Greg Egan - SS - Yeyuka.pdf - Greg Egan - przemosta

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Yeyuka a short story by Greg Egan

On my last day in Sydney, as a kind of farewell, I spent the morning on Bondi Beach. I swam for an

hour, then lay on the sand and stared at the sky. I dozed off for a while, and when I woke there

were half a dozen booths set up amid the sun bathers, dispensing the latest fashion: solar

tattoos. On a touch-screen the size of a full-length mirror, you could choose a design and then

customise it, or create one from scratch with software assistance. Computer-controlled jets

sprayed the undeveloped pigments onto your skin, then an hour of UV exposure rendered all the

colours visible.

As the morning wore on, I saw giant yellow butterflies perched between shoulder blades, torsos

wrapped in green-and-violet dragons, whole bodies wreathed in chains of red hibiscus. Watching

these images materialise around me, I couldn't help thinking of them as banners of victory.

Throughout my childhood, there'd been nothing more terrifying than the threat of melanoma -- and

by the turn of the millennium, nothing more hip than neck-to-knee lycra. Twenty years later, these

elaborate decorations were designed to encourage, to boast of, irradiation. To proclaim, not that

the sun itself had been tamed, but that our bodies had. To declare that cancer had been defeated.

I touched the ring on my left index finger, and felt a reassuring pulse through the metal. Blood

flowed constantly around the hollow core of the device, diverted from a vein in my finger. The

ring's inner surface was covered with billions of tiny sensors, spring-loaded funnel-shaped

structures like microscopic Venus fly-traps, each just a few hundred atoms wide. Every sizable

molecule in my bloodstream that collided with one of these traps was seized and shrink-wrapped,

long enough and tightly enough to determine its shape and its chemical identity before it was

released.

So the ring knew exactly what was in my blood. It also knew what belonged, and what didn't. Under

its relentless scrutiny, the biochemical signature of a viral or bacterial infection, or even a

microscopic tumour far downstream, could never escape detection for long -- and once a diagnosis

was made, treatment was almost instantaneous. Planted alongside the sensors were programmable

catalysts, versatile molecules that could be reshaped under computer control. The ring could

manufacture a wide range of drugs from raw materials circulating in the blood, just by choosing

the right sequence of shapes for these catalysts -- trapping the necessary ingredients together in

nooks and crannies moulded to fit like plaster casts around their combined outlines.

With medication delivered within minutes or seconds, infections were wiped out before they could

take hold, tiny clusters of cancer cells destroyed before they could grow or spread. Linked by

satellite to a vast array of medical databases, and as much additional computing power as it

required, the ring gave me a kind of electronic immune system, fast enough and smart enough to

overcome any adversary.

Not everyone on the beach that morning would have had their own personal HealthGuard, but a weekly

session on a shared family unit, or even a monthly check-up at their local GP, would have been

enough to reduce their risk of cancer dramatically. And though melanoma was the least of my

worries -- fair-skinned, I was covered in sunscreen as usual; fatal or not, getting burnt was

painful -- with the ring standing guard against ten thousand other possibilities, I'd come to

think of it as a vital part of my body. The day I'd installed it, my life expectancy had risen by

fifteen years -- and no doubt my bank's risk-assessment software had assumed a similar extension

to my working life, since I'd be paying off the loan I'd needed to buy the thing well into my

sixties.

I tugged gently at the plain metal band, until I felt a sharp warning from the needle-thin tubes

that ran deep into the flesh. This model wasn't designed to be slipped on and off in an instant

like the shared units, but it would only take a five minute surgical procedure under local

anaesthetic to remove it. In Uganda, a single HealthGuard machine served 40 million people -- or

rather, the lucky few who could get access to it. Flying in wearing my own personal version seemed

almost as crass as arriving with a giant solar tattoo. Where I was headed, cancer had very

definitely not been defeated.

Then again, nor had malaria, typhoid, yellow fever, schistosomiasis. I could have the ring

immunise me against all of these and more, before removing it ... but the malaria parasite was

notoriously variable, so constant surveillance would provide far more reliable protection. I'd be

no use to anyone lying in a hospital bed for half my stay. Besides, the average villager or shanty-

town dweller probably wouldn't even recognise the thing, let alone resent it. I was being

hypersensitive.

