Hemodiealysis (223.h.2)

Hemodiealysis

Mark L. Fussell

Copyright © 2022, Mark L. Fussell All rights reserved.

ISBN: 978-0-9862775-4-2

DEDICATION This book is dedicated to my wife, who both took care of me during these trying times and continued to work excessively hard at a company that did not appreciate her. I love you.

It is also dedicated to my family, who all provided support even when they had other things they needed to do. Additionally, a friend provided enormous emotional support, and for a while was the most optimistic person alive on my chance of living, which was a blessing. Thank you all.

Finally, it is dedicated to the Stanford Hospital and Satellite Healthcare doctors & staff, who dealt with a very diseased and sick individual who they helped walk out of the ICU, through the exceptional M5 program (twice), back into his house, and ultimately back into the hope of living. There is no better collection of skilled individuals anywhere. Thank you for caring, applying your skills, and for my life.

A special thanks goes to my illustrator, who has adorned all my books: Baird Hoffman (https://www.bairdhoffmire.com)

PROLOGUE : IRONY In November 2020, I stopped drinking alcohol.

Completely sober. Never drank again.

The irony?

In spite of the committed sobriety, I was terminally ill due to alcohol destroying my liver. I was sober but dead.

This singular event enabled me to see a deeper world: a world with both more iniquity and more hope.

Hemodiealysis is a novel, but describes trying to transform the real world for the better.

CONTENTS Part-I The Prank Menlo Park » Susan Transplant Lists Menlo Park (2) » Susan The Recruit » Dr. A. Hemodialysis Vampires and Slaves Menlo Park (3) » Susan Roofs Recovery Menlo Park (4) » Susan Influence Road Trips Sacramento » Nancy Bills » Mark Bills » Nancy Needles » Mark Sirius Black Phones and Watches El Toro Hemodiealysis Five Hundred Lana The Ring It Takes a Village

1 3 9 11 17 19 21 25 31 33 37 41 43 45 47 51 53 57 59 61 63 65 67 69 73 77

Part-II Ignorance Santa Maria San Diego

81 83 85 89 -i-

Palm Springs Bishop Redding Contact Lists » Mark Menlo Park » Jo-Anne Sunnyvale » Dr. A. Sunnyvale » Ms. Ramirez

91 93 95 97 99 101 103

Part-III Convoy Razors The Second Convoy July 5th Communication 350 Acres Negotiations » Dr. A. The Neighborhood » Carl Defending Boardwalk » Mark Defending Boardwalk » Ron Safe Houses » Mark Bishop » John Exodus » Mark Exodus » Sandra Exodus » Bruce Exodus » Patrick Exodus (2) » Sandra Requests » Mark Exodus (3) » Sandra Requests » Dr. A. Doctors » Dr. A

105 107 113 115 119 123 127 131 133 137 141 143 145 149 151 155 157 159 161 163 165 169

Doctors (2) » Dr. A

173

Donations » Dr. A Venice » Mark

175 177 - ii -

Epilogue Hemodienamics

181 183

- iii -

PART-I

-1-

-2-

THE PRANK The sun will rise — in a few hours… but Jerry is an early morning jogger. I am waiting by the picnic tables at Mitchell Park where I can see anyone who turns onto the dirt path… for him, Jerry will be headed to Peets for coffee… a daily ritual.

I need a nap…

April, 2021 I wake up in a room I never entered — There is a surfboard on the door. Why do I have a surfboard?

Whirring machines are behind my bed. An analog clock is up on the far wall. And a pretty nice and large window is to my right. It looks out onto a view I have never seen. Where am I?

Now Jerry rounds the corner — and I start jogging on an intersecting path. In a few moments we are very close, especially given these are Covid times. But Palo Alto has always been exceptionally good about masking, and we are both conforming to that rule.

“How are you doing Jerry? This fine balmy morning…”

“It is 34 degrees… are you from Minnesota or something?”

“Everything is relative.”

“Well, I pondered what you suggested, and I don’t think I can get you into that meetup. It may be a good cause you are pitching, but people don’t want to be pitched on good causes, they want to be pitched on big wins”

-3-

“It will be a big win. We can eradicate homelessness. More people will be alive, and warm, and safe. They won’t be as rich as your people, but they will be a lot happier and probably more productive. “ “I know, I know, but that isn’t what ‘my people’ want to hear.

Or even think about. Now being the next person in space or the first on mars, that makes them drool.”

We arrive at Peets — and both order “the usual”, which we didn’t need to say out loud. We are there every day when the doors open, and always order the same thing.

“I wish you would reconsider” “I know, but I won’t. Maybe next time” “Unfortunately, I can’t wait”. The irony is lost on him.

With a subtle motion, I knock over my scalding drink and Jerry jumps. I jump too, apologizing profusely. With my dialysis hand, I grab his hand as if to steady him. But my thumb nail also cuts into his wrist.

It is a tiny scratch, but enough to open a small vein and let the blood on my palm smear into the opening. It connects with the blood he has received from our dialysis treatments, and the binding is reestablished.

I apologize again, but this is just for show.

Less than two hours later — I exit the 80 to Sacramento, the capital of California, which lies on the foothills of the Sierras.

Driving before sunrise and away from the black hole of Silicon Valley is always very fast. As if the universe is encouraging me to leave (irony again). The reverse commute commonly takes three hours, but I may wait until sunset to help shorten it. Today I don’t -4-

have ‘my appointment’ in Menlo Park, so I have a bit more flexibility in my schedule.

I walk through the metal detector without issue: I long ago gave up all my jewelry, partially to match my public persona. No ring.

No watch. No phone. I do carry a money clip as a memento, but simply place that in a bin for the belt. I am well armed, but not in a way any normal machine could detect.

April I did not enter this room — The room seems to be in a hospital, which does strike a memory.

I came into a hospital recently. I went to Amasa Hospital. I was very sick and ultimately couldn’t move without help. My family drove me to the hospital. Is this Amasa Hospital?

Now I find Nancy’s office — and wait for our appointment. My ability to predict traffic enables me to be about ten minutes early for our meeting. I wait patiently.

Some things need time, and I have all the time in the world. But only for things that ‘age well’. Many things rot over time, so speed is essential. Hence the morning coffee-powered interaction.

I focus on the digital clock behind the secretary.

April The wall clock is slowly turning — It is daylight outside, so the hand pointing at the 9 must mean it is around 9am. The clock has no second hand, and it is very far away, so the movement is hard to discern. But I am sure time is passing.

-5-

A bit later someone walks into the room and stands near my surfboard. They have a tag, but I can’t focus enough to read it. They ask me to lift my hands. Then ask me to push on their hands. Then they push back on me.

Then they leave.

Now “We need this legislation to go through” — I start with after slowly sitting down. Everything I do appears to be slower than normal, as if I am infirm from some illness.

“Yes, I understand that. I am doing the best I can. But there are a lot of opponents.”

“They are getting fewer. How many more do you need on our side? Who would have the greatest impact?”

“Well, a lot of people would come along with Grace. I believe she lives near you?”

“Yes. I have been reluctant to contact her due to a prior relationship. But that is a foolish weakness. I will follow up with her and we can meet again next week to review the progress. Are you available next Thursday? “ “I think so, but please call my assistant to confirm before you drive out here. “ “Phones hate me. I will be here, in case you are available.

Otherwise I will get some waffles for breakfast.”

“Have a safe drive back. Nice seeing you”

The ‘wall’ is still up — and I estimate it will take three hours to get back to Palo Alto or anywhere on the peninsula. So I do go get -6-

some toasty waffles. Sacramento has a lot of waffle shops, which may be due to the nearby snow. Somehow waffles help you brave the cold.

I get the usual: pork belly and eggs on a savory waffle… praise the lard! I have not had to worry about what I eat for ten months now. There are some benefits. Actually, there are a lot of benefits, but there are a lot of losses too.

April I can’t move much — I think this is because I am weak since I don’t see any straps, but I am not sure. I try to look at the whirring machines around me, but they are mostly behind my head. And there is something attached to my neck that feels strange when I turn my head. But I can turn enough to look out the window.

The day seems beautiful, but that is common in the South Bay of San Francisco. The Santa Cruz mountains prevent fog from rolling onto us, and the Pacific peacefully sends a few pleasant clouds over our heads. The 70s is a common temperature this time of year.

Wait… what time of year is this? It seems like it is near ‘the birthdays’: my wife and I have birthdays in April. So is today April something?

Hah! Maybe it is April first!

This is a very elaborate prank on me.

-7-

-8-

MENLO PARK » SUSAN May They are going to send me to Trinity — “Please train the new guy…” and then we will send you to Trinity. Dr. A didn’t say ‘Trinity’ when she spoke to me, but they send me wherever they need more dialysis. And I bet it is up in Trinity or somewhere in ‘True Northern’ California. I don’t want to go to Trinity. This gig is good: Menlo Park is pretty easy to get to, and I can live in Oakland and commute over the bridge. I like Oakland. My family likes Oakland.

Actually, I love Oakland. Maybe they will send me to Oakland?

No, they will send me back to Bishop. Or to Oroville so I can play with the dam. Or to Palm Desert so I can play with the tortoises. Or to Trinity so I can play with the trees. That will be the pitch “Trinity is so beautiful with all the trees”. A thousand trees are beautiful… nothing but trees is Hansel-and-Gretel not beautiful.

“But the committee would really appreciate it”. I am nothing but an enslaved employee… I am not even an employee given I can’t change employers. So just a slave? I definitely did not think of this when they explained the transition to me.

‘Mark’ should show up any minute now — It is almost 2:00, so he needs to learn to get here earlier. But we have plenty of time: four hours a day, three days a week, until he can do it alone. And let me go to Trinity. Maybe I should make this training take a really long time?

-9-

- 10 -

TRANSPLANT LISTS When I finish my breakfast — I head north to Paradise and Oroville.

I visit Paradise for the reminder. My friends and family did not lose anything to the Camp Fire, but a friend in Napa lost everything but her husband and two cats to the Glass Fire. The fire burned through the area so fast that it simply ‘trimmed the flora’ and the hills are nicer than before the fire. More sunlight. More rattlesnakes.

Very pleasant if you have the money and insurance to build back your home. But those less well-off became homeless.

Next I venture over to Oroville and a tavern up by the dam. The parking lot is full of high-torque pickup trucks… and a camouflaged, all-terrain, golf cart.

This is a different type of town from where I had coffee this morning, but there are similarities in religiosity, isolation, and xenophobia. The believers and beliefs have just diverged.

I sit in the back corner booth viewing the whole restaurant and making sure I am visible. “A few months” meanders through my mind.

“What would you like today?” the server asks me.

“The Usual” I say with a smile.

“Sorry, I don’t know what that is” she says looking slightly annoyed.

“I am hoping you will in time” I return with a bigger smile. “I would like an avocado and bacon hamburger. Medium rare”.

An eyebrow is raised, but they simply continue: “What would you like to drink?”

- 11 -

“A ginger ale would be great… if you have it. Otherwise maybe a Coke or Pepsi” “Coke it is” I don’t normally eat anything medium rare. But I am out of town and can take off a little bit of my mask if I am careful. Buying a round of beers would probably help to ingratiate me with the town, but that is a bit too conspicuous. It is very unlikely anyone will oversee the way my meat is cooked… although I should change it before it does become “the usual”.

April “Do you know who you are?” — “I am Mark Fussell” “What day is it?”

“I don’t know… I think it is in April” “Who is the president?”

“Me! No… just kidding. I believe Biden is president, although I may have missed something interesting while I was ‘away’ “ “Where are you?”

“I believe I am in Amasa Hospital. Apparently in an ICU” “And why are you here?”

“I think I was going to die. I was getting weaker and weaker for weeks, and finally my family drove me here. I thought I had a room in ‘M5’ but I don’t seem to be there anymore. “ “Very good. You seem to be mentally recovering well” “So I am not going to die?”

- 12 -

Now The medium rare hamburger — was great!

Any bacteria present wandered into the dark, cold, and perilous biome that is my body. A nightmare alley for both friend and foe.

Over the next two hours I chatted with several people, sometimes in a group. We discussed the water level of the dam.

Future weather. Forest fires. Covid vaccinations. Social dissent.

Obviously these are getting to meaty topics, and coming from one of the wealthiest and highest-vaccination-rate counties of the US, this could go sideways very quickly. But I admit I haven’t been vaccinated… I don’t believe masks help me or prevent me from infecting others… and I have had disagreements with the US government. All of these are true statements, but are likely interpreted differently than the details and my real beliefs would support. I also intentionally don’t mention exactly where I live. That plus my bright yellow worker’s jacket seems to help me break through a few layers of the onion that is growing here and inch a little closer to the heart of the rebellion.

With that seed planted, I head back home to the black hole that keeps me alive.

April The machines and tubes — make more sense to me now. I have a feeding and drug-injection tube. This appears to go all the way down to my stomach or intestines. Nurses play with that a few times a day to give me drugs, and the feeding tube is pumping almost continuously. I also have a trialysis catheter inserted into my neck, which enables something called dialysis along with other things.

Apparently dialysis is replacing my kidneys… which have decided not to work anymore. I also have tubes for things to ‘leave’, but very little seems to be moving through them. I want to go to the bathroom, but apparently that is not an option. Would ‘unwiring’ me be too difficult?

- 13 -

Nurses (all RNs) come day and night to fiddle with me and the machines. I rarely sleep, and just keep watching the spinning clock.

Shifts change and new nurses come in. Each new shift fiddles with me and the machines, as if this whole system is a very interesting thing to study and play with. I am apparently a great case study for something.

Sometimes the nurses attach vials to my neck catheter, which feels a lot like they are sucking my blood. I can’t see how they do it: just the resulting test tube filled with strangely colored blood. It seems darker then I remember blood being. Maybe it is just dark in the room?

Now It is about 5 o’clock — when I return to Palo Alto. During the ride back, I did two addiction-recovery meetings by Zoom. I currently need to do four or five of these a week to stay on the ‘Liver Transplant’ list. As part of getting onto this queue for a replacement liver (mine decided to stop functioning along with those negligent kidneys), I signed a contract with Amasa that required a large number of things.

First… I am not allowed on roofs. Well… that isn’t actually first, but it is true. First, I agreed to do anything and everything a doctor tells me. Don’t drink (“check… actually wasn’t drinking long before visiting Amasa ER”); don’t climb on roofs (“check”); don’t drink too many or too few liquids (“check”); don’t eat sushi, rare-ish meat, soft-boiled eggs, and grapefruits (“apparently ‘not check’ but we will get back to that”).

Next, I agreed to do addiction-recovery meetings almost every day: it started out as more than one a day and then tapered down. I also have to talk with a psychiatrist as often as they want. I must tell someone if I “feel strange”. And the contractual list goes on and on.

I signed it in exchange for ‘my life’, and so I view it as an unbreakable vow. Or at least breakable in only one way.

- 14 -

The addiction-recovery meetings are both the least necessary and the most enjoyable item of this contract. They are especially pleasant when I am driving: they help fill in the otherwise idle time. A twohour commute passes more quickly for me within a meeting or two than even with a book on tape.

April Doctors visit me sporadically — but it is hard to predict when they will visit and how many of them will be in the pack. Sometimes it is just a single grey-haired man. Sometimes it is almost a dozen people of various ages, many of which may be residents. They rarely introduce themselves and commonly don’t talk to me at all. Or maybe they do, and I just keep forgetting their names?

The doctors study me and my medical records. They don’t use their stethoscopes, which seems out of character for a doctor.

Maybe some covid quarantine rule? The machines do not interest them either: I guess they are just supposed to do their duties. It is a big duty keeping me alive.

The only doctor that does actively interact with me and I am sure is ‘mine’ is Dr. A. She is a psychiatrist. My psychiatrist. She always notably arrives in beautiful outfits vs. boring, identical, medical coats.

It is easy to recognize and remember her. Why I need a psychiatrist, I don’t know. But at least for the moment, she is mine.

Apparently most patients will have to find a different doctor when they leave the hospital, but I am pretty sure I want to keep her if I must have a psychiatrist at all. For one, she is nice enough to read my book. Given it was a memoir, that saved me a lot of time explaining certain things about my past. Ultimately that past did not matter, but a veneer of a person in physical recovery needed to be developed.

We spend a number of hours talking about liver and kidney failure, addictive personalities, suicide, side effects of post-transplant drugs, restrictions post-transplant, and the physical & mental - 15 -

impacts of having liver and kidney transplant surgery. The core questions that matter to her and the Committee of Gods are: (a) will I obey the pre-surgery & post-surgery behavioral rules; and (b) will I make sure others know if anything is amiss with me mentally or physically. If I do those things, I will get on the transplant list.

A month or so later, I am on the transplant list. And find out that list is irrelevant to me.

- 16 -

MENLO PARK (2) » SUSAN May “Hi! It’s Mark right?” — I say after he is wired in to the chair next to me. We aren’t intimately close to each other, but we can talk if we make eye contact. Dialysis restricts your body if you have a chest catheter, and locks down one of your arms if you have a fistula (or graft), but you can definitely rotate your torso and head if you are careful. My fistula is on my right arm so I have a machine to my right — that isn’t required or guaranteed, but it is preferred by everyone so it is common. The tube runs are shorter, so they are less likely to get pinched or pulled.

Mark has a chest catheter, so he can actually move more easily than I can. His machine happens to be to his left, so there is nothing between us. I turn slightly towards him with my body and head.

“Yes, and you are?”

“I am Susan. I believe Dr. A may have mentioned me.”

“Yes, you have been here for a while? A few months?”

“I have been here for more than a year. I am originally from Bishop, but went to Amasa when I started retaining a lot of water: more than 14 liters.”

“That is a lot of weight.”

“Yes, I could barely move… anyway… I went to Amasa and after the transition they wanted me to help grow the clinics in the Bay Area… so here I am. We moved the family from Bishop to Oakland, but my husband is working like a dog. The housing costs are insane, even in Oakland, and we have two girls in school.”

“Yes, the housing prices are insane. The weather and opportunities are too good. Would be nice if Google and Facebook expanded significantly somewhere else”

- 17 -

“Facebook owns all the land around this clinic. I don’t think they are moving anywhere else. Not sure if any patients are from Facebook: I have not met any yet.”

- 18 -

THE RECRUIT » DR. A. April “I believe he would be a good candidate — for the advanced program.”

“I thought he had psychotic breaks?” Dr. B., the chair of the committee, started with. Always very to the point.

“No… no psychotic breaks that we know of. He has had at least one severe manic episode, caused by extreme stress.”

“But he is a good candidate in spite of that?”

“His mania under stress appears to manifest as becoming extremely energized & focused on solving the problems that caused the stress: he considers all possible actions — even extra-legal or self-transformational — that will help provide a positive resolution in his calculation. In essence, he has an on-demand bipolar condition. He crashed a bit after the problems were solved, but was not debilitated by the crash.”

“And this does not cause permanent damage to him?”

“Not damage per se, but it can transform him. Previous to the known manic episode, he was quite solitary beyond work and family, and would appear to be a very quiet introvert to most people.

During the episode, one of his solutions was to become hyper-social, interacting with almost anyone who could provide an alternative perspective. After the problems were resolved he stopped being hyper-social, but continued to be very social without needing to be.

He is social purely by choice, and is equally comfortable being completely isolated. So he effectively improved himself for our purposes” “How is that an improvement, in your opinion?”

“The members of the advanced program need to be very independent, and tend to be isolated for long stretches. But they - 19 -

must also influence others, which requires social skills. He appears to be far more socially skilled than an introvert would normally be.

He may have been quite charming actually.”

“He is no longer charming?”

