Sector General Omnibus 2 - Alien Emergencies (70 page)

A superficial examination of FROB-Forty-three would have suggested that there was not very much wrong with the patient. All six of the limbs were present and clearly in an undamaged condition, the porous tegument covering its organs of absorption was intact, and it was apparent that the cranial casing and spine had retained their structural integrity in spite of this particular Hudlar having been in a section of the wrecked accommodation module which had sustained the heaviest casualties. The case notes made brief mention of the fact that it had been shielded by the body of another FROB who had little chance of survival.

But the sacrifice on the part of Forty-three’s companion—in all probability its life-mate—could have been wasted. Just inside the midlimb on the right underside there was a pressure cap and temporary dressing which concealed the opening of a deep, punctured wound made by a length of bar metal which had penetrated the
tegument like a blunt spear. It had torn the side of the womb—the patient had been in Hudlar female mode at the time of the accident—and while it had missed the major blood vessels in the area, it had stopped within a fraction of an inch of the rearmost heart.

The fetus seemed to be in good condition in spite of the metal bar having passed within a few inches of its spine. While the heart itself had not been damaged, the blunt end of the metal bar had pinched off the circulation to the heart muscles on that side to the point where irreversible deterioration had taken place. Cardiac activity was being maintained by the life-support system, but even with that assistance the heart was in imminent danger of arrest, and replacement was strongly indicated. Conway sighed, foreseeing yet another emotionally painful postoperative experience for himself.

“A replacement is available from Eighteen,” he said to Hossantir, the Tralthan Senior in charge of Forty-three’s surgery. “We are already taking its absorption organ and all of its undamaged limbs, so donating a heart as well should not worry it.”

Hossantir turned one of its four eyes to regard Conway and said, “Since Eighteen and Forty-three were life-mates, you are almost certainly correct.”

“I didn’t know that,” Conway said uncomfortably, sensing an implied criticism of his flippancy by the Tralthan whose species, unlike the Hudlars, held their recently deceased in high reverence. He went on. “How will you proceed?”

Hossantir’s intention was to leave the section of metal bar still present in the wound in place. It had been cut where it passed beneath the skin by the rescuers to facilitate movement of the casualty, but they had wisely not removed the entire bar in case they might complicate the injuries. Since the inner end of the bar was performing a useful function in controlling some of the deeper hemorrhaging, the prior suturing of the tear in the womb would mean that the instruments necessary for the later heart replacement procedure would be able to pass it without risk of endangering the fetus.

The external wound was not in the position Hossantir would have chosen for a heart replacement operation, but it was close enough for the purpose following surgical enlargement—a course which would avoid subjecting the patient to the additional trauma of another deep incision.

When the Tralthan had finished speaking, Conway looked around the operating frame and at the surgical team drifting weightlessly nearby. There was a Melfan, two Orligians, and another Tralthan who were all junior surgeons, and five Kelgian and two Ian nurses, all of whom were watching him silently. He knew that Senior Physicians could be very touchy about seeming infringements of their authority, and especially when they were ordered to do something as a result of a simple omission on their own part. His Kelgian alter ego wanted him to come straight to the point, while the Tralthan component of his mind advised a more diplomatic approach.

“Even with surgical enlargement of the wound,” he said carefully, “access to the operative field will be restricted.”

“Naturally,” Hossantir replied. Conway tried a more direct approach.

“No more than two surgeons will be able to operate at any given time,” he went on, “so there will be a high degree of team redundancy.”

“Of course,” Hossantir said.

“Senior Physician Edanelt,” Conway said firmly, “needs help.”

Two of Hossantir’s eyes curled around to regard the preparations going on around Edanelt’s frame, then it quickly detailed his two Orligian and the Tralthan medics to help the other Senior with instructions to call on whatever nursing support as and when needed.

“That was unforgivably selfish and thoughtless of me,” Hossantir went on to Conway. “I thank you for the tactful way in which you reminded me of the transgression in the presence of my subordinates. But please be more direct in future. I carry permanently a Kelgian Educator tape and will not take offense over any seeming infringement of my authority. Frankly, I am greatly reassured by your presence, Conway, since my experience of deep Hudlar surgery is not extensive.”

If I were to detail my own experience of Hudlar surgery
, Conway thought wryly,
you might not feel reassured at all
.

Then he smiled suddenly, remembered how O’Mara had sardonically described the function of a Diagnostician in an operating theater as being largely psychological—the being was there principally to worry and accept the responsibilities its subordinates might not be able to carry.