I gathered up my things and headed for the cycle rack. Looking back across the sand, I felt the

kind of stab of regret that came upon waking from a dream of impossible good fortune and serenity,

and for a moment I wanted nothing more than to close my eyes and rejoin it.

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Lisa saw me off at the airport.

I said, "It's only three months. It'll fly past." I was reassuring myself, not her.

"It's not too late to change your mind." She smiled calmly; no pressure, it was entirely my

decision. In her eyes, I was clearly suffering from some kind of disease -- a very late surge of

adolescent idealism, or a very early mid-life crisis -- but she'd adopted a scrupulously non-

judgmental bedside manner. It drove me mad.

"And miss my last chance ever to perform cancer surgery?" That was a slight exaggeration; a few

cases would keep slipping through the HealthGuard net for years. Most of my usual work was trauma,

though, which was going through changes of its own. Computerised safeguards had made traffic

accidents rare, and I suspected that within a decade no one would get the chance to stick their

hand in a conveyor belt again. If the steady stream of gunshot and knife wounds ever dried up, I'd

have to retrain for nose jobs and reconstructing rugby players. "I should have gone into

obstetrics, like you."

Lisa shook her head. "In the next twenty years, they'll crack all the molecular signals, within

and between mother and foetus. There'll be no premature births, no Caesareans, no complications.

The HealthGuard will smooth my job away, too." She added, deadpan, "Face it, Martin, we're all

doomed to obsolescence."

"Maybe. But if we are ... it'll happen sooner in some places than others."

"And when the time comes, you might just head off to some place where you're still needed?"

She was mocking me, but I took the question seriously. "Ask me that when I get back. Three months

without mod cons and I might be cured for life."

My flight was called. We kissed goodbye. I suddenly realised that I had no idea why I was doing

this. The health of distant strangers? Who was I kidding? Maybe I'd been trying to fool myself

into believing that I really was that selfless -- hoping all the while that Lisa would talk me out

of it, offering some face-saving excuse for me to stay. I should have known she'd call my bluff

instead.

I said plainly, "I'm going to miss you. Badly."

"I should hope so." She took my hand, scowling, finally accepting the decision. "You're an idiot,

you know. Be careful."

"I will." I kissed her again, then slipped away.

I was met at Entebbe airport by Magdalena Iganga, one of the oncologists on a small team that had

been put together by Médecins Sans Frontières to help overburdened Ugandan doctors tackle the

growing number of Yeyuka cases. Iganga was Tanzanian, but she'd worked throughout eastern Africa,

and as she drove her battered ethanol-powered car the thirty kilometres into Kampala, she

recounted some of her brushes with the World Health Organisation in Nairobi.

"I tried to persuade them to set up an epidemiological database for Yeyuka. Good idea, they said.

Just put a detailed proposal to the cancer epidemiology expert committee. So I did. And the

committee said, we like your proposal, but oh dear, Yeyuka is a contagious disease, so you'll have

to submit this to the contagious diseases expert committee instead. Whose latest annual sitting

I'd just missed by a week." Iganga sighed stoically. "Some colleagues and I ended up doing it

ourselves, on an old 386 and a borrowed phone line."

"Three eight what?"

She shook her head. "Palaeocomputing jargon, never mind."

Though we were dead on the equator and it was almost noon, the temperature must have been 30 at

most; Kampala was high above sea level. A humid breeze blew off Lake Victoria, and low clouds

rolled by above us, gathering threateningly then dissipating, again and again. I'd been promised

that I'd come for the dry season; at worst there'd be occasional thunderstorms.

On our left, between patches of marshland, small clusters of shacks began to appear. As we drew

closer to the city, we passed through layers of shanty towns, the older and more organised verging

on a kind of bedraggled suburbia, others looking more like out-and-out refugee camps. The tumours

caused by the Yeyuka virus tended to spread fast but grow slowly, often partially disabling people

for years before killing them, and when they could no longer manage heavy rural labour, they

usually headed for the nearest city in the hope of finding work. Southern Uganda had barely

recovered from HIV when Yeyuka cases began to appear, around 2013; in fact, some virologists

believed that Yeyuka had arisen from a less virulent ancestor after gaining a foothold within the

immune-suppressed population. And though Yeyuka wasn't as contagious as cholera or tuberculosis,

crowded conditions, poor sanitation and chronic malnourishment set up the shanty towns to bear the

brunt of the epidemic.

