Aware of the cold splash of water clinging to her cheek, she opened her eyes and saw a globule float toward her, twirling with a rainbow of reflections. It took her a few dazed seconds to understand what she was looking at, another few seconds to register the dozens of other globules dancing like silvery Christmas ornaments all around her.
Static, then a voice, crackled over her comm unit. “Uh, Watson, this is Capcom. We hate to wake you, but we need to confirm status of the patient’s EKG leads.”
Hoarse with exhaustion, Emma replied, “I’m awake, Capcom. I think.”
“Biotelemetry shows an anomaly on your patient’s EKG. Surgeon thinks you’ve got a loose lead up there.”
She had been drifting, turning in midair while asleep, and now she reoriented herself in the module and turned to where her patient should be.
His sleep restraint bag was empty. The disconnected IV tube floated free, the catheter end releasing drops of glistening saline into the air. Loose electrode wires drifted in a tangle.
At once she shut off the infusion pump and quickly glanced around. “Capcom, he’s not here. He’s left the module! Stand by.” She pushed off the wall, shot into Node 2, leading to the NASDA and ESA labs. A glance through the hatchways told her he was not there.
“Have you located him?” Capcom asked.
“Negative. I’m still looking.”
Had he become disoriented, wandered away in confusion? Backtracking through the U.S. lab, she shot through the node hatchway. A droplet splattered her face. She swiped at the pinpoint of moisture and was startled to see her finger was smeared with blood.
“Capcom, he’s passed through Node One. Bleeding from his IV puncture site.”
“Recommend you shut off airflow between modules.”
“Roger that.” She glided through the hatchway of the hab module. The lights had been dimmed, and in the gloom, she saw Griggs and Luther, both sound asleep and zipped into their restraint bags. No Kenichi.
Don’t panic, she thought as she shut off the intermodule airflow. Think. Where would he go?
Back to his own sleep station, at the Russian end of ISS.
Without waking Griggs or Luther, she left the hab and moved quickly into the tunnel of connecting nodes and modules, her gaze darting left and right in search of her fugitive patient. “Capcom, I still haven’t located him. I’m through Zarya and heading for the RSM.”
She slipped into the Russian service module, where Kenichi normally slept. In the gloom she saw Diana and Nicolai both asleep, floating as though drowned, their arms drifting free of their restraint bags. Kenichi’s station was empty.
Her anxiety turned to real fear.
She gave Nicolai a shake. He was slow to awaken, and even after he opened his eyes, it took him a moment to understand what she was telling him.
“I can’t find Kenichi,” she repeated. “We need to search every module.”
“Watson,” said Capcom over her headset. “Engineering reports intermittent anomaly in Node One air lock. Please check status.”
“What anomaly?”
“Off and on readings indicate the hatch between the equipment and crew locks may not be fully secure.”
Kenichi. He’s in the air lock.
With Nicolai right behind her, she shot like a flying bird through the station and dove into Node 1. At her first frantic glance through the open hatch, into the equipment lock, Emma caught a startling glimpse of what looked like three bodies. Two were only the pair of EVA suits, the hard-shelled torsos mounted on the air lock walls for easy donning.
Hanging in midair, his body arched backward in a convulsive spasm, was Kenichi.
“Help me get him out of here!” said Emma. She maneuvered behind him and, bracing her feet against the outer hatch, shoved him toward Nicolai, who pulled him out of the air lock. Together, they propelled him toward the lab module, where the medical equipment had been set up.
“Capcom, we’ve located the patient,” said Emma. “He appears to be seizing—grand mal. I need Surgeon on the loop!”
“Stand by, Watson. Go ahead, Surgeon.”
Emma heard a startlingly familiar voice over her headset. “Hey, Em. Hear you’ve got yourself a problem up there.”
“Jack? What are you doing—”
“How’s your patient?”
Still in a state of shock, she focused her attention on Kenichi. Even as she restarted the IV, attached EKG wires, she was wondering what Jack was doing in Mission Control. He had not sat at a flight surgeon’s console in a year; now here he was on the comm loop, his voice calm, even casual, as he asked about Kenichi’s status.