As he moved between the three patients, Conway recalled his first few years after promotion to Senior Physician and of how he had accepted, and at times jealously guarded, his responsibilities. While working under supervision he had attempted to show that the Diagnostician concerned was redundant. In time he had been successful, because the supervision had become minimal and at times nonexistent. But there had also been a few times when Thornnastor or one of the other Diagnosticians who had been breathing down his neck and causing an irritating distraction during surgery had stepped in and saved a patient’s life as well as the professional career of a very new Senior Physician whose enthusiasm verged on the irresponsible.

How those Diagnosticians had been able to watch without intervening, or suggesting alternative procedures, or giving step-by-step instructions at every stage, Conway did not know, because he himself was finding it just barely possible to do so.

He managed to continue doing the near-impossible while the hours slid past, dividing his attention between the operating stations of Yarrence, Edanelt, and Hossantir as well as the activity around the deceased Eighteen, where the surgery required to withdraw the donor organs and limbs was as painstaking and precise as that being performed on the recipients. There were several aspects of the work he could have commented upon, although not in overly critical terms, so he remained silent and gave advice only when it was requested. But while the three Seniors were doing very well and he was careful to divide his time equally among them, the one he watched most carefully was Hossantir. If any of the patients were going to cause problems, it would be FROB-Forty-three.

It happened in the fifth hour of the operations. The depressed cranial fracture and arterial repair on Three had gone well, and the less critical work of limb replacement was proceeding in satisfactory fashion. On FROB-Ten the absorption organ replacement work was completed and the decompression damage had been repaired so that it, too, had only the time-consuming microsurgical work on the limbs to undergo. It was natural, therefore, for Conway to hook himself to Forty-three’s frame to watch Hossantir performing the highly delicate initial stages of reconnecting the replacement heart.

There was a sudden, silent explosion of Hudlar blood.

Hossantir made a sound which did not translate, and its manipulators holding the long-handled instruments moved with incredible slowness as they felt about in the totally obscured operative field. Its assistant, also moving with a lack of urgency which could only have been subjective to Conway’s racing mind, introduced a clamp but could not find the vessel which was hemorrhaging. Trained as he was to react quickly and positively to such emergencies, Conway did not move slowly.

He could not move at all.

His hands, his stupid five-fingered, Earth-human, and utterly alien hands, trembled uncontrollably while his multiple mind tried desperately to decide what to do with them.

He knew that this kind of thing could happen to medics who were carrying too many tapes, but that it should not happen too often if the Doctor concerned hoped to make it as a Diagnostician. Frantically, he tried to impose order on the warring factions within his mind by calling up the memory of O’Mara, who was totally unsympathetic where disorderly thinkers were concerned—in particular, the memory of the Chief Psychologist telling him what the Educator tapes were and, more importantly, what they were not.

No matter how he felt subjectively, his mind was
not
being taken over by the alien personalities who were apparently sharing it—his Earth-human mind had simply been given a large quantity of extraterrestrial knowledge on which it could draw. But it was very difficult to convince himself of that when the other-species material
in his mind belonged to medical people with their own individual ideas on how he should react to this emergency.

The ideas were very good, particularly those of the Melfan and Tralthan components. But they required the use of ELNT pincers or FGLI primary manipulators, not Earth-human fingers, and he was being urged to do too many things at once with the wrong organic equipment.

Hossantir’s Melfan assistant whose ID, like everything else in the immediate area, was obscured by the bloody spray, said urgently, “I can’t see. My visor is—”

One of the nurses quickly cleaned the helmet in front of the eyes, not wasting time on the rest of the transparent bubble. But the fine red spray was re-covering it as Conway watched. And that was not the only problem, because, deep inside the operative field, the light sources on the instruments were likewise obscured.

The Tralthan Senior had been closest so that only the front of its bubble helmet had been affected. One of its eyes curled back to regard Conway through the still transparent rear section.

“We require assistance, Conway. Can you suggest a…” Hossantir began; then it noticed the trembling hands and added, “Are you indisposed?”

Conway clenched his fists slowly—everything seemed to be happening in the slowest of slow motion—and said, “It is temporary.”

Silently he added,
I hope
.

But the alien personalities who were not really there were still clamoring for attention. He tried to ignore all but one of them at a time, thinking vaguely of the principle of divide and rule, but that did not work either. All of them were offering medical or surgical advice, all of it had potential value in the present situation, and all of it called for an immediate response. The only available material which did not force itself forward was the Gogleskan data accidentally provided by Khone, and that was of little value anyway. But for some reason his mind kept returning to it, holding on to that frightened but strong-willed alien personality as if it were some kind of psychological life-raft.

