Health care in the time of apocalypse

Of the panels I was on at Wiscon this year, my favourite was the one I did with Jackie Gross and Cabell Gathman on proto-apocalyptic landscapes and survival: What brings us to the point of apocalypse, culturally? How does a series of events turn into a domino effect that forever changes the world? And, critically, how do people support themselves in the short and long term? While many works of speculative fiction explore the subject, I’m often left unsatisfied, as there’s a great deal of handwaving and the circumstances are unclear—food comes from somewhere, sort of, for example, but we never see who grows and processes it. That’s why works like Not a Drop to Drink are so great, because they really do explore resource scarcity and management, putting it at the forefront of the narrative.

One thing was of particular interest to us, though: Health care.

We live in a culture where medical advances have enabled critical and amazing feats of survival. Preterm infants regularly survive, and often thrive, thanks to available medical interventions. People with severe chronic conditions can manage them with the assistance of medication and medical devices. Clotting disorders aren’t a death sentence. Autoimmune conditions are controllable. Many of us take these things for granted, including those of us who rely upon medicine to keep us alive on a daily basis.

It’s not just about the big picture when it comes to medicine, either. It’s also about the small picture: Managing routine infections, performing emergency surgery, addressing serious cuts and wounds. These are all things that, again, we take for granted. If someone falls and breaks her arm, an x-ray provides information about the break and it can be set, with surgery to repair it if necessary. If someone’s in a car accident and she sustains head trauma, a neurosurgeon is available to address it, and she’s monitored for signs of complications like clots.

One thing I enjoyed about Jericho was the direct exploration of health care. We saw the prioritisation of the clinic as a public service and the acknowledgement that its functionality was limited by the skills of the physicians and nurses available as well as the equipment, but, more notably, the supplies. The clinic wasn’t fully stocked with every medication imaginable. People died because they couldn’t access treatment. Jake was forced to go to Rogue River to find more aggressive antibiotics and stock up on other medications for the town because of the clinic’s shortcomings, and one of the most valuable resources he brought back was a trained surgeon; health care professionals became a prized commodity in a culture where healthcare was at a premium.

We kept coming back to the theme of health care on the panel because it’s such a vital part of society. Eventually, clinics, hospitals, pharmacies, and factories will run out of stock: No one is manufacturing new medication, let alone surgical supplies. There are no sutures, no new needles, no gauze and cotton balls, no tape and surgical glues. People have to start making do via whatever means they can, turning in some cases back to old methods of medicine. The news recently covered a really fascinating case where researchers replicated a medieval poultice and found that it had medical properties, illustrating that traditional treatments of the past weren’t all snake oil and uselessness, and creating an opening for the idea that in the wake of an apocalypse, in a world where people are struggling to fill gaps in health care, there might be options.

But I keep coming back to the theme of health care and who survives. In the early days of a proto-apocalypse, as people start to realise that something is going seriously wrong, I strongly suspect that people with chronic medical conditions would be stocking up on supplies. Some might also start positioning themselves in areas with a historically strong health care system, while still trying to balance the risks—an urban area around a hospital would provide the greatest access to resources, but for that reason it would also be a highly competitive area, one where people would be likely to flock in an attempt to control vital territory.

We would eventually begin to see a shift in the population as people with chronic conditions started to die without the ability to support themselves. Disabled people with certain impairments would likely be considered liabilities, reinforcing disablist attitudes. Those relying on ventilators and similar medical equipment would be at a profound disadvantage as energy resources dwindled. Diabetics and others needing consistent access to medication would be endangered. In an odd twist, when I express frustration about the lack of disability representation in speculative fiction, apocalyptic fiction is actually the one place where I would expect a lack of such representation—though I’d still resent the absence of acknowledgment—but one place where I’d expect it to play a central role is in proto-apocalyptic works, where the world is starting to fall apart and some people are living closer to the edge than others.

What happens in a world without health care is something we don’t see explored enough in speculative fiction about the end of the world. We see a consistent focus on a variety of issues—complex character studies, battles over resources, factionalism—but we don’t see much of the fundamentals of survival in a cruel and unexpected world where the resources that matter are suddenly radically different.

Image: Disposable blood pressure cuff, Quinn Dombrowski, Flickr