The PTS 2.docx

8/9/2019 The PTS 2.docx

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INTRODUCTION

“A further danger, although less well known, arises when the ego of theanalyst is engaged by the patient’s trauma so completely that theanalyst himself is also traumatized, so to speak, as if he were himself

witnessing the terrifying scene…” Sigmund Freud in an undated letterto Carl Jung.

“I heard them say at the Memorial ay parade that they were droppingthe !disorder’ and it’s "ust going to be the #$%” Veteran to his VAdoctor.

&'as hat man dir, du armes (ind getan)& oethe

Dr. !ar" #lac"$ the %s&chiatrist'In'Charge o( )osttraumatic stress *%TS+treatment at the ,estchester Count& Veterans A-airs !edical Center$was sometimes inited to s)ea" to grou)s o( high school students whowere considering an enlistment in di-erent /ranches o( the militar&.0is charisma and somewhat e1otic a))earance *South Asian$ er& tall$)er(ect 2nglish+ hel)ed him easil& ca)ture and hold the )ros)ectieenlistees3 attention$ and it was ho)ed that his tal"s would alla& theiran1iet& a/out 4catching5 the %TS.

4!ar" #lac"5 was an Americani6ation /earing no relationshi) to the

name he had /een gien in !um/ai /& his )arents$ am/itious)ro(essionals who /rought him to the United States /e(ore he startedmiddle school. 0e was e1tremel& /right7 he attended an Americanmedical school and com)leted the )restigious )s&chiatr& residenc& at%a&ne ,hitne& *which had moed (rom its )er)etuall& 8ooded!anhattan site to ,hite %lains late in the )reious centur&+. 0e wasiewed as one o( the &oung stars o( the residenc& )rogram */e(ore hewas seduced /& anti9uated Freudian theories$ much to the chagrin o(his more mentors+.

It seems that eer& generation or so$ a new )s&chiatric condition is

de:ned$ s)reads through a gien culture$ and generates seeraldi-erent treatments. The %TS$ diagnostic child o( %TSD$ generated atreatment called g'im)lantation *technicall& micro'glial cellmodi:cation and re'introduction+$ which was widel& used in militar&and eterans3 hos)itals to$ in some sense$ inoculate )atients againstwhat had come to /e seen as an ineita/le$ disa/ling conse9uence o(militar& serice. That there were more e1act$ and li"el& more e-ectie$a))roaches to the )ro/lem o( )s&chological trauma did not dissuade

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)ro)onents o( 4g'im)lants.5 ,hen the& were con(ronted with theneuroscientists3 detailed )h&sical and cognitie ma))ing o( the /rain$adocates o( g'im)lants /ecame stu//orn 6ealots$ using their/ureaucratic )ower in the militar& and the Veterans Administration to9uash the introduction o( more rationall& designed thera)ies.

Dr. #lac" sometimes e1)lained the g'cell im)lant treatment toadolescents with this lecture$ ar&ing )arts o( the tal" de)ending onthe so)histication o( his audience7

4Imagine that &ou run a s)& serice$ and that &ou need to in:ltrate anisland whose inha/itants are all er& /rown$ li"e me5 *laughter+ 4and&our own )eo)le''ma&/e on &our own island$ right$ the weather isn3ter& nice$ lots o( clouds and rain''the& are all er&$ let3s sa&)ale5 *more laughter+. 4So &ou send out an e1)edition one night andsteal a /unch o( /rown /a/ies (rom this other island$ &ou get into the

maternit& wards and


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4,e hae a wa& o( tric"ing &our immature /rain cells into doing whatwe want /& remoing them$ changing them e)igeneticall&$ andreturning them to &our /rain to @cure3 the %TS.

4#ut we don3t alwa&s hae total control oer the modi:ed stem cells$

the immature g'cells$ a(ter we introduce or re'introduce them into our)atients.

4#ut we are getting /etter at it all the time5

Somehow$ des)ite the am/iguit& o( his message$ Dr. #lac" rarel& (ailedto in(use the grou)s o( )ros)ectie enlistees with con:dence that the%TS$ m&sterious )lague o( warriors (or millennia$ could :nall& /etreated$ and the& could sa(el& /ecome heroes.

DOWN AND OUT

0e was restless all night. 0e "e)t "ic"ing the sheets and t&ing himsel(into them$ with a lot o( grunting and moaning. ,hen he :nall&settled into a /all$ he /egan )ic"ing at his right ear$ swatted it a (ewtimes.

I couldn’t hear any buzzing* I watched him, it was my "ob, more orless, although I wasn+t sure who was going to pay me* e sat up all of

a sudden and stared right at me, but he seemed to be somewhereelse, or I was* e picked at his ear some more and startedwhispering* I could make out something like “dispatch,” and“sanitize,” before he let his head drop back to the mattress.

Dis)atch wo"e him out o( a restless slee)$ the tinn& male oices)ea"ing inside his head somewhere in the icinit& o( his rightear. 4Routine$5 the oice said$ 4T ictim at B?? =awrence. Re9uestingsaniti6e.

4Name> ,hat3s the name>5 he as"ed the oice$ )ro))ing his head on

one arm to loo" at the /rown and /lac" dog l&ing at the (oot o( the/ed. It o)ened its e&es /ut didn3t moe..

4=ester Sansome$5 the oice said. 4Caucasian$ (eet$ inches$ E?&ears old$ o/ese$ moustache$ small scar on right chee". %ro(essional.5

4A doc> ,hat "ind o( doc>5

B


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how+. 0e (elt the weight o( the "ni(e ne1t to his thigh$ and heard !a1)anting /ehind him. B?? had a hologram )la9ue that read$ discretel&$=ester Sansome$ %.N.%. Trauma Reconstruction.

0e came close to the retina scan$ waited (or it to recogni6e him and

unloc" the door. There was a long dela& and he (elt the hair riseon the /ac" o( his nec"'' the unres)onsie door suggested a er&signi:cant /rea"down$ )utting him at considera/le ris" (rom the !etro%olice$ who were neer /rie(ed on his o)erations /e(orehand$ andwould not /e "ind to a homeless man carr&ing an anti9ue "ni(e.

0e ste))ed /ac"$ loo"ed (or !a1$ who had disa))eared$ then staredinto the scan again. This time he heard a )neumatic 4swoosh$5 and ittoo" him a con(using second to reali6e that a door had o)ened to hisle(t$ out o( which the (uc"ing !etro co)s were running er& (ast andthat he was a/out to /e 4su/dued.5 0e (elt with his tongue (or the

nano switch in his tooth and /lac"ed out.

DR. BLACK

4,hat we hae here$ m& (riends$5 said Dr. !ar" #lac"$ 4is a )aranoiddelusion in its )urest (orm.5 The seen medical students werecrowded into the )s&ch o/seration closet$ es)eciall& eager to seean&thing in its )urest (orm a(ter watching )re'treatment (ecessmearing in the rec thera)& room$ the wor" o( a eteran with a third o(a /rain.