As we drove north between two hills, the centre of Kampala appeared ahead of us, draped across a

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hill of its own. Compared to Nairobi, which I'd flown over a few hours before, Kampala looked

uncluttered. The streets and low buildings were laid out in a widely-spaced plan, neatly organised

but lacking any rigid geometry of grid lines or concentric circles. There was plenty of traffic

around us, both cycles and cars, but it flowed smoothly enough, and for all the honking and

shouting going on the drivers seemed remarkably good humoured.

Iganga took a detour to the east, skirting the central hill. There were lushly green sports

grounds and golf courses on our right, colonial-era public buildings and high-fenced foreign

embassies on our left. There were no high-rise slums in sight, but there were makeshift shelters

and even vegetable gardens on some stretches of parkland, traces of the shanty towns spreading

inwards.

In my jet-lagged state, it was amazing to find that this abstract place that I'd been imagining

for months had solid ground, actual buildings, real people. Most of my second-hand glimpses of

Uganda had come from news clips set in war zones and disaster areas; from Sydney, it had been

almost impossible to conceive of the country as anything more than a frantically edited video

sequence full of soldiers, refugees, and fly-blown corpses. In fact, rebel activity was confined

to a shrinking zone in the country's far north, most of the last wave of Zairean refugees had gone

home a year ago, and while Yeyuka was a serious problem, people weren't exactly dropping dead in

the streets.

Makerere University was in the north of the city; Iganga and I were both staying at the guest

house there. A student showed me to my room, which was plain but spotlessly clean; I was almost

afraid to sit on the bed and rumple the sheets. After washing and unpacking, I met up with Iganga

again and we walked across the campus to Mulago Hospital, which was affiliated with the university

medical school. There was a soccer team practising across the road as we went in, a reassuringly

mundane sight.

Iganga introduced me to nurses and porters left and right; everyone was busy but friendly, and I

struggled to memorise the barrage of names. The wards were all crowded, with patients spilling

into the corridors, a few in beds but most on mattresses or blankets. The building itself was

dilapidated, and some of the equipment must have been thirty years old, but there was nothing

squalid about the conditions; all the linen was clean, and the floor looked and smelt like you

could do surgery on it.

In the Yeyuka ward, Iganga showed me the six patients I'd be operating on the next day. The

hospital did have a CAT scanner, but it had been broken for the past six months, waiting for money

for replacement parts, so flat X-rays with cheap contrast agents like barium were the most I could

hope for. For some tumours, the only guide to location and extent was plain old palpation. Iganga

guided my hands, and kept me from applying too much pressure; she'd had a great deal more

experience at this than I had, and an over-zealous beginner could do a lot of damage. The world of

three-dimensional images spinning on my workstation while the software advised on the choice of

incision had receded into fantasy. Stubbornly, though, I did the job myself; gently mapping the

tumours by touch, picturing them in my head, marking the X-rays or making sketches.

I explained to each patient where I'd be cutting, what I'd remove, and what the likely effects

would be. Where necessary, Iganga translated for me -- either into Swahili, or what she described

as her "broken Luganda." The news was always only half good, but most people seemed to take it

with a kind of weary optimism. Surgery was rarely a cure for Yeyuka, usually just offering a few

years' respite, but it was currently the only option. Radiation and chemotherapy were useless, and

the hospital's sole HealthGuard machine couldn't generate custom-made molecular cures for even a

lucky few; seven years into the epidemic, Yeyuka wasn't yet well enough understood for anyone to

have written the necessary software.

By the time I was finished it was dark outside. Iganga asked, "Do you want to look in on Ann's

last operation?" Ann Collins was the Irish volunteer I was replacing.

"Definitely." I'd watched a few operations performed here, on video back in Sydney, but no VR

scenarios had been available for proper "hands on" rehearsals, and Collins would only be around to

supervise me for a few more days. It was a painful irony: foreign surgeons were always going to be

inexperienced, but no one else had so much time on their hands. Ugandan medical students had to

pay a small fortune in fees -- the World Bank had put an end to the new government's brief

flirtation with state-subsidised training -- and it looked like there'd be a shortage of qualified

specialists for at least another decade.

We donned masks and gowns. The operating theatre was like everything else, clean but outdated.

Iganga introduced me to Collins, the anaesthetist Eriya Okwera, and the trainee surgeon Balaki

Masika.

