Abyss Deep (12 page)

“Now hear this, now hear this. Stand by to initiate spin gravity.” There was a measured pause, as if for dramatic effect, and I knew what was coming. “All hands commence attitude adjustment. Spin gravity will initiate in ten ­minutes.”

Like most ships,
Haldane
's habitation modules were mounted within a carousel, rotating to create an out-­is-­down spin gravity. Long stretches of microgravity could cause some nasty physiological problems for the crew . . . and if you were a Marine arriving on a hostile world after weeks of zero-­gravity, your lack of muscle tone could ruin your whole day. There were drugs and exercises to lessen the effects of weightlessness, of course, but the simplest solution was for the transport to tailor-­make its own gravity.

The real problem in starship design lay in what was humorously known as “attitude adjustment.” When your ship is tooling along under acceleration, “down” is toward the rear of the ship, while “up” is toward the nose, along the direction of travel. With spin gravity, though, “up” is generally at right angles to the direction of travel, toward the ship's spine, while “down” is out, toward the deck of a rotating wheel, a wheel thirty meters across in
Haldane
's case. Her hab module rotated at a pretty fair clip—­just over five rotations per minute, to generate a half G of spin gravity in her outer deck. The higher up inside the carousel you went, the lower the gravity, until you were at zero-­G near the ship's spine, just like in the Free Fall Restaurant back at the El.

But that meant that crew compartments had to be reconfigured each time the vessel shifted between acceleration gravity and spin gravity. Decks became bulkheads, and God help us if the
Haldane
's designers had gotten the plumbing wrong. I had the duty in Sick Bay that morning when the conversion order came through. Most of the change was automatic, handled by
Haldane
's on-­board AI, but I interfaced with the compartment controls to handle the details, dissolving the examination table into the deck there, and regrowing it from the bulkhead over
there
. Decks, bulkheads, and overheads were nanomatrix substrates, and things like viewalls and furniture could be pulled from the matrix pretty much at will. Certain pieces of heavy equipment—­the full body scanner, for instance—­had to be rotated in place, and the sink, toilet, and shower in the small head had to be twisted around and remounted on the ends of highly flexible piping.

I had the sixteen-­to-­midnight watch that evening, so it was up to me to complete the rearrangement of the sick bay, the four-­bed hospital ward, and the heads in plenty of time, then swim over to the closed door of Dr. Kirchner's office, where he was working late. I palmed the contact to chime an announcement, then called, “Dr. Kirchner? Do you need a hand in there making the conversion?”

I heard a muffled and unintelligible sound from the other side of the door.

“Dr. Kirchner? Are you okay?”

“Go away,” he growled.

“Is there anything you need, sir?”

“No! Leave me alone!”

I shrugged and returned to my desk. A moment later, the final announcement came through. “All hands, commence spin gravity. That is, commence spin gravity.”

I pulled myself into the chair I'd grown on one bulkhead, and after a moment I could feel weight slowly beginning to pull me down into the padding. It took a ­couple of minutes to spin the hab modules up to a full half-­gravity, but then the transition was complete. The doors to the ward, the head, the passageway outside, and to Dr. Kirchner's office all completed their ninety-­degree crawls. The shift took a bit of getting used to, and could be disorienting.

I stood up, flexing my knees a bit to test the half-­G pull, and walked over to the bulkhead coffee mess to pour myself a cup. It took a sharp eye and steady hand; the hab module was spinning rapidly enough that the Coriolis effect could bend the stream of coffee from the carafe enough to make it miss the cup.

“Duty Corpsman to A-­Deck, Hab Compartment 2/4! Corpsman to Hab A-­2/4! Emergency!”

Damn!
I set the cup aside, snatched my M-­7 med kit off the bulkhead, and raced through the newly repositioned door to sick bay, stepping across the hatchway combing and breaking into a dead run down the main passageway. I banged past a ­couple of surprised Marines and kept going. Hab 2/4 was a Marine billet space a third of the way spinward around the carousel. I was already on A-­Deck, the outer­most level of the wheel, and it only took me a ­couple of minutes to reach the compartment.

