Hemodiealysis (22.x.1)

Hemodiealysis

Mark L. Fussell

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

ISBN: 978-0-???

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.

❦ Strangely, this did not make me feel at all well. To recover, I tried to water-fast for a few weeks, which I had done before with some success. This time though, I could not stop fasting without having unpleasant things happen.

After months of getting more and more emaciated, where my wife had to help me escape the bathroom on multiple occasions, my eldest daughter “encouraged” me (forced me) to contact my longavoided primary care doctor. This was four months into the fast, March 2021. She told me to immediately go to the Stanford ER. So we as a family got into “El Toro” (the nickname of my family vehicle) and I entered the hospital where I would spend a month before hobbling back out.

❦ The irony?

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

❦ This book describes the medical treatment I received from Stanford Hospital, its staff, and associated medical professionals — and living a meaningful life in spite of many impediments.

The Prank

1

Transplant Lists

7

Hemodialysis

13

Vampires and Slaves

17

Roofs

23

Recovery

27

Influence

31

Sirius Black

37

Phones and Watches

39

El Toro

41

Hemodiealysis

43

Five Hundred

45

Lana

49

The Ring

53

It Takes a Village

57

Convoy

61

Razors

67

The Second Convoy

69

July 5th

73

Communication

77

350 Acres

81

Exodus

85

The Neighborhood

87

Bishop

91

Exodus (2)

95

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…

❧❧❧ 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?

❦ 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” -1-

“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.

-2-

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 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.

❧❧❧ 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 Stanford Hospital. I was very sick and ultimately couldn’t move without help. My family drove me to the hospital. Is this Stanford Hospital?

❦ 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.

-3-

❧❧❧ 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.

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.

❦ “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. “ -4-

“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 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.

❧❧❧ 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!

-5-

This is a very elaborate prank on me.

-6-

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”.

-7-

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

“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”.

❧❧❧ “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 Stanford 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 -8-

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?”

❦ 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.

❧❧❧ The machines and tubes — make more sense to me now. I have a feeding and drug-injection tube. This appears to go all the -9-

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?

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?

❦

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 Stanford 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 Stanford ER”); don’t climb on roofs (“check”); don’t drink - 10 -

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.

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.

❧❧❧ 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.

- 11 -

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 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.

- 12 -

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.

❧❧❧ 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.

- 13 -

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 access method is the trialysis catheter I had when I was in the ICU of Stanford. 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. - 14 -

❧❧❧ 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.

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 Stanford. 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.

❦ 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 - 15 -

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.

- 16 -

VAMPIRES AND SLAVES 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 Stanford ICU on March 28th. A day later, you passed” - 17 -

“Passed what?”

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

“I seem pretty awake” “Yes, you are now awake… but not alive. On March 29th, Stanford 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 actually 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%, you drain only about a half a liter. 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 - 18 -

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” “Like… hold my breath?”

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

❦ “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.”

❦ 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 light-industrial unit off Old Middlefield, and believe we can build twenty units in about a week.

- 19 -

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 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: given to people living in tents or worse.

❧❧❧ 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 —” “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?”

- 20 -

“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?”

- 21 -

- 22 -

ROOFS It is noon, so I head to dialysis — My clinic is in Menlo Park, almost within the Meta 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 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?

❧❧❧ “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 Stanford-approved clinic.”

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

- 23 -

“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.

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, - 24 -

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 Stanford, so she does not know anything is unusual… except for the story of catastrophic liver and kidney failure.

❧❧❧ 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 Stanford, I am in worse shape than I was before going into the ER in March, let alone the years before when I was in pretty good shape. 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 off the roof, a lot of inconvenient questions would come from to those who saw it… or 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 - 25 -

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.

- 26 -

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

Stanford is paying me a stipend to be part of their ‘hemodialysis program’, and it is sufficient for my 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 10PM and wake at 4AM. That combined with the 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’ or ‘quo’.

❧❧❧ 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 - 27 -

with my sister. It was slow, but I only took a few breaks.”

❧❧❧ “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 be any 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.

