by Tom Kratman
“Julio, what does this say?” Anthony asked when he’d finally managed to get his roommate’s attention away from the girlfriend he’d been spending a lot of time with that semester. “You know I can’t read the notes you write for case studies!”
“You mean the ones for ‘His Honor’?” Julio Cisneros spoke the honorific with a sarcastic tone of voice—as most of the other students did when referring to Carvalho out of hearing distance. “Why don’t you just make it up? That’s what the rest of us do.”
“You know I can’t do that, this is Grand Rounds, and I have to present, too, so I need to finish this and work on mine, too. I’ll be up all night as it is.”
“Speaking of ‘up all night,’ you have noticed Annalise, right? She paid her way through nursing school as a dancer!” Julio waggled his eyebrows to convey just what sort of dancing the young lady had done.
“Enough, Casanova. I need help, here.”
“Yes, you do, and Annalise shares a flat with three other nurses, all single, and all looking to score a freshly licensed doctor. Besides, didn’t you hear that Casanova’s grandson studied right here at Duke?” Julio waggled his eyebrows again. “So I have to keep up the tradition; besides, the patient had duck fever.”
“Huh? What?” Anthony was too tired to follow Julio’s line of thought.
“Sure, Mike Casanova, back in the 2000’s, he worked with Saint Nicolelis.”
“Not that. What is it you always call me? Tonto? Idiot? No, I’m asking what you mean by ‘Duck Fever.’” Keeping up with Julio’s train of thought was like trying to catch kittens.
“Oh yeah. Avian Influenza, H9N6, traces back to a virus in ducks in Hong Kong over a century ago. The first known human cases were seen just last year. This poor guy just happened to have an allergic reaction to the vaccine, so his throat swelled up and he literally ‘quacked’ when he tried to talk. Anyway, here are my real notes, not the scribbling I handed ‘Lord Lucas.’” Julio pulled out his Phablet and sent Anthony a digital file containing the case notes.
“Thanks, Julio. I might be able to get a couple hours’ sleep tonight!”
“I keep telling you, Tonio, you don’t need sleep, you need one of Annalise’s roommates!” Anthony just threw the wadded up paper with the scribe notes at him.
“Very good, Mr. Nuné. Excellent summation. The treatment plan is sound and the patient seems to be recovering just fine.” Dr. Pegram had led the questioning during Anthony’s presentation. The attending physicians always sat in the front row of the lecture hall, and most of the time their questions were polite and professional. They didn’t necessarily wait until the end of the presentation, though; attendings frequently interrupted to ask questions meant to clarify descriptions or test a student’s thought processes in coming up with a diagnosis. It could be unnerving, even if all went well, as Anthony’s presentation had.
Carvalho was up next. Anthony had handed him the case study several hours ago, but Lucas had barely glanced at it. With a smirk, he stepped up in front of the room, immaculate in grooming, tailored white coat, and a highly expensive—and anachronistic—stethoscope draped around his neck. He began his presentation in a smooth cultured voice. Several of the female students, plus a few males and even one of the faculty had a look of sheer infatuation on their faces. Except for the attendings. Dr. Pegram’s looked like he had turned to stone. Strangely, there were no questions, and Lucas finished without interruption.
“Mr. Carvalho, is this supposed to be a joke?” Dr. Pegram’s voice was as icy as his expression.
Lucas stopped and stared, confused, as he thought back over his presentation to determine how he had angered the attending physician. The patient had presented with muscle spasms which caused spinal contracture inhibiting posture and gait, tightening the cheek muscles causing pursing of the lips, and of course, the spasm of the hyoid region coupled with swelling to cause the odd vocalization. As he recognized the implications, he began to flush, and a quick, angry glance at Anthony indicated that he’d already decided on someone to blame.