A Marine was on his back on the deck, a puddle of blood under his head and a glassy look in his eyes. Six other Marines were gathered around him, and I had to shove to get through. “Gangway!” I bellowed. “Let me through!”

“Doc coming through!” Sergeant Tomacek yelled. “Make a hole!”

I kneeled next to the downed man, but didn't touch him, not yet. He had a head injury, obviously, but there might be more. “What happened?” I demanded, pulling out my N-­prog and a nanobot autoinjector.

“Ricky fell,” one Marine said.

“I can
see
that. From where? What was he doing?”

“He was skylarking around on the overhead, Doc,” Sergeant Randy Gibbs said, “when the gravity came back on.”

There was more to it than that, I knew. The compartment was three meters high, but he wouldn't have simply fallen when the carousel started to spin. Either he'd been hit by a bulkhead when it began moving toward him, or he'd somehow managed to land on his head, and the moving deck had caused the head injury somehow.

I fired a load of nanobots into his carotid, at the angle of the jaw, and used my N-­prog to send them into and around his skull. His electronic ID said he was Private Jeremy Pollard; his medical readout gave a pulse of 50, a blood pressure of 120 over 72, a respiration of 28, rapid and shallow. His eyes shifted to look at me, and I could see some alertness returning. “How are you doing, Private?” I asked.

“O-­okay, Doc,” he said.

“Do you hurt anywhere?”

“Yeah. My head . . . back of my head.”

“Well, you gave yourself a hell of a bump. No . . . don't move. Stay put for a moment. Okay?”

Mentally, I ticked off his mental state as “A” on the AVPU scale, meaning he was alert, responsive to my questions, and reacting simultaneously to stimuli.

There was a bit of blood in his left ear, and when I checked his pupils, the left side was dilated wide open, the right closed down small. I pulled a small LED light from my M-­7 and shone it in first one eye, then the other. No response there. Classic signs of head trauma, most likely a fractured skull. I'd know more when the nanobots moving around his skull began reporting in.

There . . . that was good. Some millions of robots, each a fifth the length of a human blood cell, were migrating through the space between muscle and bone just beneath the skin of Pollard's head, transmitting their positions to my N-­prog, which in turn began building up an image inside my own skull. In effect, the image was overlaying my normal view of Pollard's head, making it look like his skin and flesh were fading away and leaving behind only the bone. By adjusting the focus of my eyes, I could look through his skull to the back side. Sure enough, there was a crack and a slight flattening at the occipit, the very back of Pollard's skull. As some of the nanobots began seeping through the crack in the skull, I began to see what was inside as well.

Yeah. I'd been afraid of that. Blood was filling a space between bone and gray matter, too, the first blush of a nasty epidural hematoma that would be putting pressure on Pollard's brain.

In-­head, I snapped off a request for a stretcher. We were going to have to be careful moving this guy. “Okay, you hurt anywhere else?”

“Nah. I'm a little dizzy, though.”

“Wiggle the fingers on your right hand for me.” I watched him do it. “Now the left hand.”

He seemed to have some trouble with that one. “Try moving your right foot. Okay . . . now the left.”

That worried me. He could move his left arm and leg, but awkwardly, as though that side of his body was weaker. I pinched his left hand. “You feel this?”

“Yeah . . . sorta . . .”

I don't know why, but it never works out exactly as the textbooks and sims and med downloads say it should.
Never
. Pollard had a serious head injury—­that much was obvious. An epidural hematoma—­a pocket of blood forming between the dura (the protective outer layer of his central nervous system) and the inside of his skull—­was potentially deadly, and needed immediate attention. But what I wasn't sure about was whether or not he might have a spinal injury as well.

