Sector General Omnibus 3 - General Practice (4 page)

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Authors: James White

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“Naturally,” Edanelt said. “You were faced with treating a member of an off-planet species, one possessing a physiology and metabolism of which you had no previous experience. Or had you previous experience? Did you consider sending for same-species medical assistance?”
“I had not seen an Earth-human before that time,” Cha Thrat replied. “I knew that one of their ships was in orbit around Sommaradva and that the process of establishing friendly contact was well advanced. I had heard that they were traveling widely among our principal cities, and that they often used our air transport, presumably to gain some experience of our level of technology. I sent a message to the nearest city hoping that they would relay it to the Earth-humans, but it was unlikely that it would arrive in time. The area is remote, mountainous, heavily forested, and thinly populated. The facilities were limited and time was short.”
“I understand,” Edanelt said. “Describe your procedure.”
Remembering, Cha Thrat looked again at the network of scars and the dark, contused areas where the subdermal bleeding had not completely dispersed.
“At the time of treatment I was not aware of the fact that native pathogens have no effect on life-forms which evolved on a different planet, and it seemed to me that there was a grave danger of infection. It was also thought that Sommaradvan medication and anesthetics would be ineffective if not lethal. The only indicated procedure was to thoroughly irrigate the wounds, particularly those associated with the fractures, with distilled water. While reducing the fractures, some minor repairs were required to damaged blood vessels in the area. The incised wounds were sutured, covered, and the fractured limbs immobilized. The work was done very quickly because the patient was conscious and …”
“Not for long,” Chiang said in a low voice. “I passed out.”
“ … and the pulse seemed weak and irregular,” she went on, “even though I didn’t know the normal rate. The only means available to
counteract shock and the effects of blood loss were external heating, provided by wood fires placed downwind so that smoke and ash would not contaminate the operative field, and pure water given intravenously when consciousness was lost. I was unsure whether our saline solution would be beneficial or toxic. I realize now that I was being overcautious, but I did not want to risk losing a limb.”
“Naturally,” Edanelt said. “Now describe your post-operative treatment.”
“The patient regained consciousness late that evening,” Cha Thrat went on. “It appeared to be mentally and verbally lucid, although the exact meaning of some words were unclear since they referred to the consigning of the faulty aircraft, the whole current situation, and myself to some hypothetical but extremely unpleasant afterlife. Since the native edible vegetation was likely to prove harmful, only water administered orally could be given. The patient complained of severe discomfort at the site of the wounds. Native pain-relief medication could not be given because it might prove toxic, so that the condition could only be treated, however inadequately, by verbal reassurance and encouragement—”
“For three days she never stopped talking,” Chiang said. “Asking questions about my work, and what I would be doing after I returned to active duty, when I was pretty sure that I would be returning in a box. She talked so much, sometimes, that I just fell asleep.”
There was a slight tremor apparent in Prilicla’s limbs. Cha Thrat wondered if the Cinrusskin was sensitive even to the Earth-human’s remembered pain.
She resumed. “In response to several urgent requests, five members of the patient’s species, one of whom was a healer, arrived with supplies of suitable food and supportive medication. Progress toward recovery was rapid thereafter. The Earth-human healer gave advice on diet and medication dosage, and it was free to examine the patient at any time, but I would not allow further surgical intervention. I should explain that on Sommaradva, a surgeon will not share or in any other way avoid personal responsibility for a patient. There was strong criticism, both personal and professional, of my standpoint, particularly from the
Earth-human healer. I would not allow the patient to be moved to its ship until eighteen days after the operation, when I was convinced that full recuperation was assured.”
“She watched over me,” Chiang said, barking softly, “like an old mother hen.”
There was silence for what seemed to Cha Thrat to be a very long time, during which everyone looked at the Melfan while it regarded the patient. It was tapping one hard-tipped leg against the floor, but the sound it made was a thoughtful rather than an impatient one.
