It is true that radiation, toxins, age, and other factors can damage the chromosomes within the germ cells. In a woman this means that many of her remaining eggs may carry mutations that make it unlikely for conception to occur or for a normal baby to be born. In a man it can result in the inability to produce new sperm or an increased likelihood of making sperm that harbor harmful mutations. Malcolm Makenzie doesn’t want to risk fathering another abnormal child, so he chooses to be cloned. So far, so good. But Clarke describes that the radiation-induced damage in Mackenzie’s gametes is shared by his clone, forcing each clone to reproduce in turn by cloning. Clarke got it wrong; all of the somatic cells will not share the radiation-induced damage done to the gametes (otherwise Malcolm Mackenzie would be dead), and so his condition would not be passed on to the clones. To put it another way, radiation damage that prevents or damages sperm production is the physical equivalent of castration. If Mackenzie had his testicles or even his appendix surgically removed, his clones would still be born with all organs intact.
Clarke was normally quite careful in getting his science correct. In an afterword to the paperback reprint, he admitted that “several expert readers have accused me of grave error by assuming that Malcolm would pass on the Makenzie defect to his clones. Though I was well aware of this problem (and tried to avoid it by being carefully unspecific) I did not go into the matter as seriously as I should have done. I am still hoping that some ingenious geneticist will be able to contrive a solution; unfortunately, I doubt if I will be able to understand it” (305). A potential solution is much simpler than Clarke envisioned. Perhaps due to his own father being exposed to radiation during space travel or simply through chance, Malcolm Makenzie could have been born with a novel mutation that made him unable to produce healthy sperm (such genetic conditions occur today) or which proves fatal to any of his offspring. Such a mutation would be in all of Mackenzie’s somatic cells and gametes, and therefore his clones would share the same defect.
In Peter Hamilton’s recent Great North Road, the original Kane North engineered three clones of himself. Each of these clones has the ability to self-clone simply through the act of sexual intercourse with women. Large families of North clones have arisen, numbering hundreds of individuals in total. Hamilton never offers an explanation for the North clones’ remarkable ability to self-clone through normal sexual intercourse except to say that “Kane’s distinctive biological identity was locked in and dominant in every cell throughout the body, including the spermatozoon. Any woman having a child by one of the brothers produced yet another copy of the original.” Are North’s sperm somehow so powerful that they force the ejection of the chromosomes in the ova? But since sperm contain a unique haploid mix of chromosomes, this would still be an insufficient explanation. North’s sperm would have to contain a complete diploid set of 46 chromosomes identical to the somatic cells in order to enable him to father true clones through sexual intercourse. The complex genetic engineering required for this would effectively make North non-human. Whatever the mechanism for North’s seemingly powerful sperm, the successive generations of clones have errors that “creep into the DNA as it replicates itself,” such that the fourth generation “had both physiological and psychological abnormalities” and the fifth generation “tended not to survive very long.” Consequently, the fourth generation were “quietly and diplomatically sterilized” to prevent them from cloning themselves further through their unique ability. Sterilizing the fourth generation would not prevent them from traditional cloning because any somatic cell in the body can be used as the source of the DNA.
Carbon monoxide vs. carbon dioxide poisoning
We breathe in oxygen and breathe out carbon dioxide that our cells generate as a waste product. A higher content of carbon dioxide causes the blood to be more acidic, but this is normally prevented by sensors in the brain that stimulate breathing in response to a rising carbon dioxide content. As noted in a previous essay (NYRSF 277), increasing carbon dioxide content of the air and blood is a more potent stimulator of breathing than falling oxygen content.
In the Macmillan UK first edition of Peter Hamilton’s Great North Road, a character is described as having carbon dioxide poisoning, and to be pale, confused, and headachy. But there really isn’t an entity such as Hamilton described. If the carbon dioxide content of inhaled air is higher than normal, it causes rapid and deeper breathing to blow off the increased carbon dioxide in blood. What Hamilton may have meant is hypoxia, which occurs when there isn’t enough oxygen. The victim will feel air hunger, breathe rapidly, become confused, and then fall unconscious. The skin will be pale or dusky. The treatment is mainly to supply fresh air or oxygen, and that is what was done in Hamilton’s novel.