A clear sign of a broken back would have been paralysis below the level of the break. A typical broken neck, for example, would have left him paralyzed from the neck down. He still had sensation all the way to his feet, though, so if there was an injury to his spinal cord, it wasn't a complete break. It seemed as though there was some nerve damage affecting the left side of his body, but that could have been due to a spinal injury—­with bone pressing against the spinal cord itself—­or it could have been a result of the head trauma instead.

Carefully, I reached under Pollard's back, palpating. “Does that hurt?”

“Nah.”

I shifted up a bit, toward the base of his neck. “How about this?”

“A little . . .”

“Hey, Doc,” a Marine said, leaning over us. “Is Polly gonna be okay?”

“He will be if you let me do my job. Back off! All of you!” Why the hell do ­people always crowd around to gawk at something like this?

My first order of business was to stabilize that epidural hematoma. As more and more blood seeped into the space between bone and dura mater, more and more pressure would build up against the brain. It happened in something like 3 percent of all head injuries, and it was 15 to 20 percent fatal if the injury was untreated.

His systole was up to 140, now, while his diastole had stayed at 82.

Interfacing directly with my N-­prog, I began delivering instructions to my fleet of microscopic nanobots. Leaving half to continue to send me an image of what was happening, I directed the rest to begin seeking out tears in the web of blood vessels both outside the skull and within, sending some through the crack in Pollard's occipit to explore for damage in the blood vessels over the dura mater.

Normally, if a patient was bleeding I would zap the wound with hemostatin foam. The stuff turned hard, like plastic, when it contacted blood, creating an instant clot that would seal off anything from torn capillaries to a major artery. I couldn't use the stuff here, though, because
anything
that put additional pressure on Pollard's brain could be fatal.

What I could do, though, was have my nanobots begin to physically grab hold of the walls of blood vessels at the breaks, then connect with one another, more and more of them pulling together to create a tough micro-­suture bridging the tear, then contracting to pull the edges of the break together. The hematoma was still small, smaller than the tip of my little finger, so it hadn't done much damage yet. There was still time.

But I needed to get Pollard back to sick bay, stat. I wanted to give him a full soft-­tissue scan to make absolutely certain his spine wasn't injured, and I wanted to put a drain into the hematoma itself to take the pressure down.

I was also working right on the edge of my own experience and expertise. I wanted Dr. Kirchner to see the patient as quickly as possible.

 

Chapter Nine

T
he stretcher team arrived and together we log-­rolled Pollard onto his side, taking care to keep his back and his neck as straight as possible, then slid the stretcher under his back and lowered him into place, centering him on a metamaterial sheet over the bed. The stretcher was a standard spin-­floater, which meant it had controls that let me grow bracing around Pollard's head and neck. I strapped him down, taking care to secure his hands as well, then engaged the spin-­repulsor motor to lift Pollard off the deck.

Quantum spin-­floater technology would have let me guide the stretcher to sick bay one-­handed, but the two-­man stretcher team was on hand, so I decided to use them. I pointed at two of the Marines—­including the one who'd been asking whether Pollard was going to make it. “I need two volunteers: you and you. Go ahead of the stretcher and clear the passageway.”

“Right, Doc!”

That would keep us from bumping into curious Marines or naval personnel, and it would also let those two feel useful. I brought up the rear, using the time to send a call down to Kirchner's office.

“What is it?” he demanded.

“Marine, twenty-year-­old male, head injury, possible spinal injury as well. Beginnings of an epidural hematoma, copious occipital bleeding, BP . . . BP is now 152 over 80 with rising systole, respiration shallow and rapid. Unequal pupils and no left-­side pupillary response. Patient is a conscious and alert . . . with severe head pain, tenderness at about C7-­T1, and weakness on his left side . . .”

I went on down the list of signs and symptoms, and described what I'd done already. Kirchner told me to get the patient on oxygen as soon as we got him to sick bay, and to put him in Rack One on the ward.

“Sir,” I said, “I'd really like to run an STS on him first. If he has a spine injury—­”

“Are you telling me my business, Petty Officer Carlyle?” Kirchner demanded. “Rack One! That's an order!”

