Last Gasp (40 page)

Ruth smiled. “How’s that, Fred?”

“Flat ... on ... my... back ... and ... shorta ... breath.” He winked at her through the plastic sheet, his narrow chest rising and falling, the air wheezing and bubbling through his furred tubes. Second-stage anoxia with pneumogastric complications. An operation was out of the question; anyway it was too late. In one respect Fred was lucky. Many anoxic patients suffered a sharp decline in their mental processes, became confused and incoherent due to the reduction of oxygen-rich blood circulating through the brain. Premature senile dementia set in, turning them into cabbages.

Ruth inserted her arms into the plastic sleeves that gave access into the tent; self-sealing collars gripped her wrists. “Tell me when you feel anything,” she said, pricking his toes and the soles of his feet with a surgical needle. Loss of sensation in the extremities was one of the first indications that the anoxia was getting worse.

Fred lay passively, not responding. The needle had reached his lower calf before he twitched.

“You feel that?”

He nodded. “Try ... lower ... down. My ... feet... are ... cold.”

“We’ll do that tomorrow,” Ruth said cheerfully. “Around here we take our time.” She took hold of his hand, which felt like clammy wax, and pricked his fingers and palm.

“My... old... lady... came... yester... day.” He paused, wheezing. “Asks ... how ... long ... this ... vacation ... lasts.”

“Well, some time yet, Fred. Why, what’s she planning to do, run off with the mailman?” Ruth tried his other hand. No response there either. She pulled her arms free and dropped the needle into the bin. “Say, how do you feel about being moved to another hospital? There’s a clinic in Maryland where they could take better care of you. It’s a special treatment center with all the latest facilities. I think I can fix you up with a place. How about it?”

“Hopeless ... case ... huh?” His moist brown eyes were fixed intently on her face.

“Hell, no, I wouldn’t bullshit you, Fred.” Ruth lowered her voice conspiratorially. “The temptation’s getting to be too strong for me. You’re driving me crazy with lust. I’ve got to get you out of here before I disgrace myself. This thing is bigger than both of us.”

“Not ... at ... the ... moment ... it ... ain’t.”

“I’ll give you some time to think it over, okay?” Ruth said, writing on the chart. “Talk it over with your wife. Let me know in a day or two.” Fred Walsh nodded and closed his eyes. Ruth replaced the chart at the foot of the bed and went on with her rounds.

An hour later it was blessed relief to put her feet up and relax with a cup of strong black coffee in the staff room. She’d take ten and then finish off the wards. No pathology lab tonight, unfortunately. Her duty didn’t end till midnight and by then she’d be dog-tired.

The door swung open and Dr. Grant McGowan breezed in and helped himself to iced tea. McGowan was head of surgery, in his forties, and happily married with three children. He had a sympathetic ear for Ruth’s grouses against Valentine, the chief pathologist, and the hospital at large.

“You still here?” she said, surprised.

McGowan scowled up at the clock. “I was on my way out when they caught me. Why do people choose such inconsiderate times to have cardiac arrest? I was all set to watch the fights on TV and I get paged at the damn door.”

“Couldn’t agree more,” Ruth said fervently. “All sickness and disease should stop at six
P.M.
on the dot. Germs and viruses knock off for the day and come back tomorrow.”

McGowan sat down in the armchair opposite and eyed her critically. “You look beat, Ruth. What is it? Too much work, not enough sleep, or both?”

“Old age.”

“Are you still working in the path lab after hours?” At her nod he shook his head and sighed. “You know you’re asking for trouble, don’t you? Being a resident on the wards is a full-time job without waging a one-woman crusade in the name of medical science. We don’t have the staff, the resources, or the backup for that.”

“You sound like Valentine,” Ruth replied testily.

“Christ, I hope not,” said McGowan with feeling. “Look, Ruth, I know the work is important and that somebody ought to be doing it, but why you? It isn’t as if you were getting
paid
to do it.”

“It isn’t a question of money; it’s what I want to do. What I must do.”

“I didn’t mean to imply—”

“You didn’t imply anything, Grant.” Ruth smiled at him. “I’m just thankful—really and truly—that you’re around to talk to. Valentine thinks the diagnostic work I did in Denver isn’t worth shit. At least you recognize it’s worthwhile.”

