The Moon and the Desert, page 30
Habitat engineer Rachel Amit and geologist Maia D’Cruz were the final two Marsbase crew, and the last two females. They reported digestive problems, particularly a phenomenon known as “dumping” where the intestines emptied themselves almost as fast as food could arrive from the stomach. One of the characteristics of the disorder was liver inflammation, as it attempted to keep up with the production of bile salts depleted due to the extremely fast emptying of bowels. Aside from the recurring indications of liver involvement, none of this made sense.
On the one hand, some of the symptoms appeared to be consistent with metal toxicity. On the other, there were symptoms consistent with a gastrointestinal toxin. In either case, it was unclear if the toxin was biological or environmental in source. Neither the exams they’d just conducted, nor Yvette’s prior analyses, had shown any sign of virus or bacteria that could be responsible for these symptoms.
He turned his attention to the possibility of metal poisoning from Mishra and Grigorescu’s still. He asked Yvette if she had run tests for heavy metal contamination, and she showed him the results. The tests had been run over a month ago, though, and while there were traces, it was nothing specific. On the other hand, both were showing signs of dehydration now—and had been when the tests were run. They were likely drinking more of their moonshine than water, so it would have been easy to miss.
He needed more samples.
Glenn was contemplating whether an Earth virus or bacterium could have mutated either in space or on Mars to cause this malady, when twin notifications announced the end of the first cycle of dialysis for Bialik and Takeda. The system retained the dialysate—the fluid and dissolved substances—removed from the bloodstream of the two crewmembers. It could provide additional clues as to what was affecting the crew.
One wall of the med bay, adjacent to the one with the treatment beds, was completely filled with medical laboratory instrumentation. A small drawer was provided to input solid tissue samples, another for semisolids such as bodily wastes and blood, while two injection ports were dedicated to liquid samples. A small console allowed the doctor to select from standard blood analyses, biopsies, chromatography, spectroscopy, and pretty much every medical test the ship designers could include. After Glenn’s experience when he’d had to perform an appendectomy—alone—on a fellow astronaut while orbiting the Moon, his input had been solicited for design of this med bay. Thus, Glenn knew what tests should be possible, and he’d programmed the treatment beds to automatically send dialysate samples to the “lab wall” for a comprehensive panel of tests.
There was still one crew exam left undone, but Glenn was deliberately stalling on that one. As he went to the lab console to inspect the test results, he reflected on the fact that things had been going so well between himself and Yvette throughout the afternoon. He was reluctant to change that dynamic by insisting on including her in the crew exams. He injected the blood samples from Mishra and Grigorescu and queued up a test for heavy metals before he opened the reports on Bialik and Takeda.
The screen first showed colorimetric and microscopic images of Bialik’s samples. The first item that struck Glenn was the color of her samples—dialysate was mostly a buffer solution plus blood plasma with the blood cells removed. It should have been straw-colored, but this was a light bluish-green. Certain metals would cause that, but then, so would excess chlorophyll from green, leafy plants in the diet.
The problem was that the dietary supplementation from shipboard aeroponics and hydroponics wouldn’t provide enough chlorophyll to turn plasma this particular color.
Microscopy of the Bialik’s dialysis was relatively normal, although the presence of broken and ruptured white blood cells was high, which was to be expected from the inflammation and immune system damage that accompanied pancreatic disease.
Takeda’s dialysate was similar to Bialik’s, with a more distinct greenish tint, but similar cellular debris. Neither patient showed any sign of bacterial or viral contamination, and there were no fragments of parasites or fungus.
Glenn felt that the green color was important and programmed the lab wall to perform the same heavy metal tests on the dialysate that he’d programmed for Mishra and Grigorescu’s blood samples. Takeda was awake, now, and looking better, so Glenn dismissed her back to her quarters to rest, with instructions to return in eight hours for another session.
With that done, he couldn’t put it off any longer . . .
“Yvette time for your checkup.”
“Okay. Do you want to do this right here? Or where we did the other exams?” She seemed to be taking it well and Glenn took that as a positive sign.
“Let’s do it in the isolation room. We have all of our instruments back there.”
“Good. We have more privacy, too.”
Oops, Glenn thought to himself.
Yvette practically rushed back to the exam room. They still had no rotational gravity, so she just flung herself across the med bay to the open door of the isolation chamber and disappeared from his view. Glenn took his time, though, pausing to look at Bialik who now appeared to be sleeping comfortably without the signs of obvious pain she’d had earlier—even when unconscious. Her skin color looked better, too.
As he drifted through the open doorway to the isolation room. He felt a hand reach out and grab the neck ring of his ship suit. Once clear of the doorway, the door closed, and he could hear the latch engage. Yvette put her other hand at the back of his neck and struggled with the helmet catch as she lifted the faceplate and gave him the long kiss she’d attempted earlier that day.
He’d gotten through the entire day without even lifting the faceplate, but now she’d opened it and was kissing him. If the disease was infectious through personal contact, he was exposed now.
