Dr. Brandie imagined the vibrance of a springtime meadow, wind whipping through her hair and bringing the unmistakable scents of life. It was a pleasant image to hold while walking through a place that was every part its opposite. At the Carlile Medical Complex, the air was unmoving and dull, stale and heavy—as though weighed down by envy for the vitality it should have carried.
In the long-term-care wing of the facility, Dr. Brandie was escorted to a private room on the sixth floor. As she entered, the first thing she noticed was the floor-to-ceiling windows, and she was heartened to see them. Such good for the spirits, natural light can be. Her eyes next traced downward—one could tell a lot about a medical facility by the condition of its floors. These were clean, polished white, and the rounded corners were neatly swept of dust and debris—impeccable, nearly, though Laura noted a strange olive-colored scuffing on the floor next to a sagging bedside chair. Multi-layered, vaguely circular pattern… could it be—
“His view’s impressive, isn’t it?” Alexandra’s scratching voice sounded from the doorway, and Laura heard the woman’s shuffling gait as she, too, made her way into the room. She clutched a bag of crackers from the hall’s vending machines under her arm. “View’s better than mine at least,” she huffed as she stumbled her way through the room, and then, with a sigh of gratitude, she set herself down into the sagging chair. As she sat, she clutched her cane, and Laura noted that its base sat at the center of the smattering of scuffmarks; its olive-colored rubber tip was the final puzzle piece.
“You’re here often, aren’t you?” Dr. Brandie asked.
“Every damn hour I can be,” she said, and the warmth in her voice made Laura hear mother more than matron.
It was enough to pull Laura’s gaze at last to the form wrapped in the bed’s white blankets. His eyes were closed, but as Laura well knew, that didn’t necessarily mean that he was asleep. Locked-in Syndrome went leagues beyond merely quadriplegic. In Brett Harmon’s case, his paralysis was essentially complete: he could open and close his eyes, he could look up and down, and he could voluntarily move not a single muscle more. And perhaps most troubling of all, his mind was otherwise intact: he was a statue that could live, could breathe, could think, but he could never speak, could never smile, could never even so much as turn his head. At war within Laura were two contradictory feelings. Here was a life-sentenced prisoner in a cell made of flesh… it was enough to bring an empathetic shudder and a ripple of goosebumps. And yet, at the same time, here was a man who stood to gain more from the KSE than perhaps anyone else; Laura’s stomach burned with anticipation as she merely imagined making such a profound difference in Brett’s quality of life.
“Is he awake?” Laura asked, and Alexandra nodded.
“You can tell by the breathing—it’s slower when he’s resting.”
Laura nodded and leaned in toward Brett, taking his hand in hers. His eyes fluttered open, but they didn’t search for Laura’s; they held flatly on the window across the room.
“Hey there Brett, my name is Dr. Laura Brandie. Did your mother tell you anything about me?”
Laura waited expectantly for the man’s eyes to move, for some acknowledgement of the question or new presence in the room, but his gaze never shifted… his eyes stayed locked on the window, perhaps staring towards the distant forest at the edge of the city.
“He stopped answering questions a few months ago, which is why the state appointed me his decisionmaker. Brain scans confirmed he’s still here—just quiet these days.”
Dr. Brandie nodded gravely. Humans normally wore their emotions on their faces—the raised eyebrows of elation, the sagging eyes of depression. But in a patient with full facial paralysis, that expressiveness was gone. Brett’s face was a placid neutral, if tired. There was no heavy set to the shoulders, no deep wrinkles of a frown, not even so much as a glimmer in the watery eyes to betray the despondency or despair he must feel.
“We’re gonna get you better again,” Dr. Brandie promised, releasing the man’s hand as she stood. And then, as though on cue, the quiet stillness of the wing was replaced with a rising commotion of murmured conversation and screeching wheels, and then the two women turned toward the scuffling footsteps of Dr. Brandie’s approaching entourage.
Eight they were, men and women both, wearing white coats and wheeling delicate machinery on carts. The terminals and casings, all of a sleek, white metal, were unloaded; keyboards, instrument panels, and electrodes were unfolded on hinges from the undersides of desks; the overhead lights flickered as a thick-grade extension cable was plugged in, and then snaking wires were passed and connected as machinery whirred to life.
“Y’all brought the whole damn laboratory,” remarked Alexandra Harmon, scooting her chair into the corner by the bedside to make more space.
“Brett seemed in little condition to visit us,” Dr. Brandie said.
“So… now? You’re doing it now?” She balked.