Haldane
's tiny hospital ward had four beds—­“racks” in Navy parlance—­and Rack One was the critical care unit. You could hook up the patient to provide constant monitoring with or without nanobots, immobilize any and all parts of the body, provide oxygen, put nutrients in, pull wastes out, and even take simple X-­ray shots.

But I
really
wanted to pull an STS on Pollard first. “STS” stands for “soft-­tissue scan,” a technique derived from various earlier MRI technologies. Magnetic resonance imaging used magnetic fields to detect the precession of certain atomic nuclei—­notably those of the hydrogen atoms in water molecules—­to get information about soft body tissue. Nowadays, though, you can't use traditional MRI techniques, because nearly everyone has a load of metal inside their skulls, the palms of their hands, and along certain key neural networks. The metals, including gold, iron, and copper, are chelated into place by standard nanotechnic processes, growing our cerebral implants, the cybernetic prostheses that give us our in-­head imaging and RAM, access to the local NET, and even control over everything from coffeemakers and doors to e-­Cars and starships. There's enough ferrous metal in our heads to make real trouble if we enter a powerful magnetic field, like the ones used by early MRIs.

Modern soft-­tissue scanning units, though, are a lot more sensitive, and they use a number of different sensory inputs, combined and interpreted by powerful medical AIs. They employ background radiation, background magnetic fields, injected nanobots, and tightly focused sound to build up a detailed image of what's going on inside the body.

So why not use Rack One's X-­ray unit? Well . . . I might have been okay with that if the unit could have handled computed tomography—­a CT scan . . . what used to be called a CAT scan in the old days. But a simple X-­ray? Too risky for my money. X-­ray images miss something like 20 percent of all fractures—­in particular hairline fractures, which can be all but invisible, especially on a wet reading. Pollard's symptoms had already told me he didn't have a
complete
break in his spine—­not if he could still wiggle his fingers and toes.

So when we reached sick bay, I told them to put Pollard on the full-­body scanner.

I chimed Dr. Kirchner's office, but didn't get an answer. What the hell? He would have heard the emergency call when it came through, and I'd been talking to him just a moment ago. Where the hell was he?

I shrugged it off and went to supervise moving Pollard onto the table. That was tricky—­getting him off the stretcher and onto the table without further injuring his skull or letting his spine go crooked. If his back was broken—­even a hairline fracture—­we could cause some truly serious problems for the guy if we weren't damned careful.

There was that sheet of metacomposite nanocloth on the stretcher beneath his back, though—­a soft fabric weave that becomes rigid when you put stress on it. When we grabbed the corners of the sheet and tugged in opposite directions, it became as unyielding as a hard plastic board, and we used that to shift Pollard onto the table, where the cloth went limp once again.

“Thank you, gentlemen,” I told the Marines. I flicked on the STS scanner. “If you guys could stand by for a sec, I'll ask you to help me move him to the ward when we're done here.”

I brought up a viewall image showing Pollard's body, as a bright bar of light switched on above his head, then slowly moved down to below his feet. An expert AI took the data and created a three-­dimensional image on the viewall, which allowed me to see inside Pollard's body from any angle, to any depth. Linking in through my in-­head, I could zoom in, rotate the image, even remove layers of tissue for a clear view.

I was still looking at the skull fracture—­hadn't even gotten to his back yet—­when Kirchner came through the door from the passageway outside and exploded all over me.

“What the fuck are you doing, Carlyle! I distinctly ordered you to put the patient on Rack One!”

“Sir . . . I thought it best to do a full-­body STS. There's a chance—­”

“You thought! You
thought
? You're supposed to follow the orders of the doctor-­in-­charge, not
think
!”

“But sir—­”

“This man has a serious skull injury! You're risking his life by doing an additional transfer! A
needless
patient transfer, since we can x-­ray him in the rack!”

“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.