Personally, I regard our tenancy in space as entirely too precarious to think of colonization. But if the World Court rules the children have to be transferred Earthside, someone’s going to have to enforce the order. I can see the whole mess being recast as a child-health issue and dumped hot and quivering in the IMS’ jurisdiction. And that is something I want to see coming.
No verdict so far, and so to work.
I see no reason to transfer the patient from Sharman; indeed, knowing about the IBDD shuttle, I prefer to keep what grace we had for accidents and true emergencies. Hence at 2030, I’ve done rounds and am configuring the operating station Y and I both favor to my own preferences, fitting the headset, loading the VR interface, and adjusting the surgical gloves. For a small man, Ygeveny has big hands.
I study Keene’s anatomical reconstructions and lab results. He has a hot gallbladder, all right, taut and inflamed, with an impacted stone in the bladder neck. With the surgical expert system in simulation mode, I run through the procedure, a remote laparoscopy. In microgravity things flip and bounce far more than you’d expect, particularly a slippery bag of fluid on a stalk. But since the operating field is entirely reconstructed from 3D imaging data, when I nick the biliary artery, the gory cloud filling the abdominal cavity does not obscure the surgical field, as it might under camera Earthside. I spend about thirty minutes refining my approach so that won’t happen in vivo, all the time with a little clock ticking in my head. As though the arrival of medical emergencies is guided by any natural law—unless it’s the one that says the pager never goes off just before you go to sleep.
I’ve spoken to Ellis Keene before I start my setup, and I bundle up the result of the simulations with the expert system commentary and squirt them over to him, adding the information to the statistics on my record. If he’s unhappy with my experience and performance, we can prepare him for drop, but I gather from our talk that, like most people up here, he’d rather not drop out of turn. For someone who has been working on short-term contracts, he has accumulated a lot of hours.
While I’m waiting for a final conversation or a registered consent, I take a quick virtual trot around the ward and the parts and activities in the platform that experience has taught me are most accident-prone. The security lockdown helps, because nobody in the area is outside who does not absolutely need to be because something needs to be fixed now, and not in four hours. Who knows: it might be a quiet night. There’s a suspected atmosphere leak over in one of the seven bioreactor pods where these days we grow most of our pharmacopeia. The suit and implanted biosensors of the team outside are normal, not even one raised heartbeat. If they’ve got a problem, they don’t know it yet, and in any case, the duty internist will have them on his screen.
Lastly, I watch the IBDD shuttle emerging from Earth’s shadow, its trefoil symbol orange on shining white. Precious little information available on what it’s carrying—I, after all, will only have a need-to-know if something goes very wrong. Several IBDD teams have been visiting Serbiastan over the past months, so odds-on it’s fungi. While the Americans liked viruses, the Europeans were partial to fungi.
Ellis Keene calls me, with a question as to how serious my nicking the biliary artery would have been. He could get the answers from the genie, of course, and let the decision-assist software assist his interpretation, but I already sense he prides himself in making up his own mind. He’ll let me do this surgery if he decides to trust me. Which, in the end, he does, because, he informs me, I personally sent him my screwups and didn’t make him look them up.
The surgery itself is straightforward—hardly a drop of blood spilled. What is less so is the results of some of the blood work. PCR shows one of the more common leukemic chromosomal translocations. There’s a higher incidence of various cancers among space workers, and often a more rapid progression. I dislike the medical exemptions given for short-term contract workers, and the way companies like Faber take advantage of them. Those of us with long-term contracts have been screened for a low-risk genotype, as well as being fully dosed with the latest tumor suppressants. Ellis Keene’s predicted cancer risk was lower than average, but still below the standards of the IMS, and I don’t regard his tumor suppressant regimen as optimal. He’ll be medically discharged Earthside for a full workup and treatment. The leukemia is eminently curable, particularly at this early stage, but he won’t be back, not with a history of malignancy; no one would insure him.
Stephe Te Kawana seems as depressed as I am. We regard each other glumly across the virtual link, having agreed that she will be the one to tell our patient.