When Lucas didn’t answer, Dr. Pegram continued: “Mr. Carvalho, we are professionals. Our patients do not have ‘fits,’ they have ‘seizures.’ They don’t ‘bleed like a Mother F—’ . . . whatever . . . they have ‘profuse hemorrhage.’ Under no circumstances will we accept ‘if it looks like a duck, walks like a duck and quacks like a duck, it’s Duck Fever’ as a diagnosis.” As one, he and the rest of the Attendings stood and exited the room. “Dismissed,” he called over his shoulder.
“You’ve made a powerful enemy, Mr. Nuné.” Dean Thompson rose from his desk as Anthony entered the office. He gestured to indicate that the two would sit at a pair of chairs to the side of the office. The dean of students indicated Anthony’s bruised and swollen face and continued, “but I suspect you’ve already learned that.”
“I fell in the stairway,” Anthony muttered.
“Of course you did, and the ER report does not indicate injuries consistent with a beating.” Anthony did not respond, so the dean resumed. “Mr. Carvalho comes from a very powerful family. Not only is his father deputy director of WHO, his uncle is being talked about for secretary general. There’s also talk of investing them with noble titles. I shudder to think of the possibility of ‘Viscount WHO,’ but there’s even talk of making the titles inheritable. There’s nowhere on Earth that you can go to escape them, and believe me, they intend to ruin you.”
A small sound escaped from Anthony’s throat. It was as near a sob as he could manage through the swelling. All he had ever wanted to be was a doctor, and now that was permanently out of reach. He couldn’t even really blame Julio for setting him up, the symptoms were exactly as described, it was only the interpretation—and delivery, he had to admit—that were at fault. Of course, if Lucas had actually read the presentation ahead of time, he could have changed it enough to avoid embarrassment, but Lucas would never take the blame for his own actions. He was already circulating a story that Anthony had pranked him out of spite and had replaced Lucas’s own scholarly work with the fake diagnosis.
The dean was still speaking, but Anthony had missed something. “—accept transshipment to Terra Nova and we can ensure that you are licensed and certified. Balboa needs doctors, and you may even have family there.”
“Excuse me, Sir, but . . . what was that?”
“Some of our more ‘indigent’ students agree to serve on Terra Nova to pay their loans. You were on scholarship, but it’s still an option. The United Nations Interplanetary Settlement and Boundary Committee, or UNISBC, is in charge, but it will be a bit easier to get a clean start, since it’s handled at a much lower level than the WHO. Your friend Cisneros is one of several upcoming graduates due to head there, but even so, you’re unlikely to run into people who would know you.”
“Terra Nova? The colony planet? What would I do there?”
“The same thing you would do here. Your grades are excellent, and you’ve passed all of the exams. You’ll have to complete a residency in Hamilton and then you’ll be assigned to a clinic, probably in Balboa City since you are Panamanian. It’s a twenty-year commitment, or else you will have to pay back the transshipment costs; but it pays better than you could expect here. Besides, it’s your only real option.”
Terra Nova? It was too much all at once. He was supposed to go to Panama City next month to start a residency at the “Hospital del Niño”—the children’s hospital—with the statue of Vasco Nuñez de Balboa in the park across the street. Now the dean was talking about going to the country of Balboa on the only other planet that humans had ever discovered. Not to mention, it was a planet filled with plants and animals that were deadly to humans.
On the other hand, it was a chance to escape the attentions of Carvalho. He’d be needed. Just maybe he could make a new start . . . but at the cost of leaving friends, family . . .
He felt a cold lump in his stomach. His shoulders slumped and he felt as if a heavy weight had fallen on him. �
��Yes, sir. I’ll go,” he said in a quiet, defeated voice.
“Has sido una buena chiquita, Janina. You’ve been a good girl.” George Noonan taped a small bandage over the site of the vaccination, then lifted her off of the examining table and handed her to the mother. “She probably won’t be hungry tonight, but make sure she has plenty to drink. No cacao, por favor. She needs water or juice. Watch for fever, and come back if she is not feeling better in three days. Tres días, señora.”