“No, now he is very charming, but it is unclear whether the transformation is the major cause of that. Something about the transformation tends to produce that skill: innate charisma you might call it.”

“We are hoping it produces a number of skills, please be on the lookout for them. Your recommendation was already approved unanimously by the whole committee: this was all just a formality.”

“Thank you”

- 20 -

HEMODIALYSIS The sun is setting — behind the Santa Cruz mountains at 5 o’clock, so I shift into twilight-mode and start visiting the local ‘houses’ and communities that I know. These are people’s homes, but not the standard white-picket-fenced wood-siding-shingled houses that is iconic (if not real) of the American home. Some people are in RVs. Some are in cars. Some are in tents. And some are in boxes, under a blanket, or completely exposed. There are shelters, but they have many rules that many people do not like. And in the time of Covid, many of the shelters are shut down. I only visit people’s homes, not the shelters.

Mostly I am trying to keep in touch with people, and see if there is anything I can do to help. The problem is both massive (hundreds of thousands of people that are ‘homeless’) and intimate (‘Linda’ needs to replace her carburetor to stay warm). I continue to hope the intimacy will spark insights into new solutions. The ‘Pico Pico House’ project was one solution that came out of intimate understanding of individual needs, and the discourse with Jerry and Nancy are meant to help with the massive problems.

I need to talk to Grace.

History Hemodialysis was invented — by Drs. Kolff, Haas, Abel, and other great minds. It removes undesired dissolved substances and excess water from the blood through special membranes. After a few hours of pumping a patient’s blood through a dialysis machine, the body has been ‘cleansed’ similarly to the way kidneys clean it continuously. With dialysis, you can live without your kidneys.

There are a few issues though.

First, the machine needs to access your blood, which it does in a couple ways. Initially, it is done through a catheter (a tube) that is hooked into your blood stream. The short-term version of that - 21 -

access method is the trialysis catheter I had when I was in the ICU of Amasa. This access method is so dangerous that you can not leave the hospital with it. A longer term version is attached to your chest, and goes pretty directly to your heart after passing over your collar bone. This access can be used outside of a hospital, but can still only be used by an RN because the risk of a deadly infection wiggling up the catheter line is so high.

The ‘upgrade’ from a catheter gets rid of any permanent attachment to your body, and is useable by technicians that do not need to be RNs. Instead your body is augmented with access points beneath your skin, and the technicians ‘cannulate’ you with two needles to access your blood only during dialysis itself. But don’t think “Insert two blood draw needles… in my arm… for a few hours… eek!” No. Think “Insert two sewing needles… in my arm… for a few hours… “ It is true, that after a few hours of dialysis with those needles… and a few more for the holes to seal… all you have left are impressive track marks running up your arm. You look like a ‘druggy’ but with different benefits.

Second, your schedule — is seriously impacted by the dialysis rhythm: in my case I do it every other day for about four hours. Plus time to get to the clinic, be wired into the machine, be unwired, make sure I am not going to pass out, and then the time to get back to my ‘normal’ life. In theory, you can work during part of this. But one of your arms is pinned by dialysis needles. The room can be noisy.

Sometimes you cramp or have other symptoms. Most people just mindlessly watch TV.

Third, Drs. Kolff, Haas, Abel — and other great minds… never got dialysis to work. The papers, conferences, public announcements, and Google searches are all a deception. Machines with membranes are unable to replace what your kidneys do. They will not keep you alive if your kidneys fail. You need a more radical treatment to stay alive.

- 22 -

Fortunately, Drs. C, G, K, and other great minds _did_ get dialysis working. It appears to work the same as I described above.

Same catheter and needles. Same schedule issues. Same result: unwanted things are removed from your body through your blood.

But this successful version of dialysis does not use a bunch of membranes. It uses a bunch of ‘me’.

I died while at Amasa. But I was brought back as something more useful than I was. And I am not the first. All the dialysis clinics throughout the world have at least one of me per shift. We process all those patients’ blood during our shift. We enable those patients to live normal lives outside that clinic. But we don’t live normal lives outside the clinic. We don’t live at all.

- 23 -

- 24 -

VAMPIRES AND SLAVES I set up a morning meeting — with Grace at Cafe Boronne.

It is a Friday, so the cafe is open. Since Covid, it has been closed on Mondays and Tuesdays, which is inconvenient since I enjoy coffee after my dialysis sessions, and Monday is the first session of the week. Dialysis takes up 15+ hours a week of my daylight hours, so the remaining time is very scheduled by me… apparently even ‘manically’ scheduled… like this is my last day on earth. Rhythms like coffee keep this innate mania a bit in check.

“How have you been doing Grace? I know Martha took over after you ‘went on’, and your kids were going to Priori, but I don’t know what you have been up to since then. Are you still living off Alpine?”

“Yes. Still there. The kids are grown, but we like the house, and it is good for entertaining.

I am the angel investor for several companies, and the gaming and VR spaces are doing really well. I also represent the 13th district, so that takes a bit of time. “ “Sounds exciting. Can I pitch a public benefit to you as state senator?”

“I agreed to meet, and you are very transparent, so clearly ‘yes’. “ “I want to end homelessness. I believe this will save and improve lives. And the newly housed will be able to contribute much more effectively to the local economy … maybe even as gamers”.

I say the last part with a smile. Grace has been in the game industry for decades. Never seemed to match her professionalism and personality to me, but people have layers.

- 25 -

April Dr. A comes by — after I get on the transplant list.

“Congratulations Mr. Fussell” “Please, ‘Mark’. And not ‘Mr. Mark’, which seems to be very popular among the RNs” “Ok. Mark. You are now on ‘the list’… and I am here to discuss it with you.

You appear to be mentally stable under stress & significant unknowns, are willing to do what the doctors tell you to do, and are a generally productive (even slightly ‘manic’) individual. These were the prime considerations that we used to put you on that list.”

“I assume that and my general health” “Yes. Kind of.

The list I am talking about is a different list. The liver transplant list is just a ‘cover’. You are now on the hemodialysis list.”

“Isn’t that just for my kidney functions until I get a transplant? I thought I was already getting dialysis?”

“You are and aren’t. This will take a bit of imagination and acceptance on your part. Please keep any open mind for a few minutes” “Ok, I will try to hold off my questions for a bit” “You were admitted to Amasa ICU on March 28th. A day later, you passed.”

“Passed what?”

“No. Passed. Passed away. You never woke up from the ammonia spike.”

- 26 -

“I seem pretty awake” “Yes, you are now awake… but not alive. On March 29th, Amasa decided you were a good candidate for the hemodialysis program. So you were moved to ‘V5’ and were brought back.”

“I am ‘back’ but not alive?”

“You are something different. Informally we call you Vampires.

But you aren’t much like the myth. The core characteristic is that you need human blood: you get the ‘nutrients’ you need to continue functioning from blood.”

“That does sound very vampiric” “Yes, but in exchange you purify the blood similarly to a kidney.

When you are hooked to a dialysis machine, you get other peoples’ blood, purify it, and return it to them.”

“O….K….”

“You do ‘net’ take some blood, but not a lot from any one person. And you can handle a higher flow rate than the patients, so in four hours, you can process the blood of a dozen people. If you take about 10-percent, you drain only about a half a liter from each person. And we can give that back as saline without the patient being harmed.”

“O…. K….”

“So, as long as you do dialysis, you can function between sessions. And by doing dialysis, you enable a dozen people to live” “O…. K…. That sounds very fair and pretty logical. Except the ‘you are dead’ part. I don’t feel dead. The machines say I am alive. The tests say I am alive. I act like I am alive.”

“Yes. The machines and tests are lying. Try not to breathe for a bit” - 27 -

“Like… hold my breath?”

“Yes, hold your breath… until you _need_ to breathe”

Now “Well, that is a small and simple task” “I realize it is not, but I just want California to follow in Berkeley’s footsteps and not prevent homeless from using public/government lands to live. We will do our best to get them off it, but on their own terms. We could use money for that, but that is a different pitch.”

“So you want me to vote for bill 2022-0401?”

“Yes, along with as many of your friends as possible” “Ok. I will work on it. And will call you if I need some details.”

“Call, and I will come ASAP. Thank you.”

April 30 minutes later — I give in and start talking.

“I don’t need to breathe? Except to talk?”

“It may mentally help you talk, but you don’t need to do it for that either. It appears you communicate through suggestion. More by visual contact than anything else. There may be some telepathy involved. Either we don’t understand it yet, or it is above my pay grade.”

“You don’t understand the ‘things’ you are using to keep people alive? That is keeping tens of thousands —” - 28 -

“hundreds of thousands” “Ok. Hundreds of thousands of people alive. So there are tens of thousands of vampires wandering around?”

“Yes” “And you don’t understand them?”

“Yes: we don’t understand them. But they appear to be pretty ‘human’. So possibly somewhat safer than AI. You have seen the Matrix?”

“Well, that went badly for humanity, but rampaging vampires doesn’t seem very good either.”

“No, but we do test you and decide whether to go forward” “Where backwards is to kill me?”

“Possibly… but living dead don’t have many rights … including the right to complain.”

“So I am a slave?”

- 29 -

- 30 -

MENLO PARK (3) » SUSAN May “You came all the way here from Bishop? — Did you like Bishop? That is on the Nevada border right?”

“Yes, Bishop is on the far side of the Sierras. It is beautiful there, and you can buy a house for $250K… which would buy you… nothing… in the Bay Area. So our move to Oakland moved us from a house to an apartment” “You couldn’t find a house to rent? A lot of people rent, both apartments and houses.”

“No houses on our joint income. Amasa pays me something, but it isn’t much above the minimum hourly wage, which doesn’t buy you much in the Bay Area. I should become a programmer for Facebook, but the schedule for dialysis is getting in the way.”

“You could change to a night dialysis, right?”

“If we were just patients, yes. But we don’t have that flexibility: the clinics puts us in whatever shift they need us, not what works for us. I thought the stipend would help, but the relationship is actually costing me money. And freedom. For both me and my family.”

“I am sorry to hear that. I hadn’t thought that through… everything is so new” “Not for long”

- 31 -

- 32 -

ROOFS After leaving Boronne — I drive to Home Depot to talk with David about a mass purchase of siding, lumber, bolts, etc. My goal is to make twenty ‘very small’ houses. I recently acquired a lightindustrial unit off Old Middlefield road, and believe we can build twenty units in about a week. Probably two weeks, but the target is one.

There is no problem with the order, and the price is fine: about half of what Virginia gave me for the units, so the other half can be used to pay for the labor involved. If we get it done in two weeks, that will be fine. We might sell some of the units to defray costs, but the bulk will be donated to people living in tents or worse.

By the time I am done — It is noon, so I head to dialysis. My clinic is in Menlo Park, almost within the Facebook campus. I was on Facebook when it first came to California, but got off it when the social value of the social network became very suspect.

Dialysis patients get hooked up to a hemodialysis machine using either their catheter or the two dialysis ‘sewing needles’ described above. I used a catheter for about six months, but progressed to direct artery access, which looks the same as a fistula. The flow rate can be higher with the needles, so I can support all the patients in my shift. For the first six months I needed to have another vampire (Susan) with me, but now I can go it alone.

My machine is different from everyone else’s, but that isn’t visible to anyone who works in the main room. There is a technician controlling flows between patients and me, so people get their own (cleansed) blood back. I feel like the RNs know something is unusual, but they keep their concerns and questions to themselves.

Josephine ‘wires’ me up, and for the next four hours I am trapped. Dialysis can be very draining for normal patients: cramps, sleepiness, etc. It is draining for me also. I commonly need to sleep - 33 -

for most of it. Given my dialysis shift starts at noon, it is somewhat ironic. I need to sleep for a while at night too, so maybe I am just half-vampire? What am I?

April “No, you are not exactly a slave — but you are also not free.

From now until you wish to die, you will need to do dialysis with a Amasa-approved clinic.”

“Can’t I just bite people on the neck or something?”

“You can try, but there isn’t any evidence that would work. And you would likely end up dying in jail” “So, as long as I do dialysis, you will help me to continue to exist?”

“Yes” “No other quid-pro-quos in this contract?”

“No, but we might like your help at times” “Yes… master. Am I going to say no to the Gods?”

“I suspect you might, at least sometimes. That is really up to you… and how happy you want your gods to be “ “Ecstatic?”

I return to M5 from the ICU — except now I am part of the clandestine V5 clinic (an ‘M’ contains a ‘V’ hiding in plain sight). My diet changes: I can now eat more kinds of foods. This is all just practice for my cover story; I don’t actually digest any of it.

- 34 -

But to be compliant, I should avoid foods rich in phosphate, never eat foods that could contain bacteria, keep my sodium intake low, and so on. Basically standard practices for a liver and kidney transplant patient. A living person’s biome needs to be balanced, and without a liver and kidney monitoring and adjusting to what you are consuming… tests, diet changes, and medications take their place.

It is critical that I understand all of this to keep my cover, especially because one of the addiction-recovery meetings I go to focuses on liver and kidney issues. For me to attend, I need to know a bunch of tests, activities, and experiences that an end-stage patient would know. This is beyond just dialysis, and includes regular testing of all kinds of things. Some of these tests collectively produce a MELD (model for end-stage liver disease) score. This determines your priority for a transplant, so my score has to match needing dialysis, but not be so high that a transplant (or death) would be imminent. I pick 21 as my normal MELD score, and my test results are set up to match that. In California, a 21 (out of 40) means it will take years before I am offered a transplant.

The layers of lies are to keep vampires relatively secret. My normal doctor (Dr. J.), is outside Amasa, so she does not know anything is unusual… except for the story of catastrophic liver and kidney failure.

May I am not allowed on roofs — because — in spite of being a ‘vampire’ — I am not particularly coordinated, strong, fast, or anything special. When I am discharged from V5 and Amasa, I am in worse shape than I was before going into the ER in March, let alone the years before when I was fairly athletic. I get up and move very slowly, and I can’t get up at all without help if I sit on a couch or the floor… or fall. I can make sudden movements sideways, when I had no intention of doing so. I am not a ninja vampire. This is common for people who spend a month in the hospital: your body atrophies every day you spend in that comfortable bed. So my physical condition is consistent with my hospital stay. If I did fall - 35 -

off the roof, a lot of inconvenient questions would come to those who saw it… or saw me after it.

But I am recovering very quickly. My physical therapy sessions end after only three of them. I shuffle along faster in my walkers: I have both two-wheeled (for inside) and four-wheeled (to go the distance and bring a chair to boot) walkers that I need less and less every day. Hemodialysis is very draining initially, but within a month I can drive myself to the sessions. My family is freed from watching and helping me 24x7, and they can get on with their lives as I get on with mine.

- 36 -

RECOVERY May I have a lot of free time — outside of the dialysis sessions.

Amasa is paying me a small stipend to be part of their ‘hemodialysis program’, and it is sufficient when combined with my wife’s income for our monthly expenses, even in Silicon Valley where the rents are exorbitant (see accounts like ‘The Slums of Palo Alto’ for details on that). I am allowed to work, teach, play, or do anything I want — as long as it does not blow my cover.

I enjoyed the work I did before becoming sick, but since recovery it is very hard for me to focus on it. I can’t seem to sit still without dozing off. Watching TV makes me fall asleep, and then I wake up at midnight ready for a new day. I guess that would be within character, but I prefer to take advantage of daylight as much as possible, so my hours become quite regular: I go to ‘second-bed’ at about 10 p.m. and wake at 4 a.m.. That combined with the draining rest from the four hours of dialysis seems to be enough for my body and mind.

So I begin down very new paths for me: over time I learn about building houses, politics, professional driving, farming, and more.

These are part of my normal life, and are known to all my friends and acquaintances. I also have a large collection of ‘hobbies’ that I don’t speak of normally. My hobbies help make The Gods ecstatic when they want a ‘quid’.

As the weeks and months — go by, I more than recover. My sessions with Dr. A. occur every other week in the guise of a blood draw test. They are short, but can be insightful.

“How are you doing this week Mark?”

“Good. I still carry a cane in case I need it, but I put all the walkers into storage. I walked about a mile around Lake Elizabeth with my sister. It was slow, but I only took a few breaks.”

- 37 -

“My sister went back to New York — but before she left we took a hike up St. Joseph’s in Los Gatos. I also walked around the Botanical Garden in San Francisco with my family.”

“I started playing tennis again — but it doesn’t seem to take any physical effort at all. I was pretty good at tennis before, but now I am not getting winded at all. I could play all day” “That is excellent Mark. Your recovery has been almost miraculous. Most vampires have a long recovery timeline and many never become particularly strong. Immortal, yes, but not particularly notable otherwise.”

“Any new research on whether I can just bite people in the neck and forgo the whole dialysis thing?”

“Above our pay grades” she says with a smile. “See you in two weeks”

I am now well beyond recovery — and can do things I could not before. It is possible this is due to being a vampire, but it may also just be because I can seriously focus and can repeatedly fail with limited repercussions. I did chop up my hand pretty badly with a d*** handheld router, but V5 repaired my flesh and my healing abilities transformed the nasty injury into train-tracks of scars up my left hand. Apparently my body thinks healing is ‘just enough’ to function vs. making me pretty. I need to get some of that ‘glitter’ lucky vampires have.

The first interesting ability I discovered was when studying my wounds after dialysis. The dialysis needles are removed at the end of the session, and you now have two holes into your blood stream.

Unfortunately, that blood stream finds those holes a viable direction to travel (whether patient or vampire it is the same at the end of a session). So the dialysis technicians ‘plug the holes’ with a lot of - 38 -

gauze and tape. After a few hours, the holes seal and you can take the pressure-bandage off.

Unfortunately, it is possible to miss the hole with the gauze. If this happens, blood starts spurting everywhere. This is a major reason dialysis patients have to wait after their session: to make sure they don’t spray their windshields from the inside when they drive home.

The first time this happened to me, I looked at spraying blood in a bit of horror. I wear a short-sleeved shirt for dialysis, so the blood was just shooting down my arm (the needles are aimed ‘upward’ when inserted) and not actually inconveniencing me. But getting bathed in blood is a bit disconcerting at first. The nurses simply cleaned me up, found the right spot, and tried again.

The second time the spraying happen, I intensely focused on the blood. This was a bit risky because I have previously passed-out when concentrating intensely on wounds, but this time the result was very different. I could ‘see’ the blood a bit more vividly than my eyes were seeing it. Or at least, more than my eyes previously would see it. It was as if the blood was glowing. This was interesting, and a bit psychedelic.

Beyond seeing blood — by focusing on it intensely, I could move it. Not very far, and not very much (no elevator scene from the Shining) so it wasn’t clear what use this would be. But I still found it fascinating. It was as if I was playing with rain-drops, except they were a deep red.

“Good morning Dr. A.” “Good morning Mark” “I can see and move blood”

- 39 -

“Well… yes… it is a visible, non-toxic, liquid. But I am guessing you don’t mean that?”

“I can see blood even in the dark. I don’t need light to see it. I can even see it beneath skin. Apparently lead, wood, and concrete get in the way, but skin does not.”

“Well, that is unusual, but not unheard of” “Other vampires can see blood?”

“Yes. There are some abilities that some vampires have. They aren’t very common, but they are also not unique.”

“And seeing and moving blood is one of them?”

“Moving blood? Without touching it?”

“Yes. I can make my blood move. Not very much of it, but I seem to be able to control more and more as I practice. I have not tried moving other people’s blood” “Interesting…”

- 40 -

MENLO PARK (4) » SUSAN May “So patients can choose whatever shift they want — and we need to balance for that?”

“Yes, the customer is always right. We are just poorly paid employees” “This is keeping us alive… how can that be poorly paid?”

