by Ian Douglas
“Sir,” I said, “I’d really like to run an STS on him first. If he has a spine injury—”
“Are you telling me my business, Petty Officer Carlyle?” Kirchner demanded. “Rack One! That’s an order!”
Haldane’s tiny hospital ward had four beds—“racks” in Navy parlance—and Rack One was the critical care unit. You could hook up the patient to provide constant monitoring with or without nanobots, immobilize any and all parts of the body, provide oxygen, put nutrients in, pull wastes out, and even take simple X-ray shots.
But I really wanted to pull an STS on Pollard first. “STS” stands for “soft-tissue scan,” a technique derived from various earlier MRI technologies. Magnetic resonance imaging used magnetic fields to detect the precession of certain atomic nuclei—notably those of the hydrogen atoms in water molecules—to get information about soft body tissue. Nowadays, though, you can’t use traditional MRI techniques, because nearly everyone has a load of metal inside their skulls, the palms of their hands, and along certain key neural networks. The metals, including gold, iron, and copper, are chelated into place by standard nanotechnic processes, growing our cerebral implants, the cybernetic prostheses that give us our in-head imaging and RAM, access to the local NET, and even control over everything from coffeemakers and doors to e-Cars and starships. There’s enough ferrous metal in our heads to make real trouble if we enter a powerful magnetic field, like the ones used by early MRIs.
Modern soft-tissue scanning units, though, are a lot more sensitive, and they use a number of different sensory inputs, combined and interpreted by powerful medical AIs. They employ background radiation, background magnetic fields, injected nanobots, and tightly focused sound to build up a detailed image of what’s going on inside the body.
So why not use Rack One’s X-ray unit? Well . . . I might have been okay with that if the unit could have handled computed tomography—a CT scan . . . what used to be called a CAT scan in the old days. But a simple X-ray? Too risky for my money. X-ray images miss something like 20 percent of all fractures—in particular hairline fractures, which can be all but invisible, especially on a wet reading. Pollard’s symptoms had already told me he didn’t have a complete break in his spine—not if he could still wiggle his fingers and toes.
So when we reached sick bay, I told them to put Pollard on the full-body scanner.
I chimed Dr. Kirchner’s office, but didn’t get an answer. What the hell? He would have heard the emergency call when it came through, and I’d been talking to him just a moment ago. Where the hell was he?
I shrugged it off and went to supervise moving Pollard onto the table. That was tricky—getting him off the stretcher and onto the table without further injuring his skull or letting his spine go crooked. If his back was broken—even a hairline fracture—we could cause some truly serious problems for the guy if we weren’t damned careful.
There was that sheet of metacomposite nanocloth on the stretcher beneath his back, though—a soft fabric weave that becomes rigid when you put stress on it. When we grabbed the corners of the sheet and tugged in opposite directions, it became as unyielding as a hard plastic board, and we used that to shift Pollard onto the table, where the cloth went limp once again.
“Thank you, gentlemen,” I told the Marines. I flicked on the STS scanner. “If you guys could stand by for a sec, I’ll ask you to help me move him to the ward when we’re done here.”
I brought up a viewall image showing Pollard’s body, as a bright bar of light switched on above his head, then slowly moved down to below his feet. An expert AI took the data and created a three-dimensional image on the viewall, which allowed me to see inside Pollard’s body from any angle, to any depth. Linking in through my in-head, I could zoom in, rotate the image, even remove layers of tissue for a clear view.
I was still looking at the skull fracture—hadn’t even gotten to his back yet—when Kirchner came through the door from the passageway outside and exploded all over me.
“What the fuck are you doing, Carlyle! I distinctly ordered you to put the patient on Rack One!”
“Sir . . . I thought it best to do a full-body STS. There’s a chance—”
“You thought! You thought? You’re supposed to follow the orders of the doctor-in-charge, not think!”
“But sir—”
“This man has a serious skull injury! You’re risking his life by doing an additional transfer! A needless patient transfer, since we can x-ray him in the rack!”
“I thought there was a chance—”
“Thinking again! My God . . . save me from enlisted men thinking!” He drew a deep breath. “You’re on report!”
His fury took me aback. It even startled the Marines standing there in the sick bay, and they were used to getting chewed on by angry D.I.s in boot camp, and by gunnery sergeants and other deities once they became full-fledged Marines.
“The scan is completed, sir . . .”
“Delete it!”
“Sir?”
“I said delete it!” Before I could thoughtclick the controls, though, he did it for me. The image on the viewall winked out.
“Get the hell out of my sick bay, mister! You’re confined to your quarters until further notice!”
“Aye, aye, sir.” There was nothing else I could say or do. I turned on my heel and walked out of the compartment, making my way back to my berthing compartment.
I was in a pretty foul mood by the time I got there. The sheer . . . injustice of it all was mind-numbing. And here I was on report for the second time in less than two weeks. This was going to look like hell on my personnel record.
“Hey, E-Car?” It was Dubois, calling on my in-head. Less than an hour had passed since Kirchner had thrown me out of sick bay. “What gives? I just heard some scuttlebutt . . .”
