Star Surgeon

by Alan Edward Nourse

  CHAPTER 13

  THE TRIAL

  Red Doctor Dal Timgar knew at once that there would be no problem indiagnosis here. The Black Doctor slumped back in his seat, gasping forair, his face twisted in pain as he labored just to keep on breathing.Tiger and Jack burst into the room, and Dal could tell that they knewinstantly what had happened.

  "Coronary," Jack said grimly.

  Dal nodded. "The question is, just how bad."

  "Get the cardiograph in here. We'll soon see."

  But the electrocardiograph was not needed to diagnose the nature of thetrouble. All three doctors had seen the picture often enough--thesudden, massive blockage of circulation to the heart that was so commonto creatures with central circulatory pumps, the sort of catastrophicaccident which could cause irreparable crippling or sudden death withina matter of minutes.

  Tiger injected some medicine to ease the pain, and started oxygen tohelp the labored breathing, but the old man's color did not improve. Hewas too weak to talk; he just lay helplessly gasping for air as theylifted him up onto a bed. Then Jack took an electrocardiograph tracingand shook his head.

  "We'd better get word back to Hospital Earth, and fast," he saidquietly. "He just waited a little too long for that cardiac transplant,that's all. This is a bad one. Tell them we need a surgeon out here justas fast as they can move, or the Black Service is going to have a deadphysician on its hands."

  There was a sound across the room, and the Black Doctor motioned feeblyto Tiger. "The cardiogram," he gasped. "Let me see it."

  "There's nothing for you to see," Tiger said. "You mustn't do anythingto excite yourself."

  "Let me see it." Dr. Tanner took the thin strip of paper and ran itquickly through his fingers. Then he dropped it on the bed and lay hishead back hopelessly. "Too late," he said, so softly they could hardlyhear him. "Too late for help now."

  Tiger checked his blood pressure and listened to his heart. "It willonly take a few hours to get help," he said. "You rest and sleep now.There's plenty of time."

  He joined Dal and Jack in the corridor. "I'm afraid he's right, thistime," he said. "The damage is severe, and he hasn't the strength tohold out very long. He might last long enough for a surgeon andoperating team to get here, but I doubt it. We'd better get the wordoff."

  A few moments later he put the earphones aside. "It'll take six hoursfor the nearest help to get here," he said. "Maybe five and a half ifthey really crowd it. But when they get a look at that cardiogram on thescreen they'll just throw up their hands. He's got to have a transplant,nothing less, and even if we can keep him alive until a surgical teamgets here the odds are a thousand to one against his surviving thesurgery."

  "Well, he's been asking for it," Jack said. "They've been trying to gethim into the hospital for a cardiac transplant for years. Everybody'sknown that one of those towering rages would get him sooner or later."

  "Maybe he'll hold on better than we think," Dal said. "Let's watch andwait."

  But the Black Doctor was not doing well. Moment by moment he grewweaker, laboring harder for air as his blood pressure crept slowly down.Half an hour later the pain returned; Tiger took another tracing whileDal checked his venous pressure and shock level.

  As he finished, Dal felt the Black Doctor's eyes on him. "It's going tobe all right," he said. "There'll be time for help to come."

  Feebly the Black Doctor shook his head. "No time," he said. "Can't waitthat long." Dal could see the fear in the old man's eyes. His lips beganto move again as though there were something more he wanted to say; butthen his face hardened, and he turned his head away helplessly.

  Dal walked around the bed and looked down at the tracing, comparing itwith the first one that was taken. "What do you think, Tiger?"

  "It's no good. He'll never make it for five more hours."

  "What about right now?"

  Tiger shook his head. "It's a terrible surgical risk."

  "But every minute of waiting makes it worse, right?"

  "That's right."

  "Then I think we'll stop waiting," Dal said. "We have a prosthetic heartin condition for use, don't we?"

  "Of course."

  "Good. Get it ready now." It seemed as though someone else weretalking. "You'll have to be first assistant, Tiger. We'll get him ontothe heart-lung machine, and if we don't have help available by then,we'll have to try to complete the transplant. Jack, you'll giveanaesthesia, and it will be a tricky job. Try to use local blocks asmuch as you can, and have the heart-lung machine ready well in advance.We'll only have a few seconds to make the shift. Now let's get moving."

