Star Healer

CHAPTER 14

The first three hours were spent on preparatory work, tidying up the traumatic amputations performed by flying metal at the accident site, charting the extent of the internal injuries, checking on the readiness of the operating teams, and, in spite of the cooling unit in his suit, sweating.

At this stage in the proceedings his work was chiefly supervisory, so his increased output of perspiration was unconnected with physical activity and was what O’Mara referred to as psychosomatic sweating, a condition which the Chief Psychologist would tolerate only on rare occasions.

When one of the patients died preoperatively, Conway’s feelings lacked the intensity he had been expecting in that situation. The prognosis on that particular Hudlar had been very poor in any event, so when the sensors indicated termination it was not a surprise. The Melfan, Illensan, Kelgian, Tralthan, and Gogleskan components of his mind registered low-key professional regret at the loss; the Hudlar alter ego felt more strongly, but its sorrow was tinged with relief because it knew how drastically curtailed would have been the patient’s quality of life had it survived, and because the other three cases were occupying so much of his attention, Conway’s own reaction lay somewhere in between.

He maintained the cadaver’s respiration and cardiac functions so that its undamaged organs and limbs, what few of them remained, would be in optimum condition for transplantation. A small part of his mind wondered if the Hudlar’s parts were used for replacement surgery on its more fortunate colleagues, could it truly be considered to be dead? Which led, inevitably, to a minor conflict within his multiple mind between the Hudlar component and the others regarding the treatment of the physical remains after death.

For reasons which were not fully understood even by the members of the species themselves, the Hudlars, although in all other respects a race of highly intelligent, sensitive, and philosophically advanced beings, were unique in that they did not honor or show the slightest degree of respect for their recently deceased. The memory of the person while alive was treasured by its friends, and commemorated in various fashions, but these records invariably omitted any reference to the fact that the being concerned had died. The life and accomplishments of the entity were remembered; the death was studiously ignored, and the deceased disposed of quickly and without ceremony, as if it was a piece of unsightly litter.

In this case the Hudlar idiosyncrasy was a distinct advantage, because it removed the often time-consuming necessity for obtaining the consent of the next of kin for organ removal and transplant.

Realizing suddenly that he was mentally sidetracking himself and wasting time, Conway gave the signal to begin.

He joined the operating frame around FROB-Three, who was the patient with the fractionally better chance of making it, taking the observer’s position beside Senior Physician Yarrence, the Kelgian surgeon who had charge of the team. His original intention had been to head the team on the recently deceased FROB-Eighteen’s operation, but that patient’s demise meant that he could now keep a close watch on the three operations, all of which were urgent and critical enough to require simultaneous rather than consecutive performance. The members of his original team had been divided up between Yarrence, Senior Physician Edanelt, the Melfan in charge of FROB-Ten, and the Tralthan Senior Hossantir who had taken FROB-Forty-three.

Even though the FROB life-form was capable of living and working in gravity-free and airless conditions, this was only possible when the immensely tough and flexible tegument remained intact. When the skin had been pierced and the underlying blood vessels and organs exposed, as had occurred in several areas with this patient, deep surgery was impossible unless the natural gravity and pressure environment was reproduced. To do otherwise was to invite massive hemorrhaging and organ displacement due to the high pressure of the internal fluids. For this reason the OR staff were forced to wear gravity repulsors set to four Gs and heavy-duty protective suits whose gauntlets had been replaced by tight-fitting operating membranes designed to minimize the effects of the high external pressure.

They clustered around the patient like a shoal of ungainly fish, Conway thought, about to begin their surgical nibbling.

“The rear limbs have escaped with superficial damage and will heal naturally,” Yarrence said, more for the benefit of his recorders than for Conway. “The two midlimbs and left forelimb have been lost, and the stumps will require surgical trimming and capping in preparation for the fitting of prosthetics. The right forelimb is still attached but has been so badly crushed that in spite of efforts to reestablish circulation to the affected areas, necrosis has taken place. This limb will also require removal and capping …

The FROB in his mind stirred restively and seemed to be raising objections, but Conway did not speak because he had no clear idea of what it was objecting to.

Of the stump,” the Kelgian Senior went on. “There is a metal splinter which has been driven into the right thoracic area with associated damage to a major vein, the bleeding from which has been incompletely controlled by the application of external pressure. This situation must be rectified urgently. There is also cranial damage, a large depressed fracture which is compressing the main nerve trunk and affecting mobility in the rear limbs. Subject to approval” … Yarrence glanced briefly in Conway’s direction we shall remove the damaged forelimb, which will allow easier access for the teammembers working in the cranial area, and prepare the stumps for—”

“No,” Conway said firmly. He could not see anything but the Kelgian’s conical head inside the heavy protective garment, but he could imagine the silvery fur tufting in anger as he went on. Do not cap the forelimb stumps, but prepare them instead for a transfer and transplant of the rear limbs. Otherwise your procedure as outlined is approved.”

