Halting the reaper, p.23
Halting the Reaper, page 23
Head swimming, Simone said, “Dios mio!”
Worriedly, the nurse said, “BP is 80 over 50. Pulse rate’s 130 and seems irregular. Breathing is thirty per minute.”
Simone heard Dr. Jonas say, “Dammit! Flatten that chair out. Mary finish drawing that blood, then hook up the IV and give her 500 ccs of fluid. Everyone, we’re gonna staze her again. We’ll unstaze her when we’ve got our labs back and know what’s wrong.”
Simone looked into Grace’s round fearful eyes. Scared as she was, she took time to say, “Grace, it’s gonna be okay.” She didn’t say it’d be okay if she died because she knew that wouldn’t be okay for Grace.
Grace stiffened a trembling lip and said, “You’re right. It’s going to be okay. Um, while we’re recording can you confirm that you did intend to write Carl and Kary out of your will?”
Grace nodded. “I did. They’ve treated me like shit since you and I got married.”
Grace said, “And if that doesn’t keep them from insisting you be unstazed, do you give me the power to negotiate with them and award them some part of your estate so you can stay in stasis until it’s safe to bring you out?”
Simone nodded, trying to look firm, even though things were going gray around the edges. “I do.”
Then the people around her were zipping a bag up around her. The IV bag was placed on her chest and the bag was zipped shut the rest of the way. They immediately started unzipping it. “What happened?” she asked.
Grace was wearing different clothes again.
She thought dazedly, I can’t even tell I’ve been stazed.
Grace said, “The labs are back. You’re dehydrated, malnourished, anemic, and your liver’s failing. This is probably mostly due to spread of cancer into your abdominal organs… intestines, liver, etcetera.”
Simone produced a weak laugh, “That’s all?” Though she was trying to put on a brave face, she silently but fervently hoped something could be done about the litany of medical problems.
Grace looked grim. “Those are enough. They don’t think you’re strong enough for Arvinzamab right now. They’re going to feed you by vein since your intestines probably aren’t working very well. They’ll give you IV fluids for the dehydration and a transfusion for the anemia. They’ll also start a few things they can do for your liver failure. Maybe tomorrow they can dose you with the Arvinzamab.”
The nurse said, “Roll up on your side and we’ll get this bag out from under you.”
To Simone’s dismay, even rolling up on her side was hard.
The nurse said, “Here, let me help.”
On her side, she was facing Grace’s worried eyes. Softly, she said, “I’m gonna be okay, Grace.”
Grace pasted on a fake-looking smile. “You damned right you are.”
***
Gerald Horton was one of the attending physicians in the Emergency Department that evening. His nemesis, Morgan Warfield, was on that night as well. Horton had a strange case of a patient with unexplained abdominal pain. It sounded psychosomatic, but Horton was worried it might be due to pathology he just hadn’t recognized. The scans had been clean though.
Horton decided to get Warfield’s opinion, despite the fact that doing so frequently resulted in a tongue lashing for wasting Warfield’s time. But sometimes Warfield made the most uncanny diagnoses. Ones that provided unique learning opportunities. Those, unfortunately, were often accompanied by Warfield’s derision for not recognizing the diagnosis yourself. Nonetheless, he said to the resident, “Let’s go present the patient to Dr. Warfield. See what he thinks.”
The resident gave him an alarmed look. “Do we have to?”
“Come on Jim. It’ll be a good learning experience.”
Slumping his shoulders, the resident led the way back to the station where Warfield was signing charts.
When they arrived, Horton opened the discussion by saying, “Hey Morgan. I’ve asked Jim to present an unusual case of abdominal pain to you. It may be psychosomatic, but I’m worried we’re missing something.”
Warfield rolled his eyes, “Don’t you want to just put the guy in stasis and let the next shift’s crew figure it out for you?”
Warfield was always hitting him with annoying little jibes, but Horton kept a smile on his face. “We’ll do that if you don’t have any ideas.”
