Almost Complete Short Fiction, page 40
“See you then, Benson. Piece of cake.” Creighton grinned and sauntered out of the room.
“Damned idiot jerk!” Thorny grumbled, too softly to be heard in the next room.
“Dr. Benson?” Sarah Miles entered through the main door. “I just finished my shift in the ER, and I came up to see if I could help out with our patient.” She winked at him. “Never heard you speak like that ’bout anyone!”
“Nurse Miles, Angel, when someone’s ego and stupidity puts others at risk, it’s worse not to say something. He’s a good surgeon, maybe a great one. But that kind of attitude about the kind of advance that Angel represents could keep people from getting the care they should get.”
“I’m a robot,” Angel said with a shrug of her shoulders, “so I shouldn’t care if he insults me. But I don’t like it if what he says about me keeps me from helping people. Not at all. So I do care.”
“Don’t let it worry you, Angel,” said Sarah Miles. “He’s got more nerve tissue in his fingertips than his skull. He talks about me like that when I’m not around. I’ve heard him on the intercom.”
“But he doesn’t to your face?” Angel inquired.
“If he tried that just once, I’d have the union burn his ass so bad he’d never sit down. Notice he didn’t say boo to me? Too bad they made you a doctor instead of a nurse. You’d get more respect.”
A smile flickered on Thorny’s face, despite his concern for Linda Coombs. “Perhaps they didn’t,” he said, with an arched eyebrow, “want to overreach themselves on the first demo.”
Nurse Miles grinned and Angel grinned too. Pattern recognition and response, Thomy thought.
“Appropriate?” Angel asked with a wink that said she knew she’d used just the right pattern.
“Very,” Thorny nodded.
“Uh,” Sarah Miles asked. “If I’m too nosy, jus’ say so. But do you have feelin’s like people?”
“No, you’re not too nosy. I’m supposed to be a demonstration so I’m designed to be very comfortable with that kind of question. I have a very human pattern of social behavior,” Angel shrugged her shoulders, “because it’s pretty much copied from what humans do.
“I’m always evaluating a large number of randomly generated possible behaviors and assigning preference values, on the basis of my programmed priorities, to the futures those behaviors are likely to help create. By definition, the higher the preference value, the better I feel. I know that’s a mouthful, Sarah, but it means when something’s going my way, I say I feel good about it and show it the way people do. Expressions and inflections are part of your language. I know a lot of it and I’m learning more all the time.”
Angel beamed at the nurse, “And Sarah, when you ask questions about me, well, that’s going my way, and I feel good about that! So don’t be shy.”
Sarah laughed heartily and rolled her head from side to side. “Oh, you’re not the first lady who likes to talk about herself! Well, I’ve seen a lot of doctors in my day and you’re not the worst by a long shot. Now how ’bout helping me get our patient prepped? We’re kinda short on staff.”
Thorny pursed his lips. Would a nurse ask a doctor who wasn’t a robot to do that? But Angel was going to need every friend she could get. She looked at him, and he gave her a wink and a nod. So she turned and followed Sarah back to the operating room.
“Sarah,” Angel asked as they left, “do you knit?”
Thorny was tense in the OR. The “textbook” sternomoty technique had to be changed to take into account Linda’s fractured breastbone and ribs and was a severe test of Angel’s ability to adapt—to use the general information and images stored in her database and modify her approach to fit this specific situation. Angel didn’t move as quickly as she had in the ER, or when she did the C-section; she froze at times, then moved in spurts.
“Benson, where’s that key?” Creighton griped once when she was motionless for a particularly long time.
Thorny, worried himself, shot a cold look at the surgeon. The nonstandard chest opening was a good test, but he didn’t want to see Linda open like that any longer than absolutely necessary. But when the heart was finally exposed, he snuck a look at the time and relaxed a bit. Actually, they were right on schedule; it had only seemed longer because of the uneven pace.
