I certainly had my work cut out for me.
I would not soon forget the sheer physicality of having to deal with five darkpox patients. It was like being in high school PE class all over again, except, instead of grades, it was lives that were at stake. Without thinking—I was focusing almost entirely on doing whatever seemed to be the most helpful—I ended up becoming a relay racer, carrying bags of IV fluid and wheeling in temperature-controlled storage units filled with type O blood.
I was also doing everything humanly possible to not think about the hunger crawling around inside my stomach. Every half minute or so, I had to swallow the saliva tide rising in my mouth. It made me run that much more quickly, to the point where I couldn’t feel my toes anymore.
Jonan and I shoved people out of the way as we ran off to the front of the pharmaceutical repository and ordered Mildred to give us darkpox monoclonal antibodies quicker than you could say “darkpox monoclonal antibodies.”
About seventy years ago, DAISHU had come out with a mass-producible line of monoclonal antibodies against darkpox. These were made by transgenic rabbits genetically engineered to express certain human gene sequences, so as to become living factories for human darkpox antibodies. Officially, the proportion of the human genome used in the rabbits was no more than 10%, but some people argued using molecular evidence that it had gone as high as 30%, maybe higher. That there were whispers of escaped half-man-half-rabbit abominations roaming the slopes of Mount Aoi did not help DAISHU’s public image.
She gave us bags of pale, fulvous fluid without the slightest hint of sass. We ran back to the patients’ rooms carrying the bags under our arms. One the way, I tripped, falling forward with a rude thump as my clavicle clonked on the floor.
I really couldn’t feel my toes anymore. But I was too hungry and stressed to give it a second thought.
The initial examination consisted of us staring into the darkpox beds’ curved rooftops, pressing our gloved hands through the pliant plastic, palpating where necessary and administering the standard barrage of assays. By the end, we’d separated our mystery patients into two groups according to the severity of their condition.
I did not want to use the word “triage”.
Of the five strangers, the two adult males were the least worst off—although, with them being Munine and this being darkpox, that wasn’t saying much. I was glad to learn my initial hunch was correct: of the five, the mother was the worst off. She was bleeding internally, and we had her wheeled off into surgery without any delay. At this very moment, surgeons were at work with their wands, weaving collagen mesh over her principal internal tears with a combination of microfibrillar hemostatic agents and bioprinted cellular matrices. Both children were more severely affected than the adult males, though—unlike the mother—when I’d left with Jonan to get the monoclonal antibodies, the two kids hadn’t been in critical condition.
As Jonan and I re-entered the patients’ room, we mounted the antibody bags on the IV stands and hooked them up to the drips that fed into the two adult males. Ani was busy giving the younger of the two a fresh bag of replacement fluids: electrolytes, salts; the works.
Finally—after what seemed like forever—I was able to collapse, butt-first, into an empty chair against the wall. I couldn’t feel my feet, wanted to eat a horse, and was terrified out of my mind that Frank or some other ghost would appear to me and send me into a frenzy.
I’d been trying to get her attention by thinking her name loudly in my head, but to no avail. Heck, my thoughts felt like mud. Staticky mud. I could swear I heard white noise. If I stared too long, lines and corners started twitching before my eyes.
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“Don’t tire out on me yet, Doc,” Jonan said, smirking at me. “We’re just getting started!”
But I wasn’t listening.
“Doc?”
I closed my eyes and moaned.
I heard Jonan ask a question: “Ani, where’s the boy?”
“Taken into surgery,” she said.
At the words “boy taken into surgery,” my eyes popped open and I shot up in my seat, sitting up so straight, you’d have thought I had a rod in my spine. “What hap—”
“—One moment, he was fine,” Ani said, shaking her head, “the next, he went into tachycardia—hypotension, too.”
Fudge.
“Is he bleeding internally?” I asked.
Ani nodded. “He’s in surgery now.”
Dr. Lokanok’s eyes peeked out from between her hair’s dark curtains. The expression on her face was not one of hope.