- 28 -

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 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 it 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 - 29 -

they were a deep red.

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

- 30 -

INFLUENCE I started driving for Lyft — after about 9 months from being discharged.

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 Sandra 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” — Dr A. is dressed fashionably [[in …]] as always. “Yes, Mark, you can have a major impact to the - 31 -

world, especially given how long you will be with us. Is that what you are referencing?”

“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. Suggested Yosemite, 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…”

❧❧❧ “Stanford 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” - 32 -

❦ 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.

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 Stanford 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 - 33 -

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 sporadically help her get home after the sessions.

❦ “There is a bill ‘2022-114’ — that would be very bad for Stanford” 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”

❦ The bill is killed — after a few weeks of interactions with Nancy during our drives. It is slow because I am worried. Worried Nancy realizes what I am doing. Worried someone else will grow suspicious. Worried I will be exposed and likely ‘canceled’.

It is also slow because I don’t always drive her home, and don’t have any good reason to meet up with her otherwise. But slow and methodical seems to do the trick.

The gods don’t say anything, but I am scheduled back at my - 34 -

normal clinic. So they must be at least happy.

❦ 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, 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’ in a 50-year-old is about 10mm).

Returning to the needle, that means a 14-15 gauge needle is taking up about a third of the ‘tube’. 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 can 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?”) and someone needs to put them into my arm. Not a good way to keep a vampire under cover.

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.

- 35 -

❦ 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 be closed if anything is amiss.

An unclosed 2mm hole sprays blood into and then through the gauze quite 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 [cough].

- 36 -

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 3AM. Rose greets Sirius with open arms, gives me a kiss on the cheek, and I head off to my morning coffee routine.

- 37 -

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

- 38 -

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 Apple Watch — to support my liver disease cover. Wearing a body-state monitor and alarm after discharge was very common among Stanford patients, and a smart watch could do this quite well.

- 39 -

A normal Apple Watch uses multiple LEDs and photodiodes (light sensors) to look at your blood flowing underneath it. This can see your blood oxygen and your pulse by lighting variations. Given my blood barely moves except when in dialysis, an off-the-shelf watch would not give ‘good’ numbers. But V5 provided a special one for cover. It is 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 watch hoax, after getting the fistula I couldn’t wear it. 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 watch 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 watch band very much enjoyed surrounding my wrist with sharp dust shards. Although amusing, this was a bit socially awkward to explain.

So the watch migrated to my pants pocket as a pocket watch for a while… and now is displayed prominently 24x7 on its charging stand. Like a tiny wall clock.

- 40 -

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.

- 41 -

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 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.

- 42 -

HEMODIEALYSIS Nancy marked the end of several things — Not of using my abilities, but of some wavering I was having around them. Nancy was a nice person, and just doing her job (representing her constituents) as best as she could. The bill we just shot down would have enabled more of her constituents to have dialysis, at a risk of medical complications. Deciding amongst those tradeoffs should be done in a public forum, and not in the smoke-filled (metaphorically) Lyft trips with Nancy. It is true that the bill put us vampires at a premium (more dialysis… more needed vampires), but I believe that could have been addressed in other ways if Stanford had not decided to crush the bill.

Based on the Nancy assignment by Stanford, I decided to change a number of things. First, I stopped telling Dr. A about any new abilities. Second, I standardized on ‘Only use on ass****s’ principle: I try to actively avoid influencing or harming anyone that is not an ‘ass****’. Especially if I don’t consent to the goal, or just can find an alternative approach. Third, I started my v-wan (vampire widearea-network) project.

❦ 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 Stanford 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.

- 43 -

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]]

- 44 -

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 - 45 -

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.

❦ 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.

- 46 -

❦ 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.

- 47 -

- 48 -

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.

- 49 -

❦ 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 Stanford 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.

- 50 -

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.

❦ 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.

- 51 -

- 52 -

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.

❦ 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 - 53 -

represents $6K per session. If we could run eight shifts (MWF and THS at 6AM, 10AM, 2PM, and 6PM) 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 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 - 54 -

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.

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.

