14z: We meet Immigration and Customs Enforcement

So, today I got called to a surprise meeting. We were about to revitalize this really elderly zombie with severe acrolysis and what appeared to be a fractured spine. I guess that this guy had been converted while he was on some big golf course in the UK, and immediately attacked a guy on a golf cart.  They somehow rolled the cart, pinning the zombie, who was then beset on all sides by golf-club-wielding oldsters and their caddies. They had really done a number on him. We were planning to do the revitalization in an OR with CT scanner. The plan was, I bite the zombie’s shin, and then they paralyze, sedate, intubate and resuscitate, and then a quick pan-scan and then straight to the OR table. Right as we were starting, I got this call. Obviously, I couldn’t shut the whole thing down for Dr. S, so I continued as planned with the revivification and then took off. It’s really not a big deal for me anyway – I just have to bite their shins, after all – but I usually like to observe and learn what medicine I can.

Dr. S was standing with folded arms waiting for me when the elevator opened in the CPTLD lobby. “So pleased you could make some time to join us. I am sure that the zombies could have waited a few minutes while we dealt with some very important visitors…” His smile never wavered, but his tone dripped contempt. We walked back to the breakroom.

Nick was already there, sitting at our little table. A morose-looking woman was seated across from him, looking around the room. A large, balding man who looked to be in his early fifties was standing next to the table smiling at Nick. Nick was pointedly ignoring him, eating kimchi with a knife and fork. Both the man and the woman were dressed in black and wearing jackets that said “ICE” in small letters in the front and big letters on the back. The jackets were sort of puffy-looking, quasi-military. I was thinking when I saw them that big black jackets with “ICE” written all over them just seem really 1990s, or even earlier, like pre-MC Hammer.

The smiling man came over and shook my hand, and I could see that he was some kind of cop. He had handcuffs and a gun in his belt, along with a couple of pouches and other vaguely dangerous-looking objects. I started to get very nervous.

The ICE-cop was effusively friendly, though. “I’m officer Speck, from Immigration and Customs. Sorry we had to call you away. Please, sit down – We won’t be taking up too much of your time.”

I dropped into a chair. Officer Speck beamed at me as if I had won a spelling bee. The woman stared at the table in front of her. “We understand that you are involved in the conversion of zombies.”

Dr. S, who was standing in a corner by a refrigerator, piped up. “Yes, officer. He’s involved. He assists in executing our revivification process.”

Our process,” I was thinking, but Officer Speck was talking. “One of the main issues that we are tasked with, as you know, is immigration enforcement. In filling that role, we are obligated to look at any possible sources of infiltration by illegal immigrants. It has come to our attention that many of the zombies warehoused at Revenant Units across the country – and I’m going to be honest here, that includes yours – may include illegal immigrants.”

Speck paused, I guess for effect. I hadn’t really considered the immigration status of the living dead, but I suppose it was true. It’s just not the sort of thing that we generally think about. And the records on most of our zombies are spotty at best – in older cases we may not even have their real names.

Speck continued: “Now, I know, you aren’t exactly in a position to inquire as to their immigration status. But you have to ask, what happens when they are revived, and sent on their way – then what? Are they simply allowed to walk free, throughout our country, as if the nation’s borders meant nothing?” Speck’s double chin wobbled with umbrage. “A nation is defined by her borders! We must protect our borders! And infiltration by illegal alien zombies is precisely the sort of threat that President Trump is concerned about.

“Now, I know, not every immigrant is illegal. Immigrants have contributed immense amounts to our country, from the Dutch, to the Germans, and even the Irish and Scottish. All good, upstanding immigrants. And even people from other places, which President Trump also cares about. Like you, for example – “ He pointed at Nick – “Where are you from?”

Nick shrugged. “Anaheim.” Speck looked confused. “It’s in California.”

Speck smiled. “No, no, I mean, where are you from?”

I broke in. “I think he was actually born in Los Angeles. Right? So you aren’t technically from Anaheim.” The morose-looking woman was staring at me as if she were about to reach for her cuffs. Speck laughed. “Okay, okay, well, anyway, wherever you’re from, you have to play by the rules. That’s the American way. We need to play fair, be aboveboard and honest, and that’s why President Trump was elected. And that is why he has concentrated on immigration enforcement, as the set of rules most being neglected in America today. Now I know, that as physicians, immigration enforcement is probably not your highest priority. But we all need to step up and do our part.”

Nick was clearly getting irritated. “So what are we supposed to do? Ask them for their passports first?”

The female officer spoke for the first time. “It’s simple. If you see someone who might be an illegal, you need to let us know before you revive them. If they are indeed illegal, then we will need to begin deportation proceedings on them.”

I looked at Nick. “So, wait, you are telling us that we need to be identifying the zombies of illegal immigrants, and then you are going to prevent revivification and deport them? Even if we were able to identify a possible illegal, we wouldn’t necessarily know which country they are from.”

Speck shook his head. “We aren’t going to deport them until the wall is built. Once we have that wall, then we are going to just drop them off on the other side.”

Nick’s eyes widened: “Wait, you aren’t even going to check which country they’re from?”

Speck nodded. “No, whether human or zombie, if we can’t tell where they are from, then we are going to send them to Mexico. I mean, that’s probably where they came in anyway.”

I looked at Dr. S, but he was looking carefully at his fingers. “Well, how are we supposed to know whether they even are immigrants, anyway?”

Speck sort of shrugged. “Well, uh, you know, sometimes….sometimes you have a clue. Like a, uh, you know…..a name…that sounds like it doesn’t belong….or, you know, maybe, in the right context….I mean, you have….like I said, clues! Clues. Like, for example, when I look at you” – he pointed at Nick again  – “I can tell….there are clues….that you aren’t from here. I mean, from here….right?”