The mother nodded and muttered her thanks in heavily accented English. George thought it highly ironic that the patients and family considered him the “gringo doctor” since he had come to Balboa from his residency in the largely Anglo areas of Hamilton. The relocation deal had included a legal name change. The beating he’d received at the hands of Carvalho’s thugs had carried an unexpected benefit—reconstructive surgery that had changed the profile of his face just enough to fool facial recognition, although close friends, if he’d had any, might have been able to recognize him as once going through school as Anthony Nuné.
Residency had been totally different from anything he’d experienced on Earth, and he truly felt that he’d gained a fresh start, so much so that he’d extended the residency in Pediatrics to include Obstetrics and Gynecology as well as Emergency Medicine. He knew he’d certainly need it for some of the UNISBC’s hospitals and clinics. He’d hoped that residency would count toward his twenty-year obligation, after all, he worked seventy-two-hour shifts at county hospitals and ERs throughout, but the UN was adamant. Twenty years in service as a fully qualified doctor, residency most definitely not included.
Here he was, six years of residency and eight of practice, he should have been at least two thirds of the way through his commitment, but instead was less than halfway. He really should have read the fine print on his transportation contract. He couldn’t really complain, though; he was alive, wasn’t he? He’d intended to spend quite a few years at the Children’s Hospital in Panama City before moving on to private practice, so it wasn’t as if he had something urgent to do other than treating children and their mothers. The UNISBC Women’s and Children’s Hospital in Ciudad Balboa was both challenging and rewarding. It was a small hospital, only a dozen beds, a family clinic that doubled as an emergency room, and a small laboratory filled with outdated equipment. He rented a room in the building next to the hospital, and spent most of his time at those two locations. He was paid well despite his “indenture” and the families he’d treated had spread the word that the “gringo doctor” was a good man. There was at least one restaurant in town that would not allow him to pay, and the butcher at the market near his apartment always ensured that he received choice cuts of meat.
The only thing he didn’t have was a family of his own. He’d dated a few times, but residency, like medical school, was time consuming and he was reluctant to get involved with a girl he would have to leave behind when the UN reassigned him. He’d officially been at W&C for eight years, now, but he spent weeks at a time working rural clinics, and even a month per year on-call for emergency services at the forts along the Rio Gamboa. The river provided a navigable waterway from the continental divide to the Shimmering Sea—more than halfway across the narrow Balboan Isthmus—and there was a lot of cargo on the river and roads crossing Balboa. The UN Marines built several forts to protect official commerce, and naturally, needed medical services for their troops; who better than someone that already owed the UN their service? Despite the primitive conditions at some of the sites he worked, they were still a damn sight better than his boyhood home in Chorillo.
The mothers of some of his patients, not to mention some of his older female patients, had started to hint about finding him a “muy buena señorita.” While he feigned disinterest, he had to admit that he’d been thinking about it; the butcher’s daughter was rather cute. Then there was the girl with the construction company building the pediatric wing. He’d seen her several times when he’d had to go to the company office to discuss the new patient rooms. Now there was a girl who could stop traffic! What was her name?
Yelena! That was it. Yelena . . . Guerrero, or Carrera, or Callejo, or something like that. Maybe he should ask her out. After all, he was the Gringo Doctor; that had to be worth something! His work habits didn’t leave much time for dating, though—or, at least they hadn’t until lately. The out-of-town duties had reduced as word of a new insurgency had arisen. Yes, he could ask her out, although it seemed strange that back-country terrorists would provide him an excuse for a normal love-life.
After six months of seeing Yelena Guerrero, George had to admit that he’d made the right decision. Finding time to spend with her and her family had gotten easier once he decided to make the time, rather than simply find the time. He’d met most of the family by now since many of their “dates” were chaperoned; Balboa had a very traditional culture, and it was getting time to have The Meeting with her father . . .
It would have to wait, though; he’d been called out to Fort Cristóbal on an emergency. It was nearly time for his annual trip to the fort overlooking the mouth of the Rio Gamboa, so he’d been told to simply report early and plan to stay the extra time. He’d hurriedly packed, arranged for one of the other doctors to cover his hospital duties, and stopped briefly at the construction office to say good-bye to Yelena. He promised to meet with her father once he got back, and received a very enthusiastic kiss in return!
