2084: An Algorithmic State — Act XI: Answerability, Chapter 59: The Duty Officer

One course of a paediatric antiviral. Two children in the corridor at 2:40 in the morning. For twelve years a screen has given Rukhsana Baig the answer. Tonight the field comes back blank.

In Brief: Rukhsana Baig is the duty officer at Sector 9’s district clinic. During the thirty-day suspension, allocation decisions fall to the attending officer. On the tenth night a supplier delivery does not arrive, and she has one course of medicine for two sick children.

Where practicable, Rukhsana Baig thought, at 2:40 in the morning, with two families in a corridor and one course of the thing in the cabinet.

She had read the notice on the first day of the suspension the way everybody read notices, which was not at all. On the second day a locum who had actually read it explained it to her. She had said, “So it’s us,” and the locum had said, “It’s us,” and they had both got on with the shift.

For nine days it had not mattered. For nine days it had been the opposite of mattering. Things she had been requesting for a season came through in an afternoon. The paediatric respiratory case she had been arguing about since March simply resolved itself overnight, and nobody told her why. For nine days the ward had been the ward she had trained in.

On the tenth night the supplier delivery did not come.

There was no drama about it. There rarely was. The delivery was scheduled and did not arrive. The tracking said it had left, and the depot’s line rang out. At some point somebody would find out that a vehicle had broken down on the ring corridor. That is what had in fact happened, and nobody would find it out until the following afternoon.

What it meant at 2:40 was that Sector 9’s district clinic had one course of a paediatric antiviral and two children in the corridor.

Rukhsana had done this perhaps four hundred times in twelve years. Ordinarily she would have entered both cases, and the system would have returned an allocation priority within seconds. It was weighted on presentation severity and projected outcome and forty other things, and she would have followed it. Not because she was told to. Because it was better than she was. She had checked it against her own judgement for the first two years of her career, obsessively, in a notebook. It had been better than her about eight times in ten, and she had stopped keeping the notebook.

Tonight the field came back blank.

Automated threshold suspended. Determination at attending officer discretion. Record basis where practicable.

The girl was four and had come in at ten with the presentation you did not like, the quiet one, the one that looked like coping.

The boy was two and had come in twenty minutes ago. He was working hard, visibly, audibly, and the whole corridor could hear him. His mother had not stopped talking since the door.

Rukhsana knew, in the abstract, what the difference between those two things was worth. Every nurse knows. It is the first thing anybody teaches you. And it is still, at 2:40, at the end of a shift, with a woman’s hand on your arm, the hardest single fact in the profession to act on.

She examined both again. Nine minutes. She took a saturation on the girl three times because the first two did not agree.

The girl was worse.

She gave it to the girl.

Then she went to the boy’s mother and told her. The woman went from talking to not talking in the space of a second and a half, which Rukhsana had seen before and had never got used to. And she said, “Why.”

And there was, tonight, no number.

Nobody had explained that to any of them when the notice went round. For twelve years the answer to why had been an allocation priority, generated by a system. It was presented on a screen, and Rukhsana could turn the screen round so the family could see it, and routinely did. She had never once thought of that screen as protection. She discovered at 2:40 on the tenth night that it had been protection, entirely and completely. She had been standing behind it since she was twenty-four.

“Because I looked at both of them,” she said, “and I think she’s sicker, and I’ve been doing this twelve years.”

The woman looked at her.

“That’s it?”

“That’s it.”

She recorded the basis. Where practicable. She wrote four lines. It took her longer than the examination had.

02:40. One course paediatric antiviral in stock, supplier delivery not received. Two presentations.

Girl, 4, admitted 22:00. Quiet. Saturation taken three times, falling on the third.

Boy, 2, admitted 02:20. Audible distress, saturation holding. Both examined 02:41 to 02:50. Course given to the girl as the sicker child. R. Baig, duty officer.

The boy was fine. She wants that on the record, in the version she tells, and it is true. The delivery came at four the following afternoon, and he had a hard night, and he was fine. By the time he left she had gone off shift and did not see him go.

The girl was also fine.

Nobody ever told Rukhsana Baig why she had been standing in that corridor without a number. A man of seventy-one, in an office three sectors away, had put his name to thirty days of the eastern arc. He had done it precisely so that a thousand clinic determinations like the one she made at 2:40 would go to people rather than to thresholds.

She would not have thanked him. She has thought about it since. The suspension came up at a training day, eventually, as a case study, and she sat through it with her arms folded. What she thinks is this:

For nine days the suspension gave her ward everything it had been quietly refused for a season, and she is not going to pretend otherwise. And on the tenth night it gave her a corridor and two children and no number, and she made the right call. She knows she made the right call, and she has not slept properly on a Tuesday since.

Both of those. She has never found anyone who wanted to hear both.

About this serial: 2084: An Algorithmic State is a dystopian novel by Nithin Palal, published online one chapter at a time.

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