Susan glanced at the parents, who squirmed. They, too, would have preferred being elsewhere.
“Oh.” Susan tried to sound interested rather than repulsed. “Where did you come from?”
Payton spat out, “Da sun!”
Because of his bizarre pronunciation, it took Susan a moment to make sense of the words. She suppressed the urge to correct his science; it seemed absurd to point out that the average distance from the Earth to the sun was only ninety-three million miles. “I see.” Susan could think of nothing more significant to say. Obviously, Payton Flowers was in no condition to give consent to anything. “Well, thank you for coming.” She turned her attention to the family. “I assume you have guardianship.”
The mother gave a weary nod. She looked elderly, frail, and tired. Her eyes sank darkly into her wrinkled face. “We do. I know it’s hard to tell now, but Payton was his high school valedictorian and a talented basketball player, too. He had an A average in prelaw when he decided he could fly off the roof of his dorm.”
“I’m so sorry,” Susan said. She could think of nothing else. She knew about schizophrenia, how it came out of nowhere, striking young adults with a madness most people could scarcely comprehend. “I wish I could have met him then.” She could imagine the call that had come from Payton’s college, the desperate rush to the hospital, the certainty that illegal drugs had played a role. The parents had probably fought a losing battle to jaded hospital staff far more accustomed to experimentation than a sudden break with reality. Then would have come the clean toxicology screen, the hallucinations, delusions, and a diagnosis that left the parents wondering why they had so fervently prayed against drugs. Rehab might work for those; schizophrenia was forever.
There followed years of promising medications, lost to ineffectiveness or intolerable side effects. Some schizophrenics preferred the disease to the medications, and forcing treatment on someone required a criminal history most schizophrenics did not have.
Mrs. Flowers seemed to read Susan’s mind. “We try to keep him on his meds, but he gets so miserable. Even when he’s on them, he’s not …”
“Normal,” Mr. Flowers inserted in a slow, raspy voice. He said nothing more, almost as if conserving syllables.
“Not himself,” Mrs. Flowers asserted.
Susan commiserated with a problem that existed for as long as effective treatment. “When they’re lucid, they notice only the side effects. It’s hard to remember the side effects are the price for lucidity.”
“Yes,” Mrs. Flowers said, and the sister nodded enthusiastically.
Susan opened a lower cupboard to retrieve a palm-pross containing the consent information. “Before you sign this, I need to go over it with you.” She held it directly in front of the sitting group, while Payton’s gaze rolled around the examination room. As she turned her back to him, Susan could feel sharp prickles along her spine, her mind creating imaginary gouges and bites.
Susan had gone over the consent form earlier and summarized it for her patient’s guardians. “Basically, it states this is an experimental procedure with limited prior testing. We have just entered the human experimental stages.” She lowered the palm-pross to look the mother directly in the eyes. “In fact, Payton is our first patient.”
“Understood,” the woman said.
“If you choose to sign this consent, I will be injecting radioactively tagged diamondoid nanorobots into Payton’s cerebrospinal fluid at the level of the lower spine.” Susan tapped a finger on a diagram of the human circulatory system. “These will travel through the spinal fluid and into the brain itself.” She traced a pathway from the lumbar area, along the back, to the skull. “Theoretically, these nanorobots have no biologically active ingredients, so rejection should not be an issue. Also, their diamondoid coating should not be capable of stimulating an immune reaction or actual infection.” Susan looked up to make certain the parents were following her explanation.
The sister’s head was bobbing. Dad crossed his arms on his chest. Mom studied the screen.
“The nanorobots will be left in place for two weeks, during which time they will gather information about the chemical and neurological processes occurring in Payton’s brain. At that point, we will remove the nanorobots via another lumbar puncture. We will then insert them into a special computer, which will help us target appropriate therapies to assist with Payton’s mental health issues. In this case, schizophrenia.”