I looked over to the third and final darkpox bed still in the spacious, modern room. “How’s the princess?” I asked, wearily.
For some reason, the girl reminded me of the heroine of Sina and the Wind. I hoped her journey would end as happily as Sina’s had in Himichi’s manga.
Ani turned, only to press her hand in shock against her PPE visor. “Fuck!” she hissed.
The father in me stirred. I shrugged off my numb feet, tingling legs, and screaming belly and joined Ani at the girl’s bedside. The girl was in a delirious state—that hadn’t changed.
The twitching movements, however, were new.
Her hands trembled. They bent upwards from the wrist, flapping like birds’ wings.
I knew I’d seen it before. As I focused on the thought, I suddenly had what I can only describe as an out of body experience. One minute, I was standing beside my colleague and our patient; the next, I was sitting in a lecture hall at Elpeck Polytechnic—my medical alma mater—watching Dr. Silverwish lecture on neurological disorders of metabolic origin. Holograms of chemical compounds, neurons, and various organs floated mid-air, surrounded by flocks of bullet pointed texts.
When I was younger, I used to joke that human selfishness had a neurophysiological basis. After all, the brain was the most selfish organ in the body. During times of high oxidative stress, blood loss, sepsis, or any other systemic troubles, the brain’s automated decision-making protocols dictated that blood flowing to non-brain organs had to be rerouted toward Kingpin Brain, even if that meant shutting down the heart or the lungs. Excessive selfishness was as much an individual problem as it was a societal one, both physiologically and psychologically.
I glanced at Ani and then pointed at the girl’s hands, which were still making flapping, wing-like motions. “That’s asterixis,” I said. “Her body’s metabolic well had been poisoned, and now her brain is taking damage.”
“Asterixis?” Jonan asked, from behind me.
I turned to face him. “Metabolic encephalopathy is usually lower down on the list of differential diagnoses,” he said.
Ugh, I don’t have time for this!
“She has fulminant darkpox, Jonan!” I snapped.
Ani nodded. “I’ll do a blood assay ASAP. You can—”
“—I’ll set up the EEG,” I said.
The quicker we got this done, the quicker I could stuff food into my face.
Dr. Lokanok blinked in surprise. “Actually, yeah, that’s exactly what you’d need to do.” She nodded in approval. “You’re getting the hang of this more quickly than I thought you would.” Her eyebrows softened. “No offense.”
“None taken,” I said. I sighed.
Ani’s brow furrowed. “Is something wrong?”
Grunting, I shook my head. “Long day. Long, crazy day.”
The praise was nice, but I didn’t feel like I deserved it. I hadn’t thought about metabolic encephalopathy in decades. If it wasn’t for my memories and the surreal growth of their detail and verisimilitude, I think I would have been little more than dead weight.
I gulped as I cut through the part of the plastic barrier near the girl’s head and hooked up the electrodes of the electroencephalogram. It took all of two seconds for the darkpox bed’s protective plastic covering to seal itself shut. In a moment, it was as if I’d never cut into it in the first place. Wireless signals from the processors on the electrodes reported her brainwave activity, sending it straight to my PortaCon, which I promptly pulled out of my PPE pocket.
It took only a moment of staring at the EEG data to notice something was amiss, but I had to squint my eyes to keep the text from twitching and blurring.
I pointed at my console’s screen. “Look, there’s slow diffuse activity in the theta and delta waves.”
As Ani did so, Jonan looked up from the readout on Ani’s console, displaying the results of the lightning-quick blood assay.
“Shit,” he said, “she’s got high ammonia levels.”
Dr. Lokanok and I stared at one another for a moment, and then spoke in unison. We both said it was the girl’s liver, only in slightly different ways.
Our darkpox patient was suffering from acute liver failure.
“Watch out, Jonan,” Ani said, “Genneth is catching up to you.”
“Then,” Jonan replied, “I’ll just have to pick up the pace.”