When she came up for air, she stopped struggling with his helmet, leaving it still attached, but only partially latched. She started removing her clothes.
“No! No, Yvette, you can’t do this.”
“Oh, but you wanted to examine me, Shep. I thought this would make it so much easier for you.”
“In this case, I’m your doctor. I must remain professional, and I know you don’t really want to do this. It’s not right.”
“Oh, but I want to. I want you so badly,” Yvette replied in a husky voice. “I’ve missed you, Shep, and I want you. I know you want me too.”
“Yvette, this is not right. Us . . . we . . . that was so long ago, and I’m . . . I’m with someone.”
“She’s not here now, is she?”
“Well, no, but . . .”
“Then she doesn’t matter. I’m engaged too, but he’s not here, either. You are. It’s been so long, Shep, I need you!”
“They do matter, Yvette. We made promises.” In the heat of the moment, he couldn’t take the time to consider whether her supposed fiancé was real or imaginary. He had to take that at face value for now.
She was completely naked and pressed herself against him. He was still in his skinsuit; the tight weave dulled sensations on his skin, but not completely. Moreover, he could feel her body heat radiating through the thin material. It was starting to invoke a physical reaction . . . he needed to stop this.
“Yvette, this isn’t right. You’re acting irrationally.” As soon as the words were out of his mouth. He knew it was a mistake.
“Irrational? You think I’m irrational!” Just that quickly, Yvette’s mood changed. Now instead of trying to get him out of his skinsuit, Yvette started scratching and clawing at him. She braced her feet on the table and pushed him forcefully toward the ceiling, causing him to hit the bulkhead hard enough for the back of his head to hit the inside of his helmet.
That hurt, he thought to himself.
He also felt the helmet separate from the neck ring even though the latch was still partially engaged. His own motion made the helmet come loose and start to drift. With a damaged helmet and neck ring, his plan of trying to remaining isolated—at least from the rest of the crew—while solving the mysterious disease was now completely out of the question. The helmet separation also caused his self-contained air supply to cut off. He was breathing ship’s air, now. He hoped the causative agent wasn’t airborne, or at least that it wouldn’t affect him quickly.
That was for later. Right now, he was under attack and needed to stop Yvette before she hurt him.
There was a spray hypodermic of midazolam on the instrument table over by the cot. It was a strong sedative that was good for stopping seizures. It would also work to at least slow down a person intent on violence. Glenn had included it as a precaution in case any of the other crew had been irrational.
The problem of course, was that it was on the opposite side of the room, and Yvette was coming at him, swinging her fists. In zero gee, the motions were causing her whole body to twist and drift off course, but she was still between him and the table. She began to scream at him, that he was “working for them” and here to “take us all away.” Her eyes were wild and unfocused.
As soon as Yvette’s motions brought her close to Glenn, she tried to hit him on the head, even though that sent her tumbling back in the opposite direction. The next approach, she extended her fingers and attempted to jab at his eyes. His helmet was also drifting about the room—out of reach, of course—so he had no protection other than to put his arm across his eyes and attempt to push her away with the other hand.
The drifting helmet hit the instrument table, and now the hypo, scissors, a biopsy needle and various bits of gauze and tape joined the floating mess. She grabbed at his ears, pulled him close, and tried to bite him. Fortunately, that brought him closer to the drifting implements and he grabbed the spray hypo. Instead of attempting to turn toward Yvette, he hooked his feet below the cot and waited for her to come at him again while he held the hypo low and to his side. When she reached out again to claw at his face, he grabbed the side of her neck with one hand, pressed the autoinjector in the hollow just under her collarbone and triggered the injection.
Unfortunately, no matter how fast acting, the sedative didn’t work immediately, and he needed to push her away and try to keep his distance, lest she actually manage to catch his eyes or ears again. They struggled for several more minutes, while Glenn accumulated scratches. Since he was still wearing his skinsuit, his head and neck were the only things she could reach.
Eventually Yvette stopped fighting and her body went limp. She drifted slowly across the exam room, and Glenn took a moment to catch his breath before he pulled himself to the bulkhead, then reached out to grab the sedated woman and strap her down to the cot. It occurred to him that he still had not done her examination. Given his concerns with how she would react, this was the time to do it. As much as it disturbed him to be examining an unconscious, naked woman—he had to do it.
The exam revealed that she was exhibiting early signs of organ failure. More importantly, she was suffering from encephalitis. The fluid-filled membrane protecting the surface of the brain had become inflamed, putting pressure on the frontal and prefrontal cortex—areas associated with personality and the ability to make rational decisions. Of all of the crew, this reaction was unique to Yvette, but it also explained her irrational actions and changes in personality.
It was also a clue.
There was a particular metal toxicity that could account for everything—every symptom from insomnia to encephalitis—including the irrational behavior of Yvette, Taketani’s OCD, and LeBlanc’s hallucinations.
He just needed to check the blood and dialysate tests for copper. If he was right, the detective work was over. He needed to find the source and start the crew on chelation treatments. It would stop the deterioration, and reverse the symptoms . . . if he was in time.
