By Alex Bottle
The tall, portly gentleman breezed into Sami’s clinic just as he always did at donation time. No one breezed out again afterwards, not even him, and she felt every note of his whistled “New York, New York” breach her professional facade. She forced out her nurse technician smile and scanned his proffered wrist ID. She never relished observing her handiwork’s effect on the other donors, but she always said it was worse with friends.
As usual, she didn’t get Cecil’s reference. “Not England,” she pointed out. “Minister Vozd.”
“Please refrain from mentioning her.” Cecil pulled an amateur dramatic grimace. “But from your tone, my dear, I’d say that holiday hasn’t done you much good.”
“The pyramids were just amazing.” Sami allowed a grin to peep through at the memory. “I found the walking hard, though.”
“Of course,” he said quietly. “You look a little thin, if I may say so. Any word on whether you’ll get the treatment?”
Sami shrugged. “I don’t know yet.” It was out of her control. No point dwelling on it. She switched to her professional voice. “How is your mood today?”
“I’m just grand, though I can’t say I’m glad to be here. Not your fault, I know.”
It still felt like it was. Now she had bad news for him. “Cecil, I’m afraid you’re due for your extended donation. Were you aware of that?”
“Extended?” Cecil sat up. “I can’t be due yet. I can’t be. But I haven’t received any notification. I’m sure I’ve only donated three times this year. Sami, I can’t be.”
She didn’t want to meet his grey-blue eyes. “I’m sorry, Cecil. Under the new guidelines, every fourth is an extended.”
“Oh God.” He blew out his cheeks.
“I’ll give you extra neocoke afterwards to take the edge off it.”
He held up a palm. “No, thank you. Well, once more unto the breach, I suppose.”
“To the what?”
“Sometimes I forget how young you are,” Cecil said with a sigh, “and how little your generation reads.”
She fixed the donation apparatus around Cecil’s scalp and tested the connections before setting the timer to extract the higher harvest. “I’m sorry you get so low afterwards, if it’s any consolation.”
“You’re very sweet, Sami.”
“So, have you chosen your visualization routine?”
“Scarborough beach. It’s not Giza, but the fish and chips are better.”
She strapped his head against the bed extension and applied the muscle relaxant gel to his forehead. Poor old Cecil, she thought, always tries to make me laugh. As she monitored the flow from her screen in the next ten minutes, she tried to drive from her mind the image of Minister Vozd’s podgy, grasping fingers and the sound of her whining about healthcare reform opponents.
“How much longer?”
Her insides kicked. She could already hear that telltale change in his voice. “Ten more minutes. Try to continue your visualization.”
Why was this necessary? Particularly during a friend’s donation, she often went over it in her mind. After the obesity epidemic had come the “fifth horseman” — depression — just when the neurochemical model that had launched a dozen classes of medications hit a crisis. Then came the technology for transferring mood itself, at least in its basic forms of “up” and “down.” Mood donation took off as blood donation had done, though many governments had felt the need to mandate it. As a technician, Sami was exempt from any mood donation. Her friends all told her they felt low for at least a fortnight afterwards, and longer for extendeds. In a cruel irony, some people even killed themselves.
“Done.” Sami got up and uncoupled the apparatus.
For a few seconds, he didn’t move. She held out a tissue to wipe his dampened face, but he didn’t take it.
“Are you okay?” She usually didn’t ask this most pointless of questions, but she couldn’t help it with Cecil.
He looked up. The pain in his eyes made her look away. “Am I okay?” He heaved out a laugh. “What do you think?”
She said nothing and wiped the scalp contacts clean and dry. More souls waited in line outside.
“I can let you have five more minutes, Cecil.”
Barely moving, he took all five minutes.
“I’m so sorry, Cecil, but it’s time for the next donor.”
“Of course, of course,” he mumbled as he got to his feet.
She pretended to focus on her screen. Anything but watch him shuffle out. Yes, it was worse with friends.
After the next donor had left, Sami’s webphone rang. There was no mistaking the fake silver hair flowing over those well-padded shoulders.
“Good day, Sami,” said Minister Galya Vozd, her hands folded on her enormous ministerial desk. “How are the extractions going?”