Warfield snorted. Then he said, “You know, tonight might be a night when we really could use the damned thing. We’ve sent a bunch of people up to the interventional people for various stents and clot busters and localized clotting agents. There are people down here waiting for procedures who really shouldn’t be waiting.”
Horton gave him a wide-eyed look. “What?! Your stance is softening?!” He turned to the resident, “Jim, make a note,” he checked his watch. “At 11:53 PM, the night of November twentieth, Morgan Warfield acknowledged there may be some justification for stazing patients.”
Warfield said, “Wait a minute—"
But Horton cut him off by sitting in the chair next to Warfield and saying, “Go ahead and present your case, Jim. No point of you getting dragged into our little disagreement.”
Jim gave a nervous chuckle and began to present the case.
The resident was about a minute into it when Warfield nudged Horton with an elbow.
Horton turned to see what the man wanted, thinking he was going to make some comment on the young resident’s inept presentation.
Warfield had fallen asleep! Or was pretending to. Which was funny, but extremely rude to a young nervous resident. Horton frowned, wondering how to handle it.
Jim’s presentation stumbled to a stop, “Dr. Horton! I think Dr. Warfield’s had a stroke!”
A spike shot down Horton’s spine. He jerked erect, then leaned around to look at Warfield from the front. When he moved away from his position beside Warfield, the man slumped even farther to his right. Holy crap! Warfield’s face was drooping on the left. “Morgan!” he barked at the man, but Warfield didn’t seem to understand. It’s a left hemisphere stroke!
“We need a gurney over here!” Horton shouted as he grabbed Warfield’s shoulder to keep him from falling out of the chair. He turned to the resident, “Start admission orders! We need a cerebral MRI with contrast. Find out how long it’s going to take to get it!”
Horton looked around. Several nurses were staring at him in surprise, obviously having no idea why he wanted a gurney in the doctors’ work area. He focused his eyes on one of them. “Elaine! Dr. Warfield’s had a stroke. I need a gurney and some help. Now!”
She jolted into action.
Once they’d manhandled Warfield onto a gurney and put him in an exam bay, Horton did a quick neurological exam, then asked Jim how long until they could get him in the scanner.
Jim said, “There’re three people waiting on the scanner. Want me to bump him up the line?”
“What do the others have?” Horton asked, dreading the answer. Bumping someone critical ahead of someone who wasn’t was the right thing to do. Bumping a VIP ahead of someone with a worse or even the same diagnosis without good justification was… unethical.
Two of the three people ahead of Warfield were just as critical. One of them had also had a stroke.
Shit! Horton thought. My ethics say I should staze Warfield. Warfield thinks I shouldn’t… Or that’s what he did think… He did just say that we might need the stazer this evening…
Horton got up. “I’m going to get the stazer.” He ignored the shocked looks people gave him. He knew a lot of them had seen the debate between himself and Warfield when he’d made his presentation to the ED about stasis. They think I shouldn’t do this. But I’m the one who’d have to live with it if I didn’t.
As he hustled past the main ED desk, he told the clerk to call in the reserve ED attending, something rarely done. But with Warfield out and me taking care of Warfield, we’re gonna be seriously shorthanded, he thought.
A couple of minutes later, they were sliding Warfield from his gurney to the one with the stazer. As soon as he’d stazed Warfield, Horton thought, In for a penny, in for a pound. He asked where the other patient with a stroke was. They stazed him too.
A resident came over and said, “Dr. Horton, one of my patients is bleeding from a splenic injury. He’d been stable but now his vital signs are crapping out. The OR’s swamped so I’m giving him more blood, but…”
Horton sighed, “You want to staze him too, right?”
She nodded. “Would that be okay? He’s a really nice guy.”
Horton closed his eyes a moment, decided he couldn’t get in any more trouble than he may already be in, and grabbed the gurney with the stazer on it, “Let’s go do it.”
