Up and Down (40 page)

“But we don’t have any other options. We have to get him down,” Dr. Phillips replied.

“Of course there’s another option. We open him up here and now and deal with it. If it hasn’t ruptured, we’re into a routine appendectomy. If it has, we’ll do what we can to flush him clean. But we’ve got to do it now, not in an hour.”

“Negative, station,” said Dr. Phillips, angrily. “You can’t open him in orbit. You’re not equipped. There’s no general anaesthetic on board. You can’t do it. It’s never been done. We have to take our chances and bring him down.”

“It’s too big a risk. I’ve seen dozens of these and the commander is too close to wait any longer. Do you want that on your record? We’ve got everything we need. We’ve got instruments, we’ve got oxygen. We’ve got sutures. Eugene is a blood-type match if we need to transfuse. The only thing we don’t have is general anaesthetic and suction. We can easily rig up suction using the toilet vacuum hose. I’ll just use liberal amounts of local anaesthetic, keep administering it throughout, and Bob’s your uncle. It’s the right call.”

“Are you really proposing to do an emergency appendectomy in zero gravity under local anaesthetic?”

“We don’t have time to debate this, Doc. It’s a simple enough procedure. It’s the best of a set of bad options,” Landon pushed. “He’s running out of time.”

“When is the last time you did an appendectomy?” Dr. Phillips asked.

“My memory’s a bit hazy on that. I think bell-bottom pants were on the way out. But it’s like riding a bike. And the inflamed appendix hasn’t changed much since then, has it? You know this is the right call. We’re going to do it. We’re out of time.”

There was a long pause but Landon was already in motion. Because of her headset, we could all hear what she was saying.

“
Aeres
, we’re operating right here and I need help. Get yourselves back in here. Okay, Eugene, your job is to figure out in the next ten minutes how to turn the toilet vacuum into a narrow surgical suction device. Go.”

In the next thirty seconds or so, she gave each member of the
ISS
crew a different job, including getting disinfectant, sterile drapes, basic surgical instruments, and the suture kits from their storage compartments; finding better lighting; and using Velcro tie-down straps to secure the patient to the flat work surface near the toilet. She was running a very tight ship. Eventually, Houston caught up and finally made the only call they were in a position to make.

“Station, Houston here, Dr. Phillips has given the green light but he’ll talk you through the procedure. It’s critical that no fluids of any kind start floating through the cabin or we could have some problems. Do you copy that, station?”

“Yep,” was all Landon said in return.

Eugene floated over with the toilet vacuum hose. He’d already added an extra length of hose using duct tape so it would reach over to the makeshift operating table. He showed Landon the modifications he’d already made.

“It’s a start, but the opening is way too big. We don’t want to suck out his liver, just the stray blood and toxins in the incision. Can you fit something over the opening to make it smaller? And we need to be able to turn down the power a bit.”

Eugene nodded and floated away. Martine moved in with two helmets used in space walks. They were each fitted with strong halogen lamps. Martine used duct tape to secure them to the ceiling above the patient and, with Landon’s help, oriented them to illuminate the commander’s midsection. Two minutes later, Eugene was back with the back cover of a manual rolled and taped into the end of the vacuum hose so that it telescoped to a much smaller opening.

“I found a rheostat on the electric motor running the vacuum pump and dialled it down. How’s this now?” asked Eugene.

“Eugene, you’ve outdone yourself. This should work well. I knew you had it in you,” replied Landon. She beamed at him and held his shoulder while she spoke.

Eugene was chuffed. He said nothing but moved off to hold the plastic tray, where elastic straps secured the basic surgical instruments on board. There were two pairs of scissors, four clamps, two retractors, two sizes of forceps, and two scalpels. Landon disappeared to scrub but was soon back at what passed for the operating table. There was no gown to wear, but she did wear a mask and surgical gloves. Martine held the syringes prefilled with local anaesthetic. Finally, Landon instructed Eugene to duct tape her ankles to the table supports to stabilize her position. She did not want to be the
first doctor in history to float away from her patient during surgery.

She pulled off her headset and leaned over to look directly in Commander Hainsworth’s eyes, even as he grimaced.