Scuttlebutt—shipboard rumor. A form of faster-than-light travel that actually surpasses the theoretical top velocity of the Alcubierre Drive by a factor of at least ten.
“You heard right,” I told him.
“What the hell happened?”
I told him.
“Well that sucks,” he said. “For what it’s worth, I think you did the right thing.”
I sighed. “At this point, Doob, right and wrong don’t count for a hell of a lot. How’s Pollard?”
“In the CC rack, wired up the wazoo. Head elevated to help drain the excess fluid out of his skull. I think they’re going to put in a microtube and draw it out.”
“What about his spine?”
“We did an x-ray on the rack. Nothing.”
I sagged inside. It wasn’t that I’d wanted them to find a fractured vertebrae . . . but it might have justified my decision.
The hell of it was, I knew that Kirchner was right about one thing. Every time you move a patient—from deck to stretcher back in the berthing compartment, from stretcher to STS table, from table back to stretcher, from stretcher to Rack One—you add to the risk, and the less you have to move him the better. The skull fracture was bad enough; a bad jostle at any point in the evolution could have further injured Pollard’s brain.
And if his back had been broken—even just a hairline fracture—a bit of awkwardness in any one of the patient transfers could have pulled his spine apart and torn the spinal cord. We can reconnect major nerves, of course, but it’s not something you want to have to do, especially in a small exploration vessel with limited medical resources. That sort of surgery is best carried out in a major med facility, like Bethesda or San Antonio.
“Don’t worry, E-Car,” Doob told me. “It’ll work out okay.”
I wasn’t so sure of that. “Listen, Doob, watch out for Kirchner. He’s . . . hell, I don’t know what his problem is, but he’s not acting rational.”
“So what else is new? He’s
been on all our cases. Machine is about ready to jump ship, I think. Shit . . . they’re calling me. Gotta go.”
The connection cut off.
I checked the time—just before 2100. I wondered what Doob and Machine were doing in sick bay when they didn’t have the duty . . . then decided that Kirchner must have called one of them in to cover for me.
Fuck it. They would sort it out without me.
But what was Kirchner’s problem, anyway? Was he just a class-A asshole . . . or was he under some kind of stress? In the Navy—even in the Medical Corps, which is its own, private little navy of its own—you don’t often think about what sort of pressure your department heads or senior officers might be under. An ancient adage has it that shit rolls downhill . . . which means that when the captain is unhappy, he makes his exec unhappy, who makes the department heads unhappy, and eventually all of that unhappiness makes it all the way down to the enlisted guy pushing the broom. We don’t have push brooms any longer, not when we have robots for keeping things tidy and filters to keep out the dust, but you get the idea.
Who was dumping enough shit on Kirchner that he felt it necessary to send some my way?
Well, maybe that was just life in the Navy, a natural consequence of rank and responsibility. It would have been nice, though, if I’d had someone to kick.
I turned in early, and crawled out of my tube at reveille. Bruce Tomacek was nice enough to bring me a plate of breakfast up from the mess hall. It sounded as though my disagreement with the ship’s doctor was now the chief topic of discussion on board the ship.
“We’re with you on this one, Doc,” he said. “We know you were looking out for Polly.”
“Well, win a few, lose a few,” I replied, shrugging. “Sometimes we screw up.”
One difficulty with medicine is that there very rarely is a clear-cut right or wrong. Oh, sure, you can be wrong with a diagnosis or read a blood type wrong, or you can do something so blindingly right that everyone thinks you’re working miracles. It happens.
But nine times out of ten, whatever symptoms your patient is showing are not going to be textbook. Okay, so you spotted the broken leg right off . . . but maybe his pain was masking another pain where his rib punctured his spleen. Or you treat the skull fracture but miss the broken neck. Or—and this is the one I really hate—you’re confronted by a half dozen minor symptoms that let you know something is definitely wrong, but those symptoms could point to damn near anything. Allergic reaction, poisoning, AIDS or a similar autoimmune breakdown, lyme disease, varicella-zoster virus, erythema, roseola, angioedema, lupus, or just a bad rash—all of them and many others can show the same collection of vague symptoms, especially early on.
“Bullshit, Doc,” Tomacek said. “Kirchner is nuts. You see that look in his eyes?”
I decided it was best if I didn’t let myself get drawn into that sort of talk. “Kirchner knows his shit,” I said. “He’s been a doctor for longer than I’ve been alive. But thanks, man. I appreciate the vote of confidence.”
I got a call from Captain Summerlee’s office a couple of hours later, telling me to report for mast.
Janice Summerlee’s rank was commander, but she was skipper of the Haldane and her title always was Captain. I’d wondered at first if I would be going up in front of Lieutenant Kemmerer. She was the CO of the Marines, and technically in charge of all Fleet Marine Force personnel on board, which included us.
A Marine lieutenant, though, is lower in rank than a Navy lieutenant; it’s the equivalent of a Navy lieutenant junior grade, or “JG,” which isn’t normally a command rank. Kirchner outranked Kemmerer by two grades, but he couldn’t hold mast for me because he was the one filing the report.
Ultimately, though, the ship’s captain is the one to adjudicate all legal problems, and she outranked Kirchner. So I chimed her door, heard her say “Come,” and walked in.