“I’ve just done another extended, Minister,” Sami was glad to report. Pity it was Cecil.
“Excellent! And how many is that this month?”
She brought up the analysis module on her screen and displayed the bar chart.
Vozd looked down and read off the total above the bar marked “extended.”
“So you’ve been a busy bee. Our citizens are so obliging. But is Citizen Sami as obliging?”
Sami swallowed. “How much would you like?” She tried to sound like she was merely handing out ice cream but failed.
“My dear Sami, there’s no need to be like that. It’s very stressful being a minister in the government, with these doctors all so up in arms against my new bill. I need my relief. And there’s plenty of relief to spare, wouldn’t you say? Especially with all these lovely extra donations. You’re always so good to me. One of my better decisions. There were others, you know, in the same position as you. Others who could, shall we say, have received a degree of unwanted high-level attention were it not for my … modest efforts.”
Vozd never let Sami forget it. “How is my case coming on?”
“I’ll bring you right up to date when I arrive. Shall we say seven o’clock this evening?”
Sami excused the receptionist who needed to go home and prepared the apparatus to give rather than receive. At five to seven, Vozd strutted through the door, marched up to Sami’s desk, and put her gloved hands together in a gesture of expectative delight.
“I’ve felt the weight of responsibility particularly keenly this week,” said Minister Vozd. “Do you know how much responsibility weighs, I wonder?”
Sami didn’t look up from her task. “Nearly ready, Minister.”
Vozd threw her handbag and coat over the back of Sami’s chair. “I can’t decide what to listen to during the procedure. First I thought that I was in the mood for something grand like Mahler, like his Symphony of a Thousand. But it’s been such a stressful week, with my tiresome advisors talking about another flu epidemic, and everyone shouting about who should be given the vaccine first. Perhaps something calmer like a Mozart piano concerto would be better. What do you think?” She settled herself on the bed and took out her portable music device.
Sami made some kind of non-committal gesture and connected the Minister to the donation apparatus coupler. “Mozart.”
“What a good idea. That’s another thing I like about you, Sami. You make such good decisions, though I suspect that this one was intuitive. Being a technician has its advantages, like exemption from donations, but knowledge of culture is unlikely to be among them.”
Sami began the loading procedure, diverting the precious good humor that Cecil and so many other citizens had given up for the public good. Before the Minister’s attention was completely lost to the euphoric hit, there was just time to introduce the subject of most importance to Sami.
“Minister, can we talk about my case?”
Vozd was now humming along with the Chicago Symphony Orchestra’s opening tutti. Sami moved closer and repeated her question.
“Your case? Well, I do believe it’s receiving favorable attention. Ah, and now the soloist enters.” She lifted her hands as if imitating the pianist at the point of striking his first notes.
“So, where am I on the list?”
“I believe that the medical assessment tribunal are meeting again soon. This time, of course, they have some new information on your circumstances, namely my … patronage. Is that the right word? This ought to work very well in your favor, don’t you think? And after the development comes the recapitulation. Such a master of sonata form!”
“So, will I know soon? I need to know. Soon.”
As the ecstasy suffused the minister’s face, Sami hated herself just a bit more.
“Yes, yes, you’ll know soon.” Vozd’s voice was faint now. “Don’t you worry your pretty little head.”
Sami was the first to admit that her head wasn’t in fact all that pretty. “When will they decide?”
But she knew that this conversation was over for the next fifteen minutes. There was nothing else to do but sit on the chair and watch the monitor. She sat upright, not wanting to make contact with the minister’s coat still draped there, looking at the monitor without really seeing. She tried not to think about Cecil or how he was coping right at that moment. Probably not well. Here she was, giving his happiness away to increase her chances of getting her the one treatment that would halt her cancer. With a tumor as rare as hers, it was inevitable that the more standard — and cheaper — approaches had failed. The medical tribunal alone would decide if she got the eta-interferon. As its members were reliant on state funding for their research, they generally considered it unwise to upset the Minister who doubled as National Research Council chairman.
She checked Vozd for signs of returning awareness. “How was that?”
“Oh Sami, my dear little Sami. Just wonderful, oh just wonderful. I feel as if I could handle any public inquiry single-handedly. You’re so good to me.”