  Tiger stared at him. "Are you sure that you want to do this?"

  "I never wanted anything less in my life," Dal said fervently. "But doyou think he can survive until a Hospital Ship arrives?"

  "No."

  "Then it seems to me that I don't have any choice. You two don't need toworry. This is a surgical problem now, and I'll take fullresponsibility."

  The Black Doctor was watching him, and Dal knew he had heard theconversation. Now the old man lay helplessly as they moved about gettingthe surgical room into preparation. Jack prepared the anaesthetics,checked and rechecked the complex heart-lung machine which couldartificially support circulation and respiration at the time that thedamaged heart was separated from its great vessels. The transplantprosthetic heart had been grown in the laboratories on Hospital Earthfrom embryonic tissue; Tiger removed it from the frozen specimen lockerand brought it to normal body temperature in the special warm salinebath designed for the purpose.

  Throughout the preparations the Black Doctor lay watching, stillconscious enough to recognize what was going on, attempting from time totime to shake his head in protest but not quite succeeding. Finally Dalcame to the bedside. "Don't be afraid," he said gently to the old man."It isn't safe to try to delay until the ship from Hospital Earth canget here. Every minute we wait is counting against you. I think I canmanage the transplant if I start now. I know you don't like it, but I amthe Red Doctor in authority on this ship. If I have to order you, Iwill."

  The Black Doctor lay silent for a moment, staring at Dal. Then the fearseemed to fade from his face, and the anger disappeared. With a greateffort he moved his head to nod. "All right, son," he said softly. "Dothe best you know how."

  * * * * *

  Dal knew from the moment he made the decision to go ahead that the thinghe was undertaking was all but hopeless.

  There was little or no talk as the three doctors worked at the operatingtable. The overhead light in the ship's tiny surgery glowed brightly;the only sound in the room was the wheeze of the anaesthesia apparatus,the snap of clamps and the doctors' own quiet breathing as they workeddesperately against time.

  Dal felt as if he were in a dream, working like an automaton, goingthrough mechanical motions that seemed completely unrelated to theliving patient that lay on the operating table. In his training he hadassisted at hundreds of organ transplant operations; he himself had donedozens of cardiac transplants, with experienced surgeons assisting andguiding him until the steps of the procedure had become almost secondnature. On Hospital Earth, with the unparalleled medical facilitiesavailable there, and with well-trained teams of doctors, anaesthetistsand nurses the technique of replacing an old worn-out damaged heart witha new and healthy one had become commonplace. It posed no more threat toa patient than a simple appendectomy had posed three centuries before.

  But here in the patrol ship's operating room under emergency conditionsthere seemed little hope of success. Already the Black Doctor hadsuffered violent shock from the damage that had occurred in his heart.Already he was clinging to life by a fragile thread; the additionalshock of the surgery, of the anaesthesia and the necessary conversion tothe heart-lung machine while the delicate tissues of the new heart werefitted and sutured into place vessel by vessel was more than any patientcould be expected to survive.

  Yet Dal had known when he saw the second cardiogram tha
t the attemptwould have to be made. Now he worked swiftly, his frail body engulfed inthe voluminous surgical gown, his thin fingers working carefully withthe polished instruments. Speed and skill were all that could save theBlack Doctor now, to offer him the one chance in a thousand that he hadfor survival.

  But the speed and skill had to be Dal's. Dal knew that, and theknowledge was like a lead weight strapped to his shoulders. If BlackDoctor Hugo Tanner was fighting for his life now, Dal knew that he toowas fighting for his life--the only kind of life that he wanted, thelife of a physician.

  Black Doctor Tanner's antagonism to him as an alien, as an incompetent,as one who was unworthy to wear the collar and cuff of a physician fromHospital Earth, was common knowledge. Dal realized with perfect claritythat if he failed now, his career as a physician would be over; no one,not even himself, would ever be entirely certain that he had notsomehow, in some dim corner of his mind, allowed himself to fail.

  Yet if he had not made the attempt and the Black Doctor had died beforehelp had come, there would always be those who would accuse him ofdelaying on purpose.

