26. Membrane Saw
Date: 44/1/2733
Patient: Prithini Anaarda, Adrilaen
Patient ID: 7458293
Presenting Complaint: Delayed emergence
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Transcript
[SOUND: footsteps, chair]
[SEC: typing on screen, questioning ping]
FAYE
Go on, then. I knew you were going to look them up as soon as they left.
[SEC: file open]
[MUSIC plays]
[They listen] Huh. Not what I expected.
[MUSIC: harmonies]
There’s that extra larynx . . . they’re not bad, are they?
[SEC: typing on screen]
Rai’s playlists have rotted your wires, boy.
[SEC: negative ping]
I’ll just let Xael know we’re done in case she wants to assign someone new to us. Could you call her, please?
[SOUND: comms call, unanswered]
She must be busy.
[SEC: typing on screen]
Yeah . . . She’s been busy for nearly a whole day cycle, that’s why I worry. Let’s try her again in a bit. Are you ready?
[SEC: affirmative ping]
Date: 44/1/2733
Patient: Prithini Anaarda, Adrilaen
Patient ID: 7458293
It was a pleasure to review this 34 Earth year old or 9.4 Vesta year old Adrilaen who presented at the clinic today with her band-mates.
Sec - um, I forgot to ask their names but I think the themite with the pink fuzz was the keyboard and bass player and the thyreophoran with the jaunty little sunglasses that looked like they were going to fall off any second played the drums.
[SEC: affirmative ping]
I understand they are about to begin an Orbit’s tour of the Asteroid Belt.
Prithini’s bandmates sought assistance because Prithini went into her Change cocoon weeks ago and had not yet emerged. The tour starts on Ceres tomorrow night . . . Prithini needed to be out of those membranes yesterday.
I, um, suggested that Prithini’s friends left the clinic room for the duration of my assessment, but they both wanted to be there. I could see the shadowy outline of Prithini’s hands through the murky grey of her overdue cocoon and she was able to make fists on command to demonstrate that it was okay that they stayed.
According to her band-mates who, I note, are not Adrilaen, Prithini has been well so far during this altiraans. They are aware of at least two form changes in the past which were completed successfully without any complications.
[SEC: typing on screen, questioning ping]
Um, well, I mean, worst case scenario, your cocoon is damaged and you spill out like a jelly fish and, sadly, die. There have been cases where Adrilaen have come out slightly too early and their organs aren’t quite in the right places, or they’re . . . strangely hairy or an unexpected colour? Being unable to escape the cocoon once they’re ready to come out is an issue as well. There’s been a real culture shift where Adrilaen used to take themselves off and altir privately but now it’s a family event where they have a few people checking in on their progress, so help can be sought if something’s wrong.
[SEC: typing on screen]
Yeah. It’s usually better to have an Adrilaen looking after you because they’re actually taught what to do, but these guys did the right thing by bringing her in to us!
Um, Prithini is usually fit and well aside from a mild spiroconstrictive lung disease. The band play without real or fake smoke at their gigs. Otherwise, she rarely reports any breathing symptoms to her friends.
She has inhalers which she rarely uses and they thought that she took a contraceptive pill but they weren’t sure which.
Prithini is a non-smoker. Her bandmates reported that she likely drinks above recommended limits for her age and they occasionally use stimulant drugs when on tour.
I questioned Prithini’s bandmates regarding her risk factors for delayed emergence. I note that she uses hormonal contraception and there is some evidence that a subsequent imbalance can have a knock-on effect on the hormones involved in altiraans. They were certain that she had not been carrying young recently and it is highly unlikely that she is at the present time.
Prithini has, however, been acutely stressed with the tour coming up, which is known to disrupt altiraans.
Neither of the bandmates were Adrilaen but they were -
[SEC: typing on screen]
How did you know I was going to say that?!
[SEC: typing on screen]
Yes! They were FULL of questions. I felt as though I was being interrupted every third word with a request for clarification or more detail. I took the opportunity to talk them through the Change step-by-step.
Adrilaen altiraans starts with a conscious decision to altir or a subconscious reaction to some kind of threat. Clinically, the first visible sign of change is the development of ‘altir spots’, thickened patches of, um, skin, I guess, if they have skin in their current form. The cocoon forms from two day cycles later, as the previous form dissolves into a cell-rich goo. From that point the colour changing can also be seen.
[SEC: typing on screen, questioning ping]
Huh. I hadn’t thought about it, really. Maybe it was for camouflage initially, but most altiring Adrilaen I’ve seen are lit up like a Space Whale’s underbelly. I’ve never seen it, but apparently some Adrilaen change colours with their emotions.
