Sector General Omnibus 2 - Alien Emergencies (69 page)

“Wreckage subsistence casualties,” the pathologist replied. “They were members of the rescue team from the nearby Orligian processing plant. You are always complaining that you never get enough DBDG surgical experience.”

“You’ve given me just one case,” Diagnostician Vosan said. The Crepellian octopod turned to regard Thornnastor, then it made a noise which did not translate before adding, “Rarely have I seen such a discouraging clinical picture, and I shall certainly have my hands full, all eight of them, with this one.”

“It was the number and dexterity of your manipulatory appendages,” Thornnastor replied, “which impelled me to assign the case to
you in the first place. But the time for discussion grows short. Are there any other comments before we move to procedures?”

Ergandhir said quickly, “During the intercranial work, on one of my patients in particular, emotional radiation monitoring would be distinctly advantageous.”

“And I,” Vosan said, “would find it useful during the preoperative phase to check on the level of unconsciousness and required anesthesia.”

“And I! And I!” clamored several of the others, and for a moment there were too many voices talking at once for the translators to handle them. Thornnastor gestured for silence.

“It seems,” the Tralthan said, “that the Chief Psychologist must remind you once again of the physiological and psychological capabilities of our one and only medically qualified empath. Major?”

O’Mara cleared his throat and said dryly, “I have no doubt that Doctor Prilicla would be willing and anxious to help all of you, but as a Senior Physician who is being considered for elevation to Diagnostician status, it is in the best position to judge where and when its empathy can be used to best effect. There is also the fact that while it is useful to have an empathic sensitive constantly monitoring the condition of a deeply unconscious patient during an operation, the patient does not really require it and the only benefit lies in the mental comfort and reassurance of the surgeon.

“There is also the fact,” the Chief Psychologist went on, ignoring the untranslatable sounds of protest from around the table, “that our empath functions best when among people who like and fully understand it. This being so, it should be clear to you that Prilicla is allowed a wide degree of latitude in its choice, not only in the cases it takes but in the surgeons it agrees to assist. And so, if the person who has worked with Senior Physician Prilicla since it joined us as a junior intern, and who helped it during its early medical training, if this Doctor requested the assistance of Prilicla during an operation, it would not be refused. Isn’t that so, Conway?”

“I, yes, I expect so,” Conway stammered. He had not been listening closely for the past few minutes, because his mind had been on his cases, his close to hopeless cases, and on thoughts of open professional rebellion.

“Do you need Prilicla?” O’Mara asked quietly. “You have first
refusal. If you do not need, as opposed to merely want, the assistance of your empathic friend, say so. A line of your colleagues who do need Prilicla will form rapidly on the left.”

Conway thought for a moment, trying to coordinate and evaluate the input from his other mind components. Even the friendly and perpetually frightened Khone was radiating sympathy for his cases, and previously the mere sight of an uninjured Hudlar was sufficient to throw it into a panic reaction. Finally, he said, “I do not think that an empath would be of much help to these cases. Prilicla cannot work miracles, and at least three separate acts of supernatural intervention would be needed if these cases are to make it. And even then, well, I very much doubt that the patients or their close relatives will thank us.”

“You can refuse the cases,” O’Mara said quietly, “but you will have to give us a better reason than that they appear to be hopeless. As we have mentioned before, as a Diagnostician on probationary status you will be given what seems like an unfair share of such cases. This is to accustom you to the idea that the hospital must deal with partial successes and failures as well as nice, tidy, and complete cures. Up until now you have never had to concern yourself with problems of aftercare, have you, Conway?”

“I realize that,” he replied angrily, because it sounded as though he was being criticized for past successes, or being accused of grandstanding in some obscure fashion. And then he began to wonder if his anger was due to there being a certain amount of truth in the accusation. More quietly, he went on, “Perhaps I’ve been lucky…”

“As well as surgically adept,” Thornnastor interjected.

“…In the past with cases which could only be complete successes or utter failures,” he went on. “But these patients…Even with the life-support systems in continuous operation it seems to me that they are only technically alive, and I would need Prilicla’s empathic faculty simply to verify that fact.”

“Prilicla sent these casualties to us,” one of the Kelgians said who had not previously spoken. “Clearly, it did not consider them hopeless. Are you in difficulties deciding on procedure, Conway?”

“Certainly not!” Conway said sharply. He went on. “I know Prilicla and Cinrusskins tend to be incurable optimists. Unpleasant ideas like the thought of failure with a patient, or a case that is
hopeless from the start, are utterly foreign to it. There have been times when it shamed me into feeling the same way. But now I am being realistic. It appears to me that two, perhaps three of these four cases are little more than not quite dead specimens for investigation by Pathology.”