The patient, a middle-aged man, was covered in orange Betadine-soaked surgical drapes, arranged

around a long abdominal incision. I stood beside Collins and watched, entranced. Growing within

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the muscular wall of the small intestine was a grey mass the size of my fist, distending the

peritoneum, the organ's translucent "skin", almost to bursting point. It would certainly have been

blocking the passage of food; the patient must have been on liquids for months.

The tumour was very loose, almost like a giant discoloured blood clot; the hardest thing would be

to avoid dislodging any cancerous cells in the process of removing it, sending them back into

circulation to seed another tumour. Before making a single cut in the intestinal wall, Collins

used a laser to cauterise all the blood vessels around the growth, and she didn't lay a finger on

the tumour itself at any time. Once it was free, she lifted it away with clamps attached to the

surrounding tissue, as fastidiously as if she was removing a leaky bag full of some fatal poison.

Maybe other tumours were already growing unseen in other parts of the body, but doing the best

possible job, here and now, might still add three or four years to this man's life.

Masika began stitching the severed ends of the intestine together. Collins led me aside and showed

me the patient's X-rays on a light-box. "This is the site of origin." There was a cavity clearly

visible in the right lung, about half the size of the tumour she'd just removed. Ordinary cancers

grew in a single location first, and then a few mutant cells in the primary tumour escaped to seed

growths in the rest of the body. With Yeyuka, there were no "primary tumours"; the virus itself

uprooted the cells it infected, breaking down the normal molecular adhesives that kept them in

place, until the infected organ seemed to be melting away. That was the origin of the name:

yeyuka, to melt. Once set loose into the bloodstream, many of the cells died of natural causes,

but a few ended up lodged in small capillaries -- physically trapped, despite their lack of

stickiness -- where they could remain undisturbed long enough to grow into sizable tumours.

After the operation, I was invited out to a welcoming dinner in a restaurant down in the city. The

place specialised in Italian food, which was apparently hugely popular, at least in Kampala.

Iganga, Collins and Okwera, old colleagues by now, unwound noisily; Okwera, a solid man in his

forties, grew mildly but volubly intoxicated and told medical horror stories from his time in the

army. Masika, the trainee surgeon, was very softly spoken and reserved. I was something of a

zombie from jet lag myself, and didn't contribute much to the conversation, but the warm reception

put me at ease.

I still felt like an impostor, here only because I hadn't had the courage to back out, but no one

was going to interrogate me about my motives. No one cared. It wouldn't make the slightest

difference whether I'd volunteered out of genuine compassion, or just a kind of moral insecurity

brought on by fears of obsolescence. Either way, I'd brought a pair of hands and enough general

surgical experience to be useful. If you'd ever had to be a saint to heal someone, medicine would

have been doomed from the start.

I was nervous as I cut into my first Yeyuka patient, but by the end of the operation, with a

growth the size of an orange successfully removed from the right lung, I felt much more confident.

Later the same day, I was introduced to some of the hospital's permanent surgical staff -- a

reminder that even when Collins left, I'd hardly be working in isolation. I fell asleep on the

second night exhausted, but reassured. I could do this, it wasn't beyond me. I hadn't set myself

an impossible task.

I drank too much at the farewell dinner for Collins, but the HealthGuard magicked the effects

away. My first day solo was anticlimactic; everything went smoothly, and Okwera, with no high-tech

hangover cure, was unusually subdued, while Masika was as quietly attentive as ever.

Six days a week, the world shrank to my room, the campus, the ward, the operating theatre. I ate

in the guest house, and usually fell asleep an hour or two after the evening meal; with the sun

diving straight below the horizon, by eight o'clock it felt like midnight. I tried to call Lisa

every night, though I often finished in the theatre too late to catch her before she left for

work, and I hated leaving messages, or talking to her while she was driving.

Okwera and his wife invited me to lunch the first Sunday, Masika and his girlfriend the next. Both

couples were genuinely hospitable, but I felt like I was intruding on their one day together. The

third Sunday, I met up with Iganga in a restaurant, then we wandered through the city on an

impromptu tour.

There were some beautiful buildings in Kampala, many of them clearly war-scarred but lovingly

repaired. I tried to relax and take in the sights, but I kept thinking of the routine -- six

operations, six days a week -- stretching out ahead of me until the end of my stay. When I

mentioned this to Iganga, she laughed. "All right. You want something more than assembly-line

work? I'll line up a trip to Mubende for you. They have patients there who are too sick to be

moved. Multiple tumours, all nearly terminal."