“Slaves were kept alive too. And it isn’t like this is just (or even) for our benefit: we are each keeping a dozen other people alive. How much would those people pay if we did it directly for them? Say get rid of the clinics… provide it directly.”

“I don’t know how much they would pay… I guess it would be some combination of what it is worth to them, what they could afford, and what alternatives they would have.”

“It would be worth their lives, so that factor is clear. But currently there aren’t alternatives… the clinics own the process keeping patients alive… and the clinics own us. It is like Amazon only worse: they have a complete monopoly and there is no possibility of competition” “There are multiple chains. They should be competing.”

“Except we can’t change clinics. Patients can, but we can’t.”

“The clinics are conspiring to keep us restricted?”

“I assume so. We can’t change employers… we don’t control where we work… we don’t control when we work… we can’t go out on our own… and we can’t negotiate a better salary, benefits, or situation.”

“Has anyone tried?”

- 41 -

“I think so, but the results were similar to trying to form unions within Amazon or similar companies. It did not go well. I believe the leaders of those activities are not around anymore.”

“They aren’t still trying to unionize?”

“No… they aren’t ‘trying’ to do anything anymore. People don’t appreciate undead who complain. We do not appear to have that right.”

- 42 -

INFLUENCE December I started driving for Hoyst.

There were several impetuses: I like driving quite a bit and am a decent navigator in the Bay Area; my vehicle is very comfortable for both the driver and to infirm passengers — I know the later because my sister, wife, and daughters would drive me around in it when I was first discharged; and finally, there were too few ‘paratransit’ drivers for the people that did dialysis with me. I was never an official paratransit driver and vehicle (no wheel chair lift, for example), but I understood the needs of infirm and post-dialysis patients. I also had nothing much to do early in the day, so I drove both early and afternoon (post-dialysis) shifts.

During one of the afternoon shifts, I encountered another ability.

While I drove Timi home, I suggested she try a Mexican restaurant (“La Fonda de Los Carnalitos”) in Redwood City. It was an innocuous suggestion, but two days later I found out she tried the restaurant. That same night. In spite of her saying she was having fried chicken for dinner during that drive.

Nothing incredible, but it seemed very unlikely to be just a coincidence. I tested this out with more (good) restaurant suggestions, and every time ‘my patient’ and rider would eat there that night.

Very strange. Didn’t work in the morning though, so the impact was limited.

“I can influence people” — I say to Dr A., who is dressed fashionably as always.

“Yes, Mark, you can have a major impact to the world, especially given how long you will be with us. Is that what you are referring to?”

- 43 -

“No. I can my cause my patients to do things… immediately… and even sometimes silly or out of character actions. I suggested ice skating at Winter Lodge for exercise, and met the patient on the ice at the very next public session. I recommended visiting the Schulz Museum in Santa Rosa, and found out the patient had made the several hour trip the next day. I suggested touring Yosemite and they visited over the weekend (this was after Friday’s session).

I am now being very careful what I suggest, and adding lots of caveats (like ‘in the summer’) to prevent messing with their lives.”

“Interesting…”

- 44 -

ROAD TRIPS December “Amasa would like you — to go to a different dialysis clinic” Dr A. says at the next session.

“OK. Why?” “We can discuss that later. Can you go to the San Carlos clinic for a while?”

“Sure. Since I stopped using the catheter, I am not as nervous with new technicians. Before it was pretty scary when a different RN would hook up and clean the catheter. That direct connection to my heart is a little too powerful. Better than the neck catheter though” “You realize you are dead right? What could they have done to your vestigial heart?”

“I didn’t say it was rational”

A number of members — of my addiction-recovery program are now deceased. These are people who had kidney and liver failure, and were either patiently waiting for a transplant or already had a transplant. A liver transplant is no guarantee of life. A lot of things can go wrong.

The body can reject the liver, and then you need a second or third one to get one (if any) that are accepted. Kind of like cats: sometimes they just don’t like you and you need to get some more until one is a match.

The body can be too traumatized by the transplant and die from the operation. This is a real problem because you are ranked higher in priority the sicker you are. So generally the most sick get transplants first. It is like playing chicken though, because if you get too sick they won’t do the transplant either.

- 45 -

The body can simply get terribly ill due to the drugs you need to take post-transplant. To prevent liver rejection, a patient takes immunosuppressants. That is: the drugs _turn off_ your immune system. That is nice and friendly for the newly invited liver, but is also an open invitation to many uninvited bacteria and viruses. Over time the immunosuppressants are reduced, so the risks get reduced, but they do not go away.

Death is something I already experience much more of since the hospital, and it will only get worse over the upcoming decades. I wonder if Amasa will ‘cancel’ me if I look too young?

“We would like you to go to Sacramento — for dialysis” “That is a bit of a drive doctor. I can do it, but we are talking several hours of overhead” “It should only be for a few weeks. And it would make the gods ecstatic “ I meet Nancy a few days later, and start helping her get home after the dialysis sessions.

- 46 -

SACRAMENTO » NANCY January I hate dialysis. Over the two hours of a session I go from onehundred-percent down to no energy at all. I am lucky even, others like Mark do almost twice as long. I don’t know how he seems so unaffected… it is almost like he gets stronger from the treatment.

I had a liver transplant last summer, but my kidneys never came back. They said they should: the transplant went well, and I recovered from surgery in a couple months. But the old kidneys don’t seem to like the new liver… why can’t they just get along? Why didn’t the doctors add a kidney at the same time they swapped in the new liver? Now I have to wait again. And go through surgery again.

And recover again.

I can only hope other senators don’t notice my second absence.

I come to dialysis as late as possible — in my afternoon session, so I can stay in the office or on the senate floor as long as possible. I know I have hurried a lot of work and bills through as 3pm approached, but I hope it is just a good kick in the pants to keep things moving. People just think I am very impatient, which is true… but now more than ever.

Because I come so late, I finish a bit after Mark. His session is longer, but he seems to arrive a bit after noon. His needles are pulled and he is dressed before my catheter is recapped. The first week he showed up, he was just another masked man. We never talked during dialysis. We are even in different sections because I need an RN for my catheter. I don’t think the needles are worth it, but at least he doesn’t have to protect his chest all the time. He can even take showers… sigh, that would be nice.

It was a strange coincidence — that turned a masked man into the living person named Mark. I take Hoyst to and from dialysis. I - 47 -

can’t drive after a session: both medically proscribed and I know realistically I would be a danger on the road. The catheter isn’t likely to open during the commute like the needle access holes could, but I have passed out on the trip home. I can’t risk plowing my convertible into whatever is on the road when I head for an abrupt exit or crash.

Last Monday, I launched Hoyst and inside the app a driver immediately offered to take me home. ETA: zero minutes. How can it be zero minutes? A Hoyst is waiting for passengers right next to a Voyager clinic?

No, a Hoyst driver was waiting for passengers in the Voyager parking lot

A grey SUV pulls up in front of the doors — but doesn’t have front plates, so I can’t match that to the app information. But the car is correct, and the eyes in the profile picture seem familiar. And the balding head.

After the driver door opens, Mark comes around the front of the vehicle and quietly says “your chariot awaits” as he slightly bows and opens the rear passenger door with his right hand. He offers his right forearm for me to use to get inside. He is favoring his left arm, which is common for fistula patients. I hope he can drive me home safely.

The car is spacious, but not the size of the Escalade that I am sometimes transported in. The door thumps shut after I am comfortably in the seat. Hoysts have personality. Different drivers have personality in their vehicles, personality in what they think you want from their vehicle, and personality in their behavior. Mark’s SUV was very personalized. It had power cords designed for passengers to charge everything from an iPhone to a computer. It had a lap desk you could use for the computer (or maybe snacks) you might have. And it had dragons: stuffed black and white variations of the dragon from the movie ‘How To Train your - 48 -

Dragon’. Why Mark needs or wants dragons in his car may take a while to tease out of him.

When Mark asks me to dinner — I feel almost compelled to agree. I am not doing anything else, and I am a terrible cook. I mostly eat ready-to-eat dinners from Foodbox.

So we tend to have an early supper together right after dialysis, and he has a second meal when his wife gets home at 8:00 or so.

Some people who have a failed kidney or liver burn a lot of calories just to stay alive, so Mark must be part of that group. When he weighs in his ‘wet weight’ — The weight before dialysis. After dialysis is the ‘dry weight’. Nurses and patients call out the weight to each other and everyone can hear — sounds pretty low. From all appearances he is definitely not retaining fluids, so he must have some amount of kidney function. I wonder why his dialysis session is so long if that is the case?

- 49 -

- 50 -

BILLS » MARK January “There is a bill ‘2022-114’ — that would be very bad for Amasa” Dr. A says in her office. We always meet in person. It is much less tiring for me than the concentration I need during a zoom call.

Telephones are even worse: I should be able to vocalize, but I have lost the coordination between my lungs and vocal cords. The slight telepathy (or whatever it is) with visual contact is a crutch that helps me a lot.

“OK. That is unfortunate. And… ?”

“We would like you to help kill it. Nancy is a proponent and major influencer in the state senate. We would like you to convince her to reconsider her support of the bill. It would make the gods ecstatic”

- 51 -

- 52 -

BILLS » NANCY January Eventually our driving and dinner conversations — turn to different bills that are appearing on the senate floor. He is very interested in dialysis-related bills, for obvious reasons. There are several of them, one of which (2022-114) reduces the numbers of nurses and technicians that are needed for a given number of patients.

“So this bill will increase the number of people who can get dialysis by reducing the needed nurses?” Mark asks me.

“Yes, the current ratio is twelve patients to one nurse. The language of the bill would double that, so twice as many patients would require only one nurse.”

“So it would reduce costs and increase profits?”

“Yes, but it would also increase risks to patients. If an event occurred with two of the patients at the same time, there wouldn’t be a second nurse available. The probability of co-occurrence is almost double: if it is a 10% chance with twelve patients, it is a 20% chance with twenty four.”

“That is a lot of increased risk” “At the same time, the bill would make dialysis available to another ten thousand or so poorly insured patients, because of the cost reduction. So they would go from no dialysis to the prescribed amount, we are hoping.”

“And that is worth the risk?”

“I don’t know.”

We are at an Indian restaurant tonight — ordering a dozen different breads for just the two of us. Mark really loves Indian - 53 -

bread and food. He says it is nostalgic of a previous life. I know he lived in India for a while, so maybe he is referencing that? He barely eats anything when the food comes, but his eyes seem like they might be glistening when he looks at it.

Normally he stares straight at me, like he is trying to see who I am through the portals of my eyes.

“What are your thoughts about ‘2022-114’ today?” He shifts the conversation after asking about my dialysis session.

“I am likely to vote against it. I haven’t said this publicly but I do not think the risk is worth it. I would rather focus on getting more money for those that need dialysis than increase the risks to those that get it.”

“So… you are on the same side as Amasa and Voyager?”

“Apparently, yes. I can’t believe it is for the same reasons, but maybe they are as concerned as I am about patients. It seems like something else is going on though: I can’t understand them wanting to give up profits. Especially Beloved is a for-profit company making billions of dollars… I suspect they and their shareholders would like to make billions more.”

“When does the vote come up?”

“Thursday. The bill will fail: it does not have the votes. — How is the bhatura?”

“Evocative. Some Appam would be even more so, but outside Kerala it is hard to find good Appam.”

“We have to enjoy what we have in life” I say with a smile “I do my best” Mark responds with an expression I can’t read.

- 54 -

Mark was at dialysis today — the day after ‘2022-114’ went down in flames. He must have had to get home to Palo Alto because he is not in the parking lot when I get out, and he apparently doesn’t have his Hoyst app running. Instead of just offering me a ride, Mark needed to use Hoyst to formally leave dialysis (and the clinic’s responsibility) and return to work as a driver. Otherwise the clinic could get into trouble for letting a patient drive another patient home. By turning his Hoyst app off, Mark (accidentally I am sure) ghosted me. I don’t have his email… maybe I should Google him to find it?

- 55 -

- 56 -

NEEDLES » MARK January The committee of gods don’t say anything — but on Friday I am scheduled back at my normal Menlo Park clinic. I hope Nancy doesn’t think I ghosted her. I can’t call her and never got her email address, so I guess I will have to visit her in Sacramento soon. I am thinking this is the beginning of a beautiful friendship, even if there were initially intended (but unperformed) ulterior motives.

History Inserting dialysis needles into your arm — is painful for most patients. The needles commonly used for hemodialysis are ‘15gauge’, which means 15 of them will fit into an inch diameter tube, or each is about one-fifteenth of an inch in their outer diameter. For metric people that is a bit less than 2mm. I have heard of patients that use 14-gauge needles, which are more than 2mm. This is big enough that it is quite difficult not to flinch, and I regularly fail in spite of the lack of actual injury. I commonly chat or play music to distract myself.

A matured fistula used for hemodialysis is normally about 6mm, so a bit larger than a major vein (the ‘great saphenous vein’ returning blood to your heart from each leg is 2-4mm) and a bit smaller than a major artery (the ‘femoral artery’ providing blood to your arm is about 10mm in a 50-year-old). Returning to the needles, that means a 14-15 gauge needle is taking up about a third of the ‘tube’ of the fistula. Presumably the other two-thirds are to make sure your arm does not fall off due to gangrene.

In my case, I have a bit-better-than-normal sized fistula (8mm) and given gangrene is not an issue, I could use quite a bit bigger of a needle. But this would be a bit too conspicuous since needles are physical objects and would need to be in inventory (“do you have any 8mm / 2-gauge needles available?”), or would have to be carried.

And in either case, someone needs to put them into your arm. Not a good way to keep a vampire under cover.

- 57 -

Instead, I use normal needles and the machine lies about its flow rate. The 15-gauge needles in my arm are used by the dialysis machine to pump huge amounts of blood through my body at a much higher pressure (flow rate) than normal. This is equivalent to having larger needles and enables me to support dialysis for a dozen people during the four hour session.

Removing dialysis needles — from your arm is less painful but more problematic. The problems arise from having two 2mm holes in your body, that have been there for as much as four hours. Your body does have a desire/ability to close these holes. But at the same time, your blood stream has a desire to take advantage of them: they are like two holes in a dike and are the ‘easy way out’ for the blood.

For a fistula, the dialysis needles are taken out in reverse order: the downstream needle (closer to returning to your heart) is taken out first and covered with _a lot_ of gauze and then pressurebandaged to your arm (or leg) to plug the hole. This combined with either hand-pressure or a mechanical (plastic) pressure system will enable the body to close the hole without the blood streaming through it getting in the way. The second needle is done the same way, but (for me at least, post-dialysis when my blood has been replenished), this one has a lot more pressure on it and is more likely not to close properly if anything is amiss.

An unclosed 2mm hole sprays blood into and then through the gauze very quickly. Then down your arm. Onto the chair, floor, neighboring patient, helpful RNs, and so on. The solution is simple though: be like the little Dutch boy and stick your finger into the dike… until a technically savvy nurse with a lot more gauze can come and help. As mentioned above, this has happened to me multiple times, and by just using the ‘Dutch method’, I have managed to live through all of them.

- 58 -

SIRIUS BLACK The amber light — from the streetlight is casting a glow that makes the hedges look black. ‘Black on black’ would be hard to see, but that is not the spectrum that I use for this kind of task.

Earlier a family of raccoons wandered by in search of water, fish, trash cans, or whatever their nightly need was. A skunk ventured right by me, but I didn’t move and Pepe Le Pew did not notice me.

I have been sitting here for a couple hours, hoping to see the runaway in what may be their periodic trail. I am sure they are nearby: I just have to catch them mid-stride. Maybe five feet would be close enough, so I continue to ‘recline’ into my shrubbery. I need a nap

A hint of red — turns the corner onto Bryant by the bridge. Part of the difficulty around the task is that this path is for bikes only, so you can’t just cruise back and forth in a car. In a car you have to skirt around the poles (bastions) by shifting a couple blocks and then coming back. But in that time, the target could have wandered away.

And being actively on-foot is likely to scare the quarry as well. So I just sit and watch as the faint red gets closer and closer.

Three hours later — I drop Sirius Black (a cat… but pitch black, so they at least got one thing right) at the front door of the Waverly house. Sirius spent the night with me in a cage in ‘El Toro’ (my car, which snorts like a bull when you turn it off) given I thought it a bit rude to ring the doorbell at 3 a.m.. Rose greets Sirius with open arms, gives me a kiss on the cheek, and I head off to my morning coffee routine.

I have done about one lost pet a fortnight since my discharge, always based on postings on Nextdoor that are not resolved within a few days. Most pets are just opportunists taking a little trip into the world, but some get a bit lost and another ‘night prowler’ can - 59 -

relatively easily return them home. The pet return program is both a public service and good practice for other stealth operations.

- 60 -

PHONES AND WATCHES My problem with phones — became apparent about a month after discharge. The hospitalization and preceding sickness scared my mother and sister significantly. So I committed to check in regularly… by video or phone.

At one point we were having bandwidth issues during a video call, so I turned my video off. The conversation abruptly ended to be replaced by several repeated “Are you still there?”. I turned video back on, and continued my (choppy) description of my week.

There were hints prior to this interaction of an issue: for example when my mother would miss things I said when I was looking away from the screen, or when I would try to ‘check-in’ while in a voiceonly meeting from my car and they would ignore my comments. But these were sporadic enough to be explicable other ways (like simply me not speaking loudly enough). The video-toggle interaction was a blatant confirmation that audio-alone would no longer work for me.

From that confirmation point onward, I stopped carrying a phone (even a smart phone) so I would avoid being in a voice-only situation or seem like I was ignoring calls from important people.

Instead, I ignored calls from everybody, but made up for it by ‘just appearing’ as soon as possible. This behavior also improved my social interactions: I was always intensely focused on the current situation and had no phone (or watch) to distract me.

I had a special monitor on my wrist — to support my liver disease cover. Wearing a body-state monitor and alarm after discharge is very common among Amasa patients. The monitor uses multiple LEDs and photodiodes (light sensors) to look at your blood flowing underneath it. These diodes can see your blood oxygen and your pulse by lighting variations. Given my blood barely moves except when in dialysis, an off-the-shelf monitor would not give ‘good’ numbers. But V5 provided a special one for cover. It is - 61 -

more like a screen saver in that it just generates results based on an algorithm based on an inputted ‘healthiness’ level. Reminds me of ‘Flying Toasters’, except for a less-fun pulse graph. Still definitely interesting to watch: I even sent screen shots to my family. None of which were real.

In spite of all the effort — into the technological wrist monitor hoax… after getting the fistula I couldn’t wear it anymore. If you get a fistula, you can no longer wear any restrictive jewelry on that arm, including rings and watches. It may be that the fistula diverts a redundant blood supply, so if you pinch the remaining one you are effectively suffocating the cells in your hand. This causes minor problems like gangrene.

I could wear the monitor on my right wrist, but that is unnatural for me. Further, I use my right hand to do things like drill steel, and the magnetic monitor band very much enjoyed surrounding my wrist with sharp dust shards. Although amusing, this was a bit socially awkward to explain.

So the monitor retired to live 24x7 on its charger.

- 62 -

EL TORO I drive very quickly — when the roads are clear & empty, and fairly slowly when they aren’t. On local roads I commonly drive exactly the speed limit. This appears to annoy people a little: they may desire to run over neighborhood kids at 40 mph. But given ‘El Toro’ is one of the biggest non-truck vehicles in existence, they can gripe at it all they want as it enforces local traffic laws.

On freeways, in the middle of the night, the situation is different.

