‘Yes they are,’ said Simon Penarth. He sat with his arms folded in a pose of stubborn defensiveness. As Alex looked at him, Simon’s jaw set firmer. ‘I can save him,’ he declared.
Rangi looked even more distressed at that.
‘Simon, you can’t,’ he said, clearly continuing a discussion they’d been having before they came to the daycabin. ‘Quite apart from anything else, it’s illegal to give someone more than thirty per cent cloned brain cells!’
Simon gave him a look which held some ferocity.
‘Unlawful,’ he corrected. ‘There’s a difference. And I have done it before: Jaymes Winthrop.’
‘Yes, but the Medical Ethics Authority is still investigating that case,’ Rangi pointed out. He would have gone on, but Simon interrupted with a complex noise registering contempt and impatience.
‘They’ll be at that for years, before they have to admit I was right,’ he said, and turned back to Alex, aware that the skipper was the one he had to convince, here, not Rangi. ‘Listen, the rules about how much cloned brain material you’re allowed to use are so out of date, they’re archaic, and have always been more about irrational fears and politics than they have about medical science. It says it all, in that, that the official legal-medical term for giving someone more than thirty per cent cloned brain matter is ‘zombification’. It’s true, admittedly, that in the early days of geno-neurology the best possible outcome was one of severe brain damage, but medicine has moved on a long way since then. Even a basically competent neurosurgeon could repair Ali Jezno sufficiently to have him on his feet again, and you’ve got me, okay? I am without any doubt at all the best neurosurgeon in the medical profession. I have pioneered treatments other consultants are still trying to understand. I can do this, okay? I’m telling you, Alex, I can save him.’
Alex looked at Rangi, who was making a heroic effort to keep it together so that the skipper would listen to him. It could not be easy for him to take any kind of stand against Simon, his hero, but it had to be tearing him apart to be taking this stand, with a friend’s life on the line.
‘No, you can’t,’ he managed to keep his voice almost steady. ‘He’s already gone. Everything that made him Ali, his memories, his personality, his spirit – his soul, that’s gone. You can’t save him, you can’t bring him back. It’s just wrong, Simon. I’m sorry, but …’
‘Shut up,’ Simon told him. Then, seeing that Alex was about to tell him not to fling such blunt commands at his ship’s medical officer, he went on in slightly more appeasing tones, ‘Look, I’m sorry, but have a little faith in me, here. We are not talking about bringing back a shambling idiot. Jaymes Winthrop is back at work, right?’
‘He is also,’ Rangi pointed out, ‘suing you for what you did to him.’
‘No, he isn’t,’ Simon gestured dismissively. ‘He’s only suing me because the media kept calling him a zombie, which he lays at my door for having used the word ‘zombification’ in the press briefing. Me, I don’t mind that one bit – the man has his life back, his kids have their dad, that’s a result in my book. The fact that he’s alive and able to be peed off at being called a zombie is great news as far as I’m concerned. And I’m telling you,’ he went on, turning back to Alex, ‘that I can save Ali Jezno. I can’t promise that I’ll be able to bring him back to a hundred per cent functionality, there will be memory loss and he may drop some IQ, but I can save him.’
Alex looked back from him to Rangi. He was still trying to understand this. He had been so sure that they were coming to tell him officially that Ali Jezno was dead.
‘What does he say?’ he asked, and then, quickly clarifying, ‘on his MA?’
Every member of the Fleet was required to complete a Medical Affidavit as part of signing into service. It detailed, amongst other things, the circumstances under which they would not wish their life to be artificially prolonged. Alex himself had signed such a document, specifying that he would not want to be kept alive in a persistent vegetative state, and that a Do Not Resuscitate order must be put in place if he had such serious brain damage that he would no longer be able to function as an independent adult. If Ali Jezno had done the same – and those were fairly common stipulations amongst spacers – that would weight the argument pretty heavily on Rangi’s side.
