Riding the Red Horse

by Christopher Nuttall

  He checked to make sure he had the coded scans and targets for each of the patients, and downloaded them to a chip that he would insert into the control console in surgery. The 'bots would do most of the fine work, but he needed to direct them and be able to take over if things went south. The residents and his fellows attending would handle opening and closing, so he'd likely need just a couple of hours per patient. Time for more coffee, and then go scrub in.

  Before he left the office, two messages popped up on his screen. One was from Billy: "Dad, I'm fine, quit worrying, you don't have to text me every other day. In fact, I should be back in a few weeks. Command is rotating us home soon. Best, -Billy." Ah, good. That's better, even if it won't stop the nightmares. Unconsciously, he raised both hands over his head, intertwined the fingers and started to brush his hands through his hair. At least it wasn't Billy on the table in this morning's dream—although the cyborg-like creature wasn't much of an improvement. Speaking of which… The second message was from Sheila, the departmental administrator manager. She handled appointments for the faculty, and it was a notice that he had an appointment with a Ms. Guerra at 11 AM Thursday morning. Oh. That's right, he'd promised Geuiszlerr. John must have gotten tired of waiting and scheduled it for him. Okay, he'd go—he'd meant to in the first place.

  Ten hours later he'd finished all four procedures and still managed time to eat and take care of essential functions. He felt dirty and sweaty and needed to clean up before heading home—not to mention a shower would help to keep him awake for the drive home. There was no hurry, no one else would be there anyway, so he headed for the surgeon's locker room, tossed the soiled scrubs in the laundry return and went to stand under the scalding hot water. The procedures had gone well, and he'd called it exactly right, this morning. Three bomb victims, one gunshot, all four were soldiers that he'd ensured would live to fight another day. He'd managed to save the leg, and the amputee would now be suited to accept prosthetics; he'd repaired the pericardium and the kid who'd been gut-shot would live the rest of his life with three fewer inches of small intestine—but they all would live.

  He did good work. It was essential—he saved people, soldiers and civilians alike, gave them back 'quality of life.' He kept telling himself that.

  Silvia Guerra came to his office promptly at 11. The Medical Center had a policy of providing in-office counseling for faculty with therapists that didn't scream 'shrink' when they showed up for their 'consultation.' Toby appreciated the discretion, but it wasn't as if everybody in the academic offices didn't know everyone else's business anyway.

  He'd been dreading the meeting, because he knew exactly what she would decide—that he had lost 'it'—the motivation, drive they makes a surgeon the best in his field. He'd felt it this morning on the drive in. Normally a precise, focused driver, he'd been distracted, drove right past a patrol car at too fast a speed, then almost panicked when the officer turned on his flashing lights and went past him chasing a car that had been going even faster. The news headline didn't even get a second glance this morning: "Not a comet? Signs of Intelligence, Say Astronomers."

  "Ms. Guerra?" Toby greeted his visitor and directed her to a pair of comfortable chairs set away from his desk. "Or is it Dr. Guerra?"

  "It's Doctor, Dr. Greene, but actually I hope you will call me 'Sylvia'," the counselor said as she sat in one of the chairs.

  "Very well, Silvia. In that case, it's 'Toby'" he said taking the other chair. "Although if you've been talking to John Geuiszlerr, he probably has you inclined to say 'Tobias,' and I'd really rather you didn't." Silvia laughed. It was a nice laugh. She was older than he was, with a full head of white hair and smile lines around the eyes. Toby might even have relaxed, if he hadn't been dreading this meeting so much.

  "To start with, I am very glad we're not talking across a desk. I find that we have a more relaxed conversation without a symbol of authority in the way." She gestured at the neat desk, and then the plaques and framed certificates on the wall. "Although the main reason for meeting in your seat of power is to put you more at ease… and you're not at ease, Toby."

  "I'm not entirely sure I want my head shrunk, Doctor. I have my hands inside enough patients that I'm not that comfortable with having someone else in my head."