But Hamilton may instead have been thinking of carbon monoxide poisoning, and indeed, on a later page he refers to the patient as having a “carbon monoxide fugue.” It’s unfortunate that Macmillan’s copy editor failed to pick up on the author’s mention of carbon dioxide three times and carbon monoxide once, all within a few pages. The editor for the later Del Rey U.S. first edition was evidently more alert because carbon monoxide is mentioned all four times. But carbon monoxide poisoning leads to a different presentation and requires a specific treatment, neither of which is what Hamilton described.
Carbon monoxide arises from incomplete combustion such as in gas-powered engines. In an enclosed room, carbon monoxide concentration will rise, and in turn its concentration in the lungs and blood will increase. Oxygen is carried from the lungs to all cells of the body by binding to hemoglobin within red blood cells. But carbon monoxide binds more avidly than oxygen to hemoglobin. If a victim breathes air that has a normal oxygen content but a high carbon monoxide content, the hemoglobin will preferentially bind and carry carbon monoxide, leaving little or no space for oxygen. Consequently, the person suffocates despite a normal concentration of oxygen in the air. The victim is not pale but characteristically very pink or rosy, and this will also be evident in the gums or nail beds of a dark-skinned individual. The blood will also appear very bright red, which can fool paramedics and ER physicians into thinking that the victim is well oxygenated. The redness is caused by carbon monoxide binding to hemoglobin. Simply giving a victim fresh air or oxygen will do little or nothing because carbon monoxide binds so avidly to hemoglobin. Instead the mandatory treatment is to put the patient in a hyperbaric chamber so that very high pressures of oxygen force the carbon monoxide off the hemoglobin and also increase the amount of oxygen dissolved in blood. If Hamilton’s character truly had carbon monoxide poisoning, he’d have died if the only treatment given was to move him into fresh air.
Seizures and jaw muscles
In our first essay (NYRSF 277), we noted how a common myth that the tongue will be swallowed during a seizure and that anyone rendering first aid must force the jaw open to prevent this from happening. The reality is that not only is it impossible to swallow the tongue, but the jaw muscles are so powerfully clenched during a seizure that they will not be easily opened by a bystander. Broken teeth are more likely. And yet in recent novels, characters continue to casually open the mouth of a seizing person in order to stop tongue swallowing. In Kelley Armstrong’s Spell Bound, the character “wrenched her mouth open to hold the tongue down” during a poison-induced seizure. Had she momentarily achieved that jaw opening, she would have lost fingers when the jaw inevitably snapped shut. In Charles Stross’s The Apocalypse Codex, a character casually uses the reverse end of a taser to open the mouth and prevent the tongue from being swallowed. That maneuver could conceivably result in the tasering of the hapless individual who performed this maneuver.
One might ask: if this myth is believed by so many people in real life, what is wrong with having characters do the same in fiction? The reality is that basic CPR training teaches how to properly respond to seizures. In any crowd where someone hollers to hold the person down and shove something in the mouth to stop the tongue from being swallowed, we hope t
hat there will also be someone knowledgeable enough to countermand those orders.
The gymnastics of space sex
The concept of zero-gravity sex is one that fascinates space enthusiasts and figures in many science fiction novels. Has it been achieved yet? One of us participated in a panel on space medicine at Chicon 7 with astronaut Story Musgrave and took the opportunity to ask him whether he or any astronaut he knew of could report first-hand (so to speak) experience with sex in microgravity. He laughed but declined to respond.
Microgravity creates practical problems that the space sex enthusiast must consider. In any sexual position, one relys on gravity to anchor oneself to a surface (e.g., the bed, the wall, the partner) to accomplish a thrusting motion. Consider also Newton’s Third Law that for every action there is an equal and opposite reaction. Any thrusting or pushing movement of one partner toward the other will cause the two individuals to fly apart, unless a tether keeps them linked together. In the woman on top position, as she enthusiastically pushes down with arms and legs to raise herself, she may achieve escape velocity as she rises up, up, and away.
