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  “As your doctor and the leading expert on this condition in the United States, General, let me set it straight for you if I may,” Summers interjected. “The syndrome was most likely caused by what we call myocardial stretch, where severe G-forces deform the heart muscles and nerves and create electrical abnormalities. The syndrome has obviously lain dormant for your entire life until you flew into space, and then it hit full force. It’s interesting to me that you obviously experienced some symptoms during some or perhaps all of your space flights, but then it lay dormant again until you had a mere videoconference confrontation—I’d guess it was equally as stressing as flying in space, or maybe just stressful enough to provide the trigger for another full-blown episode.”

  “The White House and Pentagon can do that, Doctor,” Patrick said.

  “No doubt, sir,” Summers agreed. “But do you not see the danger in this condition, General? The stress of that simple videoconference episode, combined with your repeated trips into orbit, sparked electrical interruptions that eventually created an arrhythmia. It was so severe that it created cardiac fibrillation, or irregular heartbeat, a true heat ‘flutter,’ which like a cavitating pump means that not enough blood gets circulated to the brain even though the heart hasn’t stopped. It goes without saying, sir, that any stressor now can bring on another episode, and without constant monitoring we have absolutely no way of knowing when or how severe it would be. Allowing you to stay on flight status would jeopardize every mission and every piece of hardware under your control.”

  “I assume you were going to add, ‘not to mention your life,’ eh, Captain?” Patrick added.

  “I assume we’re all thinking of your welfare first, sir—I could be mistaken about that,” Summers said dryly. “Your life is at risk every minute you spend up there. I cannot stress that too strongly.”

  “I get it, I get it, Doctor,” Patrick said. “Let’s move on past the dire warnings now. What’s the treatment for this condition?”

  “‘Treatment?’ You mean, other than avoiding stress at all costs?” Summers asked with obvious exasperation. He sighed audibly. “Well, we can try beta blockers and careful monitoring to see if any electrical abnormalities crop up again, but this course of treatment is recommended only for non-syncopic patients—someone who has never passed out before from the condition. In your case, sir, I would strongly recommend an ICD—implantable cardioverter-defibrillator.”

  “You mean, a pacemaker?”

  “ICDs are much more than just a pacemaker, sir,” Summers said. “In your case, an ICD would perform three functions: carefully monitor your cardiac condition, shock your heart in case of fibrillation, and supply corrective signals to restore normal rhythm in case of any tachycardia, hypocardia, or arrhythmia. Units nowadays are smaller, less obtrusive, more reliable, and can monitor and report on a wide variety of bodily functions. They are extremely effective in correcting and preventing cardiac electrical abnormalities.”

  “Then it doesn’t affect my flight status, right?”

  Summers rolled his eyes in exasperation, completely frustrated that this three-star general wouldn’t let go of the idea of getting back on flying status. “Sir, as I’m sure you understand, installing an ICD is a disqualifier for all flight duties except under FAA Part 91, and even then you’d be restricted to solo day VFR flights,” he said, taken aback simply by the fact that anyone who had an episode like this man did would even think about flying. “It is, after, all an electrical generator and transmitter that can momentarily cause severe cardiac trauma. I can’t think of any flight crewmember, military or civilian, who’s been allowed to maintain flight status after getting an ICD.”

  “But if they’re so good, what’s the problem?” Patrick asked. “If they clear up the abnormalities, I should be good to go.”

  “They’re good, much better than in years past, but they’re not foolproof, sir,” Summers said. “About one in ten patients suffer pre-syncopic or syncopic episodes—dizziness, drowsiness, or unconsciousness—when the ICD activates. Three in ten experience enough discomfort to make them stop what they’re doing—truck drivers, for example, will feel startled or uncomfortable enough that they will pull off to the side of the road, or executives in meetings will get up and leave the room. You can’t pull off to the side of the road in a plane, especially a spaceplane. I know how important flying is to you, but it’s not worth—”

  “Not worth risking my life?” Patrick interrupted. “Again, Doctor, with all due respect, you’re wrong. Flying is essential to my job as well as an important skill and a source of personal pleasure. I’d be ineffective in my current position.”