[SEC: typing on screen]
[Laugh] Yeah, you could. Uh, blue for: ‘I’m sad that my favourite characters are fighting in the stream I like’, Purple for ‘your secretions are really bad, can you do that elsewhere?’
[SEC: typing on screen]
Nu-huh. Humans are not the problem! Everyone excretes, Sec.
[SEC: negative ping]
By day 9, limbs have usually formed and the cocooned Adrilaen should be visibly wriggling about by day 12.
Um, Prithini’s bandmates . . . unfortunately, appeared to be labouring under the impression that the length of this metamorphosis was directly proportional to the extent of form modification. Prithini had reassured them that the altiraans would not delay their tour as she only needed to adjust her voicebox. They were visibly dismayed when I informed them that . . . this level of cellular reorganisation - [Sigh] It’s not a chop and change kind of situation!
[SEC: affirmative ping]
‘She might not be ready?’ Sunglasses asked me, huffing a classic Thyreophoran plume of smoke that I chose to interpret as anxiety.
‘We can work that out.’ I tried to reassure them.
Examination of Prithini inside her change cocoon revealed a form with two palpable upper limbs and a mass of lower tentacle-like appendages. As previously demonstrated, she was able to obey motor commands. There was no evidence of ongoing colour change and the membranes had settled into a semi-lucent shade of khaki.
The membrane turgor was good and I could not identify any visible breaks or other signs of damage. There were no signs of infection such as leucocytic ooze, localised oedema or membranous pyrexia.
Auscultation was attempted but Prithini appeared to find this uncomfortable and moved too much for me to appreciate whether there were any audible respiratory or cardiovascular issues. I certainly didn’t hear any obvious wheezing.
Her bandmates watched me as I stepped back from the cocoon. By all accounts, Prithini should have been ready to emerge. The weight of their hopeful expectation felt tight around my chest like I had my own membranes.
The next clinically appropriate step was to proceed to biochemical testing by taking a sample of the fluid Prithini was bathed in inside her cocoon.
[SEC: typing on screen, questioning ping]
Yes! Twice! You’re right, I should probably document that.
[SEC: typing on screen]
Don’t say that! I’m sure she’s fine.
I bleeped Dr Adra - twice - after an ultrasound scan revealed only a thin rim of fluid given how close Prithini was to the end of her change. We needed the fluid to check for hormone levels and the quantity and classification of free cells. As I explained to my patient’s worried friends, we could answer two questions from these studies. One: is Prithini actually ready to emerge - have the majority of the cells in the hyperviscous change fluid found a place in one of her new organs?
And, if cells counts are suitably low, two: why isn’t she coming out?
At this point, the bassist finally pushed their tiny little specs straight on their snout and said: ‘It’s hormones, isn’t it?’
For Prithini’s reference, as I am unclear how much she was able to hear inside the cocoon, I will briefly recount the explanation I gave her friends.
[SEC: typing on screen]
Yeah, it’s like . . . One of my dads had to have a knee replacement a few years ago.
[SEC: typing on screen, questioning ping]
[Laugh] A spring so he could jump really high.
[SEC: questioning ping, typing on screen]
[Laugh] No! Course not! He had arthritis, they just take out the damaged bone and put a metal joint surface in. But! My sister was there after his operation with him and she - not her finest moment, to be honest - but she was so stressed that she forgot all of the information the surgeon told her about how to look after my dad on the transfer home. When I remember, I’ve made an effort to fill my actual patients in since.
[SEC: affirmative ping]
So - in basic terms, Adrialaen release the hormone symparaash in response to stress or a synthetic trigger. Stress, I explained, usually means physiological stress. Fight, flight. Life, death. Less so, the overwhelming stress that makes you want to cry trying to decide what to have for dinner.
[SEC: typing on screen]
Yeah. I’m good. I’m fine - let’s omit that.
[SEC: affirmative ping]
Um, increasing symparaash concentrations induce the release of the ‘altir hormone’ which, in turn, stimulates the release of ecdytaaric hormone.
[SEC: typing on screen]
Yes, ecdytaaric hormone is what causes the membrane to grow.
I didn’t get into this with them so don’t put it in the letter but we often use ecdytaaric hormone for Adrilaen who are struggling to altir. There’s a certain level at which we would expect change spots to appear so if the level is high and there are no spots, it means there’s something going on with their skin or . . . exoskeleton - depending on what they’re contained by at the time.
[SEC: affirmative ping]
Er - yes. Once the membrane has formed, this hormone reaches a threshold at which a new hormone orgaraash is released which sets off a cascade of changes leading to organ formation and reduces the release of ‘altir hormone’ and ecydactaaric hormone.
[SEC: typing on screen, questioning ping]
Yeah, with no ecydactaaric hormone to sustain its growth, the membrane thins and, eventually, the metamorphosed Adrilaen can break out of it.
