"Yes, I do. He's a pimp, a hustler, a con man. He has no convictions at all. He's never even practiced law, but he's helped write thousands of them. He's not a doctor, but he's established national health policy. He's been a professional politician his whole life, always on the public payroll. He's never generated a product or a service in the private sector of the economy, but he's spent his life deciding how high the taxes should be, and how that money should be spent. The only black people he ever met as a kid were the maids who picked up his bedroom, but he's a champion of minority rights. He's a hypocrite. He's a charlatan. And he's going to win unless you get your shit together, Mr. President," Arnie said, pouring dry ice over Ryan's fiery temper. "Because he knows how to play the game, and you don't."
THE PATIENT, THE records said, had taken a trip to the Far East back in October, and in Bangkok had indulged himself in the sexual services for which that country was well known. Pierre Alexandre, then a captain assigned to a military hospital in the tropical country, had once indulged in them himself. His conscience didn't trouble him about it. He'd been young and foolish, as people of that age were supposed to be. But that had been before AIDS. He'd been the guy to tell the patient, male, Caucasian, thirty-six, that he had HIV antibodies in his blood, that he could not have unprotected sex with his wife, and that his wife should have her blood tested at once. Oh, she was pregnant? Immediately, right away. Tomorrow if possible.
Alexandre felt rather like a judge. It wasn't the first time he'd delivered news like this, and damned sure it wouldn't be the last, but at least when a judge pronounced a sentence of death it was for a serious crime, and there was an appeals process. This poor bastard was guilty of nothing more than being a man twelve time-zones from home, probably drunk and lonely. Maybe he'd had an argument over the phone with his wife. Maybe she'd been pregnant then, and he wasn't getting any. Maybe it had just been the exotic locations, and Alex remembered well how seductive those childlike Thai girls could be, and what the hell, who'd ever know? Now a lot of people would, and there was no appeals process. That could change, Dr. Alexandre thought. He had just told the patient that. You couldn't take their hope away. That's what oncologists had told their patients for two generations. That hope was real, was true, wasn't it? There were some smart people working on this one—Alexandre was one of them—and the breakthrough could happen tomorrow, for all he knew. Or it could take a hundred years. The patient, on the form card, had ten.
"You don't look very happy."
He looked up. "Dr. Ryan."
"Dr. Alexandre, and I think you know Roy." She gestured at the table with her tray. The dining area was packed today. "Mind?"
He got halfway to his feet. "Please."
"Bad day?"
"E-Strain case," was all he had to say.
"HIV, Thailand? Over here now?"
"You do read M&M" He managed a smile.
"I have to keep up with my residents. E-Strain? You're sure?" Cathy asked.
"I reran the test myself. He got it in Thailand, business trip, he said. Pregnant wife," Alex added. Professor Ryan grimaced at the addition.
"Not good."
"AIDS?" Roy Altman asked. The rest of SURGEON'S detail was spread around the room. They would have preferred that she ate in her office, but Dr. Ryan had explained that this was one of the ways in which Hopkins docs kept up with one another, and was for her a regular routine. Today it was infectious disease. Tomorrow pediatrics.
"E-Strain," Alexandre explained with a nod. "America is mostly B-Strain. Same thing in Africa."
"What's the difference?" Cathy answered.
"B-Strain is pretty hard to get. It mainly requires direct contact of blood products. That happens with IV drug users who share needles or through sexual contact, but mainly it's still homosexuals who have tissue lesions either from tearing or more conventional venereal diseases."
"You forgot bad luck, but that's only one percent or so." Alexandre picked up the thread. "It's starting to look as though E-Strain—that cropped up in Thailand—well, that it makes the heterosexual jump a lot more easily than B. It's evidently a heartier version of our old friend."
"Has CDC quantified that yet?" Cathy asked.
"No, they need a few more months, least that's what I heard a couple weeks ago."
"How bad?" Altman asked. Working with SURGEON was turning into an educational experience.
"Ralph Forster went over five years ago to see how bad things were. Know the story, Alex?"
"Not all of it, just the bottom line."
"Ralph flew over on a government ticket, official trip and all that, and first thing happens off the plane, the Thai official meets him at customs, walks him to the car and says, 'Want some girls for tonight? That's when he knew there was a real problem."
"I believe it," Alex said, remembering when he would have smiled and nodded. This time he managed not to shudder. "The numbers are grim. Mr. Altman, right now, nearly a third of the kids inducted into the Thai army are HIV positive. Mainly E-Strain." The implications of that number were unmistakable.
"A third? A third of them?"
"Up from twenty-five percent when Ralph flew over. That's a hard number, okay?"
"But that means—"
"It might mean in fifty years, no more Thailand," Cathy announced in a matter-of-fact voice that masked her inner horror. "When I was going to school here, I thought oncology was the place to be for the supersmart ones" — she pointed for Altman's benefit—"Marty, Bert, Curt, and Louise, those guys in the corner over there. I didn't think I could take it, take the stress, so I cut up eyeballs and fix 'em. I was wrong. We're going to beat cancer. But these damned viruses, I don't know."
"The solution, Cathy, is in understanding the precise interactions between the gene strings in the virus and the host cell, and it shouldn't be all that hard. Viruses are such tiny little sunzabitches. They can only do so many things, not like the interaction of the entire human genome at conception. Once we figure that one out, we can defeat all the little bastards." Alexandre, like most research docs, was an optimist.
"So, researching the human cell?" Altman asked, interested in learning this. Alexandre shook his head.
"A lot smaller than that. We're into the genome now. It's like taking a strange machine apart, every step you're trying to figure what the individual parts do, and sooner or later you got all the parts loose, and you know where they all go, and then you figure out what they all do in a systematic way. That's what we're doing now."
"You know what it's going to come down to?" Cathy suggested with a question, then answered it: "Mathematics."
"That's what Gus says down at Atlanta."
"Math? Wait a minute," Altman objected.
"At the most basic level, the human genetic code is composed of four amino acids, labeled A, C, G and T. How those letters—the acids, I mean—are strung together determines everything," Alex explained. "Different character sequences mean different things and interact in different ways, and probably Gus is right: the interactions are mathematically defined. The genetic code really is a code. It can be cracked, and it can be understood." Probably someone will assign a mathematical value to them… complex polynomials… he thought. Was that important?
"Just nobody smart enough to do it has come along yet," Cathy Ryan observed. "That's the home-run ball, Roy. Someday, somebody is going to step up to the plate, and put that one over the fence, and it will give us the key to defeating all human diseases. All of them. Every single one. The pot of gold at the end of that rainbow is medical immortality—and who knows, maybe human immortality."