  His mouth was dry; he longed for a drink of water, even though he knewthat no water could quench this kind of thirst. His fingers grew numb ashe worked, and moment by moment the sense of utter hopelessness grewstronger in his mind. Tiger worked stolidly across the table from him,inexpert help at best because of the sketchy surgical training he hadhad. Even his solid presence in support here did not lighten the burdenfor Dal. There was nothing that Tiger could do or say that would helpthings or change things now. Even Fuzzy, waiting alone on his perch inthe control room, could not help him now. Nothing could help now but hisown individual skill as a surgeon, and his bitter determination that hemust not and would not fail.

  But his fingers faltered as a thousand questions welled up in his mind.Was he doing this right? This vessel here ... clamp it and tie it? Ordissect it out and try to preserve it? This nerve plexus ... which onewas it? How important? How were the blood pressure and respirationsdoing? Was the Black Doctor holding his own under the assault of thesurgery?

  The more Dal tried to hurry the more he seemed to be wading throughwaist-deep mud, unable to make his fingers do what he wanted them to do.How could he save ten seconds, twenty seconds, a half a minute? Thathalf a minute might make the difference between success or failure, yetthe seconds ticked by swiftly and the procedure was going slowly.

  Too slowly. He reached a point where he thought he could not go on. Hismind was searching desperately for help--any kind of help, something tolean on, something to brace him and give him support. And then quitesuddenly he understood something clearly that had been nibbling at thecorners of his mind for a long time. It was as if someone had snapped ona floodlight in a darkened room, and he saw something he had never seenbefore.

  He saw that from the first day he had stepped down from the Garvian shipthat had brought him to Hospital Earth to begin his medical training, hehad been relying upon crutches to help him.

  Black Doctor Arnquist had been a crutch upon whom he could lean. Tiger,for all his clumsy good-heartedness and for all the help and protectionhe had offered, had been a crutch. Fuzzy, who had been by his side sincethe day he was born, was still another kind of crutch to fall back on, away out, a port of haven in the storm. They were crutches, every one,and he had leaned on them heavily.

  But now there was no crutch to lean on. He had a quick mind with goodtraining. He had two nimble hands that knew their job, and two legs thatwere capable of supporting his weight, frail as they were. He knew nowthat he had to stand on them squarely, for the first time in his life.

  And suddenly he realized that this was as it should be. It seemed soclear, so obvious and unmistakable that he wondered how he could havefailed to recognize it for so long. If he could not depend on himself,then Black Doctor Hugo Tanner would have been right all along. If hecould not do this job that was before him on his own strength, standingon his own two legs without crutches to lean on, how could he claim tobe a competent physician? What right did he have to the goal he soughtif he had to earn it on the strength of the help of others? It was _he_who wanted to be a Star Surgeon--not Fuzzy, not Tiger, nor anyone else.

  He felt his heart thudding in his chest, and he saw the operation beforehim as if he were standing in an amphitheater peering down over someother surgeon's shoulder. Suddenly everything else was gone from hismind but the immediate task at hand. His fingers began to move moreswiftly, with a confidence he had never felt before. The decisions to bemade arose, and he made them without hesitation, and knew as he madethem that they were right.

  And for the first time the procedure began to move. He murmuredinstructions to Jack from time to time, and placed Tiger's clumsy handsin the places he wanted them for retraction. "Not there, back a little,"he said. "That's right. Now hold this clamp and release it slowly whileI tie, then reclamp it. Slowly now ... that's the way! Jack, check thatpressure again."

  It seemed as though someone else were doing the surgery, directing hishands step by step in the critical work that had to be done. Dal placedthe connections to the heart-lung machine perfectly, and moved with newswiftness and confidence as the great blood vessels were clamped off andthe damaged heart removed. A quick check of vital signs, chemistries,oxygenation, a sharp instruction to Jack, a caution to Tiger, and thenew prosthetic heart was in place. He worked now with painstaking care,manipulating the micro-sutures that would secure the new vessels to theold so firmly that they were almost indistinguishable from a healedwound, and he knew that it was going _right_ now, that whether thepatient ultimately survived or not, he had made the right decision andhad carried it through with all the skill at his command.

