To Heal by Burning

Fiction by Jeff Harrell

I’m just getting the old guy’s belly open when my whole day goes right to hell.

“Jesus,” I mutter through my mask. “Looks like somebody went through here with a lawnmower.”

“Adhesions?” Brentley asks, even though he’s standing right there and can see for himself.

“All over the damn place.” I start appreciating the bowel, looking for that little pouch. It’s not easy to find. This guy’s got diverticula all over the place. It doesn’t help that his belly is a web of scar tissue. “What happened in here, anyway?”

Morris is across the OR with the guy’s chart. “MVC twelve years ago,” he says. “Took a steering wheel to the stomach.”

“Did they have to fix him up with duct tape and super glue?” I’m trying to do the math in my head. “Somebody better call Marsters and let him know we’re gonna go over our window.” I’m running the guy’s bowel with my fingers now, trying to find all the places I’ll have to cut. There are a lot of them.

“Bovie.” The instrument’s in my hand before I finish asking for it. I run the tip along a translucent sheet of tissue that connects the guy’s small intestine to his abdominal wall. There’s a puff of smoke. The edges turn white and separate. There’s no blood. It’s all neat and clean. Electrocautery: the beauty of modern medicine.

An alarm goes off, shrill beeping. It’s been three minutes. I take a step back. Brentley puts extra weight on the retractor so Gandapur can get in there with the bucket. She pours. Oily black liquid splashes down over every cut surface, drowns the patient’s belly in a potent soup of antibiotics, antivirals, antifungals, antiprionals. You name it, this stuff will kill it. I turn my head; you don’t want to breathe the fumes too deeply. I did once and had persistent nosebleeds for a week. Every medical student makes that mistake.

Gandapur bathes the guy’s belly for sixty seconds, then suctions it all out. Assuming everything worked as it should, the surgical field should be nice and sterile again. At least until somebody touches it, or breathes too close to it, or looks at it funny, or even thinks too hard about it.

Across the room, Morris resets the alarm for another three minutes. I dive back in with the cautery knife to try to make as much progress as possible before we have to stop for another wash.

The procedure takes seven hours.

I’m in the middle of post-op scrub-down when I hear a dull tap-tap-tap on the glass. Morris is on the other side, holding up my pager so I can see the display. It’s Bryson, the chief of surgery, so I know it’s a Protocol thing. Again. Sign language: miming a phone held to my ear, pointing to Morris, pointing to my wrist, five fingers, five fingers. Morris nods. He disappears. I know he’s calling the chief, telling him I’m in scrub and that I’ll be there in fifty-five minutes. Bryson’s going to be pissed, but it’s the best I can do.

Three quarters of an hour later I come out of the double airlock, naked as the day I was born and stinging like hell all over. My surgical scrubs have been incinerated, along with the three pairs of gloves I was wearing, both masks, my goggles and everything else that directly or indirectly touched my skin during surgery. Two chemical showers, twenty minutes under a UV lamp and then another chemical shower, and finally a regular shower under water held just below the boiling point to rinse away all the toxic gunk that I’d been dosed in.

If I keep this up, my skin’s going to be the color and texture of an old saddle by the time I’m thirty.

These days, surgery is for suckers. I should have gone into dermatology.

Fresh scrubs from the vending machine and I’m climbing the stairs to the lofty heights of the administration floor. Bryson’s office is the third from the end of the hall. The floor secretary just nods at me, so I go in without knocking.

I’m expecting to see somebody from Protocol there for yet another debriefing. It happens with depressing regularity now; despite all the procedures, six weeks post-op a patient will come down with some resistant infection — VRSA or LRE if they’re lucky, Proteus or MRAB or TRRV or ERCJ if they’re not — and the chain of responsibility leads right back to me, and the next thing I know I get to spend six hours hooked to a polygraph answering questions about whether I might have picked my nose that morning or whether I used all three of the special soaps after urinating.

But the guy sitting across from Bryson isn’t from Protocol. He doesn’t have the look. Black suit, black tie, meticulous haircut. It’s a quarter after five and he isn’t showing even a hint of a shadow. He must shave every morning with a belt sander.