She arched back in the chair, massaging the nape of her neck with her fingertips. Pale and tired as she was, McGowan couldn’t bring to mind many women as sexually attractive and good-looking. Short, dark, naturally curly hair framed an oval face in which her full lips and vibrant dark eyes would have inspired a Goya. Gypsy eyes. There was something of the same passion and intensity in her personality, too....

With a guilty start he swiveled around to look at the clock, then hurriedly finished off his tea. “Better get along before they start without me. See you tomorrow.” He strode to the door and paused there. “And listen, Dr. Patton, get a good night’s rest. Forget Manhattan Emergency even exists.”

“Yes, sir, Dr. McGowan.” Ruth wrinkled her nose at him as he went out. Easier to forget you had a raging toothache.

She got up and went to the window and gazed down into the tunnel of smog that was East Sixty-eighth Street. She recalled her first visit to New York as a teen-ager, the thrill and excitement of the electric city. Just to stroll down Fifth Avenue was in itself a magical experience. The tall buildings gleaming in the sunlight, the haute
couture
shops and bustling department stores, the vendors on every street corner assailing the senses with mouth-watering smells—all the crazy mad whirl of big-city life that was like a shot of pure adrenaline into the bloodstream.

And the people!

Elegant women who had stepped straight out of a Vogue fashion plate, slender-hipped black dudes in soft wide hats and dazzling striped suits lounging behind the tinted windows of long limousines; old bags in threadbare fur wraps; goggled-eyed tourists trying not to look battered and bewildered; poets, prophets and cretins addressing the passing parade from the gutters.

The smile of fond remembrance faded. Nobody strolled down Fifth Avenue anymore. If you tried it without a respirator you could manage maybe fifty paces before collapsing facedown on the sidewalk and coughing up shreds of pink lung tissue. She’d seen that happen, and more than once. From the safety of a sealed car she’d observed a couple of down-and-outs, a man and a woman, slumped against the granite base of Rockefeller Center. Gray exhausted faces. Eyes blood-red and streaming from the photochemical irritants in the air. Lips drawn back in a ghastly snarl of abortive inhalation.

That had been during her first week in New York, almost three years ago.

Her friends and colleagues back in the wide clear spaces and mountains of Colorado had thought her deranged. What in heaven’s name had possessed her to exchange a responsible well-paid research job in a decent part of the country for a thankless and disgusting last-ditch stand in the foul canyons of New York City? She wasn’t cut out to be a Florence Nightingale. What a criminal waste of talent and brains. Stay in Denver, they had urged her, where you can live a decent life and make a real contribution.

Sometimes she thought they were right and wished she had. What exactly did she think she was achieving here? Saving one old guy because he happened to remind her of her grandfather? When hundreds—thousands—were rotting outside? And she wasn’t even saving Fred Walsh, Ruth reminded herself brutally. Only passing him on to a special clinic where they would test another new batch of drugs on him in the hope that one of them would work a minor miracle.

Every day now, several times a day, she searched her thirty-five-year-old face in the mirror for a hint of the ravages to come. Inevitably they would. Everyone who stayed in the city was affected, sooner or later.

Emphysema. Anoxia. Pollution.

Together they were a lethal combination. But that was only the start of the story. What now seemed to be happening was that a new range of viral infections and diseases was taking over from the age-old diseases such as polio, smallpox, malaria, typhoid, and yellow fever, which medical science had conquered. Medical theory said that environmental changes over the past quarter century had triggered off a new and mysterious strain of illnesses. There was Reye syndrome, which attacked children between the ages of five and eleven, and killed nearly a third of all those who contracted the disease. Cause unknown. There was Lyme disease, in which patients suffered skin lesions and painfully swollen joints caused by bites from the tiny parasite
Ixodes
dammini, which until recent years had been a harmless pest. There was infant botulism, where a highly toxic bacterium in the form of spores found in the dust on fruit and vegetables produced a nerve poison in the intestines of babies up to a year old. There were hemorrhagic fevers, the generic term for a group of virus-related illnesses from which up to 90 percent of the victims died.