Kirchner wasn’t there. That surprised me. I’d figured he would be there to put the boot in, as it were. “HM2 Carlyle, reporting for mast, as ordered, ma’am.”
“Stand at ease, Carlyle.” She gave me a sharp look up and down. “You seem to be making a habit of coming to captain’s mast.”
“That certainly was not my intent, ma’am.”
“I suppose not. Dr. Kirchner says you disobeyed explicit orders in the handling of a patient last night. What do you have to say about that?”
Well, what could I say? Dr. Kirchner was an officer and a doctor and I was a mere petty officer second class . . . the equivalent of a sergeant in the Marines or Army. If it came down to his word against mine in an argument over medical procedure or diagnosis, guess who was going to win?
And if I criticized Kirchner in any way, or tried to point out that he’d been acting strangely since he’d come aboard, or called him an asshole or even just said something snarky about how I didn’t know what his problem was, it was certain to rebound back against me. I would be the one with the attitude problem . . . or the one who thought he knew it all.
“I don’t know what to say, Captain,” I replied. “I did disobey an order, but I was worried about missing a spinal fracture. I was trained to . . . well, if a guy falls on his head, you always check for spinal injury along with the obvious head trauma.”
“And Dr. Kirchner didn’t do this?”
I grimaced. “You can use the CC rack to get X-rays of the patient, ma’am. But there’s a chance of missing something. You have a much better chance of seeing it on the soft-tissue scan.”
“So you were second-guessing the doctor.”
I could see which way this was going. “Yes, ma’am. No excuse, ma’am.”
“Why?”
“Ma’am . . . when a patient has a serious head injury—especially if he falls on his head, or is in a serious accident—you always assume there’s a C-spine injury as well, until you can rule it out. Always.”
“But as I understand it, Dr. Kirchner was making that assumption. He didn’t want you risking that additional patient transfer onto the scan table, and then from there to the critical-care rack, which did have the diagnostic equipment required to determine if Pollard had a spinal injury.”
There are very rarely clear-cut situations in emergency medicine.
“That’s . . . that’s correct, ma’am.”
What, I wondered, was Summerlee going to do to me? I was already confined to quarters—which essentially meant the ship. She might extend the extra duty, which was pretty much a joke to begin with since I didn’t have much else to do. Or she might write me up with a recommendation for further disciplinary action when we got back to Earth. Or . . .
Her office door chimed. “What is it? I’m busy!”
The door opened and Chief Garner came in. “Captain? I’ve got something you ought to see.”
“About this case?”
“Yes, ma’am. May I?”
She nodded, and Garner looked at the captain’s viewall, which switched on with his thoughtclick. Pollard’s three-D STS image came up on the bulkhead, eerily translucent, rotating in space.
“Those images were deleted!” I said. “I watched Kirchner do it!”
“Doctor Kirchner,” Summerlee said, stressing the title.
“Yes, ma’am.”
“The doctor deleted the images from the table,” Garner said, “but there’s always a record with the AI that runs the medical-imaging systems.”
True. But it was also true that to get at those records, you needed special authorization. Kirchner—sorry, Dr. Kirchner—could have given it, though that hardly seemed likely. Captain Summerlee could have ordered it, but she obviously was as surprised by Garner’s arrival as I was. Fleet Command or a medical review board could have given the necessary authorization . . . but they were light years away, now, and even if there was such a thing as faster-than-light radio,
we were wrapped up inside our Alcubierre warp bubble, in effect barricaded inside our own private universe.
Garner was steering the viewpoint on the image in toward the side of Pollard’s neck, which grew so huge against the viewall that all we could see were his cervical vertebrae, neatly interlocked and protecting the all-important spinal cord within. The image continued to expand until we were looking at a pair of vertebrae, one atop the other, now stretching across three meters of space and still expanding slowly.
“There,” Garner said. “You see it, ma’am?”
“I’m not sure what I’m looking at.”
“C6, the sixth cervical vertebra down from the spine.” He touched the back of his neck, right above his shoulders. “Just about here.” A hair-thin line appeared in the bone, highlighted by the imaging program. “That is a hairline compression fracture, ma’am. And if you’ll notice, the entire vertebra is very slightly out of line with the one above, with C5. See how it’s pushed forward a bit? The medical term is spondylolisthesis, the forward slippage of one vertebra over another.”
The bone faded away, revealing a slender trunk of tissue hidden inside, with branches extending out and down.
“No damage to the spinal cord, thank God,” Garner said. “But the slippage was putting some pressure on the nerves just about here. See the swelling? Any movement at all and that fracture could have split and shifted.”
“And that would have killed him?”
“That, or it would have left him paralyzed from the neck down. That we could have fixed, once we got him back to a big hospital Earthside. But, yeah, it could also have killed him, at least temporarily. Pollard had a CAPTR program on file—all of the Marines do—so we could have downloaded his backup once we repaired his body, but, well—”
“But it’s not the same. I know.”
Summerlee didn’t say it, but I could feel her thinking the unpleasant word. Zombie.
The bone faded back into view on the screen, the minute fracture again visible. “So, would this have shown up on X-rays?”