Epilogue
Kaem was walking back to his desk from talking to Lee about the “space tower extruder” as she was calling the construct she was planning to use to build the tower. It was something like a self-building crane in that it consisted of a box you could side-load segments of the tower into. Then they would push the segment up until it locked into the next higher one like a Lego, but using Morse tapers. Once they were jammed together under high pressure, three Stade spot-welds would be applied—one to hold it, one for insurance, and a third for paranoia. They were a new little widget Gunnar had come up with, consisting of a bent Stade wire that was welded to bridge from one Stade to another. In the middle of the wire was a separate bit of Stade. A specially designed “de-welder” could easily fit over that bit and destaze it, thus un-welding those segments of the tower.
They still planned to hold some segments of the tower together with standard very-heavy-duty explosive bolts. In an emergency, the bolts could be fired to break the tower into manageable segments that would float around in the upper atmosphere until they could be collected and destazed or reassembled. A little of the explosive was inside the Morse tapers, ready to push them apart to be sure the segments separated.
Lee was working with a couple of their new manufacturing engineers to automate the stazing and insertion of the segments so they could turn it into a rapid assembly process. They had an eye toward making it into a system that could also be used to put up buildings when skyscraper architects finally got excited about Stade.
Kaem’s phone spoke in his earbud, “You have a call from Dr. Gerald Horton.”
Kaem said, “He’s the one applying for grants to study stasis in medicine, right?”
“That’s correct.”
“I’ll take it… Dr. Horton, what can I do for you?”
“I just thought I’d bring you up to date on some events here at the hospital regarding the stazer.”
“Okay. Nothing bad I hope?”
“Well, no. After thinking about it a lot, I started worrying about how there were going to be patients who would benefit from being stazed even though it wasn’t approved for use yet. Um, what I mean is that some patients, you know they’re going to have a horrible outcome or death from strokes or blood loss or… a multitude of other conditions or events. It’s become more and more obvious to me that if we could pause their deterioration until we’re ready, we could make a huge difference in their outcomes. By that, I mean that we’d staze them until we’re ready to give, for instance, clot busters to stroke patients or till we have plenty of blood and a surgeon ready to stop the bleeding in trauma victims…”
“Yeah. We’ve talked about this before.” Kaem said, feeling as if his time was being wasted going over it again.
“But…” Horton sounded frustrated, “I’ve realized it isn’t ethical to wait until we had approval to use your device. A lot of people would die in the meantime. People we could’ve saved.”
“That bothers me too,” Kaem said.
“So, I met with the ethics committee and they agreed that in the absence of evidence that something bad was happening during stasis, it would be unethical not to staze patients in such time-critical situations.”
“Oh, it’s good that they agree. Isn’t it?”
Horton snorted a little laugh, “It’s going to make it difficult to randomize patient to treatment without stasis. We’ll be limited to animal studies to look for ill effects.”
Kaem didn’t say anything for a moment, then said, “That’s certainly fine with me. I’ve thought that all along. I’ve been worrying about all the people who might be saved with stasis, but wouldn’t be because we were waiting to do studies. And, I sure as hell think it’s unethical to randomize people to delayed treatment instead of stasis.”
Horton said, “So then, the day before yesterday, Morgan Warfield, was on shift with me. You’ll remember he was the doc who was so opposed to using the stazer?”
“Hard man to forget,” Kaem said dryly.
“Anyway, he had a stroke, right there at work in the ED while he was talking to me. Unfortunately, there were other critical patients waiting for the scanners so we couldn’t even evaluate him in a timely fashion.”
“Oh, no,” Kaem responded, dismayed. “What’d you do?”
“I stazed him.”
“You stazed Warfield?! Even though he was personally opposed to stasis?”
“Well, he’d made an offhand, mostly joking, comment to me that there was such a backlog for the scanners that night that we might have to staze some people who were waiting in line. That suggested he wasn’t as opposed anymore. Anyway, we stazed him until he could be scanned. Then stazed him again as soon as he came out of the scanner and until he could get to the interventional neuroradiology suite and have clot-busting drugs and a stent for the vascular block that was causing his stroke.”
