Analog SFF, April 2012

by Dell Magazine Authors

  “Doctor,” Aidmit called, “you must continue your procedures.”

  Sissy studied the soldier's face. It told her nothing. She never looked at their faces, not unless that was where they were wounded. The experimental protocol the entire medical unit operated under in many ways reduced her to even more of a single depersonalized cog in a much larger machine than was usual for the military. The patients were brought straight to her from pre-op, and left her table never to be seen again. The patient's meds guaranteed that he or she would not remember the procedure. They would be wounded, put under, and come out on the other side whole again, with no memory of what had happened in between. This was supposed to cut down on the psychological trauma that came from being wounded.

  At first the seamless impersonality of the endless stream of nameless patients had seemed wrong. But over time she'd come to terms with the motto and underlying philosophy of the system they were testing: The faster fixed, the sooner well. We make it like nothing ever happened.

  Had she worked on this soldier before?

  Unlikely, but not impossible.

  “Doctor, please. You must get back to work.”

  Sissy shook her head to clear it, bent back to the task at hand.

  She finished up with that patient and worked quickly and efficiently on the ones who followed.

  But her thoughts kept drifting back to that tattoo—and the nebulous almost-memories it had triggered.

  The mess hall was nearly deserted. Not a surprise since it was well past midnight. Sissy went through the line and got her tray filled by a sleepwalking corporal, collected a hot tea from the dispenser, then shuffled wearily over to a table in one corner.

  She sat down with a sigh. Took a sip of tea, then just sat there staring blankly at her tray, gaze hazed with images of bloody viscera, and thinking, There's no place like home.

  “Mind if I join you?”

  Sissy jerked in surprise, looking up.

  Standing by her table was Colonel Bob Webb, the officer in charge of the entire field surgical unit program.

  “Uh, sure.” You don't say no to the boss, inside the military or out. She started to rise to her feet, belatedly adding, “Sir.”

  “Stay put. You've had a hard night.” Colonel Webb was a tall, Lincoln-homely man who customarily exhibited the loose-limbed slouch of a scientist rather than the ramrod-straight posture of a career soldier. What kind of scientist wasn't exactly clear; somehow that line of inquiry always got neatly sidetracked. She figured there was some psych in the diploma pile.

  He parked his tray and settled into the chair across from her. “You look beat, Sissy.”

  “It was a long shift, sir.”

  “No need for ‘sirs’ after midnight.” He inspected the slab of meatloaf filling one compartment of his tray. “Not sure if this is animal or vegetable—or other. But I can be pretty sure it will give me heartburn.”

  His doleful expression made her smile. “Maybe we need a mints bowl full of antacids on the chow line.”

  “A gesture of surrender, but I could get behind it,” he said with a chuckle. “So, do you think the surgical shifts are too long?”

  “No, probably not.” Sissy forced herself to sit up straighter and focus. Webb habitually did this, shifting from breezy chat to serious questions about the program and back again. She recognized this as a technique, one he had completely mastered. “I think it's not so much the duration as the monotony.”

  The Colonel had started cutting his meatloaf into pieces that were smaller, if not necessarily more digestible. He nodded, looking up. “Can you be more specific?”

  Sissy took a sip of tea, searching for the best way to explain it. “Back in the ER in Detroit, wounds like I'm seeing here would be a crash situation. Everyone and every system kicking into high gear.”

  “Code rush.”

  “Yeah. You have to summon every skill and mobilize every asset, stat. It's an adrenaline situation, knowing you're doing a high-stakes, high-wire act.”

  Webb squirted some ketchup on the pieces of meatloaf. “But here the thrill is gone.”

  Hearing it put that way made it sound petty. Even selfish. “I guess you could say that. The tech I get to work with here is incredible, even better than I imagined it could be. But the system is structured to provide minimum involvement, which means minimum feedback. I don't know who the patients are. I don't know what happens to them after they leave my table.” She hesitated, then added in a joking tone, “For all I know it's the same patients passing through over and over again.”

