Greg Egan - Yeyuka

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Yeyuka a short story by Greg Egan

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

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

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

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

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

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

colours visible.

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

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

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

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

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

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

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

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

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

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

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

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

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

released.

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

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

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

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

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

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

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

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

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

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

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

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

overcome any adversary.

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

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

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

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

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

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

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

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

sixties.

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

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

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

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

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

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

definitely not been defeated.

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

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

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

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

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

hypersensitive.

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

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

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

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Lisa saw me off at the airport.

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

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

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

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

judgmental bedside manner. It drove me mad.

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

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

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

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

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

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

obstetrics, like you."

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

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

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

doomed to obsolescence."

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

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

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

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

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

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

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

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

instead.

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

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

you know. Be careful."

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

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

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

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

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

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

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

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

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

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

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

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

"Three eight what?"

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

brunt of the epidemic.

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

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

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

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

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

shouting going on the drivers seemed remarkably good humoured.

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

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

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

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

inwards.

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

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

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

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

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

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

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

the streets.

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

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

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

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

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

mundane sight.

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

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

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

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

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

could do surgery on it.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

have written the necessary software.

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

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

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

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

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

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

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

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

specialists for at least another decade.

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

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

Masika.

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

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

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