“You’re doing the math right,” Michael assured her. “In fact it is less than half of one percent. I’d say it’s a damn good advertisement for automation, which is what they had told us was key.”
“Like I said, they have to be doing something right. It’s even more impressive if they are using their patients for drug testing.”
“What did you say you found was the major cause of death in coma patients?”
“Pneumonia and other infections often stemming from bedsores. It is because the patients are so immobile.”
“Maybe keeping visitation to a minimum really works. It’s like reverse precautions for immune-compromised people.”
Lynn nodded. Michael had a good point, even though the visitation policy bothered her from a personal perspective because of Carl. “Let’s look at the other side of the coin,” she said, “and check how many people recovered enough to be discharged. Remember, trauma is a major cause of coma and around ten percent of them recover enough to go home.”
Suddenly Michael straightened up. He looked back toward the hallway.
“What’s the matter?” Lynn asked nervously. As focused as she was on what she was doing, she had forgotten where they were.
“I thought I heard something,” Michael said.
For a few moments both students listened intently, holding their breaths. All they could hear was the hum of the powerful ventilation system.
“I don’t hear anything suspicious,” Lynn said.
“Nor do I,” Michael agreed. “Okay, my mind must be playing tricks.” Nervously he glanced at his watch. “I’m thinking it’s best if we get our asses out of here. Someone someplace is going to be aware that these stats are being accessed by someone in the middle of the fucking night. What we are doing here is legally more serious than our coming into this place.”
“I’m with you,” Lynn said. “I know! But this is important. Just a few minutes more.” She went back to the keypad and quickly asked for the number of people discharged since the Shapiro had been in operation. The answer was as surprising as the death rate: none!
Lynn looked back up at Michael. She was taken aback. “I’m not sure which is more incredible: the low death rate or the lack of any discharges.”
“Well, maybe they don’t take trauma patients.”
“I can’t believe that. As I said, trauma is a major cause of persistent vegetative state and coma.” Lynn laughed even though she didn’t find anything funny. “They are doing a bang-up job with survival but have a piss-poor cure rate.”
“Okay, let’s go,” Michael said. He tried to pull Lynn’s chair back from the terminal.
Lynn resisted. “Just one more thing,” she said. “Let’s see what the cause of death was for the thirty-one patients. I’d guess pneumonia will top the list.” Quickly Lynn typed in the query, and when the answer came back, she was as shocked as she had been when she found out there had been no discharges. Almost half the deaths were from multiple myeloma!
Throwing up her hands, Lynn said, “This can’t be true. No way!”
“It’s big-time weird,” Michael agreed, but at the moment he had other things on his mind even if she didn’t. With a bit more force he succeeded in pulling her chair back. “Enough data surfing if you want to try to visit Cluster 4-B and the recreation space, like we planned!” Without waiting for a response, he went to the door and opened it. When he was sure the coast was clear he said, “All right, let’s go, girl! Get your ass in gear!”
Lynn followed him out into the hallway. She looked stunned. “Those numbers are crazy! How can the Shapiro have a death rate from multiple myeloma that is one hundred times what’s seen in the general population?”
“Let’s hold off this conversation until we get out of here,” Michael snapped as he got the NOC door to close. It was a pocket door operated by a touch pad in the wall at chest height. “Come on! Let’s get to the stairway.”
For the rest of the way down to the stairwell door, Lynn held her tongue, but her mind was roiling. As soon as the stairwell door closed behind them, she stopped and said, “I’m sorry, but there is something truly weird about multiple myeloma and this institute.”
“Listen!” Michael said with exasperation. “Let’s get this visit over with before we launch into a lengthy discussion about what it all means. You seem to be forgetting we’re on borrowed time in hostile territory.” He undid his mask for a moment to wipe the perspiration off his face. It was warm and humid in the stairwell.
“Okay, you’re right,” Lynn said. “But I wish I’d had tried to see if there is any data on the incidence of gammopathy in here. Maybe on our way out, we can stop back in the NOC. It would only take a couple of minutes.”
“We’ll keep it in mind,” Michael said, replacing his mask. “Provided, of course, we are not being chased.”
“Don’t joke about such a thing,” Lynn said.
“I’m not joking,” Michael said.
As they descended the stairs down to level four, Lynn consulted the floor plan. When they reached the landing, they paused outside the door and she showed him that there were several ways for them to get to Cluster 4-B.
“Let’s stay as far away as we can from the room labeled ‘automation control.’ My sense is that is where the staff will be holed up.”
“Good point,” Lynn said. “That means we should go left out of the stairwell and follow the hallway to the end and then turn right. I hope the doors are labeled. If they are not, it will be the fourth door on the right after the turn.”
Michael cracked the door onto the fourth floor and listened. Except for the omnipresent sound of the HVAC, silence reigned. He opened the door just enough to look up and down the hallway. It was a mirror image of the hallway above on five and just as white and brightly illuminated. Most important, it was similarly without a soul in sight. The only difference was that, at its far end, it lacked a door to the exterior. “Let’s not make this our life’s work, you know what I’m saying?”
