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.
As to why--she didn't know. Thus far in her lone campaign she had concentrated on observing her patients and hadn't ventured into diagnostic speculation.
One thing she did know for an absolute certainty: These aberrations were the result of living in an atmosphere with a reduced oxygen content and a high pollution factor--and all the signs were that the atmosphere was getting worse.
At 2:17 a.m. on a chill moonless night the class IXL submarine Gagarin, the largest and most powerful nuclear submarine ever built, surfaced in the Bering Sea alongside the missle destroyer U.S.S. Nebraska 375 miles off the coast of Kamchatka, the desolate and most easterly peninsula of the Soviet Union.
For twenty minutes the two vessels precariously held station on the black treacherous swell while breeches-buoy transfer was carried out. Then the darkened destroyer turned to starboard, steering a course due east, leaving the long featureless hull to slide silently into the cold inky depths. On one-third propulsion the Gagarin proceeded north-northwest at a depth of forty-five meters. In the signal room on the middle deck the radio operator tapped out an apparently random sequence of letters and numerals, which were picked up by satellite and beamed to Moscow.
At 3:00 a.m. precisely Com. Lev Yepanchin led the way to the executive stateroom, ushered the two men inside, touched the peak of his cap, and departed.
The stateroom was spacious, thickly carpeted, and lined with illuminated map panels, now conspicuously blank. A long glass-topped table had been centrally positioned, four walnut-and-leather chairs on one side, two on the opposite side. A metal water jug and three plastic-wrapped tumblers had been placed with military exactness, a set of each on plastic trays at either end of the table. A large plain pad and two sharpened pencils were arranged in the center of each leather-trimmed blotter, embossed with the insignia of the Soviet Third Fleet.
In the low-ceilinged room the only sound was the just-audible hum of the humidifier. The Gagarin s nuclear power plant and progress through the water were both utterly silent.
Col. Gavril Burdovsky came forward, stubby hand outstretched, while his three fellow officers waited in a respectful semicircle. What he lacked in height--five feet four in thick-soled shoes--Burdovsky made up for in girth. His dark-blue tunic with its ribbons and goldthread epaulets strained to contain his meaty bulk. His face too was broad and smooth, the pink flesh packed tight so that what should have been wrinkles became folds, and with a thick dark moustache that did nothing to camouflage his prissy belly button of a mouth.
That he had chosen to wear full-dress uniform seemed to the two Americans more a trait of personal vanity than a matter of military protocol. They were wearing forage caps and plain army greatcoats over zippered quilted blousons, displaying the minimum of rank designation and decoration.
Colonel Burdovsky introduced his colleagues, a blizzard of Russian names, and then stood with his hands on the place where his hips should have been and said in good though halting English, "We will drink, yes? To keep out this dreadful Siberian cold. We will have French brandy."
Brandies were brought forth on a tray. Maj. Jarvis Jones, a tall slim black man with a triangular shoulder flash--an S-shaped green snake twined around and thus joining the letters A and P--glanced circumspectly at his superior as if worried that this might constitute a breach of regulations. But Colonel Madden unhesitatingly took two glasses from the side of the tray--not the ones nearest him--handed one to Major Jones, and after a curt salute with his glass drank it down. Everyone did likewise. No one proposed a toast.