  And then the heart-lung machine fell silent again, and the carefullyapplied nodal stimulator flicked on and off, and slowly, at firsthesitantly, then firmly and vigorously, the new heart began its endlesspumping chore. The Black Doctor's blood pressure moved up to a healthylevel and stabilized; the gray flesh of his face slowly became suffusedwith healthy pink. It was over, and Dal was walking out of the surgery,his hands trembling so violently that he could hardly get his gown off.He wanted to laugh and cry at the same time, and he could see the silentpride in the others' faces as they joined him in the dressing room tochange clothes.

  He knew then that no matter what happened he had vindicated himself.Half an hour later, back in the sickbay, the Black Doctor was awake,breathing slowly and easily without need of supplemental oxygen. Onlythe fine sweat standing out on his forehead gave indication of theordeal he had been through.

  Swiftly and clinically Dal checked the vital signs as the old manwatched him. He was about to turn the pressure cuff over to Jack andleave when the Black Doctor said, "Wait."

  Dal turned to him. "Yes, sir?"

  "You did it?" the Black Doctor said softly.

  "Yes, sir."

  "It's finished? The transplant is done?"

  "Yes," Dal said. "It went well, and you can rest now. You were a goodpatient."

  For the first time Dal saw a smile cross the old man's face. "A foolishpatient, perhaps," he said, so softly that no one but Dal could hear,"but not so foolish now, not so foolish that I cannot recognize a gooddoctor when I see one."

  And with a smile he closed his eyes and went to sleep.

  CHAPTER 14

  STAR SURGEON

  It was amazing to Dal Timgar just how good it seemed to be back onHospital Earth again.

  In the time he had been away as a crewman of the _Lancet_, the seasonshad changed, and the port of Philadelphia lay under the steaming summersun. As Dal stepped off the shuttle ship to join the hurrying crowds inthe great space-port, it seemed almost as though he were coming home.

  He thought for a moment of the night not so long before when he hadwaited here for the shuttle to Hospital Seattle, to attend the meetingof the medical training council. He had worn no uniform then, not eventhe collar and cuff of the probationary physician, and he remembered hisdespair th
at night when he had thought that his career as a physicianfrom Hospital Earth was at an end.

  Now he was returning by shuttle from Hospital Seattle to the port ofPhiladelphia again, completing the cycle that had been started manymonths before. But things were different now. The scarlet cape of theRed Service of Surgery hung from his slender shoulders now, and thelight of the station room caught the polished silver emblem on hiscollar. It was a tiny bit of metal, but its significance was enormous.It announced to the world Dal Timgar's final and permanent acceptance asa physician; but more, it symbolized the far-reaching distances he hadalready traveled, and would travel again, in the service of HospitalEarth.

  It was the silver star of the Star Surgeon.

  The week just past had been both exciting and confusing. The hospitalship had arrived five hours after Black Doctor Hugo Tanner had recoveredfrom his anaesthesia, moving in on the _Lancet_ in frantic haste andstarting the shipment of special surgical supplies, anaesthetics andmaintenance equipment across in lifeboats almost before contact had beenstabilized. A large passenger boat hurtled away from the hospital ship'sside, carrying a pair of Four-star surgeons, half a dozen Three-starSurgeons, two Radiologists, two Internists, a dozen nurses and anotherFour-star Black Doctor across to the _Lancet_; and when they arrived atthe patrol ship's entrance lock, they discovered that their haste hadbeen in vain.

  It was like Grand Rounds in the general wards of Hospital Philadelphia,with the Four-star Surgeons in the lead as they tramped aboard thepatrol ship. They found Black Doctor Tanner sitting quietly at hisbedside reading a journal of pathology and taking notes. He glared up atthem when they burst in the door without even knocking.

  "But are you feeling well, sir?" the chief surgeon asked him for thethird time.

  "Of course I'm feeling well. Do you think I'd be sitting here if Iweren't?" the Black Doctor growled. "Dr. Timgar is my surgeon and thephysician in charge of this case. Talk to him. He can give you all thedetails of the matter."

  "You mean you permitted a probationary physician to perform this kind ofsurgery?" The Four-star Surgeon cried incredulously.