Susan could hear herself adopting the neutral voice common to all doctors while explaining a complicated procedure to laymen. “Risks include discomfort during the lumbar punctures and the possible introduction of bacteria or viruses, which I will minimize with sterile procedure. As we discussed, the nanorobots should not theoretically cause either rejection or foreign body reaction, but a small risk still exists for either of these. As with any procedure, minimal but possible risks include death, debilitation, or worsening of the problem.”
The mother laughed nervously. “You certainly do cover all the bases.”
It seemed ludicrous to Susan, too; but aggressive lawyers always spurred greater caution, sometimes to a ridiculous extreme. Manufacturers even plastered warnings on their boxes such as CAUTION: HOT WHEN HEATED. “Do you have any questions?”
The mother shook her head, but Payton’s sister piped right in. “What’s to prevent these nanobots from escaping into the rest of his body? What if they get loose … into the food supply or something?”
Susan appreciated the question. It meant at least one member of the family had a full understanding of her explanation. “There’s a semipermeable system of endothelial cells in the brain that separates the cerebrospinal fluid from the circulatory system. We call it the blood brain barrier. Most of the time, its job is to keep dangerous things out of the brain: bacteria, foreign substances, body hormones, dyes, most medications. In fact, it’s what makes brain infections both rare and hard to treat; most antibiotics can’t cross it, either. These nanorobots were manufactured with the blood brain barrier in mind. They’re too large to slip through, completely fat-insoluble so they can’t diffuse through, and also highly charged. Radiation can break down the blood brain barrier, so their tags are deeply inserted.” Susan knew she had gotten too technical. “In other words, it’s not possible for these nanorobots to get out of the patient’s brain except by lumbar puncture.”
The parents sat silently, but the daughter had one more question. “And when you remove them, how do you know you got them all?”
“Good question.” The sister clearly was paying attention. “When we perform the second lumbar puncture, we use a small magnetic device to draw the nanorobots. Another device keys onto the radioactive markers to ensure we don’t leave anything behind. If any of the nanos get stuck, we only need to reposition your brother in such a way as to free it. On his side, his back, standing. I’ll make sure they’re all in the right place before performing the lumbar puncture. Even if one did get left behind, it’s inert. It would simply flow around with the cerebrospinal fluid, taking in data forever.”
Susan could only imagine the reactions at USR to having one of their ten-thousand-dollar robots lost in a schizophrenic brain for a lifetime. For the patient, however, it would not prove a danger.
Finally, the mother found a question. “What about the radiation?”
Susan reassured her. “It’s just a tag and deeply buried in the nanorobots. It won’t affect your son directly.” She handed the palm-pross to Mrs. Flowers.
The woman stared at the screen, rereading everything Susan had elaborated. She seemed reluctant to sign. “Dr. Calvin, there’s a chance this could kill Payton, right? Or he could develop a brain infection that might make things even worse than they are now.”
Susan dared not lie, even to pacify a worried mother. During her M-4 pediatrics rotation, she had watched a panicked mother beg absolutes from a tenderhearted resident. The routine nature of the surgery gave the resident leeway to say the chance of death was
as close to zero percent as anything ever got. The procedure had gone fine, but an atypical sensitivity reaction to the anesthesia had resulted in a massive heart attack that killed the patient. It was the kind of thing no one could have foreseen, but the parents felt betrayed, and the resident had slid into a deep depression. “A very small chance, yes. Unfortunately, nothing in life is wholly without risk, and an experimental procedure is more dangerous than, say, eating a meal in a fast food restaurant or taking a shower. Yet people do die of those things, too.”
Susan had no intention of talking this family into the procedure. If they refused, Goldman and Peters would simply find another desperate patient. Schizophrenia affected one percent of the world’s population. Current procedures cured nearly fifty percent, and all but about five percent of the chronic patients responded at least tolerably well to some form of medication. That still left a million and a half possible replacements for Payton Flowers.