Bryson shakes my hand when I come in. The other guy shakes too. He’s got a grip that could pop a volleyball. “Carter Sullivan,” he says, and that’s all the introduction I get.

“Chris Anderssen,” I say, and take a seat.

“That’s a nasty burn,” Sullivan says, pointing at my face. I know it’s lobster-red and shiny from the ointment.

“Comes with the territory,” I say.

“Does it hurt?” he asks.

The truth, of course, is that it hurts like hell. But I still don’t know who this guy is. So all I say is, “You get used to it.”

Sullivan kind of gives me this look, a long, slow stare that makes the hair on the back of my neck stand up. Five seconds, ten. I’m just about to open my mouth and say God knows what when he sits back in his chair. “Doctor Bryson,” he says, keeping his eyes locked on mine. “Would you excuse us please?”

And I’ll be damned if Peter Bryson, chief of surgery for the entire hospital and one of the biggest of the big-wigs here, doesn’t get up without saying a word and walk right out of his own office.

When the door closes behind him, Sullivan visibly relaxes. He even smiles a little, sort of, just a twitch at the corner of his mouth. He reaches into his jacket pocket, comes out with a business card. He hands it to me. It doesn’t have his name on it. Just a rainbow hologram in the corner, a twelve-digit telephone number and the words “Department of Homeland Security.”

My instinct is to crack a joke, to ask him if I’m under arrest. Anything to relieve the tension. But I’m not that stupid.

“Do you know why I came to see you?” Sullivan asks.

I shake my head.

“Good,” he says. “If you did, that’d be a pretty good reason to disqualify you.”

“Disqualify me from what?”

“You’re not a doctor yet, right?” he says, ignoring my question. “I mean, technically. You don’t have your MD.”

“Not until June,” I say.

“But you’re in there performing surgery all by yourself,” he says.

“That’s how we do it,” I say. “See one, do one, teach one. That’s how medical school works.”

I know what he’s doing. He’s getting me talking, trying to relax me. The lousy part is that it’s working, even as I’m aware that he’s doing it.

“And what happens next? Where do you go from here?” he asks.

“In July I start my residency,” I say.

“Where?”

“Tacoma.”

He just nods, like he knew that already. Which I’m sure he did. He’s HomeSec. He probably knows what kind of jellybeans I like best and the exact length of my dick to the millimeter. Which begs the question, of course, of why he’s asking me these things in the first place.

“Medical school’s expensive,” he says, continuing the theme of baffling small-talk.

“Very expensive,” I say.

“You’re going to walk out of here with some serious loans to repay.”

I nod.

“How much is this all costing you?”

Enough is enough. I lean forward, elbows on my knees. “I think you know exactly how much this is costing me, down to the penny, don’t you?”

He smiles for real this time. It’s genuine and warm and totally out of place.

“Sorry,” he says. “They put us through all this training, and I don’t even know why. It never works. We just end up alienating people.”

I think he wants me to smile back at him, but I don’t.

“Okay, Chris, I’ll make this short. The Department has a program in place, a new program, and we’d like you to join.”

“I already have a job.”

“Yes, I know. Five years in residency as a general surgeon, then two years of thoracic surgery, where you’ll make a grand total of forty-seven thousand dollars a year while trying to pay off student loans that come in just over two hundred grand. Do I have all that right?”

“I didn’t say it was a great job.”

“I think I can make you a better offer.”

“I’m not interested in the public sector.”

He shakes his head. “It’s not like that. It’s more of a service program, like the Peace Corps. What we’ll do is set you up with a residency program overseas, someplace you’d like to live. You’ll make your regular salary, plus an annual stipend from the Department. In return, we repay your student loans for you.”

“What?” I say without meaning to.

There’s that smile again. “That’s right,” he says. “All of them. Undergraduate, medical school, everything.”

“What’s the catch?”

He tells me. And then his smile goes away. I never see it again.