There was a pause.

I said, “He’s from Anaheim.”

Nick shook his head. “Actually, I’m from LA.”

“Well – “ Speck was flustered. “Well, if you see something, say something. That’s what I mean. See something, say something.”

There was another pause. Then Nick laughed abruptly. “Anyway, it doesn’t matter. Illegals don’t tend to be insured, right? But we are doing all of our revivifications based on whether or not the patient can pay for it. So we really haven’t been doing anybody except mostly elderly wealthy people.”

“What?” Speck looked shocked. “You’re kidding me! That’s unethical!” The policewoman had a look of open horror.

Dr. S broke in. “I think that’s enough. We don’t need to get into the specifics of our challenges in maintaining a payer mix that enables us to accomplish our core missions.” He looked murder at Nick, who had gone back to his kimchi. “Anyway, we have understood your message, which I think boils down to ‘If you see something, say something.’ And we will, indeed, I promise you. We will certainly say something, if we see something.”

The policewoman still looked scandalized, but Speck was back to his cheerful self immediately. “Yes, that’s it, that’s exactly what I’m talking about. Dr. S has our contact information, so if you see something, say something – to Dr. S – and then he’ll say something to us – and then we can take care of it!”

So, now we are supposed to be doing immigration enforcement. I’m going to basically ignore this, but I guess it does open up a new set of complications. Like, supposing we do revivify a zombie who turns out to be an illegal – are we then accomplices to some sort of a crime? It’s kind of a mess.

13z: We can’t find Ayn Rand

Lunch again with Mattie and Nick. My mom had sent me a small steamer/rice cooker and we were eating mandu from Super Asia Fast Mart.

Nick has already finished up his paper, apparently. He’s going to send it around to us. I guess I’m second author, which is totally fine by me. It’s likely to be pretty high impact. That said, Nick doesn’t really have huge amounts to report. Apparently, my blood, spit, urine, hair, poop, skin and mucus membranes showed no unusual analytes. The zombies themselves show every evidence of instantaneous conversion to normal humans, reaching normal body temperature in 4 seconds with immediate resumption of EEG and EKG activity. About 80% of them have to go to the ICU after conversion, and about 70% of those survive. So, not bad, not great.

Mattie just got back from New York. Dr. S really liked the idea of revivifying the zombie of Ayn Rand. He made some phone calls to a friend at the revenant unit at Presby, who in turn checked around and learned that after Rand became a zombie, she was warehoused at the St. Genevieve of the Undead Revenant Care Facility. Unfortunately, St. Genevieve’s soon closed after funding was cut under Reagan, and she was then moved to the Bronx Zombie Unit. Mattie made the trip out to the BZU, which was a completely unorganized shambles (“worse than LaGuardia airport”), only to find, after consulting moldy, coffee-stained records dug out of the back of some linen closet, that Rand had been transferred years ago to the Bernard B. Kerik Zombie Complex (aka ‘The Tombs’) in Lower Manhattan.

So Mattie tried The Tombs, again with no luck. It was actually less organized than the BZU. They had records of Rand’s arrival, but she had been stored in a unit that no longer exists (The Tombs underwent some rebuilding a while ago) and no one knew which unit she was in.

Mattie spent two days going over decaying, illegible paper records. Even sitting with us, she seemed a little traumatized by it. “I coughed every time I turned a page. These records, they had a smell…I can’t describe it. I found a mouse skeleton in one of the boxes. And do you realize I was checking floppy disks on an old Macintosh Classic?”

Nick perked up at that: “Oh, wow, it still worked? Was it a Classic or a Classic II? Or was it an SE? How many drives did it have?”

Mattie shook her head. “I don’t know. Didn’t take pictures of it. I’m sorry. But the point is that I couldn’t find anything about Rand. But then I was eating in the cafeteria, and this other cryptothan fellow walked up to my table and asked: ‘Are you looking for the zombie of Ayn Rand?’

“I told her yes. She asked me to meet her at a bar across the street in four hours, after her shift got off.

“So I met her there and bought her a beer. She looks around, really conspiratorial…” Mattie imitated her, looking dramatically from one side to the other, switching hands with her pink flavored water as she did so. “And then she tells me this story: ‘One night, many years ago, Allen Greenspan came to The Tombs, searching. He was Ayn Rand’s most famous acolyte, and he wanted to find her zombie. A group of black-clad Federal Reservists were with him. They extracted Rand’s zombie, placed it in a gold-plated steel box with green dollar signs emblazoned on it, and took it back to Washington.

‘I’ve heard it said that Ayn Rand’s zombie still remains deep within the bowels of the Eccles Building. Ben Bernanke tried to get rid of it in 2008, but there was the subprime mortgage crash and everyone insisted that she stay around for good luck. They say that as long as she remains in the Reserve, the nation will never face an inflationary crisis.’

“So I gave up the search. I think we are just going to have to find another celebrity zombie.”

Nick was nodding thoughtfully. “I’ve heard a version of that story as well. People say that Greenspan was a strong believer in the efficacy of the Invisible Hand of Capitalism.”

Ah, yes, the Invisible Hand. An urban legend of government. Supposedly, the hand of Ayn Rand’s zombie is kept in a silver box on the desk of the Chairman of the Reserve. It’s consulted as a kind of oracle, tapping out answers in response to questions about interest rates.

I laughed. “The Hand of Rand is just a story, Nick. It’s totally ridiculous. Ayn Rand knew less than nothing about monetary policy.”

Nick shrugged. “Maybe so. Anyway, the needs of Dr. S for ego gratification and of the Institute for more money and recognition shouldn’t concern us right now. We have our own problems.”

