Castaway Resolution

by Eric Flint

  “Concur,” Pearce said, her voice strained; seeing the damage—and, probably, cutting into Whips this deeply—was putting her under pressure too. “Vitals still stable, blood circulation still at seventy-seven, circulation pulse fourteen per minute, internal temperature at thirty-eight point four.”

  Laura grimaced. Reducing Whips’ internal temperature significantly—say, to about the current air temperature of twenty-nine Celsius—would have drastically reduced Whips’ demand for oxygen, slowed his blood flow, and reduced possible operative bleeding. When he had just been suspended, that had been his body temperature. But I can’t devote so much nanosupport to keeping his metabolism shut down, not now. They needed to be able to observe his responses to the operations, and such nanosuppression would interfere in those responses.

  “Sheath around artery allows damaged edges to be brought into contact with minimal to no tension.” Relief went through her; she didn’t want to patch or splice if she could help it. “Commencing suturing of primary inlet filtration artery using nanoenhanced dissolving sutures.” She carefully stitched the artery back together, then repaired the sheath, ensuring there was nanosupport to keep the sheath smooth around the artery as it healed.

  Over the next hour she managed to repair all the other significant veins and arteries that had been damaged in the Sutter Organ, systematically working out from the deepest parts of the fissures, repairing the blood vessels and then pulling together the organ’s tissues with both sutures and carefully spaced dots of fleshbond. Pearce had kept the pace going smoothly, handing her each tool or material as needed, controlling the flow of blood substitute, and monitoring the vitals.

  Finally Laura sat back and sighed, stretching up. “Repair of Sutter Organ complete. Nanomonitoring shows blood flow is beginning to return to previously-severed portions. Preliminary indications are therefore cautiously positive.”

  “So far so good,” Pearce said.

  “Next we do the plexus repair. God, I hate fiddling with nerves.”

  “Worse than blood vessels?”

  “Much worse. A blood vessel actually doesn’t care if you chop out part of it and replace it with a synthetic, but even today we don’t have easy synthetic nerve splices for major nerve junctions. On the positive side, the medical kit includes neurospecific repair nanos, so if I can dissect out the main nerve fibers and their associated secondaries and bring them into proper general alignment, the nanos can probably handle the rest.”

  “Ready?”

  “Yes.” She leaned back down. “McCoy’s Plexus is visible through the current incision, located a few centimeters ventrally and towards the central axis of the body from Sutter’s Organ, beginning approximately seven centimeters posterior from the rearmost portion of that organ and extending…seventeen centimeters in length. Again we see significant compression and impact damage to the organ, resulting in significant neural trauma. The ventral portion of the Plexus appears intact and unharmed, and there is sufficient functionality seen that full repair may be possible. Beginning dissection of primary neural components…”

  As she passed Laura another set of microsutures, Pearce said “Campbell’s pinged me.”

  “Hello, Sergeant,” she said, beginning the placement of the sutures.

  “Didn’t mean to interrupt—”

  “Not a problem right now, at least if it’s just talking. I’m doing a bunch of fiddly little repairs, but they’re ones I know how to do. I can talk while I work, at least right now.”

  “So it’s going all right?”

  “Fingers crossed. I’m still a long, long way from getting done, but Whips was in great shape before he was hurt and he’s still very young, so his body can handle it much better than someone older. So far, he’s stable. The Sutter Organ’s repaired as best I could manage it, and I’m making good progress on the Plexus. If those are both done, I’ll be on to some simpler work for a while. The real moment of truth is going to be working on the manifold.” To distract her from worrying about that, she went on, “How’s the work with the satellites going?”

  “Satellites?” Campbell repeated. “Oh, that. Lemme put Mel on. Melody? Your mom wants to know about the satellite work.”

  “Mom? Is Whips okay?”

  “So far, honey. So tell me about the satellites.”

  “Oh. Well…it’s working, I guess.”

  “You guess?”