  “Would you rather be dead, sir?”

  Patrick looked away for a moment, but then shook his head determinedly. “What are my other alternatives, Doctor?”

  “You don’t have any, General,” Summers said sternly. “We can put you on beta blockers and constant monitoring, but that’s not as effective as an ICD, and you’d still be restricted in flight duties. It’s almost guaranteed that within the next six months you’ll have another long-QT episode, and the odds are greater that you’ll suffer some level of incapacitation, similar or probably more severe than what you experienced before. If you’re in space or at the controls of an aircraft, you’d become an instant hazard to yourself, your fellow crewmembers, innocent persons in your flight path, and your mission.

  “General McLanahan, in my expert opinion, your current job or just about any military position I can think of is too stressful for a man in your condition, even if we install an ICD. More than any treatment or device, what you need now is rest. If there is no history of drug abuse or injury, long-QT syndrome is almost always triggered by physical, psychological, and emotional stress. The damage done to your heart by your position, duties, and space flights will last the rest of your life, and as we saw, the stress of just one simple videoconference meeting was enough to trigger a syncoptic episode. Take my advice: Get the ICD installed, retire, and enjoy your son and family.”

  “There have to be other options, other treatments,” Patrick said. “I’m not ready to retire. I’ve got important work to do, and maintaining flying status is a big part of it—no, it’s a big part of who I am.”

  Summers looked at him for a long moment with a stern and exasperated expression. “Bertrand Russell once wrote, ‘One symptom of an approaching nervous breakdown is the belief that one’s work is terribly important,’” he said, “except in your case, you won’t suffer a nervous breakdown—you’ll be dead.”

  “Let’s not get too dramatic here, Captain…”

  “Listen to me carefully, General McLanahan: I’m not being dramatic—I’m being as honest and open with you as I can,” Summers said. “It is my opinion that you have suffered unknown but serious damage to your cardiac muscles and myocardium as a result of your space flight that is triggering long-QT episodes that are causing arrhythmia and tachycardia resulting in pre-syncoptic and syncoptic occurrences. Is that undramatic enough for you, sir?”

  “Captain—”

  “I’m not finished, sir,” Summers interjected. “The likelihood is that even with rest and medication you will suffer another syncoptic event within the next six months, more severe than the last, and without monitoring and immediate medical attention, your chances of survival are twenty percent, at best. With an ICD, your chances of surviving the next six months go up to seventy percent, and after six months you have a ninety percent chance of survival.”

  He paused, waiting for an argument, and after a few moments of silence he went on: “Now if you were any other officer, one who didn’t use to date the Vice President of the United States with the Secret Service in tow, I would simply advise you that I will recommend to your commanding officer that you be confined to the hospital for the next six months. I will—”

  “Six months!”

  “I will still advise your commanding officer so,” Summers went on. “Whether you decide to get an ICD installed i
s your decision. But if you insist on not getting the ICD installed and you are not on 24/7 monitoring, you have virtually no chance of surviving the next six months. None. Do I make myself clear to you, sir?” Patrick momentarily looked like a rapidly deflating balloon, but Dave Luger could see his dejection quickly being replaced with anger—anger at what, he wasn’t quite certain yet. “It appears to me that the final decision is up to you. Good day, General.” And Summers logged out of the videoconference with a rueful shake of his head, certain that the three-star general had no intention of complying with his orders.

  Once Summers left the conference, Patrick sat back in his chair, took a deep breath, then stared at the conference room table. “Well, shit,” he breathed after several long moments in silence.

  “You okay, Muck?” Dave Luger asked.

  “Yeah, I guess so,” Patrick replied, shaking his head in mock puzzlement. “I always thought it was Will Rogers who made that quote about mental breakdowns, not Bertrand Russell.”

