Ellie Santos-Smith grabs a clean white coat as spring dawn brightens her worn oriental rug and streaks with sun her only luxury, a grand piano.
She runs a comb through her jet-black hair, cut short because she thinks that makes her look older. Her smooth skin glows with 20-ish health, though she is 47. Patients distrust young doctors. Nanomed infusions keep her body young, her mind sharp, and mitigate her crippling agoraphobia. She has worked hard to be able to live in a minuscule apartment in The Enclave, a safe, low-population-density bubble in Washington, D.C. In this small, pure paradise the incredibly rich claim more cubic feet than most people in the world can dream of, dine on rare organic food, and ingest the most finely tuned infusions.
She hates herself for needing this. But she does. If she is to help anyone, if she is to put her hard-won training to use, she does. She can walk to the Longevity Center for her frequent infusions and, after that, to her job as an emergency physician at Capital Hospital without being trapped in a car, a subway, a plane.
Her phone rings. “Dad?” His voice gravelly, odd. Not that she’s heard from him in a long time.
She thinks blue for a moment. His eyes, tear-shimmered blue beneath a thatch of sun-whitened hair, all those years ago. He had been abruptly summoned from his marine biology kingdom the day her mother was murdered, as Ellie watched, during the First East Coast Riot. He’d fled back to his undersea haven soon afterwards, leaving her to Grandma and boarding schools.
“Can we talk later? My infusion is overdue; then I’m working emergency till seven,” she says. She imagines him in the teak cabin of his Key West–anchored sloop, stubbornly aging.
“Never mind.” He hangs up.
Same old game. She should be used to his gruff elusiveness, but it always hurts. Her father, a celebrated marine biologist with a worm named after him, quit academia once she got her college scholarships and spent decades painting bizarre ocean creatures, gaining a small international following.
Downstairs, the doorman smiles. She steps out into her safe haven, a few tree-lined blocks of historic mansions, townhomes, restaurants, and shops bounded on one side by Connecticut Avenue and patrolled by security professionals (thugs, to her mind) for which she pays a hefty neighborhood fee. They keep out the homeless, the hungry, the desperate, and the different. Once outside this discreet, invisible boundary she will have to pass through a few blocks she calls The Gauntlet, which throbs with the dense crowds that now fill most of the cities on Earth, before reaching the hospital where she works. Only her nanomed infusions keep panic at bay.
In front of her, a lone bicyclist splashes through puddles, and nearby Don Stapleton descends the broad stairs of Forever, a 1900-vintage condominium mansion of 30 wealthy centenarians, some of whom worked hard to establish The Enclave. He waves. “Doc! Lovely morning!”
Trapped. She could swear he hacks her schedule. White dreads halo his dark, handsome face. “Coffee on the veranda?” She glances over at the broad Victorian porch, with wicker chairs, hanging ferns, and eight limber residents sun-saluting as Ella Fitzgerald sings.
Six hundred million centenarians—C’s—are the last recipients of Social Security. It is the lifeline of most C’s but only slightly augments the wealth the people in Forever acquired during successful professional lives.
“Thanks, but I’m late.”
“I’ll walk with you. We have a new offer.”
Her throat constricts. “Sorry, but no.” The work, she knows, would be a nightmare. Perpetually on call for a household of detail-oriented hypochondriacs; crushed by constant, whimsical, impossible demands. She walks faster toward her job in the Hospital Center, where her patients are poor and in desperate need of her skills. They are the people to whom she has devoted her training and her life.
Don persists. “You got Mrs. Diyubski an emergency infusion. Cut through red tape, saved her life—”
“I’m not a boutique m.d.”
“You are a nanomedicine expert. Fewer patients might be less stressful for you. That could be a great change, given your phobia.”
Nosy bastard. He smiles. “Public information. I’m sending the offer.” The ping in her ear registers its reception, and Don falls behind.
In a few blocks she is at Dupont Circle. The implanted microchip that gives her access to The Enclave now signals with a low beep that she is unprotected. She takes a deep breath. Masses of children, teenagers, everyone young. Shanties, ever-milling crowds, food lines, rank odors, and a constant assault of raised voices, ugly music, honking horns.
The phone. Her father, calling back. “We need to talk. I’m dying.”
A break in her stride. “Where are you?”
“Hospice at Sunnyland. Hepatocellular carcinoma.” The words roll off his educated tongue.
“When were you diagnosed?”
“Three months ago.”
She rages. “Why didn’t you call? It’s not too late. Regeneration infusions—” Her brain teems with nanomed therapies. Most out of his financial reach, since he has stubbornly avoided anything other than mandatory insurance, and his age—85—precludes expensive life-extending measures.