‘But that’s just it, skipper,’ Rangi said, looking quite startled for a moment as he realised that he had failed to mention the reason they had come to see the captain. ‘Ali hasn’t specified his wishes beyond ‘DNR if PVS’, but he has ticked the box giving you power of attorney. Well – ‘Current Commanding Officer’, of course, but right now, obviously, that’s you. We need you to decide. But please, sir, I know Ali has gone. Nearly half his frontal cortex has been blown away. Everything that made him him is gone. You can’t repair that. You can’t fix it. There are limits to what we can do, limits to what we should do.’
Alex held up a hand, seeing from the way he was talking that Rangi would go on indefinitely, becoming more impassioned as he stood on his deeply spiritual views. As Rangi faltered reluctantly into silence, Alex looked back at Simon, considering.
‘You said ‘unlawful’,’ he observed.
‘Yes, it’s a matter of civil law,’ Simon told him. ‘And kind of a grey area. Views on it are so varied, culturally, that the MEA has left it to individual worlds to decide where they set the bar on that, as to what’s allowed and what isn’t. Chartsey is reviewing at the moment, based on the surgery I did on Jaymes Winthrop.’
Alex nodded. ‘But is this against the law on Therik, Simon?’
It was the medic’s turn to look bewildered.
‘Huh?’
‘It’s important,’ Alex explained. ‘We’re bound to obey the laws of our base-world, see. That’s not just regs, it’s enshrined in the Fleet constitution as a fundamental principle. In any situation where there’s a difference in planetary laws, we have to comply with our base-world’s.’
‘But that’s ludicrous,’ Simon objected. ‘That would mean that if two Fleet ships met out in space, something like this would be legal on one and not on the other.’
‘True, it can be a bit confusing,’ Alex agreed, with a dry note. ‘But that is better than having squadrons in port at odds with the system authorities because they’re violating their laws. And this is, you know, fundamental stuff, respect for the sovereignty of member worlds, not something I am prepared to go against. So I will need to check if this is legal on Therik, okay?’
‘I’ll look now,’ Simon said, and accessed a comp, punching in coding with an imperious finger. ‘No, we’re okay,’ he said, with a satisfied look. ‘They seem quite enlightened on Therik.’ His tone was so patronising that Alex raised an eyebrow, at which Simon grinned. ‘Sorry – I’m a Chartsey boy, myself,’ he said. ‘Every other world seems provincial to me – kind of like travelling back in time, too, as the further you get out of Chartsey the more behind the times they are in, well, just about everything – tech, fashions, attitudes. Therik seems pretty progressive, medically, though – decisions that look like they’ve been made by doctors, not politicians. So yes, we’re good to go, no legal issues.’
‘All right,’ Alex said. ‘What are your best and worst case outcomes?’ He held up a hand to him, too, preventing Simon from leaping in with instant assurances. ‘Honestly, now, give me a realistic probability of Mr Jezno’s quality of life.’
‘Best outcome?’ Simon didn’t hesitate. ‘I get him back ninety nine per cent functionality – he has some memory loss and drops maybe five to ten points from his IQ, but he is able to pick up his life, reconnect with his loved ones and lead an active, productive life. He’d need to re-train to get back to work, and it is possible, realistically, that he won’t be able to recover enough to get back to work in space. I feel sure, though, that he could be back at work in a groundside role within a few months.’
He paused, momentarily. ‘Worst case? He drops so much IQ that he becomes cognitively dysfunctional, perhaps as low as eighty four o
n the Reyder-Shicht Scale…’ he saw that that meant nothing to Alex and decided against trying to explain it to the layman. ‘He would be, effectively, like a small child,’ he said.
Alex winced, but Simon didn’t give him time to respond. ‘But that is a very very small probability of a desperately awful ‘worst case’ outcome, as you asked for, being totally honest,’ he said. ‘I could try to argue that even that worst case scenario gives him life, the capacity to love and be happy, and I could also point out that families would almost always prefer to have a survivor needing care than a corpse to mourn. But for me, there is no question here. I can save him, I know I can. We could sit here debating medical ethics and the possible existence of the soul for the rest of the day, but what it comes down to is this – I can save him. I can. So will you trust me and let me do this, or not?’