  "So it's back to Doctor, is it?" The laugh came again, then she turned serious. "Toby, I'm not here to psychoanalyze you, 'bench' you or make you give up coffee." She stopped at his expression, smiled, and continued. "Oh, come on, you do realize I've counseled a few surgeons before, right?" The smile was genuine, and Toby realized she was trying hard to project a 'kindly grandmother' aura… and it was working.

  "Let me start with what I already know. You are 55 years old, widely regarded as the top trauma surgeon in the state, if not the country. You and your wife separated 6 months ago after 28 years of marriage. You have two children, older daughter—married, giving you two grandchildren—and a younger son in the Army. And you feel grief because your subconscious puts your son's face on every single soldier you lose on the table and guilt for every one you send back into combat."

  Toby said nothing, just stared back at her, his face slack.

  "So now you have nightmares every night, get too little sleep, drink too much coffee and you're thinking about taking up nicotine again because you're too proud and stubborn to think about prescription drugs. And that, young man, is a good thing, because if you prescribed them for yourself, we would have to bench you."

  Toby thought for a moment. All he could think of for an answer was "Yes, Ma'am" because she really did remind him of his grandmother the time she had caught him in his grandfather's study, reading the books that were 'too old' for him. He sighed. "Yes, I know. John… and Jany are worried. I just can't shake the feeling that this just isn't right." He paused as she looked intently at him. "Oh, not that it's wrong patching these kids up, but that so many of them just go back into combat."

  "It's their choice, Toby" she said, quietly. "You don't make them go back. You make it possible for them to live. The rest is up to them." She waited a moment for that to sink in. "Toby, I suspect what you really need is to talk, and I don't think you've had anyone around to listen. Tell me about the nightmares."

  Toby sat back, started rubbing his scalp, and started telling about the early ones, the medical school anxiety dreams he hadn't experienced in over 20 years, until they resurfaced last year. He told of the surgery dreams, the helplessness, the dread, the times he saw his own family in the patients, finishing with this morning's dream with the cyborg. When he finished, he realized he'd been talking for more than an hour. Sylvia had not taken notes, and he couldn't see a recorder, but he had the impression she had at least mentally recorded and stored every story he had told.

  Then again, if I can miniaturize a surgical trauma team, who knows how small a recorder can get?

  Neither of them had even looked at the time during the session until Toby caught a glimpse of his desk clock as he related the final dream. It was well after lunch, and Sylvia probably had other clients. As if reading his mind, she nodded and reached into her bag, pulling out a small leather-bound book. The cover said simply 'Grief' in gold on the pale leather material.

  "Toby, take this. Read it. There are also places for you to write inside, to find your own way through this time. I take back part of what I said earlier—there is no guilt in you, and I think you actually know that. But a near loss is still a loss as far as the human mind is concerned, and it doesn't matter if you aren't close to the boys and girls you work on. Maybe you should, but that's up to you. What you do need is time. Both time to grieve and time away from here." She held up a hand as Toby started to protest. "I said I wouldn't bench you, but how long has it been since you've had a vacation?"

  "Well, there was the conference in Aspen last fall…"

  "No, a real vacation—time away from work and the clinic and the OR. Go fishing, camping, hike the Appalachian Trail or dive a South Pacific atoll." She looked at him
sternly this time.

  It was such a contrast, it almost made him laugh, but he wasn't certain how she would take that. He raised one hand and started to absently rub his scalp, and answered simply, "It was Jany and my 25th, and we went to Hawaii. I don't think I could bear to do that right now, but John's been offering to let me use his place in the mountains."

  "Do it then" she said, standing up and picking up her bag. She touched the elbow of his upraised hand, halting the unconscious habit. ". . . and you might even let your hair grow out a bit while you are at it."

  Toby considered her advice after she left the office. He could talk to John. It should be sooner rather than later. He picked up the phone to call just as his pager went off. Dialing the call-back number on the pager instead of Geuiszlerr - it was the Trauma desk. He quickly got the basics: highway accident upstate, female patient coming in by airlift, severe abdominal injuries. There wasn't enough time to pre-program the surgical nanobots, so this one would require much more hands-on work.