  Webb shrugged. “I admit that's one of the downsides of the system we're testing. But I like to think that the upside more than compensates for it.” He put down his fork and dug into the pocket of his white rounds jacket, pulling out an Army issue armored Brick. His fingers moved across the screen.

  “Here we go,” he said with a nod. “Today, in the course of your twelve-hour shift, you successfully treated fifteen patients whose trauma score would have meant at least four hours each in a standard, fully staffed ER or operating theater. You did this solo. With zero patient loss and close to zero disability from either their wounds or their treatment.” He looked her in the eye. “That fifteen is your average. Your lowest was six, your highest twenty-one.”

  Those numbers were a lot to absorb. Fifteen patients who might have needed sixty hours of work from a team of at least five done single-handedly in under twelve hours. “Those are pretty good numbers, right?”

  “Good? They're excellent! You're meeting and exceeding the benchmarks we were hoping the effsue program could achieve. What we're doing here will not only revolutionize battlefield medicine, but the methods and techniques we're developing and testing will fundamentally change civilian trauma care.”

  And that, Sissy reminded herself, was why she'd said yes when the Army had contacted her and asked her to participate in this experiment. Why she'd worked so hard to master the new tech, and pushed so hard using it.

  “Then I guess we're doing good work here.” That statement was followed by a yawn.

  “You bet we are.” Webb studied her face a moment, smiled. “Listen, as your commander and friend I'm strongly suggesting that you call it a night. Head back to your quarters and grab some rack time. Call today a good day done and rest up for tomorrow.”

  Sissy looked down at her tray, surprised to see that half the food on it was gone. Eaten robotically while they talked.

  Just call me Dr. Autopilot.

  “Sounds like a good idea.”

  Colonel Webb pushed his chair back. “Come on, I'll walk you there.”

  Sissy's quarters were part of a cluster of Ballisti-Board huts sheltered by a high sandbag berm. The interior of the hut was a drab gray, three-meter cube. While not exactly a suite at a five star hotel, it offered a small island of quiet and privacy.

  Her status as an officer in the medical unit had one benefit. She and several other officers shared an orderly. Private Kopinsky had already been through and done her work. The bed had been turned down. A thermal carafe of hot cocoa and a mug were on the table beside her bunk, a plastic cup holding her vitamins alongside it.

  Sissy turned on the wall screen to the landscape feed that helped her sleep. It lit with a view of Detroit as seen from a tall building, filling the cubicle with the muted sound of traffic, a rumbling hum broken by distant car horns and the occasional lonesome wail of a siren. The sound of home.

  She plunked down on the side of her bunk, sighing at the pleasure of getting off her feet. Kicked off her boots. Poured a mug of cocoa. Collected her vitamins, once again telling herself she really should find out exactly what she was taking. Not that she had any complaints. Her health had been excellent in spite of the grueling surgical shifts, and she'd been sleeping well. Better, in fact, than back home where she'd been prone to bouts of insomnia.

  Maybe some of that could be chalked up to its having become such a rarity for her sleep to be ruined by her mind dwelling on the da
y's failures. She'd done right by them all, right on down the line. Still, she missed the city and her old noisy, chaotic, overburdened emergency room.

  No place like home. A sensible sentiment for any soldier, herself included.

  She knocked back her vitamins, washing them down with a swig of cocoa. Peeled off her scrubs and crawled into her bunk to be lulled to sleep by the urban soundscape of her own, not particularly Emerald city.

  Eighteen days later, halfway into her shift, she was preparing to put every bit of the experimental medical tech at her disposal to work.

  The mechanisms and practices for locating and disabling mines, IEDs, and booby traps had improved to the point that such killing strategies were being used less and less as their success rate diminished. This was one of the reasons warfare had grindingly reset to two opposing sides engaging each other directly; action was street by street and house to house, and quite often hand to hand, waged with snipers and strike teams and snake wranglers. Artillery was still popular, but anti-artillery defense weapons managed to block most incoming shells, RPGs, mortar rounds, and tank shells midair. Cutting back their effectiveness, but not stopping them altogether.

