action: royalties plus punitive damages. You’ll raise hundreds of millions of dollars. Then you can buy as many machines as you want.”
The woman laughed bitterly. “We have no proof. The files were sent anonymously, there’s no way to authenticate their origin. And can you imagine how much HealthGuard would spend on their defence? We can’t afford to waste the next twenty years in a legal battle, just for the satisfaction of shouting the truth from the rooftops. The only way we can be sure of making us
e of this software is to get a bootleg machine, and do everything in silence.”
I stared at the screen, at the cure being played out in simulation that should have been happening three times a day in Mulago hospital. She was right, though. However hard it was to stomach, taking on HealthGuard directly would be futile.
Walking back across the campus with Masika, I kept thinking of the girl with the liver infestation, and the possibility of undoing the moment of clumsiness that would otherwise almost certainly kill her. I said, “Maybe I can get hold of a bootleg machine in Shanghai. If I knew where to ask, where to look.” They’d certainly be expensive, but they’d have to be much cheaper than a commissioned model, running without the usual software and support.
My hand moved almost unconsciously to check the metal pulse on my index finger. I held the ring up in the starlight. “I’d give you this, if it was mine to give. But that’s thirty years away.” Masika didn’t reply, too polite to suggest that if I’d owned the ring outright, I wouldn’t even have raised the possibility.
We reached the University Hall; I could find my way back to the guest house now. But I couldn’t leave it at that; I couldn’t face another six weeks of surgery unless I knew that something was going to come of the night’s revelations. I said, “Look, I don’t have connections to any black market, I don’t have a clue how to go about getting a machine. But if you can find out what I have to do, and it’s within my power … I’ll do it.”
Masika smiled, and nodded thanks, but I could tell that he didn’t believe me. I wondered how many other people had made promises like this, then vanished back into the world-without-disease while the Yeyuka wards kept overflowing.
As he turned to go, I put a hand on his shoulder to stop him. “I mean it. Whatever it takes, I’ll do it.”
He met my eyes in the dark, trying to judge something deeper than this easy protestation of sincerity. I felt a sudden flicker of shame; I’d completely forgotten that I was an impostor, that I’d never really meant to come here, that two months ago a few words from Lisa would have seen me throw away my ticket, gratefully.
Masika said quietly, “Then I’m sorry that I doubted you. And I’ll take you at your word.”
Mubende was a district capital, half a day’s drive west of Kampala. Iganga delayed our promised trip to the Yeyuka clinic there until my last fortnight, and once I arrived I could understand why. It was everything I’d feared: starved of funds, under-staffed and over-crowded. Patients’ relatives were required to provide and wash the bedclothes, and half of them also seemed to be bringing in painkillers and other drugs bought at the local markets―some genuine, some ripoffs full of nothing but glucose or magnesium sulphate.
Most of the patients had four or five separate tumours. I treated two people a day, with operations lasting six to eight hours. In ten days, seven people died in front of me; dozens more died in the wards, waiting for surgery.
Or waiting for something better.
I shared a crowded room at the back of the clinic with Masika and Okwera, but even on the rare occasions when I caught Masika alone, he seemed reluctant to discuss the details of getting hold of a bootleg HealthGuard. He said, “Right now, the less you know the better. When the time comes, I’ll fill you in.”
The ordeal of the patients was overwhelming, but I felt more for the clinic’s sole doctor and two nurses; for them, it never ended. The morning we packed our equipment into the truck and headed back for Kampala, I felt like a deserter from some stupid, pointless war: guilty about the colleagues I was leaving behind, but almost euphoric with relief to be out of it myself. I knew I couldn’t have stayed on here―or even in Kampala―month after month, year after year. However much I wished that I could have been that strong, I understood now that I wasn’t.
There was a brief, loud stuttering sound, then the truck squealed to a halt. The four of us were all in the back, guarding the equipment against potholes, with the tarpaulin above us blocking everything but a narrow rear view. I glanced at the others; someone outside shouted in Luganda at Akena Ibingira, the driver, and he started shouting back.
Okwera said, “Bandits.”
I felt my heart racing. “You’re kidding?”
There was another burst of gunfire. I heard Ibingira jump out of the cab, still muttering angrily.
Everyone was looking at Okwera for advice. He said, “Just cooperate, give them what they want.” I tried to read his face; he seemed grim but not desperate―he expected unpleasantness, but not a massacre. Iganga was sitting on the bench beside me; I reached for her hand almost without thinking. We were both trembling. She squeezed my fingers for a moment, then pulled free.