Finally it said, “Without immediate surgical attention you would undoubtedly have died as a result of your injuries, and you were fortunate indeed to receive the necessary attention from an entity completely unfamiliar with your physiological classification. Fortunate, too, in that the entity concerned was not only skilled, resourceful, and deeply concerned with your aftercare, but made the proper use of the limited facilities available to it. I can find no serious fault with the surgical work performed here, and the patient is, indeed, wasting the hospital’s time.”
Suddenly they were all looking at her, but it was the empath who spoke first.
“From Edanelt,” Prilicla said, “that is praise indeed.”
T
he private office of the Earth-human O’Mara was large, but the floor area was almost entirely covered by a variety of chairs, benches, recliners and frames designed for the use of the entities having business with the Chief Psychologist. Chiang took the indicated Earth-human chair and Cha Thrat chose a low, convoluted cage that looked as if it might not be too uncomfortable, and sat down.
She saw at once that O’Mara was an old Earth-human. The short, bristling fur covering the top and sides of its head, and the two thick crescents above its eyes, were the gray color of unpainted metal. But the heavy muscle structure apparent in the shoulders, upper limbs, and hands was not that of the other aged Earth-humans she had seen. The flexible, fleshy covers of its eyes, which were similar in color to its hair, did not droop as it studied her in every physical detail.
“You are a stranger among us, Cha Thrat,” it said abruptly. “I am here to help you feel less strange, to answer questions you have been unable or unwilling to ask of others, and to see how your present abilities can be trained and extended so that they may be put to the best possible use by the hospital.”
It turned its attention to Chiang. “My intention was to interview you separately, but for some reason you wish to be present during my initial talk with Cha Thrat. Can it be that you have heard, and believed,
some of the things the staff say about me? Do you have delusions of being a gentleman and Cha Thrat a lady, albeit of a different physiological classification, who if not actually in distress is a friend in need of moral support? Is that it, Major?”
Chiang barked quietly but did not speak.
“A question,” Cha Thrat said. “Why do Earth-humans make that strange barking sound?”
O’Mara turned its head to regard her for a long moment, then it exhaled loudly and said, “I had expected your first question to be more … profound. But very well. The sound is called laughing, not barking, and in most cases it is a psychophysical mechanism for the release of minor degrees of tension. An Earth-human laughs because of a sudden relief from worry or fear, or to express scorn or disbelief or sarcasm, or in response to words or a situation that is ridiculous, illogical, or funny, or out of politeness when the situation or words are
not
funny but the person responsible is of high rank. I shall not even try to explain sarcasm or the Earth-human sense of humor to you, because we don’t fully understand them ourselves. For reasons that will become clearer the longer you stay here, I rarely laugh.”
For some reason Chiang barked—laughed—again.
Ignoring it, O’Mara went on. “Senior Physician Edanelt is satisfied regarding your professional competence and suggests that I assign you to a suitable ward as soon as possible. Before that happens you must become more familiar with the layout, operation, and work of the hospital. You will find that it is a very dangerous and frightening place to the uninformed. At present, that is you.”
“I understand,” Cha Thrat said.
“The people who will impart this very necessary information,” it went on, “are of many different physiological types and medical and technical specialities. They will range from Diagnosticians, Senior Physicians, and healers like, or totally unlike, yourself, to nursing staff, and laboratory and maintenance technicians. Some of them will be your medical or administrative superiors, others will be nominally subordinate to you, but the knowledge they impart is equally valuable. I’m told
that you are averse to sharing patient responsibility. While learning you may, at the discretion of the doctor in charge, be allowed to practice, but under close supervision. Do you understand, and agree?”
“I do,” Cha Thrat said unhappily. It was going to be her first year in the School for Warrior-Surgeons on Sommaradva all over again but, hopefully, without the attendant nonmedical problems.