“Is he still seizing?”
“No. No, he’s making purposeful movements now—fighting us—”
“Vital signs?”
“Pulse is rapid—one twenty, one thirty. He’s moving air.”
“Good. So he’s breathing.”
“We’re just getting the EKG hooked up now.” She glanced at the monitor, at the cardiac rhythm racing across the screen. “Sinus tach, rate of one twenty-four. Occasional PVCs.”
“I see it on biotelemetry.”
“Taking BP now . . .” She whiffed up the cuff, listened to the brachial pulse as the pressure was slowly released. “Ninety-five over sixty. Not significantly—”
The blow caught her by surprise. She gave a sharp cry of pain as Kenichi’s hand flailed out, striking her across the mouth. The impact spun her away, and she flew across the module, colliding with the opposite wall.
“Emma?” said Jack. “Emma?”
Dazed, she reached up to touch her throbbing lip.
“You’re bleeding!” said Nicolai.
Over her headset, Jack’s frantic voice demanded, “What the hell is going on up there?”
“I’m okay,” she murmured. And repeated, irritably, “I’m okay, Jack. Don’t have a cow.”
But her head was still buzzing from the blow. As Nicolai strapped Kenichi to the patient restraint board, she hung back, waiting for her dizziness to pass. At first she did not register what Nicolai was saying.
Then she saw the look of disbelief in his eyes. “Look at his stomach,” Nicolai whispered. “Look!”
Emma moved closer. “What the hell is that?” she whispered.
“Talk to me, Emma,” said Jack. “Tell me what’s going on.”
She stared at Kenichi’s abdomen, where the skin seemed to ripple and boil. “There’s something moving—under his skin—”
“What do you mean, moving?”
“It looks like muscle fasciculations. But it’s migrating across the belly…”
“Not peristalsis?”
“No. No, it’s moving upwards. It’s not following the intestinal tract.” She paused. The squirming had suddenly stopped, and she was staring at the smooth, unworried surface of Kenichi’s abdomen.
Fasciculations, she thought. The uncoordinated twitching of muscle fibers. It was the most likely explanation, except for one detail: Fasciculations do not migrate in waves.
Suddenly Kenichi’s eyes shot open, and he stared at Emma.
The cardiac alarm squealed. Emma turned to see the EKG whipsawing up and down on the screen.
“V tach!” said Jack.
“I see it, I see it!” She flipped on the defibrillator charge button, then felt for a carotid pulse.
There it was. Faint, barely palpable.
His eyes had rolled up, and only the bloodred sclerae were visible. He was still breathing.
She slapped on defibrillator pads, positioned the paddles on the chest, and pressed the discharge buttons. An electric charge of one hundred joules shot through Kenichi’s body.
His muscles contracted in a violent and simultaneous spasm. His legs thrashed against the board. Only the restraints kept him from flying across the module.
“Still in V tach!” said Emma.
Diana came flying into the module. “What can I do?” she asked.
“Get the lidocaine ready!” snapped Em
ma. “CDK drawer, right side!”
“Found it.”
“He’s not breathing!” said Nicolai.
Emma grabbed the ambu-bag and said, “Nicolai, brace me!”
He maneuvered into position, planting his feet on the opposite wall, his back pressed against Emma’s to hold her in place as she applied the oxygen mask. On earth, performing cardiopulmonary resuscitation is demanding enough; in microgravity, it is a nightmare of complex acrobatics, with drifting equipment, tubes twisting and tangling in midair, syringes filled with precious drugs floating away. The simple act of pressing your hands against a patient’s chest can send you tumbling across the room. Although the crew had practiced this scenario, no rehearsal could reproduce the genuine chaos of bodies frantically maneuvering in a closed space, racing against the clock of a dying heart.
With the mask over Kenichi’s mouth and nose, she squeezed the ambu-bag, forcing oxygen into his lungs. The EKG line continued to thrash across the screen.
