by Ian Douglas
“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?”
“It did not, ma’am. I couldn’t see it, at any rate.”
“What about the . . . what did you call it? The slippage?”
“Spondylolisthesis, ma’am. That depends on the exact angle of the X-ray shot. I missed it when I saw the X-rays last night. If you know exactly what to look for, you can maybe see that the one vertebra is very slightly out of line, but it’s not obvious.”
“I see. So you are challenging Dr. Kirchner’s handling of the case?”
“Challenging? No, ma’am. Not really. Medicine is not an exact science, whatever they say. It’s an art, and success in medicine depends on luck and skill and training and really good instincts. Private Pollard was very, very lucky, ma’am. And Carlyle here had some excellent instincts going for him.”
“Has Dr. Kirchner seen these images?”
“No, ma’am. I just pulled them down from the sick bay AI.”
“Uh-huh.” I wondered if she was going to call Garner on his unauthorized tapping of sealed medical records. “And how’s the patient?”
“Doing well, ma’am. His condition is stable and improving. The swelling inside his skull is down, now that we have it drained, and the intracranial bleeding has stopped. His head and neck are immobilized, of course, but we’ve applied a very slight traction to his head, which let the surrounding soft tissue push the misalignment back into place. Now we have nanobots beginning to reconnect the bone. We’re applying low-intensity pulsed ultrasound to accelerate bone growth. The prognosis for a full recovery is excellent.”
“In how long?”
“Two, maybe three weeks.”
“I see.” Summerlee looked at me. “So, Carlyle, it seems that you have . . . good instincts.”
I said nothing. It seemed the safest course of action.
“However,” she went on, “those instincts have left us with a rather serious problem.”
“Yes, ma’am,” Garner said. He didn’t look happy.
“I cannot relieve Doctor Kirchner of his responsibilities as expedition medical officer, nor can I challenge his fitness as a physician. That would require a medical board back on Earth. And if Petty Officer Carlyle goes back to working in sick bay, it will raise . . . issues.”
She was dead right there. I’d just been wondering how the hell I was going to fit back into shipboard routine after this little . . . misunderstanding.
“We all make mistakes, ma’am,” Garner said.
“Indeed. But when doctors make mistakes, people die. I can’t sideline him. I can’t even write him up for a reprimand, because I don’t have the medical training to sit in judgment on his decisions.”
“If I could make a suggestion, ma’am?”
“By all means, Chief. I would love to hear it.”
“Nurses and Corpsmen a
re used to . . . let’s call it managing doctors.”
“How do you mean?”
“Look, doctors are busy, okay? In a hospital, they sweep into a patient’s room, half the time in conversation with an expert AI so they’re not really there. They look at the test results, prescribe a round of treatment, and they’re gone, usually muttering to themselves. It’s the nursing staff that’s with the patient all the time, including the patient-care AI that’s supervising everything.”
“So?”
Garner’s expression said he didn’t really want to go into the details. “Don’t get me wrong. There are good doctors out there, really good ones. But there always are a few bad apples, and nursing staffs know how to take up the slack and look after the patients’ best interests.”
“That’s horrifying.”
Garner shrugged. “It’s the way things are. The medical community—other doctors, mostly—tend to close ranks and protect the bad ones. Sometimes it’s tough to tell which ones are genuinely bad, and which ones are just having a bad day.”
“Is Dr. Kirchner . . . a bad doctor?”
“Ma’am . . . I don’t know. I don’t even want to guess. It’s not my place to say.”
“Take a shot at it.”
“Ma’am, he must know his stuff. He taught medicine at SMMC, and that’s not a billet for mediocrity. But since he’s come aboard, he’s been abrupt, short-tempered, rude, and making snap decisions that . . . aren’t always the best. He doesn’t listen—”
“None of which makes him incompetent. He sounds like he’s a little shy on people skills.”
“Yes, ma’am.”
I’d been wondering if they’d forgotten I was in the room, but now the captain looked at me.
“What do you think, Carlyle?”
“I don’t think Dr. Kirchner is incompetent, ma’am. He’s been acting like . . . I don’t know. Like he has personal problems, maybe? Stress at home . . . or maybe he didn’t want to come on this expedition.”
“Mm. Point. How do you feel about going back to work with him?”
Damn, what was I supposed to say to that? “I’m not exactly looking forward to it, ma’am . . . but I’ll do what I’m told to do.”