True. But I really wish that they would figure out how it is that I am able to revivify zombies, replicate it, and let me go back to my life as a resident. I haven’t had the energy to read a journal in weeks, even when I am off. ACGME ensures that they are pretty careful about not making me work more than 80 hours per week – in fact, I work less than that, much of the time – but I am so destroyed at the end of each day that I barely have energy to eat a carton of Thai takeout and go to bed. But the thing about residency is that it pretty much just sucks, no matter what hours you work or how many zombies you cure.

12z: Science. Finance.

Nick is working hard on writing this whole thing up for one of the major zombie journals. Dr. N wanted to send it to Cryptothanatology, which is the main clinical cryptothan publication, but Nick thinks that this is big enough and interesting enough for a real science journal. He was thinking Nature, or at least Nature Cryptothanatology. It’s pretty exciting, but kind of a pain for me. He made me submit a detailed timeline of my life up to now, along with a pedigree for some reason (my family history is, as they say, noncontributory). He and someone from one of the central labs are spending their spare time analyzing every fluid I can produce for some kind of clue. Nick actually wanted to scrape one of my teeth (“Just a bit of enamel! You’ll remineralize! It’s for science!”) but I refused. They settled for some bite-wing x-rays and a pharyngeal swabbing, which took longer than I wanted it to and sort of sucked. I think it was probably the first one Nick had done since medical school.

Dr. S is spending a lot of time doing different public relations things. He’s actually at a conference in the south of France right now, presenting his preliminary findings. I understand he’s also spent some time lately at the Trump palace in Florida. I wish him luck. If they can find a set of donors or funding from the NIH, then we’ll be able to revivify more uninsured zombies.

As it stands right now, that isn’t going to happen. The Institute has really cracked down on seeing patients on anything other than private insurance. My friends in internal medicine clinic have told me that lately all they are seeing are wealthy hypochondriacs.

For my part, I am basically only revivifying elderly white guys. I honestly don’t know whether these people or their families have turned around and made the big donations that the Institute has been hoping for. It actually would sort of surprise me if they did. I mean, suppose one of these guys has been a zombie, warehoused in the CPTLD for, say, five years. And let’s say that he was, in fact, wealthy. Well, his family would have inherited all that money when he phenoconverted. Once they are declared a zombie by an MD, coroner or revenant-containment officer, they are dead under the law. But once I bite them, the family has to deal with their deceased patriarch (as I said earlier, these are nearly all men that I’m converting) returning to them, alive but typically in desperate health and with at least some murky legal claim to whatever they’ve done with his money since he became undead…No, I do not expect that the Institute will be able to count on massive donations from most of these families. Of course, it only takes a few, and I’m sure they’ll keep trying.

In the midst of all this, they’ve actually reduced the number of zombies that I am biting, because of ICU capacity issues. I think that there has been a certain degree of burnout among ICU staff, as well. This frees up my afternoons to actually do clinical work, which is great. My rotation schedule is a complete mess, so no one knows what I should be doing. I had wanted to do half-days on pulmonology, but I’m not very popular in the ICU right now. So I’m on cardiology, which is fine.

 

11z: We discuss celebrity zombies.

At lunch today, Dr. N let slip that they were looking for a celebrity zombie to dezombify. Although there has been some support from donors, we are going to need much more if we are going to continue converting zombies at the rate we’re going. Otherwise, it’s actually more profitable to the Institute to leave them in storage. As part of our PR drive to drum up donations, we are trying to make a bigger splash. “Keep the momentum going,” as Dr. N put it.

To be clear, I don’t know what momentum she could possibly be talking about. The initial excitement regarding our zombie-conversion procedure has been entirely drowned out by the consternation, confusion, and outright horror and fear surrounding the Trump administration. No one is clicking on our Youtube commercial anymore – they want to hear about the latest outrage occurring in Washington. We don’t have any more momentum – all the oxygen has been sucked out of the public discourse by the slow-motion implosion of our federal government.

Nick and I looked up over our ramyun. The other person at the table, a Brazilian cryptothanatology fellow named Mattie, recommended that we find a zombie politician to convert. “After all,” she said, waving a bottle of pink flavored water, “that’s what’s on everyone’s minds right now. It’s politics, politics all the time. Ride the wave!”

Dr. N smiled and pulled a string of meat from a half-destroyed rotisserie chicken. “I like your style, Mattie. Can you think of anyone?”

We all drew a blank for a moment. Then Mattie brightened.

“How about Richard Nixon? Wasn’t he a zombie?”

Nick shook his head. “I think he went by natural causes. But Henry Kissinger’s a zombie, I’m pretty sure.”

It was my turn to demur: “No. I don’t think so. I think he’s still alive.”

Dr. N waved a chicken leg. “Pity. How about Robert Dole?”

Nick looked thoughtful. “No. I mean, I know why you would think that, but no, he’s actually still alive too. I think Jefferson Davis was a zombie, but they didn’t keep them in storage back then. I think he went on a zombie rampage, right? And they shot him with a cannon?”

I laughed. “No, no, that’s ridiculous. You’re thinking of Andrew Jackson. What about that cross of gold guy? Like, didn’t he become a zombie right after the monkey trial?”

Mattie smiled, showing a mouthful of braces. “No, that’s William Jennings Bryan. He died in his sleep.”

These cryptothan people; full of weird trivia about how everybody in history died. Nick gestured with his chopsticks. “Maybe a politician is the wrong tack anyway. People want a distraction from politics, not more of it. How about an entertainer?”

Dr. N beamed. “That’s a great idea! Our CEO actually feels the same way – we are looking through the Revenant Management Consortium’s records, but we have no one in specific in mind. What do you think?”