Dr. Brandie pursed her lips. No matter how in-detail the consent forms went, no matter how significant the stakes, patients (and their caretakers) would often scratch their signatures on the line without so much as reading 10 words. It was the legal equivalent of crossing the street without looking both ways, but in the world of medical science, that street was more like a highway. There was science to be done, real, life-changing science, and Alexandra Harmon apparently could hardly be bothered to read the entire volunteer agreement. Dr. Brandie tried to not let her frustration color her reply.
“As the paperwork outlined, we start with this, well, calibration visit.” She gestured with her neck toward a technician holding what might have seemed a price scanner at a grocery store. “We start with taking full-body measurements—not merely height and weight, but specific dimensions for things like the arms, legs, torso, and more. Ensuring the proper amount of KSE to install is something of an exact science.”
A bottle of viscous gel squirted into a gloved hand, and then the clear gel was rubbed unceremoniously into Brett’s thinning hair. “We scan brain activity, of course, to better understand the health of the control centers atop the nervous system.” A series of electrodes were adhered to Brett’s scalp, and then a cap with dozens more was placed atop it. Meanwhile, technicians touched pointed probes with needle-like tips to Brett’s arms, staring at readings at their base. “We test nerve conductivity—really a measure of body hydration more than anything else. Don’t worry, it’s painless to the paralyzed. We use them to look for any unexpected breaks in nerve conduction—full-body paralysis happens in the brainstem, which would make it hard to see if there were a nerve severed in an arm or leg.”
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The technician with the needle-point probe raised a thumbs up, and Dr. Brandie smiled. “All clear, at that. That man to Brett’s right is performing something akin to an allergist’s scratch test—the KSE is a foreign substance entering the body, so we’d like to make sure Brett doesn’t react poorly.”
“What is it, exactly?”
“Think of it like a thousand tiny machines that work together to move Brett’s muscles—a single network, directed by his brain. Speaking of,” Dr. Brandie said, gesturing towards a silvery metal case. A technician popped it open with reverence, raising the lid slowly.
Alexandra rose to better see the case’s contents. Inside, on a bed of sleek, velvety black packing foam, sat a strange square of burnished rose-gold-colored metal that glistened as though rubbed with oil. Etchings and gridlines of laser-cut circuitry formed arcane patterns across its face, and a tangle of fine fibers like mechanical dreads extended out the object’s base. The technician at the case lifted the device with exaggeratedly slow movements—as though the thing might explode if mishandled. All of the bustling pin-pricks and measurements and electrodes seemed to pause as everyone in their room—save for Brett—craned their necks to look at the small square. It was no larger than a slice of cheese, but Alexandra suspected it would cost more than a whole hamburger franchise. “What is that?” she asked, whispering now, as though the sound of her voice might crack its polished face.
“That, there, is the Nexus… the swarm controller, the system’s own brain. The braid of fibers at the base, that will be grafted to Brett’s nerve system—directly to the brain. The pinkish square—we call it the ‘black box’—that will read Brett’s nerve signals and translate it, so-to-speak, into a language that the KSE can understand. Do you know much about neural networks—the machine learning types, not the biologic type?”
Alexandra mutely shook her head.
“Me neither, to be honest, before I started this project… seemed like esoterica for the computer scientists. But the human brain is a complicated thing: we’ve got something like 85 billion neurons, each of us. That’s billion with a B. If you wanted to lift your arm, the right neurons in the right places fire off, sending signals to the muscles—in Brett’s case, that signal never goes anywhere, given that things are cut where the brain plugs into the nervous system. But imagine that we had real-time, perfect knowledge of which neurons are firing. Suppose I gave you a list of which neurons specifically are firing, in which clusters, at what intensities, and at what time… how do we tell which limb Brett is trying to lift?”
Alexandra shrugged her shoulders. “Enlighten me, doc.”
“Hell if I know myself,” Dr. Brandie said. “But that type of question—turning a massively large and complex input to a single, actionable output—that is exactly the type of thing neural networks are good at.”
“So, what, is that thing artificial intelligence?”
Dr. Brandie shook her head. “Not quite—it’s not awake, not thinking in the traditional sense. Maybe it’s more like a subconscious mind at best. It can decide things, sure, but a calculator can ‘decide’ whether to show a number as a fraction or a decimal based on the operations used. It’s clever, and it’s complex, but it’s nothing more than a wild tangle of interlocking rules, hard coded into sophisticated chipware.”