40is a))earance is unremar"a/le. !ost untreated )aranoids are er&care(ul a/out their clothingGthe& (eel )rotected /& an orderl&a))earance. Notice I said @)aranoid$3 not @)aranoid schi6o)hrenic3 or@delusional )ersonalit&.3 This "ind o( )aranoid )atient started comingto our clinics a/out :(teen &ears ago$ not long a(ter the discoer& o(contagious trauma and our use o( g'im)lants.5

4Sir$5 one o( the students$ South Asian as so man& o( the medicalstudents were these da&s$ 4this man will ma"e sense> 0e will not haethe @word salad3 or the @loa3>5

Dr. #lac" smiled$ "indl&$ as he remem/ered his own struggle with)s&chiatric 2nglish$ and said 4Not @loa$3 that3s an a//reiation$ @l3 @o3 @a$3 (or @loosening o( associations.3 And no$ he should /e 9uite coherent. =isten while the tech interiews him.5

The three students closest to the screen /ac"ed awa&$ howeer$ asthe )aranoid seemed to stare right at them$ een though the ideosensors were scattered throughout the interiew room and inisi/le to


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the )atient. 40ow does he "nowK5 one o( the students as"ed$ /ut Dr.#lac" shushed her gentl& with a :nger to his li)s. 4=isten$ 5

4es$ the De)artment o( Sanitation. I get m& orders (rom them. I onl&

tal" to themK5

4,ell !ichael$ I can call &ou !ichael>5 The tech smiled his mostthera)eutic smile$ /ut !ichael stared awa& (rom him at the wall$e1)ressionless. 4The De)artment o( Sanitation handles the cit&disin(ectant su))l&. #ut the& don3t gie an&one orders e1ce)t theirown em)lo&ees. And the&3e neer heard o( &ou.

!ichael continued to stare$ un/lin"ing$ at the wall se)arating him (romthe medical students and said 4ou can laugh at me all &ou want. #ut

it3s the )s&chsGthe shrin"s$ the )s&chiatrists$ the tele'thera)ists$ whocarr& the contagion. And that3s wh& we need sanitation serices. Readthe histor&K5

Dr. #lac" swi)ed the screen /ac" into the wall and the audio (aded.

4Now who can tell me what the )s&chiatric term @delusion3means> 0ow do &ou "now someone is delusional>5

The student who had s)o"en /e(ore$ a slim /lac" haired womanwith une1)ectedl& /lue e&es$ said 4,ell Dr. #lac"$ I thin" it3s a /elie($ a/elie( that is contrar& to realit&.5

4ou mean$ m& &oung (riend5 Dr. #lac" said$ a little unctuousl&$ 4li"e a/elie( in Lrishna$ or the #uddha>5

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e2ecuted beha-iors to commands0 is something o-er 456* 'hich, if you think about it, is a lot better than the best human agents’,something like 776*

4Sorr& doc$5 one o( the guards said$ )ulling the dog3s mu66led mouth/ac" with a wire leash$ 4it must hae gotten awa& (rom the researchla/.5

4,ell$ 5 The guards snared the dog and led it awa&$ itsresistance suddenl& gone.

4In m& countr&$5 the woman said$ 4we hae had drones (or&ears. !an& o( them are 9uite deadl&$ &ou "now$ so een as er&&oung children we had to /e care(ul a/out to& air)lanes$ dolls$ een/unnies. ,e had er& (ew dogs$ &ou "now$ /ecause o( our culture$ /utthe ra//its and the /irds had those same shining e&es.5

As the dog )assed the interiew room$ the )aranoid could /e heard to&ell something a/out 4!a15 and 4)atch.5 Dr. #lac" sighed and wal"edin the other direction$ the medical students (ollowing him li"e a /roodo( chic"s.

I want a -iew of that female medical student’s tablet, but all the doglooks at is a lot of /ngers and that nauseating smile of r* 8lack, wellknown to the Agency as a sub-ersi-e ass9hole* #rotected by godknows which politician*

ANITHA


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All the students (ollowed Dr. #lac" e1ce)t (or Anitha Saro&a$who lagged /ehind$ turned /ac"$ and let hersel( into the o/serationcloset$ using her general hos)ital "e& in the ideo loc". She actiatedthe wall screen and was suddenl& (ace to (ace with the )aranoid

!ichael$ who seemed to /e staring right at her.

4,e loo"ed &ou u) in the militar& data/ase5 the tech was sa&ing$ 4and&ou were an intelligence s)ecialist at the COT in %ortland. ourmedical records areK5

4Classi:ed5 !ichael said$ still staring at the wall. 4#ut i( it will get meout here an& (aster$ I3ll tell &ou a/out m& @treatment3K5

4A(ter &ou were committed>5 The tech was suddenl& hesitantGhereali6ed he shouldn3t hae mentioned a situation in which a )aranoid

)atient had /een )owerless.

!ichael was$ o( course$ restrained /& electronic /racelets and an"lets$/ut the tech had allowed him some (reedom o( moement /&modulating the current in the arm and (eet )lates o( the restrainingchair. So when !ichael moed er& suddenl& to stand u) a(ter heheard the word 4committed$5 the restraints wrenched his arms /ehindhim /ut allowed him to lean (orward. 4ou coc"suc"er5 he &elled in thetechs (ace$ 4&ou )s&ch coc"suc"er.5 0e managed to moe within a(ew inches o( the tech$ who


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4I thought &ou might want to tell me a/out this @dis)atch3K5

4ou were there$ weren3t &ou>5 0e said a(ter a )ause$ loo"ing at theo/seration closet wall. 4I "now the setu)$5 he said. 0is oice wasrough$ and now that he wasn3t &elling$ he s)o"e with an e-ort$ li"e

someone who went (or long )eriods o( time without tal"ing to an&one.

4es$ I heard &ou sa& something a/out dis)atch. I wondered i( ma&/e&ou were haing trou/le with &our g'im)lant.5

A(ter another )ause$ he loo"ed awa&$ (reeing her (rom his :1edstare. 4I don3t hae a g'im)lant$5 he said. 4I neer signed a release (orthat.5

4Um$ doctor$5 the tech said$ who a(ter a scan o( her /adge and a silentelectronic communication (rom hos)ital securit& now understood her

actual status$ 4That isn3t )art o( the interiew )rotocol. Um$ &ou areone o( Dr. #lac"3s medical students>5

!ichael laughed. 4ou aren3t een a doc>5

Anitha retained her com)osure$ /ut touched her identi:cation /adgeinoluntaril&. 4No$ I was o/sering &ou with some other students. I amin m& last &ear o( training and I will /e (ull& 9uali:ed soonK5 0er2nglish still carried a lilting (oreign (ormalit&$ and she (elt that shewas de(ending not onl& her )ro(essional standing$ /ut her right to /e inthis American eterans hos)ital$ des)ite her legal status and her /lue

e&es.