“Here’s the drill, Commander,” she said. “You’ve already had a triple dose of codeine. My apologies for what that’ll do to your innards when we’re back. I see a couple of boxes of All-Bran in your future, but it’s a small price to pay. We’re going to do this under local. We’ve got plenty so I’ll keep you pumped up with the stuff and you shouldn’t feel a thing. But don’t be a tough guy. Tell me if you feel it. Okay, lie back and enjoy the ride.”

It was hard to see on the monitor with the crowd around the table, but I saw him nod. Landon used her secured ankles to draw herself back down to his now draped abdomen. She put her headset back on.

“Okay. We’re going to start. I’ll need you to hold him down so he’s grounded and stable. He can’t be floating. Got it? You monitor his breathing. And you take his pulse every two minutes.”

Two crew members pushed down on the commander and held him still. The other two took to their tasks as well. Lee Hainsworth was awake for it all.

“Station, Houston. Okay, Landon, have you swabbed the site with disinfectant?”

“Done.”

“Okay, let’s inject the local. Go deep with the needle and give about five ccs. Then pull up and give another five ccs closer to the surface.”

Landon followed the instructions and then took the scalpel from the tray Eugene was holding. She poked the site with the handle of the scalpel.

“Can you feel that, Commander?”

“Feel what?” he grunted.

“Thank you.”

“I can’t see the site well enough. Can you move the camera?” asked Dr. Phillips.

A crew member pulled the camera from its Velcro mount and floated up above the patient, directing the camera downwards.

“Better. Okay, time to cut. Let me see where you’re going to make the incision.”

Landon moved the scalpel along the imaginary incision line.

“Good. But no more than three inches long.”

“Eugene, ready on the suction. You’ve got to catch it all,” Landon said.

Eugene gave Martine the tray and lowered the cardboard adapter towards the site. Landon cut into the commander and drew the scalpel along the line. Blood appeared and Eugene did his thing. The incision gaped and Landon made another pass going deeper. More suction. Landon used the sterile gauze to clear away the site and get a look at where she was.

“More local now, Landon,” said Dr. Phillips.

“I know, I know,” she replied, taking the syringe Martine offered her. She injected the whole area deep within the incision.

“It looks like you’re right on it. You’ll have to reach in, expose the appendix and draw it up into the incision. You can recognize the appendix by the way …”

“I’ve done appendectomies before, Doc. Just let me do it without all the distracting colour commentary,” Landon cut in.

Normally, I’m a bit squeamish, but I found this fascinating and stayed glued to the screen. She had a crew member use the retractors to keep the incision spread. Then she moved her fingers inside. I couldn’t see what she was doing but when she pulled back, a very red, swollen, and, at the tip, white little object about the size of my pinkie was front and centre. Behold, the mighty appendix.

“It’s ugly and angry near the tip but I don’t see any perforations. I think we just caught it in time. It sure looks ready to blow,” Landon said.

“Give me some more light, please,” asked Dr. Phillips.

The helmet headlamp was retargeted.

“Agreed. It’s close but I don’t see any perfs,” commented Dr. Phillips. “Let’s get it out and tie it off. I’ll walk you through it.”

“No need to navigate, Doc. I’ve got it. Thanks,” said Landon. She then pulled off the headset. It floated away from the action.

“Landon, Landon. I’m the flight surgeon, I’ll walk you through it. Landon!”

But she was no longer hearing him. She severed the appendix after holding it inside a clear plastic cup. Thankfully, the liquid oozed rather than gushed. She managed to contain almost all
of it in the plastic cup. Eugene used his makeshift suction hose to snag the few droplets of toxins that floated free. None of the foul fluid found its way into the commander’s abdomen. She cut the appendix beyond the redness and very close to where it was attached to the large intestine. As she instructed, it was placed in a Ziploc bag and sealed. She quickly sutured the little nub that was left, pushed it inside the large intestine, then added a final suture to keep it there. The commander was awake but kept his eyes fixed on the ceiling. Landon saw him begin to wince so she re-administered the local anaesthetic. It worked remarkably fast, and the patient’s face relaxed. Landon pulled the headset back on.

“I think everything is shipshape now,” she said.