They let me pick my posting. I’ve never been farther overseas than the Bahamas, so I don’t have that much of an opinion. In the end, I pick Norway. My great-grandparents on my dad’s side are from there, came over in one of the wars of the last century. Maybe I’ll fit in there, or something. Or maybe I just like the pictures I find on the Internet.

Once I sign the last of about a hundred intimidatingly official pieces of paper, Homeland Security takes care of everything. They set me up with a job at an international hospital in Bergen, the kind of place where nobody will care if I only speak English. They find me a place to live, take care of all the arrangements. At our last meeting, Sullivan even gives me the keys to the place. The following Monday, I get a letter in the mail. A polite one. Thank you for your sending your final payment, it says.

Two hundred grand in debt just vanished from my credit report.

I have to wonder, though, given everything I know now, whether I’m still getting the short end of the deal.

It takes a long time to get to Bergen. I have to change planes in Seattle, and again in Copenhagen. I have a lot of time to read the book Sullivan gave me. Well, calling it a book is being generous. It’s three hundred double-sided pages run off on an office photocopier and bound with a metal clip. The cover page is stamped DECLASSIFIED in half a dozen places with illegible signatures scrawled under each. The title of the book is CAUTERY.

It doesn’t take me long to figure out that it’s a code name. And an impressively appropriate one at that. I don’t expect that kind of creativity from the government.

Anyway, I read the book.

How many terrorist attacks against the United States can you think of in the past year? Three? It’s easy to think of three. That thing in the DC Metro, the elementary school in Seattle and what happened in San Antonio. Everybody knows about those three.

Would it surprise you to learn that there were seventeen hundred and nine separate terrorist attacks against the United States last year? That’s right. Four a day.

Most of them you never heard of. Over a thousand were electronic attacks. Even the ones that succeeded — about six hundred of them, or nearly two for every day in the year — were little more than an inconvenience. We can ignore those; the news certainly does.

Of the other six hundred and change, over five hundred were biological attacks.

Bet you didn’t know that, did you?

Everybody knows what antibiotics are. If you’re under the age of forty, chances are you’ve never been prescribed any. But you know what they are. You get an infection, some kind of bacterial infection that your body can’t handle, and you take antibiotics. They make you better.

The trouble is, antibiotics only kill most of the bacteria that are making you sick. Some of them, due to mutations or just random chance, aren’t affected by the antibiotic you’re taking at all. And the ones that survive, multiply.

That’s where antibiotic-resistant bacteria came from, about a hundred and fifty years back.

For a while, nobody really noticed a problem. Every so often, somebody would get an infection that should be easy to cure, only it would kill them anyway. Just bad luck, everybody thought. Just how it goes.

Eventually people started getting these infections more and more frequently. And most dramatically of all, people started getting these infections in hospitals, the cleanest places on Earth. It’s easy to see why, in hindsight. We were showering our hospitals in antibiotics that would kill everything except the resistant strains, which meant the resistant strains were left with no competition at all. They were free to thrive.

Around the end of the last century, people started to catch on. Drug companies started working on new antibiotics, ones that would kill even the most resistant little bastards. Simultaneously docs stopped prescribing antibiotics except in cases of life-threatening systemic infections. Sure, it took you six weeks to get over walking pneumonia instead of just two, but at least we weren’t out there breeding whole new generations of bacteria we couldn’t kill.

Except the genie was out of the bottle.

Let’s say you’re a terrorist. A religious fanatic, maybe, or one of those anti-government nutcases from the Midwest. Let’s say you want to build a nuclear bomb. It’s a giant pain in the neck. Sure, getting the basic plans off the Internet takes about thirty seconds. But actually building it is hard, and with sensor drones orbiting twenty thousand feet overhead all the time, you can forget about ever assembling enough radioactive material to arm your bomb. Hell, you can’t assemble enough radioactive material to make a decent dessert topping.

But what if you don’t care about making a nuclear bomb? Let’s say you just want to kill a whole lot of people very quickly and you’re not fetishistic about big explosions?

In that case, all you need is a petri dish and a steady supply of antibiotics.