“So … about my case, Minister. When will I know? I’ve lost more weight this month, I’m sure I have.”
“Don’t look so worried! I think it suits you. Even though I myself am always in rather rude health, I have to admit, I understand how difficult it is for you. I really do. I’ll find out and will put in another good word for you. You’ll get that eta-interferon, little Sami. I’m convinced of it.”
At last, it was done. With the apparatus disconnected, the minister got up and adjusted her clothes, sighing contentedly. The echoing of her heels striking the floor echoed in Sami’s head. On hearing the door shut, Sami fell onto the chair and let it spin her halfway round. She wanted to lie down on the bed, but this one had been rendered unclean. Seconds after telling herself Don’t cry, she broke into sobs. She told herself to keep her eyes on the prize, as someone very famous had once said. It didn’t matter who or what the prize was then. All that mattered to Sami was the tribunal.
Maybe she had got the date wrong. Maybe the hearing hadn’t been when the Minister had said it would be. And maybe it would take a while for them to inform her of their decision. The uncomfortable fact was that Sami was still at her day job, sucking the living joy out of the public, waiting for news a month after the Minister’s last visit. With guilty conscience, she rang Cecil. He’d been signed off work and had barely moved from his living room sofa. Despite their friendship, she found herself retreating into day-job mode. After some long silences, she hung up. She couldn’t tell if he’d appreciated her calling or not.
Then came the call. The call.
“I’m pleased to tell you, Miss Varda, that the tribunal has recommended you for eta-interferon treatment.”
Sami shot to her feet. “I’ve been selected? Are you sure?”
There was no doubt.
“Oh, thank you, thank you.” She was in luck, getting an appointment the next day. “Can you tell me why I was chosen?”
“It’s a clinical decision based on factors such as how likely your body is to respond to the drug, and also on the degree of benefit in terms of years of life gained. The fact that you’re young and that you work would count in your favor.”
“So … was the nature of my job considered at all?”
“No, that wasn’t a special factor, though it’s good that you are skilled.”
“And … did anyone else put in a good word for me that could have been important in the decision?”
“I mean, other than the tribunal members or my family doctor, someone else who could have said something in my favor?”
“This was a medical decision, Miss Varda, as all such matters are. No one is allowed to make any representations on behalf of patients other than medical professionals. You have three senior doctors to thank for making a difficult decision in your favor. Other patients will therefore have been disappointed.”
A purely medical decision. So had the Minister just strung her along the whole time to get her fixes? Or had she in fact made the critical intervention, which was in theory beyond her jurisdiction though not beyond her influence? If the latter were true, then the tribunal could hardly admit to such an obviously improper intervention. She spent some time rooted to the center of her lounge, phone still in hand, squealing with joy at the news and mulling over every detail of the conversation.
The next day she had the first infusion of eta-interferon. It felt like an infusion of hope, though with nausea and localized itchiness. During the next few months, Sami continued to help the government increase their mood stocks while her scans showed a steady reduction in the size of her tumor. Her energy levels picked up too.
One Thursday afternoon her webphone rang between donors as if the caller knew it was a good moment. Minister Vozd’s image appeared behind her infinite ministerial desk. Sami’s heart thumped briefly.
“Sami, you’re looking well. Could it be something to do with that new and grotesquely expensive eta-interferon you’ve been having?”
“The doctors are very pleased with my progress.”
“So why do you look like you’ve been donating yourself? Was my intervention not wanted?”
“No, I’m very grateful, Minister,” she replied, mustering some vigor.
Vozd shrugged her immense padded shoulders. “So?”
“Well, it’s just that … they told me that I got it because of my age, because I’m so young and have a job and therefore have a lot of good years left … and because of my type of tumor. They said it would be likely to respond to treatment better than other people’s, which it has, and that it was just a clinical decision.” She looked up again at the minister in time to see those great eyebrows descend.
“Did you really expect them to admit I told them to break their precious rules that they spend so much of their time dreaming up? One word from me and you’ll soon see them change their minds.”
“What do you mean, change their minds?”
