Out on the streets, everyone is wearing a surgical mask. Inside, building walls are papered with political posters: “9 Million Dead a Year. Rationing Is Rational.”
In a hospital, a female surgeon snarls at a male supervisor. “I’m sick of being told how I should treat my patients. First we’re told to cut antibiotic prescriptions by 50 percent. And next the government locks up the antibiotics and controls their use?”
The place is London. The year is 2036. And the story of Surgeon X—a monthly graphic novel written by British filmmaker Sara Kenney and published by U.S.-based Image Comics—is off to a gritty, gory, swear-y start.
Surgeon X, which began publishing in September on paper and online—its second issue is just out—is an intense, dark drama set inside a thought experiment. It takes place in a world where the worst predictions of the rise of resistant bacteria have come true: Antibiotics have run out of usefulness, millions are dying of simple infections, and hospitals have become death traps. A repressive government has cracked down to save the few drugs that remain—and, to decide who gets them, has introduced a “Productivity Contribution Index” that downvotes anyone unhealthy, marginalized, or poor.
At the center of the story is Rosa Scott: young, talented, sick of bureaucrats, and sick at heart over the mysterious death of her mother, a microbiologist who was looking for new antibiotic compounds out in the wild. Working around her distinguished surgeon father and microbiologist twin sister, and recruiting her schizophrenic brother to help, she builds a secret outlaw clinic to save those whom society won’t protect—and, maybe, loses herself in the process.
“I now believe life is a privilege, not a right,” Scott thinks in the first chapter. “As a doctor, this scares the s--- out of me.”
Surgeon X comes into being at a moment when antibiotic resistance, and the uncertain possibility of controlling it, are getting a lot of attention: in the recent meeting of the United Nations General Assembly, at the international meetings of the G7 and G20, in a two-year series of reports commissioned by the British government, and in new initiatives in the United States that hope to revive development of new drugs.
I've got two young children ... They were premature. What if antibiotics had not been available for them?
But when I recently met Kenney while on a reporting trip to London, she told me the idea for the comic arose not from the news but from a concept for a character that had obsessed her for years.
“She’s an amazing surgeon,” Kenney told me, “but she changes because she decides to pass judgment on people, in terms of whether they’re worthy of living or dying, which is something a doctor would never do. In my original concept I wanted to explore the future of surgical medicine, because here in the U.K., we have incredible advancements, amazing technologies, but also a health-care system that can’t afford them.”
The precarious finances of Britain’s National Health System have a fictional equivalent in the story. So do current political systems: There are echoes of Britain’s Brexit vote and also of the U.S. election. (The story opens with a televised debate and “Making Britain Strong Again” is the slogan of the party pushing for antibiotic rationing.)
Kenney told me it was only when she started building for herself what she calls the “story world” that she realized antibiotic resistance is such a threat to medicine that it needed to be in her narrative as the obstacle the protagonist must overcome.
“I realized the antibiotics crisis we’re facing is probably one of the most extreme obstacles you could throw at a surgeon,” she told me. She found the complexities of the problem—resistance is believed to kill 700,000 people around the world each year—to be staggering.
“I’ve got two young children, and I think about the antibiotics they have taken already,” she said. “They were premature. What if antibiotics had not been available for them?”
Kenney studied ecology and has a masters degree in science communication; her previous work includes articles, animations, TV segments, and films on a variety of medical and health topics, including an award-winning short on mental illness that was narrated by the actress Samantha Morton. From that experience, she understood how to seek funding to support her work. For Surgeon X, she won a $275,000 Society Award from the London-based Wellcome Trust under a program that supports public engagement with science.
“We fund public engagement because we believe that it’s very important the public has a chance to understand science, explore how science is done, and help inform science,” Tom Ziessen, the Trust’s senior national programs advisor, told me later. “We funded Surgeon X because we’re interested in the broad range of ways that the public can engage with science—events, exhibitions, film, theatre—and comics are a relatively underexplored mode of engagement.
“Surgeon X touches on a lot of areas that are of interest to the Wellcome Trust—medical ethics, drug-resistant infections—but it’s not prescriptive. The comic book format pares the story down to the minimum and encourages the reader to imagine the story’s universe and its implications.”
Kenney had never written a comic before, and her first concept was to make the book in just a digital version, “because I didn’t think anyone would publish me,” she confessed. The Wellcome Trust funding allowed her to seek out collaborators. She ended up with people distinguished in the world of comics: artist John Watkiss, colorist James Devlin, and especially editor Karen Berger, who fueled the trend for dark, non-superhero comics when she founded Vertigo, which published V for Vendetta and Neil Gaiman’s Sandman.
With Image Comics backing the team, Surgeon X expanded to print and digital editions, but Kenney’s original app concept is still at the center of the project. The comic’s iOS and Android versions will update every month with mini-documentaries that fill in the characters’ back stories and feature interviews with the medical researchers, philosophers, and historians who advised her.
The Wellcome money supports Surgeon X’s first six-month arc; after that, its success will be up to readers. “I’ve got so much material, so many different stories and ideas,” Kenney told me. “I know what the ending is. In my head, this could run for four or five arcs—but it all depends on whether the audience buy into it and like it.”