There are enough bacteria floating around in the atmosphere right now to kill every living human being. Twice. The only thing that keeps us alive is our immune system, and when that fails, modern medicine. But if you take the bacteria that are naturally floating around out there and dose them, generation after generation, with powerful antibiotics, in about six months you can breed a colony of superbugs that our immune systems can’t hope to touch.

Bottle up that bacterial colony, release it in a crowded place, and there you go. Armageddon in a jar.

By the time my plane lands in Copenhagen, I’m about ready to piss myself. I haven’t been in surgery in weeks, but the skin on my hands is still peeling from the daily chemical holocausts I’ve been putting it through. It’s the price of saving lives. If you want to cut someone’s belly open and put your hands inside to remove a diseased organ or repair traumatic damage, you have to scour your body so thoroughly that even your own cells can’t survive. If you don’t, some bacterium on your skin will make its way into the operating room, and from there into the patient, and then the patient will die because there won’t be any way to kill the bacteria while keeping the patient alive.

And don’t even get me started on the funguses or the viruses or the prions. Those things make bacteria look like kittens and puppies.

The flight from Copenhagen to Bergen is only about an hour and a half. I try to sleep, but the best I can do is doze off a little bit. I doze and try to forget everything I know about CAUTERY.

I’m not really successful.

Settling into life in Bergen is easier than I expected it to be. The hardest part is learning my way around, since I can’t read any of the street signs. But the locals are friendly enough, and besides the life of a first-year surgical resident doesn’t leave me with much free time. Eighteen hour days at the hospital are typical. When I’m on call, I don’t go outside for days.

My Norwegian gets better, slowly. Jeg forstÃ¥r ikke. Vær vennlig og snakk saktere. I say those sentences so many times I start to dream about them. Jeg forstÃ¥r ikke. I don’t understand. Vær vennlig og snakk saktere. Please speak slowly. Beklager, jeg snakker ikke norsk. I’m sorry, but I can’t speak Norwegian. Snakker du engelsk? Do you speak English? Over and over again, twenty or thirty times a day.

Getting used to Protocol here takes some doing, too. The first time I scrubbed for surgery my attending gave me a lengthy and profane chewing out in a baffling blend of broken English and incomprehensible Norwegian for moving too slowly. The superbugs just aren’t a problem here like they are in the States. Spending as little as an hour in pre-op scrub would be considered criminally irresponsible back home; here it’s an intolerable waste of time and resources.

The changes hit me hard at first.

But eventually I get used to them. With time, I start to fit in, feel at home here. It takes a while, but eventually everything that came before — my life, medical school, those surreal meetings with the man in the black suit — starts to seem like a distant memory.

That’s when I get the call.

In the packet Sullivan gave me at that last meeting was a satellite phone, one of those little ones that doesn’t look obviously different from a disposable mobile you’d buy for three Euros at a vending machine on any street corner. He told me to keep it with me at all times, in my pocket, never more than a few feet away. He told me it would never, ever ring, but that if it did I had to answer it immediately. It was part of the job. Part of the price I had to pay.

It didn’t take me long to forget about it. To imagine that it was all just an elaborate dream.

But then it rings, and it all comes flooding back. My hands are shaking when I answer it.

“Cautery,” says the voice on the other end. A woman’s voice, preternaturally calm.

I fish in my pockets for the little laminated card. Twelve rows of type. I know I’m supposed to read the fifth. I recite the words in the phone. “Particle. Mezzanine. Pretense. Longitude. Aplomb.”

I flip the card over, read along as she recites words back to me. “Matriculate,” she says. “Umbrage. Caravan. Penetrate. Coupling.”

“Cautery nine seven nine three one,” I say, completing the ritual. Sweat’s dripping into my eyes now.

“Please wait,” she says, and there’s a click. I think the line’s gone dead. But then another click, and it’s Sullivan on the other end of the phone.

“Good morning,” he says. It’s the first time I’ve heard his voice in three years.

“The chances are,” he said to me that morning, the day he gave me my final paperwork and handed over the thick envelope with everything in it, “that you will never hear from us. The odds that we’ll need to contact you are very small.”