It is possible to save hours each week based on how fast you chose to drive when hundreds of miles are involved in each trip. Because I can’t use a phone or fly on planes, I commonly need to drive to destination as far as 900 miles away (Seattle, San Diego, Salt Lake City, etc.) although most trips are a third of that. I am also very timeboxed due to the dialysis appointments, which are only 40 hours apart. Saving 10 hours on 1200 miles of travel is critical to being functional let alone effective.

This is not a new vampiric trait though. I crossed from Philadelphia to Los Angeles in 30-some hours when I was 18. That is about 3000 miles depending on the route you take. Back then I thought my time was very valuable, but now I know it is.

‘El toro’ is my bat-mobile — I guess it should be named ‘el murciélago’, but I acquired it before the transformation. The name is from the grunting noise it makes when the air suspension releases.

It is a fantastic vehicle: I can transport 6 people or 10-foot 2x4s completely inside. And 12-foot pipes in jousting mode out the shotgun window. And I commonly carry a pretty large (almost 3 x 4 x 3 feet) dog/animal crate, to aid in pet retrieval.

The cage is for my dog “Rorschach”. While in the hospital, my wife offered me the incentive of getting a dog when I got better. The idea was that it would motivate me to walk Rorschach, which would help my physical recovery. And mentally, I would have to take care - 63 -

of Rorschach despite how badly I felt. The show “After Life” has that second type of dynamic: a dog’s existence keeps the main character alive.

So I decided to get a Belgian shepherd from a particular breeder, named it Rorschach, figured out a vet and trainer, and acquired a cage for its initial home. And then I died, so only the cage remains of that idea.

- 64 -

HEMODIEALYSIS Now The episode with Nancy marks the end and beginning — of several things. Not of using my abilities at all, or even having certain disagreeable goals. But I wanted to believe in my disagreeable goal and use my abilities within some kind of moral framework. I also needed to work on my relationship with Amasa.

Nancy was a nice person, and just doing her job (representing her constituents) as best as she could. Amasa wanting me to change her mind with a particularly talent of mine did not sit well for me. Yes, she did what Amasa wanted after ‘my influence’, but all I did was give her an open ear to talk into. I may not even have done that.

Maybe, I just picked a bunch of good restaurants to eat at and convinced her they would be better than eating Foodbox every night.

Amasa clearly had its own motives separate from both Nancy’s and mine. They wanted to limit their immediate (and even longterm) dependence on vampires like me, because we were already at a premium. Bill ‘2022-114’ would also have caused a lot of questions about why access to dialysis and pricing did not change if nurses were the bottleneck. Amasa did not want those kinds of questions circulating around.

I decided having Amasa know what I could do (more than they knew already) or what I wanted to do was unwise. The next time, they might ask me to do something that the universe won’t give me for free. My relationship with Dr. A. would have to change and be more distant. I liked her, but while she worked for Amasa, I couldn’t trust her. Maybe I should make a company where she can work for me?

Regarding my abilities, I decided I should try to convince people without actually brain-washing them. If I couldn’t do that, I should accept being in the wrong… at least as far as they are concerned. All I really need is unusually-good access, which I feel is a fair use of my - 65 -

influence capabilities. I am not sure I will live up to this honor code, but I will try.

I also decided I needed to get to know more vampires.

As Dr. A and I discussed, — there are tens of thousands of vampires / slaves. But I know less than a dozen. How is that possible? My guess is that the hospitals and clinics do not want us to know each other. It could be we are too valuable and they don’t want us negotiating a better contract or getting poached. As it is now, I make Amasa happy or I don’t exist. I have no idea how to contact someone at the Mayo Clinic or Cedar Sinai to get into their ‘V5’ equivalent program. The hospitals may even have formal relationships barring poaching. Google, Apple, and others conspired with each other to prevent competitive wages… until they were caught and paid several hundred million to avoid going to trial.

We vampires are like employees who have life-long non-compete clauses. Or possibly more descriptively, well-treated slaves.

The V-Wan project — started as a virtual meetup: just a Meetup listing containing Zoom-based get togethers. The meetup was titled Hemodiealysis, where the misspelling was intentional.

But otherwise, the details sounded normal. It was for patients in hemodialysis to discuss their physical and emotional problems and needs. [[todo]]

- 66 -

FIVE HUNDRED The thought came to me — during one of my sessions. I watched the pump of the dialysis machine spinning as it pushed my blood through the tubes, into the membrane, and then back to my body. Spin spin. Pump pump. Flow flow. The machine would do this for four hours and an amount of blood equivalent to two-times the amount of water in the patient’s body would be processed. The blood picks up new ‘dirty’ water from the body each time it cycles through. At least that is the theory around hemodialysis.

But that is not what is really happening. My blood (cleansed of undesirables) is put through a switchable manifold into the proper line to go to one of the twelve different patients I am supporting.

Essentially, this is just a fancy way to do a two-way blood transfusion between me and that patient. Why do we need the middle men and machines?

The next piece of the puzzle — was to understand that pump: how do you buy or make a ‘roller pump’ (formally a ‘peristaltic pump’) since that pump seems to be necessary for the transfusion?

A quick google search and some conversations with a college friend made it clear this was not an issue: I could easily get a ‘patient pump’ capable of the 500mL/minute maximum flow rate. To support a vampires flow rate would require a pump capable of 6L/minute, but that is only about twice as expensive. And the concept I was working on does not require that rate to begin with: it could easily be a oneto-one speed of transfer. The patient gives me their blood and I send it directly back — after wandering through the nooks and crannies of my cardiovascular system — with the blood moving at that 500mL/minute flow rate.

In less than four hours, a single patient and I would have exchanged blood. The patient would get kidney-clean blood to enable them to live and I would get… what? Payment? It would need to be at least a half-liter (a pint) of their blood for me to live also.

- 67 -

Who would pay — for dialysis with their blood instead of with cash? The answer seemed quite obvious: anyone that is not wellinsured or incredibly wealthy. Each dialysis treatment-session costs about $500. Over a year (150 sessions) that is $75K. The median salary in the US is less than that, so the cost of dialysis is more than the patient “is worth”. And this gap will likely be for the rest of their life, or until they come up to the front of the transplant list and can pay $1M for the privilege of not spending $75K in perpetuity.

So at least half of the dialysis patients at my clinic can’t afford to be doing dialysis except by the favors of the government, employment, insurance, or other unreliable sources. On any given day they could walk into the clinic and be asked “Pay your tab or leave”.

My basic concept — is offering to pay dialysis patients $500 for a half-liter of blood. Or even more simply: I am offering them their lives for a half-liter of their blood. The medical system is offering the same reward (brokering me) for $500 per session and a half-liter of their blood. I do get a cut of that $500 in my stipend, but definitely not a significant portion of the million dollars that the twelve patients gave the system.

The patient could sell their plasma (where legal) for maybe $50 per session, but they would still be down $450 to get their treatment.

And I am not sure whether dialysis patients are allowed to donate plasma.

Too complicated — Maybe I should just buy the blood instead and store it? That would require spending something like $2K a week. That and the equipment would be a serious expense. And it would only help me: it would keep me ‘alive’ without giving me any reason to be. I can only truly live by enabling others to live.

- 68 -

LANA The US Army — accidentally provided a major part of the ‘cave dialysis’ solution. Blood transfusion kits are not available at the local CVS, so even after getting the tubes, needles, pump, and bandages that seem to be required to make this work, you need someone that knows how a non-hospital transfusion setup would function. And would trust it enough to try it out. On themselves.

That person was Lana: a combat medic for the US Army discharged about a decade ago. And now homeless. Our country has a serious problem with taking care of people we put in harm’s way after we are ‘done’ with their service.

Lana would sporadically visit my clinic instead of the VA (or nothing at all I assume), and I started driving her home shortly after she showed up. She happened to arrive very late, so I was always done for the day at about the same time as she was. During the drives I started bringing up her in-field medical activities.

Recounting this was traumatic for her, but I believe it was also cathartic, and she did it because she wanted to and not because I influenced her.

Over the next couple weeks, I learned she had done many field blood transfusions and although not thrilled by them, was certainly comfortable with them. Venipuncture (putting a needle into a vein) and cannulation (creating a ‘canal’ for the blood to flow through) are simply skills with a high-degree of risk associated with them. Lana was good at them from a war-time of experience.

In theory I should have been good also, but that was both not true and irrelevant. Not true because I never had to do it myself and had not picked up the skill. And irrelevant because Lana had to trust the process, and she was always going to trust herself as a skilled medic than almost anyone else.

- 69 -

We use ‘El Toro’ — as the first medical bay for our first transfusion attempt. It may seem strange to do a transfusion in a car, but this was a very large and comfortable vehicle. It also has extensive power supplies due to several Goal Zero lithium batteries and inverters within its trunk. Further, I made custom sanitary flooring, seat, and window covers. Finally, we parked the vehicle in the Amasa Hospital parking garage in case anything went terribly wrong. Calling 911 might provide a gurney to wheeled directly to our vehicle. We hoped it would be unnecessary or in record time if it was.

We happen to luck-out with our first attempt logistics because she uses her right arm for dialysis and I use my left: we can just connect the tubes between our two ‘biceps’ right-to-left. After getting the four 15-gauge needles in place, we unclamped the flow from her to me, and a few minutes (and a half-liter) later from me back to her. The flow meter measures about 100mL per minute through this diversion without the pump turned on. That means we will be sitting here for about 16 hours.

Lana can handle 400mL/m from her normal dialysis sessions, so we try that. Higher rates can be hard on a living heart and also cause a ‘dry zone’ between the two needles, and we were both used to 4 hour down time.

For the next four hours — we talk about the war, family, and life in general. She never asks what blood type I am or why ‘trading blood’ will help her and me. Somehow she has faith, but I am suspicious this is actually an influence side effect. I do not think I am steering her wrong, so I don’t offer any vampiric information.

Lana and I also sleep quite a bit, but four hours later we are both awake and alive. Lana has a blood test tomorrow (we both do them every week, except mine are faked), so we will know how well this worked for her.

- 70 -

The blood tests — come back completely normal for her weekly dialysis regimen. I can’t commit to doing just her every other day, but I do commit to doing this once every four weeks if not more often. That way we will work out any kinks with the process.

Ultimately I have to figure out how to support multiple people of the same blood type and then multiple people of different blood types. At scale (multiple vampires, with each focused on a single blood type), this will be easier but the process has to bootstrap on me until then. Lana’s blood type is ‘O’, so we need some more ‘O’s to scale up.

- 71 -

- 72 -

THE RING It is my anniversary — A year ago today I woke up to the vampiric April Fool’s day prank. Amusingly it is also Friday, so I have a normal dialysis session before my weekend off, although Sunday is a cave dialysis day. We have finally reached twelve people, all of whom are homeless, do dialysis, have Type-O blood, and know Lana. She gets the commission for all of them. I visit homeless people fairly often, but I am not part of the tribe and they do not trust me enough to even provide the information we need to include them in the program. They do trust Lana: besides being homeless herself she does provide medical assistance to other homeless people. A doctor without borders of sorts, except the border is between the haves and the have-nots vs. geographical.

I built out a fairly nice ‘medical space’ within the Pico Pico House building. Other people help me sporadically with building houses, but no one but me has keys, so no one else can open the ‘iron door’ that holds thirteen comfortable chairs and a lot of tubing connecting them all together. We called it the ‘bat cave’.

The space looks like a discussion ring — twelve chairs ring around a single chair in the center. They are spaced about two feet apart for easy access to the left and right arm of a participant. The chairs themselves are quite wide and deep: almost three feet in both directions when not reclined. They are about five feet deep when reclined. So the total perimeter is around 60 feet where the seats are seven feet from the center. The space is thirty by thirty, so supporting this layout isn’t a problem. We could probably pack twice as many in the space if we slid chairs after wiring up the patient, kind of like sliding library shelves.

But space is not a problem and with 12 people in the room, this represents $6K per session. If we could run eight shifts (MWF and THS at 6 a.m., 10 a.m., 2 p.m., and 6 p.m.) totaling 24 sessions per week, we would make $150K a week, or over $7M a year. The rent would not be a problem. It would require eight vampires and the - 73 -

costs for consumables, but vampires are actually pretty inexpensive: they don’t work for peanuts, but a few pints will do nicely. Anything beyond that is fun money.

I don’t actually charge the 12 people anything: this is still just once a month so the costs are not prohibitive. The patients are happy to have a possible backup for dialysis and it actually turns out that we are doing a better job of cleaning their blood than the clinic technology does. Plus they actually know each other reasonably well, and without the noise of the machines they can talk and get to know each other even better. Or maybe it is just we don’t have televisions for them to zone-out with.

The startup, running, and shutdown — of ‘cave dialysis’ is a balancing act. With twelve patients, each is producing a maximum of 400mL/m or 5L (10 pints) per minute in aggregate. I can run 5L/m continuously but am not an unlimited reservoir: I have about the same 5 liter capacity as a normal person. Maybe I can go all the way to 6 liters. And I start out at about 1L if it has been two days since my last facility dialysis (taking a pint a patient was always a theoretical maximum in case I came in like the walking dead). So ideally I replenish to 5 liters (and get rid of any residual blood of a type that is incompatible with the patient) and then hold at that 5 liter level until all the patients are done: for each liter in, I put a liter back out… whether someone is ready for it or not.

To handle this balancing act, we have a 10 liter vampire-input and 50 liter vampire-output reservoir per blood type to deal with transitions and stutters. The v-input reservoir is filled and held at 5 liters by an Arduino control system that controls the peristaltic pump speeds on a per-patient and per-vampire level. The output reservoir is managed similarly, but is simpler to balance since there is only one input and plenty of capacity. The only issue that pairs the input to the output is if the vampire expires. In that case, the input is pumped directly to the output and returned to the patients. It is not cleansed, but it is better than losing another pint (one in the vampire, one in the reservoir). I have never expired… yet. But the system needs to be fault tolerant when lives are at stake.

- 74 -

Swapping blood types requires a set of valve changes and accepting a bit of flushed contaminated blood if there is an incompatibility. Putting ‘O’ into an ‘A’ isn’t a problem, so that transition just ignores the possibility of residual ‘O’ blood. When the blood is incompatible, the system is run into the flush tank until an insignificant amount of residual is left. This ‘contaminated blood’ is stored in the 50 liter flush tank and effectively represents part of the blood cost for the cave dialysis service. This contaminated blood can be returned to the one or more vampires at the end of a session/shift since vampires are not affected by heterogenous blood types of any kind.

The dialysis centers may work this way also, but I have never been let into the back room. At the start of a cave dialysis it does appear I have heterogeneous blood.

- 75 -

- 76 -

IT TAKES A VILLAGE Jerry’s Meetup — is in the Trophy Room of Menlo Soleil, just a few blocks from downtown Menlo Park. Menlo Soleil is just like a YMCA, if your family plays Polo and owns a two-to-three-digit home (the millions are implied). The Trophy Room overlooks the Polo Field from an angle, and has a pleasant waterfall burbling away.

There are only about twenty of us in the intimate space, so I have about twenty tries depending on how many I pitch at a time. While the mini lobster rolls are being passed around, I go for one of the big fish.

“Hi Larry, how are things in Lanai?”

“Very nice: it is where I created my ultimate garden and retreat: very Zen and reinvigorating. You should visit sometime” “That would be wonderful, but the drive will kill me.” I am quite sure the invitation was not sincere.

“Ha, most people fly, but I have heard you don’t” “Not until I get wings or my own private jet” “I understand the feeling” “I am sure you do” I say with a smile, knowing full well he is neither a vampire nor plebeian enough to touch a commercial plane.

So he does not understand the feelings of ‘most people’ at all. But still, I have to chase the money.

“I would like you to help with a problem” I continue.

“I need a fair amount of land in the Bay Area, and I would like you to own it.”

“Prices in the Bay Area are a rip-off, even for me, can’t you just buy land in the Midwest or Hawaii?”

- 77 -

“No, the people are here, and they don’t have private jets either” “You are talking about the homeless I assume. Your reputation precedes you.”

“Yes, homes for the thirty-five thousand homeless. I am targeting getting about 350 acres around the bay. That would house the homeless in about the same or higher density as Buena Vista”.

Buena Vista is a 4-acre mobile home park in Palo Alto that is worth about the same as the lesser fishes houses: a bit under $100M. It houses 400 people, or about 100 people per acre. Larry is more used to 100 acres per person, so this may be hard for him to fathom.

“That could be several billion dollars depending on where it was.”

“It does not have to be quite that valuable of land. The goal would be to keep it under a billion.”

“I bought Lanai for about that, assuming a third of a billion.

Lanai is a paradise of 90,000 acres.”

“Well, if you are offering 40 acres and a mule in Lanai, that is very generous if it includes travel” “Um… no” “OK, so returning to the easier-to-reach Bay Area. Google has 80 acres in San Jose, relatively close to the city, transit, and other resources. Wouldn’t you like to outshine them?”

“By owning an 80-acre mobile home park?”

“Well, it wouldn’t be mobile homes: they would look more like ‘normal’ houses except being very small” “So like a homeless village?”

“Yes, but done more nicely. Basically trying to be as nice as a suburban village except at much higher density. The homeless - 78 -

would own their small homes. There would even be a HOA [Home Owners Association] to apply rules for keeping things looking good” “Co-governing homeless villages have not been doing well” “This isn’t co-governing, just normal home ownership. Except the lots are very small. That is also how it is different from mobile home parks where you are renting your lot vs. owning it.”

“OK. So I buy 40 acres in Fremont for a billion dollars; develop it for a few tens-of-millions to have water, sanitation, and power for the area; you figure out how to get four thousand people to build (or move) tiny homes onto it and we everyone is happy?”

“Well… at least most of those four thousand would be quite ecstatic” “And I get the warm fuzzies for giving away a billion dollars?”

The rest of the conversation — did not go well. My actual proposal was to do a proof of concept (POC) on a 4-acre plot, ideally in East Palo Alto or Redwood City, but Fremont would be fine also.

Fremont just meant I had to cross bridges a lot, and ‘modern’ vampires don’t have problems with that or running water in general.

If I did, I could always swing around the San Jose base of the peninsula.

But Larry and others did not want to spend $100M (or less) on the land to house 400 people. Only special employees are worth $250K each because they can potentially cause a big-bump in stock price. Other people… “meh”.

Apparently these homeless are worth something though: about $1,500 each. Although no one wanted to buy the land needed for the homes, they were willing to donate to the cause. By the end of the evening I had $50M in the Firehorse (501c3) bank account and various electronic equivalents. A few even gave me paper checks, - 79 -

which made ‘El Toro’ feel like an armored car on the drive home.

Maybe I should upgrade it a bit more.

Coffee with Jerry did ultimately enable a successful fishing trip, I just didn’t catch as much as I was hoping for. But the Skuna Salmon that Circus served must have been tasty.

- 80 -

PART-II

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- 82 -

IGNORANCE The darkness became all consuming — I wasn’t depressed, but sad… and angry.

It may have been the numbers: a half a million Americans are getting a gift every year worth more than most earn each year. At the same time, a half a million Americans are homeless and being left out in the cold on any given night.

It may have been first-hand experience: a dialysis clinic is a crosssection of humanity. The gift is granted fairly’, especially in California. If you need dialysis, you will get dialysis. Well… if you can make it to the clinic, you can keep your job during it, you can manage a fairly precise schedule, and you can stay healthy — e.g. in spite of sleeping outside all night.

I could see this cross-section every other day, and how extra-hard it was for those coping with being homeless. Nothing was different about their humanity: the person with the latest iPhone is being kept alive by the same kind of machines (and vampire) that the homeless person is.

It may have been the partial employment-enslavement of the vampires. Being forced to work when and where a monopolistic employer wants is initially frustrating and eventually depressing & debilitating. This frustration had not built up that far in me yet, but I could feel it growing. And Susan & others were clearly far beyond frustration.