“One amp lidocaine IV push now,” said Diana.
“Nicolai, shock him again!” said Emma.
After the briefest hesitation, he reached for the paddles, placed them on the chest, and pressed the discharge buttons. This time two hundred joules arced through Kenichi’s heart.
Emma glanced at the monitor. “He’s gone into V fib! Nicolai, start cardiac compressions. I’m going to intubate!”
Nicolai released the defib paddles, and they floated off, dangling at the ends of the wires. Bracing his feet against the opposite wall of the module, he was about to place his palms on Kenichi’s sternum when he suddenly jerked his hands away.
Emma looked at him. “What is it?”
“His chest. Look at his chest!”
They stared.
The skin on Kenichi’s chest was boiling, squirming. At the contact points where the defib paddles had delivered their electric jolts, two raised circles had formed and were now spreading, like ripples cast by a stone in water.
“Asystole!” came Jack’s voice over her headset.
Nicolai was still frozen, staring at Kenichi’s chest.
It was Emma who swung into position, bracing her back against Nicolai’s.
Asystole. The heart has stopped. He will die without cardiac compressions.
She felt nothing moving, nothing unusual. Just skin stretched over the bony landmarks of his breastbone. Muscle fasciculations, she thought. It had to be. There’s no other explanation. With her body braced in position, she began chest compressions, her hands performing the work for Kenichi’s heart, pumping blood to his vital organs.
“Diana, one amp IV epinephrine!” she ordered.
Diana injected the drug into the IV line.
They all looked at the monitor, hoping for, praying for, a blip on the screen.
ELEVEN
“There has to be an autopsy,” said Todd Cutler.
Gordon Obie, director of Flight Crew Operations, flashed him an irritated look. Some of the others in the conference room gave Cutler dismissive nods as well, because he had merely stated the obvious. Of course there would be an autopsy.
Over a dozen people had gathered together for this crisis meeting. An autopsy was the least of their concerns. Right now, Obie was dealing with more urgent issues. Normally a man of few words, he’d suddenly found himself in the uncomfortable position of having reporters’ microphones thrust at his face whenever he appeared in public. The excruciating process of assigning blame had begun.
Obie had to accept a portion of responsibility for this tragedy, because he had approved the choice of every member of the flight crew. If the crew screwed up, in essence, he had screwed up. And his choice of Emma Watson was starting to look like a major error.
That, at least, was the message he was hearing in this room. As the only physician aboard ISS, Emma Watson should have realized Hirai was dying. An immediate CRV evac might have saved him. Now a shuttle had been launched, and a multimillion-dollar rescue mission had turned into nothing more than a morgue run. Washington was hungry for scapegoats, and the foreign press was asking a politically incendiary question: Would an American astronaut have been allowed to die?
The PR fallout was, in fact, this meeting’s major topic of discussion.
Gretchen Liu said, “Senator Parish has gone on the record with a statement.”
JSC director Ken Blankenship groaned. “I’m afraid to ask.”
“CNN-Atlanta faxed it over. And I quote: ‘Millions of tax dollars went into the development of the emergency Crew Return Vehicle. Yet NASA chose not to use it. They had a critically ill man up there whose life might have been saved. Now that courageous astronaut is dead, and it’s apparent to everyone that a terrible mistake was made. One death in space is one death too many. A congressional inquiry is in order.’” Gretchen looked up with a grim expression. “Our favorite senator speaks.”
“I wonder how many people remember that he tried to kill our Crew Return Vehicle program?” said Blankenship. “I’d love to rub that in his face right now.”
“You can’t,” said Leroy Cornell. As NASA administrator, it was second nature for Cornell to weigh all the political ramifications. He was their link to Congress and the White House, and he never lost sight of how things would play out in Washington. “You launch a direct attack on the senator, and things will really hit the fan.”
“He’s attacking us.”
“That’s nothing new, and everyone knows it.”
“The public doesn’t,” said Gretchen. “He’s making headlines with these attacks.”