4I want the Veteran3s Adocate$5 !ichael said to the Tech. I3m nottal"ing to &ou.5

4Um$ !iss>5 the tech said$ 4I need to call the Adocate now$ and I thin"it might /e /est (or &ou to go :nd Dr. #lac"K5

4O"a&$ /ut wait$


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and girls at the COT /ecause some clum) o( /rain cells gets eaten u)/& mista"e.5

The door slid o)en and the two securit& guards Anitha had seen with

the dog in the corridor came into the o/seration room. One o( themhad a ust assigned here, right)”

“?resh out of ?ort 8ragg* @ou’re Mc-oy, right)”

%o we go through the ritual chit9chat, compare notes on the

instructors at 8ragg, re-iew any highlights of the last si2 hours thatmight lead to a change in the operation* $hen I go to the #$%screening clinic, put my hand into the sensor glo-e, and watch thedisplay* $he only real an2iety I feel this shift is watching the intensityread9out* My career can end in the three seconds it takes to processthe data from the sensor glo-e* “@ou’re good to go, :aptain” the techon duty says* And I lea-e the :;$, undiagnosed, free to take theshuttle home* 'hat a big fucking relief*

!ichael =incoln$ "nown as 4A/e5 to his /uds at )s&o)s )re) school atFort 0uachuca$ and as !ichael the %aranoid to Dr. #lac"$ had not /een

so (ortunate. Although his memor& o( the eent was highl& distorted$he had constructed a narratie that he /elieed to /e true7 he had le(ta COT (acilit& seeral &ears )reiousl& with a diagnosis o( %TS$ /asedon a much higher hand dis)la& reading than !c2o&3s *which had also/een high$ /ut su/clinical+. All o( his screaming and shouting and sel('


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the ma


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something li"e 4I "now$ Ca)tain$ I "now that the choices are un(air. It3sun(air that a(ter what &ou3e su-ered &ou can3t (eel normal again$ it3sun(air that &ou3e /een as"ed to sacri:ce so much and are /eingo-ered so little. #ut we need to do something a/out &our %TS$ &ourtrauma$ &our memories. And we reall& hae er& little else we can do

(or &ou /esides the g'im)lantGsurger&$ a/lation o( the hi))ocam)us$mum/o'


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them (rom the trend& mechanical com'im/eds that stimulated auditor&and retinal neres /ut resided su/cutaneousl& and outside the /rain$and had /een aaila/le (rom A))le'US since ?;M+. The docs lecturedhim and his classmates a/out the 4(ailures o( nano mechanical/ehaior modi:cation and inorganic arti:cial intelligence deices5 and

the serendi)itous discoer& that glial cells$ which alread&demonstrated remar"a/l& su/tle in'io (unctioning as the& essentiall&trimmed and tended neurons in the /rain$ and could /e mani)ulatedthrough iral DNA modi:cations. Or$ as one doc )ut it$ 4Thin" o( glialcells as the /rain3s onl& line o( de(ense against in8ammation. And alsoas a lot o( tin& ecienc& e1)erts$ gardeners$ so to s)ea"$ that goaround sni))ing o- )ieces o( neurons that aren3t /eing used at themoment. Or4 *giggling and waing his )udg& hands+ 4to )ut it moree1actl&$ the& reduce or eliminate the dendritic and s&na)ticcommunication /etween neurons at di-erent )oints in time$ de)endingon what the /rain is doing or not doing.5

And i( &ou wanted to$ the lecturers said$ &ou could si)hon o-someone3s glial cells$ se)arate out the immature ones$ alter their DNAand e)igenetic res)onses$ and get the cells to )er(orm s)eci:c tas"s*li"e wi)e out memories$ (or instance+$ and then reintroducethem. And$ o( course$ the De)artment o( De(ense reall& wanted to. Ithad used u) a lot o( com)uting time$ la/ animals$ and mem/ers o( theciilian )rison olunteer )o)ulation to get the )rocess to wor"$ andeentuall& g'im)lants were declared sa(e and e-ectie. In /io'drones:rst$ then in some S)ecial O)s gu&s$ who had since disa))eared. Thee-ectieness studies were classi:ed and unaaila/le to him and his

classmates$ /ut the lecturing docs all said that 4the data showedremar"a/le thera)eutic e-ectieness when com)ared to )lace/o.5

Un(ortunatel&$ the& also said$ des)ite all the com)uting )ower and theso)histicated DNAmeth&lation alterations$ immature g'cells weresometimes un)redicta/le$ /ecame cancerous$ or (ormed 4re/el teams5as the doc )ut it in his lecture 4that act in concert and sometimes$rarel&$ destro& the (unctional a/ilit& o( large areas o( the neocorte1 andother /rain centers.5 %roduce the 6om/ie cler"s$ in other words.

#ut usuall&$ according to the )u/lished literature$ the g'im)lantscreated reall& scar& soldiers who could tune out an&thing that wasn3t4mission critical.5 !eaning the& not onl& ignored distractions /utessentiall& had no (ear$ no thought o( )ersonal conse9uences$ noregrets. No trou/ling memories o( home or (amil& until the& weretreated to reerse the )rocess. ,hich also sometimes (ailed$ withs)ectacularl& tragic results (or man& o( their (amilies. *Nothing wassaid in the g'im)lant literature a/out the )recision neuroscience had

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achieed in ma))ing /rain (unction. Neuroscientists weren3t)s&chiatrists$ a(ter all$ and had no idea what it too" to diagnose andtreat real )eo)le )leading with &ou to cast out their cra6iness+.

SUPERVISION

As the door closed /ehind her$ she (elt that she had entered a roomthat hadnt changed in the last hundred &ears or so. Dr. #lac"3s des"at the (ar end o( the room was an anti9ue wooden roll to). A /lac"chair$ also wooden and coered with crac"ed hard (a/ric that mighthae /een leather$ was ne1t to the des" in a corner and (aced thedoorwa&. *0e later e1)lained to her that this )ut %TS su-erers at ease/ecause the& had nothing /ehind their /ac"s and could see a clearwa& out+. Framed )ictures$ not hologram screens$ hung on the wallsH

one was a )ainting o( a /oat nearing a deserted island. A couch with aheadrest stood ne1t to one wall.

Dr. #lac" sat with his /ac" to her (or a (ew seconds$ then swieled hischair and (aced her$ holding her ga6e with his (or a /rie($ and (or her$an oddl& e1citing$ moment.

4%lease !s. Saro&a$ hae a seat.5 She sat down and :ddled with herta/let$ (rowning at it.

4ou are here (or &our )s&chiatr& su)erision> For this rotation> For

the time honored e1)erience o( @see one$ do one$ teach one3>5

4es$5 she said. 4I as"ed (or &ou$ &ou "now.5 She loo"ed u) (rom herta/let and (ound him smiling at her.

4es$ I "now$ we are told which students as" (or us. I wonder wh& &oure9uested an old'school doc li"e m&sel(>5 0e said the word 4doc5 witha slight hesitation$ as i( the in(ormalit& was something he wasn3tentirel& com(orta/le with.

4I "new that &ou didn3t li"e g'im)lants to treat %TS )atients. That &ou

used the older techni9ues$ a/reaction$ e1)osure thera)&$ dreamanal&sis. No/od& else seems to use those here.5

4es$ &es$ it3s much easier (or the modern )s&chiatrist not to tal" to his)atients$


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4,ell$ &es$ m& /rother was$ he was in the militar& in m& countr& and hehad a /ad e1)erience$ something that (rightened him. And he had theim)lant. It was success(ulK5

4Success(ul>5

4es$ he sto))ed sta&ing in his room$ his 9uarters$ he wasn3t a(raidwhen he went out. The& let him sta& in the militar&.5

4ou said @m& countr&.3 ou and I ma& hae come (rom the same)lace>5

4I lied in NK ,K until I was nine &ears old.5

4Ah &es$ the /eauti(ul mountains. #ut alwa&s :ghting there. oursurname is not o( that region> ou had to leae> ,ith &our (amil&>5

4,ith m& (ather$ &es. 0e was an immigrant (rom !acao$ /ut m&mother was %ashtun. !& /rother$ li"e I said$ was in the militar&. 0ewas much older than me. 0e had a di-erent mother.5

She loo"ed u)$ sus)iciousl&. Dr. #lac" was watching her with a slight(rown$ /ut s&m)atheticall&.