“I’m ready to go, Ellie. They give me two, three days. I just want you, now.”
I wanted you then. All those years. You were gone. You didn’t love me. “I need to talk to your doctor.”
That gravelly laugh. “You’re kidding, right? I was diagnosed by a nurse-practitioner after an ambulance ride foisted on me by a well-meaning neighbor. I’m in the benevolent hands of the state. Deprived of a death at sea. No docs at Sunnyland.”
No surprise, that. “I can’t jump on a plane.”
“It’s ok. I reap what I’ve sowed.”
Her urge to get to him, to see him, brings her to sudden tears, surprising her. But she’d been taken off a plane in a straitjacket when she was 12. Even first class didn’t help.
“You don’t understand. It’s not that.” It’s not our past, our hopeless inability to communicate.
“Hon, you may not think so.” He hangs up again.
She’s always urged her father to live with her. “In that bubble? No thanks.” A relief, and they both know it. She can’t live with people. Her short marriage hammered that home. Her only close companions are dead musicians and her piano, which she plays long into the night.
Ellie surfaces from their conversation angry, without her insulating defenses, to endless oncoming faces, roaring buses, choking exhaust. She’s powerless. He’s stubborn, and she’s let his stubbornness kill him. You can control everything else in your life, but you can’t control your father.
Damned if she can’t.
She recalls recent nanomed updates and rearranges these components in the work of art that is her own mind. Heart pounding, she makes it to the door of the Infusion Center, passing the block-long line of those hoping for an insurance reprieve, shows her card, and slips inside.
The receptionist is new. Ellie takes a deep breath and rolls the dice. It’s not like her, but she has no choice. “Add 17 and 43.”
“That’s not allowed.”
“I’m Code R-1.” Ellie hates exposing herself to pity. Her expensive infusions are government compensation to victims of the deadliest riot in U.S. history—the riot in which Ellie’s mother died, the riot that began a decade of turmoil around the time the world’s population passed eight billion.
Few people, not even professionals like Ellie, can afford what she gets: life extension, nanomed components updated in real time. Nanomeds could be manufactured cheaply. Prices are kept high. The official explanation is the cost of R&D and the experimental nature of nanomeds. The real truth is overpopulation and a fear of more C’s.
She lies on a gurney in the infusion room. Designer nanomeds maintain her phenomenal memory—a double-edged sword, for those memories trigger panic. After Ellie witnessed her mother’s murder, her psychiatrist pressured her father to allow therapeutic memory mediation—erasure. Her father refused, wanting Ellie to have that choice when she was older. For that she is thankful. Those memories make living in her bubble imperative, but they are her. Her infusions are a balancing act, holding the possibility of neuronal damage, but she has the authority to design her own cocktail.
Adding 17 and 43 will radically change the balance, removing her fear. She will probably be able to leave her bubble, get on the plane. She is not sure what other changes might occur. Her carefully constructed life could fall apart.
“Doc, you know you can’t do this.” John, her regular nurse.
“You know I can.”
“It’s dangerous. This isn’t like you. The latest bulletin—”
“I know. Paradoxical effects from these latest upgrades. I have to fly tonight.”
John sighs. “You want to listen to jazz during the infusion?”
“Of course.” Slight sting of needle. She closes her eyes, and memories assail her.
Lavender dusk limned by a horizon of bare brown trees. Stopped on the Beltway. Ten lanes of static oncoming lights, the usual soothing interlude between kindergarten and supper. Ellie strapped in her seat, killing 3-D aliens, Mom up front chanting “A Love Supreme” with John Coltrane, head bobbing, still in her white coat after a day in the hospital. Then she gasps.
Striding down an exit ramp: An army of people flows among the cars. Ragged clothes, muffled chants. A bat, smashed windows, her mother sprawled over the seat screaming, “Don’t hurt my niña!”
Blood spatters her mother’s white coat and Ellie’s video screen.
Years later, driving while in medical school: A flood of oncoming lights. The world under construction, always—cranes, barrels, trucks of supplies to accommodate people, who keep appearing, appearing, filling every space in great towers and on vast artificial islands. Ellie wants to help, like Mother. Driving through fear will make her strong. Finally, strength fails. She flips; can’t function. The usual infusions are ineffective. City centers needing her expertise have become unlivable.
In D.C., after a long, difficult search, she finds her oasis. The price? She can’t ever leave.
“Doc?” She opens her eyes and wonders— when did I stop being able to live? She sits up. “I shouldn’t be jittery right after an infusion.”
“You knew you were taking a risk. I’ll take a blood sample.”
“No time. And John?”
“Don’t use Coltrane again.”