"Okay." Me and my big mouth; I knew I hadn't been seeing the worst cases, but I hadn't given much

thought to where they all were.

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We were standing outside the Sikh temple, beside a plaque describing Idi Amin's expulsion of

Uganda's Asian community in 1972. Kampala was dotted with memorials to atrocities -- and though

Amin's reign had ended more than forty years ago, it had been a long path back to normality. It

seemed unjust beyond belief that even now, in an era of relative political stability, so many

lives were being ruined by Yeyuka. No more refugees marching across the countryside, no more

forced expulsions -- but cells cast adrift could bring just as much suffering.

I asked Iganga, "So why did you go into medicine?"

"Family expectations. It was either that or the law. Medicine seemed less arbitrary; nothing in

the body can be overturned by an appeal to the High Court. What about you?"

I said, "I wanted to be in on the revolution. The one that was going to banish all disease."

"Ah, that one."

"I picked the wrong job, of course. I should have been a molecular biologist."

"Or a software engineer."

"Yeah. If I'd seen the HealthGuard coming fifteen years ago, I might have been right at the heart

of the changes. And I'd have never looked back. Let alone sideways."

Iganga nodded sympathetically, quite unfazed by the notion that molecular technology might capture

the attention so thoroughly that little things like Yeyuka epidemics would vanish from sight

altogether. "I can imagine. Seven years ago, I was all set to make my fortune in one of the

private clinics in Dar es Salaam. Rich businessmen with prostate cancer, that kind of thing. I was

lucky in a way; before that market vanished completely, the Yeyuka fanatics were nagging me,

bullying me, making little deals." She laughed. "I've lost count of the number of times I was

promised I'd be co-author of a ground breaking paper in Nature Oncology if I just helped out at

some field clinic in the middle of nowhere. I was dragged into this, kicking and screaming, just

when all my old dreams were going up in smoke."

"But now Yeyuka feels like your true vocation?"

She rolled her eyes. "Spare me. My ambition now is to retire to a highly paid consulting position

in Nairobi or Geneva."

"I'm not sure I believe you."

"You should." She shrugged. "Sure, what I'm doing now is a hundred times more useful than any desk

job, but that doesn't make it any easier. You know as well as I do that the warm inner glow

doesn't last for a thousand patients; if you fought for every one of them as if they were your own

family or friends, you'd go insane ... so they become a series of clinical problems, which just

happen to be wrapped in human flesh. And it's a struggle to keep working on the same problems,

over and over, even if you're convinced that it's the most worthwhile job in the world."

"So why are you in Kampala right now, instead of Nairobi or Geneva?"

Iganga smiled. "Don't worry, I'm working on it. I don't have a date on my ticket out of here, like

you do, but when the chance comes, believe me, I'll grab it just as fast as I can."

It wasn't until my sixth week, and my two-hundred-and-fourth operation, that I finally screwed up.

The patient was a teenaged girl with multiple infestations of colon cells in her liver. A

substantial portion of the organ's left lobe would have to be removed, but her prognosis seemed

relatively good; the right lobe appeared to be completely clean, and it was not beyond hope that

the liver, directly downstream from the colon, had filtered all the infected cells from the blood

before they could reach any other part of the body.

Trying to clamp the left branch of the portal vein, I slipped, and the clamp closed tightly on a

swollen cyst at the base of the liver, full of grey-white colon cells. It didn't burst open, but

it might have been better if it had; I couldn't literally see where the contents was squirted, but

I could imagine the route very clearly: back as far as the Y-junction of the vein, where the blood

flow would carry cancerous cells into the previously unaffected right lobe.

I swore for ten seconds, enraged by my own helplessness. I had none of the emergency tools I was

used to: there was no drug I could inject to kill off the spilt cells while they were still more

vulnerable than an established tumour, no vaccine on hand to stimulate the immune system into

attacking them.

Okwera said, "Tell the parents you found evidence of leakage, so she'll need to have regular

follow-up examinations."

I glanced at Masika, but he was silent.

"I can't do that."

"You don't want to cause trouble."

"It was an accident!"

"Don't tell her, and don't tell her family." Okwera regarded me sternly, as if I was contemplating

something both dangerous and self-indulgent. "It won't help anyone if you dive into the shit for

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