Alex could see two paths opening up ahead of him. In one he followed the orthodox, regulated path and told Simon they had to comply with the current guidance on medical ethics however out of date Simon might consider them to be. In that path, he had to write the letter to Ali Jezno’s family and the reports for the inquest which would be held once they got back to Therik. In that path, they would acquire a small memorial plaque to be placed beneath their ID in the main entry airlock, honouring Petty Officer A Jezno, killed in action.
In the other path, he would have to explain his decision to the inevitable Fleet enquiry and very probably to the Medical Ethics Authority, too, under a tsunami of outrage from all directions over what he’d allowed Simon to do. The word ‘zombification’ would trigger highly emotive reactions even amongst people who generally didn’t know much about the Fourth, or care. The public and political fallout would be horrendous. Worse, though, far worse, was the possibility that the wreck of what had once been Ali Jezno might one day look at him with haunted eyes and say, ‘You should have let me die.’
There were perhaps four seconds when neither medic spoke – something quite remarkable in itself – and Alex considered his options. When he looked back at Simon, a decision was forming.
‘You are absolutely sure of your ability to do this?’ he queried. ‘And in no way experimenting on my crewman, here?’
‘Alex!’ Simon looked shocked. ‘No, of course not! I mean, okay, technically I suppose, the procedure would still be regarded as experimental, but I am in no way treating Ali Jezno as an experiment. Nor is this an emotional decision – he is a mate of mine, too, I like him a lot and yes I am upset about what’s happened to him, but that is not steering my medical judgement. If you want it in writing I can give you a detailed analysis of his condition and on what basis I believe I can save him, but that will of necessity be so technical – medically technical – that only a handful of other consultant neurosurgeons could understand it. Rangi certainly can’t – he’s a good kid but this is way above his level of skill and understanding. So what it comes down to, absolutely, is ‘Do you trust me, or not?’’
Seventeen
There was a stunned silence throughout the ship as Alex finished telling them about his decision regarding Ali Jezno. Even the officers on the command deck were just staring at him, some amazed, others frankly appalled.
‘I agree,’ said Buzz, after that one moment of deathly hush. ‘It is the only thing you can do, in fairness to Ali.’
His opinion was just that. Unless he intended to challenge Alex’s fitness to command, this was not a decision Buzz had any say in. Alex had not consulted him before making his choice. That, after all, was in the nature of command decisions. Still, he appreciated Buzz’s immediate, steadfast support.
‘I…’ Jonas Sartin hesitated, but he knew his duty and faced up to it manfully. ‘I am sorry, sir – for the record, I want to state that I personally support your decision, one hundred per cent. But you know my position, here – as IA officer, my duty is prescribed. So I have to go on record with a logged advisory that to allow this is contrary to medical procedure laid down in regulations.’ He saw Alex’s nod and carried on, apologetic but determined. ‘I must also, I’m sorry, register a concern at the decision to keep O/S Triesse in stasis for three days, as this, too, is contrary to established Fleet medical procedure.’
Alex had not appreciated that, though when Jonas reminded him of it he recalled that there were, indeed, regulations about how long casualties should be kept in stasis. The stasis bags did not hold them in complete suspended animation, after all, merely slowed everything down to the absolute minimum the human body could survive. There would be increasing deterioration as time went by – the longest anyone had survived stasis was a month, but every hour was important and the principle of getting the patient on the operating table as quickly as possible was very well established. Alex had assumed that the medics needed three days in order to prepare for the surgery needed to save Banno’s life, which would justify that decision. As Jonas spoke, though, he passed him a formal Internal Affairs ‘notice of concern’ which pointed out that the medics had the ability to bring Banno Triesse out of stasis and perform life-saving surgery on him after just four hours. That was the time it would take to grow sufficient cloned material to repair his liver and intestines, all badly damaged in the explosion. He was also going to need reconstructive surgery on one leg, and a complete clone-graft on the other. That was what would take the time, Alex saw. The medics were intending to clone the leg before they got him out of stasis, to carry out all the surgery in one marathon endeavour. This was, indeed, contrary to established Fleet and indeed civilian medical procedure. Normally the procedure would be to get the patient stabilised enough to survive on life support machines, then to work through surgeries on priority. Providing either a cloned or prosthetic leg would be very low down on that list and might not happen for weeks in a case with such severe injuries as this.
