Surgeon X – The Path of Most Resistance

by Matt Peters

Surgeon X: The Path of Most Resistance is a graphic novel that blends dystopian fiction, mystery, and medical drama in a fast-paced story about a global public health crisis. Set in London in 2036, Surgeon X imagines what will happen as the world enters a post-antibiotic era, a time when bacterial infections become increasingly difficult to treat, because bacterial evolution has outpaced pharmaceutical science. In this imagined future, antibiotic-resistant strains have emerged, leaving clinicians all but helpless when treating pneumonia, gonorrhea, tuberculosis, and other infections.

In the real world of today, medical experts have predicted that a post-antibiotic era is on the horizon. The reasons for the prediction are many, including a paucity of research that could lead to new antibiotics, as well as the widespread overuse and misuse of existing antibiotics. Examples of the latter problem include the demand from patients for quick fixes, especially when an illness will cost them time off from work they can’t afford. In veterinary medicine, overuse has been rampant, as factory farms have used low-dose antibiotics in livestock feed to keep infections at bay. While antibiotics are still reliable in most cases, they leave open the possibility that some bacteria will develop advantageous traits that enable their survival—and their eventual dominance.

Some bacteria have already developed those advantageous traits. Today, an estimated 700,000 people die annually from antibiotic-resistant infections. In Surgeon X, those deaths have risen to nine million per year. The graphic novel opens with a two-page spread showing Londoners walking along Westminster Bridge, the iconic Big Ben in the background. Those whose faces are visible are wearing surgical masks or respirators, protecting themselves from sinus and respiratory infections.

The two-page spread is reminiscent of the COVID-19 pandemic, when face coverings became ubiquitous in the collective effort to slow the spread of an infectious virus (a different type of pathogen, to be sure, but one with relevant similarities). However, Surgeon X was published well before that pandemic, which arrived in early 2020. Released in 2017, the graphic novel collects a six-issue comic book series (titled Surgeon X with no subtitle) that debuted in 2016. The graphic novel was prescient in many ways. It depicts a rising tide of xenophobia among native-born Londoners, who frequently scapegoat immigrants, accusing them of bringing deadly and debilitating diseases from their home countries. That xenophobia evokes the anti-Chinese bigotry that surged in the early months of the COVID-19 pandemic, when then-U.S. President Donald Trump incited tensions by referring to COVID-19 as the “Chinese virus,” alluding to its early emergence in Wuhan, China.

In brief asides, Surgeon X depicts diverging perceptions of London’s healthcare system among the general public. Some segments of the public respond to widespread antibiotic resistance (ABR) by viewing healthcare as one of London’s most critical resources—something needed now more than ever. Others lose faith in conventional healthcare, turning to alternatives like homeopathy. Still others develop conspiracy theories about a pharmaceutical industry with ulterior motives to keep people sick and medicated indefinitely—and a government too corrupt to do anything about it.[1]

Against that backdrop of polarization and racial animus, Surgeon X follows a surgeon, Dr. Rosa Scott, as she navigates a world where social orders and healthcare systems are starting to fall apart. Dr. Scott is a flawed protagonist—in fact, almost an antihero. She fiercely objects to the UK government’s response to the ABR crisis, a response that largely consists of a rationing and triaging system to drastically reduce antibiotic use. She chooses to leave her career in the mainstream healthcare system to practice medicine in her own underground clinic, so that she can dispense antibiotics as she sees fit, based on patient needs instead of government restrictions.

Dr. Scott’s anger at the restrictions is understandable. The government’s triaging mandate prioritizes antibiotics based on a ranking system called the Productivity Contribution Index. Patients are scored based on their age, health behavior, and health outcomes so that younger patients with fewer risk factors are given preferential consideration for antibiotics. It effectively amounts to a eugenics program, leaving people with disabilities and people of advanced age to die—and exacerbating the health inequities caused by poverty and discrimination.

To take her career underground, Dr. Scott goes underground in the literal sense, turning her basement into a private clinic with exam, surgical, and other medical equipment. To fund the enterprise, she takes wealthy patients who are willing to pay a premium for unregulated access to antibiotics—and the kind of personalized care that is becoming scarce as conventional clinics are in perpetual crisis mode, dealing with disease outbreaks that are beyond their control. Dr. Scott needs the high fees she collects from those wealthy patients to pay for black-market drugs and other medical supplies. At the same time, those fees help her act as a medical Robin Hood, taking money from the rich to give free or low-cost care to patients from underserved communities.