“At last you are showing signs of accepting your situation, Conway,” Thornnastor said in its slow, ponderous voice. “You may never again be able to concentrate your entire mind and capabilities on a single patient, and you must learn to accept failure and make your failures contribute to your future successes. It is possible that you will lose all four of your patients, or you may save all of them. But no matter what procedure and treatment you decide upon, and the good or bad results which ensue, you will use your multiply augmented mind to learn whether or not that same mind is stable enough to endure and maintain control over your procedures, whether personally performed or delegated.

“You will also bear constantly in mind,” the senior Diagnostician went on, “the fact that while treating your four cases from the Menelden emergency list, you have other concerns. The FROB geriatric problem, our presently unsatisfactory organ replacement postoperative difficulties, the approaching parturition of your Protector, and even, if its presence suggests a new viewpoint or procedure on any of these problems, the data provided by the nonerasable mind of your Gogleskan friend. And if you are bearing all these things in mind, and my own Earth-human mind partner is unhappy with that phrase because it is what your DBDGs call a pun, you have already realized that FROB replacement surgery will play a vital part in the treatment of your four cases, and any failure could provide ready access to the organs needed to ensure the success of a not quite so hopeless case.

“We all find it difficult to accept failure, Conway,” Thornnastor continued, “and your past record will make it less easy for you. But these cases are not being assigned to you for psychological reasons. Your level of competence as a surgeon warrants—”

“What our overtalkative colleague is saying, once again,” one of the Kelgians broke in, its fur tufting with impatience, “is that good Doctors are given the worst patients. And now, may I discuss my two cases before they both terminate, from old age?”

The first three hours were spent on preparatory work, tidying up the traumatic amputations performed by flying metal at the accident site, charting the extent of the internal injuries, checking on the readiness of the operating teams, and, in spite of the cooling unit in his suit, sweating.

At this stage in the proceedings his work was chiefly supervisory, so his increased output of perspiration was unconnected with physical activity and was what O’Mara referred to as psychosomatic sweating, a condition which the Chief Psychologist would tolerate only on rare occasions.

When one of the patients died preoperatively, Conway’s feelings lacked the intensity he had been expecting in that situation. The prognosis on that particular Hudlar had been very poor in any event, so when the sensors indicated termination it was not a surprise. The Melfan, Illensan, Kelgian, Tralthan, and Gogleskan components of his mind registered low-key professional regret at the loss; the Hudlar alter ego felt more strongly, but its sorrow was tinged with relief because it knew how drastically curtailed would have been the patient’s quality of life had it survived, and because the other three cases were occupying so much of his attention, Conway’s own reaction lay somewhere in between.

He maintained the cadaver’s respiration and cardiac functions so that its undamaged organs and limbs, what few of them remained, would be in optimum condition for transplantation. A small part of his mind wondered if the Hudlar’s parts were used for
replacement surgery on its more fortunate colleagues, could it truly be considered to be dead? Which led, inevitably, to a minor conflict within his multiple mind between the Hudlar component and the others regarding the treatment of the physical remains after death.

For reasons which were not fully understood even by the members of the species themselves, the Hudlars, although in all other respects a race of highly intelligent, sensitive, and philosophically advanced beings, were unique in that they did not honor or show the slightest degree of respect for their recently deceased. The memory of the person while alive was treasured by its friends, and commemorated in various fashions, but these records invariably omitted any reference to the fact that the being concerned had died. The life and accomplishments of the entity were remembered; the death was studiously ignored, and the deceased disposed of quickly and without ceremony, as if it was a piece of unsightly litter.

In this case the Hudlar idiosyncrasy was a distinct advantage, because it removed the often time-consuming necessity for obtaining the consent of the next of kin for organ removal and transplant.

Realizing suddenly that he was mentally sidetracking himself and wasting time, Conway gave the signal to begin.

He joined the operating frame around FROB-Three, who was the patient with the fractionally better chance of making it, taking the observer’s position beside Senior Physician Yarrence, the Kelgian surgeon who had charge of the team. His original intention had been to head the team on the recently deceased FROB-Eighteen’s operation, but that patient’s demise meant that he could now keep a close watch on the three operations, all of which were urgent and critical enough to require simultaneous rather than consecutive performance. The members of his original team had been divided up between Yarrence, Senior Physician Edanelt, the Melfan in charge of FROB-Ten, and the Tralthan Senior Hossantir who had taken FROB-Forty-three.