“The risk to the patient is increased,” Yarrence said sharply, “and the operational time will be extended by at least twenty percent. Is this desirable?”

Conway was silent for a moment, thinking about the quality of life of the patient following the success of the simple as opposed to the more complex operation. Compared with the immensely strong and precisely controlled forelimbs possessed by a normal FROB, the telescoping, hinged, and swiveling prosthetic was ridiculously weak and inefficient. As well, Hudlar amputees found them aesthetically displeasing and distressing when the forelimbs-which were the members most conveniently placed to the eyes and used for the more delicate physical manipulations, including the long and involved preliminaries to mating-were artificial. Transplanting the rear limbs forward, although risky considering the weakened state of the patient, was infinitely preferable, because if the operation were successful, it would provide the FROB with forelimbs which would be only fractionally less sensitive and precise than the originals. Since the limbs would be coming from the same entity, there would be no immune system involvement or tissue rejection problems.

The Hudlar material in Conway’s mind was insisting that he disregard the risks, while his own mind was trying desperately to find ways of reducing them.

He said, “Leave the forelimb transplant until the cranial and abdominal work is successfully completed; otherwise the transplant would be wasted effort. Don’t forget to clean the tegument frequently and respray with anesthetic. In cases like this the absorption mechanism is affected by the general condition of—”

“I know that,” Yarrence said.

“Of course you do,” Conway went on. “You have the Hudlar tape, too, probably the same one as I have. The operation carries a strong element of risk, but it is well within your capabilities, and if the patient were conscious I have no doubt that—”

“It would want to take the risk, too,” Yarrence broke in again. “But if the Hudlar in my mind feels that way, I, as the surgeon, feel obliged to express caution on its behalf. But I agree, Conway, the operation is desirable.”

Conway detached himself from the operating frame, paying Yarrence the compliment of not watching the opening stages of the operation. In any case, incising an FROB’s ultratough tegument required the tools of an engineering workshop rather than an operating theater, because the cauterization effects of using fine laser cutters, which were so necessary during internal surgery, seriously inhibited healing along the faces of tegument incisions. The blades which had to be used were two-handed Kelgian Six scalpels, and they required a lot of physical effort as well as a high degree of mental concentration in use, and frequently the medic was in greater danger from the blade than the patient. It was a good time to remove all unnecessary distractions from Yarrence, which included the presence of a would-be Diagnostician, and move to FROB-Ten.

It was obvious from the first look that this patient would never again see its home planet. Five of the six limbs had either been traumatically severed during the accident or damaged beyond the possibility of surgical reconstruction. In addition there was a deep incised wound in the left flank which had penetrated to and destroyed the function of the absorption organ on that side. Decompression, brief as it had been before the victim’s self-sealing safety bubble had deployed inside its room, had damaged the organ’s twin on the right side because of the sudden rush of body fluid toward the area which had been opened to zero pressure. As a result FROBTen was able to receive barely enough sustenance to continue living, providing that it did not exert itself in any way.

An FROB perpetually at rest was difficult to imagine. If such a thing were possible, it would certainly be a very unhappy Hudlar.

“A multiple replacement job,” Senior Physician Edanelt said, curling an eye to regard Conway as he approached. “If we have to replace a major internal organ, there is no point in fitting prosthetic limbs rather than real ones. But it bothers me, Conway. My Hudlar alter ego suggests that we don’t try too hard with this one, while my own purely selfish Melfan mind is concerned chiefly with gaining more other-species surgical experience.”

“You are being too harsh with yourself,” Conway said, then added thoughtfully, “At the same time, I’m very glad that the hospital discourages visits from patients’ relatives. The postoperative talk with the patient, especially in a case like this one, is bad enough.”

“If the prospect causes you serious mental distress,” Edanelt said quickly, “I would willingly relieve you of it.”

“Thank you, no,” Conway said, feeling tempted. “It is supposed to be my job.” He was, after all, the acting Diagnostician-in-Charge.

“Of course,” said Edanelt. “Presumably the replacements are immediately available?”

“Patient Eighteen terminated a few minutes ago,” Conway said. “The absorption and food-processing organs are intact, and there are three usable limbs. Thornnastor will let you have more as and when you need them. This was one accident which left us with no shortage of spare parts.”