4,e seem to /e tal"ing a/out m& (amil&$ and not a/out )s&chiatr&$5she said. 4I am not usuall&$ I don3t usuall& sa& much a/out m&(amil&K5

4,ell !s. Saro&a$ )s&chiatr& is a /it di-erent (rom the other /rancheso( medicine. I need to get to "now &ou$ &our histor&$ to understandhow &ou might reactGemotionall& react'' to the )atients &ou will seehere. So i( I ma&$ I will as" &ou )ersonal 9uestions$ /ut not to /enos&$ 5

4es. And m& mother diedK5

4,hen &ou were nine or ten &ears old>5

4No$ when I was seen. She had one o( the )rion diseasesK5 Thewords caught in her throat.

4Ah$ that must hae /een terri/le (or &ouK5

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0e reached oer to her$ touching her /are (orearm with his right hand$leaing it there (or a little too long she thought$ watching her (ace$waiting (or her to loo" u). 4%lease !s. Saro&a$5 he said$ 4&ou seem tohae so much sorrow right now. ou didn3t tal" to the #0 nurse at all>5

She )ulled her arm /ac" and loo"ed at him coldl&. 4No$ Dr. #lac"$ andI don3t thin" I want an& @/ehaioral health3 right now. I am not a %TS)atient$ &ou "now.5

4Are &ou sure$ !s. Saro&a> Are &ou reall& sure>5

She loo"ed at him silentl&.

4ou are almost a doctor$ a )h&sician$5 he said. 4The %TS is dangerousto us all$ it tra)s us in angr& sel('hatred$ ma"es us un:tK5 0e le(t the

rest uns)o"en$ /ut she understood the danger$ that he would diagnoseher$ tal" to her other )ro(essors$ hold her /ac". 4I thin" that )erha)s&our (amil& was secular>5

4es$ Dr. #lac"$ secular. ,e were @seculars.35 0er oice 9uaered$ toher disma&. 4,e had no tri/al aliations$ we were @unclean3 or @in:del3or @enemies o( the (aith5 to almost eer&one we met.3 2en as littlechildren.5

4=ittle children> ou were er& ulnera/le then$ a(ter the$ let3s see$ the(ourth war>5

She loo"ed awa& (rom him$ into hersel(. This was a er& di-erentinteriew than her two medical student (riends had had with him. O(course the& had /een u)set to hae /een assigned to him in an& case$called him 4that dinosaur$5 4(raud$5 and worse in their )riateconersations. #ut the& said later that he had /een "ind$ rational$ alittle )om)ous in their sessions with him.

4es$ er& ulnera/le. The )rion disease was eer&where a(ter thee1)losion in Islama/ad.5 *She was re(erring$ o( course$ to thedestruction o( the nano'mechanical la/orator& there in ?; that

released a )articularl& )ersistent cloud o( nano )articles$ engineered/& a terrorist grou) (or some aw(ul )ur)ose$ which in:ltrated thenerous s&stems o( geneticall& ulnera/le )eo)le as the& /reathed themountain air$ /eginning the chain reaction that ine1ora/l& trans(ormedtheir /rains into com)le1 tangles o( useless )rotein chainsG)rionsG"illing them within wee"s+. 4#ut when m& (ather learned what wascausing it$ what "illed our mother$ he wasn3t gien )ermission to leaethe countr&. #ecause he was a @secular.35

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4So &our (ather tried to )rotect &ou. #ut he couldn3t>5

4I didn3t thin" so at the time. I thought that he was ou had to ta"e the )lace o( &our sic" mother$so to s)ea">5

4!& mother was not dead &et$ /ut almost. Vanna$ that was m& sister3sname$ Vanna$ she wanted to go out to the )ar"$ it was stillda&light. She was a )rett& little girl$ )rettier than me. She had long

/eauti(ul /lac" hair and green e&es that m& (ather said )roed she wasalso a %ashtun. She was alwa&s dancing aroundGstrangers smiledwhen the& saw her and gae her things$ (ood$ cand&. I would &ell atthem not to gie m& sister an&thing$ and I would tell her that she didn3t"now i( the& were )oisonK5

4ou might hae /een a little


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21/49

Down and Out

Alone in the med students3 a)artment she shared with a loud$malodorous$ and oerweight American woman$ she sat staring at thewall screen$ num/$ a little sha"&. The a/ru)t end to the session withDr. #lac" had again le(t her (eeling a/andonedH it angered her that hecould so easil& shi(t to his com call and leae her with her )ast and

)resent transgressions. The )atient she would see again$ ociall&$legall& i( &ou li"e. #ut her sisterK.

That morning had /een /right$ siler almost$ or that is what sheremem/ered. She wanted to sta& in the house$ to aoid the throngs o(endors that crowded her er& )oor street. The stall'/o&s waitedthere (or Chinese /usinessmen or their A(ghani underlings to cruise /&in e1)ensie cars at slow s)eeds$ on the loo"out (or /argains Ga )rett&or)han$ s&nthetic drugsGin the wretchedness and de/ris.

Vanna /egan to whine as soon as their (ather le(t on another (ruitlesstri) to the American em/ass&$ where he would again /e denied a isa/ecause o( his 49uestiona/le origins$ 4 )ro/a/l& /& the same cler" hesaid alwa&s humiliated him. Vanna wanted to go outside to )la&$ shewanted to go to the )ar"$ she didn3t want to wear a mas". Anitharemem/ered wishing that when she (rowned adults would laugh andsa&$ as the& alwa&s did when Vanna was rude and angr&$ that she wascute. She did not remem/er$ sitting alone now in her room$ how sheand her sister negotiated the main road without /eing "illed /& aChinese limo$ or how the& started the short clim/ u) the hill to the)ar".

She did remem/er$ howeer$ standing at the /ro"en gate and reading$one more time$ the signs that said 4Danger5 4Contaminated5 42nem&%resence5 in seeral languages and al)ha/ets. Sometimes (rom theedge o( the )ar" &ou could see little shin& clouds on undistur/edground$ 8oating$ anishing 9uic"l& with an& distur/ance o( theair. These clouds were )oc"ets o( nano )articles$ which Anitha "newwouldn3t "ill her /ecause she had tried )ur)osel& to inhale a cloudo( them the da& a(ter she was told a/out her mothers illness. Sheassumed$ a(ter this e1)eriment$ which le(t her memor& intact$ that shewas neer going to get the )rion disease *later she would /e told that

she had$ in (act$ inherited a )rotectie gene+$ /ut she reall& didn3t"now a/out little$ unmas"ed$ Vanna. She let her run through the/ro"en metal /ars an&wa&$


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Down and Out

"now *she told hersel( later+ that an&thing else was wrong with the)ar" that da& e1ce)t (or the nano'clouds. And she had a memor&$ li"ea dream that /egins to lose its coherence in the da&light$ o( littleanimals running$ not awa& (rom them$ /ut in little


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Down and Out

There had (ollowed a long /arren time in Anitha3s li(e during whichshe duti(ull& attended school$ endured her (ather3s silent neglect$ anddeelo)ed an ulcerous s"in condition that sent her /ac" to thehos)ital seeral times. It was there that she was introduced to the

thera)ist$ a short s9uat woman with 2uro)ean (eatures who tried tointerest her in doll/ots 4who lost their mommies and sisters$


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Down and Out

screening (or %TS$ /een ordered to su/mit to a g'im)lant. That the)atient was an unwilling su/


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Down and Out

twitched itsel( o- a monitoring shel(. *The ocial re)ort stated thatthe 4)rimitie /rain tissue and sca-olding were dro))ed /& a mem/ero( the #roo"haen technical sta-$ who has since retired5+.