Even though the FROB life-form was capable of living and working in gravity-free and airless conditions, this was only possible when the immensely tough and flexible tegument remained intact. When the skin had been pierced and the underlying blood vessels and organs exposed, as had occurred in several areas with this patient, deep surgery was impossible unless the natural gravity and pressure environment was reproduced. To do otherwise was to invite massive hem
orrhaging and organ displacement due to the high pressure of the internal fluids. For this reason the OR staff were forced to wear gravity repulsors set to four Gs and heavy-duty protective suits whose gauntlets had been replaced by tight-fitting operating membranes designed to minimize the effects of the high external pressure.

They clustered around the patient like a shoal of ungainly fish, Conway thought, about to begin their surgical nibbling.

“The rear limbs have escaped with superficial damage and will heal naturally,” Yarrence said, more for the benefit of his recorders than for Conway. “The two midlimbs and left forelimb have been lost, and the stumps will require surgical trimming and capping in preparation for the fitting of prosthetics. The right forelimb is still attached but has been so badly crushed that in spite of efforts to reestablish circulation to the affected areas, necrosis has taken place. This limb will also require removal and capping…”

The FROB in his mind stirred restively and seemed to be raising objections, but Conway did not speak because he had no clear idea of what it was objecting to.

“…Of the stump,” the Kelgian Senior went on. “There is a metal splinter which has been driven into the right thoracic area with associated damage to a major vein, the bleeding from which has been incompletely controlled by the application of external pressure. This situation must be rectified urgently. There is also cranial damage, a large depressed fracture which is compressing the main nerve trunk and affecting mobility in the rear limbs. Subject to approval”…Yarrence glanced briefly in Conway’s direction…“we shall remove the damaged forelimb, which will allow easier access for the team-members working in the cranial area, and prepare the stumps for—”

“No,” Conway said firmly. He could not see anything but the Kelgian’s conical head inside the heavy protective garment, but he could imagine the silvery fur tufting in anger as he went on. “Do not cap the forelimb stumps, but prepare them instead for a transfer and transplant of the rear limbs. Otherwise your procedure as outlined is approved.”

“The risk to the patient is increased,” Yarrence said sharply, “and the operational time will be extended by at least twenty percent. Is this desirable?”

Conway was silent for a moment, thinking about the quality of
life of the patient following the success of the simple as opposed to the more complex operation. Compared with the immensely strong and precisely controlled forelimbs possessed by a normal FROB, the telescoping, hinged, and swiveling prosthetic was ridiculously weak and inefficient. As well, Hudlar amputees found them aesthetically displeasing and distressing when the forelimbs—which were the members most conveniently placed to the eyes and used for the more delicate physical manipulations, including the long and involved preliminaries to mating—were artificial. Transplanting the rear limbs forward, although risky considering the weakened state of the patient, was infinitely preferable, because if the operation were successful, it would provide the FROB with forelimbs which would be only fractionally less sensitive and precise than the originals. Since the limbs would be coming from the same entity, there would be no immune system involvement or tissue rejection problems.

The Hudlar material in Conway’s mind was insisting that he disregard the risks, while his own mind was trying desperately to find ways of reducing them.

He said, “Leave the forelimb transplant until the cranial and abdominal work is successfully completed; otherwise the transplant would be wasted effort. Don’t forget to clean the tegument frequently and respray with anesthetic. In cases like this the absorption mechanism is affected by the general condition of—”

“I know that,” Yarrence said.

“Of course you do,” Conway went on. “You have the Hudlar tape, too, probably the same one as I have. The operation carries a strong element of risk, but it is well within your capabilities, and if the patient were conscious I have no doubt that—”

“It would want to take the risk, too,” Yarrence broke in again. “But if the Hudlar in my mind feels that way, I, as the surgeon, feel obliged to express caution on its behalf. But I agree, Conway, the operation is desirable.”

Conway detached himself from the operating frame, paying Yarrence the compliment of not watching the opening stages of the operation. In any case, incising an FROB’s ultratough tegument required the tools of an engineering workshop rather than an operating theater, because the cauterization effects of using fine laser cutters, which were so necessary during internal surgery, seriously
inhibited healing along the faces of tegument incisions. The blades which had to be used were two-handed Kelgian Six scalpels, and they required a lot of physical effort as well as a high degree of mental concentration in use, and frequently the medic was in greater danger from the blade than the patient. It was a good time to remove all unnecessary distractions from Yarrence, which included the presence of a would-be Diagnostician, and move to FROB-Ten.