Lynn knew exactly what Michael meant. “I’ll be right behind you,” she said.
It wasn’t a mad dash, but they moved as quickly and silently as they could, passing under a number of what they guessed were ceiling-mounted video cameras. The doors that they passed were labeled, for the most part. They turned the corner and resumed their speed. They hadn’t needed to count. Cluster 4-B was clearly labeled on the door in black sans serif letters and numerals.
“You ready?” Michael questioned.
“As ready as I ever will be,” Lynn responded, bracing herself. Seeing Carl in this sterile, deserted place was going to be an emotional challenge.
45.
Thursday, April 9, 12:48 A.M.
The door to Cluster 4-B was a pocket door, like the one to the NOC, only stouter. And like the door to the NOC, it was operated electronically, with a lever to the right of the frame. Michael pressed it and the door started to slide open.
Before they could see inside the room, they heard the intermittent whining of electrical motors and the clanking of heavy machinery. The noise had been completely muffled by the sound-insulated door and the walls. As the door opened all the way, Lynn and Michael were treated to a view of what looked like a completely mechanized, highly complex assembly line in an automobile plant, with robotic arms, and a forklift-like apparatus with oversize rubber tires connected to a constantly moving conveyor system. No staff was in attendance.
With some trepidation they entered, and the door automatically closed behind them. It was a large rectangular room about the size of a small theater, with a very high ceiling. The level of sound was so loud that they practically had to yell to hear each other. The air was warm and humid.
“Can you fucking believe this?” Michael half shouted.
“It’s like a futuristic horror movie,” Lynn yelled. She was taken aback, unsure if she truly wanted t
o see what was in front of her. “This is automated patient care taken to the nth degree.”
“And there are eleven other rooms just like it,” Michael said in awe.
The entire right side of the room was composed of a hundred angled but mostly horizontal Plexiglas cylinders in twenty-five vertical stacks of four. Each cylinder in each stack was about four feet in diameter and seven feet deep, separated from other ones on either side by a three-foot-wide metal grate. These grates formed a scaffold as a means of access for service, and could be reached by metal ladders that were attached. The opening to the lowest cylinder was waist high and the highest was near the ceiling. Each cylinder was numbered and had a computer monitor on an adjustable arm.
As Lynn and Michael stared in horror, they could now appreciate that about half the cylinders contained a patient, each naked save for the headgear resembling a football helmet that they remembered the mannequin wearing during their second-year introductory visit.
Suddenly, through an opening high up, on the left side of the room, a supine, naked, comatose patient entered the room moving quickly on the conveyor system. He, too, had a helmet. In a manner that reminded Lynn and Michael of a modern baggage-handling system at a major airport, the patient was rapidly transported to a specific area of the room not too far away from where they were standing. With some additional clanking and grinding noises the entire conveyor system adjusted to bring the patient just outside the proper cylinder, which was the top container in the sixth row. There, the robotic arms went to work to make all the appropriate connections for the feeding tube and other embedded lines. Once all the connections were set up, which happened surprisingly quickly, the patient was slid into the cylinder like a rocket being loaded into a launcher.
Before Lynn and Michael could respond to what they had just seen, the conveyor system noisily repositioned itself seven rows away from where it had deposited the first patient, and rapidly extracted a second patient from a different cylinder. Once this second body was completely in the open, the robotic arms went to work disconnecting the various lines. Then, following a reverse route from that of the first, the second patient was zipped out of the room. Everything was accomplished in just a few minutes.
“Good God!” Lynn exclaimed when she could find her voice. “This is obscenely mechanized. There’s no humanity, no dignity! It’s against everything medicine stands for.”
“Where the hell do you suppose the bodies are going?” Michael asked.
“God only knows,” Lynn said. At that point they were treated to a repeat of the sequence, with another body coming back from parts unknown. After that, another body was taken away. The students soon got the impression that what they were witnessing was a constant process, maybe even 24/7, of bodies coming and going.
Being careful to steer clear of the huge and very active business end of the conveyor system that unpredictably moved back and forth on its oversize tires and up and down in front of the cylinders, the two students approached the last stack. Despite their horror, they felt a morbid curiosity. The cylinder at waist level was numbered 100. The one immediately above it was 99. Approaching the mouth of the hundredth cylinder, they looked inside. The patient was female, lying on a series of moving rollers to keep pressure off any given spot. While they were watching, a sprinkler system was suddenly activated inside the cylinder, rinsing and disinfecting the woman. A sucking sound came from the base of the cylinder as the fluid was drawn off. From their vantage point, they could appreciate that the container was angled down at an incline of something like fifteen degrees.
“It’s like a freaking car wash,” Michael commented with a mixture of disgust and admiration. “Somebody’s put some real thought into all this.”
“I suppose that’s why their survival rate is so good.”
The monitor to the side of the cylinder showed the patient’s home page, which included her name, Gloria Parkman; her age, thirty-two; her location, Cluster 4-B 100; RANIBIZUMAB 3+ ACTIVE; and a long list of real-time vital signs and other extensive monitoring data. The monitoring was so extensive that the students intuitively understood that the patient had to have sensor chips implanted to make it possible. There were even real-time electroencephalogram tracings.