“Well, let’s just say that the treatment you’re responding to so well, the treatment that costs this country’s taxpayers a veritable arm and a leg, the treatment that is denied to so many others in your situation, well, that treatment could easily be withdrawn and given to someone else. Someone else who is more grateful for it, for example.” Vozd leaned still further forward in her chair, her image looming larger on screen as if trying to break through it.
“But I am grateful.”
“I’m so glad to hear that, Sami. I’ve been following your progress and would hate to lose my favorite loader.” She let the last word hang for a moment. “Talking of which, I wondered if I might pay you a visit today after the last donation? It’s been such a stressful time lately.” She let out an exaggerated sigh. “The nurses’ unions are being so difficult. All I want is for the best to be rewarded and that those who are, shall we say, less able should be made to do better. Is that so wrong?”
“I’ll see you at seven. Same dose as last time? Show me that clever graph of the donations. My, the extendeds have been going well. You know, I really do think that another dose will give me just the edge I need to make those nurses see sense. My plan will improve patient care, I’m quite sure of it. Why ever can they not see it?” She sighed again.
Sami felt sick. She had naively assumed that her “loading” days had ended. Could Vozd really get the doctors to withdraw the interferon? Sami recalled how a year earlier she’d had a car accident. She’d had too much neocoke, and the court case had been made to disappear just a fortnight after she had obliged the minister with her first loading. Coincidence? Key medical notes showing the extent of her intoxication disappeared, a witness changed his mind about what he had seen, and the case collapsed. Now the same minister had moved from the justice department and was overseeing healthcare, and Sami had started a course of one of the most expensive drugs ever developed. Another coincidence?
Vozd arrived punctually at Sami’s desk. She stood with her gloved hands clasped together in readiness. Sami finished the preparations and looked up to see the minister beaming. She shuddered.
Vozd lay down and took out her portable music device. “I suppose,” she said with a sigh, “that when you’re cured, I shall have to find another loader.”
Sami said nothing.
“Well, I must make the most of this occasion, then, mustn’t I?”
Sami connected the minister’s scalp to the apparatus, applied the gel and began the outflow. This could be the last time she would have to do this, any of this. She sat erect in front of the monitor, not bearing to touch the minister’s bag and coat draped there once again, and followed the flow graphic. Just one more time.
Another citizen’s donation lost. Time passed slowly. Don’t think about Cecil. It’s him or your cancer.
Afterwards, Vozd blithely alighted from the bed, gathered her things and sighed, each emission of pleasure a further humiliation. Their eyes finally met as Vozd said simply, “Goodbye,” and left without a word of thanks.
Sami flopped onto the chair. She spent a long time staring at the same floor tile. In the bathroom she spent even longer trying to scrub the disgust from her hands.
She was declared tumor-free by December — just in time for Christmas, as her doctor put it. During that time, Minister Vozd had made several appearances on screen. Sami would immediately dive for the remote control to change the channel. She should have known she could not escape that easily. One day, Vozd amazed her by webphoning the clinic room just after the day’s last donation.
“My dear Sami, how are the donations going?”
“We’re on target, Minister,” Sami replied as blandly as she could, bringing up the relevant charts on screen.
“Excellent work,” said Vozd, nodding. “Then you would still have a little to spare? Just a little?”
Sami put a hand to her mouth as if to hold back vomit. “Why, Minister?”
“Now don’t be like that. It’s nearly Christmas, and I’m rather short of Christmas cheer at the moment, what with the poor reception of the recent White Paper. Surely you wouldn’t begrudge me just one more load? It’s been such a stressful time, such a stressful time.” She used her little-girl voice again that Sami never heard on television.
Sami hesitated and moved her lips without saying anything.
“You’re looking very well, Sami. I see that the eta-interferon did the trick, which is of course wonderful news. When something is that expensive, it is particularly heartening when it works, don’t you think?”
“Yes, it worked very well.” She fixed her eyes on the minister’s desk.
“I’m so pleased. So let us consider this final load an expression of your gratitude. Usual time, usual dose? Just once more, I promise. Okay?”
There was a hint of uncertainty in her voice as if Sami had the option of saying no, which in truth she did. In a sense, she’d had the option all along, but hadn’t taken it. A final expression of gratitude.
But also an opportunity. She called Cecil’s mobile webphone. The poor man was nearly due for another donation.