  “They’re still settling in, but we’re getting images of the starfield and it looks like we can get full, pretty good res, scans of the sky around Lincoln every twenty minutes or so.”

  “You don’t sound happy about that.”

  “Oh, no, no, that’s just fine,” Melody said. “But…even with the best metamaterials enhancing things and the multi-imager base design that gets built into all of them, the effective aperture’s about seventy-five centimeters. We’ll be able to see some stuff coming, but…”

  “But?”

  She sighed. “A lot of stuff that could do us real damage is still going to be too small to see. We’ll probably spot big things coming, but not ones only a few dozen meters across…which are still awfully big if you’re asking what kind of an impact event we’d want to avoid. Really big things…I don’t think we could do anything about them even if we wanted to. If something ten kilometers comes down anywhere on the planet we could be toast.”

  That was disappointing. But at the same time, did they really want to know if something completely lethal was on its way? “Is there any reason for us to keep the cameras looking outward, then?”

  “Probably not,” Campbell said after a moment. “We got our imagery for anyone who just wants to take a good, no-atmosphere look at the area around us, but if we can’t spot the stuff we wanted to, no point in keeping them pointed out. We can always make use of the planetside images for forecasts, navigation, that kind of thing.”

  “Okay,” Mel said. “I guess we’ll start turning them back, then.”

  “It was worth a shot, Melody. Still good work.”

  The last of the nerve sutures were in place. Thank God. She filled in the entire area with the neurorepair nanogel, then began the much more straightforward work of closing up the incision. “Repair of McCoy’s Organ complete,” she said.

  The day continued. Momentary breaks for water or a bite of food were interspersed with painstaking, sometimes arm-strainingly difficult work. Pulling muscles and ligaments together that belonged to a creature six times your own size was challenging work, to say the least. Her narrations continued, dryly describing the horrific damage—a main skeletal plate broken in half, ligaments torn from their anchors, split muscle tissue, damaged interior veins leaking blood within the abdominal cavity, a mangled eye that had to be repaired, sealed, then injected with sterile fluid to re-inflate it—as she tried to stay detached and work to fix each of them.

  Finally there was only one thing left. “Doc—Doctor Kimei. Do you really want to do this now? He seems able to breathe all right in air. Couldn’t we just keep him out of the water until he finishes healing everything else, then fix this when he’s as strong as can be?”

  “I really wish we could, Pearce. I’ve been trying to convince myself to do that as I’ve been working. But…no. It’s one organ, not two separate ones, though it does have separate working surfaces. That means, though, that the damaged surface is still connected to the other, and if he even accidentally tries opening the other—which they sometimes do, the equivalent of a human yawning—it’ll start hemorrhaging everywhere, and the damage might even start propagating across the whole surface. Also, damaged the way it was, we might have some kind of infection set in; some of the nanoreports from the area aren’t encouraging.”

  “So what’s the plan?”

  “We’ll have to clamp off the respiratory vessels, here, here, and here.” She indicated the points on the displayed virtual model in both her and Pearce’s omnis. “Once that’s done, Whips is getting no oxygen intake. Start the oxygen supplement drip now, I wa
nt his body as saturated with it as possible before we start.”

  “Got it.” Laura backed away from Whips’ still form, reached to a nearby table and poured herself a cup of water, drained it in a swallow, poured and drank another while Pearce hooked up the bag and made sure the infusion was working properly. Taking a deep breath after drinking, Laura could smell her own sweat, the sharp tang of Bemmie blood, the earthier undertones from the organs still hanging in the air despite the efforts of the air filters in the shelter. She grabbed a few hedrals from the bowl on the table, chewed and swallowed the tangy fruit, then pulled her mask back on.