‘A Veil of Ignorance’ — is a way to determine if something is fair. It is generic version of “You split the cookie, I pick the half”, except it works when the universe splits the cookie for us both.

Given the creation of two life scenarios — two ‘lots in life’ and society’s behavior around them — if you and I don’t know which lot we are in, would we accept that the two scenarios are fair. Would we freely accept being in either lot. Lot-1: need life-sustaining dialysis… and you get fifty thousand dollars. Lot-2: need a life- 83 -

sustaining home… and you get nothing. You do not know which will be your lot in life. Let’s flip a coin. Sound good? Sound fair?

- 84 -

SANTA MARIA I meet Carl at Voyager in Santa Maria — along the coastline north of Santa Barbara. Carl lives in Santa Barbara with his wife and two children, but has to commute more than two hours every other day to Santa Maria, driving by the Solvang ostriches, which study his pickup truck as he passes. Why Voyager couldn’t open a clinic in Santa Barbara is beyond his comprehension, but Carl tends to just go with the flow of the universe. He apparently was like this as a teenager, so it had nothing to do with his conversion.

Amasa and Voyager needs periodic review of the different clinics from a vampire’s perspective, and based on several successful (noeffort) achievements after Nancy I was promoted to this role. All those missions were flukes the same as Nancy’s: I believe my influence was no better than a good bar room debate. But Amasa was so happy with me they promoted me to this clinic audit and relations role. Others check out the RNs, technicians, machines, and procedures. I just look for any issues associated with the vampires and process for them. The job involves constantly traveling for just a few day visit.

A few years earlier and I would have despised this new role: my kids were young, still at home with my wife, and I actually enjoy being with them. But the kids are adults now, my wife works all hours of the day, and I am frequently bored. The last of these statements is a lie: I created it specifically for Dr. A. And Amasa. I am not at all bored: I just need a good excuse to visit as many clinics as possible over the next year. And being on the road has to seem like it is not a problem for me or my family.

Santa Maria is the first — of a five city circle route including San Diego, Palm Springs, Bishop, and Redding. Carl and I have lunch after his morning shift and before my afternoon session.

“How are things running at the clinic and for you, Carl?”

- 85 -

“Things are fine… I can’t complain…”

“Well, I am here to hear your complaints, so you can definitely complain. How is the commute going? It looks like it takes a couple hours round-trip.”

“Yes, as much as three hours if traffic is bad. I am thinking we should move to Santa Maria, but the kids are happily in school and my wife likes the Santa Barbara boardwalk and is taking classes at UCSB. So it doesn’t seem like a good trade.”

“Has anyone explained why there isn’t a clinic in Santa Barbara itself?”

“There is a clinic, but it is run by Remigius. Apparently they have their own clinics along with making the machines that Voyager uses.”

“Could you shift to that clinic?”

“No, there is some kind of exclusive contract that prevents vampires from changing providers. Remigius will not respond to my emails or visits to their clinics. I think this would be considered ‘hiring collusion’ and is illegal in California at least, but undead don’t have the right to complain or sue.”

“That is apparently one of our mottos. I am not sure it is true, but I understand where you are coming from.”

“Other than the drive, and the fact that I have a shift schedule I don’t like, I have nothing to complain about. I just wake up at 3 a.m., get in the car, and eventually get home at about 2 p.m. Maybe I should drive for Hoyst: you said you do that?”

“Yes, but not for the money. With gas at current prices, each trip is basically a net loss.”

“So why do you do it?”

- 86 -

“Primarily to help dialysis patients that can’t manage or afford their own transport. I should also tell you about a project I am working on…”

By the time I leave Santa Maria heading south for San Diego, I think I have Carl on my team. The desire for more control and meaning is enough to overcome his apathy. He may also be able to get a college friend, Hod, to help him when the time comes.

- 87 -

- 88 -

SAN DIEGO I meet Patrick at Voyager in San Diego — …

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PALM SPRINGS

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BISHOP

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REDDING

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CONTACT LISTS » MARK One of the goals of the exodus — is to take some significant percentage of patients along with the vampires leaving California.

We do not need to bring all the patients (ten per vampire) but bringing two or three would be great. This is both to protect the patients from the hemodialysis reduction ramifications and to make it clear we are doing our best to avoid harm to others. If this ever hits the press, our counter might be "We are providing dialysis for free to thousands of patients, what are the clinics charging?"

The problem is figuring out who to contact and how to contact them. The subset of patients we want to talk with are not on an email list we can buy from marketers. And I have no idea how to write the email to those people.

In theory, the vampires could contact their own patients, but even if influence could help with that interaction, it would look very suspicious to have vampires contacting all their patients. Plus vampires are a pretty general cross-section of humanity, and many of them are actually pretty anti-social. Nothing about dialysis encourages social interaction, so a vampire has to personally drive this patient contact and have the personality or influence to succeed at that. We want this to be as simple and successful as possible.

To lead to this success, I need a targeted contact list of patient and their non-dialysis addresses. Phones are unfortunately useless for most vampires, and patients are unlikely to have an easy way to video chat… some won't even have email addresses. So an old fashioned door-to-door salesman marketing list is the way to go.

With the list being filtered by current dialysis patients, and possibly organized by income level.

I hope Jo-Anne, my dialysis social worker, can help.

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MENLO PARK » JO-ANNE Mark is a very unusual dialysis patient — Most patients get pretty depleted from dialysis, but Mark rarely even naps and seems more energetic after the session than before it. Except for favoring his left arm from the needles. Susan was kind of like that too, but she seemed somewhat depressed. I think she moved up to Redding.

I hope she likes it up there: I hear the redwood trees are magnificent.

Mark also asks _a lot_ of questions. Not questions about his treatment, which is pretty normal although lots of patients just trust their doctors are doing the right thing. Social questions like “How are you doing?”, “How is your husband handling chemo?”, and the like. It is bizarre that he remembers that my husband is in chemo treatment, let alone that is how he starts a conversation with me. In spite of having a machine pulling blood out of him while we talk, he is worried that I might be having a rough week. He is engaging like a salesman, except he isn’t selling anything. Asking a lot of questions though.

Today he asked how people pay for dialysis, and whether some people stop coming because they can’t pay. In general dialysis is paid for by medical plans or Medicare. It costs most insurers about five hundred dollars per session although Medicare has a three hundred dollar rate that is publicly documented — transparency is an advantage of social medicine. I have never heard of anyone paying for it out of their pocket. Whether three or five, when you multiply by more than fifteen thousand, you get a very expensive yearly cost.

If you aren’t covered by medical plans or Medicare, different states have different levels of Medicaid coverage. Even with Medicare, transportation to and from a clinic may not be covered, in which case you can theoretically get dialysis but may practically be unable to get to dialysis. It would be like getting free take-out meals from a place you can’t reach. “Ironic”, as Alanis Morissette might say.

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I told Mark about all these different aspects — and gave prototypical examples of different kinds of patients I knew throughout the years. I mentioned Ms. Ramirez at the Medicare office as someone he could talk with to get more information. I happened to know her from both perspectives: she helps some of my patients and she is a patient herself at the Sunnyvale Voyager.

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SUNNYVALE » DR. A. “Yes, you can go to Sunnyvale.” Mark’s explanation is not particularly clear, but he says the commute is bad from Menlo Park to San Jose if he gets a position at the new Google campus, and would like to try the commute from down there. He only wants a couple weeks, and we can shuffle both vampires and patients around during that time, given the locations are only about thirty minutes apart. I guess an hour extra commute every other day is quite a bit of lost time. Probably much worse during rush hour.

Mark has been acting a bit distant lately, so I am hoping making him happy with this will help bring him back. It is almost like he is flipping personalities. One is his historically affable and sometimes loquacious demeanor, and the other is terse to the edge of being rude. The timing of the change seems near to the senate bill project, but it doesn’t match that exactly. And that went so well: the committee was very pleased.

“Is there anything else you would like to talk about? Working for Google would be exciting wouldn’t it?”

“I have other projects I would rather be working on: you know about my ending-homeless endeavors. If I could work on them full time, that would be great. Any chance Amasa is willing to buy or give away some land to let homeless people live in freedom? It would be nicely located if it was anywhere near the campus.”

“I don’t think Amasa’s charter includes that goal, sorry. And Amasa has to protect its assets for future needs.”

“Amasa has a project that needs thirty billion dollars? Is it about to provide a college education and degree to everyone in the United States for free?”

“Above my pay grade, sorry.”

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SUNNYVALE » MS. RAMIREZ Voyager has run out of chairs — where they can perform dialysis. There has apparently been a huge increase in patients needing dialysis in the Sunnyvale area, and I hear the nurses and technicians discussing it almost every day. New technicians are being trained out of Menlo Park because there is no capacity to train them in Sunnyvale. The hiring and training is intense, but somehow doesn’t seem to be sufficient to keep up with demand. They are literally out of chairs.

Remigius makes the dialysis machines we use, and we have not had a machine in ages. We tend to get them in bulk of eight or more at a time. But we have had no deliveries in months in spite of having enough staff (and patients) to use them.

I am a patient at Sunnyvale, but I also work for Medicare: I know we can pay for more dialysis patients, dialysis is profitable for clinics even with our negotiated rates, and there are patients that need the procedure every week. But Voyager and Remigius are not growing very quickly to meet that demand. I have no idea of what the holdup is.

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PART-III

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CONVOY The convoy starts moving at 1 a.m.. Today is Saturday, July of the July 4th weekend, which we hope will be symbolic. It being a Saturday means the Tuesday–Thursday–Saturday dialysis groups will be affected first by our encampment, but all local dialysis patients will be affected by July 4th. Our fleet of 24 Freightliners (half electric, half diesel Cascadias) is pulling two dozen 40-foot containers. A dozen Ford 650 Box Trucks are carrying supplies and tiny houses in collapsed form. And a dozen Ford F-450 Duallies are pulling fifth-wheel trailers: predominantly Living Vehicle (LV) Pro models for their solar power. Two tanker trucks are full of mostly diesel with some gasoline mixed in. Two more are full of potable water. There are also a large number of Jerry Cans of diesel and gasoline, along with lots of other supplies including water in 3.5 gallon storage ‘Lego Blocks’ redundantly dispersed around all two dozen containers. We spaced the departure of each truck by about a minute, with an escort SUV for each vehicle.

2nd

It took almost an hour to get the final of the 52 trucks on the road. The first half of the trucks had parked before the second even started, so we only needed a couple dozen escorts.

Our encampment — is the parking lot of the mostly vacant Peninsula Boardwalk shopping center. Presumably the name ‘Boardwalk’ was meant to conjure an image of being right on the bay. It used to be thriving with a Toys R’ Us and other magnet stores. But the universe killed those stores, and only a rarely patronized Sports Seller eventually took its place. The shopping center is notable in a few ways.

First, it is right next to highway 101, the major corridor up the peninsula side of the San Francisco Bay Area. Billions of dollars and millions of people travel the 101, many of them to Facebook, Google, and Apple. Those commuters will see our camp in the light of dawn. The sudden appearance alone should be newsworthy.

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Second, the shopping center is right next to a canal. Once people lived in low-cost house boats in the canal and the adjoining marina.

But the moorings for those inexpensive house boats were recently transformed into million dollar homes at much lower density, and the house boats kicked out. Affordable housing became insanely unaffordable housing in exactly the same area of the city.

Third, the parking lot is not being used even to ten-percent of its capacity because the car traffic to the shopping center is insignificant. All the people shopping there could easily use the nonfreeway side parking without having to compete for spaces. At worse they have to walk around or through the Stibnite, like they would in any indoor mall.

Fourth, the parking lot is quite large, and we can easily create a 600-foot x 150-foot (2 acres) space within it. The perimeter is established by the Cascadias and their trailers, where each is 70 feet long. Including some amount of overlap and redundancy, the perimeter is 3 + 9 + 3 + 9 = 24 rigs. Six of the rigs create makeshift sliding doors on each end. A hill to the 101 forms the NorthEast border, the Sports Seller forms the South-West, there is a bridge over the canal in the North-West entrance, and the main entrance is the rest of the parking lot to the South-East. Our encampment isn’t a fort, but you also couldn’t wheel up an armored battalion and just roll over us. At least, not without it being an entertaining scene to those on the 101.

The perimeter of Boardwalk is set up — as the last rigs (which become the doors) roll in. We are working rapidly to get the containers on the ground and stowing the chassis out of the way in the remaining space of the parking lot. If people take our chassis (or the exposed Freightliners), it will take that much longer for us to be moved.

The container access doors are all facing inward and test-opened to confirm we can get to the provisions within them. A couple containers have special side entrances because both of their ends are exposed to the outside. To speed up the process of parking trucks, - 108 -

the perimeter looks more like a very-squished hexagon. The side entrance containers are needed at the top and bottom, where all the other containers (except the doors) can face ‘left’ or ‘right’ as you look down on the hexagon. We lose a fair amount of internal space to the thickness/width of the containers and parked box trucks, but we still have more than 500 x 100 feet of remaining space… more than an acre. We have about 120 live people and two dozen vampires, so our density is a bit higher than the Buena Vista mobile home park.

The fifth-wheel trailers provide facilities — like bathrooms and kitchens, and the Living Vehicles (‘LV’s) also provide a large amount of Solar power. The models we have can extract over 3kW (kilowatts) from the sun at peak and can store more than 2kW-days (e.g. run a 200 watt lightbulb for 10 days on just storage). We ended up using eight of them to get 25kW and more than a kW-week of storage.

The LVs are also our primary dialysis caves, so are essential to our survival. We also have caves set up in the containers in case the primaries are targeted, but getting power to them requires either running wires along the ground or running a diesel generator near them. And keeping a container clean is more complicated than the LV, which includes several sinks and a bathroom. We did bring a large number of ‘cable speed bumps’ (speed-bump looking wire & tubing protectors) so we can run electricity and water where ever we need them.

The other four fifth-wheelers are all Forest River Sandpipers because they have two bathrooms. In total, we have sixteen bathrooms, which is quite luxurious for a group like this.

We set up twenty six tents — to mostly cover the grounds.

The awnings extend down to 8-feet off the ground, so to a bit below the container heights. This enables the containers to protect the tents from the elements and avoided any gaping holes at the edges.

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The peaks are 20-feet high, so the whole thing looks a bit like a small circus.

Twenty four identical 40-foot by 30-foot tents run the North/Bay side of the camp in two rows of twelve. These are the most flexible tents, and can be easily replaced or moved. Assuming 8-feet by 6-feet as the allotment (‘lot’) for each Pico House, twentyfive homes can fit under each tent.

Next to the main collection of tents are two 20-foot by 240-foot tents attached tightly to each other at the center. These are ‘stilted’ up an extra four feet with wooden 4x4s so they can function as a driveway for tall vehicles moving anywhere along the corridor between the front and back doors. Box truck or SUVs with a large roof rack are taller than eight feet, so we provide twelve feet of clearance for them. Extra awnings prevented gaps at the sides and ends.

Finally, the LVs “fill in” the hexagon on the South/Mall side of the camp. With the solar-awnings deployed and after staggering them for easier movement, the eight units take up a twenty-foot strip on the far side of the driveway which they share with the other narrower fifth wheelers and the parked vehicles that we don’t want to hide under the tents.

With the tents in place — very little of the ground is visible from the air… unless someone crawls onto the twenty-foot high tents or hovers a drone near the gaps. The tents are white & tall, and enough light comes through the spacing that it is not at all claustrophobic.

Probably the least “homey” aspect is the freeway noise. The 101 is very close and there isn’t even a sound wall in this section blocking its noise. Only the containers, tiny house insulation, and any earplugs made sleeping similar to a more normal house. But many of the patients were used to much worse.

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The tanker trucks — are under the driveway canopy because they represent how long a siege we are ready to handle. We have much more water and fuel in jerry cans, but the image of 50K-liter triple-axel tankers would make ‘the man’ think in terms of months instead of days. We would rather ‘the man’ not learn that potential timeline with just a cursory view of our compound.

Pico Pico Houses are rectangular cubes — normally 40 inches by 80 inches by 52 inches high. These dimensions come from standard pallet sizes: a 48x40 and 32x40 are combined side-by-side.

The houses come unassembled (floor, sides, ceiling, all stacked on top of each other), and are less than two feet high in that form. In an eight-foot high container or box truck, you could potentially get two per 40x48 floor space, or ten in a 20-footer, or twenty in a 40footer. We have less than 160 people, so need eight 40-foot containers dedicated to this, or have them dispersed in the box trucks. We spread all supplies around fairly evenly in case any trucks were attacked or crippled somehow. But they all arrived safely.

With the perimeter setup, the solar awnings deployed, and the containers all verified, about half of the group starts assembling houses while the other half rests or patrols. Although we use power wrenches to assemble the Pico houses, there is enough freeway noise combined with a large distance to any slumbering households to make us as quiet as a bat.

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RAZORS At 7 a.m. — Two of the vampires start getting calls from their clinics. Of the two-dozen vampires, only these two are on the TuTh-Sa at 6 a.m. shift. They are from different clinics, so finding a replacement should not be a problem or particularly noticed. But the nurses say the vampires should come at the last (2 p.m.) shift, and they will bump the other vampires to earlier slots.

Sports Seller opens at 10 a.m., but none of the employees appear to care that we are blocking part of the parking lot. On a Saturday morning very few people are rushing to get equipment. All of our containers are simply white with the Firehorse logo on them, a QR code, and a web link to ‘hemodiealysis.com’. Anyone following that link will get some information about housing the homeless. The simplicity and consistency of the containers may make us look like a construction crew.

Around 11 a.m., two more vampires get called by their (different) clinics. Again, they are told to show up at 2 p.m.. In this case, one of the 2 p.m. vampires is called and asked to come in early, which she says she can’t do. There was no arguing, so there must have been an alternate.

During all this time — we finished setting up our camp: housing is assembled, water and food stations are set up, refrigerators and freezers are running in a few containers, waste management is prepared, and twenty scheduled patients and the four scheduled vampires have all done dialysis. Our ratio is a bit off because we believe we needed a lot of redundancy among vampires.

But if we do it more often and mostly with compatible blood types, there should not be a blood-thirst problem.

There are also ladders to the top of the containers and jerryrigged metal shields. We don’t expect things to get to the assault level given the value of our aces — our aces are our vampires, ever notice how an ‘A’ is mostly just a ‘V’ upside-down? — but we don’t - 113 -

want to be easily swarmed. Since our arrival, the containers are manned as watch towers with at least a dozen people and vampires up there. We use chicken wire backed by razor wire to fill the gaps between containers, where the chickens are used to mask the razors.

At 2:30 p.m. — we get the next wave of calls to vampires. We have four that committed hooky and don’t answer the phone call.

And we have two more that say they can’t come in. I believe the clinics may start calling doctors, but I doubt any doctors will answer on July 4th weekend. That supposes there is not a ‘renegade vampires’ alerting system, or at least this wouldn’t trigger it.

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THE SECOND CONVOY It is 7 a.m. on Monday — and a rush of calls to the 6 a.m. crew is coming in. The vampires again hedge and get told to come in by 2 p.m.. But this time we immediately get calls to the 10 a.m. crew asking if they can come in. Basically all of the vampires scheduled for today are getting called in. All of them refuse.

When my call from Fane (my RN) comes in, I answer: “Sorry, no, I can’t come in today. I should be fine though, I did dialysis through another clinic yesterday, so I should be good until Wednesday”. Fane seems a bit perturbed, but just grumbles a “Fine, see you Wednesday”. “Have a Happy Independence Day!” I finish with.