We thought for a moment. Mattie looked into her bottle of pink water. “Maybe…..How about that singer, Frank Sinatra?

Nick looked puzzled. “Wasn’t he a politician? Like, prime minister of, uh, Laos or Sri Lanka or something?”

I shook my head. “No, I think you’re thinking of someone else. Shinawatra, not Sinatra. Thaksin Shinawatra. He’s Thai. Sinatra was an Italian.”

“Oh. Was he in the mob?”

I frowned. “Just because someone’s an Italian-American doesn’t mean that they know people in the mob. Anyway, yeah, he was a singer…..what did he sing again?”

Unforgettable. I think that was his big song.” Mattie was tapping at her cell phone. “He was never a zombie though. What about MC Hammer?”

“Also not a zombie. He’s still on TV, I think. Uhhhh…..what about Kirk Cameron?”

Mattie tapped at her phone and squinted at the search results. “Oh, no, jeez, he’s making movies about marital fidelity and endorsing Donald Trump. Not really a zombie. You could try biting him anyway, though. Can’t hurt.”

Nick sighed. “Man, I wish that they had preserved Nietsche. That would be a real coup.”

“I don’t want to bite Nietsche. Wasn’t he the guy who said ‘those who would bite monsters must be careful –’”

“Yeah, something like that. But Nietsche was never a zombie. You guys are thinking of Heidegger.”

“Oh, yeah, that’s right. No way am I biting that motherfucker.”

Nick suddenly paused from stirring his ramyun. He looked up and smiled. “Ayn Rand.”

We all grinned. Dr. N raised her chicken leg in a sort of toast. “That’s perfect! The CEO loves Ayn Rand! Have you read her work?”

I made a face. “I read Anthem when I was in, uh, fourth or fifth grade, I think. I was really into it for a few months. I made a construction-paper collage in art period representing the individual triumphing over collectivism. But then I kind of got into building model rockets and forgot about it.”

Nick was looking her up on Wikipedia. “Yeah, I started reading one of her books, because this guy in my econ class was way into it and I thought he was sort of cute. But it was very poorly written with no sympathetic characters, and the guy in my class turned out to be some kind of crazy fetishist. A zombophiliac, in fact.”

Dr. N was emailing the CEO. “Yes, Ayn Rand is very popular among zombophiliacs, but her work is also extremely popular among our prospective donor class. We couldn’t do better as far as spokespeople go. Assuming that we are able to locate her zombie. That was all a long time ago.”

“Wikipedia says she was on Medicare…..aren’t we not converting zombies on public assistance?”

Dr. N finished her email and went back to stripping the last bits from her chicken carcass. “We’ll take the loss for this one. I mean, it’s Ayn Rand, for god’s sake, one of the architects of our value system. We can do a freebie for Ayn Rand.” She smiled suddenly. “We could make it back by filming it as a reality TV show. Or what do they call, like, a long reality show that’s just one episode?”

“A documentary?”

“Right, a documentary. We could call it ‘Biting Ayn Rand.’”

We went back to eating lunch. I am not really looking forward to biting the shin of the revenant corpse of the author of We the Living, but I suppose that there are people who would give almost anything to do so, or just to see me do it. So maybe this will be the shot in the arm that the administration is looking for, to drum up some donor support. But of course, first they need to find Ms. Rand.

10z: Our cure for the undead is not getting enough press. Zombie conversion through history.

It’s been a little while since I’ve written. It’s been a busy (and depressing) week, and I’ve had a bit of a cold.

Anyway, not all that much has changed on the ground. I’m biting fewer zombies per day now. I guess we’ve exceeded ICU capacity a few times. We have the beds, but the acuity of the patients that we are sending up is sometimes pretty severe. Lots of hemothoraces. Blood pressures seem to be unstable in the hours after phenoconversion to the human state, and they can have a mild coagulopathy similar to von Willebrand disease. Infection can also set in pretty early, probably mostly because of the many wounds that they have. Occasionally they are seeing some kind of late granulomatous reaction, which Nick thinks is due to exposure by some of the zombies to a failed “miracle cure” that was attempted back in the mid-90’s. Apparently the ICU is putting them all on vancomycin, ceftriaxone and ampicillin for the first few days, and even with that there have been one or two meningitis cases due to occult skull-base fractures.

That said, many of them seem to do quite well. There have been a few scenes of ex-zombies (ex-zees in recently coined ICU parlance) reuniting with family. The first zombie that I converted to human – the one who started all of this, when she attacked me down by the soda machine and I bit her in self-defense – left the hospital after just a week. I understand that she is going to be releasing a memoir soon.

Actually, I am really looking forward to reading it. You know, I haven’t really had any in-depth discussions with any ex-zombies, despite my work. I’ve stopped by the SICU a few times and seen them up there, and I’ve had short conversations with a few ex-zees and their families, but that’s really all. One of my fellow IM residents told me that they don’t have any memory of their period of undeath, but that they also don’t feel like they were completely unconscious during that time. I don’t pretend to understand it. Nick is fascinated by this – he keeps talking about minds and bodies and Cartesian dualism, but whether he’s for or against the latter, I really can’t say.