“This interview,” O’Mara went on, “will not decide whether or not you are accepted as a permanent member of the hospital staff. I cannot tell you what or what not to do in every situation that will arise; you must learn by observation and attention to the words of your tutors and decide that for yourself. But if there are really serious problems that you are unable to solve for yourself, you may come to me for guidance. Naturally, the fewer visits you make to this office the better disposed I shall feel toward you. I shall be receiving continuous reports on your progress, or lack of it, and it is these that will decide whether or not you remain here.”
It paused briefly and moved the digits of one hand through the short gray head-fur. She watched carefully but saw no sign of dislodged parasites, and decided that the movement was an unthinking one.
“This interview,” O’Mara continued, “is intended to explore some of the nonmedical aspects of your treatment of Chiang. In the short time available I would like to learn as much as possible about you as a person: your feelings, motivations, fears, likes, and dislikes, that sort of thing. Is there any area in which you would not want to answer questions, or would give obscure or false answers, because of moral or parental or community tribal conditioning during childhood or maturity? I must warn you that I am capable of detecting a lie, even the weird and wonderfully complicated lies that some of our extraterrestrials tell, but it takes time and I have none of that to waste.”
She thought for a moment, then said, “There are matters involving sexual encounters that I would rather not discuss, but all other answers will be complete and truthful.”
“Good!” O’Mara said. “I have no intention of entering that area and, hopefully, may never have to do so. At present I am interested in
your thoughts and feelings between the time you first saw your patient and the decision to operate, any relevant discussion between the healer who was first on the scene and yourself, and the reason for the delay in starting the operation when you did take charge. If you had any strong feelings at that time, please describe and explain them if you can, and speak as the thoughts come to you.”
For a moment Cha Thrat tried to recall her exact feelings at the time, then she said, “I was spending but not enjoying an enforced vacation in the area, because I would have preferred to continue working in my hospital instead of trying to devise ways of wasting time. When I heard of the accident I was almost pleased, thinking at first that the survivor was a Sommaradvan, and there was proper work for me to do. Then I saw the Earth-human’s injuries and knew that the local healer would not dare touch it because he was a healer of serviles. Even though the survivor was not a Sommaradvan warrior, it was plainly a warrior injured in the course of its duty.
“I am uncertain about your units of time measurement,” she went on. “The crash occurred just before sunrise, and I reached the shore of the lake where Chiang had been placed shortly before the time of the morning meal. Without proper medication or knowledge of the body structure, many things had to be considered. The sensible course would have been to allow the survivor to bleed to death or, out of kindness, expedite matters by immersing it in the lake …”
She stopped for a moment because O’Mara seemed to have a temporary blockage of the breathing passages, then she resumed. “After several examinations and evaluations of the risks, surgery was begun early in the afternoon. At the time I did not know that Chiang was the ruler of a ship.”
The two Earth-humans exchanged looks, and O’Mara said, “That was five, maybe six hours later. Do you usually take as long as that to reach a professional decision? And would it have made any difference if you had known of Chiang’s importance?”
“There were many risks to consider—I did not want to risk losing
a limb,” she replied sharply, sensing a criticism. “And yes, it should have made a difference. A warrior-surgeon is in the same position to a ruler as the servile-healer is in relation to a warrior. I am forbidden to practice beyond my qualifications. The penalties are most severe, even allowing for the increasingly lax standards so prevalent these days. But in this instance, well, it was a unique situation. I felt frightened, and excited, and I would probably have acted in the same way.”
O’Mara said, “I’m glad you don’t normally practice surgery beyond your level of competence …”
“It’s a good thing she did,” Chiang said softly.
“ … And your tutors will be relieved as well,” O’Mara went on. “But I’m interested in this stratification of the Sommaradvan medical profession. Can you tell me about that?”