Like myself, Stephe is Unified Pacifican, though her ethnic blend is Asian Pacific, while mine is American Coast. Olive skin, light hazel eyes, black hair that she wears compressed under an elastic cap on duty and in baroque sculptures when not. She always looks slightly puffy-eyed, shifting fluids and the never-settling dust and dander even in our filtered air. Or that’s how she has always explained it. I brace myself when I ask, “How was your time Earthside? With your family.”
She smiles radiantly. “Hikaru’s moving them to Canberra was the best decision we ever made. The kids were being exposed to so much propaganda against space development,” the smile turns wry in acknowledgment that the big Space Centers are papered with their own propaganda, “never mind the relatives constantly dripping ‘poor little things’ into their ears and preaching about material goods being less important than family happiness. They’re not the ones with nearly half a million in pro-school debt.”
“To be honest, I wondered if you’d be back.”
“Yes,” she said. “You would. It’s hard, isn’t it? When it looks like it has to be a choice.”
I don’t talk about the divorce much: respect for my ex-partners and my own pride. I loved them, I honor their commitment to the ideals we once shared—still do, I believe, though we express them differently now. But their rejection still hurts, even after five years. “Not the same,” I tell Stephe. “No kids, for one thing. And there were five of us. The dynamics are different.”
“Where are your exes now?”
“They’ve moved the clinic down to the southern part of United Africa.”
“Isn’t that dangerous?”
“Less than it was; Africa is more stable and prosperous than it has been for a century.” United Africa has been an unexpected beneficiary of global climate change, with the transformation of large areas once-desert by rainfall; for the last decade, they have been exporting wheat and corn.
Stephe has just drawn bream when our entire surround breaks up in red bars. A beat later, the alarm sounds, a sequence I’ve never heard before.
Behind the pulsing red bars, Stephe’s lips move soundlessly. I’m seeing red myself. I never knew any platform system or alert could interrupt the visuals on a surgical link, even if we’re not engaged in surgery. “Genii! This is a surgical circuit A closed circuit. What’s the hell’s happening?”
Then I’m hanging over blue space, over the Earth. Looking down at the IBDD shuttle, pearl white on blue, gliding by an installation that twinkles coyly in the sunlight. I recognize it, one of our nearest neighbors, a quirky little bauble we all call the Desert Rose. It looks too decorative to be what it is, one of the most state-of-the-art experimental habitats.
I almost expect to hear music, Vaughn Williams, perhaps, or Elgar. But what I do hear, or rather, feel, is an irregular vibration through the pod, and then there’s a cascade of text down the side of the image, including the symbol we can all recognize in our sleep, the warning to get to the shielded areas, now. I never knew the thumping of bodies in the tunnels transmitted through the walls.
Shielded areas—including the infirmary and telesurgery stations—are reinforced against meteorites and solar flares. But this is neither. Now I can hear the pilot’s voice through my audio, speaking very fast, reciting what she’s seeing, what she’s doing, as though her instruments, her actions, were not being recorded and transmitt
ed. And then she says, “Initiating cargo sterilization. Ejecting,” and the cabin-pod cracks away on a cleft of fire, cast into the shallowness of space.
Text screeds down both sides of my screen. At such moments I go word-blind, even as my visual perception expands and my time sense explodes. The pilot is still reciting what she’s doing as she rides the shuttle through the telelink, trying to turn it away from the platforms. She’s still talking when the whole side of the shuttle peels apart from an eruption that is for the briefest of moments brighter than the clouds of Earth. And then there’s a silence and murmured prayer.
Against the Earth light, the fragments are invisible, except for those large enough to contain their own shadow; they flicker, tumbling, Earthward, or obliquely past IMS-1. But we know the unseen ones by their passing: thin through the walls of the pod, the decompression alarms begin to squeal, and in the periphery of the display, as I have programmed it to do, the decompression warning icon blinks.
Faces bloom across my display, all the duty-docs, Julian Sutherland, space medicine; Tonia Sundralingham, radiation medicine; Nuria al-Hassam, psychiatry; and Y’, who must just have gotten to sleep. Medical emergency coordinator comes around in rotation, rather like the one shell in Russian roulette. Guess who is gazing into the little black eye of fate tonight?
