Mrs. Moore guessed, “He has trouble . . . seeing?”
“That’s how it’s usually detected,” Susan said. “Hypoplasia is when things in the body don’t develop to their full potential. Kids with ONH are often blind. Most have poorer than normal vision; but a few, like Dallas, have normal or nearly normal vision. His optic nerves are smaller and thinner than usual, but they work just fine. The best part is the damage is done before birth. So, we have no reason to believe Dallas’ vision will get any worse.”
Susan gave the Moores time to digest this information.
After several moments of dense silence, Mr. Moore finally spoke again, “So, how does this apply to Dallas?”
Susan anticipated the question. “As I said, ONH is nearly always diagnosed by ophthalmologists because of vision problems. Ophthalmologists know children with ONH often also have problems with the hypothalamus. The lucky ones with normal vision, like Dallas, fall through the cracks. They present with the hypothalamic symptoms first, and they become extremely difficult to diagnose.” She hoped this would help the Moores understand why medical science had, thus far, failed them.
Mr. Moore still worked to grasp the greater significance of the syndrome. “So . . . Dallas’ obsession with food is not obsessive-compulsive or oppositional. And his depression?”
Susan thought she had a reasonable understanding of the situation based on talking to Diesel and reading the charts and the nursing notes throughout his hospital stay. “Oh, he’s depressed, all right. Deeply and severely. Among many other things, the hypothalamus regulates mood, and people with disturbances in hypothalamic function have Moods, with a capital M. Their highs are higher, their lows subbasement, their anger —”
“Volcanic,” Mrs. Moore supplied.
“Yes.” Susan felt certain they had experienced many of Diesel’s explosions, probably since infancy. “Now, imagine you’re hungry all the time, day and night. You’re driven to eat. Tens of thousands of calories every day don’t satisfy your belly because, no matter how full your gut, your brain keeps telling you to eat or die.”
Mrs. Moore put her hands to her face. “Dallas feels like that?”
Susan did not answer, needing to continue her scenario until she made a specific point. “But you’re constantly being told that taking food is greedy and disgusting, and that fat people are undisciplined slobs. But you need that food every bit as much as you need air. So you start to sneak it, to steal it, to hide it, which only brings down more anger and humiliation. Any moral child would come to believe himself” — she used Diesel’s own words — “a monster. And hating oneself is the very definition of depression.”
Mr. Moore sat in thoughtful silence, rocking ever so slightly. Tears formed in Mrs. Moore’s eyes. “They told us he was just being . . . oppositional. Defiant. Fighting us for control.”
Mrs. Moore’s voice quavered. “One doctor said we didn’t love him enough. That he ate to fill the void.”
“Nonsense,” Susan reassured them.
Mr. Moore turned entirely practical. “So, what do we do?”
Susan had a plan all worked out for them. “First, we get you hooked up with an endocrinologist. I’m willing to bet Dallas would benefit from growth hormone and thyroid hormone replacement. He may need testosterone to go through puberty; and, even then, I should warn you he will probably be infertile.” Susan gave them time to process that information. Eventually, they would likely realize it did not matter. Given his severe lifelong problems with food, Diesel would never have the wherewithal to handle children of his own.
“Next, we hook you up with a security company that can go through your entire house and figure out how to secure any and all food-containing areas. You will need dependable locks on the freezer, refrigerator, garbage cans, and cabinets. Better yet, if you have an enclosed kitchen, lock the whole thing. We will have to work with the school as well and realize children with hypothalamic forms of obesity will take food wherever they can get it: stores, vending machines, other people’s plates, floor sweepings, dog food bowls.”
The Moores started talking at once, comparing memories of times when Diesel had raided places they never expected and had eaten items most people would never touch.
Susan let them converse. She had given them a whole new perspective on their son, and it would require them to turn their lives, and those of his siblings, upside down. Most people did not realize just how important and central a role food played in every social aspect of life until it became a problem.
When the Moores seemed ready, Susan continued. “Dallas will feel most secure when he has no personal access to food, when people he trusts fully control his access to it. If he tests the locks and finds them wanting, he will continue to work on them anxiously. If he tries and fails, he will become a much calmer person knowing his life, and his appetite, are controlled by a higher authority: his parents and doctors. We will make him up a diet and stick by it rigidly. Dallas must know he will be fed, at regular times and in predictable and consistent amounts. Food can never be used as reward or punishment, nor can it be present anywhere he is expected to concentrate.”
“And when he does steal food again?” The mother’s question left no doubt it would happen.
Susan shrugged. “We understand it’s caused by biology, not disobedience. Talk about the incident in the context of keeping him safe and healthy rather than as a terrible or criminal act. You may need to involve other people: neighbors, his friends’ parents, your church, and, of course, the school. Dallas may need a full-time aide to watch him if all of you together can’t keep him safe.”
Susan knew the parents needed time to process the vast amount of information she had dropped on them. “You can stay here as long as you want. When you’re ready to leave, let the nurses know so they can unlock the doors. By then, you may have more questions. Don’t hesitate to ask for me, Susan Calvin.” She turned to leave, stopped by another question from Diesel’s father.