Of course, the backdrop has been the unadulterated shitshow of the first week of the Trump presidency. The media circus surrounding our country’s ongoing autophagy basically drowned out the press release about our new zombie conversion procedure (which still involves my biting the shins of zombies, resulting in their instant reversion to a human state). Not to say that it was completely ignored – the BBC was actually prompted to do an interesting article on zombie conversion through history. It was pretty cool. I had been aware of a few cases, of course. My favorite was Chipper Arnie, from 19th century London, who supposedly bit and converted thirty zombies all in one evening. Apparently he had just lost a finger in a kitchen accident, and his boss had given him a little extra money as compensation. He ended up going on a four-day drunk, culminating in a rowdy dice game on a balcony in Old Nichol. Arnie was on a winning streak, and this – combined with his constant grating cheerfulness – so incensed one of his fellow players that the man pushed him through the rotted balcony rails. Arnie fell to the street and crashed through a locked bulkhead, rolling right into the middle of a basement zombie mill. Zombie mills were essentially giant engines that fed off of the near-relentless energy of zombies. They mostly consisted of huge wheels to which zombies were chained, often with a ratchet mechanism so that they could only move in one direction. These zombie-powered engines were used for textile manufacture, flour-grinding, drawing and pumping water, etc. Some of them had people who were paid to run in front of the zombies, so that the zombies would move faster and in a more unified direction. This work was usually performed by young, agile men from the countryside (called “clodhoppers” because of their sustained sprinting in circles over the uneven floors of the mills), and was the source of the famous old nursery rhyme “Jack be nimble, Jack have skill, Jack lead zombies around the mill”. In any case, Arnie was immediately set upon by the zombies in work gang, but supposedly converted all of them back to humans by biting them, just like I do. The story goes that he then resumed his dice game, lost all his money and went home to sleep it off. Apparently the owner of the mill subsequently brought Arnie to court for destruction of property, and he was briefly sent to prison before being freed by a delegation of Quakers from the United States, who wanted him to convert some of their brethren who had become zombified in Connecticut (during the Second Great Quaker Zombie Plague of the 1800s). However, Arnie died before he made the trip, after another drunken fall put him beneath the wheels of a carriage.

The BBC article also mentioned Nasrallah at-Tabiib al-Ghul, supposedly a physician in the court of Saladin who could convert zombies (not clear how) and who, despite being a Muslim, is renowned as a folk saint by certain Maronite Catholics for his having converted all the zombies of Jerusalem. There was a considerably more mercenary zombie converter in France during early part of the reign of Louis XIV, a Dutch mountebank called Jan Kreupel who was also known for biting zombies back to life. And more recently there was Altynai kyz Joldoshbek, a farmgirl from somewhere in Central Asia – one of the ‘stan countries – who could also do it, back in the Soviet times.

So the BBC article was interesting, but with everything going on, I think our success with zombie conversion just hasn’t been as big a splash as Dr. N wanted it to be. She’s still fairly happy, but I heard Dr. S mention offhand that the CPTLD is actually a bigger profit center than the ICU, even with zombies that have favorable insurance policies. They want to line up some donors to help support the conversion process. I guess we’ll see what happens.

9z: Postphenoconversion care. Bureaucratic doublespeak.

Holding steady at about 10 zombies per day, give or take. Like I said earlier, the rate-limiting step is really the capacity of the ICU. They’ve got four separate code teams that are basically earmarked for the zombie conversion service. I was pretty impressed by that, but Nick pointed out that it’s approximately the resources that a moderately busy surgeon would require. Since we know when the codes are going to happen, that takes a lot of stress off of the teams, and the whole show can be run by one or two anesthesiologists and a couple of NPs. Also, instead of the two rooms that we were using in the CPTLD for the conversions, we are now using a couple of operating rooms, sometimes more than a couple. That’s a lot easier than working in the CPTLD, not only for the resuscitations but also for security.

None of the zombies we are doing is exactly best-in-show. As I mentioned earlier, the decision on which zombies get changed back into humans is based less on their chance of surviving the transition and more on the type of insurance that they had before they were zombified. For this reason, we have almost exclusively been doing wealthy, elderly white men, regardless of their states of health before zombification. This means that while they may not necessarily do all that well with the transition, the conversion and aftercare are all paid for. Dr. N has assured me that the Institute is in the process of lining up resources to help pay for converting the uninsured. The attitude seems to be that if they’ve waited this long, they can wait a little longer until we’ve sort out the reimbursement side of things. I have to admit, this reasoning doesn’t appeal to me much – it’s pretty much the opposite of why I went into medicine – but after Dr. N went over it with us a bit, I guess I see the logic to it. I would be really upset if a patient’s family were to be bankrupted over care that I was providing.

The conversion process itself is still a work-in-progress. For a very short time, they were trying to place peripheral IVs and/or IJ lines in the zombs before the conversion, assuming that they would all need some kind of resuscitation. Turns out it’s hard to place a line in a zombie. There isn’t really an easy way to stop them from moving around, aside from restraints (which have their own problems); also, it’s really hard to place a line in someone who happens to have a MAP of zero. So now we place an IO line in the right shin. Starting yesterday, nearly all comers are getting rocuronium and rapid-sequence intubation immediately after conversion, after someone rolled off the table after I bit them. Some of these guys had been therapeutically anticoagulated for atrial fibrillation and whatnot before their zombification, meaning and they’ve already had enough chances to bang themselves up during their period as undead revenants – they don’t need a hospital fall on top of all that.

Nick and I are still kind of throwing around different zombie-related research ideas. Nick sent a proposal to Dr. S, who is however very busy these days. Apparently he and the CEO have flown to Washington to meet with some of the appointees in the new administration. It’s no secret that the Institute has been heavily in the repeal-and-replace camp regarding the Affordable Care Act. What’s coming next is anybody’s guess, but the CEO was on the news the other night: “The Institute’s emphasis is and always will be the wellbeing of our patients, regardless of race, creed, color or socioeconomic status. We look forward to finding a solution that will enable us to be true to our ideals while remaining competitive in an increasingly challenging environment.” When you really parse it, that sounds like a ton of meaningless crap, but at least we are part of the conversation. I guess.