“Load medical emergency coordinator expert system,” I … squeak. No, it’s not the atmosphere. Deep breathing.
Earth, clouds, the absent shuttle, are all replaced by a schematic of nodes, my preferred representation. Each node indicates a particular function or aspect of the disaster, color-coded according to priority for my attention. The colors dance as everyone except Y’ starts routing data toward it and me. The bioreads of scared and injured people. A map of the immediate vicinity, charting impacts, decompression reports. A report from Desert Rose’s duty-doc: They’ve been struck by debris, have lost solar panels, have four—five— perfed pods, one torn open to the point of explosive decompression, and can anyone kindly tell them what just came through their walls?
Luther Igorin, the EBDD specialist on Semmelweis, is trying to answer that question. No question about the need-to-know now, and he spreads out the shuttle’s manifest for us. It’s fungi. In the later years of the bioterrors, fungi in particular were bioengineered to withstand heat, desiccation, radiation, taking tips from Deinococcus radiodurans and other extremophiles. He’s highlighted two entries on the cargo manifest as radiation-resistants. The question is whether the radiation dose was adjusted to take account of that, whether the shuttle’s cargo got the full sterilization before the shuttle came apart. I’ve never seen Luther sweat the way he’s sweating now.
The shuttle crew announces their survival with a restrained, “I realize this may not be a good time, but we could use a pickup here.” Someone in the background is retching.
Luther withdraws from the team room temporarily to get more information from the shuttle pilot. He’s replaced by Jay McPhearson Leaphorn, responsible for rescue and retrieval. Jay traces descent from chiefs of clan and tribe, and his square, terra-cotta face reflects the stoicism of both traditions; nobody has ever sees him sweat.
Jay says, with his usual politeness, “My team have almost completed their hazard assessment. Do you have a casualty assessment, please?”
The expert system is crunching the biosensor readings, emergency calls, environmental readout, and other data, generating a list of urgent-attention cases in all the affected platforms. “I’m still waiting on a provisional list—”
“I’ll be back for your review. Excuse me,” and he blinks out.
The lit-up nodes now include: decompression, environmental compromise, radiation exposure, potential infectious agent exposure, psychological trauma.
Luther dumps the fingerprints of the shuttle’s manifest to the pathogen-sensors of all platforms above our horizon. I have a bad feeling that this means he is not satisfied that the cargo was sterilized. We should all be grateful for a man who appreciates priorities; some of his IBDD colleagues would still be trying to limit “exposure” of sensitive information. This doesn’t address the problem that, although there’s a minimum standard for platform atmospheric monitoring, not everyone has the grade of biosensors that we do, affinity sensors with a wide range of receptors associated with pathogenicity rather than specific to individual pathogens. But … I subclone the display again, in time to see one, two, three, four, five… potential positives.
I’ve gone cold, seeing the signal imposed on the familiar blueprint.
Now, the fingerprints Luther sent over have a strong bias for sensitivity over specificity: no surprise, since the consequences of failing to detect these spores are far worse than the consequences of getting excited over some innocuous mold.
Only my parents and I were in Montana in June 2034. Global warming coming atop sustained overuse and over-irrigation had cost the Prairies their place as the continent’s breadbasket; most of the Americas were dependent upon the sea, or imports from outside. I was on a student elective at a rural clinic and my parents were working on one of multiple drought-resistant engineering projects, efforts violently opposed by the Earth Redeemers. Since the Redeemers opposed genetic engineering of any organism, no one anticipated the anthrax bombing. My family had been vaccinated against all known strains ourselves, because of other areas my parents had worked; so we only got to watch other people die.
Transport of medicines and vaccines was delayed; the delay, it emerged, was because of concerns in Washington that further attacks might come, that the vaccines might be needed and better used elsewhere … in the important, economically valuable regions of the country, rather than in the depopulated, dust bowl Prairies.