The musicians blinked their eyes at me. I recapped what the findings of the fluid tests would tell us. Too little orgaraash and she might not be fully formed and her membrane may not have thinned enough.
Too much ecydactaaric hormone and her membrane will have been building all this time and may be too thick to break free of.
Glasses and pink fuzz were suitably horrified at the thought of Prithini being trapped inside her cocoon.
[SEC: typing on screen]
I’m sure Rai has seen many a stream where that happens. To be honest, though. I don’t know if it would be that bad . . .
[SEC: questioning ping, typing on screen]
If you knew you were going to get out in the end? I cocoon myself in my blankets every time my bleep goes off at night. I wonder if that’s what Xael’s doing now to avoid my calls.
Um, yeah, let’s mention that again. You’ve put the fear of medico-legal retribution in me now.
[SEC: typing on screen]
It doesn’t feel healthy.
Anyway! Dr Adra was unable to assist with the submembrane fluid sampling . . . but a sample was successfully obtained by myself using ultrasound guidance and aseptic technique.
The sample results are attached.
[SEC: file attached]
Thank you.
Of note is the free cell count of <10 and the increased ecydactaaric hormone level. This will have caused increased membrane thickness and strength, explaining why Prithini was fully formed but unable to emerge from her cocoon.
The treatment for this is amniotomy. I did kindly request that Prithini’s bandmates exit the clinic room for this part, to ensure there was room for the procedure and to give my patient some privacy on her escape. Nurse Calyxy joined me for the procedure and to help consent the patient. I could have done it solo, but it felt good to have another medical professional confirm that Prithini was making a fist - a gesture she was using as ‘yes’ - as I shouted the plan through the cool sheen of her membranes.
Again, aseptic techniques were used to make a small incision into the cocoon’s membrane, well away from the presumed site of Prithini’s face. We stepped back - and I gave Calyxy a look of pure apology - as Prithini’s fingers scrabbled at the opening, drawing it wider, and a gush of altir fluid spilled out onto the floor.
[Relieved sound] ‘Stars, thank you!’ She gasped with twin voices as the discarded membrane slapped to the floor.
Her post-procedure examination did not reveal any abnormalities. It did, however, reveal a whole load of tentacles. Prithini was thrilled with all of them.
[SEC: typing on screen]
Yes! Then it was time for the happy reunion. Pink fuzz and glasses swarmed Prithini as the clinic door opened and they were so thrilled to have her back in time for the tour that they’re going to write a song called ‘membrane saw’ and dedicate it to me. No amount of explaining could convince them that I didn’t actually use a saw at any point during the amniotomy. . . .
Bob that song on again for me?
[SEC: file open]
[MUSIC]
Hm. I wonder if Xael would like it? They’re playing on Vesta, we could just take the bleep down there and see how much of the gig we get through?
[SOUND: door opening, footsteps, hover of trolley]
[SEC: negative ping]
DAKARAI
Hi, sorry. I know you’re busy but I need you to keep an eye on Xael for me.
[Silence from FAYE]
Can I just leave her here? I could push her into the corner? . . . . What?
FAYE
[The woman was too stunned to speak . . . almost] How have you done that?
DAKARAI
What?
FAYE
You better not have fished it out of the biological waste, Rai. That’s disgusting.
DAKARAI
What are you talking about?
FAYE
My patient’s altir membrane! How - ? It’s changing colours? What have you done?!
[SOUND: fleshy movement]
DAKARAI
What?
FAYE
[Not yet understanding] What?
DAKARAI
I can assure you, I only ever go through biological waste under the dire-est circumstances. So, like, once a week. But not today! Please, I need to get back to my microbes, please can you just keep an eye on her?
[SEC: questioning ping]
FAYE
Okay, very funny.
DAKARAI
What?
FAYE
You’re not telling me that’s Xaelest.
DAKARAI
Faye?
FAYE
No. Nuhuh. Absolutely not, Rai. Tell me, now, that our boss, our HUMAN boss, the most senior doctor on this satellite is not the egg-shaped jelly inside that cocoon!
DAKARAI
I . . . can’t do that Faye.
FAYE
Rai! I’ve changed my mind! This isn’t funny!
DAKARAI
You’ve gone . . . green.
FAYE
She’s - She’s - oh, stars, oh, shit. Oh, no. No, no.
[SOUND: chair, footsteps, fleshy movement]
DAKARAI
Faye -
FAYE
Europa’s freckles, Rai! She told me - oh my STARS - she told me she needed to make some “changes”. CHANGES, RAI! I thought she was going to rearrange her clinic room, not her ORGANS. Why didn’t you tell me she was Adrilaen?!