As far as the new administration’s attitude toward zombie-care is concerned, I am cautiously optimistic. While I am not sure that any of them have any direct zombie experience, I recall reading that one wealthy cabinet nominee (I have forgotten which one) had tried to have a winning racehorse zombified so that it could potentially keep racing. He was going to import a zombie jockey from Monaco and everything. Of course, horses don’t zombify, so that wouldn’t have worked out, but I suppose some interest in the subject is better than none at all.

8z: Revenant riders and OzombaCare.

Well, I found out why we are doing so many elderly zombies.

I should start at the beginning. I hadn’t really thought too much about the recent history of zombism, but it’s interesting. I will try to catch up more later, but most of what I’ve learned in the last day or so came from Wikipedia.

Anyway, to start with, you have to bear in mind that up to just before the Second World War, being a zombie was as good as being dead. In those days, zombies were just incinerated, no questions asked. The attitude toward zombies changed quite a bit during World War II and immediately after, for a couple of reasons. First was the semi- successful deployment of the Undead Expeditionary Force in the European theater (the famous/infamous “Bradley’s Ghoulie Group”), which basically just involved dumping zombies behind enemy lines in large numbers via airdrops (using timed parachutes) and letting them do their thing. It was actually these zombie soldiers that used the first zombulkes, but those were prone to fail and so wide-scale military deployment of flamethrowers was necessary. Unfortunately, zombie penetration into civilian centers also ended up requiring massive carpet-bombing campaigns, and so use of zombies in warfare became limited. Eventually it was declared a form of biological warfare and made illegal, but I guess back at that time they were sort of considered to be morally equivalent to landmines.

Gathering and storing zombies for deployment led to a different attitude toward zombies, with the realization that they could be maintained safely for an indefinite period of time. Meanwhile, conversion among soldiers in the European theater was particularly high, at least partially because of their sometimes being bitten by the weaponized zombies used by both sides. By the end of the war, most of the soldiers who had served in combat roles in Europe had known someone who had been zombified.

Meanwhile back at home, there was a major manpower shortage, combined with a wage freeze. Since employers were unable to attract workers with higher wages, they used various benefit schemes. Among those benefits was health insurance. Zombism was of course not covered at first, but returning soldiers began to insist that, should they convert to zombies, they would like to be stored indefinitely rather than incinerated. The idea, of course, was that they were hoping to be cured. It was an optimistic period. Health insurance policies began offering “revenant riders”, covering indefinite storage and eventual cure (should one be found). The truth is that these were money-makers for the insurance companies – zombie storage is extremely cheap. Medicare/Medicaid started covering storage under pressure from the various groups, especially the California-based Church of Living-Dead Saints, which saw zombism as a necessary precursor to immortality and which actually had a surprising amount of political clout back in the 1980s. However, Medicaid didn’t promise to cover cures for zombism, just as most insurance doesn’t cover a cure for other, less active forms of death.

In the last 8 years, there was as you know a major overhaul of the insurance industry, with the passage of the Affordable Care Act. The zombie-care policy was tackled very thoughtfully (through so-called OzombaCare), covering both storage and cure – but not covering any procedures performed after zombification. In fact, postmortem procedures are generally explicitly forbidden by OzombaCare plans. You will recall that famous case of the zombie whose family wanted his arms and legs removed so that he could be safely situated by the sand trap of his favorite golf course, and tried to get Medicaid to pay for it. That was a long time ago, but there was such a public outcry over these sorts of abuses of taxpayer money that basically Medicare/Medicaid have banned any postzombification procedures at all. Although OzombaCare is distinct from Medicare/Medicaid, its policies have tended to keep the no-postmortem-procedures stipulation. The more expensive private policies are usually more nuanced. And anyway, suppose Medicare/Medicaid could be coaxed to cover a converted ex-zombie — after you do the conversion, you’re basically left with an ICU full of severely ill patients on Medicaid. Bottom line is, the Institute does not get reimbursed as well if I bite zombies with public health insurance. They could even end up losing money, strange as it sounds.

This is why I am converting mostly elderly zombies. The administration has decided that the way to make this into a profit center is to only convert the zombies whose aftercare (the code, the surgeries, etc) is guaranteed to be covered. The zombies we are concentrating on were wealthier and had better insurance before they converted.

Dr. N just straight-up told Nick and me this, all while eating a rotisserie chicken in my little improvised kitchen. She had just come from a discussion with the CFO and some other business types.

I tried to hide my shock. “Doesn’t that seem to run against, you know, our commitment to patient care above all? I mean, we always talk about how that stuff doesn’t matter, how we live our ethics…..” Dr. N didn’t look up from the chicken she was pulling apart with her fingers. “Well yes, we all believe that, everyone believes it. But we have to keep the doors open and the lights on. If we go bankrupt we don’t help anyone.” She paused for another mouthful. “Anyway, your duty to help the patient is the same, whether they are poor or rich. Just because these people are rich, doesn’t mean that you shouldn’t help them.” She took a pull on her cup of tea and went back to disassembling her chicken. “You know, health care is about to undergo a major change in this country. No one knows what’s going to happen, but OzombaCare is probably going down in a few days. And it will not become a revenant!” She chortled at her own joke. “But what comes next? We are going to have to be flexible. Who knows what the new administration will do?”

I caught Nick’s eye. He shook his head. I’ve spent weeks biting the shins of animated corpses, and today’s the first day I really felt disgust.

7z: I continue to cure zombies. My idealism is trialed.

Well, same old, same old. Still biting ten zombies a day. I’m not really learning any medicine, and so they are sort of talking about what to do with me. All my electives have been moved to this period, for the time being. This means that everything in third year is going to be a service month. I just don’t want to extend residency. I mean, if I wanted to do that then I would have tried for chief resident. But then, I’m neither social nor much of a gunner, so that particular honor is one that likely would have evaded me regardless.