It was obvious from the first look that this patient would never again see its home planet. Five of the six limbs had either been traumatically severed during the accident or damaged beyond the possibility of surgical reconstruction. In addition there was a deep incised wound in the left flank which had penetrated to and destroyed the function of the absorption organ on that side. Decompression, brief as it had been before the victim’s self-sealing safety bubble had deployed inside its room, had damaged the organ’s twin on the right side because of the sudden rush of body fluid toward the area which had been opened to zero pressure. As a result FROB-Ten was able to receive barely enough sustenance to continue living, providing that it did not exert itself in any way.

An FROB perpetually at rest was difficult to imagine. If such a thing were possible, it would certainly be a very unhappy Hudlar.

“A multiple replacement job,” Senior Physician Edanelt said, curling an eye to regard Conway as he approached. “If we have to replace a major internal organ, there is no point in fitting prosthetic limbs rather than real ones. But it bothers me, Conway. My Hudlar alter ego suggests that we don’t try too hard with this one, while my own purely selfish Melfan mind is concerned chiefly with gaining more other-species surgical experience.”

“You are being too harsh with yourself,” Conway said, then added thoughtfully, “At the same time, I’m very glad that the hospital discourages visits from patients’ relatives. The postoperative talk with the patient, especially in a case like this one, is bad enough.”

“If the prospect causes you serious mental distress,” Edanelt said quickly, “I would willingly relieve you of it.”

“Thank you, no,” Conway said, feeling tempted. “It is supposed to be my job.” He was, after all, the acting Diagnostician-in-Charge.

“Of course,” said Edanelt. “Presumably the replacements are immediately available?”

“Patient Eighteen terminated a few minutes ago,” Conway said. “The absorption and food-processing organs are intact, and there are three usable limbs. Thornnastor will let you have more as and when you need them. This was one accident which left us with no shortage of spare parts.”

As he finished speaking, Conway attached himself to the operating frame beside Edanelt and began discussing the special problems which would be encountered with this case, and in particular the necessity for performing three major operations concurrently.

Because of the nature of FROB-Ten’s injuries there was less than fifty percent of the patient’s absorption system functioning, and that situation was being maintained with difficulty and with no certainty that there would not be further deterioration within the next few hours. The absorption mechanism could be used to assimilate the anesthetic or food, but not both, so it was essential that the patient’s period under anesthesia be as short as possible. And while the limb replacements were relatively simple microsurgical procedures, removing the damaged organ from Ten and the healthy one from the deceased Eighteen was going to be tricky and only fractionally less difficult than resiting the donor organ in the receiving patient.

The organs of absorption of the physiological classification FROB were unique among the warm-blooded oxygen-breathing life-forms known to the Galactic Federation—even though, properly speaking, the Hudlars did not breathe. Situated under the skin of each flank, the organs were large semicircular and extraordinarily complex structures covering more than one-sixth of the body area and separated along their upper edges by the spinal column. The organs were integral with the skin, which was pitted in those areas by several thousands of tiny slits whose opening and closure was controlled by a network of voluntary muscles, and extended deeply into the body to a depth which varied between nine and sixteen inches.

Serving as it did the functions of both stomach and lungs, the combination of nutrition and air which was the dense, souplike atmosphere of Hudlar was taken in by the two large organs, and in a remarkably short period of time, the usable content of the gaseous liquid and solid mixture was abstracted and the residue passed into a single smaller and biologically less complex organ sited on the underside where the wastes were evacuated as a milky liquid.

The two hearts, situated in tandem between the organs of absorption and protected by the central vertebrae, circulated the blood at a rate and pressure which had made the early attempts at Hudlar surgery extremely hazardous for the patients. Now, however, much FROB surgical experience had been amassed since the planet’s inception into the Federation, and what was more important, a Hudlar was very hard to kill.

Unless, as in this case, it was more than half-dead already.

The team’s one big advantage was that all of the procedures, the multiple replacements of limbs and organs of absorption, would be open surgery. There would be no delving and cutting and suturing in tiny, restricted interorgan spaces. More than one surgeon could enter the operative field when required, and Conway knew with certainty that the operating frame around FROB-Ten would shortly be the busiest place in the hospital.

Edanelt was giving final directions regarding the presentation of the patient to its nurses when Conway left to visit FROB-Forty-three. He was beginning to feel that he was in the way again, a feeling to which he had become increasingly accustomed as his growing seniority in recent years had necessitated greater delegation of authority and responsibility. But he knew that Edanelt, as one of the hospital’s foremost Senior Physicians, was itself too responsible a Doctor to hesitate about calling for Conway’s assistance should it get into trouble.