“Dallas will come home soon?”
Susan turned back to face them again. “As soon as Endocrinology sees him, a dietitian writes a plan, and your home is secured. We will begin the transition immediately. When we change our approach to him, I believe he will respond quickly. In the meantime, we need to have your house and family fully prepared.” With that, Susan headed out of the room and down the hallway, preparing for the rest of her day. During rounds, she had outlined her plans for Diesel, and the nurses had shown support. Susan had already spoken with Diesel, preparing him for the many changes. No longer would anyone berate his willpower or damn him for stealing food; those things would not work. From now on, they would become a team, working together to find ways to make his difficult life longer and better.
Mr. Moore called down the hallway. “One more thing, Dr. Calvin.”
Hand on the locked door to the unit, Susan turned.
“We’ll need someone to coordinate all his care, someone he knows and likes. Would you do that for us?”
Susan thought the job better handled by a general pediatrician, but she recognized the honor inherent in the question. She had found the answer so many others had missed, and they trusted her. Dallas was her first breakthrough, special for that as well as all his other issues. On a more selfish level, she realized she needed to know what happened to him from this point on. “I’d be thrilled,” she replied.
Chapter 7
Susan chose to lunch alone, heading to the hidden charting room that had served as her on-call hideaway. She took her lunch and her palm-pross, dropping them on the central table in the cozy nook, but her real reason for coming was to find Nate. She sank into one of the unmatched chairs and opened her reusable lunch sack. Her father had packed her favorite: peanut butter on twelve-grain bread. She removed it from its container, took a bite, and chewed thoughtfully, studying the modular shelving, the well-worn textbooks, the computer-processing units, and the plastic storage boxes.
Susan had nearly finished her sandwich, her le
gs flopped over the arm of her chair, when Nate finally arrived, his tread light and his footsteps nearly silent on the tiled floor. When his gaze fell on her, he stopped, and a welcoming grin split his face. “Dr. Susan Calvin.”
Susan sat up properly in her chair. “Robot N8-C.”
“Call me Nate.”
“Only if you call me Susan.”
“Deal.”
For the second time in two days, Susan studied the robot. He still looked like nothing other than a tall, male human. He might have gears inside, but they did not stutter and whir. If anything, he seemed more graceful, more easily gliding than most humans. “Nate, can you sit for a little while? Do you have some time to talk?”
“I do.” Nate chose the chair catty-corner to Susan’s.
It amazed her how human that action seemed. Most people would have selected the exact same spot, comfortably close for conversation but not violating any personal space. Nothing about him suggested mechanization. Had he not told her, had her father not confirmed it, she would never have known his true nature. “Would you answer a hypothetical question for me?”
Nate spread his hands and nodded, clearly trying to calculate a purpose that had not yet become obvious. “If you wish.”
Susan leaned forward. “Let’s say a fire broke out in a chemical factory with one man trapped inside. Based on the last-known location of the man, and the composition of the fire, he is certainly dead. You also know exposure to the particular heated chemicals involved would destroy your circuitry. You’re told to go in and rescue the man. What do you do?”
Nate laughed. “Someone just learned about the Three Laws of Robotics.”
Caught, Susan could only join the laughter. “Indeed. So, what do you do?”
“Hypothetically.”
“Of course.”
Nate sat back with a sigh of consideration. “It would greatly depend on the specifics of the situation. The Laws have a balance that can actually push Number Two ahead of Number One or Number Three ahead of Number Two in certain situations. It’s not as black and white as the wording might, at first, seem.”
Susan continued to smile. She had been right.
Nate went on. “If I knew for a fact the man inside was alone and dead, Law Number One no longer takes priority. The issue of a human coming to harm from my actions or inactivity becomes moot.”
Susan nodded.
“Law Number Two commands me to obey all orders given by human beings. In your scenario, I’ve been ordered to rescue the man, presumably by a human being. If I know the man is dead, then the command becomes nonsensical; and, therefore, I am no longer obligated to follow it. In that case, Law Number Three comes into effect, and I must protect my own existence. So, assuming all the facts you and I presented, I would not enter the burning chemical factory.”
Susan had surmised as much when she had discussed it with her father.
“However,” Nate added, “if I had any reason to believe the man inside might still be alive, or another human being might be in danger, Law Number One would override all the others. With or without the command, I would do whatever I could to rescue those humans, even if it led to my own destruction.”
Susan liked that she could predict Nate’s actions, and she wished humans were that easy to read.
“Now let me add something to your scenario that might surprise you.”
Susan became all ears. This, she had not anticipated. “All right.”
“Let’s say I heard meowing coming from that burning factory and saw a girl crying and calling for her Fluffy. Then, I would also go inside.”
Susan paused in uncertainty. “To save a cat?”
“Yes.”
Susan tried to guess the reason. “Because . . . if the cat survived . . . the man might . . . also —”
“No.” Nate did not allow her to finish. “We’re still assuming the man is definitely dead.”
“The cat . . . ,” Susan started, then stopped. “The cat is not a human being. Law Number One says nothing about animals.”