  Dave laughed—this was the guy he was familiar with, making jokes at a time when most sane men would be on the verge of tears. “I guess Mark Twain was right when he said, ‘It’s not what you know, it’s what you know that ain’t so.’”

  “It wasn’t Mark Twain, it was Josh Billings.”

  “Who?”

  “Never mind,” Patrick said, turning serious again. “Dave, I need to learn everything about long-QT syndrome and treatment for heart arrhythmias before I can make a decision about what I can handle and what I can’t. There are probably a dozen companies doing research on modern ICDs, or whatever the next generation of those things becomes—I should know about the latest advances before I decide to get any old technology installed. Jon Masters probably has an entire lab devoted to treating heart disorders.”

  “Excuse me for saying so, buddy, but you just had probably the best heart doc in the country on the line, ready to answer any questions you have, and you pretty much blew him off.”

  “He wasn’t ready to help me—he was standing by ready to punch my ticket to a medical retirement,” Patrick said. “I need to handle this in my own way.”

  “I’m worried about how much time you have to make this decision, Patrick,” Dave said. “You heard the doc: most patients who have this condition either start continual monitoring and drugs or get an ICD installed, right away. The others die. I don’t see what other research you need to do on this.”

  “I don’t know either, Dave, but it’s the way I always do things: I check them out for myself, using my own sources and methods,” Patrick said. “Summers may be the best heart doc in the military, maybe even the country, but if that’s so, then my own research will tell me that too. But riddle me this, bro: What do guys like Summers do with active-duty cardiac victims who are still alive?”

  “They retire them, of course.”

  “They retire them,” Patrick echoed, “and then they’re cared for by the Veterans Administration or private doctors paid for in part by the government. Summers is doing what he always does: discharging sick guys and pushing them off to the VA. Most of his patients are so thankful to be alive that they never give retirement a second thought.”

  “Aren’t you glad to still be alive, Muck?”

  “Of course I am, Dave,” Patrick said, giving his longtime friend a scowl, “but if I’m going to punch out, I’m doing it on my terms, not Summers’. In the meantime, maybe I’ll learn something more about the condition and possible treatments that these docs don’t know, something that will let me keep my flying status. Maybe I’ll—”

  “Patrick, I understand flying is important to you,” Luger said sincerely, “but it’s not worth risking your life to—”

  “Dave, I risk my life just about every time I go up in a warplane,” Patrick interrupted. “I’m not afraid of losing my life to—”

  “The enemy…the outside enemy,” Dave said. “Hey, Patrick, I’m just playing devil’s advocate here—I’m not arguing with you. You do what you want. And I agree: it’s worth risking your life using your skills, training, and instincts to battle an adversary who’s out to destroy the United States of America. But the enemy we’re talking about here is you. You can’t outfly, outguess, or outsmart yourself. You’re not equipped or trained to handle your own body trying to kill you. You should approach this battle like any battle you’ve ever prepared for…”

  “That’s exactly what I intend to do, Dave,” Patrick said flatly. “I’m going to study it, analyze it, consult with experts, gather information, and devise a strategy.”

  “Fine. But take yourself off flight status and check into the hospital for round-the-clock monitoring while you do it. Don’t be stupid.”

  That last comment took Patrick aback, and he blinked in surprise. “You think I’m being stupid?”

  “I don’t know what you’re thinking, man,” Luger said. He knew Patrick wasn’t stupid, and he was sorry he said it, but the one thing that his longtime friend had taught him was to speak his mind. Patrick was scared, and this was his response to fear, just as it had been in the cockpit of a strategic bomber all these many years: Fight the fear, focus on the objective, and never stop fighting no matter how awful the situation appears.

  “Look at it from the doc’s point of view, Muck,” Luger went on. “I heard the doctors tell you that this thing is like a ticking time bomb with a hair trigger. It might not go off at all, but the odds are it could go off in the next ten seconds as we’re standing here arguing. Hell, I’m afraid you could vapor-lock on me as I’m arguing with you right now, and there’s not a damned thing I could do from down here but watch you die.”