As he finished speaking, Conway attached himself to the operating frame beside Edanelt and began discussing the special problems which would be encountered with this case, and in particular the necessity for performing three major operations concurrently.

Because of the nature of FROB-Ten’s injuries there was less than fifty percent of the patient’s absorption system functioning, and that situation was being maintained with difficulty and with no certainty that there would not be further deterioration within the next few hours. The absorption mechanism could be used to assimilate the anesthetic or food, but not both, so it was essential that the patient’s period under anesthesia be as short as possible. And while the limb replacements were relatively simple microsurgical procedures, removing the damaged organ from Ten and the healthy one from the deceased Eighteen was going to be tricky and only fractionally less difficult than resiting the donor organ in the receiving patient.

The organs of absorption of the physiological classification FROB were unique among the warm-blooded oxygen-breathing lifeforms known to the Galactic Federation-even though, properly speaking, the Hudlars did not breathe. Situated under the skin of each flank, the organs were large semicircular and extraordinarily complex structures covering more than one-sixth of the body area and separated along their upper edges by the spinal column. The organs were integral with the skin, which was pitted in those areas by several thousands of tiny slits whose opening and closure was controlled by a network of voluntary muscles, and extended deeply into the body to a depth which varied between nine and sixteen inches.

Serving as it did the functions of both stomach and lungs, the combination of nutrition and air which was the dense, souplike atmosphere of Hudlar was taken in by the two large organs, and in a remarkably short period of time, the usable content of the gaseous liquid and solid mixture was abstracted and the residue passed into a single smaller and biologically less complex organ sited on the underside where the wastes were evacuated as a milky liquid.

The two hearts, situated in tandem between the organs of absorption and protected by the central vertebrae, circulated the blood at a rate and pressure which had made the early attempts at Hudlar surgery extremely hazardous for the patients. Now, however, much FROB surgical experience had been amassed since the planet’s inception into the Federation, and what was more important, a Hudlar was very hard to kill.

Unless, as in this case, it was more than half-dead already.

The team’s one big advantage was that all of the procedures, the multiple replacements of limbs and organs of absorption, would be open surgery. There would be no delving and cutting and suturing in tiny, restricted interorgan spaces. More than one surgeon could enter the operative field when required, and Conway knew with certainty that the operating frame around FROB-Ten would shortly be the busiest place in the hospital.

Edanelt was giving final directions regarding the presentation of the patient to its nurses when Conway left to visit FROB-Forty-three. He was beginning to feel that he was in the way again, a feeling to which he had become increasingly accustomed as his growing seniority in recent years had necessitated greater delegation of authority and responsibility. But he knew that Edanelt, as one of the hospital’s foremost Senior Physicians, was itself too responsible a Doctor to hesitate about calling for Conway’s assistance should it get into trouble.

A superficial examination of FROB-Forty-three would have suggested that there was not very much wrong with the patient. All six of the limbs were present and clearly in an undamaged condition, the porous tegument covering its organs of absorption was intact, and it was apparent that the cranial casing and spine had retained their structural integrity in spite of this particular Hudlar having been in a section of the wrecked accommodation module which had sustained the heaviest casualties. The case notes made brief mention of the fact that it had been shielded by the body of another FROB who had little chance of survival.

But the sacrifice on the part of Forty-three’s companion-in all probability its life-mate-could have been wasted. Just inside the midlimb on the right underside there was a pressure cap and temporary dressing which concealed the opening of a deep, punctured wound made by a length of bar metal which had penetrated the tegument like a blunt spear. It had torn the side of the womb-the patient had been in Hudlar female mode at the time of the accident-and while it had missed the major blood vessels in the area, it had stopped within a fraction of an inch of the rearmost heart.

The fetus seemed to be in good condition in spite of the metal bar having passed within a few inches of its spine. While the heart itself had not been damaged, the blunt end of the metal bar had pinched off the circulation to the heart muscles on that side to the point where irreversible deterioration had taken place. Cardiac activity was being maintained by the life-support system, but even with that assistance the heart was in imminent danger of arrest, and replacement was strongly indicated. Conway sighed, foreseeing yet another emotionally painful postoperative experience for himself.

“A replacement is available from Eighteen,” he said to Hossantir, the Tralthan Senior in charge of Forty-three’s surgery. “We are already taking its absorption organ and all of its undamaged limbs, so donating a heart as well should not worry it.”

Hossantir turned one of its four eyes to regard Conway and said, “Since Eighteen and Forty-three were life-mates, you are almost certainly correct.”