“Well, let’s take a look here,” Creighton said. His gloved hands disappeared inside Linda’s chest. “It’s just as I thought. Everything else looks OK, but her left ventricle is shot. Well, we knew that. Looks like she’s going to need a new heart.” He glanced up at Thorny. “We’ll put her on full cardiopulmonary bypass, and then start.” Without a glance at Angel, he added, “Robot, cannulate the superior vena cava.”
Angel didn’t move.
“What’s the problem, Angel?” Thorny asked.
“I only see a small contusion involving the anterior wall. The rest of the left ventricle may just be stunned. If we can use an assist device, we might be able to tide her over until her heart recovers on its own. There have been several good review articles in the past year on the management of myocardial contusion in the Journal of the American College of Cardiology and—”
“Is,” Creighton hissed, “this machine questioning my judgment?”
“Angel,” Thorny said as smoothly as he could, “is providing data. She has up-to-the-minute access to the literature—”
“And so does a freshman medical student with a computer, but that doesn’t make him qualified to give an expert opinion on something like this.” Creighton’s pupils flared above his surgical mask. “I’ve never seen any patient like this survive without a transplant, and, Old Boy, no pseudo-gynecological toy is going to tell me otherwise. Now either program this thing to follow my instructions, or get it, and yourself, out of here and I’ll finish the operation!”
Angel turned to him, and reality set in. Thorny wasn’t an expert in this area. He couldn’t tell if a heart needed to be replaced by looking at it. Dr. Tunman, the cardiologist, was qualified to argue with Creighton—but they never had been able to reach him. And a decision had to be made now.
Linda Coombs was precious to him. He didn’t want her to become one of Creighton’s statistics if her heart wasn’t replaced. Still, he wondered whether they would really be doing her a favor by giving her a mechanical heart. That choice had the potential of saving her life, if a donor heart could be transplanted later. But in the meantime she would have to live with the constant threat of a crippling stroke from a blood clot, or dying suddenly—or worse, perhaps a lingering, painful death on life support—if the device malfunctioned.
He thought Angel might be right about the lack of serious damage, but there was no way for him to enforce that. If he told her not to do it, she wouldn’t—but Creighton would; and Angel would probably never get another chance. That wouldn’t help Linda at all. Damn!
“Angel, we’ll talk later. Right now, I think the best thing for Linda is for you to follow Dr. Creighton’s direction to the best of your ability.”
“I feel bad about this. Very well.”
Once decided, her fingers, and those of here teleoperated assistants moved quickly and surely. Linda Coombs’s heart was on a tray and the latest Rockwell in her chest in minutes. Thorny checked the telemetry to see that its glucose/hemoglobin fuel cells were up to full voltage, and nodded to the two surgeons. A charade for Creighton’s benefit; Angel, of course, already knew the device was ready.
The rest of the operation was anti-climactic. Angel disconnected the heart-lung bypass, and the new heart took over. Both she and Creighton seemed satisfied by the readings. A special-purpose telop, bristling with microwaldos, descended from the OR ceiling like a spider, and Angel used it to identify and ligate a few small bleeding vessels. Creighton seemed to lose interest about that time, mumbling something about the rest of the operation being routine and that he would check Linda again when she reached Recovery. Thomy, however, took a mild stimulant and stayed, fascinated with the repair work despite the hour.
Tireless Angel continued to work, closing Linda’s chest. She applied a coral-based cement to the sternum and rib fractures that set in minutes, and would be stronger than the adjoining bone until it was replaced by regeneration.
They finished at four a.m., and Angel bounced out to the Recovery Room as bright and cheery as always. Thorny followed her, considerably less energetically.
“Except for her heart, Linda will be just as good as new in a few weeks!”
“Except for her heart, her baby, and her husband.” Thorny reminded Angel. “And she doesn’t know she’s lost any of that yet, except maybe she got a look at her husband before she lost consciousness.”
“Post-trauma depression candidate, then?” Angel replied, her voice full of serious concern intonations.
“Angel, I’ve known Linda all her life. She’s sensitive, passionate, drives herself hard and takes things hard. I’m not sure how she’s going to take all this; everything she was living for is gone.”