Puzzled by what seemed to be a nonsense question, she replied, “We are not forbidden to talk about anything. On Sommaradva there are three levels of persons—serviles, warriors, and rulers—and three levels of healers to care for them …”
At the bottom were the serviles, the people whose work was undemanding and repetitious—important in many respects, but completely without risk. They were a contented group, protected from gross physical damage, and the healers charged with their care used very simple procedures and medication such as herbs, poultices, and other traditional remedies. The second level, less numerous than the serviles, were the warriors, who occupied positions of responsibility and often great physical danger.
There had been no war on Sommaradva for many generations, but the warrior class had kept the name. They were the descendants of the people who had fought to protect their homelands, hunted for food, raised city defenses, and generally performed the dangerous, responsible jobs while the serviles saw to their physical needs. Now they were the engineers, technicians, and scientists who still performed the high-risk jobs associated with mining, power generation, large-scale construction, and the protection of rulers. For that reason the injuries sustained by
warriors were and always had been traumatic in nature, requiring surgical intervention or repair, and this work was the responsibility of the warrior-surgeons.
The ruler-healers had even greater responsibilities and, at times, much less reward or satisfaction in their work.
Protected against all physical accident or injury, the ruler class were the administrators, academics, researchers, and planners on Sommaradva. They were the people charged with the smooth running of the cities and the continents and the world, and the ills that affected them were invariably the phantasms of the mind. Their healers dealt in wizardry, spells, sympathetic magic, and all the other aspects of nonphysical medicine.
“Even from the earliest times the practice of healing has been so divided,” Cha Thrat concluded, “into physicians and surgeons and wizards.”
When she finished speaking, O’Mara looked down for a moment at its hands, which were placed palms down on its desktop, and said quietly, “It’s nice to know that I would rate the top level of the Sommaradvan medical profession, but I’m not sure that I like being called a wizard.” It looked up suddenly. “What happens if one of your warriors or rulers gets a simple tummyache, instead of a traumatic injury or an emotional problem? Or if a servile should accidentally break a leg? Or what if a servile or a warrior is dissatisfied and wants to better itself?”
“The Cultural Contact people sent you a full report on all this,” Chiang broke in, “as background material on the new medic.” Apologetically it added, “The decision to send Cha Thrat was taken at the last moment, and possibly the report arrived with us on
Thromasaggar
.”
O’Mara exhaled loudly, and she wondered if it was an expression of irritation at the interruption, then said, “And the hospital’s internal mail system operates at a speed considerably less than that of light. Please go on, Cha Thrat.”
“In the highly unlikely event of a servile having such an accident,” she said, “a request for treatment would be made to a warrior-surgeon who, depending on assessment of the injuries, would or would not agree
to do the work. Responsibility for a patient is not taken lightly on Sommaradva, as is shown by the delay in treating Chiang, and the loss of a life, an organ, or a limb has serious repercussions for the surgeon.
“Should a warrior or ruler require simple medical attention,” she continued, “a servile-healer would be instructed, and would indeed be honored, to provide the necessary assistance.
“If a discontented servile or warrior is able as well as ambitious,” she went on, “elevation to a higher level is possible. But the examinations are wide-ranging and difficult, and it is much easier to remain at the level traditionally occupied by the family or tribe or, if a release from problems and responsibilities is desired, to go down a level. Promotions, even minor promotions within a level, are not easy on Sommaradva.”
“Nor are they easy here,” O’Mara said. “But why did you come to Sector General? Ambition, curiosity, or a release from problems at home?”
This was an important question, Cha Thrat knew, and the quality and accuracy of the answer would have an important bearing on whether or not she was accepted by the hospital. She tried to frame the answer so that it would be accurate, truthful, and brief, but before she could reply the ship ruler was talking again.
“We were grateful to Cha Thrat for saving my life,” Chiang said, speaking very quickly, “and we told her colleagues and superiors so in no uncertain language. The subject of treatment by other-species medics came up, and Sector General, where it was the rule rather than the exception. It was suggested to us, and we agreed, that Cha Thrat should come here. The Sommaradvan cultural contact is going very well and we didn’t want to risk offending, perhaps insulting, them by refusing.

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