  “Without the blood pressure and flow, I’ll be able to separate the layers of manifold, clean them, suture the major damage, and place a coating of nanorepair on each layer.” What she didn’t say—because there wasn’t much point in saying it—was that there were twenty-one separate layers of manifold. In the hour that black-marked bag would give her, Laura would have just slightly less than three minutes to locate and suture any injury to each layer, or she’d be running into Whips’ own reserves. And not too long after that, Whips wouldn’t have enough reserve left for the repairs to make any difference.

  But Pearce had apparently looked carefully at the anatomy of a Bemmie—as might have been expected. She took a breath, then glanced between Whips and Laura. “Laura, there’s so much work to do in that time…why do we have to do it all so fast? Couldn’t you repair a couple sections of the manifold, release the clamps and let him breathe a bit, and then repeat? This is going to be such a touch-and-go thing…I know there’s probably a reason, but I’d feel stupid if I didn’t ask.”

  Laura smiled, or tried to; she suspected the result wasn’t very convincing. “You’re right to ask the question. The reason? If the manifold isn’t properly installed inside its enclosing membrane and the fascia that keep it tight and stable, it will swell up like a balloon once blood pressure comes back up. That would of course strain or tear out any repairs I’ve made and would damage the manifold itself directly. That’s actually one of the more common life-threatening conditions that Bemmies get as they age, a ‘manifold aneurysm’; a weakening or tear in the membrane allowing part of the membrane to escape, swell up, and burst.”

  “That’s…frightening.”

  “It is. A potentially very painful way to die. The problem is complicated by the fact that the membrane, while very tough with respect to confining stretching, is not terribly strong if cut, so any damage I do to the membrane I will have to repair very carefully, and the membrane is fairly complicated in structure. The manifold itself is very delicate; it is a soft, complex structure of blood vessels, mostly at the capillary level, and very convoluted soft tissue structures for gas exchange. Any handling of the manifold has a strong potential to damage it.

  “If I tried to do this in stages, I would have to—each time we wished to give Whips a break to breathe—carefully restore the manifold to the membrane, handling it in the process, then carefully seal the membrane, then seal the fascia, then remove the clamps, let Whips breathe, then rip out the seal or sutures on the fascia, do the same to the membrane, then pull out the manifold again and, effectively, page through the layers to reach the next one I was going to work on.”

  Pearce nodded, face sober. “Each repetition would make it more likely you would do more damage than you’d repaired.”

  “Exactly.” She sighed. “So this is the way it has to be done.”

  She checked her own vitals, tweaked her nanos to improve alertness. A little stimulant wouldn’t hurt for a few hours, and she needed to be at the absolute top of her game for this. “Are you ready, Pearce?”

  “Hold on.” The redheaded woman copied Laura’s own little break, getting water and some fruit sugars into her to give her body the resources needed for this final run.

  Finally the mask was back in place and the green eyes met hers. “Let’s do it.”

  “Move the cradle up.” The cradle was a structure that fit over the top, or dorsal, ridge of Whips’ body, conforming well to the ridge outline and with long, strong leather straps connecting the wooden portions and lying flat on Whips’ surface. Laura thought that it looked rather like the inverted skeleton of a boat, the keel at the top of Whips’ dorsal ridge and the ribs that would hold the hull curving to hold Whips’ body snugly.

  Attached to the “keel” were flat, T-shaped braces that would allow the whole structure to be stable when Whips was upside-down; curved pieces like rockers projected from one side of the braces, to make it easy to roll the whole thing—Whips included—to that inverted position. Two of the rockers—the ones on the far ends—also had straight extensions that became handles, to aid in lifting and rolling the very heavy creature over. To make sure Whips didn’t fall out when they rolled it, Laura and Pearce slid wide leather straps beneath him and fastened them to the ribs.

  “Beginning procedure to repair oxygen exchange manifold,” Laura said, then took another deep breath. “Subject must now be turned onto his dorsal ridge to allow access to the manifold through the ventral pad surface.”

  They first moved the IV as far as they could in the direction Whips would be rolled. Then both Laura and Pearce pushed and lifted in a single motion.

