It is New Year's Eve 2020 and, predictably, the ER of County/USC Medical Center is swamped with victims of drunk drivers and bar brawls. Shouting to no one in particular are the partiers whose proclivity for hallucinogenic highs prompted ingestion of excessive quantities of the drug du jour, ENDORPH. A host of psychological breakdown cases, battered by holiday blues, are recuperating from a variety of creative suicide attempts. And the normal load of heart attacks, seizures, births, domestic violence, beatings and pediatric illnesses is providing Dr. Fiona James' staff with hundreds of diversions from late-night boredom.
James runs a well-oiled ER machine, admired nationwide for its efficiency and cost-effectiveness. Everyone knows their duties and performs them well. James and her residents bear ultimate responsibility for the most crucial patient decisions, which are usually based on genetic analysis.
"Seizure on open ward! We need a doctor over here STAT!" shouts one of James' nurses.
"What do we know about this guy," James asks the nurse as she grabs an air injection syringe loaded with neurotranquilizers. After shooting the chemicals into the teenage boy's arm and noting the expected instantaneous easing of his spasms, James looks expectantly at the nurse.
"Driver's license says Robert McIsaac, age 17, from Canoga Park," nurse Tom Shaddiford reads.
"Canoga Park? What's he doing way over here?" James asks. "Are there any relatives here?"
Shouts in the ER waiting room fail to roust anyone connected to young McIsaac, and the ward secretary says the teen wandered in on his own, barely coherent at the time.
"But he had this," the secretary says as she thrusts a 2-by-3-inch plastic card at James. "I already read his phone number off of it and called his parents. They're on their way in, and they e-mailed valid approval for emergency procedures as needed."
Excellent, James thinks.
Reaching into her pocket, the ER chief fumbles for her Gen-Com. Damn, where is it? At last she feels the familiar little slab of hard plastic, pulls it out, flips open the case and slides McIsaac's card in a slot behind the miniature video screen. A color 3-D image fills the screen, depicting McIsaac from all angles while a scrolling line of data across the bottom lists the boy's identification and vital statistics.
Ignoring the image, James types quickly on the tiny keyboard: SEIV.ent.EPILEP? In 10 seconds the powerful 400 megabyte mini-computer provides the following information: No seizure history. No head injury history. No trauma history.
James then types: GENSRCH. Knowing this will take a bit longer, the physician takes a glance at heart rate and temperature data on the boy. Satisfactory. She turns back to her hand-held Gen-Com and whistles at the readout.
"Bad?" Shaddiford asks.
"Uh huh. The kid's got the Chromosome 10 partial epilepsy gene coupled with the glucose intolerance gene GP6 and . . . ." "OK, I get the picture," Shaddiford says. "I'll prep the kid for gene therapy. Shall I wheel him straight upstairs now or wait for the parents?"
"Wait," James says as she reprograms her Gen-Com to run a genetic lipids utilization profile on the DNA card from an apparent heart attack victim lying beside young McIsaac.
*
In the early days of 1996, things are progressing extremely well in the global effort to sequence the entire human genetic code. The Human Genome Project, executed by the U.S. National Institutes of Health and the Department of Energy, is way ahead of schedule. So are its counterparts in Europe and Japan.
There are 3 billion bits of information, called nucleotides, that make up a human being's genetic database. By the end of 1995, scientists had very roughly mapped the locations and identities of all of those nucleotides. Most of the nucleotides are long, repetitive sequences that seem to serve structural or regulatory purposes of some kind, maintaining the shape and maintenance of the DNA. But about 100,000 stretches of the DNA are special: they are genes that determine everything from your hair color (undyed, of course) to whether or not your child will attain suitable stature and musculature to one day play in the NBA.