Khone’s presence was not at all like the sharp, intense, and artificially enhanced impressions produced by the Educator tapes. He
found himself concentrating on the little being’s mental imprint, even though the strange and visually terrifying creatures around the operating frame threatened to throw it into a panic reaction. But the Gogleskan data also included material on Conway’s work at the hospital, transferred to its mind during the mishap on Goglesk, and this to a certain extent had prepared Khone for just this kind of experience. It was also a member of a race of individualists whose mental processes were adept at avoiding contact with, or of negating the influence of, other beings around them.

More than any other entity in Conway’s experience, Khone knew how to ignore people.

All at once his hands were no longer shaking and the alien babel within his mind had quieted to an insistent murmur which he could choose to ignore. He tapped the Melfan assisting Hossantir sharply on its carapace.

“Please withdraw and leave your instruments in position,” he said. To the Tralthan Senior he added, “The bleeding is obscuring everything in the operative field, including the magnifiers and light sources of the instruments and, if we approach closely, our visors. We must…”

“Suction isn’t working, Conway,” Hossantir broke in, “and won’t until the flow has been checked at source. But we can’t see the source!”

“…Use the scanners,” Conway continued quietly, enclosing the tiny, hollow-coned handles of the Melfan clamp with his Earth-human fingers, “in conjunction with my hands and your eyes.”

Since normal vision was useless because of his helmet’s close proximity to the spray from the wound, Conway’s idea was that Hossantir use two scanners angled so as to bear on the operative field from two viewpoints as far apart as possible. This would give an accurate stereoscopic picture of what was happening which the Senior could describe for him and guide the movements of his clamp. He would be operating blind, but only long enough to find and seal off the bleeder, after which the operation would proceed in the normal way. It would be a very uncomfortable few minutes for Hossantir, two of whose four eyes would be extended laterally to the limits of its flattened, ovoid helmet. It would also have to
withdraw temporarily from the operation, Conway told it apologetically, so that its scanners and helmet would not be affected by the spray.

“This could give me a permanent squint,” Hossantir said, “but no matter.”

None of his alter egos saw anything funny in the idea of a great, elephantine Tralthan with a squint in two of its widely extensible eyes. Fortunately, a smothered Earth-human laugh was not translatable.

His hands and the instruments felt heavy and awkward, and not just because he was using Melfan clamps. The gravity nullification field surrounding him did not, of necessity, extend to the patient, so that everything at the operating site weighed four times heavier than normal. But the Tralthan used its scanners to guide him verbally to the blood vessel which had to be origin of the massive hemorrhaging, and considering the elevated blood pressure of the Hudlar life-form, he expected to feel resistance as he clamped it off.

There was none, and the bleeding continued with undiminished force.

One of his alter egos had encountered something like this situation during a transplant on an entirely different life-form, a diminutive Nidian whose blood pressure had been only a fraction of that of this Hudlar. On that occasion the blood flow had also been a fine spray rather than the pulsing stream characteristic of arterial bleeding, and the trouble had been due to a mechanical failure rather than to faulty surgical technique.

Conway was not sure if that was the problem here, but a part of his multiple mind felt sure, and he decided to trust that part.

“Stop the artificial heart,” he said firmly. “Cut off the blood supply to the area.”

“We can easily make good the blood loss,” Hossantir objected, “but cutting off circulation for more than a few minutes could kill the patient.”

“Do it now,” Conway said.

Within a few seconds the bright red spray had subsided and died. A nurse cleaned Conway’s visor while Hossantir used suction to clear the operative field. They did not need the scanners to see what had happened.

“Technician, quickly,” Conway said.

Before he had finished speaking there was a furry little Nidian, looking like a gift-wrapped teddy bear in its transparent OR suit, hovering beside his elbow.

“The nonreturn valve of the connector is jammed in the closed position,” the Nidian said in its staccato, barking speech. “This was caused, I would say, by the valve setting being altered accidentally when it was struck by one of the surgical instruments. The flow from the artificial heart has been blocked and was forcing its way out via the recess of the valve setting control, hence the fine, high-pressure spray. The valve itself isn’t damaged, and if you will raise the organ so that I will have space to reset the valve…”

“I’d rather not move the heart,” Conway said. “We are very short of time.”

“I am not a doctor,” the Nidian said crossly. “This repair should properly be performed on a workbench, or at least in an area with room for my admittedly small elbows. Working in close contact with living tissue is…is repugnant to me. However, my tools are sterile in readiness for such emergencies.”

“Do you feel nauseous?” Conway asked worriedly. He had visions of the little being choking inside its helmet.