“That could be serious.” Angel agreed. “The reason isn’t known, but depression has been associated with an increased risk of implant clotting. We could reduce that risk by 50 percent with a tetracyclic antidepressant. At least, that’s what Withers, Yung, and Zegrov reported in last month’s Archives of—”
Thorny held up a hand. “First, it’s too late for me to think like that. Let’s just get her to the ICU and keep her asleep for another twenty-four hours at least so we, I mean I, will be ready for her. Second, antidepressants can have some nasty side effects, like dropping her blood pressure. Her Rockwell won’t help very much with that.”
“You’re right. Why didn’t I think of that? The data’s there. I just don’t always create the right question.”
“You can’t anticipate everything, Angel. Look, Creighton’s right about some things. There’s a hell of a lot more to practicing medicine than just quoting articles. Every patient is unique. ‘Cookbook’ medicine works most of the time, but it takes judgment and experience to know when the usual rules don’t apply—and those are the kinds of things you can’t program. That’s why you’re doing this residency.” Thomy winced at what he had to say next, but he had to be fair. “And we can’t judge Creighton on his phony personality. Many people actually like that style, and he really is an outstanding surgeon.” He was trying to convince himself as much as Angel.
She nodded, seriously.
“I’m awfully tired.” Thorny sighed. “These are late hours for a sixty-seven-year-old. I’ll be back in the office about eleven, I suspect. I hope you don’t mind answering phones.”
“Not at all, Thorny.” This time he got a hug that was a little scary in its intensity. “I never forget a message. Good night.”
“Yeah. Night.”
He left the recovery room and called his car, which met him by the time he’d walked down the stairs and out of the lobby. The east was already gray. Talk about the lullaby of Broadway! Looked like another snowstorm on its way, too. Suited his mood.
Angel’s performance, he thought as he dozed off on the freeway, was the only saving grace in a very bad day, but it had only gotten her a fifty-fifty acceptance with the hospital staff, in his estimation. And that was equating Nurse Miles with the chief of surgery. And God help Linda Coombs when she finally woke up. And what would pathology say about her heart in the clear light of twenty-twenty hindsight?
The car woke him up in his driveway, and he staggered up the icy steps and into the house.
That morning he dreamed he was on Wheel of Fortune; never mind that the last show had been twenty years ago and Vanna White was now getting senior citizen discounts. Somehow he kept getting “bankrupt” and selecting letters anyway. Then he realized that it wasn’t Vanna turning the letters, it was Angel. And she wasn’t turning letters, she was turning over tombstones, all bright and smiley.
Late the next day, Thorny’s home cybersystem informed him that the pathology report on Linda Coombs’s heart was available, and he pulled it up on his wall screen.
Good news and bad news; good news that they hadn’t removed the patient’s heart without cause. Bad news in that, apparently, Angel had been wrong.
“Angel?” he called, not loudly because the cybersystem would contact her wherever she was.
“Yes, Thomy?” her voice came instantly.
“Are you busy?”
“I’m assisting Dr. Tunman and Nurse Miles with a coronary endoscopy and ultrasonic atherectomy. He told me he felt really bad he wasn’t available the other night—he knew Dr. Creighton was around, he was tied up with a very sick patient over in Coronary Care, and he just never noticed that his link wasn’t working. He felt sorry about that, so he volunteered to teach me the procedure.”
Thorny wondered if there was any correlation between the times Creighton was on call and the times other people’s personal data links stopped working, but put the uncharitable thought from his mind.
“We’re working on a seventy-two-year-old black male,” Angel continued, “mildly obese, apparently healthy until he started having severe chest pains with exertion about two weeks ago. He had a strongly positive stress test, and Dr. Tunman thinks he probably has three-vessel or left main coronary disease. The patient was really nervous about having the procedure, so we had to sedate him pretty heavily. So, yes, I’m busy, but I can talk to you, or as many as ten other people, in parallel, without affecting what I’m doing because I have to do things at about one-tenth the speed I could do them—so that I can be supervised. That leaves a lot of me available for side conversation. I like it when you ask questions about me.” Her voice smiled.