!a1$ /& wa& o( contrast$ had deelo)ed in a semi'arid region in theAmerican !idwest. 0is DNA had also /een contaminated$ /ut/& another mem/er o( his own s)ecies$ and when he (ailed toresem/le a )edigreed )it /ull$ or )edigreed an&thing else$ Ro/inina"o)olis$ his owner and /reeder$ decided to sell him to a )rocurero( la/orator& animals (or the (ederal goernment She dis)osed o(the rest o( the litter in the grael run /ehind her house.

I( he had had language$ he would li"el& hae descri/ed his :rst si1months as id&llic$ although er& hotH he mainl& learned to lie on the

ground with his tongue out and onl& got u) to chase chic"ens$ when hehad the energ&. And he neer had to eat "i//le. Raw chic"en organssometimes$ an occasional )iece o( wood$ /ut neer "i//le.

#ut now he was loc"ed u)$ a ictim o( circumstances and o( the oicein his head that had told him to (ollow the )aranoid$ with the im)licit)romise *one might sa& antecedent conditional e1)ectation+ o( areward. ,hich$ as it turned out$ was tasteless$ dr&$ and aguel&egetal. 0e (elt sic"$ and in (act retched a (ew times$ ho)ing one o( theguards would come. None came.

So when a la/ tech (orgot to loc" the "ennel$ he too" the o))ortunit& totr& to locate something wetter and more meat'li"e. =i"e an& normaldog$ he )aused (re9uentl& to register the smells o( the la/$ and wouldhae er& much li"ed to mar" the )lace */ut his conditioning)reented this+. Also$ /ecause his last command had /een to sta& withthe )aranoid$ he decided *i( decide is the )ro)er word+ to loo" him u).

Although it was generall& 9uite dicult (or an unaccom)anied dog to/e incons)icuous on hos)ital grounds$ !a1 had /een trained to /estealth&$ and loo"ed something li"e the 2As *2m)ath& Animals+$

)o)ular with the social wor" de)artment and allowed eer&whereH allhe lac"ed was the regulation green hal(


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Down and Out

animal to a certain goernment agenc& was a))rehended shortl&a(terwards /& Fred and a colleague.

During his ride on the eleator his handler had come /ac" online$ and/& the time Anitha and her classmates came out o( the o/seration

room he was /eing told to moe one wa& and another$ which$ des)itethe disa))ointing "i//le$ he tried to do. 0e could hae done withoutthe mu66leGhe wasn3t an attac" dog$ a(ter allG/ut the oice in hishead gae coded orders to /e still and to allow a-ectionatecontact. Anitha3s odor was strangeGa commingling o( her classmates3an1iet& and something com)licated and s)ic&Gand he would er&much hae li"ed to lic" her (ace. 0e (elt the usual strange i/ratingsensation (rom his /lind e&e *actuall& a high resolution ideotransmitter+.

As he was /eing led on a leash )ast the loc"ed interiew room he

heard the )aranoid call his name$ inducing the usual am/ialencea/out which oiceGthe one outside his head or the one insideGheshould o/e&.

GRAND ROUNDS

Anitha was su-ering (rom the /orderline e1haustion that has alwa&saicted medical students$ interns$ and residents as the& moethrough their training. She com)lained to her roommate$ who was$howeer on an een more demanding surgical rotation and thus)roided her with little s&m)ath&. The roommate was curious a/out

4Dr. =ech$5 howeer.

40e wasn3t so /ad the second time aroundKnot as smarm&$ and hedidn3t tr& to hold m& hand this time.5 The& /oth laughed. 40e saidthat he would let me see another )s&chotic )atient /e(ore I meet withthe )aranoid$ to )ractice m& @ra)idl& im)roing interiewing s"ills.5

4That was a little oer the to).5

4,ell$ I guess 8atter& is o"a&. As long as it3s not a/out m& @unusual/lue e&es.35

40e said that>5

4No$ /ut I could tell that he was going to get to that when he startedas"ing a/out m& last name again$ where m& (ather3s (amil& was (rom$all that e1')at /.s.5

?E


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4I guess I don3t "now what that3s li"e$ no/od& eer sa&s an&thing a/outm& unusuall& /rown /rown e&es. That was some lecture he gae$thoughH he reall& seems to "now his su/


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Down and Out

#ut /e(ore that$ /e(ore the %TS gloe$ we used tests and interiewsadministered /& technicians to :nd out who had %TSD *again$ listen tothat @D$3 it was considered a mental illness+.

4And o( course this was com)letel& stu)id$ /ecause there reall& was no

such animal as a @%TSD$3


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Down and Out

4#ut I can see some o( &ou are /ored *I ho)e it3s onl& some o( &ou+$ solet3s ta"e a /rea".5

GRAND ROUNDS PART 2

During the /rea" one o( the residents com)lained that 4#lac" istrashing the VA againH5 and another said 4eterans will neer gie u)their %TS.5 And when Dr. #lac" /egan the second )art o( his lecture$his audience was /oth smaller and more restless.

4,ell$ as I was sa&ing$ things had gotten to the )oint that America wass)ending a ast amount o( mone& to )a& (or treatment o( a @)s&chiatricdisorder3 that almost eer&/od& assumed eer& serice mem/er wasgoing to catch as soon as the& signed an enlistment contract. #utwhen an& rational )s&chiatrist tried to )oint out how ague this

disorder was$ how ma&/e it wasn3t real$ eterans got together to getrid o( the /ad doctor$ and the& were er& success(ul at this.

4#ut a /rilliant man$ (rom !um/ai no less5 *laughter+ 4Dr. RaiLrishnamurthiGhis )icture hangs in the main lo//& o( eer& VA in thecountr&G(ound a wa& to gie eterans their %TSD and to sae /illionso( dollars at the same time. 0e had these er&$ er& smart ideas.

4First$ he taught us that %TSDG)osttraumatic stress disorderGwas notreall& a disorder$ /ut something that


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Down and Out

made interesting loo"ing gra)hs *laughter+ and there it wasGthe %TSdetection gloe.

4A lot o( )eo)le thought this was a er& good idea$ es)eciall& /ecauseat 5 Dr. #lac" as"ed$ smiling athim.

4Sorr&$ memor& la)ses$ hallucinations$ tremors$ a lot o( alcohol anddrug a/use. And I "now that latel& &ou3e )u/lished articles a/out thedangers o( g'im)lantsGI wonder i( &ou could comment on that>5

4!a&/e in a di-erent grand rounds$ i( &ou will hae me/ac">5 *Scattered light a))lause+. 4#ut


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chec"ing ideo mail+. The resident loo"ed sur)rised$ a little guilt&. 4Ithin" I hear a legitimate concern (rom &ou$ although somewhat crudel&e1)ressed.5 The audience sto))ed tal"ing to its collectie sel(. 4Therewas$ as &ou might "now$ er& intense )ressure on VA scientists toado)t the new method$ without all the controlled studies that we

usuall& ta"e time to do. #ut (or some reason when )s&chiatr& wants tomess with the /rain the goernment tells us


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Down and Out

And this was :rst discoered when our ancestors$ our (ounding(athers$ so to s)ea"$ a/out a centur& ago$ )retended to o)erate onsome "nees /& ma"ing surgical incisions in their )atients "nees /utdid not do an&thing at all /esides that. Just a small cut or two. Andthen the& com)ared this grou) o( )atients to another grou)$ that had a

so'called arthrosco)ic "nee surger& that was su))osed to get rid o($now get this$ eer&/od&$ de/ris and (ragments that were causingarthritic )ain *a (ew chuc"les+.