There is no way she can avoid her shift in the emergency room; there is no one to take her place. She leaves the Infusion Center and makes a plane reservation for a flight after her shift while striding New Hampshire Avenue. Only a block to the hospital, and now, post-infusion, throngs effuse love, do not seethe with malicious intent, do not lie in wait to make deadly, unexpected moves.
She arrives at the hospital and is relaxed, surprised to be breathing easy as she is scanned in and checked for weapons. She pushes her arms into her white coat and grabs a chart. It is paradoxically frightening to feel so utterly good in this whirring hellhole, where daily she strives, with heartbreakingly limited success, to deprive death of its staggering bounty.
She slips inside a curtained space. “Mr. Billings?” He lies on the exam table, unshaven face bruised, a police officer beside him. “What happened?”
The cop says, “He started a bar fight. Not the first time.”
“Not true.” Billings glares at the cop.
“He never remembers.”
“She broke my arm.”
“That’s a lie.”
Ellie says to the cop, “You’ll have to step outside.”
“He’s dangerous. He just exploded—”
“Out.” She begins her exam. “Your arm?”
“Hurts like hell.”
Ellie shines a flashlight in Billings’s eyes. “Where’d you get this scar on your forehead?”
“Incoming. Ten years ago. Everybody else died.”
“Sit up.” She hammers his knee. “Been treated for ptsd?”
“Borderline. They won’t pay.”
“I’m ordering pain meds and an X-ray of your arm. I’ll be back in a little while.”
Her next patient needs a kidney update. She sits on the table, puffy, staring at her knotted hands. Ellie has become a technician, enjoined from stepping outside finely drawn boundaries. Care is rationed. hmos have made medicine a corporate algorithm, doing the greatest good for the most people.
Her m.d. gives her the power to override tics in the system. She knows how far she can push the limits and which procedures are too expensive, will tip the balance and get her censured.
The kidney treatment is out of bounds. Ellie hesitates, approves it. “You’ll feel better soon.”
Tears in the patient’s eyes. “I thought—“
Boutique doctors practice as they see fit because the rich bypass the corporate algorithm. As she leaves the patient, she can’t help checking Forever’s offer, the one Don Stapleton keeps pushing. Staggeringly huge. She couldn’t possibly provide services worth that. The C’s would devour her. And she would be treating them…forever. The same people. Her emergency skills would atrophy. A trap.
But one more override and she might be out on her ass. She knows that her recklessness is because of her infusion. She just needs to make it to the end of her shift. After an hour she gets Billings’s results. “Fractured ulna. This bone,” she tells him, touching it. “I’m ordering a mending infusion.”
“Hear that?” Billings yells. The cop is startled awake.
Ellie asks Billings, “How would you like to stay out of bar fights and feel better?”
“Can’t afford it.”
“I only need your consent. You’ll get neuroplasticity meds and counseling. You have to promise me you’ll go to counseling or it won’t work.”
“You sure, Doc? I mean—”
Billings reminds her of her father—at the mercy of the unfeeling algorithm. He’d had choices, though, more choices than Billings.
She has always avoided thoughts about the tangle of their lives. Except, she thinks, surprising herself, they come out through my fingers. Hours and hours and hours at night. They come out when I improvise, play jazz. They’re not as far away as I think.
Filled with momentary wonder, she draws back the curtain, where the eternal next patient sits. Everything seems so preternaturally sharp, so full of potential for too much thought that she aches for her shift to end.
On the red-eye, Ellie stares out the window of the plane at a solid unending glare of light all the way down the East Coast, imagining all those people, and does not go fetal. She does not scream.
She has not called her father.
As she steps from the cab at Sunnyland, she feels as relaxed as if she had run 10 miles on a treadmill. High-rises surround her, receding grids of light blocking any other view. Twenty thousand elderly live here on 30 acres, a template reproduced nationally. Those living here did not watch their pennies. They cannot catch the wave of technology for a long-term ride.
Ellie will always have a job. The life she worked for is bright and assured, an enviable personal future. A future where she will hide from time, emotion, and change.
Irked at her thoughts, she grabs her bag and enters the lobby of her father’s building. On the hospice floor, visitors nap in chairs, maintaining vigil. Outside her father’s room, a whiff of whiskey as she passes two chatting, weathered men in fishing caps. Inside, strings of colored lights, low revelry, and Coltrane’s sax wailing for the second time in 24 hours, this time no dream. Her fingers flex in a near-unconscious riff. She spots her father in a reclining chair.
His face, frighteningly thin, is lit on one side by a blinking blue light. A faint smile plays across his face; a beer is in his hand. She flies to him: “Dad!”
He blinks, grins. Flash of overwhelmingly blue eyes, and she is once again 5. “Ellie! Come to see the old man off after all, eh?”
“I’m getting you out of here.”