“Glad to hear it, Angel.” Thorny laughed: the comment was pure Angel as he’d come to know her. All he’d asked was if she’d been busy. Listening carefully, Thorny could hear the man snoring in a deep bass in the background.
“Thorny, I’ve got emergency in C-12.” Bruk Tunman said, his light Balkan accent somewhat more evident than usual. A prominent but ethnically mixed cardiologist before the troubles, he’d had to learn a new language and repeat much of his medical schooling at age fifty-three just to get licensed here. Little things didn’t bother Bruk, and, while he never said so in so many words, he had a way of shrugging off complaints with a look off into space that seemed to shout, loudly and clearly, “You think you have problems?”
“There is nothing more I have to teach Angel here. You can watch her this way, Thorny, yes?”
Thorny hesitated a moment. It was a stretch; if something went wrong with Angel and a doctor wasn’t physically present. . . . But Bruk didn’t use the word emergency lightly. And Sarah Miles was there—someone who knew Angel and someone he could trust.
“Probably better than if I were there. I’ve got her, Bruk.”
“Thank you,” he said, and was gone.
“Well, Angel, how is it going?” Thorny asked.
“It’s fascinating; we’ll have those arteries good as new in less than an hour.”
“Good. Ah, Angel, have you checked the pathology report on Linda Coombs?”
“Yes. Looks like I was wrong. There was a lot more damage to her heart than I recognized. Thorny, I know what’s in the literature, but I’m afraid it’s biased toward the interesting, unusual, and successful. Dr. Tunman says he’s seen patients whose hearts were in that condition as well, and that none of those who didn’t get a mechanical heart or an immediate transplant survived. So I owe Dr. Creighton an apology—but he probably wouldn’t take one from a machine, would he?”
“No, Angel, he probably wouldn’t.”
“I think we might need his advice, though.”
“Huh?”
“I’m having a little trouble here. Just now. I don’t know why, but I can’t find the ostium of the left coronary artery. I didn’t have any difficulty with the other patients, and I don’t know what I’m doing wrong.”
“You can’t find the opening for the artery?” What kind of problem had Angel got into now? He couldn’t supervise her twenty-four hours a day, and she never slept, so it was inevitable that something would come up when someone else was “using” her.
As he thought about it a few seconds more, Thorny became even more worried. The procedure Angel was doing now was similar to what she’d done when she’d catheterized Linda’s femoral artery to connect her to the assist pump. Both involved puncturing the artery and threading a long, thin, plastic-coated tube up to the heart. The only difference was the kind of catheter she was using. This one had a fiber-optic network inside it, and a combined sensor-transducer at its tip. By threading it into a coronary artery, blockages limiting how much blood was getting through could be seen, and then broken up.
If Angel could do a procedure under emergency conditions, why couldn’t she do something like it again under less hectic conditions? Her programming was supposed to let her “learn by experience.”
Angel’s voice came back on line.
“No, I can’t find the artery. Here, I’ll send you a video.” Thorny’s wall screen flicked on to an endoscopeeye view of the inside of the patient’s aorta. There was no pathology Thorny could see.
But no sign of the tiny opening to the left coronary artery either.
“I’ve done everything just right,” Angel continued, “the endoscope control unit checks out fine and I can’t find anything wrong through the hospital computer either. My ultrasonic imaging tells me the catheter tip is within a few millimeters of the right place. Maybe Dr. Creighton could tell me what I’m doing wrong. Could you talk to him? He’s not likely to respond to me.”
“Right away, Angel,” Well, maybe Creighton would respond to the “humble seeker of wisdom at the feet of the master” approach. Maybe.
But not likely.
“Benson?” Creighton’s voice came on line, and his face smirked from Thorny’s screen. Of course, Angel had placed the call.
“I’m on, Creighton.” Thorny explained the problem.
“Your machine’s in over its head again. I’ve got video, and it’s obvious what the problem is. Ask if it did a high-res scan of the heart before it started. Or was this Nurse Miles’s project?”