“Hey, I just remembered something,” Michael said. “Ranibizumab was in the ophthalmology lecture yesterday. It’s used for macular degeneration and is well tolerated without allergic problems.”
“If it is already an established drug, I wonder why they are giving it to her?”
“Good question,” Michael said. “Maybe there are still some allergic issues that the lecturer didn’t mention. But one way or the other, I’m beginning to think coming here might raise more questions than give answers.” Ducking his head, he moved down alongside the cylinder, between the cylinder and the wall. He was impressed by the constantly moving roller system that kept the patient’s body in motion while avoiding pressure point problems. It was a kind of massage system in a tube that encouraged circulation and protected the integrity of the skin.
“Hey!” Michael yelled to Lynn. “Come here! Look at this!” Lynn was still captivated by the monitor. She was marveling at the range of physiological data that was being followed in real time and possibly continuously run through a supercomputer.
Lynn squeezed in beside Michael. In the restricted space, the noise coming from the machinery in the room seemed even louder. Lynn tried to follow Michael’s line of sight and pointing finger. She was as impressed as he was with the roller system. “What am I supposed to be looking at?” she yelled.
“The catheter embedded in the abdomen! What do you think that could be for?”
“No idea. Do you?”
“No! But it looks to me like the abdomen is a bit distended. What’s your take?”
“Now that you mention it, it does look a bit bloated. You think they are running fluid into the abdomen? That’s not unheard of. The peritoneal cavity has quite a surface area and can even be used for dialysis.”
“True! Maybe she’s got a kidney problem. Let’s go back and look at the monitor and see if the kidney function is normal.”
Lynn backed out of the confined space first, followed by Michael. When they looked at the monitor, they could see that the kidney function was perfectly normal, including urine output. Then something from the long list of things under observation caught Lynn’s attention. She pointed to it. “This is strange. One of the stats gives her output of ascites fluid. They’re not putting anything into her abdomen with that catheter, they’re taking fluid out.”
“And she’s putting out a significant amount,” Michael said, looking at the same recording as Lynn. “The main cause of ascites is liver disease, yet her liver function is normal. Weird!”
“The second major cause of ascites is low blood protein, but hers is raised. Double weird.”
“Uh-oh!” Michael shouted. “Quick! Duck back into the cubbyhole!”
The massive conveyor system, with its oversize tires, suddenly came in their direction, its weight making the floor tremble and momentarily trapping them in alongside cylinder 100. In the adjacent stack, a body was extracted, robotically disconnected from its various lines, and whisked out of the room. Then the conveyor system trundled away for its next assignment.
A moment later, when they emerged from their shelter, Lynn surprised Michael by climbing the ladder to peer into several of the upper cylinders.
“I think we better move on,” Michael yelled up to her impatiently. “We are pushing our luck. With all this mechanical activity in here and bodies coming and going, somebody’s got to be minding this place with video surveillance.”
“I just wanted to check to see if any other patients have an intra-abdominal catheter,” Lynn said, already climbing back down. “And they all do in this stack.”
Michael stepped over to the next stack and peered in at the patient in the lower
cylinder. “You’re right. Seems they all have it.”
“That’s got to mean something, but what?”
“Good question,” Michael said, “but we’ve got to break out, girl.”
“I’m not leaving until I see Carl,” Lynn said with a tone that brooked no argument.
“My personal opinion would be to let it go,” Michael said, placing his hand on her shoulder in hopes of restraining her. “Seeing Carl here is not going to help you or him. You know what I’m saying.”
“I don’t care,” Lynn said. She shrugged off Michael’s hand and started down the line of cylinders.
For a moment Michael hesitated, wondering if it was best that she go by herself for a bit of privacy with her stricken lover. But he quickly decided otherwise. It was hardly the proper environment for any attempt at intimacy, and he didn’t want to risk her getting emotional, which he thought was a significant possibility, knowing how he would feel if the situation were reversed and his girlfriend, Kianna, was one of the patients. He quickly caught up with her. As he did so, the forklift-like mechanism that pulled the patients in and out of the cylinders suddenly came in their direction.
The students had to flee back to the walkway that ran the length of the room against the wall opposite the bank of cylinders. The conveyor track taking the patients in and out of the room arched overhead.
After a patient was deposited in a cylinder close to where Lynn and Michael had been, the whole apparatus began moving to the opposite end of the room to pick up another.
“For the life of me, I can’t imagine why they are constantly moving these patients,” Michael yelled, going up on his tiptoes to try to get a peek into the black hole into which the conveyor track disappeared. “Or where the hell they are going.” When he turned back to Lynn, he saw that she was well on her way to cylinder 64. By the time he caught up to her, he could tell she wasn’t happy.
“He’s not here,” Lynn yelled over the continuous noise.
A quick glance confirmed for Michael that cylinder 64 was empty, although the monitor displayed Carl’s home page, so it was where he had been or was to be.