- 55 -

- 56 -

IT TAKES A VILLAGE Jerry’s Meetup — is in the Trophy Room of Menlo Circus, just a few blocks from downtown Menlo Park. Menlo Circus 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.”

- 57 -

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

“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?”

- 58 -

“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 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.

- 59 -

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, 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.

- 60 -

CONVOY The convoy starts moving at 1AM. Today is Saturday, July 2nd 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 outside 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 the tiny houses in collapsed form and other supplies. And a dozen Ford F450 Duallies pulled various 5th-wheelers, but 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.

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 empty parking lot of the mostly vacant Peninsula Boardwalk shopping center. This used to be somewhat thriving with a Toys R’ Us and other magnet stores. But the universe killed those stores, and only a rarely patronized Sports Basement eventually took its place. The shopping center is notable in a few ways: first, it is right next to the 101 Freeway that is the major corridor up the peninsula side of the Bay Area. Billions of dollars and millions of people travel that road, many of them to Facebook/Meta, Google, Amazon, Microsoft, and Apple. The parking lot is visible from the 101, so everyone will see our presence - 61 -

as of sunlight. It should be newsworthy.

Second, the shopping center is right next to the canal to what was a low-cost housing area on the bay. People lived in house boats in the canal and marina on the Bay side of the freeway. Presumably the name ‘Boardwalk’ was meant to conjure being on the bay or ocean.

But that inexpensive housing approach was recently ‘transformed’ into $1M+ 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 10% 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 Kohl, 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. Two of the rigs on each end are make-shift sliding doors. A hill to the 101 forms the North-East border, the Sports Basement 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 without it being quite a scene to those on the 101.

❦ The perimeter 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 - 62 -

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 ‘inside’ 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 speed up the process, the perimeter looks more like a very-squished hexagon. The side entrances are needed at the top and bottom, where all the rest (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 a 500 x 100 foot (more than an acre) remaining space. We have about 120 live people and two dozen vampires, so our density is a bit better than the Buena Vista amusement park.

❦ The fifth-wheelers provide facilities — like bathrooms and kitchens, and the Living Vehicles also provide a large amount of Solar power. The ones we have pull over 3kW from the sun at peak and can store more than 2kW-days. We ended up using eight of them to get 25kW and more than a kW-week of storage. They are also our primary dialysis caves, so are the most essential. We also have caves set up in the containers in case the primaries are targeted, but getting power to them requires either wiring or a diesel generator. And washing is more complicated. We did bring a large number of ‘cable speed bumps’ 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 16 bathrooms, which is quite luxurious for a group like this.

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

- 63 -

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

The peaks are about 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, 25 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 were ‘stilted’ up an extra 4 feet with wooden 4x4s so they can function as a driveway for tall vehicles moving anywhere between the front and back doors. Box truck or anything with a significant 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 20-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 20-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 was the freeway noise. The 101 was very close and there isn’t even a sound wall blocking its - 64 -

noise. Only the containers, tiny house insulation, and any ear-plugs made sleeping similar to a more normal house. But many of the patients were used to much worse.

❦ 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 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, of 10 in a 20-footer, 20 in a 40-footer.

We have less than 160 people, so need 8 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.

With the perimeter setup, the Solar 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 distance to any housing to make us as quiet as a bat.

- 65 -

- 66 -

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

Sports Basement opens at 10AM, 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 11AM, two more vampires get called by their (different) clinics. Again, they are told to show up at 2PM. In this case, one of the 2PM 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.

- 67 -

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 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 2:30PM — 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.

- 68 -

THE SECOND CONVOY It is 7AM on Monday — and a rush of calls to the 6AM crew is coming in. The vampires again hedge and get told to come in by 2PM. But this time we immediately get calls to the 10AM 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 2AM 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 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 location. I am (and will always be) the only person that knows where they are. At least where they initially were: they should move every week to a new location within a 30-mile area of their starting position.

- 69 -

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.

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 6PM Sunday night.

❦ The activation of the satellites — was the major difference between today (Monday) and the vampire-calls from Saturday. With two dozen single-shift 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. Or the remaining vampires would need to do very long (eight-hour) shifts.