This had been a strange tour of duty, though. The patient had been shot with a bullet that had somehow become coated with progressivine sap—more than could be accounted for by shooting from within heavy foliage. There had long been rumors of groups of insurgents in the undeveloped areas between cities, but that was supposed to be mainly concentrated in Northern and Southern Columbia, the continents connected by the isthmus of Balboa. If the terrorists were this close to civilization, and coating weapons with poisonous sap, then it might be time to agree to having a guard when he traveled between clinics.
The local flora and fauna had been a problem for as long as humans had been on Terra Nova. For a planet that seemed perfect for terrestrial life, it seemed to have a particular animosity to intelligent terrestrial life. The planet had plenty of plants and animals that appeared to be directly equivalent to those on Earth, leading many to wonder if it wasn’t too convenient and wonder what or who had arranged the coincidence. However, there were a few native plants such as the progressivines and bolshiberries with toxins selectively inimical to intelligent life, and animals such as the antaniae with obvious alien genes and bad attitude.
George had studied the literature on the uniquely Terra Nova species during his residency. The prevailing theory was that the Novan equivalent of DNA was a hybrid of the four known nucleotides of terrestrial DNA, plus four unique nucleotide bases. The DNA “code” produced by the sequence of nucleotides determined the structure and function of proteins in all organisms; thus the Novan species produced proteins that were similar to terrestrial proteins, but had subtle differences due to the presence of extra codes. It was hypothesized that those proteins acted similar to prions—basically a fragments of protein made from normal terrestrial genes, but with abnormal structure—that mainly affected animals with complex brains. The scientific theories didn’t really matter—bolshiberry juice and progressivine sap could lead to a very painful death. Deliberate use of the toxins on other humans was attempted murder, and George had a responsibility to report it as such.
The rising insurgency was not the strange part, even though George always felt as if someone was watching. No, Novan technology was . . . schizophrenic . . . to put it mildly. At Duke, he’d had access to the best medicines and medical technology that the twenty-second century had to offer. His residency in Hamilton had mostly modern facilities, at least up to the best of the twenty-first century, although that slipped to twentieth century in the rural areas. In Ciudad Balboa, he had some modern medications and facilities, but most of the country seemed to be strug
gling to keep up with Earth’s seventeenth century. Fort Cristóbal was a perfect example, a large brick and adobe walled fortress overlooking a river that served strictly human and animal-drawn barges.
In contrast, soon after George had treated the soldier with the contaminated wound, he received several ultra-modern diagnostic devices and a shipment of a new vaccine with instructions to vaccinate all of the personnel at the fort. The devices consisted of a new blood analyzer, diagnostic scanner, biometric recorder and a rapid DNA sequencer. Every person receiving vaccine was to be scanned to confirm the infection (or lack thereof), provide a blood and tissue sample for analysis, and have their biometrics recorded. The instructions were from the Terra Nova Health Organization—the UNISBC’s version of WHO.
George shuddered with the memories that thinking of TNHO or WHO brought up. This was highly unusual; most of his patients didn’t need ultramodern medicine, even if it would have saved more lives. Life on Terra Nova, and in Balboa in particular, was hard and rather primitive. The people were strong, and they were survivors. They made do with what they had, as did most of the doctors, hospitals and clinics. Even twentieth-century medicine was good enough for most needs, so to be issued materials that literally screamed “most modern” was unheard of.
There was more to it, and the instructions he’d been given upon returning to Ciudad Balboa were the most confusing of all. There was a new influenza, and the TNHO had decided to stop its spread with the vaccine he’d been given. However, before he could administer the vaccine to any non-military or non-UNISBC personnel—even children—he had to take the biometric and genetic samples and wait for approval. It was supposedly for epidemiological research purposes, but why would he have to wait for approval if the data was simply being used to track which patients contracted the disease?