  All of this, plus the newest generation of body armor, had drastically cut down the number of traumatic amputations coming from the battlefield.

  But not stopped them altogether.

  The patient's leg had been taken off halfway between his hip and his knee, scythed off by flying metal.

  Sissy knew that this was a sure ticket to a prosthetic unless you were lucky enough to end up in one of the few high-end research hospitals that deployed the absolute cutting edge of medical technology.

  Tech that tech effsue put at her fingertips.

  She was satisfied with her study of the scan and was preparing to start the procedure when Aidmit spoke up. “Doctor, Colonel Webb requests permission to enter and observe.”

  She frowned in surprise, wondering if he was checking up on her. But there really wasn't any way to say no.

  “Sure,” she said. “As long as he's sterile.”

  “I'm clean,” Webb said as he entered her unit. “I just want to hang around and watch you work. But just to be on the safe side I'll scrub.”

  “Thanks.” One category of nanodevices cleansed wounds so well that sterile procedure was probably redundant, but old habits—especially good ones—were hard to break.

  “No problem.” The scrubber activated as he approached it. “I saw that you're going to perform a large-scale tissue replacement. I haven't had a chance to see one all the way through just yet. Hope you don't mind me rubbernecking.”

  “No, not at all.” Back stateside the ER was always jammed with people. It was strange to realize that she'd gotten so used to working by herself that having another person in her space felt weird.

  Webb stepped back when the scrubber chimed. “Glad to hear it. Don't let me slow you down. And if I get in your way don't hesitate to yell at me to move my ass.”

  “I won't. Your timing was pretty good. You haven't missed a thing.” Feeling self-conscious, she went back to where she'd been when he arrived.

  The patient was prepped, the bloody stump of his leg resting in a deep, clear, fluid-filled trough, the upper end of the vessel conforming tightly to his thigh above the injury.

  “We were lucky with this one,” Sissy said over her shoulder, pointing to the condensation-dewed canister across the table from her. “At least eighty percent of the damaged tissue was recovered. It's in there, cleaned and stabilized.”

  Webb took up a position near the head of the table. “The more original tissue you have, the better the reconstruction.”

  “Absolutely.” She raised her voice. “Aidmit, are we ready to commence all feeds?”

  “Yes, Doctor.”

  “Then start.”

  “Feeds commencing.”

  Several things started happening at once. Nanoscale transporters extracted bone and marrow tissue from the salvage tank and carried this material to the injured area. Precisely metered flows of replicells and universal bone replacement cells were mixed with the original tissue and deposited at the shattered end of the patient's femur.

  Sissy and Webb were silent as they watched this swarming cloud work, portions of it already beginning to sketch out the ghostly outline of the missing skeletal mass.

  “We have one particular limitation in this sort of procedure,” Sissy said after a few minutes had passed, time she spent making small adjustments to the work in progress. “We can't reconstruct an exact copy of the leg the patient lost—at least not in the narrow time frame we have here. So what we do is build a mirror image of the other leg.”

  “Guided by information from the scan.”

  “Yeah. I mean, there are normative rules that can be applied to guide reconstruction in cases where there isn't a second limb or matching body part to copy. But those methods, while quite good, can't compare to this approach.”

  On the table and in the trough new bone was being erected by nanoscale siroccos, the hazy outline of the new femur growing more solid by the minute. The tibia was a structured mist, and at the knee joint the ghost of the patella hung like a bone hologram.

  “The process is carefully staged,” she continued. “See how secondary transports are bringing in tissue to build the beginnings of muscles, tendons, and ligaments? Not to mention the nerves, arteries, and veins.” She leaned close and made yet another adjustment at the wide touchpad on the side of the table.

  “This is truly amazing,” Webb said. “Like time-lapse video of something being dissolved running backward.”