Two tall, smiling men in dirty brown camouflage appeared at the back of the truck, gesturing with automatic weapons for us to climb out. Okwera went first, but Masika, who’d been sitting beside him, hung back. Iganga was nearer to the exit than me, but I tried to get past her; I had some half-baked idea that this would somehow lessen her risk of being taken off and raped. When one of the bandits blocked my way and waved her forward, I thought this fear had been confirmed.
Masika grabbed my arm, and when I tried to break free, he tightened his grip and pulled me back into the truck. I turned on him angrily, but before I could say a word he whispered, “She’ll be all right. Just tell me: do you want them to take the ring?”
“What?”
He glanced nervously towards the exit, but the bandits had moved Okwera and Iganga out of sight. “I’ve paid them to do this. It’s the only way. But say the word now and I’ll give them the signal, and they won’t touch the ring.”
I stared at him, waves of numbness sweeping over my skin as I realised exactly what he was saying.
“You could have taken it off under anaesthetic.”
He shook his head impatiently. “It’s sending data back to HealthGuard all the time: cortisol, adrenaline, endorphins, prostaglandins. They’ll have a record of your stress levels, fear, pain … if we took it off under anaesthetic, they’d know you’d given it away freely. This way, it’ll look like a random theft. And your insurance company will give you a new one.”
His logic was impeccable; I had no reply. I might have started protesting about insurance fraud, but that was all in the future, a separate matter entirely. The choice, here and now, was whether or not I let him have the ring by the only method that wouldn’t raise suspicion.
One of the bandits was back, looking impatient. Masika asked plainly, “Do I call it off? I need an answer.” I turned to him, on the verge of ranting that he’d wilfully misunderstood me, abused my generous offer to help him, and put all our lives in danger.
It would have been so much bullshit, though. He hadn’t misunderstood me. All he’d done was taken me at my word.
I said, “Don’t call it off.”
The bandits lined us up beside the truck, and had us empty our pockets into a sack. Then they started taking watches and jewellery. Okwera couldn’t get his wedding ring off, but stood motionless and scowling while one of the bandits applied more force. I wondered if I’d need a prosthesis, if I’d still be able to do surgery, but as the bandit approached me I felt a strange rush of confidence.
I held out my hand and looked up into the sky. I knew that anything could be healed, once it was understood.
ONLY CONNECT
It’s beginning to look as if E.M. Forster’s famous dictum was superfluous. A theory in which the building blocks of the universe are mathematical structures, known as graphs, which do nothing but connect, has just passed its first experimental test.
A graph can be drawn as a set of points, called nodes, and a set of lines joining the nodes, called edges. Details such as the length and shape of the edges aren’t part of the graph itself, though; the only thing that distinguishes one graph from another are the connections between the nodes. The number of edges that meet at any given node is known as its valence.
In Quantum Graph Theory, or QGT, a quantum state describing bot
h the geometry of space and all the matter fields present is built up from combinations of graphs. The theory reached its current form in the work of the Javanese mathematician Kusnanto Sarumpaet, who published a series of six papers from 2035 to 2038 showing that both General Relativity and the Standard Model of particle physics could be seen as approximations to QGT.
Sarumpaet’s graphs have a fascinating lineage, dating back to Michael Faraday’s notion of “lines of force” running between electric charges, and William Thomson’s theory of atoms as knotted “vortex tubes”. Closer ancestors are Roger Penrose’s spin networks, trivalent graphs with each edge labelled by a half integer, corresponding to a possible value of the spin of a quantum particle. Penrose invented these networks in the early 1970s, and showed that the set of all directions in space could be generated from simple, combinatorial principles by imagining an exchange of spin between two parts of a large network.
Generalisations of spin networks later appeared in certain kinds of Quantum Field Theory. Just as a wave function assigns an amplitude to every possible position of a particle, a spin network embedded in a region of space can be used to assign an amplitude to every possible configuration of a field. The quantum states defined in this way consist of lines of flux running along the edges of the network.
In the 1990s, Lee Smolin and Carlo Rovelli discovered an analogous result in quantum gravity, where spin network states have a simple geometric interpretation: the area of any surface depends entirely on the edges of the network that intersect it. These edges can be thought of as quantised “flux lines of area”, and in quantum gravity area and other geometric measurements take on a discrete spectrum of possible values. It then makes sense to quantise the topology as well, with the nodes and edges of the network replacing the usual idea of space as a continuum of points.
In the first decades of the new millennium, John Baez, Fotini Markopoulou, José-Antonio Zapata and others did ground-breaking work on the possible dynamical laws for spin networks, assigning quantum amplitudes to the process of one network evolving into another. In the 2030s, Sarumpaet began to synthesise these results into a new model, based on graphs of arbitrary valence with unlabelled edges.