  The curved sections of the cradle hit the floor as Whips’ body rolled, and helped keep it rolling easily until it came to rest on the flat sections of the “T” shaped pieces. Whips’ long, triangular-cross-section body was now cradled by the structure, kept stable and still even though he now hung with his dorsal ridge straight down.

  “So far so good,” Laura said, breathing somewhat harder with the effort. Whips weighed several times what either of the women did, but the cradle had worked.

  “Vitals shifting! Pressure is down!”

  God, no!

  An immediate check didn’t show any sudden change in his injuries, but then Laura suddenly understood. The body was trying to respond to the inversion, revising the flow of blood under these unusual circumstances, but under nanoanesthesia wasn’t able to perform properly.

  “What do I do, Laura?” Pearce said, voice tense.

  “We’ll have to risk some other stress. Give me two CCs of emergenine.”

  The Bemmie stimulant caused the pressure to waver crazily for a moment, setting off alarms on the monitors and in Laura’s gut. If it stimulates the wrong parts, or triggers bleeding or spasms…

  But slowly Whips’ vitals smoothed out. Pearce breathed a long, shaky sigh of relief; Laura did the same, then turned back to her patient.

  She checked the Bemmie carefully. “All external sutures appear not to have been over-strained. Nanotelemetry does not show any damage to previous repairs. Vitals are now stable. Procedure will continue.”

  She looked down at the belly pad, scrubbed it carefully with more alcohol, and then nodded to Pearce. “Scalpel. Beginning dissection of anterior air/water intake, exterior to manifold.”

  She made a long incision to give her plenty of space to work. Clean, straight cuts were not going to be a problem; working in cramped quarters that might slow her down would be. Pearce didn’t need to be asked to apply suction to remove the upwelling blood. “The feeder veins and supply artery are now visible. Applying clamps to all three blood vessels.” The clamps gripped well and nano data indicated that blood flow had been halted. “Begin one-hour countdown for oxygen supplement. Beginning dissection of the manifold.”

  She cut through the fascia that protected and assisted the breathing organ in smooth, flexible movement. Something like a squashed-together L-shaped accordion, the oxygen exchange manifold became visible as she pulled the manifold fascia aside.

  “Air-water shunt is severely damaged and will require repair,” she began. “This will be performed after current procedure as it can be done without clamping the blood supply. Trauma is immediately visible on the ventral lobe of the manifold,” she said. Her dispassionate voice was belied by her wince at the sight. “A red-brown discoloration approximately thirty
centimeters in length and ten in width is seen, roughly centered on the exterior surface of the lobe. No trauma appears to have extended to the vertical lateral lobe. Nanotelemetry indicates the insult to the lobe extends a considerable distance through the layers.”

  With trepidation she began the dissection of the lower lobe, considerably larger than the lateral lobe. “Damn,” she said, before returning to the dispassionate narration. “Injury has produced tears through the layers of manifold. Each tear must be sutured. Beginning suturing of first layer.”

  It took her seven minutes to complete the suturing of the first layer. “There are indications of early stages of infection in the injured tissues. Treating with antibiotic nanospray and continuing.”

  The tears were slightly smaller on the second layer, and she was getting the hang of the precise motions needed to sew the thin, delicate, capillary-heavy tissue together; even so, it was nearly six more minutes. Thirteen minutes…fifteen, really, counting the dissection time. A quarter of the time used and I’ve got one-tenth the work done!

  She shoved the intrusive worry from her mind. Rushing would do Whips no good either; the repair work had to be done right or it would be disastrous. “Applying antibiotic nanospray, beginning third layer.”

  Another nearly six minutes, and the thoughts were harder to banish. She caught Pearce’s worried glance, shook her head, then moved on. “Fourth layer. Damage appears to cover a somewhat smaller extent…”

  That one took only four minutes, but she was still falling behind. Approaching half the time gone, and only about a fifth of the way to finishing.