He had to be. Failure was not an option.
CHAPTER 35:
Under Pressure
Richmond Times Features @JenButler
Tonight’s stream features Mission Medical Command, the consolidated team of physicians, surgeons, and specialists serving NASA and MarsX. We’ll also dive into the training of USSF flight surgeons. Join us in an exploration of the fascinating work these highly-trained doctors bring to our space missions. Stream it now @RTFchannel11016.
ChirpChat, October 2043
Glenn felt confident as he headed into the main room to check the toxin analysis results. Something nagged at him as he closed and latched the door to the isolation room. It was something about the little room and security, but he couldn’t place it.
First, he needed to check on his patients.
When he’d dismissed Takeda to her quarters, Katou had taken her place and was currently asleep, dialysis finished for now. He checked her condition and set the treatment bed to keep her sedated for the next eight hours so that she could rest. Glenn decided to keep her catheter connected to the treatment bed to facilitate administering the sedative.
Bialik moved slightly and her eyes shifted back and forth beneath the closed eyelids. The readout on the treatment bed indicated that the medic was currently in normal REM sleep, and not showing signs of pain or discomfort. She still needed rest, and the treatment program was due to re-dose her with a sedative in ten minutes. Pancreatic failure didn’t typically require dialysis except in severe cases. He might have to surgically implant a dialysis port later, but for now he could disconnect her from the treatment bed. He programmed an immediate dose of sedative instead of waiting, then removed the tubing and capped the catheter for the time being.
He was satisfied that dialysis had been the right call. It would have removed copper from their bloodstreams, if that was indeed the culprit. At the very least, he’d taken steps to keep the deterioration from getting worse. Copper could still linger in cells and lymph fluids, but that could be handled with chelation treatment. Still, these results were one more indication that he was on the right track.
Now to confirm it.
He sat at the console for the lab wall—or rather, pulled himself to the seat and pressed his knees under the console to keep from drifting away. He reached into his belt pouch and pulled out one of his remote chips. The interface behind the analyzer panel was tied into the whole med bay informatics system. He would finally get the remote access he hadn’t been able to do while Yvette was watching.
Once the chip was installed, he pulled up the results in his heads-up display. Each of the tests—Bialik and Takeda’s dialysate, Mishra and Grigorescu’s blood samples—showed high levels of copper.
Now, where’s it coming from?
As he had just seen with Bialik and Takeda, the crew could be treated. If the source was in their food or water, it wouldn’t matter, since he’d brought replacements from Earth. If it was some other environmental source, though, he needed to find it and shut it off. The tests indicated that ceruloplasmin levels were very high, as well as unbound copper—elemental copper, copper sulfate, copper nitrate, copper arsenate, copper chromate and other salts—this was important for Mishra and Grigorescu’s diagnosis, since ceruloplasmin was the body’s carrier of copper for normal metabolic functions, as well as ridding the body of excess. Copper sulfate was a soluble component of fungicides and bactericides. He found some metal salts in the results, too, implying that the source was associated with corroded metal, but it wasn’t enough to point to the illicit still. Copper sulfate and copper salts were common in many of the agents used to keep fungal growth down in the warm, moist, closed atmosphere of a spaceship. There was still a chance that there was a solid source for the contaminant, but the mostly likely way each crewmember would have been exposed would be the water supply.
There was a water dispenser in the small room with desk and console through which one entered the med bay from the main corridor. Glenn grabbed a syringe and went to the office to get a sample of drinking water. He opened the dispenser valve for just a moment, and a small globule of water formed on the mouth of the tube. He used the syringe to suck up the water, then returned to the analysis wall, injected the sample, then waited for a result.
Copper sulfate.
Time to go looking for copper in the water tanks.
Glenn started out of the med bay, and was hit by the smell of the atmosphere of the rest of the ship. While conducting the exams, he’d increased filtration and airflow in the enclosed medical facility. With his helmet off—and now that he understood the causative agent, he could leave it off—he was hit with the bad smell of the ship’s general air supply.
It reminded him both that he had left his helmet in the isolation room where Yvette had knocked it off during their fight, and that he no longer needed his own air supply. He would need it if he planned to enter any of the huge water storage tanks, though; they wouldn’t have airflow except through the open inspection hatches. Descending into a tank would require him to bring his own air along.
Yvette was still unconscious from the sedative. As he retrieved his helmet, Glenn realized he had another problem—he was about to leave the med bay, having locked the ship’s medical officer in a room, strapped to a cot. Acting captain or not—superior officer or not—this was not the sort of action that could go undocumented. Before starting his scavenger hunt, he needed to record a report to Earth.
He wouldn’t have trouble with the diagnosis, metal toxicities had been briefly discussed during the pre-Bat medical discussions. They had only been dismissed because the teams had been fixated on bacteria or viral causes. He now had definitive tests that showed copper levels were abnormally high. He’d attach those to the report and send it along for information, but make it clear that he had the treatment plan in hand.