=ots o( )eo)le /elieed this e1)lanation (or arthritis$ /ecause whatelse should the& /eliee> That the& were getting older> That No wa& *laughter+ #ut this research$ as unethical as itwas$ i( )atients heard a/out it and /elieed$ was going to ta"e awa&their /elie( in the de/ris theor& o( arthritis$ and ma"e them acce)t oldage and decre)itude. And &ou "now what> The& would hae none o(that$ no realit& (or them.

So instead the surgeons "e)t o)erating and scra)ing awa& de/ris andgetting )aid (anc& (ees$ and the )atients went on /elieing. For man&&ears. And eer&/od& got older...

So$ Dr. Janewa&$ who was loo"ing uncom(orta/le and irritated$ /utwas seated$ cost e-ectie doesnt mean screwing$ /ecause then wewould neer hae )ornogra)h&$


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remem/er> I mean almost'a'doc$ !iss whateer &ou said &our namewas.5

4!iss Saro&a$ /ut &ou can call me Anitha$5 she said$ :nding another)lastene chair and )ulling it toward the screen. The woman com)leted

her recitation and the ideo returned to the /eginning o( the loo)$)aused$ and /egan again. !ichael "e)t loo"ing at the screen /ut said4So &ou came /ac" to see the )aranoid> The& want &ou to /e a/le torecogni6e the enem&$ "now his wa&s and /&wa&s$ /e a/le to trac" himdown and loc" him down.5

4So either I3m &our enem&$ or &ou are mine>5 she as"ed.

4The& must hae told &ou a/out m& war on shrin"s> That I3m cra6&enough to /eliee I hae a mission$ a mission to "ill them> That I3mta"ing orders (rom a oice in m& head that no one hears /ut me and

m& dog> ou "now$ the dog &ou saw the da& we met>5

4es$ I heard that &ou seem to hate these )s&chs$ that the& gae &ou ag'im)lant without &our consent. That seems li"e a terri/lein5 she as"ed$ta"ing a chance with the 4sad truth.5 4ou watch them too$ /ut &oudon3t loe them>5

0e laughed again. 4=et3s not get )ersonal docH I3m here in m& )a


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4,ell$5 he said$ turning his head to loo" at her directl& (or the :rsttime$ 4thought control is what we3re here to tal" a/out$ ain3t it>5

She thought that his teasing was a good sign$ although she hated to/lush *she used to en& the !uslim women on her street their ni9a/sand their chadors+. 4ou mean$ the wa& the& are controlling &ourthoughts>5

4That3s it$ it3s them$ all right$5 he seemed to /e laughing at her$although his (ace$ )leasantl& s&mmetrical and /o&ish$ wase1)ressionless. 4The& )ut me u) to it$ &ou "now$ the& gie me mone&and dis)atch tal"s to me when I3m lonel&$ and then the& arrestme. 2er& time. I thin" there ma& /e a lea" somewhere. Someone3s

tal"ing.5

4So &ou remem/er what ha))ened>5

4That3s right Doc$ no amnesia (or me. I( the& did gie me the g'im)lant it didn3t wor" rightK5

4I "now &ou were er& u)set a/out that$ the )ossi/ilit& o( a g'im)lant. #ut &ou had to gie consentK5

4Doc$ in m& )art o( the o)eration &ou sort o( gie consent (or an& and

eer&thing when &ou sign on. I mean$ this )art I don3t remem/er mucha/out$ /ut when the& told me I had the %TS I "new that the&3d :nd awa& to$ &ou "now$ @cure3 me$ no matter what I said. It was &our /ig)a)a doc$ Doc #lac"$ who showed me the error o( m& inde)endentwa&s.5

4Dr. #lac" treated &ou>5 She thought that he must /e sli))ing /ac"into his )ersecutor& delusions.

4The one and onl&. Chec" it out$ where he was$ the %residio$ in ?;$he was the g'im)lant guru /ac" then. @Nothing$ m& son$ will sae &our

career (rom the %TS e1ce)t the magic g'im)lant.3 Fuc" him. 21cuseme.5

4And these oices in &our head$ the dis)atcherK5

4Dis)atch$5 he interru)ted her$ 4it3s not a dis)atcher$ not an a)). I3mnot &our u/er'ride$ I3m &our assassin. A little dignit& here.5

B


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One o( the elderl& demented )atients sat down on a )lastene chair a(ew (eet awa&$ settled into his seat com(orta/l&$ then /egan )ointing a(ore:nger at a s)ot on the 8oor.

!ichael loo"ed at him 9uic"l&$ then stood u) and /egan wal"ing

toward the nurses3 station. 4Come on doc$ that one3s u) to something.4 The elderl& )atient$ in (act$ stood u) when !ichael did and wal"edunsteadil& a(ter them. Anitha noted !ichael3s tension$ /egan to (eel ithersel($ and turned around to (ace the old man. 4!r. K> Could &ougie us some )riac&>5 The elderl& )atient$ still )ointing his (ore:ngerat the 8oor li"e a diining stic" *she had /een reading a/out anti9uemagical s&stems+$ /um)ed his hi) into !ichael3s as he wal"ed )astthem.

She had dicult& remem/ering e1actl& what ha))ened ne1t''itseemed that =incoln made a er& 9uic"$ almost inconse9uential$

moement inoling his legs and torso$ and the elderl& )atient wassuddenl& l&ing on the 8oor. Two muscular )s&ch aides started moinger& 9uic"l& toward them as =incoln gra//ed her /& the shoulders$turned her$ and then )ushed her head down /& the /ac" o( her nec" sothat her "nees /uc"led.

She managed to as" ,hat are &ou doing !ichael> when she thoughtshe saw a small moth hoering a/oe the old man$ who wasnt moing$and was suddenl& /linded /& a er& white light. !ichael let go o( hernec"$ and when she could see again he was goneH the )s&ch aideswere l&ing motionless close to the elderl& )atient$ who$ as an auto)s&

later reealed$ had died o( a m&ocardial in(arction caused$ dou/tlessl&$/& all the e1citement.

ADMINISRATIVE INQUIRY

Dr. #lac"$ as well as the detecties (rom hos)ital securit& and theassistant director o( the hos)ital$ wanted her to remem/er where!ichael =incoln had gone$ which she couldnt tell them$ haing lostseeral minutes o( isual memor&. The& learned later (rom othersources$ howeer$ that he had esca)ed the loc"ed unit with the

collusion o( one o( the aides$ in this case Fred$ who had /een waiting inthe common room to )roide a diersionar& moth stun /om/. The)atient on the 8oor$ now deceased$ had /een so demented (or so longthat not onl& he$ /ut most o( the sta-$ had (orgotten his name. 0iscontact with =incoln had /een a coincidence o( the t&)e that the)aranoid had a))arentl& /een trained to recogni6e and e1)loit 9uic"l&and ecientl&H the old man3s death$ howeer$ had /een un(ortunateand un)lanned.