These problems lead to the reality that sex in microgravity may resemble worms wriggling against each other, as the partners clutch and grab each other to keep from pushing each other apart. Sleeping tubes, open at both ends, may become popular to enable a hands-free approach to staying together.
Newton’s First Law states that an object in a state of uniform motion tends to remain in that state of motion unless an external force is applied to it. This means that bumping against walls is inevitable, and so a padded room may be necessary to avoid serious injury. It also means that when the act is over, an unceremonious push away from each other may be needed, lest the couple float in the middle of the room for hours until they drift in reach of a handhold. Or perhaps keeping one individual tethered to the wall will not only prevent injury but also avoid being left helpless in the middle of the room after the climax. In other words, even if one isn’t into bondage, some restraint is likely needed for satisfactory zero-G sex.
Floating or sinking in water?
In Kelley Armstrong’s Spell Bound, a character remarks that human bodies sink in water until they die. This is an oversimplification. In reality, most humans can float whether alive or dead, due to such factors as the specific gravity of the body normally being close to that of water, buoyancy created by extra fat in the tissues, the air content of the lungs, and air trapped by loose clothing. Floating is even more likely in salt water than freshwater. Many people are able to float face-up on the surface with no swimming movements required. But leaner individuals and especially those with denser bone structure will simply sink.
Additional factors affect whether a body floats or sinks from the start. If the person dives or is dropped into water, the body will sink to a depth consistent with the momentum of the fall and the weight and specific gravity of the body and then will rise toward the surface. How close to the surface the body comes will depend upon such variables as the specific gravity of the body, the weight of soaked clothing, whether it is salt vs. freshwater, and whether the person is conscious vs. unconscious or dead. In someone who struggles to the surface and eventually drowns, the inhalation and swallowing of water and escape of air from the lungs contribute to the body sinking. A body tossed into the water after death can have greater buoyancy due to air in the lungs as compared to someone who drowned.
In bodies that sink after drowning, decomposition creates gases within the tissues, increasing buoyancy, and some of the outer tissues (hair and skin) slough off or are consumed by fish and parasites. All of these changes increase the corpse’s buoyancy and cause it to return to the surface. That return will be faster in a tropical vs. temperate climate, summer vs. winter, stagnant vs. running water, warm vs. cold water, and salt vs. freshwater. This is why a staple of crime fiction is to weight the body with concrete or chains before dumping it in the water. Whether the body floated from the beginning or rose to the surface later, it will normally assume a face-down position because the head is proportionately denser and heavier than the rest of the body.
Humans are mostly water
In the lengthy climax of Batman Begins, a microwave device traveling on a subway train vaporizes Gotham’s water supply. The microwaves are so potent that they instantly boil the water inside thick metal pipes, prompting manhole covers to explode outward from the pressure of water turned to steam. But the largest component of human bodies is water, held in by a relatively fragile casing of skin and subcutaneous tissues that are easily penetrated by microwaves. So why weren’t Batman and everyone in the vicinity turned into steam and component dry chemicals? Star Trek got this right when Dr. McCoy recognized in “The Omega Glory” that we are just a few pounds of chemicals and the rest is water. In that episode, a viral illness reduced most of the crew of the starship Enterprise to powder and discarded clothing. Even the Adam West film Batman: The Movie recognized how much of the human body is water; in it, the villains use a dehydration gun to reduce to dust the ambassadors to the United World Organization Security Council.
Pupillary responses
In the second essay of this series (NYRSF 283), we explained some of the misconceptions about pupillary responses and the meaning of fixed and dilated pupils. In William Preston’s “Unearthed” (Asimov’s, September 2012), a character has intact pupillary reactions to light, and is assumed to be sighted. But that conclusion is not correct. The presence or absence of the pupillary reflexes does not necessarily tell us whether the patient has normal vision or is blind. The pupils react to light through reflex arcs controlled in the brain stem independent from the processing of visual information within the brain’s visual cortex. A patient with cortical blindness cannot see because the visual information cannot be processed, but the pupillary reflexes can be normal. A patient who loses function of the third cranial nerve will have absent pupillary responses but normal vision. Certain drugs and mechanical injury to the pupil will prevent pupillary responses while not affecting vision.