  “It still wows me to see it. This kind of work doesn't really give me any chance to use the skills I honed in the ER surgical unit, but then again I can't imagine trading this for a handful of scalpels.”

  “How good will the replacement be? You know, how long before it's as good as the original?”

  “I don't get to have any sort of follow-up, remember?” Sissy said, giving the Colonel a short, mildly reproachful glance. “But I can make an educated guess. This leg, while it will be perfect in musculature, will lack the tone of the undamaged leg. It will probably be weaker for a while, and stiffer, until it breaks in and tones up. Tomorrow he can walk. In a few days, run. Maybe a month until it is conditioned as well as the original.”

  “That doesn't sound too bad.”

  “It's great, in fact. The duplication actually makes improvements. This guy had some minor damage to his knee, and had broken two bones in his foot, both injuries probably dating from his teens. I've edited these defects out.”

  Webb shook his head in wonder as he watched the furious activity in the tank. “That's part of what you're doing, right? Editing?”

  “Editing and guiding. You get a feel for the optimum rate of transport and build, and how to weight the distribution of original cells versus replicells and stock replacements.”

  The Colonel smiled knowingly. “All medicine is an art, as well as a science. Still, couldn't heuristic systems pick up on these fine tunings?”

  “Maybe at some point,” she said, watching closely as the reconstruction continued. “It might work for cut-and-dried situations, but I'm not so sure about when things get dicey or complicated. A surgeon gains a physical skill set, sure, but we also get a sort of Zen feel for the human body. I'm not sure a knowledge system could learn that.”

  Webb chuckled. “Probably not. And nobody wants to be replaced by a machine.”

  Sissy shrugged as she made another small adjustment to the replicell balance. “In some ways I've already been replaced. I haven't picked up a scalpel or laid a suture since I got here. All my training in standard surgical tools and their use is being rendered outdated and superfluous.”

  “You can't miss bone saws.”

  That made her laugh. “No, only the really old guard ortho guys love their bone saws. Not to mention their hammers, chisels, and power drills.”

  The patient was beginning to get
his foot back. The foot is the most complex part of the human leg; home to 26 bones and a complicated cat's-cradle of connective tissue. The new ankle was growing more solid, the tarsi and phalanges beyond condensing out of the nanotic and cellular whirl. Higher up the leg the femur was complete and largely re-muscled, new skin creeping downward to cloak what had just been recreated.

  “So,” Webb said, “would you like to see this sort of tech in every civilian ER?”

  Sissy nodded as she studied the levels of original tissue remaining. “You bet I would. That's why I signed on here. Gunshots would become a piece of cake. So would trauma from all kinds of accidents. We have access to a little of this tech, but nowhere near all of it, and certainly not deployed on this scale. I've already had some ideas about how this stuff could be used in other ways.”

  “Such as?”

  “Well, we're already using nanomed and replicells to deal with such things as heart attacks. But the approach is almost always to patch up what's already there. I've been thinking that in some cases we should just yank out the damaged or defective organ, disassemble it, and build a new one from scratch, using only carefully selected bits of tissue from the original. In others build and transplant a—I guess you could call it—standard issue replacement. That might even be better.”

  Colonel Webb frowned. “I thought you said a rule-based replacement isn't as good as a copy of the original.”

  “For a hand or leg it isn't. Certainly not for facial reconstruction. But a spleen is a spleen, and a liver is a liver.”

  “What about hearts? Isn't there a greater diversity of morphology in cardiac structure? Some people having larger, or more efficient hearts than others?”

  “There is. But what's to keep us from designing an optimized replacement blueprint? Yank out that moped motor and drop in the engine from a sports car or bulldozer.”

  “Interesting idea.” He gazed down at the trough. “Looks like you're closing in on completion.”

  “It'll go faster now. Less mass to be moved around in the foot, and the parts are smaller.”

  The bone mass was complete, and the intricate banding of muscles, connective tissue, and circulatory structure was rapidly accreting. New skin covered the patient's leg halfway down the calf and was creeping steadily downward.