Somehow, in a way not yet properly understood, chemical changes in the environment had created the conditions that were ripe and ready for new plagues to replace the old.

Ruth’s experience with the Diagnostic Research Unit in Denver had hardly been adequate to cope with this. And so far she’d received scant support in setting up a clinical investigative facility here in New York.

Although quite a lot was known about emphysema—the fusing together of the air sacs in the lungs, which reduces the total area of efficient oxygen-carbon dioxide interchange—anoxia had never until now been thought of as a chronic condition. The only people known to suffer from it in the past were airmen, mountaineers and deep-sea divers. Ruth had read up on the subject, combed through textbooks and medical journals, and talked with air force doctors and physiologists in an effort to understand the nature of the condition.

The simplest definition of anoxia was “an insufficient supply of oxygen to the tissues.” In tests on pilots the air force had found that if the oxygen supply was cut off and then turned back on, pilots would black out within seconds and just as quickly regain consciousness without being aware of what had happened. They would have absolutely no knowledge of the incident, not even a blank space in their memories.

More crucial, however, as Ruth realized, was at what point did anoxia begin to have a permanent debilitating effect on the brain and the body?

The average adult takes ten to fourteen breaths a minute, each breath lasting four to six seconds. In one minute this is an intake of about ten pints of air, which can increase to as much as twenty gallons of air a minute with sustained strenuous exercise. In a normal day an adult will breathe in roughly 3,300 gallons of air, or 530 cubic feet, and in a lifetime approximately 13 million cubic feet. This is equivalent to two and a half times the capacity of the airship R.101.

For this vast interchange of gases an efficient machine is required, and the lungs, developed from the buoyancy air bladder of man’s fishy ancestors, serve that purpose admirably.

Each pair of lungs weighs about two and one-half pounds and covers an area of roughly one thousand square feet, largely made up of the honeycombed globule clusters of alveoli, which consist of 300 million tiny chambers where the transfer of oxygen to blood in exchange for carbon dioxide takes place.

The red blood cells pass through tiny capillaries one at a time, pick up their oxygen atoms in three quarters of a second, and are pushed on into the arterial system. When the heart is pumping vigorously, during exercise or states of emotion, the blood cells can pick up their load in one third of a second through the wall of each alveolus, which is twenty-five thousandths of an inch thick.

This is how a healthy system works when breathing in unpolluted air with an oxygen content of 20.94 percent. Emphysema, the fusing of the millions of air sacs to form larger, less efficient clusters, inhibits the exchange of oxygen between the air and the bloodstream. It is a gradual process and the sufferer hardly notices as his lungs become less and less able to meet his body’s oxygen demand until it’s too late. Death follows by slow suffocation.

From her study Ruth had learned that 15,000 feet, or nearly three miles up, was the maximum altitude at which human beings could survive for long periods of time. At that height the pressure was 40 percent lower than at sea level. Mountain climbers had scaled higher peaks without oxygen, but by God-like coincidence it seemed that Everest, at 29,141 feet, was the highest man could reach unaided, even had there been a higher peak to climb.

Here in Manhattan, although the air pressure was normal, the oxygen content was several points down. Ruth had calculated that it was similar to that at twelve thousand feet. Pollutants in the atmosphere reduced the body’s ability to assimilate oxygen still further. Carbon monoxide, for example, displaced oxygen in the lungs by combining with the blood’s hemoglobin, which normally transported oxygen to the system. Sulfur dioxide had the nasty habit of forming sulfuric acid in the lungs, which burned holes in the delicate alveoli tissue. Nitrogen oxides had much the same effect as carbon monoxide, reducing the blood’s oxygen-bearing capacity.

It was from patients suffering these complaints that Ruth had obtained much of her data. And it was the reason why she had decided to come east, to examine the problem at its most acute.

So far she had been able to pinpoint two major effects caused by prolonged exposure to an atmosphere low in oxygen and high in pollutants. One, it accelerated the aging process, bringing on premature senile dementia, as was evident from the physical condition and behavior of the people admitted to Casualty. Two, it attacked the nervous system, giving rise to a number of mental abnormalities, from hallucinatory hysteria to paranoia to violent psychotic disturbance.