The second exodus of trucks — left our staging facility at 2 a.m. on Saturday. The group of Ford F-450 Duallies was paired with another team of 12, and with the SUV escorts, the 24 Duallies scattered as far as Redding to the north, Tahoe to the east, Bakersfield to the south-east, and Santa Barbara on the southern coastline. This was the main reason we were doing everything so early on Saturday night: we needed to get all the satellites in place so I can return to Boardwalk with some reasonable chance of getting through the gates before the storm.

I am not an escort for any of the satellite Duallies: instead, I run the complete perimeter from Eureka through Bishop and back. This is just to confirm that all the satellites are up and working, and to note their approximate location. I am (and will always be) the only person that knows where they are. At least where they were initially: they are supposed to move every week to a new location within a 30mile area of their starting position.

Upon my departure, the satellites are completely disconnected cells. They know their patients and will fetch and return them.

Although we have ulterior motives, from the patients’ perspectives we are going a step-beyond by providing door-to-door limo service.

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Visiting all the satellites took more than a day — the reports of what happened in the main compound on Saturday were second hand for me — and I returned to the compound 40 hours and 2000 miles later at 6 p.m. Sunday night.

The activation of the satellites — was the major difference between today (Monday) and the vampire-calls from Saturday. With two dozen single-room caves scattered throughout California, we had capacity for more than 250 shifts & vampires. As of today, all those vampires were calling in with ‘red flu’. This strike was large enough that substitutions were not easily possible, so a couple thousand patients might no longer be getting dialysis unless the system responded to the strike. The remaining vampires would need to do very long (eight-hour) shifts or something similar.

We had reduced the symbiotic-ratio — between vampire and patient in the last few months when we realized a vampire’s bloodloss is not linear. A vampire could run for as long as a week starting and returning to ‘half-volume’. So the symbiosis from the vampire’s perspective was only for the first five patients: they provided the half-volume needed to survive. After that additional patients were nice but not essential — some of our skills like ‘blood kinesis’ require more blood volume; others like ‘blood vision’ work even better when thirsty.

With the reduced symbiosis ratio, the satellite vampires could strike in-perpetuity with just five patients. The small single-shift satellites were all they needed to live: off the grid and no longer under the control of Amasa or other medical establishment. The only way they would come back on the grid was for me to physically show up at their location and convince them to return. I was the key to unlocking the strikers, so had to know approximately where they were… and they had to know who I was.

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The rest of July 4th passes without incident — except for the increasingly frustrated and desperate calls of the dialysis clinics.

Tuesday vampires start getting called… starting with the same shifttime and then going both earlier and later to whoever they have not called yet. Through all of this, our group refuses politely but sternly.

The calls get more and more rushed and testy.

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JULY 5TH July 5th was a different story — At 9 a.m. on the dot, a Redwood City police cruiser comes to take a look. It appears he wants to circle our camp, but realizes that is not possible from the direction he came in. So he left.

And then reappeared on the bridge over the canal, being rewarded with an almost identical view of overlapping Freightliners.

Apparently he thought the first view or tactical situation was preferable because the cruiser showed up at our parking lot entrance a second time.

“Hello?!” The male officer yells. We choose not to respond.

The trucks are locked up. The chicken and razor wire is protecting the gaps. And nothing is notable about his behavior. We have three (or more) cameras mounted on every container, so we can see and hear pretty much everything near the perimeter.

We just continue our day without worrying what he could hear of us.

A number of people — are working as if nothing was unusual.

We have several cellular routers, and Covid has made remote work the norm in the Bay Area. Some companies like Apple and Google are trying to change back to in-office work, but they are not willing to risk a mass exodus.

By 9:30 — the police officer had given up going it alone and called some friends. They were now barricading us in on both sides, although you can’t really barricade a Freightliner or tanker with standard police cruisers. They would have benefitted tactically from watching a few more Mad Max movies.

The CHP helicopter started circling at around 10 a.m.. It seemed unlikely that anything notable was visible from the air, but we started - 119 -

to take defensive activity a bit more seriously. Nothing visible to the police was changed, but the perimeter team was doubled by deploying the next shift. Now we have about 50 members manning the container walls and monitoring the cameras.

The space is so small that we could simply shout to each other… except for the vampiric problem. As part of training and preparation we developed a ‘messenger’ protocol with one person from a squad (4 containers) who would run between the squads and ‘HQ’.

I am not the HQ commander: that was Ron and a different Marc (notice the ‘c’), which caused all kinds of confusion at first. But eventually people realized that Ron and Marc were the commanders they had to talk with (depending on the shift-schedule of RaM), and ‘Mark’ (I) had a different role. What that was exactly, was a bit unclear to most of the team, but that lack of clarity would not linger much longer.

The front door — had two layers of doors, each layer made up of paired Freightliners. The inner Freightliners started rumbling and shifting at 11 a.m., about the same time some news helicopter began hovering along with the CHP. I assume they were in communication to avoid colliding up there. If they fell on us, that would be fairly inconvenient.

Then the inner Freightliners moved back to their original position. Very anti-climactic for the people outside, I am sure. But the change would be apparent in a moment more.

The second-pair shifted, opening a 6-foot space between them.

And I simply walked out as they moved back in place (concealing a defense team in the bastion ‘kill-zone’ between the doors).

“Good Morning!” I say with a smile. “What brings you to my neighborhood?”

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Apparently — this was not what they were expecting to happen … or hear… because they stare at me for a minute or two.

After that brief pause, a woman walks towards me. “These are your trucks?” starts the lieutenant (‘Cressman’ by her uniform). She is apparently in command of the team.

“Not mine per-se, but yes, I do know who they belong to.”

“Why are you here?”

“We are camping. You know, a lot of campgrounds are closed due to Covid, so we decided to camp a bit closer than usual. Kind of like a ‘staycation’ ” “You are camping. With more than a dozen forty-foot cargo containers?”

“OK… more like ‘glamping’: it is pretty luxurious in there. The miniature golf course is a bit too easy though.”

“Do you have a permit to ‘glamp’ in this parking lot?”

“Possibly… that is above my pay grade.”

“I suspect you do not have a permit. The workers from Stibnite and Sports Seller think you shouldn’t be here” “I often think that myself… but yet… here I am. The universe is a strange and beautiful thing.” “ ‘Asshole’ or ‘Idiot’ ” is probably running through her head about now, and she wanders back to her team and vehicle.

The Freightliner doors open, and I head back towards them.

“Don’t go anywhere” Lt. Cressman yells at me. I give a quick wave in the air and consider how fortunate I am that I can hear with - 121 -

my back turned and my gesture wasn’t perceived as profane or anything.

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COMMUNICATION Cellular technology — is based on a number of essential elements, which enable cell phones (with a unique SIM card) to talk to the cell stations (towers) for a particular carrier. When the cell phone initially connects to the network, it finds and hand-shakes with a nearby tower. As the phone moves around, it gets transferred to a new tower so the connection is never dropped. Given distance and speed can vary for each phone, this transfer protocol is both somewhat complicated and mathematically beautiful. But the important part is simply each phone has a unique ID that a carrier’s network recognizes, connects with, and bills the account for.

We have a couple hundred different SIM cards in our team’s cellular phones and cell-based internet routers. Each of these SIM cards have a unique ID (IMSI), and the software in the phone or modem does the connection to an appropriate tower near the Boardwalk compound. Unfortunately for us, the stations are computers and carriers can use them to both identify what phone is connecting to what tower, and to disable that connection. Given our phones were all physically stationed at Boardwalk, there would only be a half-dozen plausible towers per network they had to monitor. We appear to be very bad at hide-and-go-seek.

Our phones started disconnecting — at Noon on Wednesday.

They kept mine open just to tease (or maybe ‘respect’) me, which made me doubt whether Amasa and Dr. A. knew what was going on. Although not all the cellular modems were online, we expected maybe a few hours at best when they came up. We had a couple days of communication before we were completely blacked out.

Communication is essential — which is why we had at least two solutions to this blackout problem. The less reliable but more communicative solution was C1 and C20. These two containers contained three important things: (1) cellular antennas, (2) computers, and (3) a large bank of SIM cards. I ‘stole’ this idea from - 123 -

companies in China and elsewhere that provide virtual SIMs to people who would prefer to pay local vs. international cell-phone rates. As in… pretty much everyone except Larry and Elon.

Each of the containers had a bank of a thousand SIM cards, which the computers could use with the antennas to talk to cell towers up to 45 miles away (as the crow flies). This blanketed the Bay Area, and enabled these ‘bay area telecommunications – phones’ to hop towers from Oakland to Menlo Park (F), San Francisco down to Cupertino (A), Gilroy to Sunnyvale (A), Berkeley to Los Gatos (N), and Pleasanton to Mountain View (G). Yes, the router could pretend to be an employee traveling to any of the FAANG companies. Representing three trillion dollars. With revenues a bit smaller than the economy of Canada. And that was just five companies in the area.

Identifying what SIMs were actual employees, and what SIMs were our virtual employees, would be almost impossible. We moved the Bay Area into a version of the matrix… or maybe more aptly SimCity.

With the BAT phones we believe we could last for months before anyone would consider shutting down the whole Bay Area communication grid. And this was our less-reliable solution.

More reliable communication — comes from no communication at all. That might sound like an oxymoron (‘silent communication’), but it is not as long as the two parties had plenty of time to work out the protocol ahead of time.

Our super-reliable communication technique was a delay & cancellation protocol between Boardwalk, the various remote cave dialysis cells, and the broader collection of vampires on the V-WAN. We had arranged plans for every party, and Boardwalk could only delay or cancel activities by these other parties. If Boardwalk went silent, the other parties already had the plan. Boardwalk used the wrong keyword, they already had the next activity to do. Boardwalk couldn’t direct field activities beyond applying delay tactics. And - 124 -

even then, we had to use the right keywords or it would be ignored.

The future was almost inevitable, like playing chicken with an accelerator but no steering wheel.

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350 ACRES Three black Escalades — pulled up a respectful distance from our doors. A woman in a bright yellow outfit with white flowers was let out from the shotgun position of the rear vehicle. Dr. A did not like being driven around, and certainly would not accept being unable to easily see the territory.

“Mark? Could you come out?”

After some Freightliner shuffling, I joined Dr. A in front of the lead vehicle.

“How are you doing doctor? Did you have a good July 4th weekend?”

“It was very nice. I went down to Monterey and they had fireworks over the bay. It is beautiful down there overlooking the highlands” “Yes. I love it down there. You know I proposed to my wife overlooking the highlands?”

“Yes, I read your memoirs… remember?”

“Actually, I just always assumed you were psychic” I say with a big smile.

“Apparently not… not even a good predictor” “I doubt you can honestly say that. I think you knew this would happen. In some ways, I think you want this to happen.”

“What do you want Mark?”

“I want what is inevitable: but to solve this problem in a way that does not destroy people’s lives” “Which problem?”

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“I want to house all the homeless in the Bay Area. And then the rest of the country. More specifically, I want 350 acres of land allocated to housing the homeless throughout the Bay Area, and for that land to be developed to the point of enabling housing and to be located in a way to provide support and community to those people.”

“OK. That is a very specific demand. And in exchange you will ‘go back to work’?”

“Yes. We may always keep the ‘cave dialysis’ running, but we will make sure to do enough hours with the clinics to support the current dialysis-patient-per-vampire load” “What do you think the cost of this 350 acres is?”

“About $10B. Maybe double that including the development and depending on the location.”

“You are asking for a $10B hiring bonus to go back to work? I believe people will consider that a bit too generous, even in Silicon Valley.”

“It depends on how many vampires that bonus is divided among, and how much each of us is worth.”

“Even if you are each worth $1M, that requires ten thousand vampires to be worth $10B. “ “Yes, or about hundred thousand patients. How many dialysis patients are there in California?”

“You are kidding right?”

“You know me pretty well, I think you know the answer to that.

Talk to the pay grades above us, and let me know. I believe you have seven days, although it may be a bit less than that. The wheels of the bus go round-and-round.

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It was great seeing you, as always doctor. Take care.”

I turn and the Freightliners start shuffling again. Dr. A is still standing there when the inner doors close.

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NEGOTIATIONS » DR. A. “We could wipe them off the map… — no more containers… no more tents… no more problem.”

Commander Davis is a bit enthusiastic in the use of force.

“Yes, you could do that. While all the traffic on the 101 watched in horror. And all the videos of the assault streamed live on the internet.”

“We can shut down the 101 and the internet.”

“Like Russia? I think you have seen how well that works. And this is against Boardwalk that has been on the internet — both visible internet and the dark web — for months now… in spite of our efforts to stop them. We believe they are even using our cell towers to gain access, but we can’t figure out how.”

“We can shut down the cell towers then.”

“Assuming that is the only way they are on the internet, please talk with Mark Zuckerberg, Larry Page, Sergei Brin, Tim Cook, and others before taking down their employees’ cell towers. That might be a problem when the Google busses — for example — have no internet access on their trip down from San Francisco” “It will just be a short time. It shouldn’t be a problem to employees in the area.”

“Again, commander, like Russia? Boardwalk completely repelled the first assault within minutes without using any lethal force. Do you think a more forceful operation will be quick?”

“Yes. They are non-violent. If we start shooting, they will submit.”

“No. That is not how Mark thinks. You shoot his team, he will nuke the Pentagon — if he can. He is only nonviolent because - 131 -

nonviolence will keep people alive and uninjured. You change that equation and the contract changes.”

“So he shoots back. We are armored and will not sustain significant losses.”

“Maybe you think that way. Mark thinks «They just hurt my team… I will hurt them, their boss, their boss’s boss, their boss’s boss’s boss.» Hence the nuke the Pentagon. Oh, and give the Joint Chiefs of Staff a heads up also, they might want to bunker-up during this operation.”

“He can’t hurt those people… that would be attacking innocents.”

“Really? Your boss that allowed you to hurt his team is an innocent? Do you believe that? Will Mark believe that?”

“Fine. He can’t hurt those people… he has no access to them.”

“Well, he hinted he might somehow have ten thousand vampires within his organization… if that is the case, and they are scattered across the US, I suspect he has pretty good access to almost everyone. Unless we all hide in a bunker for the next decade or so.”

This was going to take a while.

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THE NEIGHBORHOOD » CARL Hod and I parked the LV and SUV — a bit North of Oroville on a dirt pullout about a mile beyond a fire station. At this point in the road it looked like almost no one came up this far, but we moved up here late Saturday night after the last dialysis shift, so we couldn’t see what traffic was normally like. It was also hard to see the road, although I could see lots of fauna around it in the bushes. We were definitely in some nice woods, but our goal was to hide and blend in… at the same time. To “look casual”.

We unhooked the 450, leveled the RV, and simply laid back for the next 48 or so hours reminiscing about glory days.

We had gone to college together: — I started a year after Hod, but somehow managed to finish before him. I was not a genius (or cutthroat as we called them), there were just some tough things about that school and Hod got bitten by them. The torture made us life-long friends.

Hod visited me in Amasa shortly after I was admitted. This was pre-Covid, so visitors were not a problem.

Hod recruited intensely — with the local Beloved dialysis clinics: he posed as a short-term visiting patient, and shift-by-shift he convinced both the vampire (easily recognized when you know what to look for) and patients to try out a new ‘free clinic’. Within two weeks we had a total of eight vampires including me, sixty patients, and could run every shift.

Beloved has so many clinics in the area that they shouldn’t have any service-delivery issues: they can just get other vampires to double-up and substitute a day a week for the missing vampire. It would take a lot of vampires if they each only took a single shift, but Beloved had a lot of vampires in the area.

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The loss of sixty dialysis patients might be a bit of a shock: that equals about $3M per year.

The neighbors found our LV cave — which I found out by hearing the doorbell ring. I don’t scare easily, but I can be startled, and if I could fly I would have hit the ceiling. Hod is out picking up patients with SUV, so I am alone. I go to the door and look through the peep hole. There is a camouflaged golf cart blocking the 450 (gutsy, given the size differential). There are also two guys armed with AR-15s or something over their shoulders.

Not wanting to be discourteous, I open the door. “Hello?”

The taller of the two starts out: “Hi neighbor, this is Butthead & I am Beavis [not their real names]… and you are?”

“Standing here. This is a free country right?”

“Less than we want, but let me try again. We are here to welcome you into the neighborhood.”

“You brought me a cake? Or a fruit basket?”

Butthead chimes in with “Can people on dialysis eat cake?”

“I can eat all the cake I want. Why do you bring up dialysis?”

“We, as in the town, are pretty sure you are one of the satellite dialysis clinics. So we are here to find out what is up with that.”

“Well, again, I thought this was a free country. So I am not sure why you care.”

“Welllll… we think there is a good chance ‘the man’ knows where you are. And they might come visiting.”

“That might be unpleasant. I would very much like ‘the man’ not to visit me and my friends. I am Carl by the way.”

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“Thanks Carl. We would like ‘the man’ not to visit you either.

At least not while you are in our territory.”

“You want us to leave?”

“No, you are free to stay as long as you like. Especially if you are doing free dialysis for some of our residents. In that case, we actually invite you to stay. With us.”

“I need to stay with this RV. It is a bit large to move into someone’s driveway” “You should see our driveway!”

So we moved in — with Beavis and Butthead — who are actually not at all like the TV characters — in a secluded compound a bit closer to the dam. Getting the LV up the dirt driveway going fairly vertically into the hills was a notable undertaking, but we offloaded most of the provisions and transported them with the trucks after getting the LV in place. We ultimately had a very scenic view overlooking the valley, which the patients enjoyed in spite of having very little idea where they were.

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DEFENDING BOARDWALK » MARK The perimeter of Boardwalk had to be defended — well enough to prevent a breach, and without causing serious harm to any aggressor. We wanted to avoid violence, but we needed to be immovable without our consent. A cross between the Himalayas and André the Giant.

A number of solutions to this defense do not work: threatening lethal violence will not deter certain aggressors; tranquilizers are not like in the movies and can be both ineffective and deadly; knock-out gasses would be great, but are similarly unreliable; and finally weapons like tasers need to be aimed and fired at a potentially overwhelming number of aggressors. What we needed was a kind of ‘riot control’ from a position inside the riot. That matches an allto-common situation in the United States: prisons.

We defended our compound as if we were the remaining guards within a prison that had completely rioted, including the prisoners arming themselves. In this situation there is no hope of being in control. We can only defend ourselves, and we committed to doing so without forcing any attrition (i.e. killing) of the aggressors. So the prisoners are in control, and if they come for us we can only hold them off until they settle down or someone comes to help. Calling the police and other government forces ‘armed prisoners’ might seem a little unusual, but unless they decided to bring in the actual military and destroy us, the analogy is pretty apt.

We had 8-foot walls — and chicken-razor wire filling the gaps, which provides a pretty effective core of a defense. Assaulters had to go over, under, or through containers or razors. Under seemed unlikely given there were no tunnels beneath this part of the parking lot. Drainage pipes were all outside the perimeter. Through the razors was possible, but would require people to single-file cut through chicken and razor wire, with potentially armed people positioned with direct line-of-sight of the assault. That seemed

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tactically unlikely. Cutting through the containers had similar issues for the assault team.

We decided the most likely tactic was for them to try to come over: either over the containers or potentially over everything and landing on the tents themselves. The tents seemed unlikely since anything could be beneath them (say giant spikes) and there would be no way for them to retreat once dropped. So we decided the only really soft point that needed extra hardening was the containers: if an assault team could get and hold the top of a container, they would have a good tactical position against us.

To combat this tactic — all the containers had ‘flip out’ barbed wire mounts, which looked similar to the overhang wires on tops of fences or the edges of buildings. Because they were hinged, they were slightly structurally weaker (an assaulter could push up on them), but that weakness did not provide much help in breaching the container if you were coming from below. It might be a problem if they had a foot-hold on the top of a container and then could disable the overhang.