“That’s the whole point—the senator wants headlines,” said Cornell. “We fire back, it’ll feed the media beast. Look, Parish has never been our friend. He’s fought every budget increase we’ve ever asked for. He wants to buy gunships, not spaceships, and we’ll never change his mind.” Cornell took a deep breath and looked around the room. “So we might as well take a good hard look at his criticism. And ask ourselves if it isn’t justified.”
The room went momentarily silent.
“Obviously, mistakes were made,” said Blankenship. “Errors in medical judgment. Why didn’t we know how sick the man was?”
Obie saw an uneasy glance fly between the two flight surgeons. Everyone was now focused on the performance of the medical team. And on Emma Watson.
She wasn’t here to defend herself; Obie would have to speak up for her.
Todd Cutler beat him to it. “Watson’s at a disadvantage up there. Any doctor would be,” he said. “No X ray, no OR. The truth is, none of us know why Hirai died. That’s why we need the autopsy. We have to know what went wrong. And whether microgravity was a contributing factor.”
“There’s no question about an autopsy,” said Blankenship. “Everyone’s agreed on that point.”
“No, the reason I mention it is because of the . . .” Cutler dropped his voice, “preservation problem.”
There was a pause. Obie saw gazes drop in uneasy contemplation of what that meant.
“The lack of refrigeration on the station is what he’s talking about,” said Obie. “Not for something as large as a human body. Not in a pressurized environment.”
ISS flight director Woody Ellis said, “Shuttle rendezvous is in seventeen hours. How badly can the body deteriorate in that time?”
“There’s no refrigeration aboard the shuttle either,” pointed out Cutler. “Death occurred seven hours ago. Add to that the time for rendezvous, the transfer of the corpse, as well as other cargo, and the undocking. We’re talking at least three days with the body at room temperature. And that’s if everything goes like clockwork. Which, as we all know, is not a given.”
Three days. Obie thought of what could happen to a dead body in two days. Of how badly raw chicken parts stank if he left them in his garbage can for just one night….
“You’re saying Discovery can’t delay her return home, even for an extra day?” said Ellis. “We were hoping there’d be time for other tasks. There are numero
us experiments on ISS ready to come home. Scientists on the ground are waiting for them.”
“An autopsy won’t be of much help if the body’s deteriorated,” said Cutler.
“Isn’t there some way to preserve it? Embalm it?”
“Not without affecting its chemistry. We need an unembalmed body. And we need it home soon.”
Ellis sighed. “There has to be a compromise. A way to get something else accomplished while they’re docked.”
Gretchen said, “From a PR point of view, it looks bad, going about your usual business while a corpse is stored in the middeck. Besides, isn’t there some, well, health hazard? And then there’s… the odor.”
“The body is sealed in a plastic shroud,” said Cutler. “They can curtain it off out of view in a sleep station.”
The subject had turned so grim that most faces in the room were looking pale. They could talk about the political fallout and the media crisis. They could talk about hostile senators and mechanical anomalies. But dead bodies and bad smells and deteriorating flesh were not things they wanted to concentrate on.
Leroy Cornell finally broke the silence. “I understand your sense of urgency about getting the body back for autopsy, Dr. Cutler. And I understand the PR angle as well. The seeming…lack of sensitivity if we go about our business. But there are things we have to do, even in light of our losses.” He looked around the table. “That is our prime objective, isn’t it? One of our strengths as an organization? No matter what goes wrong, no matter what we suffer, we always strive to get the job done?”
That’s the moment Obie sensed the sudden shift of mood in the room. Up till then, they had been laboring under the pall of tragedy, the pressure of media attention. He had seen gloom and defeat in these faces, and defensiveness. Now the pall was lifting. He met Cornell’s gaze and felt some of his old disdain toward the man fall away. Obie had never trusted smooth talkers like Cornell. He thought of NASA administrators as a necessary evil and tolerated them only as long as they kept their noses out of operational decisions.
Gravity: A Novel of Medical Suspense Page 13