  He put the phone down. The patient would be arriving in 10 minutes and they'd have to prep her for OR. He had enough time for an email to John. This would only take 2 minutes; it's not as if he needed to take time to check whether he had accrued the necessary vacation hours…

  It was nearly midnight when Toby got home, there had actually been two patients to treat, male and female, both from the same accident, different vehicles. John Geuiszlerr had taken the second case to stabilize the young man while Toby stabilized the woman and directed the nanosurgery. Once that was underway, he switched places with John and finished up the second patient. He'd heard the nurses speculating as to which patient had caused the accident, but frankly, that was not something he dared think about; it was bad enough he dwelled on the issues of patching up soldiers only for them to return to combat.

  Now after the long day, he sat in the dining room. Jany hadn't taken her share of the furniture yet, and the straight-backed formal chairs always made his back feel better after a long day of standing in the OR. He looked over at the liquor cabinet with its selection of single malt Scotch whisky. A sabbatical in Scotland had gotten him interested at a late enough age that he could afford the good stuff. He started to reach for a glass but reconsidered. Too much caffeine, a craving for nicotine, and now drinking alone; it was not a healthy situation.

  He sighed and headed for the computer room instead. Billy's message needed an acknowledgement and he should check email as well. He'd briefly talked to John, but they'd both been preoccupied with surgery, so he wasn't expecting anything on the leave request yet. About half of his Inbox was the professional equivalent of junk mail, but important messages came in all day long… such as this one from General Odle. The general wanted to meet on Friday, and it was urgent. Toby would have to rearrange some of his clinic appointments, but it could be done.

  He sent an acknowledgement and a message to the clinic scheduler to block out the time. Next, he typed a brief message to Billy. After thinking about it for a long time, he sent a message to John Geuiszlerr as well, and then logged out without even looking at the news feeds.

  It seemed as if physical exhaustion might be the solution to the nightmares, since Toby had a reprieve following that long Wednesday. Fortunately, Thursday was not as tiring - rounds, case presentations, one clinic consult and a brief OR visit to assist a colleague who was still getting accustomed to using the surgical nanobots. Unfortunately, the nightmare was back early Friday morning. Again, he tried to go back to sleep, resulting in a rush to make it to the hospital in time for morning rounds. He was distracted and paid no attention to the traffic or the headline: "SIGNALS FROM SPACE!"

  Toby was falling apart, he knew it, and he'd have to do something about it soon. I don't even remember the drive in this morning. Such distraction was dangerous for a surgeon. He rubbed his face, then his hair. Shape up, Toby. Your next meeting is with someone who will see right through you; better get your game face on.

  General Maxwell Odle would be on time, if not early - military life had instilled punctuality and precision, but the precision was also tempered by the General's natural good humor. Far from the stereotyped barrel-chested, hard-drinking, cigar-chewing officer - Max Odle was about five years older than Toby - tall & slim, nonsmoking and a tee-totaler. He'd been an Army surgeon before the Pentagon had put him in charge of medical technology development for Joint Services. Toby had first met Max while "on-loan" to a military hospital to train trauma surgeons. Max had actually been a patient the first time they'd met, injured in a helicopter crash. After learning of the surgical techniques which had saved his life, Max had requested assignment to the research-and-development team and advocated adoption of the surgical nanobots by all military branches. Eventually he'd become the DoD liaison, and the two had developed a close friendship over those years.

  As expected, Max was early and waiting when Toby arrived at the office. After the usual greetings, Max stepped back and looked Toby up and down. He remarked, "You look like hell, Son."

  "Not a lot of sleep, Max. Coffee?" Toby turned to the coffee maker on the credenza behind his desk and pulled two clean mugs off of the rack. There were more there; mugs sporting logos from various professional societies and well as one from Max's own branch of the DOD.