BE


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0os)ital sureillance ideos showed =incoln /eing smuggled out o( thehos)ital with the trash$ accom)anied /& !a1$ who had a))arentl&receied the human'to'canine e9uialent o( a (ull /rie:ng$ somethingthat was /eing re)eated *human'to'human+ inside =incoln3s head in

the trash ca)sule.

As he and the gar/age le(t the grounds$ =incoln3s )h&sical memor& o(Anitha3s shoulders in his hands was intense7 thin$ un8inching des)itethe sur)rise$ resisting him /ut then &ielding. 0e thought that he stillcarried a hint o( the (ragrance o( her hair on his li)s where she had/rushed against him. *0is training allowed some ariation inmoement and contact$ a(ter all$ de)ending on the )h&si9ue o( theo))onent+.

Anitha$ on the other hand$ had 9uite di-erent memories o( theincident$ none o( them )leasant$ and was going to hae to 4gie anaccount5 to some hos)ital administrator named uardino. Therotation$ she told her roommate$ had alread& gien her the %TS. Andshe had wanted to s)eciali6e in )h&sical traumaK

,hen she and Dr. #lac" met outside the Assistant Director3s oce$ hetold her that she wasn3t in trou/le$ that eer&thing she had done had/een under his direction *e1ce)t$ o( course$ her original contact withthe )atient+.

4!r. uardino$ Salatore is his :rst name$ &ou will see that he is a er&short man. Un(ortunate (or him$ &ou "now$ he seems to s)end a lot o(time (eeling uncom(orta/le with taller )eo)le. 0e too" oer when theDirector had a stro"e and !rs. Director re(used to authori6e hisretirement$ so the /rain'dead Director is still in charge. #ut Salatoresigns all the chec"s$ so to s)ea".

4 0e hired a lot o( small (emale assistants when he too" oer$ and Ithin" he )ut li(ts in his shoes$ /ut the eterans all sa& that he is @a realgentleman.35

4#ecause o( his shoes>5 #lac" laughed. 4No$ /ecause he "nows that the :rst rule in the VA isthat &ou get the eterans on &our side$ &ou hel) them get /ene:ts and&ou agree with them wheneer the& com)lain a/out their docs.Including meK0e is a real master o( VA lingo$ &ou should listen (or it inhere5 *the& were outside the Assistant Director3s door now+

BM


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4,ell$ well$ Sal$5 #lac" said$ 4we haen3t s)o"en in some time$ haewe>5

4No Dr. #lac"$ and I thin" I can sa& that I3m glad a/out that$ not that Iwouldn3t contact &ou i( an&thing im)ortant came u). 0e waited a

(ew seconds$ then turned to Anitha and did what he called *to himsel(+:1ing the em)lo&ee with m& ga6e. She didnt s)ea" or seem)articularl& uncom(orta/le$ though$ and he :nall& as"ed ou are amedical student> AnitaK>5

4It is Anitha Saro&a$5 she said. 4es$ I am in m& third &ear o( medicalschool.5

4,ell !iss Sarota$ losing this )atient is a /it o( a$ well$ a sort o()ro/lem$ or a com)lication$ /ecause he might /e dangerous. And Ima(raid that a sta- mem/er com)lained two da&s ago that &ou had had

ina))ro)riate contact with the )atient>5

4,ho said that>5 Dr. #lac" as"ed.

4,ell$ I3m not reall& sure I3m allowed to sa&$ I mean$ in order (or sta-to /e a/le to tell me things o)enl&$ I hae to )rotect them (rom$ &ou"now$ retaliationK5

4From this dangerous medical student>5 Dr. #lac" as"ed$ smiling. 4Ithin" the onl& ina))ro)riate thing she has done is that she is hereinstead o( going to neurolog& (or a chec"'scan (or trauma.5

4!iss Saro&nga$ )lease "now that I am not ma"ing a Do &ou thin" she is ma&/e a s)&(or a Chinese conglomerate coming here to :nd out how to do g'

BP


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im)lants>5 *0e was re(erring$ o( course$ to what had amounted to thenon'militar& ta"e'oer o( what had /een A(ghanistan /& Chinesemining and manu(acturing com)anies$ drawn there /& the discoer& o( ama6ingl& a/undant rare and alua/le mineral de)osits during one o(the American wars+.

A(ter a )ause$ during which he stared$ (rowning$ at Dr. #lac"$ uardinosaid7 4No$ I don3t thin" that Dr. #lac". I guess$ I s)o"e to the Director$and the Chie( o( Sta-$ and the& agree that !s. Anitha$ !s. Sarota$ Imean$ ma& /e in some "ind o( danger /ecause o( this )atient. ,ehae /een dealing (or a long time with the Chinese ta"e'oer$ we haeeterans here who com)lain that we gae awa&$ &ou "now$ what the&(ought (or$ to$ wellKNow I don3t "now what our securit& )olice hae(ound out &et$ /ut it seems li"e it ma& /e /est to hae her end herrotation here earl&K5

4Salatore$ the Director hasn3t said a word (or :(teen &ears. And !s.Saro&a$ she is right here$ &ou can tal" to her directl&.5

4No$ o( course$ I3m sorr&$ so !iss Saro&nga$ I thin" that it would not /egood (or an&$ um$ s)ontaneous media accounts o( this$ &ou "now$ tolea"$ &ou "now$ to /ecome )u/lic$ /ecause$ well it would )ut &ou inmore dangerK5

4I don3t understand wh& the com/ots would sa& an&thing a/out me>5She was 8ushed and now loo"ed much more nerous.

4,ell$ what do &ou thin"$ miss$ um$ with &our )ermission o(course> !a&/e we can get out ahead o( it$ ma"e the situation sound$um$ /etter de:ned$ i( we )ut out an ocial stor& a/out the )atient3sin(atuation with &ou$ and he /ecomes agitated$ and we let him esca)e/ecause we didn3t want him to hurt &ou$ or "idna) &ou$ or. Unidenti:ed o( course$ eer&thing anon&mousK5

Anitha loo"ed to Dr. #lac" (or su))ort$ /ut he seemed to /e consideringthe idea$ which she had not e1)ected at all. 4ou mean$ Sal$ that welet the )atient3s )assion (or this attractie &oung medical student /ehis motiationG/ut wh& did we let him go> A(ter all$ now he can

attac" her an&)lace she goes outside the hos)ital.5

4es$ /ut $ well$ she was in imminent danger$ and our two )s&ch aidesattem)ted to )rotect her rather than chase himKour %R )eo)le canma"e it sound$ well$ )lausi/le$ trans)arentK5

4es$ I see &our )oint. And his g'im)lant$ we won3t mention thatK5

Q


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Anitha said$ sur)rised$ 4#ut he didn3t hae a g'im)lant Dr. #lac". Ithought &ou said he was 5

4,ell !s. Saro&a$ ma&/e we can discuss that laterH it loo"s li"e !r.uardino here has things he needs to ta"e care o(.5

uardino loo"ed satis:ed$ )aci:ed. 4,ell miss$ we will /e er& sorr& tolose &ou$ /ut )erha)s &ou can do a di-erent rotation later$ out)atientsurger&>5

Anitha recogni6ed the language o( coer'u)$ coer stor&. It remindedher$ in an odd wa&$ o( her (ather tal"ing a/out her sisterGthat Vannawas going to /e in a 4s)ecial school5 (or children with head in


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)ermanentl& e1)erimental$ and necessaril& ine1act. Anal&sis o( g'cellDNARNA (unction &ielded results s)eci:c to each indiidual$ and thealgorithms (or )rogramming immature cell /ehaior were 9uitegeneral. lial cell /ehaior was$ contrar& to )o)ular /elie( and)erce)tion$ su/


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the hall. As he o)ened the wor"ing window onto the :re esca)e$ heimagined how the /od& o( one o( the old drun"s he had ste))ed oer inthe stairwell would loo" in 8ames$ then remem/ered his FirstSergeant3s /urnt cor)se in the trac" in Singa)ore$ crusted /lac" moutho)en wide in sur)rise.