“No,” the Nidian said, “just irritated.”

Conway withdrew his Melfan instruments to give the technician more room to work. A nurse had clipped a tray of Earth-human DBDG instruments to the frame beside him, and by the time he had selected the ones he would need the Nidian had freed the jammed valve. Conway was thanking the little being for the speed of the repair when Hossantir broke in.

“I’m restarting the artificial heart,” it said.

“No, wait,” Conway said sharply. He was looking at the monitor and getting a feeling—a very vague feeling that was not strong enough even to be called a hunch—that any delay at all would be dangerous. “I don’t like the vital signs. There is nothing there which should not be there, considering that the flow from the artificial heart was interrupted, initially by the jammed connector valve and later when the system was shut down during the repair. I realize that if the artificial heart is not restarted within the next few minutes, irreversible changes leading to termination will take place
in the brain. Even so, I have the feeling that we should not restart but go instead for an immediate resection of the replacement organ…”

He knew that Hossantir would want to object and take the safer course, that of restarting the artificial heart and waiting until they were sure that the patient’s circulation had returned to optimum, and then proceed as originally planned. Normally Conway would not have argued against this, because he, too, preferred not to take unnecessary risks. But there was something niggling at the back of his mind, or one of his minds, something about the effect of long-term trauma on certain gravid, heavy-gravity life-forms, and the feeling was so persistent that he had to act on it. And while he had been speaking, Conway had unclipped his instruments to show Hossantir, nonverbally so that the Senior’s feelings would not be hurt too much, that he was not about to argue the point.

“…Will you work on the connection to the absorption organ, please,” he ended, “and keep an eye on the monitor.”

Sharing the operative field with the Tralthan, Conway worked quickly and carefully in the restricted space, clamping off the artery beyond the artificial heart connection, detaching it, and reconnecting it to the arterial stub projecting from the replacement organ. Unlike the first, shocking seconds of the earlier hemorrhaging, time seemed to have speeded up. His hands and instruments were well outside the field of the nullifiers, being acted on by four Earth-Gs, so they felt incredibly slow and awkward. Several times his instruments clinked loudly against those of Hossantir. He could sympathize with the surgeon, whoever it had been, who had accidentally knocked that connector valve off its setting. He had to concentrate hard to keep his instruments from leading a life of their own.

He did not watch Hossantir’s work, because the Tralthan knew its stuff and there was no time for surgical sightseeing.

He inserted retaining sutures to hold the artery in position on each end of the connector, which was designed both to hold the ends firmly in position when circulation was restored and to keep the sections of original and replacement tissue apart so as to reduce postoperative rejection problems. There were times when, immunologically speaking, he wondered why a highly evolved and com
plex organism should be its own worst enemy. Next he began the linkup of the vessel which supplied nutrient from the absorption organ to one of the major heart muscles.

Hossantir had completed its connection and had turned its attention to the minor vessel which supplied one half of the womb when the Hudlar was in female mode—the second, undamaged heart had been performing double duty since the start of the operation. They were short of time, but as yet not dangerously so, when the Tralthan indicated the Monitor with a free appendage.

“Ectopics,” Hossantir said. “One in five, no, one in four. Pressure is reducing. The indications are that the heart will go into fibrillation and arrest very quickly. The defibrillator is ready.”

Conway took a quick look at the visual display where the irregular, ectopic heartbeat broke into the normal rhythm once in every four beats. From experience he knew how soon it could degenerate into a rapid, uncontrollable flutter and, with the subsequent loss of the pumping function, failure. The defibrillator would almost certainly shock it into action again, but that device could not be used while the operation on the replacement heart was in progress. He resumed his work with desperate, careful speed.

So deep was his concentration that all of his minds were becoming involved again, contributing their expertise and at the same time their irritation that it was a set of Earth-human hands which were doing the work and not the assorted manipulators, pincers, and digits of his alter egos. He looked up finally to find that Hossantir and he had finished their connections at the same time. But a few seconds later the other heart went into fibrillation, then arrest. Their time was really short now.

They eased the clamps on the main artery and secondary vessels and watched the flaccid replacement organ swell slowly as it was filled with Forty-three’s blood, checking with their scanners for the formation of air embolisms. There were none, so Conway placed the four tiny electrodes in position preparatory to restarting the replacement heart. Unlike the defibrillator charge needed for the other heart, which would have to penetrate more than ten inches of hard, Hudlar tegument and underlying tissue, these electrodes would be acting directly on the surface muscles of the replacement
organ and would be carrying a relatively mild charge.