DAKARAI
Respectfully, I don’t think it’s my place to -
FAYE
Not you - you.
[SEC: questioning ping]
Yes, you!
[SOUND: footsteps]
Getting information out of Xaelest is like bleeding a gas giant but you could have said something! Beep boop, Faye! You’re boss isn’t human and you just agreed to supervise the entire satellite while she -
[SEC: typing on screen, questioning ping]
DAKARAI
Seconding that! How did you not know?
FAYE
I don’t - I don’t know. I thought - I would have thought she’d have told me? But I guess I don’t need to know anything beyond the information needed to do my job, right?
[SOUND: fleshy movement]
DAKARAI
Um, I think . . . Just so you know, she can probably hear you. She’s gone all . . . seafoam.
[SEC: typing on screen, questioning ping]
Exactly the same colour, yes.
FAYE
Right -
You’re going to have to put her over in the corner, I guess.
DAKARAI
You’re going to be alright with her?
[SOUND: hover of trolley, footsteps]
FAYE
I’ll have to be, won’t I? Luckily for Xael, I’ve just proved my competency with a membrane saw.
DAKARAI
A what now?
FAYE
Don’t worry about it.
[SOUND: fleshy movement]
DAKARAI
Right. Well. Uh. I’ll call you if I need you, I guess?
See you later, Sec.
[SEC: typing on screen]
FAYE
Rai -
[SOUND: footsteps, door opening]
DAKARAI
Hm?
FAYE
Try not to need me.
DAKARAI
Message received and understood.
[SOUND: Door close, chair, FAYE’s footsteps]
FAYE
[Sigh] Hi, Dr Adra.
[SOUND: fleshy movement]
I don’t know what swirly blue means. [Sigh] You could have talked to me - properly. I would love to know - you - properly.
[SEC: typing on screen]
[SOUND: footsteps, chair]
I’m sorry.
[SEC: typing on screen]
I know, I’m sorry too, I shouldn’t have taken it out on you. It’s just - between . . . your “stuff” and this - I feel like I know nothing. Like the most naive idiot in the Solar System and it’s not a good feeling when there’s a queue of lifeforms coming to me for the answers to their problems!
[SOUND: comms call]
Oh, stars. Answer?
[SOUND: comms call answered]
CALYXY
Faye, dear, we’ve got a crawl-in docking in 27 minutes. Calibuman, chronic chest pain.
FAYE
Alright, thanks - um . . . Calyxy, did you know about . . . Dr Adra’s, um - ?
CALYXY
‘Change’, of course!
FAYE
Cool, right. Of course.
CALYXY
I offered to take her home with me but she wanted you to monitor her.
FAYE
Oh. Really? Did she -
CALYXY
27 minutes, Dr Underwood.
FAYE
Yep! Ah, yeah. Could you please warn them that the Adrilaen in the corner is part of the medical team?
CALYXY
Mhm.
FAYE
Thanks, Calyxy!
[SOUND: comms call ended]
[SEC: typing on screen]
Hm?
[SEC: typing on screen]
Hey, go on the main network for me?
[SEC: questioning ping]
Search: what does it mean when a cocooned adrilaen goes peach coloured?
[SEC: negative ping, typing on screen]
Fine. It’s probably 25 minutes now. Remind me where we got up to?
[SEC: typing on screen]
‘Her post-procedure examination did not reveal any abnormalities. It did, however, reveal a whole load of tentacles. Prithini was thrilled with all of them.’
Um, given that my patient is to be travelling around the nearby area on tour, she has an open appointment available if she needs further medical assistance in the next couple of ten-days. She has been informed that there is a reasonable risk of the same issue occurring with future Changes and therefore she should avoid changing during stressful life periods and her transformations should be done with supervision by a medic or an experienced Adrilaen. I wish her all the best for the upcoming tour.
Signed,
Dr Faye Underwood
The Vesta Clinic
This episode of the Vesta Clinic was created by AMC. It starred AMC as Faye Underwood, Kamen Cooley Greene as dakarai Solari, Ruby Campbell as Calyxy L’Torra and Sec as himself. Music by AMC and Ruby Campbell.
Please check out our show notes for content warnings, transcripts, and your prescription of: three wishes.
If you enjoyed this episode and would like to help the show reach more ears, please tell someone who loves podcasts to check into the Vesta Clinic. You can also follow us on your social media of choice at @vestaclinicpod! A huge thank you to our Patreon supporters. We hope you enjoy this week’s bonus story and bloopers like this one:
AMC: she has an open appointment available if she needs further medical assisment in the ne - [laugh] what even was that word?
Content Warnings: Reference to recreational drug and alcohol use; deceitful behaviour