When the mother still did not sign, her daughter stepped in. “Ma, how many times have you secretly wished the fall from the roof had killed Payton? At least then we could remember him as the bright, generous boy he had been until that day. The horror of the last few years wouldn’t clutter and cloud those memories.”
Mrs. Flowers jerked toward her daughter, an appalled look on her face. “I’ve never said that.”
“No,” the daughter concurred. “But you’ve thought it. We’ve all thought it.”
The mostly silent father nodded.
“You’ve thought it, too?” Mrs. Flowers choked out. Tears turned her eyes shiny.
Susan stepped in. “It’s a perfectly normal reaction. People who don’t live with mental illness day in and day out can’t understand the agony. It’s why most mental illnesses have a standard ten percent suicide rate, and that’s with all our modern forms of treatment. A recent survey of the inmates of a top psychiatry inpatient hospital found that eighty-six percent of them would trade their current diagnoses for terminal cancer.” She had read it in Psychiatry only the previous month.
Susan had meant the words to console the mother, to make her feel less guilty for the thoughts her daughter had elicited. Instead, the two women sobbed in each other’s arms.
The father grabbed the palm-pross and signed his name with a flourishing finger. Clearly the practical one in the family, he rose from his seat. “Now, Doc, how would you like me to hold him?”
Chapter 14
Susan Calvin did not return to the PIPU until well into the afternoon. Keyed through the doors, she rushed onto the unit to receive glares from most of the staff. Uncertain what she might have done, she ignored them and headed for the staffing area to read the nurses’ notes on her patients. If anything had happened that day, someone should have keyboarded it into permanent history.
Sharicka’s day seemed to have consisted mostly of begging for human helicopter and horsey rides, though one note documented a near flood in the girls’ bathroom that was traced back to the girl. Apparently, Sharicka had “accidentally” left a wadded towel in the sink and the tap wide open. At least, this time, no alternative possibilities for the crime had been postulated. It seemed like a step in the right direction for the manipulated nursing staff.
Sable looked up from a palm-pross to give Susan a squint-eyed look that baffled her. Ignoring her, Susan glanced over Monterey’s notes, but the hostility stayed with her. She had never had a problem with Sable before. Monterey’s nursing notes contained nothing of interest. The girl remained uncommunicative, verbally and mostly nonverbally as well. The only new mention concerned a car-shaped gurney that had arrived from the pediatrics unit.
Susan had just decided to talk to Sable when Kendall entered the staffing area and plopped down heavily in a chair beside her. “Howdy, stranger. Thanks for joining us.”
Susan looked over him to where Sable had been sitting, but the female R-1 had gone. “Is that why everyone’s giving me the evil eye?”
Kendall crossed his feet on the desk and ran a hand through his hair until it stood up in red spikes. “I think it still irritates the nurses you made them look bad in front of Bainbridge.”
Susan had not considered that. “I didn’t mean —”
Kendall forestalled her with a raised hand. “No, that’s true, but it’s not the reason for the evil eye. There were two new admissions. At least one of them definitely should have been yours; you’ve only got two patients. I snagged one.”
“Don’t tell me.” Susan thought she had it figured. “Sable got the other one.”
“Yup. And it’s a doozy. Teenager. Burned her brains out on amphetamines. Nothing left but a kicking, biting, cursing handful of crazy.”
Susan winced. “Maybe she would give me —”
“Too late. She’s been assigned. If Sable lets you have her, she’ll look lazy in Bainbridge’s eyes.”
“Yeah.” Susan did not know what to do. “Well, I’m sorry. I didn’t mean to be gone so long. It’s not like we went out for lunch or anything.” Her own words reminded her she had not eaten since breakfast. Should have grabbed something on the way down here. Now it’s too late. “I’m not up there playing games. First, I had to convince a patient’s family ….”
Again, Kendall stopped Susan. “You’re not going to win any sympathy by complaining about a project we would all give an eyeball to be a part of.”
Frustrated, Susan turned argumentative. “I’m not trying to win sympathy.”