But far more essential than the structure of the overhang is that the whole flip-out awning and container roof was electrified. Our goal was to convince any assaulters that turning around would be an excellent idea. Better than any other idea that might come to them.

“We should just turnaround and go home to enjoy an evening by a cozy fire with a warm cup of cocoa. Enough of this standing in a lightning storm” To make sure these would-be assaulter could physically achieve their new purpose in life, we needed to not electrically glue them to the fence. And in worst case, we needed to be able to easily keep them alive and eventually revive them.

An electric fence runs at about 8000-volts — This is to get an electrical current through hide, skin, and clothes to the nerves beneath them. Unfortunately, 8000-volts applied against the human - 138 -

body — with a resistance of about 1kΩ (thousand ohms) — leads to 8-amps of electricity flowing through that body. That amperage is about a quarter of the current that goes to an electric oven, but it is carrying more than twenty-times the voltage. So it might feel a bit like being cooked at 2500 degrees… if you remained conscious after the ‘jolt’ caused all your muscles to contract, your brain to shortcircuit, and your heart to stop.

The solution to cooking (not) the intruder is to put a limited amount of energy onto the wires. Each wall-container has an energizer which takes its power from a pair of Tesla Powerwalls, supporting about 40-amps of load and able to run a dozen lightbulbs for a day. The energizer puts energy into the wires like they are giant capacitors (storage for energy, like transitory batteries). That stored energy provides the initial shock to an intruder. The energizer also replenishes any lost energy, about once a second. This limited speed of replenishment combined with the capacity of the fence is what prevent it from frying (and worse) the intruder.

So all we need to do is run a standard 8000-volt energizer against the string of wires protecting the container, and any intruder would turnaround as soon as they encountered this obstacle. Except we thought that unlikely. People play with electric fences all the time and learn to handle the shock. The assault team would almost certainly have some kind of protection that increased their resistance. We needed to encourage intruders to turnaround of their own free will, but to disable them if they did not.

So we tweaked the energizer — It started like normal and replenished the wires once per second, but it doubled the frequency every time the replenishment occurred within the same minute. So once a second would progress up to a thousand times per second if the doubling happened ten times. Doing this ramp within ten seconds seemed a bit draconian, so we gave the intruder a full minute to change their mind: every six seconds it would double. But in exchange for our generosity, the system never stopped increasing frequency until the replenishment was unnecessary: no more energy lost either because the intruder turned around, or they were down - 139 -

for the count. All living team members were warned to stay away from the container-wall during a breach because it could be deadlyhot depending on the behavior of the assaulting team. It was debilitatingly-hot for vampires too, but they would revive and repair eventually.

To add some fun to the defense system, we also blew bubbles at intruders with a misting system. This both made them wet, so the first shocks should be closer to 8000 volts, and because it contained some soap, it made the containers really slippery. Our vampires manning the tops of the containers had super-resistant and supergrippy boots & gloves so they could clamber around on the container tops in spite of these defenses.

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DEFENDING BOARDWALK » RON The assault of Boardwalk — was of course at night. This was a horrible time to assault us vampires, but apparently no one was willing to explain that to the assault team. So in the cover of darkness, the assault teams ran at the containers with breaching ladders. They probably had overwatch on the Sports Seller, but those snipers were hidden well enough we couldn’t see them with eyes or cameras. At least they were not shooting at us.

The ladders went up, over the wires, and stopped abruptly. We had made it so cow bell noises played whenever the energizers recharged the wires, and there was now a herd of cattle surrounding us. Admittedly, we hadn’t posted any signs warning about the electric fence, but they could have done a bit more recon before assaulting it with aluminum ladders.

Two teams had luckily used pairs of fiberglass ladders, and they scampered up on top of their containers athletically. Our soapmisters had been running for an hour, but now the fog machines kicked in too. The goal of the mist was to obscure the metal plates functioning as blinds protecting our vampires.

Most of the assault teams went down from the electric wires on the roof of the containers. A few cow bells in a row showed they weren’t initially convinced to vacate, but ultimately only three team members made it to the inner edge, the steel blind, and the vampire… who then turned into a bat… no… who then simply leapt up and tackled the assaulter onto their backs. The wires did the rest.

One of the vampires was stunned as well, but the breach was over.

We pulled down the bodies from the roof, checked their pulses, and then laid them out front of the camp, to wake up (or be fetched) sometime after our doors shuffled close. Overwatch kindly didn’t fire a shot in the dark.

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SAFE HOUSES » MARK Dialysis for ten thousand vampires — or more than a hundred thousand patients requires about two thousand ‘caves’.

There is no way we could hide two thousand caves in California.

So we didn’t. We hid about 80. The exact number, I don’t know.

They were set up without me even knowing who created them, let alone where they were. Maybe 100 in Texas. 60 in Massachusetts.

40 in Pennsylvania. 80 in New York. In total we had something about two thousand caves throughout the contiguous 48 states.

Alaska and Hawaii had caves also, but because they required air or international travel, we did not consider them. The primary goal of the two thousand caves was to support the exodus of ten thousand vampire slaves to a safe refuge. They also supported the local communities’ dialysis needs.

Detailed design plans and purchasing information was available on both our ‘dark’ and ‘plain sight’ web sites. Any vampire could easily acquire the equipment needed to support a multi-shift dialysis clinic. They just had to provide the safe and sterile facility. And figure out how to get a base-level of patients. Enough to support a few vampires visiting for a while.

With the safe-house caves in place, we simply had to communicate where they were. Simple, except the complication of preventing anyone else knowing the location. Turns out this was trivial as long as our resistance wasn’t significantly infiltrated.

Vampire powers varied per person — but one skill was available to all of us. We had heightened visual acuity towards blood.

About 100-fold better than the average person. Blood diluted one part to a hundred parts of water looked the same to us as obsidianblack ink looked to humans. We could paint signs with this diluted solution in plain sight to us, but completely invisible to the living. A few of these signs in succession and we had a treasure map that only a vampire could follow. Or an exodus plan.

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An exodus plan is a balancing act — We need to get the vampires out of harms-way by moving them as quickly as possible, but at the same time we need to avoid visibility of the migration.

The approach we picked was the simplest possible.

After each shift was complete, that vampire would simply leave the clinic and head for their safe house. The relationship of vampire to safe house was random: they simply knew where their first marker to the East was, and that marker could cause them to backtrack West or continue forward across the United States. The first marker varied by the time-of-day of their shift (earlier shifts had further markers) but were otherwise randomly assigned. Cohorts of vampires had an identifier and the marker would show which cohort should go where next. By the end, the vampire would be at their refuge.

At the end of each shift — a thousand vampires went into motion from a thousand different locations … heading for a hundred different markers … and would arrive at them sporadically throughout the day. Vampires would likely reach a particular marker at least 10 minutes apart from the previous and next vampire, but it they could possibly be spaced by hours.

There was no particular hurry for the vampires to progress along their trail: they could last a week without dialysis… as long as they allowed for how weak they would be near the end of that time period. Fortunately blood-sight improves with blood-loss, so the treasure map would always be visible.

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BISHOP » JOHN The first satellite raid was successful — which is not surprising. Although Boardwalk had defenses, the satellite caves did not. Unless they wanted them and that was discouraged. So a Bishop County California sheriff knocked on the Bishop dialysis cave and was let in.

Peritoneal dialysis — where you inject your abdomen with distillate — can be practiced at home by patients, so what our caves are doing should not be considered practicing medicine. Unless eating, discharge, insulin injections, and treating wounds are considered ‘practicing medicine’. Even taking a splinter out involved a needle when my mother did it for me as a child. Yes, our technique is different from peritoneal dialysis, but the results are similar… only better. And, finally, a doctor prescribed the patient as getting hemodialysis. We are just a ‘pop up’ clinic for it.

The Bishop sheriff was not interested in any of those details though, and decided to jail Phil and Brian, the vampire and human running the Bishop cave. Things were about to get very interesting.

From Phil’s description, Phil and Brian called John at WilmerHale from jail. I had given out his direct number to anyone in the satellites.

“Hi… John?”

“Yes, speaking” “My name is Phil, and Mark told us to call you if we had any issues with the law” “Mark Fussell?”

“Yes. Well… we are having issues with the law. We are in jail in Bishop, California.”

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“I will be there as soon as I can. Don’t say anything or do anything that could be considered ‘disobedient’ unless absolutely necessary.”

John was a longtime friend & lawyer, and WilmerHale was a longtime customer of my services before the transition. I helped FAANG companies in multi-billion litigations. So there was both a personal and financial bond between us.

I warned John of the impending calls, and he was nice enough to accept my explanation around hemodialysis which excluded the vampiric part. I am pretty sure he knew something was ‘smelly’ about my explanation, but he apparently felt he could argue the case without knowing what was causing that stink.

John was also nice enough to go bail out Phil and Brian in Bishop.

John brought Phil back to Boardwalk so we could make sure he was OK and could continue dialysis without returning (caving in) to his original clinic.

John shows up — at the perimeter of the siege in his white 300ZX TT (for T-Top). There are a half-dozen police besieging us: half in their cruisers, the other three in a water-cooler style chat circle. John walks up to the three with Phil, flashes something, and then they continue onward to our doors.

With an approving signal (the American Sign Language version of ‘let them in’) the doors shuffle. Phil & John saunter up to me a few minutes later.

“Excellent” I say with a Mr. Burns (from the Simpsons) accent.

“You could have picked locations a little further. I like driving the 300. I can only do it when my kids are not around.”

“Sorry, tried my best. But the state line was a limiting factor. Can you practice in Nevada?”

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“No… I don’t think I can. Except maybe for desert tortoises” “You studs want to get some food?”

“I should start working on the case. The DA there seemed very energetic” “I wouldn’t worry about that. I suspect the case will disappear before you get home. But you probably have better food there.

Thank you for dropping Phil off. Visit any time you can worm by those officers. Might be harder if the FBI decides to join us” “Getting past them would be inconceivable. Enjoy your evening and see you and Phil later in the week if your prediction is incorrect” “Inconceivable!” I say with a smile. “Thanks again”.

The trucks shuffle and a few minutes later John’s 300 pulls away.

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EXODUS » MARK The rolling walkout started Friday — at 10 a.m.. The nearest first markers for these cohorts could be as far as Salt Lake City, Utah; Boise Idaho; and Phoenix, Arizona. All of the markers were outside California: this was to guarantee this was a ‘national’ action, and California sheriffs, highway patrol, and district attorneys would have no authority any more. Why and how any branch of the government could impede peaceful migration of thousands of citizens was unclear, but the value of these vampires was in the billions. That is a strong incentive to break moral and legal codes.

The US interstate system — has a simple numbering system: interstates running west-to-east are numbered as multiples of 10 starting from the southern border. In the south, the I-10 runs from Los Angeles, California to Jacksonville, Florida. In the north, the I90 (the longest) runs from Seattle, Washington to Boston, Massachusetts. Interstates running south-to-north are numbered similarly, but shifted by ‘5’ and starting on the Pacific Ocean. The I-5 runs from San Diego, California to Seattle, Washington. The I95 runs from Miami, Florida up to Bangor, Maine. This grid bounded by Seattle, Bangor, Miami, and San Diego represents the most-easily accessible (in time, by land travel) locations in the US. More remote towns are within relatively short travel times from each of the interstates and their interconnections. The interstate grid enables navigation techniques similar to finding shops in back alleys within the grid of a major city like Manhattan.

All of the first-day markers were very near these interstate grid points, and subsequent-day markers were also ‘on the grid’ if the final destinations were further east. This was to enable short travel times to any destination, including crossing the country: you followed the high-speed interstate grid until the destination was within a day of an interstate exit.

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The goal was for each vampire — to reach their destination in time for their next scheduled dialysis session; i.e. in three days. The furthest dialysis caves were near Bangor, Maine and Miami, Florida, both of which are more than 3000 miles away from most of California. That requires driving 1000 miles every 24 hours, or 16 hours a day at 60 mph. That is too much driving for a person to do safely: DOT (Department of Transportation) rules for professional truck drivers is 10-12 hours (with some possible extensions) per day, so we used a 12-hour ideal to plan routes. On the interstates, speed limits are commonly 70 mph, so 3000 miles could be closer to 40 hours of driving over three days. We accepted that some vampires would need an extra day of travel in rare cases. Those vampires also had a second choice destination that was nearer if they needed to shorten the trip.

Actually, all vampires had a collection of shorter ‘treasure-maps’ to follow if they needed a shorter trip. These secondary maps guaranteed a vampire could reach a final destination within four hours of reaching a marker. The first day markers were all a full 12 hours away, but in that case the vampire could just return back to their home clinic if anything went wrong. After day one they were on a journey that needed to be safe and safely completable.

Vampires are too valuable to lose even one in this exodus.

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EXODUS » SANDRA It is very cold — as the sun starts lighting up the sky. I do the graveyard dialysis session for Voyager in Redding, California. This type of session is for patients that need a longer and gentler dialysis: 23 patients and I spend eight hours together starting from 10 p.m..

Almost everyone sleeps, although some watch late night television.

I hate the cold, but today is the beginning of a new life. Or at least a vacation. My first marker is near Phoenix, which should be ‘a tad’ warmer. It is a long drive (maybe 13 hours), but is super-wide freeways as soon as I reach I-5 until I get off the I-10. With a tank full of gas, my Prius should be able to get to Los Angeles before it — I hear some people personify and name their cars, but that seems very nerdy to me — needs to be refilled. My guess is I will stop a couple times on the way for Peets and In-n-Out, so it might take me more like nine hours to get to Pasadena where I change direction and head pure east.

The drive down I-5 is fascinating: California is like a giant garden where instead of hoses coming from your house to water various trees and plants you are growing, the water cascades down from the Sierras through aqueducts and rivers to reach huge tracts of plants and trees… which are growing food for the whole nation. I can see the rivers cross under the highway headed west for the coastal populations as I come down from Redding. Later I can see the aqueducts weaving back and forth with the I-5 to support all the farms along the way to Los Angeles. Large tracts of planted vegetation organized into various kinds of patterns. Depending on the angle of the field, they look like they are just in rows. But something about the repetition also makes them appear to be laid out in diagonals that match hexagons. And in the rear-view mirror, different columns and diagonals appear.

Many of the fields are completely brown and dry. A few have water flooding parts of them. Clearly the amount of water these farms are getting varies a lot. And none of them are getting as much as they would like. This is even a year we aren’t officially in a drought… yet. But the water a farm is allocated is based on decades - 151 -

of water rights and the needs of the many, which clearly outweighs the needs of the few… or the one.

While I progress to Los Angeles, I do-si-do with the aqueducts a dozen more times. I also read a dozen billboards saying “No Water… No Jobs!”, “Where water flows… food grows!”, and similar.

At the base of the ‘Grapevine’, the part of the I-5 that winds over the Tehachapis mountains north of Los Angeles, I study one of the largest visible slights against those farmers: a giant pump system designed to push millions of gallons of aqueduct water over the grapevine with me. A couple million gallons each minute. Three billion a day. A trillion gallons a year. All streaming by the farms on their merry way to quench the thirsts of the people and the lawns of Los Angeles. I can’t imagine why those farmers are so angry.

I stop in Pasadena — because it is a nice city along the highways to Phoenix. And it provides a good turnaround point. If I just gasup and get back on the I-5 North, I will be home for dinner.

To ponder this decision point, I visit Jones Coffee Roasters.

Besides good coffee, they have a giant, crowned, lamb mural.

Praying to the lamb does not give me insight. In the end, the sugar in the kouign-amann drives me forward to Phoenix. Or maybe I am driven forward by the resentment for the years I was sent to do dialysis in Redding… when I would prefer to be in San Diego or somewhere warm.

The trip from Pasadena to Phoenix — provides a very consistent scenery… of desert. And more desert. And towns along the desert. And casinos along the desert. And Coachella where the San Andreas fault (running through the desert) meets the I-10. So a view of… a deep (but narrow) chasm in the desert.

If I had the time to stop along the way to Phoenix, I could visit Sherman tanks, fake dinosaurs, and strange-looking Joshua trees.

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But I am in a hurry, so those are not options however enticing they might be.

It is after dark when I exit the 101 — (a circle route around greater Phoenix area) for the Courtyard in Scottsdale. This is near the Mayo Clinic, which is a major player in liver and kidney diseases, so if anything goes wrong, I suspect they will know what to do with me. I can look for the marker tomorrow, when the stores open. I don’t know why the markers aren’t out in the wild. My guess is that a bunch of people looking around a park might seem like it was a geocaching location, and then other people would start snooping around there as well.

I check in, unwind, and get some sleep before dragging myself out of bed at four in the morning: several hours before normal on a Saturday. I don’t yet know where I am headed next, so the suspense is kind-of killing me.

The Home Depot in Scottsdale — opens at 5 a.m. on Saturdays. This must be why they picked this location: so you could get cracking at the dawn of the day, or visit at 10 p.m. after you arrived in Phoenix. There could be a dozen markers hidden in here, and unless you walked all the aisles, and were a vampire, you wouldn’t have found any of them. But I had an aisle and shelf number (Aisle 21, Bay 007), so I only had to look in a few square feet. Actually, what I was given by the V-WAN was “Go home to 472-21-7”. Somehow that combined with my cohort number would be a marker and tell me how to get to the next marker.

I believe the first part of this code means ‘Home Depot’ because that company is mentioned prominently in a lot of the founder’s materials. Home Depot also has a location numbered ‘472’ that is located the right distance away. We were told the first marker could be twelve or more hours away. Ideally these pieces of information are not well known, so those outside our community would have a harder time deciphering the code than vampires would.

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The critical obfuscation though — comes from a vampirespecific talent: the ability to see blood in even small quantities. I go to Aisle 21, Bay 007, and look around. There are a bunch of Milwaukee tool sets containing power drills and impact drivers. On each of them are all the normal pricing, barcode, and descriptive information. And on each of them, in the brilliantly bright color of blood — although only a few droplets per inch — is my cohort number and the next marker: “Go chuck wine at five-one-nine”

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EXODUS » BRUCE It is super-hot — in Palm Springs today. After I get out of treatment at 10 a.m. it is already almost 100 degrees. I hate this kind of heat, in spite of it being dry. Maybe I hate it because it is dry, but I have never experienced a hot and humid climate. And today I am hoping to ditch the heat along with the humidity. That is if I can reach my marker today in the next twelve hours or so.

My clue from the V-WAN is to “Get some pipe for the commune boys: be home by 6:06 p.m.”. I am hoping there are chase vehicles or we are Lojacked in case we head in the completely wrong direction. But at worse, I turn around late tomorrow and come back to this dry heat. Maybe it will rain while I am away and cool things off.

“Get some pipe” sounds like a reference to the PVC, ABS, Copper, etc. pipe aisle of Home Depot. The founder should have just passed out a phrase book to us vampires so we can turn these obscure phrases into their meanings. But I guess he probably did say “Going to get some pipe at Home Depot” a dozen or more times a week given his fondness of construction and aquaponics. Lots of pipes needed for both of those. Maybe you can never have enough pipe.

“For the commune boys” was totally unintelligible to me. Maybe it was supposed to be a clue about the location. Or maybe they forgot to quote or misspell something, but that didn’t help me figure out the clue at all. It did help confirm I figured out the third (apparently redundant piece) correctly… probably. “be home by 6:06 p.m.” is a second reference to Home Depot, and 6:06 p.m. is 1806 in military time. Home Depot store 1806 is located at “3639 E Federal Way; Boise, ID 83705”. So I am headed to Boise via the I-15. We were told to get out of California as fast as possible, and I-15 is also usually the faster route. I pack up and head north for Primm, Nevada where I leave California. Potentially forever.