Simon, though, was evidently watching the command feed, as Alex was still reading the Internal Affairs concern when the medic’s response flashed up beside it. In tones of clear and irritated impatience, Simon stated that he had made his decision based on the psychological impact on the patient – it was the difference, as he observed, between Banno waking up in a life support tank to find himself in bits and missing a leg, or waking up in a bunk, fully restored.
‘This is what I mean by holistic medicine,’ he declared, tersely. ‘Treating this man’s body with no regard for the trauma that treatment will cause him is barbaric. I have established that the deterioration in his condition over three days in stasis is more than amply compensated for by the psychological benefits of waking him healed, and whole. And no, I will not get him out of stasis and keep him under sedation till his injuries are healed; the side effects of that level of anaesthesia are deleterious in themselves and there is evidence that some patients still experience trauma at some level of consciousness. While he is in stasis, there is no effective brain activity. It is in his own best interest to keep him in stasis till we’re ready to operate and I will defend that decision against any protest that you care to bring.’
A second memo popped on screen, from Rangi Tekawa.
‘I concur with Dr Penarth and support his decision as consultant, entirely.’
Alex logged his own decision in favour of the medics, and nodded to Jonas.
‘Concern noted, Mr Sartin,’ he said. ‘However, we are fortunate in having the services of one of the League’s foremost neurosurgeons, so it is, I feel, appropriate to defer to his medical judgement in such matters.’
‘Thank you, skipper,’ Jonas looked relieved, not just at the skipper’s response but at the understanding looks he was getting from the other officers. They all knew how hard it was to have the Internal Affairs role, forced to challenge the skipper on any deviation from policy or established procedure, even when they might well agree with that decision wholeheartedly. ‘But can I ask, sir, how long it will be before we know if the surgery on Petty Officer Jezno has been successful, or how successful it has been?’
‘They intend to operate tomo
rrow,’ Alex said. ‘They will be able to tell us at the end of that how successful the surgery has been in physical terms, but it may be some days before we know…’ he hesitated for a moment, not wanting to say ‘how much of him is left’. ‘how successful the outcome will be in terms of functionality,’ he said, deliberately official.
‘I see.’ Jonas gave a sober nod, and they all went back to the repair work. There was a sombre and uneasy mood aboard the ship, though – a sense of uncertainty, murmured conversations and dubious glances at the skipper on the command deck feed. It was as if the crew couldn’t quite understand his decision. It was apparent to Alex that many of them thought that he was so torn up with grief and guilt at losing one of his crew that he was prepared to let Simon do anything, even to conduct desperate, unethical experiments to bring Ali Jezno back from the dead. The word zombification was buzzing through the ship like an almost inaudible vibration.
Alex made no attempt to persuade them that he had been right to give Simon permission to operate. Time would tell whether that had been the right call, or not. And in the meantime, their unease was infinitely preferable to the alternative. They could, after all, be dealing with the shock and grief of Ali’s death.
They could not, in any case, spare much time to talk or think about it. They were still working flat out on second phase repairs and every available pair of hands was needed. They had not yet been able to get out of their survival suits. It was possible to use the built-in diaper facility or sip drinks through a clip-on unit, but everyone, by then, was craving either a lavatory or a hot drink, or both. The only place they were allowed to get out of their suits was sickbay – normally Alex would allow everyone comfort breaks on a rolling rota, but nobody wanted to disturb the medics right now, so all they could do was drive on with repairs. Alex would not stand them down until every life support system had a green light, and even then, not until he was sure that the Samartians weren’t about to fling another Marfikian attack at them.
Dark Running (Fourth Fleet Irregulars Book 4) Page 38