“Sorry. I could have worded that better. We’re not angry; at least I’m not. It’s more a matter of … abject jealousy.”
Susan got it. She just didn’t like it. “I see. Good things are happening to me, so that’s a reason to hate me?”
“Sure it is.”
It was not the response Susan expected.
Kendall smiled, and his dark eyes sparkled. “Not a particularly good one, but a reason.”
Susan snorted. She was tired of pussyfooting around everyone’s insecurities.
“Lighten up.” Kendall uncrossed his ankles and prodded Susan with a toe. “When you chose psychiatry, you knew the kind of colleagues you’d have.”
Susan froze. She did not know psychiatry had a type. “You mean, not arrogant and jerky?”
“That’s surgeons,” Kendall reminded her. “We’re quirky.”
“Quirky?” Susan had no idea what he meant.
Kendall sat up suddenly. “You really don’t know the reputation of people who go into psychiatry?”
Susan shook her head. When she had chosen her profession, she had selected the one she had found most interesting during her M-3 and M-4 years. She supposed the residents and attendings she had worked with, the practices she had drawn, and the particular patients who came to her during that month had as much to do with her decision as anything. She did have a keen interest in the human mind, communication of every sort, and in the challenge of the most complex organ in the human body. There was more yet to discover about the brain than all the other living systems put together.
Kendall enlightened her. “It’s supposedly the first choice for residents who worry they might be crazy or, at least, have trouble with social dealings and want to understand the reasons why.”
Susan started to reply, then stopped.
Kendall glanced around, then shifted toward Susan and lowered his voice. “Think about it. Clamhead’s socially a mess. Nevaeh’s … obvious. Monk never had a chance to be a kid, and Sable’s mother has schizophrenia, which is inherited.”
Suddenly, Susan understood something that had troubled her earlier. “That’s why Monk tries so hard and dislikes me so much. He’s used to being the little brainiac.”
Kendall raised his brows knowingly. “Two, three years makes a huge difference at eight. Not so much at twenty-three, especially when you’re getting compared to other highly intelligent people instead of common folk.”
Susan had to ask, “What about us, Kendall?”
“Well,” Kendall said, clearly taking the challen
ge seriously, “I sublimate my lack of social skills with humor. And you’re working through some … parental issue.”
An unconscious squeak snuck out of Susan’s mouth. “How could you possibly know that?”
“What?” Kendall looked truly surprised. “You mean I’m right? You have parental issues? I just guessed that because you mentioned your father on our first day. The perfect man, remember?”
“My mother died when I was three. I was considered too young to attend the funeral, and my father and I never talked things out. Until yesterday.”
Kendall pursed his lips and nodded. “I … am amazing.”
“Yes, you are.” Susan would have liked to chat longer, but the work-day had nearly ended. She still needed to handle Monterey. “Now, if you’ll excuse me, I have a patient to take off the unit. I have my Vox, if anyone needs me, and I’ll take any admission, even if it means I have to stay into on-call time.”
Kendall threw her a satirical but friendly salute.
Though made for younger children, the car-gurney fit Monterey well enough. If she felt silly, she gave no sign of it, or anything else. She allowed Susan to pull her through the corridors in silence, barely looking around her, showing no emotion whatsoever. The locked, austere hallways yielded to brighter, art-lined walls filled with bustling patients, workers, and families; but Monterey gave no indication she noticed any difference.
Apparently alerted by the rattle and creak of the gurney, as well as the movement of the knob, Nate met them at the door to the charting room. He greeted Monterey with a smile and a short bow. “Hello. You must be Monterey.”
Monterey stared at Nate, saying nothing.
Susan shut the door behind them, then threw a quick glance around the room to be sure they were alone. She could not forget the lecture on patient confidentiality, especially when it came to mental illnesses and other conditions with stigmata. Only then, Susan continued the introduction. “Monterey, Nate. Nate, Monterey.”
I, Robot: To Protect Book 1 Page 18