0e ste))ed down (rom the window sill$ /ac" into the room$ gra//ed adirt& )illow case o- the 8oor and soa"ed it in the sin". The doorunloc"ed itsel( and he )ut the )illow case oer his nose and mouth$moed into the hallwa& still hal('lit /& tu/e lights on the walls. 0edidn3t hear alarms or sirens$ /ut heard someone coughing in thestairwell. Two doors were o)en as he wal"ed down the corridor$ /utthe rest were shut and rattled when he hit them with the 8at o( hishand.

,hen he turned into the stairwell he caught his (oot on someone l&ing

(ace down and coughing. It was one o( the old men$ stin"ing o( urineand mum/ling something a/out 4!a1$ !a1 is still in m& room$ !a1.5 4,hat room> 4 4!& room$ B.5 4 It3s the (ourth 8oor$ no BKgieme the "e&.5 The smo"e was denser$ no1ious. The man startedarguing /ut he too" the "e& to"en /& (orce out o( his wet )oc"et. 4etout$ &ou3re going to die i( &ou sta& here5 he told him.

The smo"e was too thic" (or him to read the "e&3s hologram so hetried it at each door$ coughing himsel( now$ di66&. 0e heardsomething$ a dog /ar"ing$ in the third door he tried. 0e )ushed thedoor into a )ile o( /o1es and trash )a)er$ &elled 4!a15 !a1 growled

at him$ ran out the door$ and =incoln (ollowed$ tr&ing to sta& low to the8oor. 0e managed to get to the stairwell$ unoccu)ied now$ and madehis wa& with dicult& down one 8ight o( stairs /e(ore (our :remencarr&ing a1es and wrec"ing /ars sto))ed him and gae him air (rom atan".

One o( them hel)ed him down the ne1t two 8ights o( stairs$ and whenhe caught his /reath he as"ed 4Did &ou see a dog>5 The :remanshoo" his head$ as"ed him i( he could ma"e it the rest o( the wa&. ,hen he was outside$ coughing in a crowd o( other coughingderelicts$ he couldn3t see !a1$ and he didn3t see the old man (rom the

stairwell *undou/tedl& a (ellow o)eratie+. Two am/ulances were)ar"ed at the cur/$ lights 8ashing. A (ew )olicemen were tr&ing toherd gaw"ers and the hotel3s residents /ehind a &ellow caution ri//on. 0e decided that he had /etter leae now$ (ound his stoc"ing ca) in his)ants )oc"et$ )ulled it down his (orehead$ and /egan wal"ing awa&$e&es on the dirt& )aement.

0e saw the dog down an alle&wa&$ staring at him. 0is com hadn3t told

B


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him a/out this rende6ous$ although all his o)erations oer the lasttwo &ears had inoled !a1 in some wa&$ )resuma/l& /ecause theanimal was his rela& or monitor. It hadn3t e1actl& increased hise-ectieness haing the dog along$ /ut he li"ed the com)anionshi). 0e tal"ed to it more than he had tal"ed to an&one (or a er& long time$

e1ce)t ma&/e the medical student$ /ut he would )ro/a/l& neer seeher again. Regretta/l&$ since she didn3t seem to /e easil& swa&ed /&/ullshit either.

0e


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less e-ectie now against multi)le drone e1)losions that /urned his(ace and started small :res on his (atigues. !a1 ran in


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door along the wa& with his )alm$ loo"ing (or an unloc"ed esca)e routei( things went /ad.

0e (ound Salatore uardino3s oce door *the non'goernment'

standard outsi6ed hologram leaing no dou/t who occu)ied the suite +and /lin"ed his right e&e in a code that triggered a retinal )atternrearrangement to (ool the securit& s&stem. The door o)ened silentl&$and he ste))ed into the rece)tion area


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4So that3s how the& )lanned it$5 he said under his /reath$ /ut loudenough (or Anitha to hear.

She decided to /e his willing audience7 4%lanned what$ Dr. #lac">5

4To hae the cra6ed g'im)lant eteran and his dog attac" the VAhos)ital administrator$ showing the dangers$ once again$ o( using realg'im)lants to treat %TS.5

4ou mean$ instead o( @glial'negatie im)lants3>5

0e loo"ed at her steadil&$ re(using to ac"nowledge her sarcasm$ /uta(ter a moment said 4No$ there is room (or man& "inds o( thera)& (or%TS. I /eliee this ma& show our Central Oce the need (or newresidential )rograms$ where su-ering eterans can receie long termthera)&Gwhere the& can record their stories$ a/out the traumatic

things the& hae seen on their COT screens$ /ond together as warriorsagain$ and let us treat them li"e the no/le ictims the& are. ,e willhel) them ac"nowledge to themseles that the& are ill$ that the& aredangerous to their (amilies$ that "illing /& remote control has ruinedan& chance the& hae o( ada)ting to stressK.5

4ou mean$5 Anitha said$ er& angr& (or reasons she was =i"e this )lace$ where &ou hae attac" dogs chewing onlittle men and drone e1)losions on the ward>5

4Sa(e (rom themseles$ sa(e (or us. 21ce)t in cases li"e Ca)tain=incoln3s$ who doesn3t remem/er it$ /ut he actuall& as"ed (or a g'im)lant$ and we had to gie it to him /ecause he had /een in thes)ecial (orces. And li"e man& o( the other real )rocedures$ this onewent e1tremel& wrong. #ut we still had to ta"e care o( him$ or his wi(e

M


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would hae sued the goernment$ and eer&one might hae (ound outa/out the negatie glial cell im)lantsK/e(ore we had a chance to startthe old treatments /ac" u)K5

4So now he is


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#lac"7 I don3t understand wh& &ou want the )rocedure$ reall&. ou sawthe cler"s$ &our (ellow ocers> ,e can gie &ou medications$ cou)les3counseling$ cognitie /ehaioral thera)&K

=incoln7 The& tried that stu- alread&. The thera)& was the worst$ thethera)ist as"ing me to remem/er the worst things I eer did in com/atoer and oer again. Le)t telling me that would 4ta"e awa& the )owero( these memories.5 All it did was "ee) me awa"e at nightK

#lac"7 #ut the g'im)lants ma& not ta"e awa& those memories either. These memories that ma"e &ou (eel so guilt&H I mean$ we ho)e theim)lants do that sometimes$ /ut the& ma& And I saidsomething li"e$ to (eel /etter$ to /e (orgien. And he said @No$ no$&ou3re wa& o-. uilt& )eo)le$ reall& guilt&$ want to /e )unished.3

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