“But if things like this happen so frequently,” I started to say. Sullivan interrupted me.

“You’re part of what we call a highly distributed system,” he said. “There are tens of thousands of people just like you, young, highly skilled professionals who chose to participate in foreign service to pay for their educations. We activate the system once every three months, on average. But because there are so many of you, the odds that you’ll ever get the call yourself are slim.”

“What if I don’t answer the phone when it rings?”

Sullivan gave me a look then, cold and hard as granite. “There are certain redundancies,” is all he said.

“And all I’ll have to do is read some numbers?”

“Essentially, yes,” he said. “There will be a little more to it than that.”

“Like what?”

Sullivan didn’t bother answering. He just snapped his briefcase closed, then stood up and offered his hand.

He didn’t say good bye, either.

“Good morning,” Sullivan says again.

I clear my throat. “Hi.”

“Dr. Anderssen, I am required to inform you that this call is being monitored and recorded by the Department of Homeland Security.”

“I understand,” I say, because I think I’m supposed to.

“At 0923 Pacific time,” he says in a weird, detached sort of voice, “three small explosions occurred inside terminals one, four and six at Los Angeles International Airport.”

I try to do the arithmetic in my head. I think that was about ten minutes ago. Or an hour and ten. I can’t keep the damn time zones straight.

Sullivan’s still talking. “According to reports from security personnel inside the airport, there were no fatalities from any of the explosions. This implies that we’re dealing with a dispersal scenario.”

“A dispersal scenario?” I say through a dry throat.

“That is correct,” Sullivan says, robot-like. “At 0927, gas-chromatograph detectors inside the airport registered very high levels of biomatter in the air supply. This is consistent with an aerosol-dispersal scenario.”

My heart’s pounding so loudly I wonder if Sullivan and his spooks can hear it on the other end of the phone. “What’s the epidemiology look like?”

“Too early to tell,” Sullivan says. “All exterior doors and vents sealed automatically when the alarms went off. As if 0931, there’s no sign of contamination outside the airport building itself.”

“What’s the total affected population?”

There’s a long pause on the line before Sullivan says, “That information is classified at this time.”

I’ve been through LAX. I can’t even begin to guess how many people are trapped in that airport right now. Ten thousand? A hundred thousand? It could be anywhere in between. Locked inside a giant, hermetically sealed building, pounding on the glass and trying to get out. Or else waiting calmly, thinking it’ll all be over soon, not realizing what they’re breathing into their lungs.

Sullivan snaps me back to reality. “At this time,” he says, “the Secretary is asking you, in accordance with Executive Order 19371 subsection 9, to authorize Response Scenario 33-November. Do you authorize?”

“What’s Response Scenario — whatever you said?”

“That information is classified. Do you authorize, Dr. Anderssen?”

“How am I supposed to authorize something when I don’t know what I’m authorizing?”

“Chris,” Sullivan says, dropping the official-sounding talk. “We went over this. You know what this is all about. Fifteen minutes ago, there was a massive, potentially catastrophic terrorist attack with biological weapons. We have to respond, Chris. We have to act. You know that.”

“So what are we talking about here?” My hands are shaking now. I can barely hold the phone. “I say yes, and some Sudanese village gets vaporized? That’s what the ‘November’ stands for, right? ‘N’ for nuclear? That’s what we’re talking about here, isn’t it?”

“Goddammit, Chris, you know that’s classified.”

“How can you be sure? How can you be sure you’re retaliating against the right people?”

For just a second, Sullivan doesn’t say anything. Then: “Retaliating? Chris, think, okay? I can’t give you any of the details. If I try to tell you anything at all right now, there’s a Marine right outside this room who’ll shoot me in the head for violating half a dozen federal laws, and probably get a medal for doing it. But just think. Think about what you’re part of. This is Project CAUTERY, Chris. Okay? Just think about that.”

“You’re asking me to murder people!”

“They’re already dead, Chris. The people we’re talking about are already dead. They’re dead whether you give the okay or not.”

“Then find somebody else to do it,” I say.

I mash the button on the phone so hard it cracks.