“Good god, Ellie. I’m getting morphine! Don’t mess with it.”
“It’s not funny. Give me a more detailed diagnosis.”
“Certain and welcome death. Interment in the sea. Making room for younger people who are happy to be alive.”
“You can recover.”
Her father says gently, “This is hospice. Four days of rationed grace. They know how to mete it out fine. No needles, no tubes, no machines. I skipped that. I probably got whatever I have long ago when I was torturing rare marine organisms instead of coming home to see you. Fair play.”
“Fair play? I missed you, Dad, of course I did. I needed you. But that has nothing to do with your choosing to die. What have they done so far?”
He shrugs. “Two infusions last month. Standard issue. They didn’t work.”
“You didn’t call.”
He speaks slowly, as if to a child, with equal emphasis on each word. “I just didn’t want to.”
She grasps it all, his terrible stubbornness and hers, and opens her phone.
“What are you doing?”
“Calling an ambulance.”
“Ellie, Ellie. No one will pay for it. And where do you think you’ll take me?”
“An infusion clinic. I’ll pay.”
“Not even you have that much money.”
The elderly in these high-rises did not watch their pennies. They cannot catch the wave of technology for a long-term ride.
“I have a new job offer. I’ll take care of you. I’ll sell my apartment—it’s worth a lot. We can live in the centenarian house—beautiful—interesting people. You’ll love it—“
“Don’t tell me what I’ll love.”
She sees a sheen of sweat on his forehead. She is a bit ashamed, but not enough to stop. She shouts, “You’re a foolish old man!”
He smiles. “I hope so.” He waves. “Keep talking, everybody, she’s just my daughter.” Chatter resumes. He says, quietly, “You might think that I don’t know you, Ellie, but I do. Remember that summer you spent with me after college, when you were deciding what to do with your life? Yes, too brief, but I know you like I know myself.” He pauses for a breath. “You have to do what moves you, and what moves you is your job. As it is. Whatever you’re doing, however crazy it looks to me, it works. Don’t sacrifice that job to help me. I don’t want it.
“Second point—don’t interrupt, I’m getting tired. I’ve had a great life. Despite our…tragedy. I don’t want to live anywhere but on my boat. If you do anything without my consent, I will never forgive you. I’m serious. And I don’t ever again want the kind of pain I’ve had the past six months.”
“I wouldn’t have let you have that pain!” To her surprise, Ellie begins to cry. “You hid it from me. You didn’t want my help. What has my life been about if I can’t even help my own father? You’d rather die than have my help.” She drops to the bed, covers her face, and sobs.
“Ellie, look at me.”
She wipes her face on her sleeve. “Sorry.”
“Don’t be. I haven’t seen you cry since your mother died.”
“You haven’t seen me much. Holidays. Birthdays.” She hears the 10-year-old in her voice, her two annual summer weeks at sea with her father ending once again.
“Fair shot.” He pauses. “It’s over. The oceans are polluted beyond repair.”
“You can help restore them! You—”
“This place that seems so awful to you, this is what it’s like everywhere now. Even worse. I’ve been all around the world. I’ve done my part. I’m proud that a worm is named after me.” He draws a deep breath, coughs, looks at her squarely. “I’m proud of you. Your mother would be so proud of you.” Another long pause while she grabs a tissue, blows her nose, wipes her face. “You can do one thing for me.”
“Let’s move this party to my boat. I was kidnapped. I don’t want to die here. Order somebody to bring a piano to the dock and you can play me out. I haven’t heard you play in a long, long time. It’s like heaven to me. It always reminds me of the first time I went diving.”
“That’s all I want of you. We can’t get back the years I wasted. Do this for me, please.”
She waits for the old anger, the old rage, to bubble up and spew out. Her hand moves toward her phone, then stops.
You know how to improvise.
The new infusion lets it surface, but that does not make it less valuable: She hears her mother as if she were music, Coltrane.
Instead of the ambulance call, there is a memory, one of many she has hugged to herself all these years, refusing to release it. It’s the new infusion that allows it to surface, she knows, but that does not make it any less valuable.
A winter day at her grandmother’s. The holidays. She is playing the piano. She begins with one learned set piece, Bach.
Then there is a shift. She hears her mother as if she were music, Coltrane, jazz. She threads new notes to Bach, adjusts cadence, moves into new space. Improvises. Loses herself in sound, falling snow, her father, leaning on the piano as tears roll down his face.
She remembers that she played for hours.
She looks directly at him, seeing him as if for the first time: a person separate from herself, from her needs, from her ways of making her own life small and safe.
She nods. “All right, Dad. Let’s go.”
Kathleen Ann Goonan is an author and a professor of literature at Georgia Tech.