“True.” Nate met Susan’s gaze directly. His brown eyes looked placidly into hers, so very real, so human. “But the girl is. Losing her cat would harm her emotionally. And so, by Law Number One, I’m driven to save it at risk to my own existence.”
Excitement thrilled through Susan, and she could do nothing more than stare. Instinctively, she had known the Three Laws of Robotics would not prove as solid and obvious as they originally seemed. However, she had not expected to discover such critical and expressive thinking from a robot. Her father had not given this positronic brain concept the credit it deserved. Clearly, robots did not just think and learn. Nate had applied logic to circumstances to account, not only for facts in evidence, but for complex human emotions. Susan knew more than a few living, breathing people with a lesser grasp of empathy than Nate. “Wow.” She could think of nothing else to say.
Nate straightened his dress khakis, then ran a hand through his short hair. He had gestures and mannerisms that made him seem all the more alive. “Are we finished, Susan?”
Susan met Nate’s gaze again, the remainder of her lunch forgotten. “Do you have a few more minutes?”
“A few.” Nate remained in his chair. “Do you have more hypotheticals?”
Susan sighed and straightened her own clothing. “Actually, this is a real situation. I have a patient who had brain surgery performed by a man they call ‘one of the greatest neurosurgeons in the world.’”
“Dr. Sudhish Mandar,” Nate filled in.
Startled again, Susan managed only a “yes.” Then, “Do you know him?”
“If you asked him, he’d say the greatest, not just one of a group at the top.” Nate planted both arms on the armrests of his chair, gripping the ends in his hands. “You should know that, although I have read all those books” — he gestured vaguely toward the shelves — “I am not considered a medical expert.”
Susan’s attention followed Nate’s motion. If he had read every book on those shelves, and retained even a quarter of it, he had as much knowledge as most physicians. “It’s not a medical question. It’s . . . moral.”
“Moral? And you’re asking me? Morality is a human construct.”
Susan disagreed. The Three Laws inflicted an honor on the robot that humans might not appreciate, even if they recognized it. “Nevertheless, I’d like your opinion.”
“Okay.” Nate settled back into his chair.
“The neurosurgeon has declared the surgery a success and no longer looks after the patient. For months, she was believed to have dementia” — Susan looked up to see if she needed to define the word; Nate waved her on — “due to presurgical swelling of the brain because of the initial problem or damage to the brain tissue during the surgery.”
Nate continued to nod his understanding.
Susan downplayed her role in the upcoming information. “Yesterday, we discovered this young girl’s dementia is actually due to heart failure. The cardiologists put her on medicine to help control it, and her mental status is clearing.”
Nate smiled. “That’s good news. Right?”
“Well, yes.” Susan gave a less than enthusiastic response. “Except they had to put her on very high doses of serious medications, and it’s only helping to keep the problem in check. It’s not a cure. My concern is the condition will soon overcome the medications; and, not only will the dementia return, but the heart failure will worsen.”
“And she’ll die?” Nate guessed.
“Eventually.” Susan knew a young, strong body had ways of compensating for congestive heart failure. Starling Woodruff’s already had, or it would have been discovered sooner. “She can probably go home, but she can’t live anything approaching a normal life until we fix the underlying problem causing the heart failure.”
“Which is?” Nate prodded.
Susan shook her head. “We don’t actually know. Heart failure occurs when the heart can no longer meet the metabolic demands of the bo
dy at normal venous pressure. A lot of things can cause it.” A huge list ran through Susan’s head. “Most of those have to do with the heart itself or the large vessels that pump blood to and from it. But the cardiologists have examined her heart and vessels with every scanner known to modern medicine. The heart’s electrical systems and tissues, its valves and chambers are normal. The large vessels have no abnormalities. There’s no big, honking tumor sitting in or near it.”
“And the other causes?”
Susan’s head did not stop moving. “Simple blood tests. She isn’t anemic. Her endocrine system and kidneys function normally. Her blood pressure is fine.”
“So the reason for her heart failure is?”
Susan still shook her head.
“You know, Dr. Susan Calvin. Don’t you?”
Susan’s head finally stopped moving. She bit her lower lip. “I believe I do.”
“And?”
Everyone else, including the cardiologists and her own attending, had dismissed her idea; but nothing else made sense. She wondered what Nate would think, especially in light of his reading those books. “The initial abnormality in her brain is called an arteriovenous fistula. In Starling’s case, it was congenital, meaning she had it at birth.”
Nate nodded his understanding.
“Normally, blood with oxygen in it flows from arteries to capillaries. The capillaries give the oxygen to all the tissues of our bodies, and the now-deoxygenated blood flows into the veins and goes back to the heart, then to the lungs, for more oxygen. With an A-V fistula, the blood flows right from an artery into a vein, bypassing the capillaries.”
Nate was clearly still following.
“Vein walls aren’t meant for the high-pressure flow of arteries, so the vein wall stretches. Blood pools in the stretched area, making it bigger. If it’s big enough, blood pressure falls. The heart has to pump harder to make up for it, and congestive heart failure can develop.”
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