Anyway, I’ve got bigger problems. The Institute has kept me personally under wraps, to some degree, which is a good thing. Dr. S has given several interviews, along with the CEO, and I have apparently been mentioned a few times. I learned this from my mom, actually. She was watching one of those morning TV shows where people sit on couches and talk blandishments (what’s the appeal of that format? it’s like sharing an interminable elevator ride with the most obnoxious people in the office). They aired that video of the faux-zombie being revived, and then Dr. S and the CEO came on the show as guests. They were surprisingly restrained, according to my mom. They said that a research team had developed a method for conversion of zombies to humans, but that it was risky and not yet suitable for truly wide-scale application. I was mentioned briefly by name, as a “highly skilled technician who is very adept at applying the Institute’s technique.” My mom said that Dr. S seemed like a very compassionate person who genuinely cared about his patients. I did not disabuse her of this notion.

This exposure, paltry though it was, made things a little harder for me at work. I have taken to coming in through a service entrance, but people still stop me and ask if I am really the zombie-biter. I mean, word gets around. The hardest thing about it was going to lunch. There are always some residents from my program who want to know the story, or some MICU fellow or surgery resident who wanted to tell me how worn out they were with all these train wrecks that I was sending up from the Revenant Unit – it got tiresome. Dr. N has allowed me to have a cupboard and a shelf of refrigerator space in the breakroom for my eggs and ramyun and various sauces. Also I have a little teapot and some Dr. Pepper, so things are all right.

While I am on the subject of eating: You might think that biting the shins of the undead all day long would be so disgusting that I would develop an oral aversion. I would have thought that as well. I cannot say that it is pleasant, but it doesn’t seem to be leaving any major scars. For one thing, it doesn’t really feel like biting a person, more like…..I don’t know, something else. Balsa wood? Maybe balsa wood with a layer of latex paint on top? Second, they are always pretty well cleaned off, and no one expects me to bite an area that looks injured or gnarly. And then, third…..it just doesn’t bother me that much. I don’t know why.

The other thing is that I don’t really have a strong sense of doing something great and good. This is very strange. I have always been very idealistic (that was what originally attracted me to the Institute, because patient-centered care “regardless of race, creed or socioeconomic status” has always been their stated guiding principle). I still feel that way. But this particular job that I am doing – converting zombies – just sort of seems like a brief diversion. I know that’s strange, but I am much more focused on being a primary care physician, even still. I guess zombies don’t interest me much.

Not so for my friend Nick. He comes up with a new theory about zombies and zombie conversion about every ten minutes. We are going to try to get a few papers out of this. Definitely there’s a lot here, in terms of methods, epidemiology…..Nick has some really interesting ideas in terms of taking some non-invasive measurements right at the moment of conversion (he listed half a dozen assays; the only ones I had heard of were surface EMG). He wants to get sense of the rate and nature of conversion relative to different types of tissue throughout the zombie’s body. Should be very interesting, and it could make his career.

6z: A more detailed description of the conversion process. Future directions.

Well, the zombie-biting thing has taken off in earnest. I find myself missing my life as a medicine resident.

It’s weird, actually, sort of a cross between working in the MICU and going to the dentist. I mean, I’ve been present at more crazy codes than probably the average IM physician sees in their entire career, but they don’t let me participate in the resuscitation.

This is what happens. They wheel a zombie into the exam room at the Revenant Unit. Drs. S and N are both not really showing up anymore – I think that they are heavily involved with new administrative and marketing responsibilities – but Nicholas is usually there. We have two guards, and everyone is in ZombWeave armor. The zombies are heavily restrained, with zombulkes and facemasks. The masks themselves are usually opaque from the inside, but the zombies still clearly know where everyone is.

Anyway, the younger zombies tend to struggle and try to reach for us,  but they are so heavily bound there isn’t much they can do. The older zombies sort of move halfheartedly, but after a decade or so, they are usually pretty slow. The zombies have the left shin exposed. One of the guards washes the area with soap and water, and then with alcohol. I use a clorhexidine rinse. The guards take stations, one on each side of the zomb, and I bite it on the shin. Immediately I am whisked back and the code team enters, wearing light armor and behind shields. The guard on the left side of the bed pulls back the zombie’s mask and verifies the conversion. Usually the converted zombie – now a regular human – is screaming or gasping, and the team moves in to do whatever has to be done. That basically always involves intubation and a chest tube, at least. However, for some reason all the zombies we are doing these days are pretty elderly, so there is often a lot to be done. Ischemic bowel seems to be a common early complication, due to volvulus occurring during the period of zombification. Myocardial infarction, certainly, although not as much as I might have thought. Fractured ribs and unhealed pneumothoraces (which tend to turn into hemothoraces at the time of conversion, hence the chest tubes) are frequent even in the younger zombies. Fingertips and other areas that have undergone undeath-related acrolysis will bleed very briskly sometimes. Generally speaking, injuries due to trauma suffered during the period of zombification will manifest suddenly at conversion, but sometimes complications take days to show up.

Right after I bite the zombie, I am pulled to the next room, so usually I don’t see much of what transpires. They have the two exam rooms set up for conversions, and my role is really quite brief (I just bite their legs, after all), so I could probably do more of these than I actually am doing. The bottleneck is the number of MICU and SICU beds available and code team resources. I’m doing about ten zombs per day, and even so the system is pretty stressed. One of my colleagues on her MICU rotation semi-jokingly asked if I could take a few sick days to allow them to drop the census a little.