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EXODUS » PATRICK It is hot and sticky — in San Diego, although it is cooling down since it is late afternoon. I should finish dialysis at 6 p.m., but I am still training and the other vampire was willing to stay until the end of the shift. So they pulled the needles out of me early. I am almost ready to go it alone, but they wanted a couple more weeks to make sure the fistula was fully mature.

I don’t have very far to go today, somehow my destination appears to be Las Vegas, which is only five or six hours away depending on traffic. I should be able to get there before the casinos close.

- 157 -

- 158 -

EXODUS (2) » SANDRA “Go chuck wine at five-one-nine” — Well, it nicely rhymes, but I doubt that is a clue. Probably just a coincidence. “five-onenine” is probably just a number: 519, like the Home Depot store number. Or maybe part of a street address, if the rest of the information gives a very precise street. “Chuck wine” seems unlikely to identify a street. Maybe a store again? A wine store? A throwing store?

The founder doesn’t drink wine: he died from alcohol poisoning, so gave up the habit in solidarity to those who survived. He can drink, but rarely does now. But he did drink, and he did drink wine.

California wine. I believe very cheap wine most of the time (after a few glasses, who can tell the difference).

Cheap wine. On a whim, I type “Chuck cheap wine” into Google, and get… Trader-Joe’s Two-buck Chuck. Turns out I didn’t need the ‘cheap’ either: “Chuck wine” gives almost the same result. It is good this clue was written in almost invisible blood if anyone could just type it into Google and get the answer.

So the clue is “Trader-Joe’s 519” — Typing that into Google, I get “87 Marginal Way, Portland, ME”. My next marker is in Maine?

Is that ironic or just mean? Or divine justice of some kind? I better find an REI or maybe Lands’ End before the next winter.

After checking out of the hotel, I take Arizona-87 North to the I-40, and Google Maps says “drive 41 hours east”. Sigh.

- 159 -

- 160 -

REQUESTS » MARK “Beautiful day! — I always enjoy seeing you doctor.”

“Yes, Mark. It is a beautiful day. How about you take a road trip with your containers and enjoy it?”

“Hmm… not a bad idea, but we have become kind of attached to Boardwalk. The police cruisers surrounding us keep us feeling very safe and kind of cozy, it would be hard to give that up. Plus we are all watching Game of Thrones again and might lose internet access if we moved” “«You win or you die?» is a bit melodramatic isn’t it?”

“Oh… I personally just watch it for the dragons and the unicorns. And of course the happy ending. I feel a bit like Mance Rayder and am hoping someone will just give us wildlings some land to live on… in peace. That part ended pretty happily actually.”

“They are not going to just give you land. That isn’t how capitalism and negotiations work. People make fair trades that both sides agree to.”

“You can’t have a fair trade if one side could die during negotiations and the other couldn’t. That is actually coercion… in my opinion. But I accept your proposition of a fair trade. I will trade the lives of thirty five thousand people for the lives of thirty five thousand people.”

“How are we trading lives?”

“My request is still the same: reasonable land for that many people to live on in freedom. We will take care of the remaining details of keeping them alive.”

“Yes, I understand that. But how is that trading for thirty five thousand lives? Who are these other thirty five thousand?”

- 161 -

“Doctor… you surprise me! Surely you know who they are.

There are one hundred and twenty thousand of them in California alone. I will let you and others decide which thirty five thousand you are willing to let perish” “There are one hundred and twenty thousand of them? Dialysis patients?”

“Yes” “Yes?” “Yes. ‘Yes’ to those two questions and probably the next dozen questions you come up with. It has already happened. The negotiations are now fair. Now we both win or …

- 162 -

EXODUS (3) » SANDRA After stopping in Tulsa and Pittsburgh — I only have ten hours to go. The thirty predicted hours became only twenty-four with a little motivation and a lot of luck. I combined that with about four hours of sleep at each stop. It is sixty hours since my last dialysis session ended on Friday. Over a weekend, sixty-four is the norm for me, but adding an extra day or so will just make me a bit tired. I have done as many as four days before when I was relocated, especially the San Diego to Redding move took a long time to pack, drive, and unpack.

It is summer, dark for most of the trip, and the route I am taking takes me north of Manhattan, so the last ten hours take only eight.

I did lose a total of three hours to time zone changes, so my sixtyeight hours looks like seventy-one on the clock. I have a few hours to sleep before Trade Joe’s opens.

The wine section is somewhat large — but I am guessing I should be looking in the “Two-buck Chuck” portion. There is no cohort number, but all of the bottles of red wine (hah) say “Get your cape and join the 52 hunters on the other side of the stone gate”.

Obscure, tiny, and written in heavily diluted blood. I may be too tired to decipher this one.

- 163 -

- 164 -

REQUESTS » DR. A. “Mark, you said «We win or they die?» — You and I ‘win’ in some way or everyone else dies?”

“Yes” “I wish you would say a little more than that.” I am getting pretty frustrated by his terseness. It is not like him to be this terse.

“Yes, either we work out a reasonable solution for the thirty five thousand homeless so they are safe, warm, dry, watered, and fed going into their future, or we don’t. If we don’t, then those homeless will die or live miserable lives. Lives you and most dialysis patients would not pick if given a choice. Lives people would not consider fair if society did not do its best to prevent… and those people ended up with that life because of a coin toss.

So, if we don’t work out a solution for them, I will not work out a solution for the thirty five thousand dialysis patients that are now at risk due to a ‘resource shortage’.”

“There is not a resource shortage related to dialysis. We have been building up infrastructure for decades. There are thousands of clinics and hundreds of thousands of workers, machines, and patients.”

“And how many vampires?”

“Tens of thousands. We discussed this months ago.”

“And which of these ‘clinics’, ‘workers’, ‘patients’, ‘machines’, and ‘vampires’ is the limiting quantity?”

“Vampires are clearly the most limiting, although it takes a while to train workers.”

“So tens of thousands of vampires are doing dialysis for hundreds of thousands of patients. Say ten patients per vampire.

- 165 -

What would happen if ten thousand vampires stopped showing up for dialysis” “They would cease to be.”

“OK… they would cease to be. But what else would happen?”

“A hundred thousand patients would need to be reallocated to other vampires and clinics.”

“Would that actually work? Have you tried increasing patientper-vampire ratios that high? You would be asking a vampire to spend additional time in dialysis that they don’t need to survive. My guess is that it also does not work: if you could have had fewer supervampires enslaved for 24 hours every day, I suspect you would have gone that route. It would enable one vampire to support hundreds of patient, so you could have had much fewer vampires, more redundancy, more secrecy, and other benefits. It would not be morally very nice, but I recall you saying «Undead don’t have many rights, including the right to complain».”

“Yes, I am not aware that increasing patient-to-vampire works.

It could have been tried but that is above my pay grade. So assuming it does not work, there are thirty five thousand —” “A hundred thousand in the current scenario” “Right. There are a hundred thousand patients no longer getting dialysis. In a few weeks after dialysis is no longer viable for them they will die —” “Or a bit longer if they share dialysis with other patients, but that puts more patients at risk. Or maybe you could get a lot of kidney donations?”

“And you have ten thousand vampires willing to die —” “cease to be” “— willing to cease to be, to kill a hundred thousand patients” - 166 -

“No” “No?” The strange terseness again. A nervous stutter? A power play? Legalese?

“No, I do not have ten thousand vampires willing to cease to be to kill a hundred thousand patients. I have a bit less who are willing to make you save a hundred thousand patients. But those vampires will continue to be.”

- 167 -

- 168 -

DOCTORS » DR. A “We could do a marketing campaign — to get kidney donors” proposes Doctor X. “We could convert people further from death” proposes Doctor Y. “Run the existing vampires for longer? Somehow make it so their bodies can process more waste?”

“Harvest genetically modified kidneys from pigs” “Switch everyone to peritoneal dialysis” “Prioritize dialysis patients.”

I wrote each of these proposals on the white board, both to have an agenda and to help anyone brainstorm a new idea. Doctors X and Y were the most vocal, but many of their suggests were murmured by other doctors in the room.

There were twelve of us: like a jury that needs to determine the sentence… the fate… of more than thirty thousand dialysis patients.

They were already convicted by whatever caused their kidneys to fail.

The obvious sentence was simply death. But hemodialysis can prevent that, if we have enough resources for it. How do we return to the same level of dialysis resources now that thousands of vampires went on strike?

“Let’s walk through these one-by-one — and describe their details and characteristics. Starting with ‘donors’ ” I begin for the group. Again Doctors X and Y tend to vocalize what others in the room murmur… their accents were similar enough it was even hard to tell them apart with my back turned to write, so I started to think of everyone as just ‘the room’.

- 169 -

“Donors: Massive marketing campaign to get people to provide one of their two kidneys. Start transplanting kidneys into the pool of dialysis patients. An advantage is we know all this technology. A disadvantage is we only do a few thousand living donor transplants a year. This would be a massive increase in that double donor-torecipient surgery procedure. For thirty thousand patients the cost would be about five billion dollars. It would take years to successfully transplant all of them, assuming a mass willingness of the public to donate. And we might have to explain to the public why the sudden mass request.” Responds the room.

“I think the last one could simply be a heavier promotion of normal marketing: «people can live longer and better lives with one of your two kidneys… help them with minimal risk to yourself»” “But that has never worked. We are years behind in kidneys: a dozen people die every day while waiting for a kidney. With the reduced dialysis capacity that could double, and time will solve the problem” “OK, that is very pessimistic, but I believe I captured all of that on the board. Next, ‘conversion’. Can you explain that Doctor?”

“Hypothetically — there may be ways we could increase the pool of candidates for vampiric conversion. Let us call this ‘overconversion’. There would be no fiscal cost to enlarging this pool, so the only cost would be the vampire conversion itself. What are our current vampire conversion costs?”

“It costs about the same as a liver transplant, so about a million dollars. It is worth it because the revenue of hemodialysis is more than a half-a-million dollars a year per vampire. Over the ‘lifetime’ of the vampire, it is a huge return on that million dollar investment” “OK. So each vampire costs a million dollars but is worth more like three million dollars as a revenue stream. “

- 170 -

“Except we already had that revenue stream with the current striking vampires” Chimes in Dr. X. “Right, so we are just recouping a loss. In any case, it is a million per vampire, so it will cost a few billion dollars to do a mass conversion to vampires. And I glossed over the risk of exposure from over-conversion. And any costs we want to consider around morality.”

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- 172 -

DOCTORS (2) » DR. A “Next: Run Longer ” — I continue, to skip certain issues that might come up with the conversion variation.

“Right.” The room comes out of a bit of a daze: apparently they were pondering the morality question already. “We can run the vampires longer and for more patients if we can figure out how to ‘overclock’ their bodies: make them consume more unwanted elements in the blood stream per hour. Or if we can extend their effective dialysis period, so they consume more elements per session.

Either of these would not be a problem if required more blood, because that requirement would be over more patients, as long as the two-to-three tablespoon per patient loss is the same.”

“And you know how to overclock or extend a vampire? Like hard physical exercise or weight lifting consumes more calories for a living human?”

“Uhm. No” “Anyone?” All the heads in the room went down, up, left, right, and every variation other than looking at me. Sometimes I wish I was talking to Mark: he always looks straight at me during our conversations. A bit intensely at times, like he is trying to see my brain or soul through my eyes, but at least he is focused on me and what I am saying. Not on the chittering of a pretend fly on the ceiling. “Anyone?”

“OK. Next. — Sadly, even I know pig-organs aren’t real yet.

And peritoneal dialysis has a large number of issues, mostly in that patients don’t like it, but also that it is much less effective than vampiric hemodialysis. So patients will be dying from it in larger numbers and our stats will show something is wrong.” I am pretty sure I know what the next one means, but continue… “Next: Prioritize?”

- 173 -

“Yes. We know we will lose patients, so we prioritize patients based on some criteria. Probably by ability to pay the full cost of dialysis, because we will have less ability to cover those that need help.”

“You are proposing that full-pay patients are prioritized over the equally needy poorer patients?”

“Yes, we need to balance the books” “This isn’t balancing… you are saying we need to continue to make the same level of profits that gave us millions per vampire vs. keeping poorer patients alive” “Well… yes. I believe the people running the program will insist on this, whether we like it or not. At least we need to give up profits only as a final measure.”

“Are we actively trying to prove Mark and his vampires are right?

Or are we just stupid, greedy bastards?”

“So it sounds like — we have to options of: (a) increase donors, (b) expand conversion, and (c) prioritize death… as viable alternatives. I will take this to higher pay grades, but my guess is they will prioritize it as ‘a’, ‘c’, and ‘b’ where we will do all three and use ‘b’ (and I am hoping profits) as a control nob. Trading one almostpast life for several longer future lives seems a very likely approach.

Premature vampiric conversion of some for the benefit of the community.” I say all this with military stoicism. Inside I am losing breakfast and every other meal I have had recently. I can feel my left eye glistens from a single tear. Mark would have seen it, but these elite doctors are now studying a swarm of imagined butterflies.

- 174 -

DONATIONS » DR. A They spent several million dollars — hitting the airwaves and social media with the ‘Save a life… give a kidney’ campaign. The uptick in people getting evaluated for donations was noticeable within the first week. More than ten times as many people (two thousand) discussed kidney donation with their doctor or transplant clinic in that week alone than the number of undirected donations in a normal year. That sounds like a pretty effective marketing campaign, but…

Of the two thousand, less than a quarter were allowed to donate.

Many of the potential donors were excluded due to health conditions: diabetes, obesity, smoking, and even being physically unable to walk up an incline without getting winded. All of these are good predicters of deadly complications from the physical stress of surgery. Other of the donors could not deal with the financial hardship and potential job loss of being unable to work for four or more weeks. Since this was an elective procedure, it would not be considered a disability and employees would be at the whims of their employer.

Passing any laws to help with the financial issues would likely take years. An executive order would be faster if the president was on board. But both approaches required explaining why we suddenly had a desperate need, and opening the conversation with “We have had an insurrection from our vampires”… would likely be unwise.

So, if we accepted the current acceptance rate, we might get an additional thousand donated kidneys over the next year. More likely this would be much less as the pool of ‘adventurous angels’ (a reasonable term for someone willing to cut out one of their own organs to give it away) went dry. Of the tens of thousands that could die, one thousand would be saved by their fellow citizens and patriots.

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- 176 -

VENICE » MARK Cargil ‘mines’ salt — from enormous salt flats spread throughout the Bay Area, especially two locations: Redwood City and Newark.

“We will give you Cargil” Dr. A says with abrupt succinctness.

“You will give us the Cargil salt flats across the 101 highway from where we are standing?”

“Yes, we will give you the Redwood City salt flats to put your homeless people on, in exchange for certain quid-pro-quos” “You will give us 1400 acres of salt flats, worth a few billion dollars, in exchange for certain quid-pro-quos? What are these ‘quids’?”

“First, the vampires come back to work in California. We will work out how they can both work for us and also do what you call ‘cave dialysis’ if they want, so they do not feel they are slaves to our dialysis clinics. They are simply choosing to work for our clinics in exchange for payment, the enjoyment of helping others, and the wonderful company of their coworkers.”

“OK. And?” “Second, you and the other vampires don’t mention anything about being vampires, how dialysis works, the details of this transaction, and so on. Consider yourselves under a ‘gag order’. “ “OK. And?” “Third, you develop Cargil yourselves. No more favors (‘quos’) from the government or the health system. Further, you can utilize only 25% of the land/salt/water as part of that development. We need that for environmental appeasement ‘by the numbers’. You only use about a quarter of the area and preserve the rest.

- 177 -

Further, you develop that 350 acres of human-livable space out of the 1400 acres esthetically and with environmental-awareness. It can’t be ugly. It can’t dump human waste into the water. You have all ‘the best’ treatment facilities and rules for minimizing the human impacts.”

“To make environmentalists and our children’s children happy?

OK. The only issue is that development will cost a lot of money.

Maybe equal to the value of the land.”

“If you can’t convince people to put in the money for obviously good causes, then you should get out of the game.”

“OK. Valid point.”

“Finally, you make sure your development will not flood when sea levels rise. Say: your development can handle an eight-foot rise.”

“An eight-foot rise? As in a ultra-modern Venice? Or effectively a floating city?”

“Yes. We would not like the PR of «35,000 Bay Area residents died during the tidal peak of 2040» ” “Done.”

“Done?”

“Yes… done. That is a fair offer: a fair contract. It may take me a while getting the vampires to come back, but I suspect you have a bit of work to do on your side as well. But I commit to fulfilling my side of the contract. Consider it an unbreakable vow.”

“You seem to treat everything that way.”

“You know me too well doctor. We can put into the press release: ‘I think this is the beginning of a beautiful friendship’ “ “We already know each other. And you plagiarized that line” - 178 -

“I am pretty sure no vampire has said it publicly before me… although there are rumors about him being one of the first. Are they true?”

“Above our pay grade”

- 179 -

- 180 -

EPILOGUE

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- 182 -

HEMODIENAMICS ‘El Toro’ and I have been on Interstate 80 — for more than a day now: we left New Venice shortly after my dialysis session in our main Voyager facility. The song ‘Jacksonville’ is playing on the radio: this playlist is the one I created when I thought I had to travel several days to Florida for a liver transplant.

Different regions of the United States — distribute ‘deceased donor’ livers within that region. Livers can only survive a limited period after the death of the host, so they need to be within relatively short travel times: they need to be in a new host within 24 hours. So there is not a national liver bank because a liver in Boston couldn’t make it to Palo Alto in time. Each deceased donor’s liver has a destination within about a 12-hour travel-perimeter for a patient that is prepped for the transplant upon the helicopter flying it in. Human organs travel in style.

Within a region, liver transplants are not based on a first-comefirst-served or a highest-bidder model. Instead it is based on how needy a patient is, which is calculated as a MELD (Model for Endstage Liver Disease) score. The higher the score, the more and sooner you need a liver. The lower the score, the more time you potentially have before death. It is a little more complicated in that if you get too sick, you can’t handle the transplant. Not exactly a catch-22, but requires luck or sophistication to play the transplant game optimally.

California and Arizona are in Region-5 — so all livers ‘produced’ within that region are distributed to patients within that region, with the transplant priority based on the patient’s MELD score, compatibility, ability to be ready for surgery, covid test result, and a few more aspects. Most of these aspects a patient cannot control, or ideally they are making ‘worse’ (as in dropping their MELD score). If you get in better health, your MELD score can - 183 -

drop significantly. So for some there is no hope of getting a liver in Region-5.

My playlist was created — when I thought moving to Jacksonville, Florida (Region-3) would dramatically improve my chances of getting a liver. The balance of donors to recipients is dramatically different in Region-3, potentially due to the lack of helmet laws. Turns out crashing a motorcycle into an 18-wheeler rarely harms the liver, nor do lesser injuries like simply tipping your bike over and hitting your head on the curb. To get to Florida would take several days by land, and I expected to drive ‘El Toro’ so I could continue to do hemodialysis along the way, and would have a car when I arrived. It was a 72-hour playlist, so was perfect for any significant road trip.

Then I became a vampire.

- 184 -

ABOUT THE AUTHOR Mark L. Fussell lives (or lived) with his wife Rebecca, and two daughters Maya and Katrina, in Palo Alto, California. He makes a living through consulting for companies including Apple, Intel, Sony, and HP. He makes a life through the loving relationships he has with family, friends, and even mere acquaintances. He was a little strange before this adventure, and now he is even more so.