Dr. Scott’s operation sparks a number of thorny moral and social questions. Although she’s sincere in wanting to help underserved communities, she does so with black-market drugs from India and other countries. By siphoning medical supplies from places of need to places of higher-paying buyers, Dr. Scott is potentially exacerbating global inequities in medical care. Moreover, by buying from unregulated sellers, she potentially puts her patients at risk of unintentional harm. At the same time, her professional objectivity falls to the wayside as she runs a secretive clinic that gets patients by word of mouth, inevitably leading Dr. Scott to care for close friends.

A supporting character occasionally foregrounds questions of medical ethics—namely, a holographic simulation of Hippocrates that runs on artificial intelligence. The virtual Hippocrates was meant to be an interactive training tool that could appear when Dr. Scott needed guidance. He has a translucent, monochromatic appearance, often appears out of scale, and always speaks in Modern Standard English. Otherwise, he’s a faithful recreation of the ancient Greek physician known for his foundational contributions to medical ethics. However, he begins to hint at his own ethical lapses as he seems to become self-aware—or perhaps hacked by a saboteur. His behavior gradually grows more erratic, at one point disrupting an operation that Dr. Scott is performing.

Exactly what’s happening to Dr. Scott’s personal Hippocrates is never fully revealed in Surgeon X. In her afterword, writer Sara Kenney notes that the graphic novel was meant to be the “first storyline” (unpaginated) about Dr. Scott. However, the only other work to be added to the franchise was a digital-only, one-shot comic—and standalone story—titled Surgeon X Special: Trial and Error. In short, Dr. Scott’s journey as a vigilante surgeon was meant to continue in other stories not yet published.

Other narrative threads go unresolved as well, including a mystery that surrounds the murder of Dr. Scott’s mother. At the start of Surgeon X, the murder is fresh in Dr. Scott’s mind, having happened five months prior. Her mother was a physician-scientist whose final communications suggest that she was on the verge of discovering a promising organic compound, one that could usher in a new era of antibiotics. That means solving the mystery of her mother’s murder could not only give Dr. Scott some closure but potentially lead her to an important medical breakthrough—one that could be desperately needed in this imagined future.

While fictional science and technology feature heavily in Surgeon X, they are carefully researched and informed by real-world biomedicine. Before writing Surgeon X, Sara Kenney studied science communication as a graduate student at Imperial College. In addition, she had a career in film and television, which included working on the BBC medical drama Casualty and a variety of science and nature programs. Lastly, Kenney worked with more than a dozen consultants from higher education and healthcare while writing Surgeon X.

Kenney’s careful handling of medical themes helps give Surgeon X an unusual degree of verisimilitude. Her prescient sense of how an infectious disease crisis would affect the public—exacerbating xenophobia and sowing distrust toward medical and governmental authorities—is likewise compelling. Although Surgeon X was Kenney’s debut as a comic book writer, it demonstrates a command of the craft on par with veteran writers. Her keen instincts for storytelling are evident in every page.

It remains to be seen whether Surgeon X: The Path of Most Resistance will get any follow-up stories to tie up its loose ends. Even with those loose ends, the graphic novel is an engrossing and worthwhile read. Its paperback edition is out of print, but used copies can often be found at reasonable prices from comic book shops, eBay sellers, and other used booksellers. The digital edition is available at some libraries through OverDrive (the Libby app), and it’s available for purchase on Kindle.

Matt Peters is a program manager at Health Sciences Design, an interdisciplinary health innovation program at the University of Arizona Mel & Enid Zuckerman College of Public Health. He is also a longtime comic book reader and collector who can be found from time to time at his local comic book shops. Views expressed are his own.

[1] In depicting those perceptions, Surgeon X again evokes the COVID-19 pandemic, a time when empirically bankrupt “cures” ranging from nano silver to ivermectin were widely touted. At the same time, the COVID-19 pandemic prompted other members of the public to double down on their support for conventional healthcare, celebrating public health professionals, virologists, frontline healthcare workers, and White House medical advisor Anthony Fauci, among others.