  "I did not!" the Black Doctor snapped. "He had to drag me kicking andscreaming into the operating room. But fortunately for me, thisparticular probationary physician had the courage of his convictions, aswell as wit enough to realize that I would not survive if he waited foryou to gather your army together. But I think you will find the surgerywas handled with excellent skill. Again, I must refer you to Dr. Timgarfor the details. I was not paying attention to the technique of thesurgery, I assure you."

  "But sir," the chief surgeon broke in, "how could there have beensurgery of any sort here? The dispatch that came to us listed the_Lancet_ as a plague ship--"

  "_Plague ship!_" the Black Doctor exploded. "Oh, yes. Egad!I--hum!--imagine that the dispatcher must have gotten his signals mixedsomehow. Well, I suppose you want to examine me. Let's have it overwith."

  The doctors examined him within an inch of his life. They exhaustedevery means of physical, laboratory and radiological examination shortof re-opening his chest and looking in, and at last the chief surgeonwas forced reluctantly to admit that there was nothing left for him todo but provide post-operative follow-up care for the irascible old man.

  And by the time the examination was over and the Black Doctor was movedaboard the hospital ship, word had come through official channels to the_Lancet_ announcing that the quarantine order had been a dispatcher'sunfortunate error, and directing the ship to return at once to HospitalEarth with the new contract that had been signed on 31 Brucker VII. Thecrewmen of the _Lancet_ had special orders to report immediately to themedical training council at Hospital Seattle upon arrival, in order togive their formal General Practice Patrol reports and to receive theirappointments respectively as Star Physician, Star Diagnostician and StarSurgeon. The orders were signed with the personal mark of Hugo Tanner,Physician of the Black Service of Pathology.

  Now the ceremony and celebration in Hospital Seattle were over, and Dalhad another appointment to keep. He lifted Fuzzy from his elbow andtucked him safely into an inner jacket pocket to protect him from thecrowd in the station, and moved swiftly through to the subway tubes.

  He had expected to see Black Doctor Arnquist at the investmentceremonies, but there had been neither sign nor word from him. Dal triedto reach him after the ceremonies were over; all he could learn was thatthe Black Doctor was unavailable. And then a message had come through toDal under the official Hospital Earth headquarters priority, requestinghim to present himself at once at the grand council building at HospitalPhiladelphia for an interview of the utmost importance.

  He followed the directions on the dispatch now, and reached the grandcouncil building well ahead of the appointed time. He followed corridorsand rode elevators until he reached the twenty-second story office suitewhere he had been directed to report. The whole building seemed alivewith bustle, as though something of enormous importance was going on;high-ranking physicians of all the services were hurrying about,gathering in little groups at the elevators and talking among themselvesin hushed voices. Even more strange, Dal saw delegation after delegationof alien creatures moving through the building, some in the specialatmosphere-maintaining devices necessary for their survival on Earth,some characteristically alone and unaccompanied, others in the companyof great retinues of underlings. Dal paused in the main concourse ofthe building as he saw two such delegations arrive by special car fromthe port of Philadelphia.

  "Odd," he said quietly, reaching in to stroke Fuzzy's head. "Quite agathering of the clans, eh? What do you think? Last time I saw agathering like this was back at home during one of the centennialconclaves of the Galactic Confederation."

  On the twenty-second floor, a secretary ushered him into an inneroffice. There he found Black Doctor Thorvold Arnquist, in busyconference with a Blue Doctor, a Green Doctor and a surgeon. The BlackDoctor looked up, and beamed. "That will be all right now, gentlemen,"he said. "I'll be in touch with you directly."

  He waited until the others had departed. Then he crossed the room andpractically hugged Dal in delight. "It's good to see you, boy," he said,"and above all, it's good to see that silver star at last. You and yourlittle pink friend have done a good job, a far better job than I thoughtyou would do, I must admit."

  Dal perched Fuzzy on his shoulder. "But what is this about an interview?Why did you want to see me, and what are all these people doing here?"

  Dr. Arnquist laughed. "Don't worry," he said. "You won't have to stayfor the council meeting. It will be a long boring session, I fear.Doubtless every single one of these delegates at some time in the nextfew days will be standing up to give us a three hour oration, and it ismy ill fortune as a Four-star Black Doctor to have to sit and listen andsmile through it all. But in the end, it will be worth it, and I thoughtthat you should at least know that your name will be mentioned manytimes during these sessions."