“I didn’t know that,” Conway said uncomfortably, sensing an implied criticism of his flippancy by the Tralthan whose species, unlike the Hudlars, held their recently deceased in high reverence. He went on. “How will you proceed?”

Hossantir’s intention was to leave the section of metal bar still present in the wound in place. It had been cut where it passed beneath the skin by the rescuers to facilitate movement of the casualty, but they had wisely not removed the entire bar in case they might complicate the injuries. Since the inner end of the bar was performing a useful function in controlling some of the deeper hemorrhaging, the prior suturing of the tear in the womb would mean that the instruments necessary for the later heart replacement procedure would be able to pass it without risk of endangering the fetus.

The external wound was not in the position Hossantir would have chosen for a heart replacement operation, but it was close enough for the purpose following surgical enlargement-a course which would avoid subjecting the patient to the additional trauma of another deep incision.

When the Tralthan had finished speaking, Conway looked around the operating frame and at the surgical team drifting weightlessly nearby. There was a Melfan, two Orligians, and another Tralthan who were all junior surgeons, and five Kelgian and two Ian nurses, all of whom were watching him silently. He knew that Senior Physicians could be very touchy about seeming infringements of their authority, and especially when they were ordered to do something as a result of a simple omission on their own part. His Kelgian alter ego wanted him to come straight to the point, while the Tralthan component of his mind advised a more diplomatic approach.

“Even with surgical enlargement of the wound,” he said carefully, “access to the operative field will be restricted.”

“Naturally,” Hossantir replied. Conway tried a more direct approach.

“No more than two surgeons will be able to operate at any given time,” he went on, “so there will be a high degree of team redundancy.”

“Of course,” Hossantir said.

“Senior Physician Edanelt,” Conway said firmly, “needs help.”

Two of Hossantir’s eyes curled around to regard the preparations going on around Edanelt’s frame, then it quickly detailed his two Orligian and the Tralthan medics to help the other Senior with instructions to call on whatever nursing support as and when needed.

“That was unforgivably selfish and thoughtless of me,” Hossantir went on to Conway. “I thank you for the tactful way in which you reminded me of the transgression in the presence of my subordinates. But please be more direct in future. I carry permanently a Kelgian Educator tape and will not take offense over any seeming infringement of my authority. Frankly, I am greatly reassured by your presence, Conway, since my experience of deep Hudlar surgery is not extensive.”

If I were to detail my own experience of Hudlar surgery, Conway thought wryly, you might not frel reassured at all.

Then he smiled suddenly, remembered how O’Mara had sardonically described the function of a Diagnostician in an operating theater as being largely psychological-the being was there principally to worry and accept the responsibilities its subordinates might not be able to carry.

As he moved between the three patients, Conway recalled his first few years after promotion to Senior Physician and of how he had accepted, and at times jealously guarded, his responsibilities. While working under supervision he had attempted to show that the Diagnostician concerned was redundant. In time he had been successful, because the supervision had become minimal and at times nonexistent. But there had also been a few times when Thornnastor or one of the other Diagnosticians who had been breathing down his neck and causing an irritating distraction during surgery had stepped in and saved a patient’s life as well as the professional career of a very new Senior Physician whose enthusiasm verged on the irresponsible.

How those Diagnosticians had been able to watch without intervening, or suggesting alternative procedures, or giving step-bystep instructions at every stage, Conway did not know, because he himself was finding it just barely possible to do so.

He managed to continue doing the near-impossible while the hours slid past, dividing his attention between the operating stations of Yarrence, Edanelt, and Hossantir as well as the activity around the deceased Eighteen, where the surgery required to withdraw the donor organs and limbs was as painstaking and precise as that being performed on the recipients. There were several aspects of the work he could have commented upon, although not in overly critical terms, so he remained silent and gave advice only when it was requested. But while the three Seniors were doing very well and he was careful to divide his time equally among them, the one he watched most carefully was Hossantir. If any of the patients were going to cause problems, it would be FROB-Forty-three.

It happened in the fifth hour of the operations. The depressed cranial fracture and arterial repair on Three had gone well, and the less critical work of limb replacement was proceeding in satisfactory fashion. On FROB-Ten the absorption organ replacement work was completed and the decompression damage had been repaired so that it, too, had only the time-consuming microsurgical work on the limbs to undergo. It was natural, therefore, for Conway to hook himself to Forty-three’s frame to watch Hossantir performing the highly delicate initial stages of reconnecting the replacement heart.

There was a sudden, silent explosion of Hudlar blood.