And then it’s over. I’m just standing there in the silence of the locker room, wondering what the hell to do next.

I don’t have long to think it over. I’m sit there on the bench of twenty minutes, maybe thirty. Maybe not even that long.

Then, from far down at the opposite end of the hall, I hear somebody yell.

I spend the next three months looking over my shoulder. I’m sure I’m going to be arrested, or worse. I double-check the locks on my doors every night, even though I know how absurd it is. If they’re coming for me, they’ll bring helicopters and tear gas and an entire platoon of Special Forces. A deadbolt isn’t going to slow them down.

But they never come.

Then, one morning as I’m cutting through NygÃ¥rdsparken on my way to Thormøhlensgate, I see him sitting there on a bench, tossing scraps of stale bread to a largely indifferent flock of birds.

He doesn’t look at me when I sit down behind him.

“Is this purely a social call?” I ask.

“No, not purely,” he says, still not looking up. “But I’ve only got one piece of business to take care of.”

A silenced pistol emerged from the pocket of his overcoat. He presses it to my ribs and pulls the trigger. I die slumped over in the middle of a Norwegian park.

Except none of that happens, of course. What he extracts from his pocket isn’t a gun, but an envelope. A small one, just big enough to hold a letter. He hands it to me. I don’t open it.

“It’s all in there,” he says. “But the short version is that CAUTERY has been disbanded.”

“Why?” I ask. “It worked, didn’t it?”

He laughs, a sour, wet laugh. “Technically, I suppose,” he says. “But do you know how many calls I had to make before I found someone who’d read the arming codes into the phone?”

“Three?” I ask, just to keep him talking.

“Nineteen,” he says. “I had to call nineteen of you. And the last one only went along with it because I told him all the details. I lost my security clearance for that.”

“But he did it, right? He gave you the codes?”

“Oh, sure, he gave us the codes. And we keyed them in and pushed the button.” He makes the last of his bread into crumbs and tosses them high into the air. “It was the right thing, Chris,” he says.

“Maybe,” I say. “Maybe it was.”

“No,” he says, turning to face me suddenly, eyes blazing with righteous certitude. “It was the right thing. We had to do it.”

“Okay, okay,” I say softly. I want to put my hand on his shoulder or something, but the thought strikes me as absurd.

“We had to,” he says, in a whisper.

I don’t know what makes me ask, but I ask anyway. “What happened to him?”

“Who?”

“To number nineteen. The one who finally said yes.”

Sullivan laughs, but it falls apart into an exhausted sob. “Hanged himself that night, of course,” he says. “Can you blame him?”

“No,” I say. “Not at all.”

For a long time, we just sit there. The birds, realizing that no more food would be falling onto their heads out of the sky, move on to more promising hunting grounds.

“You should have just told me,” I say. He looks at me. “You should have just told me the truth.”

“Would you have done it?”

I think about those fifty-four thousand people trapped inside the airport, slowly breathing in certain death and unaware of it, dying in a flash of sterilizing nuclear fire.

It was merciful, wasn’t it?

“Yes,” I say. Then I decide to be honest. “I don’t know. But at least I would have had the choice.”

“This was all covered in the preliminary report,” Sullivan says. Then he laughs. “I’m breaking a lot of laws by even telling you this. But it won’t matter soon. There are going to be enough hearings in Washington to shut down the government for the next decade. This’ll all be a matter of public record soon.”

He reaches through his pockets, looking for more bread I guess. He doesn’t find any.

“It’s all in the preliminary report,” he continues. “The psych unit did tests. Stress tests, double-blind tests. They said that no American citizen could, under any circumstances, order the use of nuclear weapons against his own people.”

“So you lied,” I say.

He nods.

“You made it sound like it was … like it was a retaliatory strike.”

He nods again.

“Because you thought American citizens would be more likely to start a nuclear war.”

For a long time, nothing.

And then he nods.

I can’t think of anything to say after that. So I just get up and leave.

I don’t look over my shoulder as I go.

I never see Sullivan again.

Copyright © 2007 by Jeff Harrell. All rights reserved.