  "My name?"

  "You didn't know that you were a guinea pig, did you?" the Black Doctorsaid.

  "I ... I'm afraid I didn't."

  "An unwitting tool, so to speak," the Black Doctor chuckled. "You know,of course, that the Galactic Confederation has been delaying andstalling any action on Hospital Earth's application for full status asone of the Confederation powers and for a seat on the council. We hadfulfilled two criteria for admission without difficulty--we had resolvedour problems at home so that we were free from war on our own planet,and we had a talent that is much needed and badly in demand in thegalaxy, a job to do that would fit into the Confederation'sorganization. But the Confederation has always had a third criterion forits membership, a criterion that Hospital Earth could not so easilyprove or demonstrate."

  The Black Doctor smiled. "After all, there could be no place in a trueConfederation of worlds for any one race of people that considereditself superior to all the rest. No race can be admitted to theConfederation until its members have demonstrated that they are capableof tolerance, wil
ling to accept the members of other races on an equalfooting. And it has always been the nature of Earthmen to be intolerant,to assume that one who looks strange and behaves differently mustsomehow be inferior."

  The Black Doctor crossed the room and opened a folder on the desk. "Youcan read the details some other time, if you like. You were selected bythe Galactic Confederation from a thousand possible applicants, to serveas a test case, to see if a place could be made for you on HospitalEarth. No one here was told of your position--not even you--althoughcertain of us suspected the truth. The Confederation wanted to see if awell-qualified, likeable and intelligent creature from another worldwould be accepted and elevated to equal rank as a physician withEarthmen."

  Dal stared at him. "And I was the one?"

  "You were the one. It was a struggle, all right, but Hospital Earth hasfinally satisfied the Confederation. At the end of this conclave we willbe admitted to full membership and given a permanent seat and vote inthe galactic council. Our probationary period will be over. But enoughof that. What about you? What are your plans? What do you propose to donow that you have that star on your collar?"

  They talked then about the future. Tiger Martin had been appointed tothe survey crew returning to 31 Brucker VII, at his own request, whileJack was accepting a temporary teaching post in the great diagnosticclinic at Hospital Philadelphia. There were a dozen things that Dal hadconsidered, but for the moment he wanted only to travel from medicalcenter to medical center on Hospital Earth, observing and studying inorder to decide how he would best like to use his abilities and hisposition as a Physician from Hospital Earth. "It will be in surgery, ofcourse," he said. "Just where in surgery, or what kind, I don't knowjust yet. But there will be time enough to decide that."

  "Then go along," Dr. Arnquist said, "with my congratulations andblessing. You have taught us a great deal, and perhaps you have learnedsome things at the same time."

  Dal hesitated for a moment. Then he nodded. "I've learned some things,"he said, "but there's still one thing that I want to do before I go."

  He lifted his little pink friend gently down from his shoulder andrested him in the crook of his arm. Fuzzy looked up at him, blinking hisshoe-button eyes happily. "You asked me once to leave Fuzzy with you,and I refused. I couldn't see then how I could possibly do without him;even the thought was frightening. But now I think I've changed my mind."

  He reached out and placed Fuzzy gently in the Black Doctor's hand. "Iwant you to keep him," he said. "I don't think I'll need him any more.I'll miss him, but I think it would be better if I don't have him now.Be good to him, and let me visit him once in a while."

  The Black Doctor looked at Dal, and then lifted Fuzzy up to his ownshoulder. For a moment the little creature shivered as if afraid. Thenhe blinked twice at Dal, trustingly, and snuggled in comfortably againstthe Black Doctor's neck.

  Without a word Dal turned and walked out of the office. As he steppeddown the corridor, he waited fearfully for the wave of desolation andloneliness he had felt before when Fuzzy was away from him.

  But there was no hint of those desolate feelings in his mind now. Andafter all, he thought, why should there be? He was not a Garvian anylonger. He was a Star Surgeon from Hospital Earth.

  He smiled as he stepped from the elevator into the main lobby andcrossed through the crowd to the street doors. He pulled his scarletcape tightly around his throat. Drawing himself up to the full height ofwhich he was capable, he walked out of the building and strode down ontothe street.

  * * * * *

  _Also by Alan E. Nourse_

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