“Do not remove the headset again. Do not break contact. I’m in charge of this procedure as the flight surgeon. Is that clear?” said Dr. Phillips.

“Calm yourself, Doc. I’m not used to a co-pilot. I needed to concentrate. Are you satisfied with what I did?” asked Landon.

“Well, I probably wouldn’t have cut it back quite so far, but it looks okay to me.”

“Well, I’m a little closer to it than you are. It was pretty nicely inflamed so I wanted to cut out as much as I could to minimize the potential for infection. I’m going to close now.”

Fifteen minutes later it was all over. A couple of rows of sutures, one inside and one on the surface, and the deed was done. Through it all, Eugene, without prompting, kept the incision and
the air around it free of blood and any other airborne offering, with his jerry-rigged suction device. Martine took the commander’s temperature. It had already fallen, but was still above normal. Then Landon gave him morphine to relieve any post-op pain and help him sleep.

By the next morning, the
Aeres
commander’s temperature was normal, and he was feeling much better. The incision was giving him some mild discomfort but it was a completely different brand of pain than he’d experienced for the first several days of the mission. Landon apparently told him that when you cut through all the abdominal muscle right into the gut, root around a bit, slice off an infected appendix, and then sew it all back up again, it’s bloody well going to hurt when you wake up.

The cameras were recording the entire time. I, and everyone in Launch Control and Mission Control, could see the commander’s rapid recovery. We also watched as he embraced Landon in a mighty hug as soon as he felt up to it. Landon could also be seen speaking individually with each of the crew members, presumably thanking them for their support during the unscheduled in-flight emergency appendectomy. Landon held Eugene’s hand when she spoke to him. He smiled and nodded the whole time. It was like watching a reality
TV
show without the customary bickering and interpersonal histrionics.

“Station, Houston, we’ve extended your cruise for another day. Kennedy will be clear on weather by tomorrow night, so
we’ll bring you down early the next morning. Enjoy the downtime. Pilot will land
Aeres
. Commander, you’re just on for the ride this time.”

“Houston, station, copy that. Re-entry for Kennedy in forty-eight hours.”

I wondered if this would ever be made public. I shouldn’t have. Kelly Bradstreet met me outside of Launch Control. She was just shaking her head.

“I cannot believe what we’ve seen in the last twenty-four hours,” she gushed. “Who is this woman you found in the backwoods of Canada?”

“I think she found us.”

“We’re just editing a package of clips from the surgery, including some of the audio. We’re going out with it in the morning in a full court press when we’re sure the commander is out of the woods. You better get ready. Landon Percival is already a rock star. But when this breaks, she’s going to be an international hero.”

To maximize viewership of the
Aeres
landing, Kelly Bradstreet, true to her word, released the emergency in-orbit appendectomy story twenty-four hours before re-entry. Dr. Phillips gave her the green light after witnessing Commander Hainsworth’s lightning-fast recovery. It helped that he was in tip-top physical condition. There were no signs of infection. His temperature was back to normal. And Mission Control had returned command of the
Aeres
to him. In fact, at his request, he was even granted permission to land the
Aeres
, even though Jefferson Rand had been assigned the task. I wasn’t surprised he recovered quickly. He was an astronaut, after all. I was still shocked he’d gotten sick in the first place.

Landon was oblivious to all the fuss and had no idea Kelly’s celebrity-making machine was working overtime. Landon seemed serene. When she wasn’t monitoring the commander’s recovery, she spent most of the additional time in orbit floating near one
of the larger windows in the International Space Station watching the Earth passing below. My regularly scheduled ship-to-shore chats with Landon had been suspended during the surgery and immediate aftermath. But I managed to get one more talk approved before re-entry, after life in orbit returned to a semblance of normal. Well, as normal as life in orbit can ever be.

“Landon, can you hear me?”

“Loud and clear, David.”

“Again, I don’t know what to say,” I started. “But if I ever get appendicitis in space, you’re my first call.”

“I didn’t want to operate. I’d much rather have let it wait until we were back on terra firma. Unfortunately, the commander’s appendix had other plans. It was pretty straightforward when we were all prepped and set up. Just between us, I was nervous but didn’t want the commander or the rest of the crew to know.”