  "Sure. Black and bitter… Which is pretty much what you look like - that or one of my boys fresh off your surgical table. Somehow, I don't think insomnia's the whole story."

  "Well, considering that you're probably here to move up the schedule on Phase Two, I don't foresee much of a change in my future." Toby selected a bold, dark roast, popped the capsule into the Keurig brewer, closed the machine and pressed the button to prepare the mug of coffee for Max. Hah, just like a one-armed bandit! Put in your 'money' and pull the handle. At least this one has a guaranteed payoff, he thought as he repeated the process with his own cup. He motioned Max to one of the chairs, and then went around to sit behind the desk.

  "Uh oh, putting the desk between us? Is it that bad?" asked Max, then answered his own question, "Actually, I suppose it is. This is about Phase Three, not Phase Two."

  "Huh. Well, I wanted to bring up the latest data on the Phase Two trials, but why don't you tell me what you mean by 'Phase Three'." Toby turned to face the screen on his desk so as not to show the surprise he felt. How can he know about Phase Three?. He touched the display to bring up the data in hopes that the reflection of colorful graphs on his face would mask his expression as he turned back to his visitor.

  Max placed his coffee mug on the edge of the desk and reached into his briefcase, pulling out a stack of papers. "The DOD and pretty much any first rate trauma surgeon in the world consider use of your surgical nanobots by an expert surgeon to be Phase One. Your own briefing to the Chiefs two years ago said that Phase Two would be pre-programmed, field-injectable nanobots for stabilizing patients on the battlefield and accident scene." Max pulled a bound document—about half of the stack - off the top of the papers in his hand, and waved it in Toby's direction. Max sat it down on the desk and held up the remainder of the paper—like the first, it was bound and covered with a logo from Max's office. "I've been going over your progress reports and publications—and you can't tell me you haven't thought of this one." He paused.

  Toby leaned back, placed his hands behind his head. "Go on."

  Max tapped the report with his other hand. "Phase Three. Prophylactic treatment. You and I both know it works—you leave a set of nanobots in every time you perform surgery to catch the leaks and repair the bits of residual damage. I also know that they remain active for a long time. I checked. My blood shows a residual trace; probably ten percent of the kids I've got in-theater right now do, too. I'd be willing to bet yours does, from a few years ago when you thought you were having a heart attack. Am I right?"

  A ghost of a smile showed briefly on Toby's face as he absent-mindedly started brushing his fingers through his hair. The smile vanished again as he sighed. "Yes, you're right. I had a r
eport from one of the Combat Surgical Hospitals. There's a truck driver who has had the bad luck to catch three roadside bombs. First one just rung his bell, but the second one gave him the gift of shrapnel. He was sent here for a follow-up to extract a couple pieces that were too delicate for field surgery. Last year he caught number three and a ticket home—minus three fingers. The CSH reported that the amputation sites had closed and sealed off before they even got him into surgery. "Max whistled. "Yes! That's exactly what my team was predicting. I just didn't know it was confirmed."

  "Oh, there's more. Several cases of massive trauma that should have been fatal or required amputation. Jeremy Whatshisname, the truck driver? He'd had memory deficits after the first explosion but his memory is perfectly normal in his latest follow-up." Toby turned the screen to face Max. It contained charts and illustrations supporting the results. He leaned forward and stared at Max, and his eyes were full of pain.

  "We can do it, Max. You're right. We can do it… but should we?"

  Now it was Max's turn to sit back and think. "Is that what's getting you? Ah. Now I understand. Let me guess—stress, loss of appetite, headaches, nightmares?" Toby nodded. "Hell, Son, no wonder you look like crap. When did you last take a break from all of this?"

  "That's not the point, Max, and you know it. I patched that kid up! Jeremy. He came in here and was put on my surgical table; I pulled a one-inch piece of shrapnel away from his aorta and sent him back to the war. He was whole when he left here, and six months later was back missing three fingers. What's the point? I took an oath to 'First Do No Harm'!"