“A calculator,” Alexandra repeated. She watched, breath held, as a group of technicians crowded around Brett, fussing over machine readings. One whispered to Brett’s ear and then nodded to a counterpart with a syringe. Brett’s IV bag was injected with something clear, and, in moments, Brett’s watery eyes flicked shut.
“A sedative?”
Dr. Brandie nodded. “What comes next shouldn’t hurt him—his nerves transmit no pain—but we need a sample of cerebrospinal fluid. You switch off the engine before you go rummaging in the gas tank.”
Alexandra watched as Brett was gently rolled to his stomach, his gown pulled open, and then a nurse produced a new syringe; this one was larger, with a needle that nearly resembled a drinking straw. Alexandra stammered. “That looks much too—”
“No sense in watching, Mrs. Harmon, and remember that he feels no pain. Do you trust me?”
Alexandra nodded, and Dr. Brandie smiled with a practiced warmth.
“Then look up at the ceiling with me, count of four, and it’ll be done. Just like that, Mrs. Harmon. One, two, three… four. All good now.”
The two women turned back to the bed in time to see one of the nurses taping a gauze pad over a blooming dot of red. The large syringe, formerly empty, was now filled with a clear liquid that might have been water, but Alexandra knew it was anything but. The syringe was taken to the rose-gold-colored square and injected into a small reservoir at the device’s center. The liquid flowed through channels carved into the device, and if the square had appeared slick with oil before, now it looked as though it were properly lathered in petroleum jelly.
“The brain and spinal networks have their own immune system—and microglia are notoriously sensitive to invaders, be they stray bacteria or sophisticated KSE machinery. Normally, we’d use immunosuppressant medication, but the blood-brain-barrier poses, well, a difficult barrier. To combat that, we’ve just draped the Nexus in a thick layer of biologic camouflage. When his cells scan the Nexus, they’ll see his body’s own signature, and things should be left alone.” The Nexus was gingerly placed in a plastic sac filled with a thick clear liquid. “To preserve things until surgery,” Dr. Brandie noted.
“When is that supposed to be?” Alexandra asked.
“We’ll be getting the samples collected just now to our printers tonight—we need to print KSE substrate with the correct biomarkers. Based on averaged printing rates, we should have enough for the first round of injections in fifteen working days. To give time for Brett to acclimate post-surgery before that first substrate dose, how about a week from today?”
Alexandra pursed her lips, swallowed. Dr. Brandie noted that her knuckles were balled white on the head of her wobbling cane. Gone was the easy smile of an affectionate mother, replaced by the wariness of a woman who was stranded far outside of her element. “You don’t have to let me know right now—you can mull it over with Brett here.” Dr. Brandie placed a business card on the bedside table, near to a mug of coffee that sat on a stacked collage of hundreds of coffee rings—yet more proof of this mother’s tireless dedication. “Call my number directly when you’re ready to schedule.”
Alexandra nodded, grateful for the reprieve. “It’s all, you know, a lot to consider all at once. I’ll talk with him tonight and try to get him to agree,” Alexandra murmured, watching as the technicians began to collect their sophisticated equipment. With how quickly they’d come, the whirlwind of their prodding, and now how quickly it all was packed back onto their screeching carts, Alexandra felt like she’d just survived a tornado more than a medical visit.
When the swarm of footsteps retreated down the echoing halls, Alexandra’s knees began to wobble, and she fell roughly into her sagging chair. She was midway through taming her breathing back to resting baseline when a final nurse entered the room with a knock.
“Courtesy of Doctor Brandie,” he said, gesturing to a fresh mug of coffee on a metal tray. “She said it looked like yours had gone cold.”
The nurse collected the old mug and left Alexandra with the new one. Alexandra lifted it to her mouth and took a lengthy pull of the dark liquid, a frown immediately blooming on her face. Dr. Brandie acted like a woman in control of every detail, entire teams of medical experts marching to her softly-spoken commands… but despite the unquestioned authority and meticulous oversight, despite the fact that Dr. Brandie herself must have poured in half-and-half until the coffee turned to the exact same shade of fallow brown she remembered from the mug by the business card, the woman wasn’t infallible: Alexandra preferred her coffee with no sugar, but Dr. Brandie had added two packets at least.
Alexandra winced at the saccharine taste and set down the mug. It wasn’t that Dr. Brandie had failed to read her mind and learn an unspoken preference… what rubbed Alexandra the wrong way was the casual way Dr. Brandie assumed she knew everything, the way that she hadn’t even bothered to ask.