Kaem blinked, “I’m not sure I understood all that. Did it work?”
“Yeah!” Horton exclaimed with a relieved laugh. “I just left his room. Other than a little clumsiness of speech, it’s hard to tell he had a major stroke two days ago! And, believe it or not, he said he was an idiot to have objected to stasis in the first place. I’ve never seen the man change his mind so abruptly!”
They talked a few more minutes. Kaem congratulated Horton on his triumph, despite the fact there would certainly be more battles to fight.
Kaem had resumed his way back to his table when, suddenly, a clinking sound came from over at Arya’s desk. Everyone raised their heads and looked around. They’d been told that the clink indicated a significant deposit coming in, and since Arya had worked out a profit-sharing program for their employees a few weeks ago, everyone knew a big deposit meant a bonus in their next paycheck. The clinks may not be loud but it was amazing how well everyone had learned to hear them. There was another clink, then another, then they turned into a rush of clinking coins. Arya stood and smiled around at all the people staring at her. “The money’s come in for the booster Norm cast down at GLI last week. Let’s give him a hand.” She clapped once and that sound was immediately overwhelmed by a roar of excited applause from the rest of the room.
When the room calmed, Kaem said, “Ryan, reserve the big room down at the Cavalier Buffalo for six PM. Staze is buying!” He thought, I’ll wait till we’re there to tell them the stazer’s been used to save someone from a stroke.
***
Jeremy looked at the tiny hydrogen-boron fuel pellet in his forceps, then held it up to the camera they had on a tripod. The pellet was probably too small to be seen on the video, but that meant something all by itself.
He took it over and slid it into the barrel of the chamber in their fixture. Jeremy glanced at Medness. Today Medness couldn’t hide his excitement.
Jeremy said, “Ready.”
Medness read from his checklist, “Close the main compartment.”
“Compartment closed.”
“Charging laser,” Medness said. They weren’t going to run a full-power test but were running one they’d calculated should reach break-even.
Hopefully without breaking anything.
“Monitoring instruments are all powered up,” Jeremy said.
“Ready to fire?”
“Ready to fire.”
“Firing,” Medness said.
A moment later Medness said, “Laser fired.”
“All right!” Jeremy shouted. “We got a huge pulse out of the collection field!”
Tensely, Medness said, “Shutting it down. Begin your calculations.”
Jeremy looked over at Medness. He might’ve sounded tense, but he looked as happy as Jeremy’d ever seen him.
Two minutes later, Jeremy jumped up and did a leaping, bounding dance around the lab. He shouted, “Laser consumption fifteen kilowatt-hours. Collection field output… fifty-six-kilowatt hours! More than three times break-even! We’re going out for a freaking beer! Yeah!” Higher powered laser shots wouldn’t use that much more power but should produce a lot more output. They were well on their way to commercial fusion energy.
He looked over at Medness, half expecting him to throw a wet blanket on Jeremy’s celebration, but Medness was on his feet doing his own—subdued—dance. Medness said, “Call your friends. Tell them I’m buying.”
“What time? Where?”
Medness waved the questions off as if they were of no consequence. “You decide, then text me. I’ll be there. I’ve gotta thank my wife first.”
“Thank your wife?”
“Yeah, she’s the one that found Seba’s talk in the news and pointed it out to me.” Medness snorted, “I told her the reporter must have his head up his ass. So now I’ve gotta call her and apologize, then thank her. Then I’ve gotta call Seba and text a few friends, I can go as soon as I’ve gotten that done.”
“Oh! It’s already evening. Are you sure you should be calling Seba this late in the day?”
Medness laughed, “If I were him, I’d love getting this kind of interruption.”
“Can I listen in?”
“Sure.”
***
They were in the big back room at the Buffalo and it was crowded. Kaem estimated Staze had fifty to sixty people there. I’ve got to ask Arya how many people we have on the payroll now, he thought, looking around for her.
