“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.
Julian drops in to my link, synching in Stephe from Sharman to take over. Guiltily, I wonder if Nuria wasn’t right to get me to pass this off to Julian: He’s the better manager. Doubt lasts all of three seconds, then I boot up the software which will aid me in coupling expertise in the form of the telesurgeons within lag limit to need in the form of the cases pending, reserving myself for those cases that need my experience. The urgent request gets passed to the duty surgeon on IMS-2, and I get a chance to think I shouldn’t have had that cup of coffee, before Y’ pages me.
Y’s patient on Desert Rose is unstable with a thoracic cavity full of blood, Y’s going to have to open the chest, and he’s having technical problems. His visuals are degrading, his imaging input is losing resolution, and even worse, beginning to stutter. Since he’s going to be working on breathing lungs and a beating heart, he needs the system to track the motion, stabilizing the images and synchronizing his instruments with the natural movement. I route his synch through my station temporarily and call on genie for a diagnostic. It turns out that Y’s OR suite contact-priorities haven’t been set high enough, and with the current state of emergency other links are poaching some of his bandwidth. Since only sysadmin, the genie-minders, get to meddle with those settings, I call them with a “fix, please, stat.”
I’ve no sooner reclaimed my bandwidth when Stephe pages me, wanting help with the bypass setup in her patient with the badly damaged lungs; with a nervous glance at the waiting casualty list—three of whom could get into trouble very quickly—I synch with her to assist as she establishes the jugular lines and watch until the woman’s oxygen saturation and her blood pressure finally begin to come up. Then the genie pages me over to the other EMS, aboard a material research platform, where the duty-doc and paramedic are running a code on a patient who has just arrested with an arterial blood embolism. There is nothing else I can do for them: they know what they’re doing, they have the expert system support, they’ve given the recommended drugs, and they have the hyperbaric chamber ready.
I freeze all links, giving myself a chance to breathe. When I pull my hands out of the gloves, sweat glitters in the creases of my palms. I check the other departments: The shuttle capsule has been retrieved and towed to Semmelweis, its original destination. Luther has issued another set of recommendations, this time for prophylactic treatments to begin immediately for all staff in all platforms with known penetration. That means turning over three of our bioreactors to the synthesis of his recommended mycostatins, and he has recommended that they be given by intramuscular bead implants, as well as aerosolized through the ventilation system; he’s going to be a popular man.
His prediction is that prophylaxis should be ninety percent effective in preventing infection; and immediate identification and aggressive treatment of the actual diseases should produce around an eighty-five percent cure rate, even for the bad actors. He adds, comfortingly, that additional information from Earthside suggests a better-than-even probability that the abbreviated sterilization will have been effective even on the radiation-resistants, in the presently incalculable event that one of the impact fragments was carrying infectious material. I don’t bother asking genie to try the arithmetic to tell me the probability that one of us will die of fungal sepsis within the month.
I review the operations in progress, the patients waiting, and unhook myself from the surgical station for a quick visit to the head. It’s a small triumph over circumstances that I actually make it there and back before Y’ pages me. His link’s stable, but the damage to his patient’s pulmonary veins is more extensive than the diagnostic imaging suggested; now he’s in there moving things around. I confer quickly with Julian, who accepts coordination of the surgical roster from me without even a literary quip, and drop into synch with Y’ and Desert Rose. Y’ has the Rose’s second paramedic suited and scrubbed to do fluid control and monitor the sterility of the field, while the duty anesthetist from ISM-2 is working anesthesia and life support, and an on-site technician is managing the mounting of transfusions and drags onto the operating assembly. It’s a brute of an operation. IMS-1’s communications system manager overloads and crashes, and the backup system comes up with the old settings, so Y’s bandwidth steal recurs and I have to take over clipping and gluing oozing vessels while he gets that corrected. Then Desert Rose starts having power problems, and while the engineers there are rejigging circuits to keep power going to the OR suite, we run out of SynthaHeme-M and have to go to an alternative blood substitute, and the patient’s blood pressure promptly bottoms out with an adverse reaction. But Y’ and I work as though our thoughts have synched as well, the anesthetist is sharp and solid, the patient is young, fit, and tough, and God, or whoever decides these things, toys with us all and then decides he doesn’t need another angel right now.
One for our side.
I check our status: Three ORs still going, two at quarantined platforms, one something that has nothing to do with the emergency—an incarcerated hernia. Julian looks like he has been squeezed through a fist-sized hole in the outer wall, very slowly. He gives me a precis: Final casualties, seven dead, including the patient with the arterial gas embolism, twelve injured, mostly decompression. The IBDD confirms the original estimates of radiation-resistance, so Luther’s numbers stand. Further analysis of the shuttle’s disintegration suggest that it really was a malfunction, enough by the sound of things to lead to heads rolling but not, we trust, to wars starting. The same analysis gives us some hope that the trajectory of the cargo carried it away from the platforms, toward Earth atmosphere—although there’s an understandable reluctance to disclose that reassuring tidbit Earthside, even though reentry would have charred it.