As I mentioned earlier, I am doing a lot of the more elderly zombies, and this is probably compounding the problem. It doesn’t seem to have to do with how long they’ve actually been zombies, either. I mean, these are people who were elderly before becoming zombies.  At the beginning, I was doing more young zombies, but there’s been a definite shift in age. I don’t really get it, either, because the elderly zombies have more comorbidities.

Nicholas and I were talking about what we can do to improve outcomes among the zombies that we convert. I was thinking that we should try pan-scanning them before the conversion. Nicholas does try to do as much of an exam as he can beforehand, but there isn’t much information you can glean from a biologically inert animated cadaver, especially one with homicidal intent. I was thinking we could MRI them, but Nick pointed out that some of them carry bullets and other metal that might make MRI dangerous. Also, motion artifact is a killer. CT is quicker and has much better visualization of bone. Still, CT scans of zombies tend to have a lot of false negatives, because so few of the usual indicators of trouble (bleeding, edema, fat stranding, etc.) are present. Anyway, it’s a moot point – Rads doesn’t feel like there is sufficient security in the CT suites to permit scanning zombies. Hopefully we’ll get our own portable down in the Revenant Unit at some point.

5z: I am in a commercial

So, you’ve probably seen the press release already. Let me give you the backstory.

They paged me really early Monday morning. Instead of the CPTLD, Dr. N asked me to go to this other building on the outpatient campus. “Since it will be the press release,” she sort of whinnies over the phone, “I think it will be best for you to wear your nice clothes and maybe just think of shaving.” So I did.

I get there, and there’s this whole circus already going in the lobby. All people in suits, no white coats or scrubs. I was sort of afraid that they would all turn around and look at me when I came in, but no one did. Actually, it was like I wasn’t there at all. An old, semi-fat (I believe the term is “portly”) bald guy was giving a propaganda spiel. “Since its inception, our Institute has been at the forefront of care for both the living and the undead. The unofficial motto of the Institute – ‘We care’ – encompasses all people, of every creed and color, from every walk of life or death. I think I can say in honesty, with no trace of hyperbole or exaggeration, that we have the embodiment of the Hippocratic Oath right here, in our selfless devotion to each individual patient and to medicine as a whole. We have always particularly prided ourselves on our skill in ministering to the…” I blocked out Mr. Portly Propaganda and entered the hall behind him. Nick led me into another room off the hallway.

Basically, it was a TV studio, and not a cheap community access cable one. TV cameras (including two of the fancy kind that has a seat attached), boom microphones, a mixing board larger than my bed, technicians running around — everyone looked so young and energetic and excited. In the middle was a set that looked like an exam room. Not the undead-safe exam room in the CPTLD, but like a regular physician exam room, without blast shields or manacles or anything like that. Dr. S and Dr. N were waiting for me. Dr. S was at his most unctuous. “I’m so pleased to see you! I hope you’re ready for an exciting day! Please, have a donut!” He gestured behind me to a box of donuts on the far wall that a couple techs were busily picking over. “Oh, and I would like you to meet someone very special — This is Dr. R, the CEO of the Institute!” Dr. R was exactly like he looked in his pictures: black hair with perfect gray at the temples, genial smile, much taller than me — sort of like the Mitt Romney of medicine. He smiled at me (he was always smiling). “You’re the zombie-fixer. Very pleased to meet you.”

One of the techs asked whether it would be all right to start, because they had a schedule. That struck me as weird — what else are they filming in here? But I suppose that they do patient education videos and so forth. They had me stand on the stage next to Dr. S. Then we were supposed to be talking seriously about something. There wasn’t going to be any sound, so we didn’t actually have a conversation. Dr. S just made serious faces and nodded. Then at one point he was supposed to put his hand on my shoulder. They did like five takes of that.

Then they open the door and wheel in this young woman on a gurney. To say that I was taken aback is an understatement. I kind of realized that there weren’t going to be any zombies in this picture, but they didn’t even try. The woman, for one thing, was in a hospital gown, not the Kevlar bags that they actually transport zombies in. She was even wearing makeup (but so was Dr. S) — No zombulke, no gas mask, no guards, no face shield — none of us was wearing armor — Have I communicated the aura of unreality here? They were explaining the situation to her. “Does he have to bite me ?” She looked me up and down, and then asked with a different emphasis: “Does he have to bite me? Not trying to offend,” she smiled at me, “but I have a portfolio that I need to think about.”

True to form, Dr. S stepped up heroically. “No, no, of course not. No. No. No, certainly not. I don’t think so. No one wants to film anyone biting anyone. Right?” He looked at the film crew. They looked at the CEO. He shook his head.”No, you just, just lay back and, maybe, extend your arm a little…” The director took over coaching her. “More, uh…languid. Remember, you’re dead. Ok, yeah, but you’re doing it like a zombie. I know, you’re supposed to be a zombie, but don’t be a zombie. Pretend you’re, like, Sleeping Beauty. ….Yeah, better…okay, again…..”

Then they filmed her talking to Dr. S. He put his hand on her shoulder too. They didn’t even have to tell him to do it. I guess he’s a natural.

Then they had her go change into a low-cut red blouse and jeans, and stand next to the CEO and Dr. S. “Thanks to the Institute, I have my life back!” The director had her say it like ten times. “Ok. Ok. Good. Could you lean forward a little more when you say it? Yeah, that’s great. That’ll get us a lot of clicks.”

That was it. I wasn’t even in the video. They cropped me out — It’s all Dr. S looking serious. I got one mention during the voice-over, while Sleeping Beauty was extending her arm: “The Institute’s specialist applies cutting-edge techniques for the revitalization process. Medical assistance is often needed at this time, but of course the Institute is in a position to immediately render any care deemed necessary through one of our top-flight providers.”

That was what happened. I didn’t even wake a single zombie that day.