  “My chances of dying up here in Earth orbit are just a little bit greater than average with this heart thing—we can be blasted wide open and sucked out into space by a hypersonic piece of debris the size of a pea at any friggin’ time, and we’d never know it,” Patrick said.

  “If you’re not sure about an ICD, then go ahead and research it; talk to Jon Masters or the dozen or so brainiacs on our list, and think it over,” Dave said. “But do it from the safety of a private hospital room where the docs can keep an eye on you.” Patrick’s eyes and features remained determined, stoic, impassive. “C’mon, Muck. Think about Bradley. If you continue to fly without the ICD, you might die. If you don’t stress yourself out, you’ll probably live on. What’s the question?”

  “I’m not going to give in, Dave, and that’s it. I’m up here to do an important job, and I’m—”

  “A job? Muck, do you want to risk hurting yourself over a job? It’s important, sure, but dozens of younger, stronger guys can do it. Give the job to Boomer, or Raydon, or even Lukas—anyone else. You haven’t figured it out yet, Patrick?”

  “Figure what out?”

  “We’re expendable, General McLanahan. We’re all disposable. We’re nothing but ‘politics by other means.’ When it comes right down to it, we’re just hard-core hard-assed type-A gung-ho military prima donnas in ill-fitting monkey suits, and nobody in Washington cares if we live or die. If you blow a gasket tomorrow there’ll be twenty other hard-asses waiting to take your place—or, more likely, Gardner could just as easily order us shut down the day after you croaked and spend the money on more aircraft carriers. But there are those of us who do care, your son being at the top of the list, but you’re not paying attention to us because you’re focusing on the job—the job that doesn’t care one whit about you.”

  Luger took a deep breath. “I know you, man. You always say that you do it because you don’t want to order another flyer to do something you haven’t done yourself, even if the flyers are trained test crewmembers, the best of the best. I’ve always known that’s bullshit. You do it because you love it, because you want to be the one to pull the trigger to take down the bad guys. I understand that. But I don’t think you should be doing it anymore, Muck. You’re unnecessarily risking your life—not by flying a mostly untested machine, but by exposing yourself to stresses that can kill y
ou long before you reach the target area.”

  Patrick was silent for a long time; then he looked at his old friend. “I guess you do know what it’s like to face your own mortality, don’t you, Dave?”

  “Unfortunately, yes,” Luger said. As a young navigator-bombardier flying a secret mission to destroy the old Soviet Union’s Kavaznya ground-based laser site, Dave Luger had been captured by the Russians, interrogated, tortured, and imprisoned for several years, then brainwashed into believing he was a Russian aerospace engineer. The effects of that treatment affected him emotionally and psychologically—stress would cause him to unexpectedly enter a detached fugue state that left him nearly incapacitated with fear for minutes, sometimes hours—and he voluntarily took himself off active flight status years ago. “It was a hell of a ride…but there are other rides out there.”

  “Don’t you miss flying?” Patrick asked.

  “Hell no,” Dave said. “When I want to fly, I pilot one of the unmanned combat air vehicles or my radio-controlled model planes. But I have enough things going on where I don’t have the desire anymore.”

  “I’m just not sure how it would affect me,” Patrick said honestly. “I think I’d be okay—no, I’m sure I would—but would I always be demanding one more flight, one more mission?”

  “Muck, you and me both know that manned aircraft are going the way of the dinosaur,” Dave said. “Are you all of a sudden getting some kind of romantic notion about aviation, some kind of weird ‘slip the surly bonds’ idea that somehow makes you forget everything else? Since when did flying ever become anything more than ‘plan the flight, then fly the plan’ for you? Man, if I didn’t know you, I’d swear you cared more about flying than you did about Bradley. That’s not the Patrick Shane McLanahan I know.”