❦ 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 Stanford or other medical establishment. The - 70 -

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.

❦ 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.

- 71 -

- 72 -

JULY 5TH July 5th was a different story — At 9AM 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 way he came in. So he left.

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

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 and called some friends. There 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 - 73 -

a few more Mad Max movies.

The CHP helicopter started circling at around 10AM. It seemed unlikely that anything notable was visible from the air, but we started 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 a different Marc (notice the ‘c’), which caused all kinds of confusion at first. But eventually people realized that Marc & Ron were the commanders they had to talk with (depending on the shift-schedule of M&R), and ‘Mark’ (I) had a different role. What that was, was a bit unclear to much of the team, but that lack of clarity would not linger much longer.

❦ The front door — actually had two sets of doors (pairedFreightliners). The inner Freightliners started rumbling and shifting at 11AM, 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 two 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 - 74 -

defense team in the bastion ‘kill-zone’ between the doors).

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

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

After that brief pause, a woman walks towards me. “These are your trucks?” Starts the lieutenant (Lt. Cressman) that is apparently in command of the current 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 containers?”

“OK… more like ‘glamping’: it is pretty luxurious in there. The 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 Kohl and Sports Basement think you shouldn’t be here” “I often think that myself… but yet… here I am. The universe is a strange and beautiful thing” - 75 -

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

- 76 -

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 Stanford 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 - 77 -

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 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 $3 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.

- 78 -

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 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.

- 79 -

- 80 -

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?”

- 81 -

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

“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 $1OB 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 10,000 vampires to be worth $10B. “ “Yes, or about 120,000 patients. How many dialysis patients are there in California?”

- 82 -

“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.

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.

- 83 -

- 84 -

EXODUS Dialysis for ten thousand vampires — or 120,000 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.

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 obsidian- 85 -

black 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.

❦ 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.

- 86 -

THE NEIGHBORHOOD I thought there was a risk — that people in Oroville would notice the mobile cave. It is a small town and the LV is pretty conspicuous. Also, by this time we were infamous, and reporters had found out that many more dialysis clinics were having issues than just those immediately around our encampment. More than a dozen clinics had capacity problems: generally in the smaller towns where the vampire count was small.

DaVita had several clinics near Oroville so they weren’t having any service-delivery issues from the patient perspective. DaVita could convince enough vampires to do double shifts that no patient was without.

But the cell in that area (Oroville) somehow managed to recruit 8 vampires and run every shift on every day. 60 dialysis patients “disappeared” and stop going to DaVita clinics. That shocked the company ($3m/y vanished from the till) and the rumor of a cave in the area was pretty intense.

I later found out the story —

❦ They found the LV — stationed well-north of the dam. Hiding in plain sight might have been better, but cells are independent and this was their choice for that week.

A camouflaged golf cart pulled up and blocked the 450 (gutsy, given the size differential) while the escort SUV was picking up patients. Two guys armed with AR-15s jumped out and simply rang the doorbell. Vampires don’t scare easily, but they can be startled, and if Carl could fly he would have hit the ceiling.

- 87 -

Carl goes to the door and peaks through. Not wanting to be discourteous, he opens the door (also gutsy but not literally)…

The taller of the two start 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.”

“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 - 88 -

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 the Oroville cave “moved in” — with Beavis and Butthead — who are actually not at all like the 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 they offloaded most of the provisions and transported them with the trucks after getting the LV in place. It ultimately had a very scenic view overlooking the valley, which the patients may have enjoyed in spite of having very little idea where they were.

- 89 -

- 90 -

BISHOP The first 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 - 91 -

Bishop, California.”

“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.

- 92 -

“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?”

“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.

- 93 -

- 94 -

EXODUS (2) The rolling walkout started Friday — at 10am. 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 guarantee this was a ‘national’ action, and California sheriffs and highway patrol would have no authority any more. Why and how any branch of the government could legally impede peaceful migration 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 and 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 similar navigation techniques as getting to 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 - 95 -

within a day of an interstate exit.

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

- 96 -

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.