Traction
Traction refers to drawing or pulling on a long bone through the use of weights and pulleys. Pins and wires are inserted into the bone to anchor the weights; a boot or a series of straps can also be used to anchor them. Although often depicted in movie scenes when anyone has broken an arm or a leg, modern orthopedic techniques have largely made traction obsolete. Traction may still be used either to stabilize a long bone fracture in the early days of healing or to correct orthopedic abnormalities such as a shortened limb that may have been caused by a prior fracture. But when used to correct such orthopedic problems, it is used for six weeks or longer. More commonly today limb length discrepancies are fixed by distraction osteogenesis, in which the bone is deliberately cut in two and the two pieces are kept slightly apart by a mechanical device. New bone begins to fill the gap, and the device is progressively adjusted to increase the gap until the desired limb length is achieved.
In Jo Walton’s Among Others, Morganna is struck and killed by a car, while her twin Morwenna (the protagonist) survives with injuries. “My hip got all smashed up, and my pelvis.” She walks with a cane and complains about chronic pain in one leg. After another doctor looks at her x-rays, she is abruptly ordered to spend “a week in traction . . . my leg is held out on this thing, elevated on white metal bars, strapped in place, stretched agonizingly so it hurts like hell every second, and the rest of me is forced flat. I can hardly move at all.” She has limited access to pain medication. She wonders why the doctor is doing this and remarks, “He wouldn’t strap someone to a contraption just for nothing.” After seven days spent in excruciating pain due to this traction, she is released. The doctor orders her to use a metal cane, not the wooden one she had received from fairies. She is worse than before, racked with pain, and spends a lot of time in bed to recover. She eventually has acupuncture, which reduces the leg pain and improves her mobility. The acupuncturist remarks that the traction may have “
done [the leg] some violence . . . and been unwise.”
Walton herself walks with a cane and in an interview said that “all of the disability stuff in the book is entirely from experience. It’s a mythologization of part of my life. It’s a fantasy novel, but it’s drawing on autobiographical material” (“It’s a mythologisation. . .”). But the use of traction in the manner described is unusual, even for 1979. No benefit is likely to be achieved after one week in traction in a young woman who’d suffered a hip fracture many months before.
But we suspect that Walton’s unusual description of traction was not an error. Instead it appears to have been deliberately planted as evidence that Morwenna’s mother is truly a witch using her powers to make her daughter’s life miserable or even to kill her. Morwenna had earlier remarked that pain causes fairies to keep away from her, and those seven days in traction drove them away until the acupuncture later reversed her pain. The doctor’s insistence that she use the metal cane and not the one provided by the fairies is another clue that Morwenna’s mother is at work here. For many readers it may not be until the end of the novel that it becomes clear that Morwenna hasn’t been idly fantasizing about having magical powers, and that her mother truly is a malevolent witch who tried to kill both daughters. The episode in traction may simply seems like a confusing event that is never explained. But for the knowledgeable reader, that week of traction is a substantial clue that someone, likely Morwenna’s mother, is influencing the actions of others to cause her harm.
Disasters and Triage
A common scenario played over and over in movies, television, and books is the disaster. A train has gone off the rails and bodies litter the tracks. Terrorists have launched an attack on unsuspecting civilians and devastation reigns. A plague’s invasion has left masses of innocents on the verge of death. Into each maelstrom strides the intrepid medical hero. Identifying a critically injured victim, spurting large volumes of blood and clearly on the verge of death, he/she launches into an extensive, life-saving procedure. Often this includes a lot of yelling while defibrillating the patient and performing CPR. Miraculously the patient lives and is carted off for more medical support elsewhere. The hero dashes off to the next life or death situation.
The New York Review of Science Fiction Issue #296 April 2013 Page 5