Out of the outrage unslaked by the impeachment of the president, John Rand Brierly established his own Senate in Atlanta and built the New Secessionist movement. Four years after that, after an el Ninõ decimated the sea’s relied-upon harvest, Brierfy’s forces launched the first attack in what became the pan-American War. By then, I was in Africa, completing my training, falling in love with Luis and Michel, planning a future that had nothing to do with a continent half a world away splintering under environmental stress and political, religious, and racial extremities—Africa’s renaissance, after all, had come after decades of it.
“Helen,” says Nuria.
Almost unseen in all the clutter of texts and symbols is the warning signal of excessive stress on the surgical gloves. I unlock my hands and pull them out of the gloves. This is not the time to break equipment.
The other faces in the team room freeze. Only Nuria’s is animate. “I’ve locked them out for a moment,” she said. “I wanted to talk to you privately. Would you prefer to—”
“No.” And, more temperately, “The expert system will backstop my judgment. So will my colleagues and friends. We all lived through these times.”
She has a still, well-schooled face; even after five years in such proximity I cannot say I know her. Yet some shift of expression makes me wonder what she herself lived through, during the years the Islamic nations were isolated behind the “Iron Veil.”
Another flashing icon: the triage-list is complete, and Jay is waiting. We review the triage-list, stat, so Jay can start directing retrieval efforts. His job is not one I envy: besides IMS-1, four other platforms have been damaged by debris. All of those have lost one or more pods to total or severe decompression and have known casualties. Our size works for us: none of the holes were large enough to evacuate a standard IMS pod before they could be sealed. We now have four suspected sites of contamination. It was up to nine, but Luther has established by reanalysis of the sensor’s past recordings that, in five, the suspect signal actually preceded the shuttle’s destruction: false positive. Ours, unfortunately, is not one of those; the signal is new, persistent, and adjacent to one of the two pods that were penetrated. By quarantine protocols established thirty years ago, the signal, false or not, means that until we obtain IBDD clearance, w
e can neither send out rescue craft nor receive survivors, and until we obtain IBDD clearance, none of the staff from Semmelweis— enclosed in its own, inviolate, environment—can come aboard to do their own monitoring.
“I recommend,” says Nuria, “that someone else relieves Helen as coordinator of emergency medical response—” My mouth opens, though I’m not sure what would have emerged. “I recommend it,” Nuria leans on me, “because she’s the most experienced telesurgeon we have in the medical staff and we are likely to need that expertise, given that we cannot accept transfers for the foreseeable future.”
A private note flashes up, in green. “And that’s my only reason.”
Reassuringly, she does not say “believe me” or “trust me,” assertions anyone over thirteen knows to receive with skepticism.
Julian, as my successor by acclamation, squints at his suddenly cluttered work field. “Who’d have thought the old man had that many bits in him.”
That, no doubt is a literary allusion, but this is not the time to ask genie for enlightenment.
I slip my hands back into the gloves, and open synchs to the suites at the four priority platforms. All, fortunately, are within the lag-limit. Two have OR facilities; two have emergency medical stations. I squirt a message to Luther asking that priority consideration be given to lifting restrictions on transfers between one quarantined platform and the next. There’s a limit to what I can do with an EMS, which is de signed primarily for stabilization prior to transfer.
I’ve no sooner done that than the first casualty arrives in an EMS, a woman with blown-out lungs—pulmonary over-inflation syndrome—a newcomer who has never been through even a mild decompression and so never put into practice the prohibition against breath holding. Not a surgical case, but it quickly emerges that this platform’s paramedics were partners. She, sleeping in her cabin, is one of the two dead, and shock has him fumbling in microgravity as though he was only launched yesterday. So I find myself assisting with her intubation, assisting with placing lines, getting the expert support system up and running to backstop him. Her oxygen sats are lousy, her blood’s fizzy, she needs to go on bypass circulation both to get the oxygen in and to get the fizz out … And I’ve got another urgent from one of the OR stations, and Y’ is already involved with the most serious casualty from Desert Rose, decompression and chest trauma from the impact of a sizable chunk of shuttle that crushed the pod. A candidate for transfer if there ever was one. But the IBDD on the ground hasn’t changed its prohibitions: no transfers.
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