“Oh, hello my dear. Don’t tell me I’m due already.”
She felt relieved that he sounded his usual self. “Yes, in January, but that’s not why I’m calling.”
“How would you like to see the health minister make a donation? I mean, be there in the same room when it happens?”
“See the health minister make a donation? King Solomon and David! How?”
“Can you come to the Center this evening? I’ll need your help, Cecil.”
“What do they say about wild horses?”
She had no idea, but smiled at the glee in his voice. Boosted by Cecil’s response, Sami’s mood was transformed as she reprogrammed the apparatus for an extended. When Cecil arrived after the last scheduled donation, she had only ten minutes to explain the hideous truth both of the minister’s abuse and of her own complicity and shame. As his face ran through the gamut of expressions, she couldn’t always bear to watch.
“You can say no, Cecil.”
He set his jaw. “Just how low can you get her?”
“There are safety overrides, unfortunately, but if you can hold her down I may be able to do another extended straight after the first.”
“Just you watch me try.”
Sami felt already that she had made the right choice of assistant. She took him through the plan. “I felt so guilty about your reaction to the extended.”
“And so you might,” he said, before softening after a few seconds. “I know you’re just doing your job, my dear.”
The minister arrived punctually as Sami fidgeted with paper files and pretended to check over the equipment.
“My dear Sami, you are looking even better than last time. I’m so pleased. I promise this will be the last one. I finally convinced the nurses to see sense, but now it’s the media who don’t understand the benefits of my plan. It’s just so draining. I expect that now you’re cured you’ll have a happy Christmas. Well, I just want to have one too. Is that so wrong?” She tossed her bag and coat onto Sami’s chair and took up her usual place on the bed.
The two minutes’ grace Sami had asked Cecil for had nearly passed. She hooked the minister up with slightly unsteady and moist hands.
“How about Wagner today?”
Sami mumbled, “Okay,” made extra sure that the straps were secure and set the machine. Was Cecil counting the time? She looked across at the terrible grey skirt and then at the minister’s face to check for any sign that she had noticed something was amiss. The minister was still, eyes closed, humming quietly. Sami waited. Where was Cecil?
The door creaked slightly, and at last she saw him enter, tiptoeing in his none too gazelle-like manner. Vozd soon detected his presence. As she opened her mouth to protest, Cecil plonked himself on the edge of the bed, ready to grab any part of her that wriggled free. He grinned fiercely as if with pain.
“‘It is the duty of every citizen to help with the creation of a reserve of natural brain substances used for the greater happiness of all,’” Cecil quoted. “True or false, Minister Vozd?”
“Who are you? What’s going on? Get off me.”
“I am a regular citizen who regularly donates my natural brain substances, whatever they are, at great personal cost to myself, I might add. I do my duty along with millions of others in this country. After my last extended, I was off work for six weeks. Would you like to see the souvenirs of that holiday?
He grasped her wrists and rotated his own to show her. “Today I find out that not only are our beloved appointed representatives in government exempt from donating, which I knew already, but the ministers are using our donations for kicks like common junkies. I think the Minister for Health should set an example and contribute too, don’t you?”
“What do you mean? You can’t do this to me.”
“Oh yes we can. Just lie back, Minister. I would say that you’re due for an extended.”
Vozd thrashed her legs, but after thirty seconds of struggling against the straps and Cecil’s might, she resigned herself to her situation.
“After this one, we’re going to make you do another,” Cecil said. “And, if you don’t behave, we’re going to make you do another after that.” Then Cecil explained in detail how it feels after a donation.
Sami watched him throughout, with the occasional glance at the monitor and the minister. At no time did she consider the consequences for her future as a result of this assault. Nothing mattered but yanking the last nanogram of happiness out of Vozd and sending her into catatonic oblivion.
At last it was time to stop.
“We can let her go.”
Vozd just lay there. With some pushing from Cecil, she got up at last, half falling, and picked up her bag and coat without a murmur. Sami and Cecil stood an inch apart, not daring to touch. Together they watched the Minister for Health trudge through the clinic door on her way out into the weak winter moonlight.
By day Alex is an associate professor in medical statistics in London, UK, and research healthcare performance. He lives with his wife and cat in a small town famous for its forest.